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Changes of Clinical Practice in Gastrointestinal Perforation with the Increasing Use of Computed Tomography

  • Park, Ji-Min;Yoon, Young-Hoon;Horeczko, Timothy;Kaji, Amy Hideko;Lewis, Roger J
    • Journal of Trauma and Injury
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    • 제30권2호
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    • pp.25-32
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    • 2017
  • Purpose: The use of computed tomography (CT) to evaluate acute abdominal complaints has increased over the past two decades. We investigated how the clinical practice of patients with intestinal perforation has changed with the increasing use of abdominal CT in the emergency department (ED). Methods: We compared ED arrival to CT time, ED arrival to surgical consultation time, and ED arrival to operation time according to the method of diagnosis from 2003-2004 and 2013-2014. Results: In patients with gastrointestinal perforation, time from ED arrival to CT was shorter ($111.4{\pm}66.2min$ vs. $199.0{\pm}97.5min$, p=0.001) but time to surgical consultation was longer ($135.1{\pm}78.8$ vs. $77.9{\pm}123.7$, p=0.006) in 2013-2014 than in 2003-2004. There was no statistically significant difference in time to operation for perforation confirmed either by plain film or CT between the two time periods. There was no statistically significant difference in length of hospital or ICU stay or mortality between the two groups. Conclusion: With the increasing use of abdominal CT in ED, ED arrival to CT time has decreased and ED arrival to surgical consultation time has increased in gastrointestinal perforation. These changes of clinical performance do not delay ED arrival to operation time or adversely influence patient outcome.

진료협력간호사의 운영현황에 관한 연구 (A Study on the Present Status of Clinical Nurses with Expanded Role)

  • 권영대;성영희;권인각;황문숙
    • 임상간호연구
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    • 제14권3호
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    • pp.99-115
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    • 2008
  • Purpose: The purpose for this study was to identify the present state of Clinical Nurses with Expanded Role (CNERs) and provide basic data to refine the roles of CNERs. In this study, CNREs refers to nurses who perform techniques traditionally done by doctors and use titles such as clinical nursing specialist, educator with consultation, research assistant, coordinator, physician assistant and special examiner. Method: This study was conducted from September 1 to November 12, 2007. Data from 684 nurses from 38 hospitals who responded to the questionnaire were analyzed with descriptive statistics using the SPSS 14.0 program. Results: The mean percentage of time spent was, for direct practice, 41.1%, for education and counseling, 22.8%, for consultation and coordination, 10.4%, for research, 6.8%, for administration, 8.9% and for other activities, 10.0%. The most frequently implemented CNERs, activities included consultation and education for patients and their families, counseling by telephone, history taking, physical examination, reading examination results, psychosocial assessment, managing treatment, input of prescriptions, and writing up patient records, Although not frequently performed, nurses in some fields carried out invasive procedures and prescribed medication and laboratory tests. Conclusion: Although the number of hospital CNERs are rapidly increasing, there is still confusion about the title and framework as well as standards. Furthermore, because some nurses are prescribing medication and laboratory tests as well as performing techniques not traditionally done by nurses, there is an absolute need for a legalized system and systematic education system for the safety of patients who are being cared by all CNERs.

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과체중과 비만 여성의 HbA1c 지표에 따른 당뇨병 예방을 위한 영양상담의 효과 (Benefits of Nutrition Consultation for Preventing Diabetes According to HbA1c Levels in Overweight and Obese Women)

  • 권용진;선우섭;문황운;박유경
    • 대한영양사협회학술지
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    • 제19권2호
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    • pp.112-123
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    • 2013
  • HbA1c was recently adopted as a reliable indicator for screening diabetes. This study investigated the ability of nutrition consultation to prevent diabetes in overweight women (BMI 23 $kg/m^2$ or more) using HbA1c as an indicator. Twenty overweight and obese women (with $HbA1c{\geq}5.7$%) completed the 12-week nutritional study, with individual and personalized nutrition counseling performed every 2 weeks. The main study guidelines involved the following: 1) reducing the intake of high fat foods and alcohol, 2) consuming a large amount of vegetables, 3) reducing the intake of simple sugars and empty-calorie foods, and 4) increasing physical activity to ${\geq}30$ min/day. Anthropometric (height, weight, BMI, body muscle (kg), body fat (%), waist and hip circumference, blood pressure) and biochemical parameters (fasting blood sugar (FBS), HbA1c, lipid profiles, hs-CRP) were measured before and after the nutrition consultation. After 12 weeks, the HbA1c<5.7% group had significant decreases in BMI, WC, HC, WHR, HbA1c, hs-CRP and also dietary intake of energy (P<0.01), carbohydrates, lipids (P<0.01), proteins (P<0.01) and cholesterol was significantly decreased (P<0.05). In the HbA1c ${\geq}5.7$% group, HbA1c, TC, LDL, NON-HDL, hs-CRP and dietary intake of energy, carbohydrate, lipid, protein, and cholesterol significantly decreased (P<0.05). These results suggest that nutrition consultation effectively helps to prevent diabetes in overweight and obese women after applying HbA1c standards. Overall, the improvement in all markers measured suggest that HbA1c is a good indicator for blood glucose regulation, helping to prevent diabetes.

지능형 멀티 에이전트 시스템 기반의 진학 상담 시스템 (Admission Consultation System based on Intelligent Multi-Agent System)

  • 최동운;김수용
    • 지능정보연구
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    • 제12권1호
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    • pp.43-55
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    • 2006
  • 사이버 교육 분야는 인터넷의 발전에 의해서 많은 변화를 하였다. 대학 진학을 위한 분야가 하나이다. 대학 입시 업무 흐름에 있어서 수험생들은 학교에 직접 방문하여 접수하는 방식과 각 지역 접수창구와 팩스를 이용하여 접수를 한다. 최근에는 이를 유기적으로 통합 관리할 수 있는 인터넷 접수 방식이 각광을 받고 있다. 본 논문의 다중 진학 상담 에이전트 시스템은 대학과 학과를 선택하는 과정에서 적합한 학과를 추천하여 주는 인터넷 원서 접수 시스템을 설계하고 구현하였다.

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Effects of a Face-to-face Self-management Program on Knowledge, Self-care Practice and Kidney Function in Patients with Chronic Kidney Disease before the Renal Replacement Therapy

  • Choi, Eun Sung;Lee, Jia
    • 대한간호학회지
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    • 제42권7호
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    • pp.1070-1078
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    • 2012
  • Purpose: The purpose of this study was to examine the effects of a face-to-face self-management educational program on knowledge, self-care practice and kidney function in patients with chronic kidney disease (CKD) before kidney replacement therapy. Methods: This study employed a nonequivalent control group, non-synchronized design. Data were collected from 61 patients with CKD visiting an outpatient department of nephrology in a university hospital in Seoul, South Korea. The experimental group (n=31) took the pre-test, then after 3 weeks, face-to-face education and individualized consultation (1st intervention), after a week of self-practice, the 1st post-test, followed by re-enforcement education and consultation (2nd intervention), and 4 weeks later, the 2nd post-test. The control group (n=30) took the pre-test and post-tests at 4 and 8 weeks. Results: Scores for knowledge of CKD and self-care practice over time improved significantly in the experimental group compared to the control group. Kidney function did not improve significantly in the experimental group. Conclusion: Health care providers can identify various and individualized needs, and provide effective education and consultation through face to face self-management for patients with chronic irreversible illnesses. Nurses can coordinate for these program by designing and providing systematic and effective education.

제 3차 WHO 경혈 위치 국제표준화 회의 보고 (Report on the 3rd WHO Informal Consultation on Development of International Standard Acupuncture Points Locations)

  • 임윤경;강성길;김용석;손인철;이혜정
    • Korean Journal of Acupuncture
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    • 제22권1호
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    • pp.1-5
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    • 2005
  • Objective : This report is written to inform of the 3rd WHO Informal Consultation on Development of International Standard Acupuncture Points Locations, held in Kyoto, Japan, on October 12-14, 2004. Results : Eight experts from China, Japan and Korea, participated in this meeting discussed the locations and the point finding methods of 92 controversial points based on the fundamental principles established through the 1st and 2nd meetings. Through the discussion in this meeting, agreements were made on most of 92 controversial points, but 8 points(LI12, ST31, PC8, PC9, TE18, LR8, GV1, GV26) still need to be researched in the next meetings. Conclusion : A reasonable and practical International Standard of Acupuncture Point Location for acupuncture education, research and practice is expected to be accomplished in the near future.

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Need to Pay More Attention to Attendance at Follow-Up Consultation after Cancer Screening in Smokers and Drinkers

  • Shin, Jaeyong;Park, Eun-Cheol;Bae, Hong-Chul;Hong, Seri;Jang, Suk-Yong;Kim, Jae-Hyun;Chang, Jee Suk;Lee, Sang Gyu
    • Asian Pacific Journal of Cancer Prevention
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    • 제16권1호
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    • pp.109-117
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    • 2015
  • Background: Follow-up clinical consultations could improve overall health status as well provide knowledge and education for cancer prevention. Materials and Methods: This is the cross-sectional study using the Korean Community Health Survey (KCHS) 6th edition for 2012, with 115,083 respondents who underwent cancer checkups selected as subjects. Associations between the presence of consultation and the socioeconomic status were determined using statistical methods with the SAS 9.3 statistical package (Cary, NC, USA). Findings: Among the recipients, 32,179 (28.0%) received clinical consultations after cancer screenings. Those in rural areas (odds ratio, OR=0.71, 95% confidence interval (CI), 0.69-0.73) visited follow-up clinics less frequently than did those in urban areas. Starting at the elementary school level, as the education level increased to middle school (OR=1.26, 95% CI: 1.19-1.34), high school (OR=1.29, 95% CI: 1.23-1.36) or college (OR=1.76, 95% CI: 1.65-1.89), the participation rates also increased. When compared with the lowest quartile group, the quartile income level showed a statistical trend and difference as follows: second lowest quartile (OR=1.11, 95% CI: 1.07-1.16), third lowest (OR=1.12, 95% CI: 1.07-1.17) and highest quartile income (OR=1.29, 95% CI: 1.23-1.35). In addition, the people with economic activities (OR=0.87, 95% CI: 0.84-0.90) visited follow-up clinics less frequently than did the others. Current smokers (OR=0.93, 95% CI: 0.89-0.98) and inveterate drinkers (OR=0.88, 95% CI: 0.85-0.94) had a tendency to visit less often than did non-smokers and other drinkers with all cancers combined. Interpretation: We suggest primary prevention through lifestyle modifications including smoking and drinking, and environmental interventions may offer the most cost-effective approach to reduce the cancer burden.

How Internet has Reshaped the User Experience of Banking Service?

  • Nam, Kiheung;Lee, Zoonky;Lee, Bong Gyou
    • KSII Transactions on Internet and Information Systems (TIIS)
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    • 제10권2호
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    • pp.684-702
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    • 2016
  • The changes new technologies have brought to banking over the past decade are enormous in their impact on the ways of doing business and providing customer services, most notably in the areas of customer service channels. Banks have been trying to move away from the traditional, branch-based and costly staff-assisted channels toward self-assisted channels, i.e. internet banking and mobile banking, to drive down costs and improve customer loyalty. How internet and mobile have reshaped the user experience of banking service channel? To provide valuable insights for this question, this research investigates and compares customer's channel choice behavior and profit changes from bank's branch closure. Applying the propensity scoring matching method, the results of analysis demonstrates that the mobile channel can be a realistic alternative to conventional branches. Also, the reserch result shows banks can reduce conventional branches while experiencing a positive implications on their profits from the customers. Another significant implication from the research is, to accelerate the shift to digital channels, banks need to put more efforts on developing functions in the mobile channel that will allow friendly interaction with customers and consultation, such as video consultation, interactive chat, and location-based product recommendation.

이익충돌 상황에서 공개가 자문행동에 주는 효과: 자문가역할수행집단과 사익추구집단의 비교 (Factors affecting Disclosing conflicts of Interest on consultation: comparison with Role-oriented and Self-interest Groups)

  • 김수빈 ;김지혜 ;정경미
    • 한국심리학회지 : 문화 및 사회문제
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    • 제22권1호
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    • pp.1-18
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    • 2016
  • 이익충돌은 경영, 의학, 연구 등 자문이 필요한 상황에서 윤리문제를 일으키는 주요인 중 하나로 파악된다. 실제 현장에서는 공개를 해결책으로 주로 사용하고 있으나, 공개의 효과에 대한 기존 연구들의 보고는 일관적이지 않다. 본 연구에서는 개인의 이익추구 성향에 따라 공개가 자문 행동에 주는 효과가 달라 지는지를 실험적으로 연구하였다. 참가자는 20대에서 40대의 성인남녀 190명(남: 65명, 여: 125명)으로, 온라인으로 실험과 설문조사에 응답하였다. 실험에서 참가자는 자문가가 되어 가상의 파트너에게 정보를 제공하였다. 이때 참가자는 자문가로서의 역할을 수행하면 적은 보상을 받으나 사익을 추구하면 많은 보상을 받게 되는 이익충돌 상황에 노출되었다. 총 2개의 과제 중 첫 번째 과제를 통해 자문가 역할을 최대화하는 집단과 사익추구를 최대화하는 두 집단으로 구분하였다. 두 번째 과제에서는 이 두 집단에게 각각 이익충돌 상황에 대해 공개 여부를 자발적으로 결정하게 한 뒤 공개여부가 후속적인 자문행동에 어떠한 영향을 주는 지 탐색하였다. 연구 결과, 자문가역할수행집단과 사익추구집단 간 공개여부의 선택비율에는 차이가 없었다. 그러나, 두 집단 간 공개여부에 따라 자문행동에는 차이를 보였는데, 자문가역할수행집단에서는 자발적으로 공개를 선택한 집단이 비공개를 선택한 집단에 비해 파트너에게 정확한 정보를 제공해 주었다. 반면, 사익을 추구한 집단에서는 공개 여부가 자문행동에 영향을 주지 않았다. 이러한 결과를 바탕으로 연구의 의의와 더불어 후속 연구를 위한 제언을 논의하였다.

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Chromosome 22 LD Map Comparison between Korean and Other Populations

  • Lee, Jong-Eun;Jang, Hye-Yoon;Kim, Sook;Yoo, Yeon-Kyeong;Hwang, Jung-Joo;Jun, Hyo-Jung;Lee, Kyu-Sang;Son, Ok-Kyung;Yang, Jun-Mo;Ahn, Kwang-Sung;Kim, Eug-Ene;Lee, Hye-Won;Song, Kyu-Young;Kim, Hie-Lim;Lee, Seong-Gene;Yoon, Yong-Sook;Kimm, Ku-Chan;Han, Bok-Ghee;Oh, Berm-Seok;Kim, Chang-Bae;Jin, Hoon;Choi, Kyoung-O.;Kang, Hyo-Jin;Kim, Young-J.
    • Genomics & Informatics
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    • 제6권1호
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    • pp.18-28
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    • 2008
  • Single nucleotide polymorphisms (SNPs) are the most abundant forms of human genetic variations and resources for mapping complex genetic traits and disease association studies. We have constructed a linkage disequilibrium (LD) map of chromosome 22 in Korean samples and compared it with those of other populations, including Yorubans in Ibadan, Nigeria (YRI), Centre d'Etude du Polymorphisme Humain (CEPH) reference families (CEU), Japanese in Tokyo (JPT) and Han Chinese in Beijing (CHB) in the HapMap database. We genotyped 4681 of 111,448 publicly available SNPs in 90 unrelated Koreans. Among genotyped SNPs, 4167 were polymorphic. Three hundred and five LD blocks were constructed to make up 18.6% (6.4 of 34.5 Mb) of chromosome 22 with 757 tagSNPs and 815 haplotypes (frequency $\geq$ 5.0%). Of 3430 common SNPs genotyped in all five populations, 514 were monomorphic in Koreans. The CHB + JPT samples have more than a 72% overlap with the monomorphic SNPs in Koreans, while the CEU + YRI samples have less than a 38% overlap. The patterns of hot spots and LD blocks were dispersed throughout chromosome 22, with some common blocks among populations, highly concordant between the three Asian samples. Analysis of the distribution of chimpanzee-derived allele frequency (DAF), a measure of genetic differentiation, Fst levels, and allele frequency difference (AFD) among Koreans and the HapMap samples showed a strong correlation between the Asians, while the CEU and YRI samples showed a very weak correlation with Korean samples. Relative distance as a quantitative measurement based upon DAF, Fst, and AFD indicated that all three Asian samples are very proximate, while CEU and YRI are significantly remote from the Asian samples. Comparative genome-wide LD studies provide useful information on the association studies of complex diseases.