• 제목/요약/키워드: Man-hour management

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Fontan 수술을 받은 정신지체 소아에서 인상채득을 위해 시행한 깊은 진정 (Deep Sedation for Palate Alginate Impression Procedure in a Post-Fontan Procedure Patient with Mental Retardation)

  • 이정만;서광석;김현정;신순영;신터전
    • 대한치과마취과학회지
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    • 제12권1호
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    • pp.45-50
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    • 2012
  • The Fontan operation is a heart operation used to treat complex congenital heart defects like tricuspid atresia, hypoplastic left heart syndrome, pulmonary atresia and single ventricle. A single ventricle is dedicated to pumping oxygenated blood to the systemic circulation and the entire systemic venous return reaches the pulmonary arterial system without the direct influence of a pumping chamber. In the patient with Fontan operation, it is important to achieve adequate pulmonary blood flow and cardiac output in anesthetic management. In this case, a 10-year-old boy (19.6 kg, 114 cm) with cleft palate, cerebral palsy and severe mental retardation, who underwent a Fontan operation when he was 4 years old, was presented for deep sedation. Because he was suffering from eating disorder with cleft palate, the orthodontist and the plastic surgeon planned to insert intraoral orthodontic device before cleft palate repair. But it was impossible to open his mouth for alginate impression procedure. After careful pre-anesthesia evaluation we planned to administer deep sedation with propofol infusion. After Intravenous catheter insertion, we started propofol intravenous infusion with the formula of a loading dose of 1.0 mg/kg followed by an infusion rate of 6.0 mg/kg/hr with syringe pump. His blood pressure was remained around 80/40 mmHg after loss of consciousness, but he could not maintain his airway patent. So we lowered the infusion rate to 3.0 mg/kg/hr, immediately. The oxygen saturation was maintained above 95% with nasal oxygen supply, and blood pressure was maintained around 100-80/60-40 mmHg. After the sedation of 110 minutes with propofol (the infusion rate to 3.0-5.0 mg/kg/hr), he fully regained consciousness, and was discharged without complication after 1 hour observation. In case of post-Fontan patient, intravenous deep sedation with propofol was safe and effective method of behavioral management during dental treatment.

한 대학병원 부속 건강검진센터 이용자의 만족도와 재이용 의사에 미치는 요인 (Factors Affecting the Satisfaction and Revisit Intension of Health Promotion Center In A University Hospital)

  • 김희경;류황건
    • 한국병원경영학회지
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    • 제6권3호
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    • pp.5-24
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    • 2001
  • The purpose of this study was to serve as a basis for providing quality medical service and mapping out consumer-centered marketing strategies to successfully cope with the rapidly changing medical environment and meet consumer needs, by examining what affected the satisfaction and revisit of health Promotion center Client. The subjects in this study were 186 of visitor to health Promotion center in a university hospital in the city of Busan. A survey was conducted with structured questionnaire from March 2 to 30, 2001. The collected data were analyzed with SPSS for Windows (ver10.0). For more statistical analysis, frequency analysis, component analysis, t-test, ANOVA and correlation analysis procedures were utilized. Results of the study can be summarized as follows: 1. Regarding demographic characteristics, 51.6% of the Client investigated were male, and 48.4% were female. The greatest number of them were in their 40s(38.9%). 86.5% were married, and 34.2% were self-employed. 44% were a high-school graduate, and the monthly mean income of 59.4% was one to three million Won. And, the residential area of 46.8%, the largest percentage, was a half-an-hour distance from health Promotion center. 2. The most common motivation of their selection of the health Promotion center was a recommendation by Staff and neighborhood(59.7%), followed by excellent facilities and services(17.2%), the tradition and reputation of the hospital(7.5%), and its publicity pamphlets(7.5%). 3. 45.9%, the largest percentage, acquired health-related information from their friends or acquaintances. 43.8%, the greatest percentage, visited there because they felt there's something wrong with their body. 53.4% worried about the possibility of being attacked by cancer, and 57.5% wanted to take a precise cancer examination. For health maintenance, 50.1% got regular exercise. Regular exercise was considered most crucial for health maintenance or promotion. 4. The largest reason they used that examination center again was the kindness of employees(52.7%), followed by the tradition and reputation of the hospital(21%) and excellent examination setting and equipment(10.8%). 5. By demographic factor, there was no significant difference between the man and women in satisfaction level with examination and expenses. The women expressed more satisfaction at facilities, and the high-school graduate group were more contented with expenses. 6. As a result of investigating their satisfaction level according to the motivation of selecting that examination center, the group that chose the center due to excellent facilities and services were more satisfied with examination and expenses. 7. As for the relationship of total examination satisfaction to revisit. intention, there was a higher correlational relationship between total health examination satisfaction and expense satisfaction. Especially, the more they were satisfied with examination, the more they were willing to revisit there for another examination.

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양대혈관 우심실 기시 환아의 Sevoflurane을 이용한 깊은 진정 하 치과치료 (Deep Sedation with Sevoflurane in Patients with Double Outlet of Right Ventricle)

  • 현홍근;신터전;김영재;김정욱;장기택;이상훈;김종철;김현정;서광석;이정만;신순영
    • 대한치과마취과학회지
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    • 제12권2호
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    • pp.115-119
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    • 2012
  • Double outlet of right ventricle (DORV) refers to a congenital heart disease in which pulmonary and systemic circulation originates from the right ventricle. In the patient with DORV, it is important to maintain the balance between pulmonary and systemic circulation in anesthetic management. A 4-year-old boy with DORV, who underwent a Blalock-Taussig shunt operation, was transferred to the clinic with a chief complaint of multiple caries. Due to poor cooperability, it was impossible to treat the caries without sedation or general anesthesia. We planned to sedate him with consideration with detrimental effects associated with positive pressure ventilation for dental treatment. After a prophylactic administration of antibiotics, sevoflurane was administered through T-cannula site. Throughout the treatment, His blood remained stable around 80/40 mmHg, oxygen saturation remained around 91%. After 3 hour of sedation with sevoflurane (end-tidal sevoflurane con 1-1.8 vol%), he fully regained consciousness, and discharged from hospital without complications. In case of DORV patient, deep sedation with sevoflurane may be used as effective method of behavioral management during dental treatment.

유연근로시간제 개선에 대한 연구 (A Study on the Improvement of Flexible Working Hours)

  • 권용만;서의석
    • 벤처혁신연구
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    • 제4권2호
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    • pp.97-108
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    • 2021
  • 근로계약은 형식상으로는 노동력상품과 임금의 교환관계로서 나타나지만, 단순한 물물교환의 차원을 초월하는 것이기 때문에 경제학적으로 노동력상품과 화폐의 교환관계로서 '매매'로서 파악하는 것도 가능하고 '임대차'로 파악할 수도 있다. 상품교환관계를 법적인 측면에서 보면, 노동력과 임금의 교환관계를 합법적으로 지지하고 그것에 구속력을 부여하여 강제화하는 법적인 장치가 계약이다. 이러한 근로계약은 임금을 수령하고, 임금의 수령의 반대급부로 일정한 시간을 사용자의 지휘·감독하에 두는 관계를 가져오게 하였다. 근로시간은 자신의 노동력을 사용자의 처분권하에 둔 종속시간이기 때문에 장시간의 근로는 근로자의 건강과 안전을 위해할 수 있고, 더 나아가 인간으로서 누려야 할 가치를 침해하는 행위가 될 수 있음으로 그 규제가 필요하다고 할 것이다. 근로시간의 단축은 인간의 생체적 한계를 설정하고, 확대 재생산을 할 수 있도록 생산적 측면에서 근로자의 문화에 대한 향유와 인간으로서 삶의 질을 확보하는 사회적인 측면에서 단축이 필요하지만, 사용자의 기업 경영상의 노동력 확보와 생산 활동 및 자본주의 국가에서 추구하는 것과 비교하여 이 둘의 양립을 할 수 있어야 한다. 근로시간은 개인에게서의 시간과 사회전체에서의 시간으로 볼 수 있고, 개인적인 차원에서 장시간 근로는 개인에게서의 시간은 줄어들게 되어 개인적 차원에서는 바람직하지 않지만, 사회전체적인 차원에서 생산 활동에 투입시간의 증대로 인한 생산물의 증가는 사회발전에 도움이 될 수 있다. 근로시간은 이러한 개인적 차원과 사회적 차원에서의 균형을 찾아간다는 측면에서 근로시간을 고찰하는 것이 필요하다. 근로시간의 규제방법이 근로시간의 시작과 근로시간의 종료에 대한 것으로 근로시간의 총량을 규제하는 것이었다면, 근로시간의 유연화, 탄력화는 근로시간의 총량을 1주 최대 52시간의 범위 내에서 범위를 한정하면서 기업의 새로운 업무의 출현에 따라 근로시간을 탄력적으로 배분하고 편성하는 것이 가능하도록 하는 근로시간의 질적인 규제방식이다. 이에 따라 근로시간은 단축하되 기업의 상황에 따른 유연근로시간제를 확대하여 시행하는 것이 필요하다. 이를 위하여 현재 6개월로 제한되어 있는 탄력적 근로시간제의 운용의 폭의 유연화와 사용자와 근로자간의 합의에 의한 선택적 근로시간제의 실 근로시간에 대한 처리, 정보통신 기술의 발전과 4차 산업혁명에 기반한 새로운 근로형태에 출현에 따른 재량근로시간의 대상 업무를 확대하는 것이 필요하다.

월동기 흰뺨검둥오리의 일일 서식지 이용에 관한 연구 (A Study on Spot-billed Ducks' Daily Habitat Use Pattern During Wintering Period in Korea)

  • 신용운;신만석;이한수;한승우;정상민;오홍식
    • 한국환경생태학회지
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    • 제30권3호
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    • pp.328-334
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    • 2016
  • 본 연구에서는 야생동물위치추적기(WT-300)을 이용하여 국내에 월동 번식하는 흰뺨검둥오리의 하루 동안 서식지 이용과 이동거리를 파악하여, 우리나라 수조류 서식지 보호 관리의 기초자료로 활용하고자 하였다. 대상지역은 경기도 안성천, 충청남도 봉선저수지, 전라북도 만경강, 동진강, 전라남도 해남군 등 5개 하천과 저수지로 흰뺨검둥오리 20개체에 위치추적기를 부착하였다. 흰뺨검둥오리는 월동기에 내륙수를 47.3%의 비중으로 가장 많이 이용하였으며, 다음으로 논, 해양수, 내륙습지, 연안습지 등이었다. 내륙수는 시간에 관계없이 꾸준히 이용하였다. 논은 야간에 주로 이용하였고, 내륙습지, 연안습지, 해양수의 경우 주간에 주로 이용하였다. 서식지 이용률 변화는 16시와 18시, 06시와 08시에 가장 컸다. 전체 평균 이동거리는 $0.75{\pm}0.27km$/2hours이었으며, 누적 이동거리는 8.95km이었다. 06시에서 08시, 16시에서 18시에 이동한 거리는 2km이상으로 가장 길었다. 그 외 시간에는 1km미만의 이동거리를 보였다. 장거리를 이동한 시간은 서식지 이용률의 변화 폭이 가장 큰 시간과 일치하였다.

간호학 교과과정 개선을 위한 조사 연구 (A Study on improvement of curriculum in Nursing)

  • 김애실
    • 대한간호학회지
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    • 제4권2호
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    • pp.1-16
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    • 1974
  • This Study involved the development of a survey form and the collection of data in an effort-to provide information which can be used in the improvement of nursing curricula. The data examined were the kinds courses currently being taught in the curricula of nursing education institutions throughout Korea, credits required for course completion, and year in-which courses are taken. For the purposes of this study, curricula were classified into college, nursing school and vocational school categories. Courses were directed into the 3 major categories of general education courses, supporting science courses and professional education course, and further subdirector as. follows: 1) General education (following the classification of Philip H. phoenix): a) Symbolics, b) Empirics, c) Aesthetics. 4) Synthetics, e) Ethics, f) Synoptic. 2) Supporting science: a) physical science, b) biological science, c) social science, d) behavioral science, e) Health science, f) Educations 3) Professional Education; a) basic courses, b) courses in each of the respective fields of nursing. Ⅰ. General Education aimed at developing the individual as a person and as a member of society is relatively strong in college curricula compared with the other two. a) Courses included in the category of symbolics included Korean language, English, German. Chines. Mathematics. Statics: Economics and Computer most college curricula included 20 credits. of courses in this sub-category, while nursing schools required 12 credits and vocational school 10 units. English ordinarily receives particularly heavy emphasis. b) Research methodology, Domestic affair and women & courtney was included under the category of empirics in the college curricula, nursing and vocational school do not offer this at all. c) Courses classified under aesthetics were physical education, drill, music, recreation and fine arts. Most college curricula had 4 credits in these areas, nursing school provided for 2 credits, and most vocational schools offered 10 units. d) Synoptic included leadership, interpersonal relationship, and communications, Most schools did not offer courses of this nature. e) The category of ethics included citizenship. 2 credits are provided in college curricula, while vocational schools require 4 units. Nursing schools do not offer these courses. f) Courses included under synoptic were Korean history, cultural history, philosophy, Logics, and religion. Most college curricular 5 credits in these areas, nursing schools 4 credits. and vocational schools 2 units. g) Only physical education was given every Year in college curricula and only English was given in nursing schools and vocational schools in every of the curriculum. Most of the other courses were given during the first year of the curriculum. Ⅱ. Supporting science courses are fundamental to the practice and application of nursing theory. a) Physical science course include physics, chemistry and natural science. most colleges and nursing schools provided for 2 credits of physical science courses in their curricula, while most vocational schools did not offer t me. b) Courses included under biological science were anatomy, physiologic, biology and biochemistry. Most college curricula provided for 15 credits of biological science, nursing schools for the most part provided for 11 credits, and most vocational schools provided for 8 units. c) Courses included under social science were sociology and anthropology. Most colleges provided for 1 credit in courses of this category, which most nursing schools provided for 2 creates Most vocational school did not provide courses of this type. d) Courses included under behavioral science were general and clinical psychology, developmental psychology. mental hygiene and guidance. Most schools did not provide for these courses. e) Courses included under health science included pharmacy and pharmacology, microbiology, pathology, nutrition and dietetics, parasitology, and Chinese medicine. Most college curricula provided for 11 credits, while most nursing schools provide for 12 credits, most part provided 20 units of medical courses. f) Courses included under education included educational psychology, principles of education, philosophy of education, history of education, social education, educational evaluation, educational curricula, class management, guidance techniques and school & community. Host college softer 3 credits in courses in this category, while nursing schools provide 8 credits and vocational schools provide for 6 units, 50% of the colleges prepare these students to qualify as regular teachers of the second level, while 91% of the nursing schools and 60% of the vocational schools prepare their of the vocational schools prepare their students to qualify as school nurse. g) The majority of colleges start supporting science courses in the first year and complete them by the second year. Nursing schools and vocational schools usually complete them in the first year. Ⅲ. Professional Education courses are designed to develop professional nursing knowledge, attitudes and skills in the students. a) Basic courses include social nursing, nursing ethics, history of nursing professional control, nursing administration, social medicine, social welfare, introductory nursing, advanced nursing, medical regulations, efficient nursing, nursing english and basic nursing, College curricula devoted 13 credits to these subjects, nursing schools 14 credits, and vocational schools 26 units indicating a severe difference in the scope of education provided. b) There was noticeable tendency for the colleges to take a unified approach to the branches of nursing. 60% of the schools had courses in public health nursing, 80% in pediatric nursing, 60% in obstetric nursing, 90% in psychiatric nursing and 80% in medical-surgical nursing. The greatest number of schools provided 48 crudites in all of these fields combined. in most of the nursing schools, 52 credits were provided for courses divided according to disease. in the vocational schools, unified courses are provided in public health nursing, child nursing, maternal nursing, psychiatric nursing and adult nursing. In addition, one unit is provided for one hour a week of practice. The total number of units provided in the greatest number of vocational schools is thus Ⅲ units double the number provided in nursing schools and colleges. c) In th leges, the second year is devoted mainly to basic nursing courses, while the third and fourth years are used for advanced nursing courses. In nursing schools and vocational schools, the first year deals primarily with basic nursing and the second and third years are used to cover advanced nursing courses. The study yielded the following conclusions. 1. Instructional goals should be established for each courses in line with the idea of nursing, and curriculum improvements should be made accordingly. 2. Course that fall under the synthetics category should be strengthened and ways should be sought to develop the ability to cooperate with those who work for human welfare and health. 3. The ability to solve problems on the basis of scientific principles and knowledge and understanding of man society should be fostered through a strengthening of courses dealing with physical sciences, social sciences and behavioral sciences and redistribution of courses emphasizing biological and health sciences. 4. There should be more balanced curricula with less emphasis on courses in the major There is a need to establish courses necessary for the individual nurse by doing away with courses centered around specific diseases and combining them in unified courses. In addition it is possible to develop skill in dealing with people by using the social setting in comprehensive training. The most efficient ratio of the study experience should be studied to provide more effective, interesting education Elective course should be initiated to insure a man flexible, responsive educational program. 5. The curriculum stipulated in the education law should be examined.

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해양 플랑크톤 군집의 전기분해 염소소독 효과 (The Electrochemical Chlorination for Marine Plankton Community Disinfection)

  • 강정훈;신경순;현봉길;장민철;김은찬;장만
    • 한국해양환경ㆍ에너지학회지
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    • 제10권3호
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    • pp.127-137
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    • 2007
  • 전기분해 염소소독기로 처리한 결과가 국제해사기구의 협약에서 제시한 생물처리 기준(D-2 regulation)을 만족하는지 확인하기 위해 박테리아, 식물플랑크톤($10-50\;{\mu}m$) 및 동물플랑크톤($>50\;{\mu}m$)의 사멸효과를 확인하였다. 실험조건은 대조구와 잔류염소농도 10 ppm(Expt. 1)과 30 ppm(Expt. 2)을 실험구로 설정하였고, 시험수를 $23.8\;m^3/hr$의 속도로 전기분해염소독기에 통과시켰다. 시험수의 생물조건은 국제해사기구에서 작성된 선박 평형수 관리 장치의 승인을 위한 지침서에서 제시한 기준을 따랐다. 식물플랑크톤의 생사판별은 광학현미경, 형광현미경 및 형광측정기(Turner Designs 10-AU)를 이용하여 확인되었다. 두 농도 조건(10 ppm, 30 ppm)의 처리수에서 운동성이 있는 식물플랑크톤은 움직임이 나타나지 않았고, 형광현미경 하에서 엽록소 형광색이 적색에서 녹색으로 바뀌었으며, 형광값은 고농도(Expt. 1: 6.95, Expt. 2: 7.11)에서 0으로 바뀌었다. 이는 식물플랑크톤의 활성이 상실되어 모두 사멸되었음을 의미한다. 동물플랑크톤의 생사판별은 해부현미경하에서 부속지의 움직임을 토대로 결정되었다. 전기분해 염소소독기 처리 후 해양환경에서 채집되어 농축된 자연군집 동물플랑크톤은 모두 사멸되었으나, 일부 Artemia가 생존하였다. 그러나 각 잔류염소 농도조건의 암소에서 노출시킨 지 24시간 뒤에는 모든 동물플랑크톤이 사멸되었다. 박테리아는 Petrifilm plates($3M^{TM}$)를 이용한 접종배양법으로 처리수의 총 세균, 대장균 군 및 대장균의 사멸효과를 확인한 결과, 균주가 전혀 관찰되지 않았다. 또한 각 염소농도 조건의 처리수에서 추가적으로 노출시킨 5일 동안 세 그룹의 생물에서 재성장이 나타나지 않았다. 본 연구결과는 세 그룹의 생물에 대한 전기분해염소소독기 처리결과가 국제해사기구에서 제정한 선박 평형수 배출기준을 만족시켰음을 보여주었다.

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이상기후대비 노후저수지 홍수 대응을 위한 사전방류 기술개발 및 평가 (Development and assessment of pre-release discharge technology for response to flood on deteriorated reservoirs dealing with abnormal weather events)

  • 문수진;정창삼;최병한;김승욱;장대원
    • 한국수자원학회논문집
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    • 제56권11호
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    • pp.775-784
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    • 2023
  • 최근 이상기후로 수공 구조물의 설계빈도를 상회하는 극한호우의 증가 경향이 뚜렷함에 따라 과거에 설계된 농업용 저수지의 안전성 검토가 필요하다. 그러나 한국농어촌공사 관할 일정 규모 이상의 저수지를 제외한 지자체 관리 저수지는 비상시 긴급 방류가 가능 저수지는 전무하다(13,685개소). 이러한 경우 이동식 사이펀을 현장에 빠르게 투입하여 사전 방류하는 방법이 긴요하며, 본 연구에서는 사전 및 긴급방류 기능을 동시에 수행할 수 있는 직경 200 mm, 최소 수위차 6 m, 420(m2/h), 10,000(m2/day)의 이동식 사이펀을 경주시 유금저수지를 대상으로 적용 가능성을 평가하였다. 테스트베드인 유금 저수지는 1945년 준공되어 공용기간이 78년 정도 경과한 시설물로 수문학적 안정성 분석 결과 현재 댐마루 구간의 최저높이는 27.15(EL.m)로 검토 홍수위 27.44(EL.m) 보다 0.29 m 낮아 제방을 통한 월류 가능성이 있고 여유고도 1.72 m 부족한 것으로 나타나 수문학 안전성을 확보하지 못하는 것으로 검토되었다. 유금저수지는 수위-유량 계측이 주기적으로 이루어진지 얼마 되지 않아 저수지의 수위-유량 관계 곡선식을 명확하게 확립하기 어려워 수위-용적 곡선을 임의로 도출하였으며 도출된 곡선을 기반으로 중소규모 노후저수지 운영 알고리즘을 통해 사전방류시간, 여수로 방류량을 고려하고 빈도별 홍수량에 따른 저수지 월류시간을 예측함으로써 사전에 대피 시간을 확보하고 붕괴위험을 저감할 수 있는 기술을 확보하였다. 직경 200 mm 이동식사이펀 1열 기준, 30년 빈도 홍수량 유입 시 상한수위 기준 80% 수준(약 30,000 m2)을 유지하면서 주민대피 시간(약 1시간)을 확보할 수 있는 최적 사전방류시간은 12시간 이전으로 분석되었다. 중소규모 노후저수지를 대상으로 사이펀 활용 사전방류기술 및 저수지 운영 알고리즘에 따라 이상기후 대비 사전에 방류를 시행하고 관리자의 의사결정을 돕는다면, 저수지 붕괴 위험지역 내의 주민들의 안전을 확보하고 주민대피 지원체계 구축을 통해 주민들의 불안감 해소, 저수지 위험상황 시 위험회피 수단 제공으로 위험요소 감소가 충분히 가능하다.