• Title/Summary/Keyword: INTERVENTION

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The ages and stages questionnaire: screening for developmental delay in the setting of a pediatric outpatient clinic (ASQ :소아과외래에서의 발달지연 선별검사)

  • Kim, Eun Young;Sung, In Kyung
    • Clinical and Experimental Pediatrics
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    • v.50 no.11
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    • pp.1061-1066
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    • 2007
  • Purpose : Early identification of developmental disabilities allows intervention at the earliest possible point to improve the developmental potential. The Ages and Stages Questionnaire (ASQ), a parent- completed questionnaire, can be used as a substitute for formal screening tests. The purpose of this study was to evaluate the validity of the Korean version of the ASQ (K-ASQ) as a screening tool for detecting developmental delay of young Korean children in the setting of a busy pediatric outpatient clinic. Methods : Parents completed the K-ASQ in the waiting room of the pediatric outpatient clinic of St. Mary's Hospital, Catholic University Medical College. Out of 150 completed the ASQ, 67 who were born term and had no previous diagnosis of developmental delay, congenital anomalies, or neurological abnormalities were enrolled. The cut-off values of less than 2 standard deviations (SD) below the mean for the ASQ were used to define a "fail", and children who failed in one or more domains tested were classified as "screen-positive". Diagnosis of developmental delay was made when the developmental indices fell below -1 SD of the Bayley Scales of Infant Development-II. Results : (1) The mean age of children was $16.4{\pm}7.4$ months. Ten children (14.9%) were small-for- gestational age infants. The mean birth weight and gestational age were $3.1{\pm}0.6kg$ and $38.8{\pm}1.4$ weeks. Nine children (13.4%) were twins and 33 (49.0%) were male. The mean maternal education in years was $13.6{\pm}2.4$, and 31.3% had full-time jobs. The time for completing the ASQ was $10.2{\pm}3.0$ minutes. (2) Seventeen children (25.4%) were classified as screen-positive, four of them were delayed in development. Among eight children diagnosed with developmental delay, four were screen-positive and the other four were screen-negative by the ASQ. (3) The test characteristics of the ASQ were as follows: sensitivity (50.0%); specificity (78.0%); positive predictive value (23.5%); negative predictive value (92.0%). Conclusion : The high negative predictive value of the K-ASQ supports its use as a screening tool for developmental delay in the setting of a pediatric outpatient clinic.

Optimum Design of Soil Nailing Excavation Wall System Using Genetic Algorithm and Neural Network Theory (유전자 알고리즘 및 인공신경망 이론을 이용한 쏘일네일링 굴착벽체 시스템의 최적설계)

  • 김홍택;황정순;박성원;유한규
    • Journal of the Korean Geotechnical Society
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    • v.15 no.4
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    • pp.113-132
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    • 1999
  • Recently in Korea, application of the soil nailing is gradually extended to the sites of excavations and slopes having various ground conditions and field characteristics. Design of the soil nailing is generally carried out in two steps, The First step is to examine the minimum safety factor against a sliding of the reinforced nailed-soil mass based on the limit equilibrium approach, and the second step is to check the maximum displacement expected to occur at facing using the numerical analysis technique. However, design parameters related to the soil nailing system are so various that a reliable design method considering interrelationships between these design parameters is continuously necessary. Additionally, taking into account the anisotropic characteristics of in-situ grounds, disturbances in collecting the soil samples and errors in measurements, a systematic analysis of the field measurement data as well as a rational technique of the optimum design is required to improve with respect to economical efficiency. As a part of these purposes, in the present study, a procedure for the optimum design of a soil nailing excavation wall system is proposed. Focusing on a minimization of the expenses in construction, the optimum design procedure is formulated based on the genetic algorithm. Neural network theory is further adopted in predicting the maximum horizontal displacement at a shotcrete facing. Using the proposed procedure, various effects of relevant design parameters are also analyzed. Finally, an optimized design section is compared with the existing design section at the excavation site being constructed, in order to verify a validity of the proposed procedure.

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Surgical Treatment of Pulmonary Aspergillosis (III) (폐 국균증의 외과적 치료(제 3보))

  • 정성철;김우식;배윤숙;유환국;정승혁;이정호;김병열
    • Journal of Chest Surgery
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    • v.36 no.7
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    • pp.497-503
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    • 2003
  • Pulmonary aspergillosis usually results from the colonization of the existing lung lesions by chronic pulmonary diseases, such as tuberculosis. Most cases of pulmonary aspergilloma have been treated surgically for many years because it is a potentially life-threatening disease causing massive hemoptysis. Here we reviewed our results from the last 10 years. Material and Method: We reviewed 31 cases surgically treated from Aug. 1992 to Jul. 2002. retrospectively. This investigation is designed to illustrate the peak age incidence, sex ratio, chief complaints, preoperative study, anatomic location of operative site, postoperative pathologic finding and postoperative complications. Result: The peak age Incidence laid in the 3rd and 4th decade of 20 cases (64.5%). The most common complaint was hemoptysis in 27 cases (87.1%). The 31 cases had a history of treatment with anti-tuberculous drugs under impression of pulmonary tuberculosis. The 19 cases (61.3%) showed the so-called “Air-meniscus sign” on the preoperative chest X-ray. In the 31 cases (100%) on the chest computed tomography. as a preoperative diagnostic modality, positivity was shown in 37.9%, 83.3% was shown on the fungus culture of sputum for Aspergillus, serum immunodiffusion test for A. fumigatus, respectively. The anatomical location of aspergilloma was mainly in the upper lobe in 19 cases (61.3%) and the majority of cases were managed by lobectomy. The postoperative pathologic findings showed that 31 cases (100%) were combined with tuberculosis. The postoperative complications include empyema, prolonged air leakage, remained dead space, postoperative bleeding and these numbers of cases is 3 cases (9.7%), 2 cases (6.45%), 2 cases (6.45%), 1 case (3.23%), respectively. one case was died postoperatively due to massive beeding, and asphyxia. Conclusion: Compared with the previous study, there is no significant difference in results. Preoperative chest computed tomography and immunodiffusion test were more commonly available and showed high positivity. Operations often became technically difficult because of pleural space obliteration, indurated hilar structures, and poor expansion of the remaining lung, which were more prominent in the patients with complex aspergillosis. In such cases, medical treatments and interventional procedures like bronchial artery embolization are preferred. However, cavernostomy is also recommanded with few additional morbidity because of its relatively less invassiveness. Early surgical intervention is the recommended management for patients with simple aspergilloma considering the Row surgical mortality and morbidity in recent days.

A Study on The Enhancement of Aviation Safety in Airport Planning & Construction from a Legal Perspective (공항개발계획과 사업에서의 항공안전성 제고에 대한 법률적 소고)

  • Kim, Tae-Han
    • The Korean Journal of Air & Space Law and Policy
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    • v.27 no.2
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    • pp.67-106
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    • 2012
  • Today air traffic at the airport is complicated including a significant increase in the volume of air transport, so aviation accidents are constantly occurring. Therefore, we should newly recognize importance of the Air Traffic Safety, the core values of the Air Traffic. The location of airport that is the basic infrastructure of the air traffic and the security of safety for facilities and equipments are more important than what you can. From this dimension, I analyze the step-by-step safety factors that are taken into account in the airport development projects from the construction or improvement of the airport within the current laws and institutions and give my opinion on the enhancement of safety in the design and construction of airport. The safety of air traffic, as well as airport, depends on location, development, design, construction, inspection and management of the airport including airport facilities because we have to carry out the national responsibility that prevents the risk of large social overhead capital for many and unspecified persons in modern society through legislation regarding intervention of specialists and locational criteria for aviation safety from the planning stage of airport development. In addition, well-defined installation standards of airports and air navigation facilities, the key points of the airport development phase, can ensure the safety of the airport and airport facilities. Of course, the installation standards of airport and air navigation facilities are based on the global standard due to the nature of air traffic. However, to prevent the chaos for the safety standards in design, construction, inspection of them and to ensure the aviation safety, the safety standards must be further subdivided in the course of domestic legislation. The criteria for installation of the Air Navigation facilities is regulated most specifically. However, to ensure the safety of the operation for Air Navigation Facilities, performance system proved suitable for the Safety of Air Navigation Facilities must change over from arbitrary restrictions to mandatory restrictions and be applied for foreign producers as well as domestic producers. Of course, negligence of pilots and defective aircraft maintenance lead to a large portion of the aviation accidents. However, I think that air traffic accidents can be reduced if the airport or airport facility is perfect enough to ensure the safety. Therefore, legal and institutional supplement to prioritize the aviation safety from the stage of airport development may be necessary.

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Expression of Caspase 3, Survivin, and p53 Protein in Urethane Induced Mouse Lung Carcinogenesis (Urethane으로 유발된 생쥐 폐샘암종 발생과정에서 Caspase 3, Survivin과 p53 단백 발현)

  • Shin, Jong Wook;Lee, Soo Hwan;Park, Eon Sub
    • Tuberculosis and Respiratory Diseases
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    • v.63 no.3
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    • pp.251-260
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    • 2007
  • Purpose: An imbalance of cell proliferation and cell apoptosis is an important mechanism in carcinogenesis. Capase 3, survivin and p53 have been identified as important members of the apoptotic related proteins. This study evaluated the proliferating cell nuclear antigen(PCNA), apoptosis, apoptotic related protein such as capase 3, survivin and p53 using urethane-induced mouse lung carcinogenesis, which provides reproducible steps from hyperplasia to adenocarcinoma. Methods: Urethane was administered to the ICR mice through an intra-peritoneal injection, The mice were sacrificed at 5, 15, and 25 weeks after urethane intervention. The sequential morphological changes and immunohistochemical expression of PCNA, apoptosis, capase 3, survivin, and p53 were examined during mouse lung carcinogenesis. Results: During carcinogenesis, the sequential histological changes were observed from hyperplasia of type II pneumocytes, to anadenoma, and ultimately to an overt adenocarcinoma. The PCNA Labeling index (LI) was 9.6% in hyperplasia, 23.2% in adenoma, and 55.7% in adenocarcinoma, respectively. The apoptotic LI was 0.24% in hyperplasia, 1.25% in adenoma, and 5.27% in adenocarcinoma. A good correlation was observed between the PCNA LI and apoptotic LI. The expression of caspase 3 was remarkable- i.e., 46.7% in adenocarcinoma, in contrast to 15% in hyperplasia and 16% in adenoma. Survivin was detected weakly in the alveolar hyperplasia and showed an increasing expressional pattern in adenoma and adenocarcinoma. p53 expression was detected only in the adenocarcinoma lesions with an expression rate of 13.3%. The level of caspase 3 expression correlated with the increase in the apoptotic index. The positive expression of caspase 3 was associated with an increased apoptotic index. Conclusions: These results suggest that the PCNA LI and apoptotic LI might be useful markers for evaluating the risk of a malignant transformation. In addition, caspase, survivin and p53 might play a role in the early and late steges of urethane-induced mouse lung carcinogenesis.

Philosophic Investigation of the 'Ghi(氣)' Phenomena ('기(氣)' 현상에 대한 철학적 고찰)

  • Lee, Hyun-Ju
    • Journal of East-West Nursing Research
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    • v.3 no.1
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    • pp.50-67
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    • 1998
  • When recognition of the Ghi(氣) which exist in all things, is changed on the aspects of the science of nursing, the view of health and nursing will be more efficient and can be developed as the proper concept for Korean culture. I think it is nessary to confirm which philosophical basis of the will be applicable to nursing and how to it has to be developed. Therefore I can for the research of the Ghi phenomena to attain the Thoughts of philosophy that is appropriate to expound those phenomena. And I attempt to induct "the fusion of horizons" to unify the view of the I world between Korea and the West. The Ghi is very energetic and omnipresent among the universe, Nature, and the human being. So it can organize all the primary elements of mental and I physical function of human as like life, mind, breath, feeling, energy, etc. A general concept of the Ghi is described as follows ; (1) The Ghi is the origin and essence to organize the universe, Nature, and the human being. (2) It is the perpetually movable thing. (3) And there are continuous transmission between the Ghi of the universe and the human through 'body, mind, and soul. For review on the philosophic basis of the Ghi, I studied out the identity of the doctrine of Li and Ch'i(理氣論) in the field of philosophy of Korea and the West. In Korea, the concept of the Vigor is based on Ch'i monolism(기일원론) and Li Ch'i dualism (이기이원론) of Yul-gok Lee's, Toi-kye Lee's, Hwa-dam's, and/or Hekang's. These are indispensable for the view of the world of Korea as Metaphysical ideology, Concrete science, Materialism, Ontology, and Epistemology. From the viewpoint of the philosophy of the West, the doctrine of Li and Ch'i(이기론) of Korea is identical with the doctrine of Li and Ch'i(이기론) of Joo-ja, Idea of Plato, Metaphysics of Aristotle, World Spirit(Weltgeist) of Hegel, and Existentialism of Heidegger. In the nursing theory of the West, some of them referred to the Ghi as like Energy field theory of Rogers and Energy exchange of Neuman. Though there are different in terminology, "energy" and the "Ghi" are induced comparable therapeutic action between the human and the environments. With the nursing theory of Korea, I have made an attempt to compare the Ghi with metaparadigm of nursing-the human being, the environment, the health, and the nursing. For the most part, the alternative therapy is resonable to the frame of the nursing theory of Korea. It is easy to apply alternative therapy on the every spot of nursing. So this therapy could be a kind of forms as nursing therapy in the nursing centers where take the duties of supporting in local societies. In result, independent nursing intervention will be activated by the nurse who puts up with the major parts. It is available to apply this therapy to palliation of pain, insomnia of infant, Sanhujori (산후조리), pain of menstruation, arthritis. And the alternative therapy makes it possible to propose the nursing model which represent originality, tradition, and history of the nursing of Korea. Additionally, in the field of the nursing, it is indispensable to choose a suitable methodology which is considered whether it is matched with a theory of philosophy in the boundary and object of the research. Because there are many way to get the knowledge of nursing related to the Ghi. In the science of nursing, context of sociocultural background and frame are required to understand the person who need to take care of (nursing client). But the value systems of the West and the East are distinctive each other as well as the behavior of health persuance. Therefore it is the basic research data of great worth to review philosophical the Ghi phenomena which is well known to Korean.

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A Study of a Pattern of the Stress Perceived by Stroke Patients through the Rehabilitative Process (뇌졸중 환자의 재활과정에 따른 스트레스 변화 양상)

  • Lee, Jung-Min
    • Journal of East-West Nursing Research
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    • v.1 no.1
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    • pp.82-98
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    • 1997
  • The purpose of this study was to determine pattern of the stress perceived by stroke patients over time. The ultimate goal of the research is to provide data to help nurses to design the plan of nursing care of the stroke patients both in the hospital and at home. A total of 57 admitted stroke patients were collected from one general hospital in Seoul from June, 12 to September, la, 1993. The data were collected for three phases(within one week after leaving the hospital). The tools for this study, three scales were used ; Stress scale developed by the investigator. Constitution classifing scale designed by Kho(1984), and Self-care measuring scale by Kang(1984). Data were analyzed in four steps using statistical analysis. First, demographic data were determined by descriptive statistics. Second. the pattern of stress perceived by stroke patients across three phases was measured using repeated measures ANOVA. Third, stress of stroke patients classified by constitution, paralyzed area. and attack frequency were measured using ANOVA or t-test, and the pattern of stress by group over time was determined using paired t-test in post hoc test. Fourth. Pearson correlation coefficients were calculated to determine the relationship between the stress and self-care activities. The results of this study are ; 1. The pattern of stress across three phases ; There was a decrease of the stress across three phases. In general. psychological stress as the highest among three phases(F=36.92. P=.000). There was a statistically significant difference of the physical stress(F=34.55, p=.000), the psychological stress (F=15.49, p=.0005) and the social stress (F=24.71. p=.000) among three phases. There was a statistically significant difference of the stress between the first phase (on admission) and the second phase(before leaving the hospital) and was a decrease of the stress (t =6.36. p=.000). 2. The pattern of stress of stroke patients classified by constitution across three phases ; Stroke patients classified as So-Eum perceived the highest stress among three groups(Tae-Eum, So-Eum. So-Yang). There was no statistically significant difference of stress according to the constitution of stroke patients among three phases. Hence. stress was not influenced by the constitution of stroke patients, but there was a statistically significant difference of stress over time. 3. The pattern of stress of stroke patients classified by the paralyzed area across three phases ; Right paralyzed stroke patients perceived higher stress than left paralyzed stroke patients. There was, however, no statistically significant difference of stress between two groups except 2nd phase. There was no statistically significant difference of the perception of stress bet ween the right and left paralyzed stroke patients. 4. The pattern of stress of stroke patients classified by the frequency of the relapse of the disease across three phases ; Stress was higher in stroke patients who had the relapse of the disease twice more than the first time. There was, however, no statistically significant difference of stress between two groups. There was no statistically significant difference of stress of stroke patients according to the relapse of the disease among three phases. Hence, stress was no influenced by the relapse of the disease. 5. The relationship between the stress and self-care activities ; There was a negative relationship between the stress and self-care activities each phase(on admission, r= -.1563 ; before leaving the hospital, r= -.4030 ; after leaving the hospital, r= -.5291). Hence, the higher the self-care activities, the lower the stress. This study has three important findings. First finding was that psychological stress perceived by stroke patients was the highest among three phases. The second finding was that factors such as the constitution, the paralyzed area, and the relapse of the disease did not have an influence on the stress perceived by stroke patients across three phases(on admission, before leaving the hospital, after leaving the hospital). There was a statistically significant decrease of the stress perceived by stroke patients across three phases. The third finding was that there was a negative relationship between the self-care ability and stress. In this study, these findings have implications for nursing care for the rehabilitation of stroke patients and suggest the need of nursing intervention to promote the self-care ability and to support the psychological self-esteem of stroke patients.

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A study on oral discomfort in gynecological cancer patients undergoing chemotherapy (화학요법을 받는 부인암환자의 구강불편감에 관한 연구)

  • 정재원
    • Journal of Korean Academy of Nursing
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    • v.25 no.2
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    • pp.372-389
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    • 1995
  • The frequency with which administration of chemotherapy for gynecological cancer treatment is used has increased along with the use of surgery and radiotherapy Among the various side effects of chemotherapy, stomatitis causes a problem of function and sensation in the oral cavity. This oral discomfort can be categorized into two components ; perceived oral symptoms and observed oral symptoms. If the oral problem continues, it may cause infection, bleeding and nutritional deficiencies. As a result of this condition, compliance with the treatment process can be affected as well as the prognosis for the cancer patients. But as the oral discorrfort usually appears after chemotherapy, it is often not reported to the health care personnel as a patient problem. Without problem identification of the oral discomfort and ability to assess the problem, effective intervention cannot be planned. Therefore, this study was conducted to identify the pattern and the degree of oral discomfort due to cancer chemotherapy and thus to provide data for identification of the patient problem and for nursing assessment. The design of this study was a longitudinal de-scriptive study The subjects were in - patients who received chemotherapy under the diagnosis of gynecological cancer between Mar. 15, 1994 and May 15, 1994 at a general hospital in Seoul, Korea. The number of subjects was 64 and they were divided into two groups, one of 41 (A : 5FU & Neoplatin), the other of 23(B : Neoplatin, Cytoxan, Adriamycin), according to the treatment regimen. The data were collected for 24 days using self-re-port instruments. The instruments were the 「Perceived Oral Symptom Assessment Tool」 and 「Observed Oral Symptom Assessment Tool」 developed by this researcher. Data were analyzed using the SPSS-PC program, ANOVA, t-test, paired t-test and the Pearson Correlation Coefficient were applied. The results of this study are as follows : 1. In A regimen the peak time for perceived oral symptom scores was the fifth day after chemotherapy, and the tenth day for observed oral symptom scores. Both of the problems started on first day of chemotherapy and were not resolved completely until the 24th day after treatment. 2. In B regimen, the peak time for perceived oral symptom scores was on the seventh day after chemotherapy, and the eighth day for observed oral symptom scores. It was noted that perceived oral symptom scores were higher than observed oral symptom scores consistently for 24 days. Both also started on first day of chemotherapy, and were not resolved completely until the 24th day after chemotherapy. 3. There were no differences statistically in perceived oral symptom scores between A and B regimen. The loss of appetite and xerostomia caused the most severe discomfort in both of these two groups. 4. The were no differences statistically in observed oral symptom scores between the A and B regi moil. In the A regimen, the highest observed symptom scores were the lips, gingiva, tongue and buccal membrane in that order. But in the B regimen, the highest observed symptom scores were tongue, lips, buccal membrane and gingiva in that order. 5. In A regimen, the patients who had gingival edema and dentures had significantly higher perceived oral symptom scores. And those who had gingival edema and bleeding, foul odor and aphthous stomatitis had significantly higher observed oral symptom scores. 6. In B regimen, the patients who had the experience of stomatitis in the last course of chemotherapy had significantly higher perceived oral symptom scores. Those who had gingival edema had significantly higher observed oral symptom scores. 7. In the A regimen there was no correlation between lab values for lymphocytes and albumin with perceived oral symptom scores and observed oral symptom scores. In the B regimen, there was a significant negative correlation between lymphocytes and albumin with the observed oral symptom scores, but not between perceived oral symptom scores and lymphocytes and albumin values. In conclusion, the nurse should expect that the patient undergoing chemotherapy will complain severely about subjective discomfort and before objective physical change is observed. Also the patients who have chronic oral problems such as dentures, gingival edema and bleeding, foul odor, aphthous stomatitis will complain of severe oral discomfort due to chemotherapy.

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Ethical Dilemma and Empowerment among Dental Hygienists in Some Regions (일부 지역 치과위생사가 경험하는 윤리적 딜레마와 임파워먼트)

  • Kim, Mi-Jeong;Park, In-Suk
    • Journal of dental hygiene science
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    • v.12 no.4
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    • pp.383-391
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    • 2012
  • The purpose of this study was to examine the ethical dilemma of dental hygienists and the level of empowerment among them in an attempt to provide some information on how to alleviate the ethical dilemma of dental hygienists to boost their empowerment. The findings of the study were as follows: The dental hygienists got a mean of 1.58 out of possible four points in ethical dilemma. Among the subfactors of ethical dilemma, they scored highest in ethical dilemma about dental hygienists and profession (1.79), followed by dental hygienists and patients (1.53), life reverence and respect for human rights (1.51) and dental hygienists and cooperators (1.49). As for the general characteristics of the dental hygienists, those who were better educated and who intended to temporarily work just until marriage fell into a more ethical dilemma. The dental hygienists got a mean of 3.05 out of possible five points in empowerment. Among the subfactors of it, they scored highest in support structure (3.52), opportunity structure (3.18), information structure (3.08) and resources structure (3.04). There were significant gaps among the dental hygienists in empowerment according to their attitude toward the dental hygienist job as a profession. There was a significant negative correlation between ethical dilemma and empowerment. Regarding influential factors for the ethical dilemma of the dental hygienists, marital status and empowerment were identified as significantly influential factors, and empowerment had a significant relationship to age, academic credential and ethical dilemma. Given the findings of the study, the development of various intervention programs and empowerment-boosting strategies is required to relieve dental hygienists of ethical dilemma.

The Dental Hygienists' Perception of the National Practical Examination (치과위생사의 국가 실기시험에 대한 인식)

  • Ko, Da-Kyung;Bae, Sung-Suk
    • Journal of dental hygiene science
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    • v.16 no.6
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    • pp.488-494
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    • 2016
  • The purpose of the present study was to examine dental hygienists' perception of the current national practical examination. This research was performed using 199 self-reported surveys answered by professors of dental hygiene studies and clinical dental hygienist. Frequency analysis, chi-square tests, and analysis of variance were performed by using IBM SPSS Statistics ver. 20.0. The results revealed that many of the respondents consider the current national practical examination to be neutral. They did not think that the current national practical examination questions are useful for assessing occupation-centric integrated clinical practice ability and counseling techniques for patient intervention. The professors of dental hygiene studies believed that among the research tasks required as mentioned in the national practical examination questions, dental polishing and tooth brushing education are of paramount importance, whereas clinical dental hygienists believed that ultrasonic scaling is the most important (p<0.05). Most of the professors of dental hygiene studies reported that they conducted skills education for dental polishing and tooth brushing education, while most of the clinical dental hygienists reported that tasks actually performed in the clinic included impression taking, model fabrication, ultrasonic scaling, and explaining treatment precautions (p<0.05). Therefore, these tasks can be effectively carried out with the improvement of the national dental hygienist practical examination.