• Title/Summary/Keyword: Supporting method

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CQI Action Team Approach to Prevent Pressure Sores in Intensive Care Unit of an Acute Hospital Korea (중환자의 욕창 예방 연구 : 욕창 예방 QI팀을 중심으로)

  • Kang, So Young;Choi, Eun-Kyung;Kim, Jin-Ju;Ju, Mi-Jung
    • Quality Improvement in Health Care
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    • v.4 no.1
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    • pp.50-63
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    • 1997
  • Background : A pressure sore was defined as any skin lesion caused by unrelieved pressure and resulting in damage to underlying tissue. The health care institutions in the United States were reported the incident rate of pressure sores ranging from 6 to 14 %. Intensive Care Unit needed highest quality of care has been found over 40% incidence rate of pressure sore. Also, Annual expenditures for the care of pressure sores in patients in the United States have been estimated to be $7.5 billion; furthermore, 50 percent more nursing time is required to care for patients with pressure sore in comparison to the time needed to implement preventive measures against pressure sore formation. However, In Korea, there were little reliable reports, or researches, about incidence rates of pressure sore in health care institution including intensive care unit and about the integrated approach like CQI action team for risk assessment, prevention and treatment of pressure ulcers. Therefore, this study was to develop pressure sore risk assessment tool and the protocol for prevention of pressure sore formation through CQI action team activities, to monitor incident rate of pressure sore and the length of sore formation for patients at high risk, and to approximately estimate nursing time for sore dressing during research period as the effect of CQI action team. Method : CQI action team in intensive care unit, launched since early 1996, reviewed the literature for the standardized risk assessment tool, developed the pressure sore assessment tool based on the Braden Scale, tested its validity, compared on statistics including incidence rate of pressure sore for patients at high risk. Throughout these activities, CQI action team was developed the protocol, called as St. Marys hospital Intensive Care Unit Pressure Sore Protocol, shifted the emphasis from wound treatment to wound prevention. After applied the protocol to patients at high risk, the incident rate and the period of prevention against pressure development were tested with those for patients who received care before implementation of protocol by Chi-square and Kaplan-Meier Method of Survival Analysis. Result : The CQI action team found that these was significant difference of in incidence rate of pressure sores between patients at high risk (control group) who received care before implementation of protocol and those (experimental group) who received it after implementation of protocol (p<.05). 25% possibility of pressure sore formation was shown for the patients with 6th hospital day in ICU in control group. In experimental group, the patients with 10th hospital day had 10% possibility of pressure sore. Therefore, there was significant difference(p<.05) in survival rate between two groups. Also, nursing time for dressing on pressure sore in experimental group was decreased as much as 50% of it in control group. Conclusion : The collaborative team effort led to reduced incidence, increased the length of prevention against pressure sore, and declined nursing care times for sore dressing. However, there have had several suggestions for future study. The preventive care system for pressure sore should be applied to patients at moderate, or low risk throughout continuous CQI team activities based on Bed Sore Indicator Fact Sheet. Hospital-wide supports, such as incentives, would be offered to participants for keeping strong commitment to CQI team. Also, Quality Information System monitoring incidents and estimating cost of poor quality, like workload (full time equivalence) or financial loss, regularly in a hospital has to be developed first for supporting CQI team activities as well as empowering hospital-wide QI implementation. Being several limitations, this study would be one of the report cards for the CQI team activities in intensive care unit of an acute hospital and a trial of quality improvement of health care in Korea.

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Biodiesel production using lipase producing bacteria isolated from button mushroom bed (양송이 배지에서 유래한 Lipase 생산균을 이용한 바이오디젤 생산)

  • Kim, Heon-Hee;Kim, Chan-Kyum;Han, Chang-Hoon;Lee, Chan-Jung;Kong, Won-Sik;Yoon, Min-Ho
    • Journal of Mushroom
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    • v.13 no.1
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    • pp.56-62
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    • 2015
  • A lipase producing bacterium was isolated from button mushroom bed, which showing high clear zone on agar media containing Tributyrin as the substrate. The strain was identified as Burkholderia cepacia by analysis of 16S rDNA gene sequence. Crude lipase (CL) was partially purified from 70% ammonium sulfate precipitation using the culture filtrate of B. cepacia. Immobilized lipases were prepared by cross-linking method with CL from B. cepacia and Novozyme lipase (NL) onto silanized Silica-gel as support. Residual activitiy of the immobilized CL (ICL) and immobilized NL (INL) was maintained upto 61% and 72%, respectively. Biodiesel (Fatty acid methyl ester, FAME) was recovered by transesterification and methanolysis of Canola oil using NaOH, CL and ICL as the catalysts to compare the composition of fatty acids and the yield of FAME. Total FAME content was NaOH $781mg\;L^{-1}$, CL $681mg\;L^{-1}$ and ICL $596mg\;L^{-1}$, in which the highest levels of FAME was observed to 50% oleic acid (C18:1) and 22% stearic acid (C18:0). In addition, the unsaturated FAME (C18:1, C18:2) decreased, while saturated FAME (C16:0, C18:0) increased according to increasing the reaction times with both CL and ICL, supporting CL possess both transesterification and interesterification activity. When reusability of ICL and INL was estimated by using the continuous reaction of 4 cycles, the activity of ICL and INL was respectively maintained 66% and 79% until the fourth reaction.

Feasibility of Off-Pump Coronary Artery Bypass Grafting Using Bilateral Skeletonized Internal Thoracic Arteries (양측 내흉동맥을 이용한 관상동맥 우회술의 임상적 분석)

  • Lee, Jun-Wan;Lee, Jae-Won;Kim, Jong-Woo;Choo, Suk-Joong;Song, Hyun;Rheu, Sang-Wan;Kim, Jong-Wook;Park, Jong-Bin;Song, Meong-Gun
    • Journal of Chest Surgery
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    • v.36 no.10
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    • pp.728-733
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    • 2003
  • Background: The aim of the current study was to assess the effects of total arterial myocardial revascularization (TAMR) with bilateral internal mammary arteries. Material and Method: 139 consecutive patients who underwent off pump coronary artery bypass surgery from January 2000 to December 2001 were included in the current retrospective study. Patients were divided into those receiving bilateral internal mammary artery, BITA (n=85) and those receiving single internal mammary artery, SITA (n=54). Result: There was only one death in each group. No significant differences were noted in the total ICU and hospital stay; 2.4$\pm$1.7 and 11.2$\pm$17.7 days, in the BITA group, respectively and 2.8$\pm$2.7 and 9.7$\pm$7.1 days in the SITA group, respectively (P>0.05). The mean number of distal anastomosis of 3.9$\pm$0.7 was slightly higher in the SITA group compared to the SITA group, which was 3.1$\pm$0.8. Myocardial infarction occurred in 7 patients (BITA group: 2, SITA group: 5) and deep sternal infection necessitating reoperation occurred in 4 patients (BITA group: 3, SITA group: 1). Coronary angiogram was performed in the immediate postoperative period in 104 patients (BITA group: 64/85, SITA group: 40/54). Of these patients, stenosis in the LAD anastomosis site occurred in 4 patients (BITA group: 2, SITA group: 2). A total of 8 anastomotic sites were stenotic in the entire series of which percutaneous intervention was performed in 3 patients and none required reoperative coronary artery bypass. Conclusion: The results of the current data did not show a significant difference in patiency rate with bilateral internal mammary artery use for CABG supporting the feasibility of its use as a viable alternative method for TAMR.

Characteristics and Survival of Genus Vibrio Isolated in the Intertidal Zone of the Yellow Sea near Kunsan (군산인근해역에서 분리동정된 Vibrio 속의 특성과 해수에서의 생존)

  • 왕혜영;이건형
    • Korean Journal of Environmental Biology
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    • v.17 no.4
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    • pp.439-448
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    • 1999
  • To investigate the population dynamics and survival of Genus Vibrio, population densities of aerobic saprophytic bacteria and Vibrio groups were measured 4 times in the intertidal waters of the Yellow Sea near Kunsan from November, 1997 to June, 1998. The distribution of heterotrophic bacteria during the survey periods by plate count and direct count method ranged from 1.2$\pm$0.6$\times$10$^3$~2.0$\pm$1.5$\times$10$^4$CFU ml­$^1$and from 6.0$\pm$4.0$\times$10$^{5}$ ~1.9$\pm$1.5$\times$10$^{7}$ cells ml­$^1$, respectively. Vibrio groups were distributed in the range of 1$\times$10 and 6$\pm$2.2$\times$10$^2$CFU ml­$^1$. The proportion of Vibrio groups to total heterotrophic bacteria was between 0.1 and 6% during the survey periods. A total of 51 isolates was obtained from TCBS agar plates and identified to species level by Biolog Identification System$^{TM}$. As a result, dominant genera were V, mediterranei, V aitguillarum, tr metschnikovii, and V. parahaemolyticus, and isolates were clustered into 26 groups based on the relatedness of average linkage clustering method at 70% level. As for the susceptibility of 51 isolates to 7 kinds of antibacterial agents (gentamicin, ampicillin, chlorarnphenicol, streptomycin, kanamycin, tetracycline, carbenicillin), 96% of isolates showed high resistance to more than one antibiotics and 65% of isolates contained a plasmid, of which size was observed greater than 12 kb, The number of cells of 3 tested strains (V. anguillarum, V. vulnificus, and V. metschnikovii) in filtered aged seawater decreased by approximately 1 to 5 orders of magnitude during 30-d incubation. In most cases, the numbers of cells decreased rapidly until day 3, then decreased slowly by day 30. The number of cells incubated at 15$^{\circ}C$ showed higher survival than those at 4$^{\circ}C$ and $25^{\circ}C$. These results may be considered for the basic supporting data in the risk assessment of vibriosis in summer.r.

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A STUDY OF THE STRESS DISTRIBUTION OF THE ABUTMENT AND SUPPORTING TISSUES ACCORDING TO THE SLOPES AND TYPES OF CHIDING FLAMES OF THE LAST ABUTMENT IN DISTAL EXTENSION REMOVABLE PARTIAL DENTURE USING THREE DIMENSIONAL FINITE ELEMENT ANALYSIS METHOD (국소의치 최후방 지대치 유도면의 기울기와 형태가 지대치 및 지지조직의 응력분산에 미치는 영향)

  • Kim, Yang-Kyo;Lee, Cheong-Hee;Jo, Kwang-Hun
    • The Journal of Korean Academy of Prosthodontics
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    • v.37 no.5
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    • pp.581-596
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    • 1999
  • The purpose of this study was to investigate the stress distribution of the abutment and sup-porting tissues according to the slopes and types of the guiding plane of distal extension removable partial dentures. The 3-dimensional finite element method was used and the finite element models were prepared as follows. Model I : Kratochvil type guiding plane with $90^{\circ}$ to residual ridge Model II : Kratochvil type guiding plane with $95^{\circ}$ to residual ridge Model III : Kratochvil type guiding plane with $100^{\circ}$ to residual ridge Model IV : Krol type guiding plane with $90^{\circ}$ to residual ridge Distal extension partial denture which right mandibular first and second molar were lost was used and the second premolar was prepared as primary abutment with RPI type retainer. Then 150N of compressive force was applied to central fossae of the first and second molars and von Mises stress and displacement were measured. The results were as follows 1. Model I and Model IV showed a similar stress distribution pattern and the stress was concentrated on the apex of the root of the abutment. 2. The stress was increased and concentrated on mesial side of the root of the abutment in Model II. The stress was concentrated on buccal and mesiobuccal side of the root of the abutment in Model IV. 3. In Model I, the root of the abutment displaced and twisted a little in clockwise. In Model IV, the root of the abutment displaced to distolingually at apical region of the root and mesiobuccally at cervical region of the root. 4. In Model II, the root of the abutment displaced to mesiolingually at apical region of the root and more displaced and twisted in counterclockwise at cervical region of the root. In Model III, the root of the abutment displaced to mesiobucally at apical region of the root and more displaced and twisted in clockwise at cervical region of the root.

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Development of Korean Green Business/IT Strategies Based on Priority Analysis (한국의 그린 비즈니스/IT 실태분석을 통한 추진전략 우선순위 도출에 관한 연구)

  • Kim, Jae-Kyeong;Choi, Ju-Choel;Choi, Il-Young
    • Asia pacific journal of information systems
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    • v.20 no.3
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    • pp.191-204
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    • 2010
  • Recently, the CO2 emission and energy consumption have become critical global issues to decide the future of nations. Especially, the spread of IT products and the increased use of internet and web applications result in the energy consumption and CO2 emission of IT industry though information technologies drive global economic growth. EU, the United States, Japan and other developed countries are using IT related environmental regulations such as WEEE(Waste Electrical and Electronic Equipment), RoHS(Restriction of the use of Certain Hazardous Substance), REACH(Registration, Evaluation, Authorization and Restriction of CHemicals) and EuP(Energy using Product), and have established systematic green business/IT strategies to enhance the competitiveness of IT industry. For example, the Japan government proposed the "Green IT initiative" for being compatible with economic growth and environmental protection. Not only energy saving technologies but energy saving systems have been developed for accomplishing sustainable development. Korea's CO2 emission and energy consumption continuously have grown at comparatively high rates. They are related to its industrial structure depending on high energy-consuming industries such as iron and steel Industry, automotive industry, shipbuilding industry, semiconductor industry, and so on. In particular, export proportion of IT manufacturing is quite high in Korea. For example, the global market share of the semiconductor such as DRAM was about 80% in 2008. Accordingly, Korea needs to establish a systematic strategy to respond to the global environmental regulations and to maintain competitiveness in the IT industry. However, green competitiveness of Korea ranked 11th among 15 major countries and R&D budget for green technology is not large enough to develop energy-saving technologies for infrastructure and value chain of low-carbon society though that grows at high rates. Moreover, there are no concrete action plans in Korea. This research aims to deduce the priorities of the Korean green business/IT strategies to use multi attribute weighted average method. We selected a panel of 19 experts who work at the green business related firms such as HP, IBM, Fujitsu and so on, and selected six assessment indices such as the urgency of the technology development, the technology gap between Korea and the developed countries, the effect of import substitution, the spillover effect of technology, the market growth, and the export potential of the package or stand-alone products by existing literature review. We submitted questionnaires at approximately weekly intervals to them for priorities of the green business/IT strategies. The strategies broadly classify as follows. The first strategy which consists of the green business/IT policy and standardization, process and performance management and IT industry and legislative alignment relates to government's role in the green economy. The second strategy relates to IT to support environment sustainability such as the travel and ways of working management, printer output and recycling, intelligent building, printer rationalization and collaboration and connectivity. The last strategy relates to green IT systems, services and usage such as the data center consolidation and energy management, hardware recycle decommission, server and storage virtualization, device power management, and service supplier management. All the questionnaires were assessed via a five-point Likert scale ranging from "very little" to "very large." Our findings show that the IT to support environment sustainability is prior to the other strategies. In detail, the green business /IT policy and standardization is the most important in the government's role. The strategies of intelligent building and the travel and ways of working management are prior to the others for supporting environment sustainability. Finally, the strategies for the data center consolidation and energy management and server and storage virtualization have the huge influence for green IT systems, services and usage This research results the following implications. The amount of energy consumption and CO2 emissions of IT equipment including electrical business equipment will need to be clearly indicated in order to manage the effect of green business/IT strategy. And it is necessary to develop tools that measure the performance of green business/IT by each step. Additionally, intelligent building could grow up in energy-saving, growth of low carbon and related industries together. It is necessary to expand the affect of virtualization though adjusting and controlling the relationship between the management teams.

A Comparison of the Overall Satisfaction of the Tourist Attractions at the Terelj Tourist Area in Mongolia by Mongolian and Korean Travelers (몽골 테렐지 관광지 관광자원 매력에 관한 몽·한 관광객 만족도 비교 분석)

  • Kim, Dong-Chan;Byambajamts, Nasanjargal
    • Journal of the Korean Institute of Landscape Architecture
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    • v.41 no.6
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    • pp.96-106
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    • 2013
  • The aim of this study was to reveal the advantages and disadvantages of Terelj Mongolian National Park based on the impressions of foreign and domestic travelers, and subsequently suggest supporting ideas to make this tourist attraction more enjoyable for travelers. A statistical program(SPSS 20.0) and an IPA matrix method were used to reveal the impressions of travelers and the results showed the following ideas. First, we made the technical analyses to demonstrate the characteristics of the current natural scenery which travelers want to see and the results indicated that both Korean and Mongolian travelers overall were not satisfied and the Park was not as they had imagined. The second part of the research highlighted the differences between the impressions held by Mongolian and Korean travelers, which showed dissimilarities in cultural resources, food, variety of events, cultural functions and parking, all of which were shown as important criteria in sightseeing. The variations were found in scenes of nature, variety of programs, and food, areas which revealed and were very important in the overall satisfaction of travelers. Third, the IPA method was used for analyze the advantages and disadvantages of Terelj National Park. The Mongolian travelers nominated the width of the road, cleanliness, variety of events and parking are the most essential things to feel satisfied, but Koreans selected safety of travel, accommodation, the width of the road and cleanliness. Finally, we analyzed the feelings of the travelers at the end of their trip. The Mongolian travelers preferred the area resource and environment convenience to feel satisfaction. For Korean travelers, the area resource is the most important when choosing travelling sights. Based on these results, if we take responsibility to protect the beauty of nature, and create a sightseeing place using natural sources, while also making more comfortable accommodations and improving the services, it can be a more unique place than others and lead to greater overall satisfaction for travelers.

A Study on Gardening Theories of Li, Yu in 'Xian Qing Ou Ji' (한정우기(閑情偶寄)를 통해 본 이어(李漁)의 조원(造園) 이론)

  • Zhang, Lin;Jung, Woo-Jin;Sung, Jong-Sang
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.36 no.3
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    • pp.137-148
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    • 2018
  • Li Yu's Xian Qing Ou Ji was written during the late Ming and early Qing Dynasty when material culture flourished due to the development of the commercial economy. Xian Qing Ou Ji is considered a retrospective work that reflects the rich material society at that time. This study focuses on his gardening theories through the interpretation and analysis of these two texts of 'Jushibu(居室部)' and 'Zhongzhibu(種植部)' in Xian Qing Ou Ji. The results are summarized as follows. First, he explained the method of garden configuration and orientation according to the topography utilizing the theory of 'suiting one's measures to local conditions(因地制宜)'. He emphasized the detailed understanding of topography as the starting point for all the gardening theories. It stated that he tried to adjust the height of the terrain artificially to create an ideal form of 'anterior high and posterior low(前低後高)'. The successful arrangement of houses, pavilions, rockery and waterways et al. was able to be achieved because of his accurate understanding of topography. Second, 'borrowing scenery(取景在借)' means 'borrowing the outside scenery to the inside'. He applied this theory by 'viewing in motion(動觀)' and 'viewing in repose(靜觀)'. 'Viewing in motion' is seen as a positive methodology for landscape enjoyment. For example, the view through a window changes with movements of the boat, and it can portray thousands of landscape paintings which can be seen through the windows. In the case of 'viewing in repose', the window is regarded as a means of attracting outside garden views to the inside. Third, he emphasized 'the firmness of objects(制體宜堅)', where the design of windows and railings must be considered ahead of others. Fourth, he interpreted the contents of 'the pursuit of novelty(創異標新)'. This generalizes the characteristics of his gardening theory. The contents included 'hall wall(廳壁)', 'variable sun visor(活?)', 'hanging boards and couplets(聯?)' and 'method of supporting vines with bamboo screen(竹屛扶植法)'.

An Experimental Study on Evaluation of Axially Compressive Buckling Strength of Corroded Temporary Steel (부식 손상된 가시설 강재의 축압축 좌굴강도 추정에 관한 실험적 연구)

  • Kim, In Tae;Lee, Myoung Jin;Shin, Chang Hee
    • Journal of the Korea institute for structural maintenance and inspection
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    • v.15 no.6
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    • pp.135-146
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    • 2011
  • Steel structures have been generally painted to prevent corrosion damage. However, the painted film is deteriorated with increase in service life, and then corrosion damage resulting in cross sectional area occurs on steel surface. As a result, the buckling strength of steel structures can be decreased due to the corrosion damages. The evaluation method of the axial buckling strength of columns about a variety of section shapes and supporting conditions have been presented, but evaluation method of buckling strength about irregular nonprismatic columns is not established. In this study, the axial buckling strength of corroded steels was evaluated based on the buckling test results of corroded steel specimens that were cut off at a temporary steel structure. The corroded specimens were picked up total 10 specimens according to various slenderness ratio from the web of a temporary structure's main beam. The length of specimens is 200, 300, 400, 500 and 600mm respectively. The rust productions were removed by the chemical treatment. Then, the surface geometry was measured at intervals of $1{\times}1mm$ by using the optical 3D digitizing system, and the residual thickness of the specimens was calculated. The axial buckling test was performed on 10 corroded specimens and 12 non-corroded specimens under the fixed-fixed support condition. From the test results, the effect of corrosion damages on axial buckling load was investigated. Regardless of corrosion damage degree, the axial buckling strength of corroded specimens and non-corroded specimens was evaluated identically by using minimum average residual thickness or average residual thickness to minus its standard deviation. Reasonable measuring intervals of residual thickness was proposed by using the results to apply for practical works.

A Study on the Consciousness Survey of Improvement of Emergency Rescue Training -Based on the Fire Fighting Organizations in Gangwon Province- (긴급구조훈련 개선에 관한 의식조사 연구 -강원도 소방조직을 중심으로-)

  • Choi, Yunjung;Koo, Wonhoi;Baek, Minho
    • Journal of the Society of Disaster Information
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    • v.15 no.3
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    • pp.440-449
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    • 2019
  • Purpose: Fire-fighting organizations are the very first agencies that take actions at a disaster scene, and emergency rescue training is carried out for prompt and systematic response. However, there is a need for a change due to the limitations in emergency rescue trainings such as perfunctory trainings or trainings without considering regional or environmental characteristics. Method: This study is to conduct theoretical review with regard to emergency rescue training and present a measure to improve the emergency rescue training through attitude survey targeting fire-fighting organizations in Gangwon area. Result: Facilities that cause difficulties when doing emergency rescue activity were mostly hazardous material storage and processing facilities. In terms of the level of emergency rescue and response task, most respondents answered that the emergency rescue was insufficient. The respondents answered that the effectiveness of emergency rescue training was helpful, but some responses showed that the training was not helpful because of scenario-based training, seeming training, similar training carried out every year, unrealistic training, and lack of competent authorities' interest and perfunctory participations. Most respondents answered for the appropriateness of emergency rescue training and evaluation that they were satisfied, however, they were not satisfied with the evaluation methods irrelevant to the type of training, evaluation methods requiring unnecessary training scale, and evaluation methods leading perfunctory participations of competent authorities. Lastly, respondents mostly answered that training reflecting various damage situations are necessary regarding the demand on the improvement of emergency rescue training. Conclusion: The improvement measures for emergency rescue training are as follows. First, it is necessary to set and prepare various training contents in accordance with regional characteristics by reviewing major disasters occurred in the region. Second, it is necessary to revise the emergency rescue training guidelines and manuals for appropriate training plan for each fire station, provide education and training for working-level staff members, and establish training in a way that types, tactics, and strategies of emergency rescue training could be utilized practically. Third, it is necessary to prepare a scheme that can lead participation and provide incentive or penalty from the planning stage of training in order to increase the participation of supporting and competent authorities when an actual disaster occurs. Fourth, it is necessary to establish support arrangements and cooperative systems by authority through training by fire stations or zones in preparation for disaster situations that may occur simultaneously. Fifth, it is necessary to put emphasis on the training process rather than the result for emergency rescue training and evaluation, pay attention to the identification of supplement points for each disaster situation and make improvements. Especially, type or form of training should be considered rather than evaluating the execution status of detailed processes, and the evaluation measure that can consider the completeness (proficiency) of training and the status of role performance rather than the scale of training should be prepared. Sixth, type and method of training should be improved in accordance with the characteristics of each fire station by identifying the demand of working-level staff members for an efficient emergency rescue training.