• Journal of Chest Surgery
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• 제48권2호
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• pp.105-111
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• 2015

Background: The aim of this study was to establish whether pulmonary lobectomy using video-assisted thoracic surgery (VATS) can be safely performed by trainees with limited experience with open lobectomy. Methods: Data were retrospectively collected from 251 patients who underwent VATS lobectomy at a single institution between October 2007 and April 2011. The surgical outcomes of the procedures that were performed by three trainee surgeons were compared to the outcomes of procedures performed by a surgeon who had performed more than 150 VATS lobectomies. The cumulative failure graph of each trainee was used for quality assessment and learning curve analysis. Results: The surgery time, estimated blood loss, final pathologic stage, thoracotomy conversion rate, chest tube duration, duration of hospital stay, complication rate, and mortality rate were comparable between the expert surgeon and each trainee. Cumulative failure graphs showed that the performance of each trainee was acceptable and that all trainees reached proficiency in performing VATS lobectomy after 40 cases. Conclusion: This study shows that trainees with limited experience with open lobectomy can safely learn to perform VATS lobectomy for the treatment of lung cancer under expert supervision without compromising outcomes.

• Journal of Chest Surgery
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• 제53권5호
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• pp.263-269
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• 2020

Background: The benefits of epicardial ultrasound scanning (EUS) in coronary artery bypass grafting (CABG) have not yet been established. The aim of this study was to evaluate the usefulness of EUS in CABG, including in the assessment of the quality of distal anastomoses, the identification of epicardial target vessels, and the evaluation of any graft issues other than the distal anastomoses. Methods: Fifty-three patients undergoing CABG were enrolled between March 2018 and February 2019. Intraoperative EUS was performed along with transit-time flow measurement (TTFM). Graft evaluations were performed early (shortly after surgery) and 1 year after surgery for 53 (100%) and 47 (88.7%) patients, respectively. Results: EUS was applied to assess the quality of all distal anastomoses, 32 target vessels, and 2 conduit trunks. Insufficient TTFM findings were obtained for 18 grafts. However, graft revision was performed for only 3 distal anastomoses; based on the EUS findings, the remaining 15 sites were not revised. The early and 1-year overall graft patency rates were 100% (141 anastomoses) and 96.1% (122 of 127 anastomoses), respectively. All 15 of the distal anastomoses that were not revised despite insufficient TTFM results were patent at the 1-year mark. Conclusion: The routine application of EUS in CABG could be beneficial by confirming the quality of surgery and reducing unnecessary procedures.

• 한국의료질향상학회지
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• 제2권2호
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• pp.32-45
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• 1996

Background : A critical path defines an optimal sequencing and timing of interventions by physicians, nurses, and other staff for a particular diagnosis or procedure, designed to better utilize resources, maximize quality of care, and minimize delays. It can be thought of as a visualization of the patient care process. In this study, a review of appendectomy patient records was undertaken to identify a critical path for the management of this treatment. Methods: For this study, records of patients under 15 or over 65 years of age were excluded ; cases where the patient was pregnant, or where complications developed were also excluded. The remaining 21 cases were divided into two categories according to the indication for appendectomy : for acute appendicitis, and for perforated appendix or drainage of periappendical abscess. The time frame for the review was from patient examination immediately prior to operation, through discharge. The study team was composed of a surgeon, research head nurse, education head nurse, surgical part head nurse, and medical recorder. Following their review of the 21 charts, the team determined an appropriate progression and schedule for an appendectomy. Result : Through the chart and literature review, the following aspects of the care process were identified as typical and tracked : monitoring/assessment, treatment, lines/drains, medication, activity, diet, tests and patient education. Conclusion : From this study, the design team determined two separate critical paths : one for appendectomy only, and one for appendectomy plus drainage. Next, these paths must be validated and fine-tuned through clinical implementation. In addition, a comparison of our design with the critical paths determined at other hospitals would be extremely valuable for advancing research in this area. Lastly, the critical path approach to improving patient care and maximizing hospital resources should be applied to other procedures.

• 한국식품조리과학회지
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• 제8권2호
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• pp.137-145
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• 1992

A computer-assisted microbiological quality assurance program was developed based on HACCP data obtained from a 500 bed general hospital by assessing time and temperature conditions and microbiological qualities of six categories of menu items according to the process of food product flow. The purpose of the study was to develop a computer-assisted microbiological quality assurance program in order to simplify the assessment procedures and to provide a maximum assurance to foodservice personnel and the public. A 16-Bit personnel computer compatible with IBM-PC/AT was used. The data base files and processing programs were created using dBASE III plus packages. The contents of the computerized system are summarized as knows: 1. When the input program for hazard analysis runs, a series of questions are asked to determine hazards and assess their severity and risks. Critical control points and monitoring methods for CCPs are identified and saved in Master file. 2. Output and search programs for hazard analysis are composed of 6 categories of recipe data file list, code identification list, and HACCP identification of the specific menu item. 3. When the user selects a specific category of recipe from 6 categories presented on the screen and runs data file list, a series of menu item list, CCP list, monitoring methods list are generated. When the code search program runs, menu names, ingredients, amounts and a series of codes are generated. 4. When the user types in a menu item and an identification code, critical control points and monitoring methods are generated for each menu item.

• Journal of Gastric Cancer
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• 제23권2호
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• pp.275-288
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• 2023

Purpose: This study aimed to examine the effects of 4 main types of gastrectomy for proximal gastric cancer on postoperative symptoms, living status, and quality of life (QOL) using the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45). Materials and Methods: We surveyed 1,685 patients with upper one-third gastric cancer who underwent total gastrectomy (TG; n=1,020), proximal gastrectomy (PG; n=518), TG with jejunal pouch reconstruction (TGJP; n=93), or small remnant distal gastrectomy (SRDG; n=54). The 19 main outcome measures (MOMs) of the PGSAS-45 were compared using the analysis of means (ANOM), and the general QOL score was calculated for each gastrectomy type. Results: Patients who underwent TG experienced the lowest postoperative QOL. ANOM showed that 10 MOMs were worse in patients with TG. Four MOMs improved in patients with PG, while 1 worsened. One MOM was improved in patients with TGJP versus 8 MOMs in patients with SRDG. The general QOL scores were as follows: SRDG (+39 points), TGJP (+6 points), PG (+3 points), and TG (-1 point). Conclusions: The TG group experienced the greatest decline in postoperative QOL. SRDG and PG, which preserve part of the stomach without compromising curability, and TGJP, which is used when TG is required, enhance the postoperative QOL of patients with proximal gastric cancer. When selecting the optimal gastrectomy method, it is essential to understand the characteristics of each and actively incorporate guidance to improve postoperative QOL.

• 해양환경안전학회지
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• 제15권2호
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• pp.79-89
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• 2009

본 논문은 수산자원보호구역의 효과적이고 합리적인 관리방향에 대한 정책수립 지원라 체계적인 어장환경실태조사 시스템 구축을 위한 사전 진단적 연구접근으로서 수산자원보호구역에서 계절별로 장기적으로 모니터링된 국가해양환경측정망 등의 자료를 이용해서 어장환경의 실태와 변화를 분석하고 평가하였다. 어장환경은 오염이 진행되었거나 진행 중인 것으로 진단되었는데, 각 영역별로 수질과 저질 오염특성이 다소 다르게 나타나서 오염원과 이용실태 및 지형적 특성 등 제반 환경요소를 고려한 맞춤형 수질관리방안 수립이 요구되었다. 또한, 보호구역의 지정면적은 점차적으로 변화되어 왔는데, 2003년도와 처음 시정시의 면적을 비교해 볼 때, 총 면적변화는 $-22.9{\sim}2.4%$ 범위로 완도 도암만은 약 2.4% 정도 미미한 증가를 보였지만, 전체 구역은 평균 약 6.4%가 감소하였고, 한산만이 가장 큰 비율로 감소하였다. 전체 면적 중 육역이 약 6.1%, 해역이 약 6.6%가 감소되었지만, 2008년 시 군별로 고시된 상황을 종합적으로 고려하면 지정면적의 감소는 대부분 육역인 것으로 사료 되었다. 보호구역의 환경을 양호하게 유지하고 효과적인 관리정책을 수립하기 위해서는 실효적인 수질관리방안 뿐만 아니라 개발 및 이용실태 파악을 위한 조사와 데이터(정보)관리가 체계적으로 이루어지고 해역별로 종합 관리할 필요가 있을 것이다. 아울러 각종 관련 법률을 정비 보완해서 조사, 평가, 협의 등 관리방향과 관련된 요소를 일관성있고 체계적으로 정립할 필요가 있다고 판단된다.

• 한국지하수토양환경학회지:지하수토양환경
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• 제22권3호
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• pp.1-9
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• 2017

The numerical analysis of groundwater flow is indispensable for predicting problems associated with water resource development, civil works, environmental hazards, and nuclear power plant construction. Korea lacks public regulatory procedures and guidelines for groundwater flow modeling, especially in nuclear facility sites, which makes adequate evaluation difficult. Feasible step-by-step guidelines are also unavailable. Consequently, reports on groundwater flow modeling have low-grade quality and often present controversial opinions. Additionally, without public guidelines, maintaining consistency in reviewing reports and enforcing laws is more challenging. In this study, the guidelines for groundwater flow modeling were reviewed for three countries - the United States (Documenting Groundwater Modeling at Sites Contaminated with Radioactive Substances), Canada (Guidelines for Groundwater Modelling to Assess Impacts of Proposed Natural Resource Development Activities), and Australia (Australian Groundwater Modelling Guidelines), with the aim of developing groundwater flow modeling regulatory guidelines that can be applied to nuclear facilities in Korea, in accordance with the Groundwater Act, Environmental Impact Assessment Act, and the Nuclear Safety Act.

• Safety and Health at Work
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• 제3권3호
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• pp.155-165
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• 2012

Reflecting the current international trends toward proactive risk assessment and control at work with practical procedures, participatory action-oriented approaches are gaining importance in various sectors. The roles of these approaches in promoting the safety and health at work are discussed based on their recent experiences in preventing work-related risks and improving the quality of work life, particularly in small-scale workplaces. The emphasis placed on the primary prevention at the initiative of workers and managers is commonly notable. Participatory steps, built on local good practices, can lead to many workplace improvements when the focus is on locally feasible low-cost options in multiple aspects. The design and use of locally adjusted action toolkits play a key role in facilitating these improvements in each local situation. The effectiveness of participatory approaches relying on these toolkits is demonstrated by their spread to many sectors and by various intervention studies. In the local context, networks of trainers are essential in sustaining the improvement activities. With the adequate support of networks of trainers trained in the use of these toolkits, participatory approaches will continue to be the key factor for proactive risk management in various work settings.

• 대한전기학회:학술대회논문집
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• 대한전기학회 2000년도 추계학술대회 논문집 학회본부 C
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• pp.413-415
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• 2000

Piezoelectric ceramics of PZT have been developed to apply for transformers in notebook. Use of piezoelectric ceramics in applications like piezoelectric transformers was made possible by the development of new materials with high electromechanical coupling coefficients and high mechanical quality factor. "Hard" ferroelectiric ceramics of complex composition based on lead zirconate titanate with Mn additive have been prepared. The perovskitic phase reaction of the oxides. The crucial role played by the intermediate mixing and grinding procedures in the assessment of the final properties of the material was investigated. Densification up to approximately the theoretical density value was achieved. The polarization was obtained by subjecting the samples at $30kVcm^{-1}$ poling electric field, in a silicon oil bath heated at $110^{\circ}C$. Their microstructural and morphological properties were checked by X-ray diffraction analysis and scanning electron microscopy. The optimized samples presented very high qualify and electromechanical coupling factors, together with small dielectric loss.

• 한국식품조리과학회지
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• 제19권5호
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• pp.647-658
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• 2003

Foodservice at elementary schools has been provided nation-wide. It is predictable that foodborne diseases would increase continuously. Formation of a counterplan is urgently needed. This study was designed to identify the stage which contains the critical control points (CCPs) for the microbiological management of HACCP (Hazard Analysis Critical Control Point) at the foodservice provided at elementary schools. Foodservice places at four elementary schools in Seoul were sampled and the overall hygiene of cooking, utensils and equipment, employees, and environment by season were examined. The results showed that the number of bacteria in overall samples was increased and that E. coli, Salmonella and Staphylococcus by biochemical test emerged in more diverse samples in summer than in spring. Particularly, the number of aerial bacteria in summer was three-fold greater than that in either spring or winter. E. coli 0157 was not detected, although Salmonella was identified by PCR analysis in the meat knives, chopping boards, waste bins and meat dish at elementary school foodservice. According to this data, cross-contamination should be managed in the stage of mixing up the ingredients with improper equipments and insanitary treatments. Thus, the establishment of SSOP (Sanitation Standard Operating Procedures) and GMP (Good Manufacturing Practice) at elementary school foodservice is stringently required, along with sanitation education for workers and employees as CCPs.