• 대한한방내과학회지
• /
• 제28권4호
• /
• pp.863-871
• /
• 2007

Objects : To gain better insights of East-west integrated treatment of ischemic stroke. We analyzed 89 patients with severe acute ischemic stroke who were admitted to the East-west integrated intensive care unit. Methods : Subjects enrollment was from the East-west integrated intensive care unit of Kyung Hee Medical Center from March 2006 to February 2007. Patients were admitted within 14 days after the onset of ischemic stroke. We assessed the subjects' general characteristics, risk factors, admitting routes and periods, diagnostic imaging, process of western treatment and Korean traditional treatment, complication and consequence. Results : The proportion of males was 50.6%, of females 49.4%, average age was male 66.0$\pm$10.3 and female 71.1$\pm$10.5. Average length of hospital stays was 19.5 days. Monthly admissions were highest in November and December. The admission route was through emergency room (61.8%) or ward (34.8%). Mean Glasgow coma scale score was 10.0$\pm$2.5, average time from symptom of onset to hospital admission was 2.3$\pm$2.2 days. Dominant ischemic vascular territory was middle cerebral artery (66.3%). Initial western treatment was argatroban (22.5%), urokinase (28.1%), and heparinization (38.2%). Distribution of Sasang constitution of So-yang to Tae-eum to So-eum was equal to 5.4 to 2.9 to 1.5. Major complications were observed in 40 (42.7%) patients. In hospital mortality was 12.4% (11 deaths), all of them caused by aggravation of neurological deficit and only 3 of them with major complications. There appears to be a significant positive relationship between length of hospital stay and occurrence of complications (P<0.05). After discharge from the ICU, 64 (71.9%) patients were improved, 11 (12.4%) patients had expired, and 14 (15.8%) patients were transferred. Conclusions : From this study, we suggest that patients with severe acute ischemic stroke should be treated with East-west integrated therapy for more favorable consequences and decreased mortality.

• 한국의료질향상학회지
• /
• 제4권2호
• /
• pp.260-278
• /
• 1997

Background : Quality of professional nursing care is the most essential factor for survival and growth of nursing profession. Then, nursing professionals have responsibility for the evaluation of quality of professional nursing care. The purpose of this study was to develope an evaluation tool of nursing care for patients received gastrointestinal surgery with general anesthesia. This study was a primary work for the developement of a computer program for the evaluation of nursing care. Methods : This study was done through some consecutive steps. They were (1) Developement of items for the tool (2) Developement of an evaluation tool of nursing care quality for the G-I surgery patient (3) Test of reliability and validity of the tool. Two groups of experts and expert pannels who had much experience of the QA and the care of G-I surgery patients participated for developement of the items. 85 nursing records were used for the test of reliability and validity of the developed tool. The evaluation tools were developed with two types of scoring, norm-referenced tool and criterion-referenced tool. Results The system of items for tool was evaluation area evaluation item-indicator. There were 7evaluation areas which contained 32evaluation items which contained 7lindicators. Evaluation areas 1, 2, 3, 4 were for the evaluation of process and 5, 6, 7 were for the evaluation of outcome of nursing care for G-I surgery patient. For the test of interrator reliability, correlation coefficients of each scores of items and intragroup correlation coefficients were calculated. The average correlation coefficients between two rators were 0.65, 0.54 and the intragroup correlation coefficient were 0.99 and 1.00 by the types of scoring. The Cronbach alpha coefficients of the tools were 0.54 and 0.46 by the types of scoring. The average content validity index of the items was 0.95 from 4 pairs of experts. Because there were significant differences between some scores of quality of nursing care of 3 general hospitals regardless of the types of scoring, the tools could be thought to have some construct validity. And also, there were significant correlations between some scores of quality of nursing care and admission days and admission days after surgery regardless of the types of scoring, the tools could be thought to have predictive validity. Conclusion In this study, the evaluation tool of nursing care was developed for the very specified group of patient, G-I surgery patient. And the items were developed and tested by the experts of nursing practice. Because of these reasons, it was supposed that the tool could be used effectively in nursing pratice. And the procedures for the development and the test of the evaluation tool of nursing care in this study were supposed to be used for the developement of other tools.

• 대한간호학회지
• /
• 제5권1호
• /
• pp.93-111
• /
• 1975

As the hospitalized patients will be facing new stress situation due to change of his environment from home to hospital it will be very important to understand the psychological stress experienced by hospital patients not only for helping patients in the process of recovery from illness but also fulfil1ing the objective of comprehensive nursing care by understanding the needs of the patients. There is no doubt that it would be very helpful for treatment of patients as well as for improvement of nursing care if we know more about psychological needs of patients and give them adequate support to meet these needs. The study to find out the causes and degree of stress events experienced by hospitalized patients, with the objective of instituting improvement of nursing care program based on the needs of patients, was conducted during the month of September 1974 with 60 patients randomly selected from those admitted to medical and surgical wards at Yonsei Medical Center in that period The questionnaire form included 36 questions which are considered to be stress events for hospital patients, and was devide into five areas namely, such events related to 1) disease itself, 2) hospital environment, 3) nursing care and treatment, 4) communication and human relations, and 5) family and economic problems. The results of the study were as follows: 1. It was confirmed that hospitalization considered to be a stress producing factor and most patients perceived the admission to hospital as a stress factor. 2. According to the rating scale, it was found that degree of perceived stress shows a variation according to the source of stress producing event. 3. No significant differences in the mean values were observed statistically with the perceived stress levels according to demographic and other variables of patients related to hospitalization. 4. Among the questions related to disease itself, "Admission for surgery" was perceived most frequently as a stress event (97.14%) by patients. 5. With regard to the questions related to hospital environment, "death of the patient room-mate" was the most serious stress event perceived by patients (90%) and "living with hospital regulations"was considered to be less serious stress event (23.33%). 6. As for the questions related to nursing care and treatment, "limitation of freedom" was perceived as a stress factor most frequently (70.91%) by the patients and "worry for wrong treatment" turned out to be less frequent stress event (50.0%). 7. As for the questions related to communication and human relations, "difficulty to meet doctors when wanted"appeared to be the most frequent stress event by the respondents (75.86%) , followed by "no explanation about treatment or examination"(75.0%) and "no explanation about nursing care procedures"(71.66%). 8. With regard 111 tile questions related to family and economic problems, "inadequate finances for family living due to hospitalization"and "high cost of hospitalization" were the most frequent cause of stress mentioned by the patients. (80.0%). 9. As a result of application of the stepwise regression analysis, it was found that about 89% was explained by those events associated with disease itself, hospital environment and family and economic problems. By adding those events related to "nursing care and treatment" and "communication and human relation", 100% of stress associated with hospitalization was explained.

• 한국간호교육학회지
• /
• 제4권1호
• /
• pp.66-80
• /
• 1998

With the opening of healthcare market, the health care environment in Korea is anticipating a drastic change. In this Internationally open market environment, it is necessary to introduce a systematic health care plan and DRG system which offer qualitative medical services as well as reduced cost. Purpose of this study is to develop and test the critical pathway for Cesarean section patient in the way to be possible the integrated inpatient management. It was adopted the process of six phases to develop the critical pathway as the theoretical framework implemented by Johns Hopkins Hospital, Maryland, U.S.A. In the first phase, make a selection of diagnosis/procedures to develop. In the second phase, organize a development team consisted of eight expertises working in maternity nursing area. In the third phase, analyze the overall medical service offered to patient through review medical records and decided the service content and the implementation period for the Cesarean section patient. In the forth phase, make out a preliminary critical pathway after verification of expert group on content validity. In the fifth phase, validity operate to ten Cesarean section patients to test implementation in practice by using the preliminary critical pathway, In the sixth phase, defined the final critical pathway. The result of this study was as follows. 1. There were classified 8 categories as monitoring/assesment, treatment, medication, activity, diet, test, consult, education/discharge plan for vertical axis and showed hospital stayed from admission to discharge for horizontal axis of critical pathway through analysis 68 Cesarean section patients medical records. 2. After critical review 68 medical records to make out a preliminary critical pathway, hospital stays for horizontal axis were showed 6 days, mean hospital stays were 7.5 days, 2.1 days were to be taken operation after admission and 4.2 days were stayed until discharge after operation. 3. After making out a questionare in 90 items of a medical service content of eight categories and verifying the content validity of expertises, the 85 items of the preliminary critical pathway were selected by expertises agreement over 88% and modified or deleted 5 items showing agreement below 75%. 4. After verifying a validity to 10 patients for 4 weeks, hospital stays were 5.9 days. There were deleted 1 item and modified or supplemented the 9 items of the 10 items.

• Journal of Trauma and Injury
• /
• 제25권4호
• /
• pp.159-165
• /
• 2012

Purpose: For trauma patients, an early-transport and an organized process which are not delayed in hospital stage are necessary. Our hospital developed a procedure, the trauma Critical Pathway (CP), through which a traumatic patient has the priority over other patients, which makes the diagnostic and the therapeutic processes faster than they are for other patients. Methods: The records of patients to whom Trauma CP were applied from January 1, 2011 through April 15. 2012. were reviewed. We checked several time intervals from ER visiting to decision of admission-department, to performing first CT, to applying angio-embolization, to starting emergency operation and to discharging from ER. In addition, outcomes such as duration of ICU stay, hospital stay and mortality were checked and analyzed. Results: The trauma CP was applied to a total of 143 patients, of whom, 48 patients were excluded due to pre-hospital death, ER death, transferring to other hospital and not severe injury. Thus 95 patients (male 64, 67.3%) were enrolled in this study. Fifty-nine patients(62.1%) were injured by the traffic accident. The mortality rate was 10.5% and the mean Revised Trauma Score (RTS) of the patients was $6.4{\pm}2.0$. After visiting ER, decision making for admission was completed, on average, in 3 hours 10 seconds. The mean time intervals for the first CT, angio-embolization, surgery and discharge were 1 hour 20 minutes, 5 hours 16 minutes, 7 hours 26 minutes and 6 hours 13 minutes, respectively. Conclusion: The trauma CP did not show the improvement of time interval outcome, as well as mortality rate. However, this test did show that the trauma CP might be able to reduce delays in procedures for managing trauma patients at the university-based hospitals. To find out the benefit of CP protocol, a large scaled data is required.

• 한국보건간호학회지
• /
• 제4권1호
• /
• pp.5-16
• /
• 1990

'What is nursing' this question could always be arised and such a question could bring forth the new possibility to definete the nursing concept more clearly. At the middle of 19th Centry, Mrs. Nightingale defined the concept of nursing as follows; 'Nursing is a kind of treatment act to aid the patient so that the health of patients may be recovered naturally, as keeping the most comfortable circumstances.' But after then, the role and function of nurses about purpose and method of nursing has continuously been studied, as the social circumstance has been changed. The fact that care provider and client have the same concept about nursing is very important at the first step of assessment. But at the present time, the care provider and client have not same concept yet, so the difference of unrsing concept between care provider and client is analyzed in this study. This study would be belived to be helpful for the advance of nursing in the future. In this study, 20 questionare from nursing objectives developed by Abdellah(basic care needs, sustenal care needs, remedial care needs and restorative care needs) are used for adult. The data of this study by the 6 point rating scale are analyzed by SAS as follows; 1. Respondent's view is that nursing is necessary in case of group(school or company) rather than private and in case of abnormal conditions rather than normal conditions. 2. Every questionares of nursing objectives are divided into 4 points of view such as basic care needs, sustenal care needs, remedial care needs and restorative care needs are examined. The evaluation by 6 point rating scale revealed that $5.08\pm0.65$ point in basic care needs $4.93\pm0.68$ point in sustenal care needs $4.91\pm0.80$ point in remedial care needs and $4.61\pm0.91$ point in restorative care needs. While basic care needs and substenal care needs that need more physical care show high points, remedial care needs and restorative care needs that need more psychological, social and spiritual care show low points. 3. It was checked whether there is any significant difference between above 4 point of views in nursing objectives and qeneral characteristics or not. As a result, there is significant difference between 4 point of view and ages, educational level, marriage, composition of children. And also there is significant difference between religion and basic care needs, remedial care needs and restorative care needs. But there is no significant difference between any point of view and sex, occupation, experience of admission and experience of family admission. As this study is based on the data gethered from a restricted area, the result can not represent the opinion of all the clients. Therefore the same kind of study should be carried out on many areas repeatedly and also it should be tried to extract objective concept. And also periodical study is needed to observe the changing process of nursing concept.

• 한국통신학회논문지
• /
• 제29권10A호
• /
• pp.1131-1138
• /
• 2004

IP 기반의 이동 통신망에서는 사용자들에게 연속적인 이동성을 제공하기 위해서 여러 이동성 에이젼트가 사용된다. 대규모 모바일 IP 시스템의 경우 이러한 에이젼트의 확장성과 규모성이 중요한 문제가 될 수 있다. 모바일 Ipv6에서의 시그널링 부하와 핸드오프 지연 시간을 줄이기 위해서 제안된 계층적 모바일 Ipv6에서는 MAP이라고 하는 지역 홈 에이젼트를 사용하여 위치 등록을 지역적으로 처리 가능하도록 한다. 하지만 한 지역 내에서의 움직임이 많은 경우 이러한 MAP이 성능상의 병목 지점이 될 수 있다. 이는 MAP이 시그널링 트래픽 뿐만이 아니라 이동 단말기에게 전달되는 데이터 트래픽에 대한 터널링 기능도 담당하기 때문이다. 따라서 보다 안정적인 서비스를 위해서는 이러한 MAP에서 서비스 받는 단말기의 수를 제한할 필요가 있다. 본 논문에서는 기존의 무선망 자원 할당에서 사용되던 수락 제어 기법과 SMR (Session-to-Mobility Ratio)에 기반한 교체 기법을 이용하여 MAP의 부하를 효과적으로 제어할 수 있는 적응형 부하 제어 기법을 제안한다. 성능 분석을 위해서 제안한 기법을 마르코브 체인을 통해 모델링하여 핸드오프 이동 단말기 봉쇄 확률과 새 이동 단말기 봉쇄 확률을 분석하였다. 그 결과 제안한 기법은 두 봉쇄 확률을 아주 낮은 수준으로 낮출 수 있다는 것을 알 수 있었다.

• 한국비블리아학회지
• /
• 제21권3호
• /
• pp.17-27
• /
• 2010

본 연구는 대학생들의 문헌 독해 실태를 분석, 문제를 파악하여 개선방안을 제언하기 위해 수행되었다. A대학교 1학년생을 대상으로 지문을 읽는 시간 독해패턴 이해력 기억력 독해습관 및 태도 등을 분석한 결과, 첫째 수능평균을 기준으로는 조사대상 학생의 58%가 양호하고 42%가 미흡한 것으로 분석되었다. 둘째 조사대상 학생의 77%는 양호한 패턴을 가지 있으나 23%는 독서패턴에 문제가 있는 것으로 파악되었다. 셋째 이해력과 기억력을 평가한 결과 각각 전체의 69%와 67%가 양호한 것으로, 31%와 33%가 보통 또는 미흡으로 평가되었다. 넷째 평소 독서습관 및 태도를 조사한 결과, 문제가 없는 것으로 파악된 학생은 평균 77%, 문제가 있는 학생은 평균 23%로 파악되었다. 본 연구에서는 이 같은 문제를 해소하기 위해 첫째 대학생들의 독해평가를 위한 과학적이고 표준화된 평가도구를 개발할 것을, 둘째 입학전형과정 또는 입학 후에 독해능력과 독서습관 및 태도를 평가할 것을 제언하였다. 그리고 평가결과 미진한 학생들을 교육할 수 있는 가칭 기초학력교육원을 운영할 것을 제언하였다.

• 한국산학기술학회논문지
• /
• 제20권7호
• /
• pp.372-379
• /
• 2019

본 연구는 입학전형별 입학생들의 대학생활에 대한 생각을 분석하고, 그에 따른 학업역량 수준을 알아보고자 하였다. 이를 위해 2012~2017학번 동국대학 대학생들을 대상으로 대학생활에 대한 만족도를 분석하고, 대학생활에 대한 중요도와 집중도의 차이가 발생하는지 비교하였다. 마지막으로 입학전형별로 학업역량 중 GPA를 중심으로 차이가 발생하는지 비교 분석하였다. 그 결과 대학생활에 대한 만족도를 분석한 결과 수시전형 학생들이 정시전형 학생들에 비해 만족도가 높은 것으로 나타났다. 대학생활 중 교육에 대한 만족도는 높으나, 생활과 밀접한 장학금에 대한 것은 불만족으로 나타났다. 그리고 대학생활에 대한 중요도와 집중도의 차이에서는 졸업 후 취업에 대한 고민이 가장 높았으나 현실적으로는 집중하지 못하고 현재 상황인 학점 및 팀플 과제에만 집중하는 것을 확인할 수 있었다. 마지막 입학전형 GPA도 수시전형 학생들이 정시전형 학생들보다 높은 것으로 나타났는데 수시전형 학생들이 학교생활에 빠르게 적응하고 만족도가 높은 것에도 영향을 미친다는 것을 확인할 수 있었다. 이를 통해 대학생활에 대한 전반적인 생각들을 파악하고 이를 보완해 줄 수 있는 교육정책 및 프로그램 마련이 필요하다는 것을 제안한다.

• Journal of Nutrition and Health
• /
• 제55권1호
• /
• pp.85-100
• /
• 2022

본 연구에서는 다발성 외상 중환자에게 있어 급성 단계에서의 이화학적 상태 및 경장영양 공급 수준이 임상적 예후에 미치는 영향을 알아보고자 하였다. 먼저 조사 대상자 302명의 특성을 분석한 결과, 남성의 비율이 높으며 다른 중환자실에 비해 연령이 낮게 나타났으며 과체중의 체격을 가지고 있었다. 입원 후 7일간의 경장영양 공급 수준에 따라 일반적 결과와 합병증 발생률, 영양 관련 생화학적 지표를 비교한 결과, 초기 경장영양이 가장 적극적으로 공급되었던 High EN 그룹에서 사망률, CRP에서 유의적으로 감소하였다. 질소 평형을 기준으로 이화상태가 양호한 그룹에서는 경장영양 공급 기간이 길수록 HAIs 발생률이 높았으나, 이화상태가 불량한 그룹에서는 적극적인 경장영양 공급에도 여러 합병증 발생이 증가하지 않았다. 생화학적 검사 결과에서는 그룹 간 유의적인 차이가 없었으며, 경장영양 공급 수준에 따른 사망률 감소 추세는 두 그룹 모두에서 유지되었다. 결론적으로, 본 연구에서는 사망률 감소, 염증 수치의 감소 등에서 초기 경장영양 공급 일수가 증가할수록 긍정적인 효과를 확인하였다. 단, 후향적 관찰연구라는 제한점을 미루어 보아 향후 연속적으로 이화상태를 모니터링 및 평가하며 기본 특성의 차이가 없는 그룹 간에서 경장영양 공급 수준을 차별화한 전향적 코호트 연구가 필요하겠다.