• Title/Summary/Keyword: Risk management factors

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A Fifteen-year Epidemiological Study of Ventriculoperitoneal Shunt Infections in Pediatric Patients: A Single Center Experience (소아 환자에서의 뇌실-복강 단락 감염의 역학적 고찰: 15년 간의 단일 기관 연구)

  • Kim, Yeon Kyung;Shin, Hyung Jin;Kim, Yae Jean
    • Pediatric Infection and Vaccine
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    • v.19 no.3
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    • pp.141-148
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    • 2012
  • Purpose : Ventriculoperitoneal (VP) shunt insertion is an important treatment modality in children with hydrocephalus. VP shunt infection is a major complication and an important factor that determines the surgery outcome. This 15-year study was performed to evaluate the epidemiology of VP shunt infections in pediatric patients treated at our center. Methods : A retrospective review of medical records was performed in patients 18 years old or younger who underwent VP shunt insertion surgery from April 1995 to June 2010. Results : Three hundred twenty-seven VP shunt surgeries were performed in a total of 190 pediatric patients (83 females, 107 males). The median age of the patients was 2.4 years (range, 0.02-17.9 years). Having a malignant brain tumor was the most frequent cause for VP shunt insertion. The shunt infection rate was 6.7% (22/327) per 100 operations and 9.5% (18/190) per 100 patients, and the incidence rate was 0.45 infection cases per 100 shunt operations-year. The most common pathogen was coagulase-negative staphylococcus (n=7) followed by methicillin resistant Staphylococcus aureus (n=1). Ten cases were treated with vancomycin and beta-lactam antibiotic (cephalosporin or carbapenem) combination therapy and 7 cases were treated with vancomycin monotherapy. The median duration of antibiotic treatment was 26 days (range, 7 to 58 days). Surgical intervention was performed in 18 cases (18/22, 81.8%). Conclusion : Epidemiologic information regarding VP shunt infections in pediatric patients is valuable that will help guide proper antibiotic management. Additional studies on the risk factors for developing VP shunt infections are also warranted.

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Clinical Results of Pulmonary Resection for Hemoptysis of Inflammatory Lung Disease (염증성 폐질환에 의한 객혈 환자의 폐절제술 후 임상결과)

  • Kim Nan Yeol;Kuh Ja Hong;Kim Min Ho;Seo Yeon Ho
    • Journal of Chest Surgery
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    • v.38 no.10 s.255
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    • pp.705-709
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    • 2005
  • Background: To assess the outcome of pulmonary resection in the management of hemoptysis caused by benign inflammatory lung disease. Material and Method: A longitudinal cohort study of 45 consecutive patients who were presented with hemoptysis and were treated with pulmonary resection from January 1995 to May 2004. The predictive preoperative risk factors of morbidity and recurrence of hemoptysis were analyzed. The mean age of the patients was 47.1 years. The mean follow-up was $35\pm34$ months. Result: The overall hospital mortality rate was $4.4\%(2/45)$. Postoperative complications occurred in 8 patients $(18.6\%)$. Complications were more common in patients who received blood transfusion than non-transfused patients (p=0.002). Patients with tuberculous destroyed lung disease had more amount of preoperative hemoptysis (p=0.002), more probability of transfusion (p=0.001), more probability of undergoing pneumonectomy (p=0.039) and more probability of postoperative morbidity. Patients of undergoing pneumonectomy had more probability of reoperation due to postoperative bleeding (p=0.047). Hemoptysis recurred in five patients but three had been subsided and two sustained during follow-up. A latter two patients had been prescribed with antituberculosis medication due to relapse of tuberculosis. Conclusion: A tuberculous destroyed lung disease has a higher rate of postoperative morbidity than other inflammatory lung diseases. A pneumonectomy in patients of inflammatory lung disease should be performed with great caution especially because of postoperative bleeding. Future study with longer and larger follow-up might show the reasons of recurrence of hemoptysis.

Linkage between Trade and SPS Measure through Establishment of Reasonable-Regulator Approach to Judicial Review : Focusing on US-Hormones Suspension Case (합리적 규제자 기준의 확립을 통한 무역과 위생검역조치의 조화 - US-Hormones Suspension 사건을 중심으로 -)

  • Lee, Ju-Young;Lee, Eun-Sup
    • International Commerce and Information Review
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    • v.13 no.3
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    • pp.403-431
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    • 2011
  • The environmental issues including domestic measures to protect public life or health are generally easy to bring the tension between the WTO and its member countries. The standard of review, whether de novo review, total deference, or somewhere in between, is largely important in the WTO's adjudicating mechanism because it is closely related to the appropriate balance of power between sovereign nations and the WTO: The multilateral trading regime, through the proper standard of review, could harmoniously operated without interest conflicts among the member countries and at the same time between the WTO and the member countries. Irrespective the important function of the standard of review in the WTO judicial system, applicable standard of review has not been established in the current SPS Agreement. Furthermore, the nature of the SPS Agreement related in scientific factors, such as scientific experiment, data and assessment prevents the WTO's panel from applying consistent standard of review. Considering the judicial demand for the moderate treatment of the case under the SPS Agreement, this paper explores appropriate standard of review applicable the SPS-related environmental measures, particularly, by analysing the recent SPS-related dispute, US-Hormones Suspension.

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Effects of Health Education on the Knowledge and Self-care of Hypertension for Visiting Nursing Clients (일 보건소 고혈압 관리 교육이 방문간호대상자의 고혈압 지식, 혈압변화 및 자가간호에 미치는 효과)

  • Ko, Il-Sun;Kim, Gwang-Suk;Lim, Mi-Hye;Lee, Kyung-Ja;Lee, Tae-Wha;Park, Hyo-Sook;Lee, Hyun-Sook;Kim, Jeong-Ae;Kim, Eun-Young;Chung, Su-Kyoung;Choi, Jung-Min
    • Journal of Korean Public Health Nursing
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    • v.21 no.2
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    • pp.134-145
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    • 2007
  • Purpose: To test the effects of health education on the blood pressure, knowledge, and self-care of visiting nursing clients. Methods: The study subjects were 96 participants who had been diagnosed with hypertension or had high risk factors for hypertension among those registered at a public health center in Seoul. The education program was individualized and delivered to enhance the management of hypertension including life-style modification, medication, and complication managements. Data were collected using questionnaires from May to December 2006 and analyzed using descriptive analysis, t-test, paired t-test, and ANOVA. Results: The blood pressure of the participants after the education was significantly decreased compared to before the education. Education also significantly affected the increases of knowledge of the disease and self-care capability. However, the blood pressure and self care were not significantly improved for the age group over 85 years. Conclusions: This study proves that the individualized health education for visiting nursing clients was effective in improving blood pressure, knowledge, and self-care of hypertension. However, it is necessary to develop strategies that are specifically targeted at particular age groups in order to improve the capability of self-care of hypertension.

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A Study on Construction of Optimal Wireless Sensor System for Enhancing Organization Security Level on Industry Convergence Environment (산업융합환경에서 조직의 보안성 향상을 위한 센싱시스템 구축 연구)

  • Na, Onechul;Lee, Hyojik;Sung, Soyoung;Chang, Hangbae
    • Journal of the Korea Convergence Society
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    • v.6 no.4
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    • pp.139-146
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    • 2015
  • WSN has been utilized in various directions from basic infrastructure of environment composition to business models including corporate inventory, production and distribution management. However, as energy organizations' private information, which should be protected safely, has been integrated with ICT such as WSN to be informatization, it is placed at potential risk of leaking out with ease. Accordingly, it is time to need secure sensor node deployment strategies for stable enterprise business. Establishment of fragmentary security enhancement strategies without considering energy organizations' security status has a great effect on energy organizations' business sustainability in the event of a security accident. However, most of the existing security level evaluation models for diagnosing energy organizations' security use technology-centered measurement methods, and there are very insufficient studies on managerial and environmental factors. Therefore, this study would like to diagnose energy organizations' security and to look into how to accordingly establish strategies for planning secure sensor node deployment strategies.

A Case of Descending Necrotizing Mediastinitis (하행 괴사성 종격동염의 치험례)

  • Lee, In Soo;Choi, Hwan Jun;Lee, Han Jung;Lee, Jae Wook;Lee, Dong Gi
    • Archives of Plastic Surgery
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    • v.36 no.3
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    • pp.351-355
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    • 2009
  • Purpose: Cervical necrotizing fasciitis tends to involve the deep soft tissues and spread caudally to the anterior chest and mediastinum, often resulting in major complications and death. It may rapidly spread into the thorax along fascial planes, and the associated diagnostic delay results in this descending necrotizing mediastinitis. So, aggressive multidisciplinary therapy with surgical drainage is mandatory. We present a very rare case of descending necrotizing mediastinitis with literature review. Methods: A 53 years old male visited our department 7 days after trauma in neck. His premorbid conditions and risk factors of necrotizing fasciitis were concealed hepatoma, trauma history, chronic liver disease, and nutrition deficit. Computed tomographic scans of the head and neck region were performed in this patient : signs of necrotizing fasciitis, were seen in the platysma, sternocleidomastoid, trapezius muscle and strap muscles of the neck. Fluid accumulations involved multiple neck spaces and mediastinum. At the time, he diagnosed as necrotizing fasciitis on his neck and anterior chest. Necrotic wound was excised serially and we treated this with the Vacuum - assisted closure(VAC, Kinetics Concepts International, San Antonio, Texas) system device. After appropriately shaping the sponge and achieving additional 3 pieces drainage tubes in the pockets, continuous negative pressure of 125 mmHg was applied. The VAC therapy was utilized for a period of 12 days. Results: We obtained satisfactory results from wide excision, abscess drainage with the VAC system, and then split thickness skin graft. The postoperative course was uneventful. Conclusion: The refined technique using the VAC system can provide a means of simple and effective management for the descending necrotizing mediastinitis, with better cosmetic and functional results. Finally, the VAC system has been adopted as the standard treatment for deep cervical and mediastinal wound infections as a result of the excellent clinical outcome.

A Study on the Assessment of Growing Conditions and Production Capacity in the Upland-Field Area of Highland - Focused on Kimchi-Cabbage, Radish, Potato - (농업 생산기반 능력 및 재배여건을 이용한 고랭지 작물 주산지의 생산역량 분석 - 배추, 무, 감자를 중심으로 -)

  • Jung, Hyun-Woo;Kim, Dae-Sik;Bae, Seung-Jong;Park, Jung-Soo;Kim, Han-Joong
    • Journal of Korean Society of Rural Planning
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    • v.22 no.4
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    • pp.131-138
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    • 2016
  • Recently, the cultivated area is reduced, the ratio of upland-field in the total cultivated area is increasing relative appeared in 36.2% in 1990 from 43.7% in 2013. If upland-field can be applied well designed-infrastructure, good income crop production is possible, however, maintenance of infrastructure and a significant portion of the upland-field is maintained under insufficient infrastructure. While imports of agricultural products expanded since the 2000s in progress, looking at the self-sufficiency of upland-field crops, it is reduced to from 90% to 42% for the pepper, it is from 90% to 74% for the garlic, cereals is reduced from 42% by 26%. As a result of these conditions, the competitiveness of farmers has weakened, the risk to meet the challenges of this area of production and supply reduction increased. This study was the first to conduct a basic evaluation index, data analysis and evaluation of indicators to diagnose the agricultural production capacity of the upland field. 12 kinds classified index of producing conditions from the natural environment and eight factors for the cultivation and production capabilities have developed for the assessment of productivity of upland-field (especially Kimchi cabbage). Through this regional imbalance was found, based on the production capabilities conditions are good in Haenam, Gangneung, Pyeongchang. 3 Regions have been low and the lowest Youngwol to 0.8992. Climate(Cultivation conditions) indicators of Mungyeong region is the highest, relatively low areas were in Taebaek. In particular, it is determined to be preferred that the area required for the enhancing the production environment based on providing the convenience for the producing and maintenance of the first production area. It is necessary Increasing part of mechanization, agro-industrial competitiveness through aggressive management plans for facilities as required in the process of post-harvest storage, processing, distribution line can be improved.

A Study on the Characteristics of the Patients Discharged Against Medical Advice (한 대학병원 자의퇴원 환자의 특성 연구 - 퇴원환자 지료정보 DB를 이용하여 -)

  • Hong, Joonhyun;Choi, Kwisook;Lee, Jeonghwa;Lee, Eunmee
    • Quality Improvement in Health Care
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    • v.8 no.2
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    • pp.208-217
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    • 2001
  • Background : The objective of this study is proving the basic data for developing a management system for the discharges against medical advice(AMA) by identifying the characteristics of the AMA patients of an university hospital for 10 years. Methods : By using discharge abstract data base, we divided the total discharges(435,254) into two groups, discharge against medical advice and discharge with discharge order. We confirmed the characteristics of AMA group by analyzing discharge abstract data of the both groups by SAS software V6.12 and $x^2$ test. Medical records of AMA patients in the year 2000 were reviewed to identify the reasons for AMA which we couldn't extract from discharge abstract DB. Result : The total number of AMA for 10 years were 9,358(2.15%) and the AMA rate has been continuously decreased for 10 years. Male, admission through emergency room, discharges admission via other hospital, patients without operation during hospitalization, discharges in hopeless or not improved condition showed higher AMA rate. The AMA rate was higher as the age of the patients was higher, and the average length of stay was longer in AMA patients than in those with discharge order. The AMA rate in psychiatry was highest(14.3%) and it was higher in surgery departments than those of medical or other sections. The AMA rate varied by attending physicians even in the same department and it was statistically significant. Patients with the principal diagnosis of "medical observation and evaluation for suspected diseases" showed the highest AMA rate(15.5%), and that of schizophrenia or psychosis was the nest. One hundred twenty-one patients(19.5%) out of 622 AMA in 2000 discharged against medical advice for transfer to order health care facilities. Among them 71 patients(58.7%) discharged with their medical care information, such as copies of medical record, medical certificates, summaries, etc. Written oath of the patients discharged AMA was filed in their medical records in 466 cases(74.9%) although some of them were incomplete. Conclusion : Characteristics of AMA discharge could be used as the basic data in developing a system to manage the patients who have risk factors to leave the hospital against medical advice. By reducing number of patients leaving the hospital against medical advice we can increase satisfaction of medical providers and consumers.

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Association Between Transport Accident Type And Mortality In Elderly Inpatients : Using Korean National Hospital Discharge In-depth Injury Survey Dataset (퇴원손상심층조사자료를 이용한 노인 입원 환자의 운수사고 유형과 사망 사이의 연관성)

  • Ryu, Han-Jun;Kang, Sun-Hee;Boo, Yoo-Kyung
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.21 no.7
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    • pp.616-624
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    • 2020
  • This study analyzed the association between the type of transport accident and the associated mortality of elderly inpatients. The findings will contribute to the development and establishment of a systematic and effective policy according to the type of transport accident to reduce the mortality of inpatients. The data on elderly inpatients with transport accidents was extracted from the 2013-2017 Korean National Hospital Discharge In-depth Survey dataset. The data was analyzed by descriptive statistics analysis, chi-square tests and multiple logistic regression analysis. After adjustment for sociodemographic, disease, injury and policy factors, the elderly inpatient deaths due to transport accidents were significantly higher for pedestrian accidents (OR: 2.522 95%, CI: 1.291-4.972), bicycle/cart accidents (OR: 2.809, 95% CI: 1.328-5.942) and motorcycle accidents (OR: 2.330, 95% CI: 1.226-4.819) rather than that for car accidents. Likewise, elderly inpatients have a higher risk of death from other types of transport accidents than those caused by car accidents. However, Korean policies related to transport accidents of elderly inpatients are concentrated on car accidents. Effective policy is needed according to the characteristics of each type of transport accident to reduce the transport accident mortality of elderly inpatients.

The Research of Process High Alarm Priority Analysis for Efficient Emergency Response (효율적인 비상대응을 위한 Process High Alarm의 Priority 분석)

  • Kim, Youngse;Cho, Gyusun;Jun, Jinwoo;Kim, Byungjick;Lee, Joonwon;Park, Kyoshik
    • Korean Chemical Engineering Research
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    • v.58 no.4
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    • pp.604-609
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    • 2020
  • The purpose of this study is to check the priority control status of the current operation process alarm by comparing the priority of the alarm set up in PV high trip point, which is being installed and operated in the domestic petrochemical industry, with the criteria presented in ISA 18.2 International Standard or EEMUA 191 Guidelines. In the event of a process problem, excessively set high alarm is provided to the driver in a short period of time, making it difficult to identify the alarm that needs to be handled first. As a result, it is likely that the operator will not be able to carry out appropriate actions within the specified time frame, and many cases have been reported leading to unexpected process shutdowns or process accidents. Therefore, this study aims to introduce international standards related to alarm management and identify the level of alarm control used at the domestic petrochemical industry site to inform potential risks that may occur in the petrochemical process of the national industrial complex in the future and suggest ways to reduce risk factors. This paper was submitted to Professor Lee Inbeom's retirement anniversary issue.