• The Korean Journal of Emergency Medical Services
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• v.11 no.3
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• pp.47-64
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• 2007

Purpose : This study examines satisfaction of students at the department of Emergency Medical Technology with clinical practice and relationship between motivation of achievement and satisfaction with clinical practice and aims to provide basic materials contributing to the improvement of clinical practice education. Method : It selected 237 students in the second and third grade at the dept. of Emergency Medical and having experience in clinical practice as the subjects, collected data from Sept. 1 to 30, 2007 and analyzed 237 questionnaires collected with SPSS 12.0 program. Result : 1. Degree of motivation of achievement scored 3.46 of full marks of five points and they showed motivation of achievement over average score. Students who entered the dept. of Emergency medical after beginning social career(3.78) showed higher motivation of achievement in the period of entrance and group having will to be volunteer(3.66) showed the highest motivation of achievement in selecting this major. The better personal relationship they have, the greater hospital grade and the higher their transcript, the higher motivation of achievement they have. In the desired area of employment after graduation, first-aid staffs at the field of industry group(3.85) showed the highest motivation of achievement. 2. Degree of their satisfaction with clinical practice scored 3.53 of full marks of five and they showed satisfaction with it over average score. They showed the highest satisfaction in the contents of practice(3.64). 3. There was statistically significant positive correlation between motivation of achievement and satisfaction with clinical practice(r = .165, p < .05). Conclusion : There was statistically significant positive correlation between motivation of achievement and satisfaction with clinical practice. Repeated research through sampling based on probability to generalize relevance of motivation of achievement and satisfaction with clinical practice is needed and further researches on developing program to inspire motivation of achievement in theoretical learning as well as in clinical practice are required.

• Transactions of the Korean Society of Automotive Engineers
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• v.22 no.6
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• pp.1-8
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• 2014

Safety performance of a new car is evaluated through USNCAP and their results in the star rating are provided to the consumers. It is very important to obtain high score of USNCAP to appeal their performance to consumers. Therefore the car companies have made the effort to improve their car safety performance. These efforts should satisfy the demand not only to get high score but also to pass the FMVSS, NHTSA regulations on safety. Huge numbers of car crash tests have been conducted on these bases by car companies. However physical tests spend too much cost and time, as an alternative way, the simulation on the car crash could be a solution to reduce the cost and time. Therefore the simulations have been widely conducted in car industry and various researches on this have been reported. In this study, restraint system had been optimized to minimize the injury of female passenger. Belted $5^{th}%ile$ female frontal crash test was selected from various test methods of USNCAP for the study. Initial velocity of the test was 56km/h. The combination injury probability of USNCAP was selected as an objective function and the injury limit value, which was defined in FMVSS, was set to an optimization constraint. Many researches that were similar to this study had been conducted, however most of them had limitation that interaction between airbag and safety belt had not been considered. Contrary to these researches, the interaction was considered in this study.

• Journal of Korean Neurosurgical Society
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• v.55 no.2
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• pp.69-72
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• 2014

Objective : There was no abundance of data on the use of anticoagulant in patients with previous high risk of thromboembolic conditions under a newly developed intracranial hemorrhage in Korean society. The purpose of this study was to evaluate the safety of discontinuance and suggest the proper time period for discontinuance of anticoagulant among these patients. Methods : We reviewed the medical records of 19 patients who took anticoagulant because of thromboembolic problems and were admitted to our department with newly developed anticoagulation associated intracranial hemorrhage (AAICH), and stopped taking medicine due to concern of rebleeding from January 2008 to December 2012. Analysis of the incidence of thromboembolic complications and proper withdrawal time of anticoagulant was performed using the Kaplan-Meier method. Results : Our patients showed high risk for thromboembolic complication. The $CHA_2DS_2$-VASc score ranged from two to five. Thromboembolic complication occurred in eight (42.1%) out of 19 patients without restarting anticoagulant since the initial hemorrhage. Among them, three patients (37.5%) died from direct thromboembolic complications. Mean time to outbreak of thromboembolic complication was $21.38{\pm}14.89$ days (range, 8-56 days). The probability of thromboembolic complications at 7, 14, and 30 days since cessation of anticoagulation was 0.00, 10.53, and 38.49%, respectively. Conclusion : Short term discontinuance of anticoagulant within seven days in patients with AAICH who are at high embolic risk ($CHA_2DS_2$-VASc score >2) appears to be relatively safe in Korean people. However, prolonged cessation (more than seven days) may result in increased incidence of catastrophic thromboembolic complications.

• Quality Improvement in Health Care
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• v.7 no.2
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• pp.218-228
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• 2000

Background : Among 'structure', 'process' and 'outcome' approaches, outcome evaluation is considered as the most direct and best approach to assess the quality of health care providers. Risk-adjustment is an essential method to compare outcome across providers. This study has aims to judge performance of hospitals by severity adjusted mortality rates of coronary artery bypass graft (CABG) surgery. Methods : Medical records of 584 patients who got the CABG surgery in 6 general hospitals during 1996 and 1997 were reviewed by trained nurses. The MedisGroups was used to quantify severity of patients. The predictive probability of death was calculated for each patient in the sample from a multivariate logistic regression model including the severity score, age and sex. For evaluation of hospital performance, we calculated ratio of observed number to expected number of deaths and z score [(observed number of deaths - expected number of deaths)/square root of the variance in the number of deaths], and compared observed mortality rate with confidence interval of adjusted mortality rate for each hospital. Results : The overall in-hospital mortality was 7.0%, ranged from 2.7% to 15.7% by hospital. After severity adjustment the mortality by hospital was from 2.7% to 10.7%. One hospital with poor performance was distinctly divided from others with good performance. Conclusion : In conclusion, severity-adjusted mortality rate of CABG surgery might be applied as an indicator for hospital performance evaluation in Korea. But more pilot studies and improvement of methodologies has to be done to use it as quality indicator.

• YAKHAK HOEJI
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• v.53 no.5
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• pp.274-280
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• 2009

To survey the status of quality control of major ingredients of 'Ssanghwatang (Oriental medicine used for fatigue)', we analyzed 1,024 samples (9 kinds) of medical herbs to determine amounts of ashes, acid-insoluble ashes, loss on drying that are major elements to ensure basic quality of herbal drugstuffs. After ash analysis, Paeoniae Radix (from China) failed to meet the herbal standard criterion. After yielding Z-score(indicating the probability of exceeding its criterion) Zizyphi Fructus, Zingiberis Rhizoma, Paeoniae Radix, Rehmanniae Radix Preparata became objects of intense quality control (=IQC). Analysis on loss on drying shows Cinnamomi Cortex was unsuitable and was put under the IQC. In case of respective heavy metals, Angelicae Gigantis Radix, Cnidii Rhizoma, Cinnamomi Cortex exceeded the maximum permissible range for Cd. The 3 kinds of sub-standards were put to the IQC. Statistic figures showed a significant correlation (t-test, p<0.01) between country-of-origin and sub-quality rates. Compared to domestic one, imported medicinal herbs were less suitable in regard of acid-insoluble ash, loss on drying and Pb/Hg content. Meanwhile, amounts of Acid-insoluble ash showed positive relation with amounts of Pb (r=0.202) and As (r=0.243) among heavy metals leading to an inference that herbs of which root/rhizome is used for medical purposes attribute its high heavy metal content to the fine earth/sand being stuck to its root stalk.

• Journal of Dental Anesthesia and Pain Medicine
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• v.18 no.5
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• pp.295-300
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• 2018

Background: Removal of the plate following Le Fort I osteotomy and BSSO (bilateral sagittal split osteotomy) is a common procedure. However, patients who undergo plate removal experience intense pain and discomfort. This study investigated the half-maximal effective concentration ($Ce_{50}$) of remifentanil in the prevention of plate removal pain under sedation using dexmedetomidine. Methods: The study evaluated 18 patients, between 18 and 35 years of age, scheduled for elective surgery. Remifentanil infusion was initiated after sedation using dexmedetomidine, and started at a dose of 1.5 ng/mL on the first patient via target-controlled infusion (TCI). Patients received a loading dose of $1.0{\mu}g/kg$ dexmedetomidine over 10 min, followed by a maintenance dose of $0.7{\mu}g/kg/h$. When the surgeon removed the plate, the patient Modified Observer's Assessment of Alertness/Sedation (MOAA/S) score was observed. Results: The Ce of remifentanil ranged from 0.9 to 2.1 ng/mL for the patients evaluated. The estimated effect-site concentrations of remifentanil associated with a 50% and 95% probability of reaching MOAA/S score of 3 were 1.28 and 2.51 ng/mL, respectively. Conclusion: Plate removal of maxilla can be successfully performed without any pain or adverse effects by using the optimal remifentanil effect-site concentration ($Ce_{50}$, 1.28 ng/mL; $Ce_{95}$, 2.51 ng/mL) combined with sedation using dexmedetomidine.

• Journal of Korean Public Health Nursing
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• v.16 no.1
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• pp.105-114
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• 2002

This study was to investigate the level of fatigue and its associated variables in patients with systemic lupus erythematosus(SLE) in Korea. From March to June, 2001, 100 patients, registered at one university hospital rheumatology clinic in Seoul, were accepted as subjects for this study. The sampling method was adopted a non-probability, purposive technique. The instruments used for this study were The Multidimensional Assessment Fatigue scale developed by Tack and Beck Depression Instrument develped by Beck. The collected data were analyzed by SAS program using t-test, ANOVA with Scheffe-test, Pearson correlation coefficients and stepwise multiple regression. The results were as follows: 1. Total scores of fatigue of the subjects averaged $24.46(\pm10.85)$, degree of fatigue was $5.08(\pm2.29)$, and influence of fatigue was $3.52(\pm2.12)$. 2. Regarding characteristics, more depressive(p=.0001) and more painfuI(p=.0122) patients revealed more fatigue. Also, the subjects with spouse(p=.0337) and having poor quality of sleep(p=.0445) revealed more fatigue. 3. The subjects' total fatigue score, depression, pain and age was correlated positively(r=.53; r=.48; r=.24), and total fatigue score, and exercise time, quality of sleep was correlated negatively(r=-.45; r=-.21). 4. The main influencing factors on the fatigue were depression$(52.92\%)$ and quality of sleep $(8.10\%)$. These two main variables made it possible to explain $61.02\%$ of the varience in fatigue. In conclusion, this study revealed depression and quality of sleep is an important factor that can improve quality of life in patients with SLE. It is recommended that nursing intervention for SLE patients would be focused to decrease depression and to enhance quality of sleep.

• Journal of Gastric Cancer
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• v.19 no.4
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• pp.393-407
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• 2019

Purpose: To identify the potential therapeutic role of postoperative radiotherapy (RT) in patients with locally advanced (stage II and stage III) gastric signet ring cell carcinoma (SRC). Materials and methods: Patients with locally advanced gastric SRC from the Surveillance, Epidemiology, and End Results program database between 2004 and 2012 were included in our study. Univariate and multivariate Cox proportional models were performed, and survival curves were generated to evaluate the prognostic effect of postoperative RT and surgery alone on SRC patients. Propensity score matching (PSM) was used to avoid selection bias among the study cohorts. Results: We found that patients with postoperative RT had better probability of survival compared with those who did not receive RT (overall survival [OS], P<0.001; cancer-specific survival [CSS], P<0.001). After PSM, analysis of both overall and CSS showed that patients who underwent postoperative RT had better prognosis than those receiving surgery alone in the matched cohort (OS, P=0.00079; CSS, P=0.0036). Multivariate Cox proportional model indicated that postoperative RT had better effect on prognosis compared with surgery alone with respect to both overall (hazard ratio [HR], 0.716; 95% confidence interval [95% CI], 0.590-0.87; P=0.001) and CSS (HR, 0.713; 95% CI, 0.570-0.890; P=0.003). Conclusions: Postoperative RT had better prognosis compared with surgery alone for both overall and CSS for patients with locally advanced gastric SRC.

• Journal of Korean Neurosurgical Society
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• v.55 no.4
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• pp.195-199
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• 2014

Objective : Age is a strong predictor of mortality in traumatic brain injuries. A surgical decision making is difficult especially for the elderly patients with severe head injuries. We studied so-called 'withholding a life-saving surgery' over a two year period at a university hospital. Methods : We collected data from 227 elderly patients. In 35 patients with Glasgow Coma Score 3--8, 28 patients had lesions that required operation. A life-saving surgery was withheld in 15 patients either by doctors and/or the families (Group A). Surgery was performed in 13 patients (Group B). We retrospectively examined the medical records and radiological findings of these 28 patients. We calculated the predicted probability of 6 month mortality (IPM) and 6 month unfavorable outcome (IPU) to compare the result of decision by the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) calculator. Results : Types of the mass lesion did not affect on the surgical decision making. None of the motor score 1 underwent surgery, while all patients with reactive pupils underwent surgery. Causes of injury or episodes of hypoxia/hypotension might have affected on the decision making, however, their role was not distinct. All patients in the group A died. In the group B, the outcome was unfavorable in 11 of 13 patients. Patients with high IPM or IPU were more common in group A than group B. Wrong decisions brought futile cares. Conclusion : Ethical training and developing decision-making skills are necessary including shared decision making.

• Proceedings of the Korea Water Resources Association Conference
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• 2015.05a
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• pp.244-244
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• 2015

Managed Aquifer Recharge (MAR) in the form of Aquifer Storage and Recovery (ASR) systems are being applied for numerous water augmentation projects both in developed and developing countries. Given the onset of Climate Change and its influence on weather patterns and land use, it has been acknowledged the utilization of this technology will be ever increasing. This technique like all others does have its drawbacks or disadvantages, whereby to overcome these drawbacks or disadvantages it is recommended that logical planning process be followed. In this study, we developed a decision framework known as "Decision framework for the planning, designing, construction/testing and implementation of subsurface water storage system" to further standardize the planning and design process of subsurface water storage system to increase the probability of having a successful ASR/ASTR project. The formulation of this framework was based on earlier frameworks, guidelines, published papers and technical reports which were compiled into a data collection database. The database of which consider both qualitative and quantitative aspect for example recharge objectives, site location, water chemistry of the native, source and recovered water, aquifer characteristics(hydraulic conductivity, transmissivity, porosity), injection/pumping rate, ecological constraints, societal restrictions, regulatory restrictions etc. The assimilation of these factors into a singular framework will benefit the broad spectrum of stakeholder as it maps the chronological order under which ASR project should be undertaken highlighting at each stage the feasibility of the project. The final stage of which should result in fully operational ASR system. The framework was applied to two case studies and through the application of a modified ASR site selection suitability index (Brown et al., 2005) a score was derived to identify the performance of each site. A high score of which meant a maximize chance of success given the reduce presence of project constraints.