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A Study on the Job Activities of the Emergency Nurses (응급실 근무 간호사의 업무분석)

  • 김광주;이향련;김귀분
    • Journal of Korean Academy of Nursing
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    • v.25 no.4
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    • pp.709-728
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    • 1995
  • The job related activities of sixty nine nurses, working in the emergency rooms of three university hospitals, were analyzed for six days according to preestablished checklist of nursing activities ; the frequency of these activities and the amount of time spent in each specific nursing activity. The established checklist was monitored every five minutes for the duration of the duty autu, thus producing 414 items of data. The data were not gathered on consecutive days but over the period of one month from May 6, 1994 to June 5, 1994. The following conclusions are derived from analysis of the data : 1. Twelve categories of nursing activities were obtained : The primary activity was communication related to the patient and all information pertaining to the patient. Other activities included maintaining the patient's record, observation and assessment of the patient, cooperation with other medical personnel, management of equipment and drugs, procedure and treatment, specimen collection, consultation and education for the patient, including drug management and personal hygiene and any other relevant education to the patient's condition. 2. The average frequency of categorized nursing activity can be classified as follows : communication related to patient was the highest at 17.6 times. The next was maintaining the patient's record at 17.3 times. The observation and assessment occurred 16.9 times. Consultation and education for patients and family, 8 times, medication, 5.7 times, and procedures and treatments, 6 times. 3. The average time required for each activity was as follows : 230.1 minutes (or maintaining the patient's record, 204.9 minutes for communication related to the patient, 199.2 minutes for observation and assessment, 71.2 minutes for medication, 66 minutes for consultation and education of the patient and family, and 51.8 minutes for procedures and treatment. 4. The most demanding nursing activity in the emergency room for the nurse was answering questions from the patient's family, maintaining communication between the medical staff, maintaining and reviewing the patient's charts, writing prescriptions and monitoring 1. V. infusion rates. 5. The most time consuming nursing activities for the emergency room nurse include maintaining and following the patient's charts, communication between the medical staff, answering questions from the patient's family, observation of the patient and relaying all of the appropriate patient information to the incoming nurses during a shift change. 6. The F-test was administered to measure the required time for the categorized nursing activities according to day, evening, and night-shift nurses. There were significant differences (p<.05) in specimen collection, observation and assessment, cooperation between medical staffs, personal hygiene, communication related to patient, education and re-search. Posterior multiple comparison test showed that specimen collection, cooperation between medical staffs and personal hygiene were mostly done by the evening-shift nurses. Also most observations and assessments were done by the night-shift nurses. Education and communication to patients were done by day-shift nurses. Thus there were significant difference between shifts for the main nursing activities. So there should considev a reallocation of the duty of nurses on each shift. 7. The F-test also indicated that there wes a similarity in time duration for procedures and treatments and for cooperation between medical staff and nurses in all three hospitals. However, the remaining categories of nursing activities also showed a significant difference between the three hospitals. This indicated that there were differences in each emergency room that influence time for each categorized nursing activities and this should be given more consideration. Recommendations : 1. A seasonal difference should be considered in the activities of nurses in the emergency room and a comparative analysis should be carried out to deter-mine seasonal differentiation. 2. A study on more objectively measurable nursing activities should be administered as well as one determining the subjective responds towards nursing activities in the emergency room.

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Effect of Cytarabine, Melphalan, and Total Body Irradiation as Conditioning for Autologous Stem Cell Transplantation for Patients with AML in First Remission (1차 관해된 급성 골수성 백혈병에서 자가 조혈모세포 이식을 위한 Cytarabine, Melphalan, 전신 방사선치료의 효과)

  • Kang Ki Mun;Choi Byung Ock;Chai Gyu Young;Kang Young Nam;Jang Hong Sek;Kim Hee Jae;Min Wo Sung;Kim Chun Choo;Choi Ihl Bohng
    • Radiation Oncology Journal
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    • v.21 no.3
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    • pp.192-198
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    • 2003
  • Purpose: Current results of autologous stem cell transplantation (SCT) suggest that this procedure may prolong disease free survival In patients with acute myeloid leukemia (AML). Autologous SCT is increasingly used as treatment for AML in first remission. The aim of this study was to evaluate the outcome of autologous SCT for patients with AML in first remission treated by autologous SCT using cytarabine, melphalan and total body irradiation (TBI) as the conditioning regimen. Materials and Methods: Between January 1995 and December 1999, 29 patients with AML in first remission underwent autologous SCT. The median age of patients was 33 years (range, 16 to 47). The conditioning regimen consisted of cytarabine ($3.0\;gm/m^2$ for 3 days), melphalan ($100\;gm/m^2$ for 1 day) and TBI (total 1000 cGy in five fractions over 3 days). Results: The median follow up was 40 months with a range of 3 to 58 months. The 4-year cumulative probability of disease free survival was 69.0%, and median survival was 41.5 months. The 4-year relapse rate was 27.6%. The factor Influencing disease free survival and relapse rate was the French-American-British (FAB) classification ($M_3$ group vs. other groups; p=0.048, p=0.043). One patient died from treatment-related toxicity. Conclusion:: Although the small number of patients does not allow us to draw any firm conclusion, our results were encouraging and suggest that the association of cytarabine, melphalan and TBI as a conditioning regimen for autologous SCT for AML on first remission appears to be safe and effective.

Retrospect and Prospect of Medical Law 20th Anniversary (Medical Criminal Law) (의료법학 20주년 회고와 전망(의료형법 분야))

  • Ha, Tae Hoon
    • The Korean Society of Law and Medicine
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    • v.20 no.3
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    • pp.47-79
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    • 2019
  • The Korean Society of Law and Medicine has faithfully played the role of professional academic organizations last 20 years in terms of academic activities, accumulated achievements, diversity, professionalism, and influence on academic circles. The Korean Society of Law and Medicine and the Journal of Medical Law serve as a platform for academic information and exchange of opinions on medical law. Medical law began in the midst of increasing conflicts and disputes caused by medical malpractice and the enactment and legal coercion of medical care as pressure on medical workers. It tried to find a way to coexist with each other through the encounter and convergence of medicine and law. Medical criminal law extends from traditional crimes in the realm of life and body protection to bioethics violations caused by the development of biomedical technology, corruption and economic crime in the medical field. Medical law has evolved into a comprehensive legal area dealing with legal issues raised in medical treatment, healthcare, bioethics, and life sciences technology. On the legal side, medical law is not independent legal areas. It is overlapping with traditional law areas such as civil law, administrative law, criminal law, social law, civil and criminal procedure law. However, it is now established as a convergence study in medicine, bioethics, life science, as well as in various fields of law. It has become an area where collaboration is needed with the field of law, medicine, ethics, sociology and economics. Medical criminal law has undergone a dynamic development over the last two decades. The development of medicine and medical technology provides new and innovative methods of diagnosis and treatment. The achievements and risks of revolutionary developments in biotechnology, genetic engineering and medicine coexist. While there is a dazzling achievement that mankind has hoped for: combating disease and improving health, it also creates unwanted side effects and risks to humans. There is a need to reconsider ethical and legal principles. The discovery and development of patient identity and autonomy has changed the medical doctor-patient relationship. Furthermore, it was complicated by the triangle relationship of patients, medical doctors and insurance. Legal matters are also complicated. This is why the necessity of legislation is emerging. Criminal punishment provisions are also required. The Medical Law and Biomedical Law are systematically and coherently deformed as mosaic-based legislation that takes place whenever there are social issues, citizens' needs, and medical organizations' interests, rather than sufficient enactment and revision procedures. It needs a complete overhaul, and this is possible through interdisciplinary collaboration which is the strength of The Korean Society of Law and Medicine.

The Patient Specific QA of IMRT and VMAT Through the AAPM Task Group Report 119 (AAPM TG-119 보고서를 통한 세기조절방사선치료(IMRT)와 부피적세기조절회전치료(VMAT)의 치료 전 환자별 정도관리)

  • Kang, Dong-Jin;Jung, Jae-Yong;Kim, Jong-Ha;Park, Seung;Lee, Keun-Sub;Sohn, Seung-Chang;Shin, Young-Joo;Kim, Yon-Lae
    • Journal of radiological science and technology
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    • v.35 no.3
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    • pp.255-263
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    • 2012
  • The aim of this study was to evaluate the patient specific quality assurance (QA) results of intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) through the AAPM Task Group Report 119. Using the treatment planning system, both IMRT and VMAT treatment plans were established. The absolute dose and relative dose for the target and OAR were measured by using an ion chamber and the bi-planar diode array, respectively. The plan evaluation was used by the Dose volume histogram (DVH) and the dose verification was implemented by compare the measured value with the calculated value. For the evaluation of plan, in case of prostate, both IMRT and VMAT were closed the goal of target and OARs. In case of H&N and Multi-target, IMRT was not reached the goal of target, but VMAT was reached the goal of target and OARs. In case of C-shape(easy), both were reached the goal of target and OARs. In case of C-shape(hard), both were reached the goal of target but not reached the goal of OARs. For the evaluation of absolute dose, in case of IMRT, the mean of relative error (%) between measured and calculated value was $1.24{\pm}2.06%$ and $1.4{\pm}2.9%$ for target and OAR, respectively. The confidence limits were 3.65% and 4.39% for target and OAR, respectively. In case of VMAT the mean of relative error was $2.06{\pm}0.64%$ and $2.21{\pm}0.74%$ for target and OAR, respectively. The confidence limits were 4.09% and 3.04% for target and OAR, respectively. For the evaluation of relative dose, in case of IMRT, the average percentage of passing gamma criteria (3mm/3%) were $98.3{\pm}1.5%$ and the confidence limits were 3.78%. In case of VMAT, the average percentage were $98.2{\pm}1.1%$ and the confidence limits were 3.95%. We performed IMRT and VMAT patient specific QA using TG-119 based procedure, all analyzed results were satisfied with acceptance criteria based on TG-119. So, the IMRT and VMAT of our institution was confirmed the accuracy.

Studies on the Embryo Transfer of In Vitro Matured/ In Vitro Fertilized Embryo in Hanwoo (한우 체외성숙.체외수정란의 수정란이식에 관한 연구)

  • 황환섭;장현용;김성곤;김종택;박춘근;정희태;김정익;양부근
    • Journal of Embryo Transfer
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    • v.19 no.1
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    • pp.1-10
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    • 2004
  • These studies were carried out to improve the reproductive efficiency through embryos transfer of Hanwoo IVM/IVF embryos. Following routine IVM/IVF procedure, oocytes and zygotes were cultured far 40 to 44 h in CRlaa medium with BSA. Then 2 to 8-cell embryos were removed the cumulus cell and were cultured in CRlaa medium containing 10% fatal bovine serum and 2.5 mM taurine in 5% $O_2$ and 5% $CO_2$ at 38.5$^{\circ}C$. The fresh embryos of the morulae and blastocysts cultured for 6 to 9 days in vitro or the frozen-thawed embryos were transferred into recipients. The pregnancy rates of the blastocyst produced for 6, 7, 8, and 9 days in vitro culture were 59.4, 68.2, 66.0 and 100%, respectively. In the developmental stage, pregnacy rates of early blastocysts (61.1%), blastocysts(64.7%) and expanded blastocysts(69.5%) were higher than that of morulae stage(20.0%). The pregnancy rates according to the corpus luteum grades of A, B and C in recipients were 73.6, 62.9 and 50.0%, respectively. Effects of donor-recipients synchrony of after day 2, 1 and 0, before day 1 and 2 on the pregnancy rates were 35.7, 65.5, 72.6, 67.9 and 60.0%, respectively. Pregnancy rates of the body condition score of recipients $\leq$2(71.3%) were higher than those of $\geq$3.0 score(40.0%). The pregnancy rates according to the parity of recipients when embryo was transferred to cow(70.6%) was higher than in heifer(59.1%). The pregnancy rates according to hormone treatment before embryo transfer were 69.9% in hCG + GnRH administration group and 63.0% in control group. Fresh and frozen-thawed embryos on the pregnancy rates were 70.6 and 36.4%, respectively. Pregnancy rates in single and AI+single was 90.0% and 64.8%. Pregnancy rates in twin induction was better than in single. These results indicate that pregnancy rates after transfer were affected on the embryo ages, donor-recipient synchrony, body condition score of recipients, corpus luteum status, parity and hormone treatment to recipients.

Development of BIM-based 3D Modeling Instruction Materials and its Application Analysis for Professional Drafting Subject of Specialized Vocational High School (특성화고 전문제도 과목을 위한 BIM 기반 3D 주택설계 수업자료 개발 및 적용)

  • Kwon, Se-Jeong;Yoo, Hyun-Seok
    • 대한공업교육학회지
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    • v.43 no.1
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    • pp.1-19
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    • 2018
  • As the BIM designing technology has been applied recently in the construction field, architectural design education in the field of work and university has been changing to 3D modeling. Nevertheless, architectural design & drafting education in the construction specialized vocational high school is not responding appropriately to change. Despite the fact that students need to have 3D modeling design ability, there is a very lack of 3D housing design instructional material that can satisfy the change. The purpose of this study is to develop BIM-based 3D modeling instruction material and apply to analyze effect on interest and task performance ability on Housing Design. The 3D modeling instruction material used in this study was developed through four stages of preparation, development, implementation and evaluation according to the PDIE model procedure. Also, the experimental design model for hypothesis testing was used nonequivalent control group pretest-posttest design. Based on the experimental design model, BIM-based 3D modeling instruction material was performed in the experimental group and 2D CAD-based standard instruction material was taught in the control group. Experimental treatment was conducted on the students of construction specialized vocatinonal high school, and applied to the subject of Professional Drafting in the 12 hours. Before and after the experimental treatment, the interest and task performance ability on Housing Design were tested. Based on the test results, we analyzed the effects of the 3D modeling instruction material through the independent samples t-test. The results of the study are as follows. First, BIM-based 3D modeling instruction material was developed of 'Housing Design & Drafting' unit on the subject of Professional Drafting in construction specialized vocational high school. Second, the application of 3D modeling instruction material has shown to be effective in improving students' interest. Third, the application of 3D modeling instruction material has shown to be effective in improving students' task performance ability on Housing Design.

Folate Content of Fast Foods and Processed Foods (패스트푸드와 가공식품의 엽산 함량)

  • Ji, Hyun-Jung;Kim, Seung-Ki;Yon, Mi-Yong;Hyun, Tai-Sun
    • Journal of Nutrition and Health
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    • v.42 no.4
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    • pp.397-405
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    • 2009
  • A trienzyme extraction method (use of ${\alpha}$-amylase, protease and folate conjugase) for food folate assay has been used to release folate from the food matrix. In order to reduce the incubation time with three enzymes, folate values were compared between two incubation protocols; separate incubation (SI, incubated with ${\alpha}$-amylase and conjugase separately for 2 hours after protease treatment) and combined incubation (CI, incubated with ${\alpha}$-amylase and conjugase together for 2 hours after protease treatment) using 88 food items from 12 kinds of fast foods and processed foods. We found that folate values by CI were comparable to or higher than those by SI, indicating that CI might be a better extraction procedure to shorten the entire incubation time. We measured folate contents in 49 fast foods and 26 processed foods by microbiological assay after CI. Mean folate contents of one serving of various burgers ranged from 43.1 to 62.0 ${\mu}g$. One serving of French fries, pizza, sandwich and triangled kimbab contained a mean of 53.3, 28.4, 47.4, and 25.7 ${\mu}g$ of folate, respectively. Folate contents of non-alcoholic beverages were very low, ranging from 1.0 to 5.2 ${\mu}g$/100 g. Some of our values were comparable to the values in the folate database published in Korean Nutrition Society, however, some of the published values were 140 times higher than the measured values in this study. Folate values measured by the more recent modifications here can be used to update Korean folate database to accurately estimate dietary folate intake.

Patients Setup Verification Tool for RT (PSVTS) : DRR, Simulation, Portal and Digital images (방사선치료 시 환자자세 검증을 위한 분석용 도구 개발)

  • Lee Suk;Seong Jinsil;Kwon Soo I1;Chu Sung Sil;Lee Chang Geol;Suh Chang Ok
    • Radiation Oncology Journal
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    • v.21 no.1
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    • pp.100-106
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    • 2003
  • Purpose : To develop a patients' setup verification tool (PSVT) to verify the alignment of the machine and the target isocenters, and the reproduclbility of patients' setup for three dimensional conformal radiotherapy (3DCRT) and intensity modulated radiotherapy (IMRT). The utilization of this system is evaluated through phantom and patient case studies. Materials and methods : We developed and clinically tested a new method for patients' setup verification, using digitally reconstructed radiography (DRR), simulation, porial and digital images. The PSVT system was networked to a Pentium PC for the transmission of the acquired images to the PC for analysis. To verify the alignment of the machine and target isocenters, orthogonal pairs of simulation images were used as verification images. Errors in the isocenter alignment were measured by comparing the verification images with DRR of CT Images. Orthogonal films were taken of all the patients once a week. These verification films were compared with the DRR were used for the treatment setup. By performing this procedure every treatment, using humanoid phantom and patient cases, the errors of localization can be analyzed, with adjustments made from the translation. The reproducibility of the patients' setup was verified using portal and digital images. Results : The PSVT system was developed to verify the alignment of the machine and the target isocenters, and the reproducibility of the patients' setup for 3DCRT and IMRT. The results show that the localization errors are 0.8$\pm$0.2 mm (AP) and 1.0$\pm$0.3 mm (Lateral) in the cases relating to the brain and 1.1$\pm$0.5 mm (AP) and 1.0$\pm$0.6 mm (Lateral) in the cases relating to the pelvis. The reproducibility of the patients' setup was verified by visualization, using real-time image acquisition, leading to the practical utilization of our software Conclusions : A PSVT system was developed for the verification of the alignment between machine and the target isocenters, and the reproduclbility of the patients' setup in 3DCRT and IMRT. With adjustment of the completed GUI-based algorithm, and a good quality DRR image, our software may be used for clinical applications.

A study on the mandibular setback osteotomy and reduction genioplasty in mandibular prognathism with long anterior facial height (과도한 하안면 고경을 동반하는 하악전돌증환자의 하악골 후퇴술과 이부 감소 성형술식에 관한 연구)

  • Chang, Young-Il;Im, Dong-Hyuk;Suhr, Jeong-Hoon;Kim, Tae-Woo
    • The korean journal of orthodontics
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    • v.30 no.3 s.80
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    • pp.343-355
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    • 2000
  • The purpose of this study was to evaluate the amount and interrelationship of hard and soft tissue changes after mandibular setback osteotomy and reduction genioplasty in mandibular prognathism with long anterior facial height. The control group (Group A) consisted of 20 patients who had severe horizontal discrepancy. They experienced Presurgical orthodontic treatment and orthognathic surgery via mandibular setback. The experimental group (Group B) consisted of 20 patients who had severe horizontal and vertical discrepancy. They experienced presurgical orthodontic treatment and orthognathic surgery via mandibular setback and reduction genioplasty. The presurgical and postsurgical lateral cephalograms were evaluated. The computerized statistical analysis was tarried on with EXCEL 97 program. The results were as follows : 1. The correlation of hard and soft tissue horizontal changes in lower 2/3 of lower anterior facial height were high for both groups. The correlation coefficients of hard tissue changes and Ls, Stm, Li changes in Group B were moderately higher than Group A. 2. The correlation of hard and soft tissue vortical changes in Group B were lower than Group A. (except for pointB-Ils, Me-Me') 3. The ratio for soft tissue to Pog in Group B was lower than Group A. The ratios of hard and soft tissue vertical changes were 32% at Ils, 54% at Pog', and 60% at Me'. 4. The ratio of lower anterior facial height to total anterior facial height was reduced for both groups. But ratio of upper 1/3 of lower anterior facial height to total anterior facial height did not changed significantly in Group B. 5. Reduction genioplasty combined with mandibular setback procedure showed no change in upper one third(Sn-Stm) and significant decrease(Stm-Me') in the lower two thirds of the soft-tissue anterior lower facial height

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PULSE RATE AND OXYGEN SATURATION IN CHILDREN DURING ROUTINE RESTORATIVE DENTISTRY (소아 치과치료시 심박동과 동맥혈 산소포화도의 변화)

  • Kim, Ha-Na;Baik, Byeong-Ju;Kim, Jae-Gon;Yang, Yeon-Mi;Park, Jeong-Yeol
    • Journal of the korean academy of Pediatric Dentistry
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    • v.35 no.1
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    • pp.65-72
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    • 2008
  • Pulse oximeter to monitor oxygen saturation during pediatric dental sedations enables early detection of hypoxemia. The purpose of this study was to monitor the hemoglobin oxygen saturation level and pulse rate of nonmedicated pediatric patients during routine restorative procedures to study the effect of procedure and treated jaw. We obtained data from 53 children treated at the Department of Pediatric Dentistry, Chonbuk national university hospital. Pulse rate and oxygen saturation were measured and recorded using pulse oximetry at each step of treatment. The results are as follows: 1. In non-anesthesia group, steep increase of pulse rate was observed during rubber dam application in the maxilla and during cavity preparation in the mandible. 2. In anesthesia group, pulse rate started to decrease after the rubber dam application in the maxilla, while its decrease observed since cavity preparation step in the mandible. 3. In non-anesthesia group, oxygen saturation level was relatively constant during all steps in the maxilla, but in mandible, it was higher during operation compared to its pre and post operation baseline. 4. In anesthesia group, oxygen saturation level was observed at 99% level through all steps in both jaw groups, and there was no statistical significance between the maxilla and the mandible groups(p>0.05). The purpose of this study was to evaluate the effect of routine dental treatment on the pulse rate and oxygen saturation level in nonmedicated pediatric patients during routine restorative procedures in the maxilla and mandible.

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