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Application of Noninvasive Positive Pressure Ventilation in Patients with Respiratory Failure (호흡부전 환자에서 비침습적 양압환기법의 적용)

  • Seol, Young Mi;Park, Young Eun;Kim, Seo Rin;Lee, Jae Hyung;Lee, Su Jin;Kim, Ki Uk;Cho, Jin Hoon;Park, Hye Kyung;Kim, Yun Seong;Lee, Min Ki;Park, Soon Kew;Kim, Young Dae
    • Tuberculosis and Respiratory Diseases
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    • v.61 no.1
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    • pp.26-33
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    • 2006
  • Background: Noninvasive positive pressure ventilation(NPPV) has been increasingly used over the past decade in the management of acute or chronic respiratory failure and weaning of mechanical ventilation. We performed this clinical study to evaluate the usefulness of NPPV in patients who developed acute respiratory failure or post-extubation respiratory failure. Methods: We analysed thirty four patients(sixteen males and eighteen females, mean ages 58 years) who applied NPPV(BIPAP S/T, Respironics co., USA) for respiratory failure or weaning difficulty at medical intensive care unit(MICU), emergency room and general ward of a tertiary hospital. We evaluated the underlying causes of respiratory failure, duration of treatment, the degree of adaptation, complication and predictive parameters of successful outcome. Results: The overall success rate of NPPV was seventy-one percent. The duration of NPPV applying time, baseline blood pressure, pulse rate, respiration rate, $PaO_2$, $PaCO_2$, $SaO_2$ were not different between success group and failure group. But, the baseline pH was higher in the success group. Predictors of success were higher baseline pH, patients with underlying disease of COPD, improvement of vital sign and arterial blood gas value after NPPV application. The success rate in patients with post-extubation respiratory failure was eighty percent. There were no serious complication on applying NPPV except minor complications such as facial skin erythema, abdominal distension & dry mouth. Conclusion: NPPV may be effective treatment in patients with acute respiratory failure or post-extubation respiratory failure in selected cases.

Critical Pathway Development for the Hysterectomy Patients and its applied Effect (자궁적출술 환자를 위한 critical pathway 개발과 적용효과)

  • Noh, Gi-Ok;Park, Kyung-Sook
    • Women's Health Nursing
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    • v.6 no.2
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    • pp.234-257
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    • 2000
  • At present in the medical care, the study and effort for producing health service to consider efficiency, effectiveness, and quality are urgently called for because of the difficulty in the keen competition according to the inter- nationalization and opening, the operation in the medical institution service testing system, the change in the medical policy of KDRGs, and the lack of the health care cost increasing rate. As an alternative, the case management for the new management system is introduced in the U.S., and the Critical Pathway that is the method designing the contents of activity and its result has been developed and applied in order to anticipate and manage the patient-outcome for the realization of the cost-effective case-management. Thus, this study intended to analyze the effectiveness to obtain by developing the Critical Pathway presented as the method to improve the quality-betterment and cost effectiveness through the continuous and consistent patient management for the hysterectomy patient and applying it to the real practice. As a study method, this author formed a conceptual framework through considering five Critical Pathway used in the current U.S. and three Critical Pathway presented in the literature to develop the Critical Pathway for the hysterectomy patient, and made out the preliminary Critical Pathway through reviewing the old chart. This author made the verified the validity of the expert group about the developed Critical Pathway, and to confirm the possibility of practice application, completed and settled the final Critical Pathway after using the Critical Pathway to the hysterectomy patient from March 1st to 15th, 1997. Finally, to analyze the application-effect of the developed Critical Pathway, this author offered health care service applying the Critical Pathway to the hysterectomy patient from April 15th to August 31th, 1997. The guide for the Critical Pathway was carried out in advance by outpatient setting nurse for outpatient setting visit before the operation, and after hospitalization the primary nurse monitored the execution degree on the every duty. After discharge this author surveyed the complication through phone visiting, and one month after discharge surveyed the patient's reaction about the offered service when outpatient setting visit and analyzed the result. The source for health care cost was obtained by the statistics about the hospital charge which was offered by the General Business Department. The results were as follows. 1. It was decided that the vertical line of the Critical Pathway was made up of eight items such as monitoring/assessment, treatment, line/drains, activity, medication, lab test, diet, patient teaching, and the horizontal line of the Critical Pathway was made up of from hospitalization to discharge. 2. After the analysis of service contents through reviewing the old chart, it was decided that the horizontal line of the preliminary Critical Pathway was made up of from hopitalization to fourth postoperative day, and the vertical line of it was divided into eight items which were the contents to occur with the time frame of the horizontal line. 3. After the verifying the validity of the expert group about the preliminary Critical Pathway, the horizontal line was amended from hopitalization to third postoperative day, and taking their consensus, some contents of the horizontal line was amended and deleted. 4. From March 1st to 15th, 1997, to confirm the clinical suitability, this author offered eight hysterectomy patients the medical service through the Critical Pathway. The result was that three of them could be discharged at the expected discharge day, and the others later than that day. Supplementing the preliminary Critical Pathway through analyzing the cause of that delay- case, this author developed the final Critical Pathway. 5. There were no significant differences between the experimental and the control group in the incidence of complication(P > 0.05). 6. The 92.4% of experimental group was satisfied with the Critical Pathway service. 7. The length of hospital stay of the experimental group offered with the Critical Pathway service was 4.6 days and there was a significant difference that it was 1.3 days shorter than that of the control group(t=-29.514, P=0.000). 8. There wsa a significant difference that the mean medical charge per one patient of the experimental group offered the Critical Pathway service was cheaper \124,150 than that of the control group(t=-9.826, P=0.000). 9. The result that the author assumed and analyzed hospital income with the rate of turning bed was assumed that the increase of hospital income was \63,245,072 for that study, and the income increase was expected with \68,704,864 for a year. The result that this author applied the Critical Pathway to the hysterectomy patient have no differences in the incidence of complication, high satisfaction with that service, and the length of hospital stay decreased in the experimental group, and the mean hospital charge per one patient decreased, but hospital income increased. Suggestions for further study and nursing practice are as follows. 1. The study to apply the Critical Pathway for a year, verify the validity, and measure the effect repeatedly is needed. 2. To apply and manage the Critical Pathway effectively, the study to computerize it is needed. 3. The study to develop hospital-based Critical Pathway about other diseases or procedure, and measure the effect is needed.

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Clinical characteristics of congenital myotonic dystrophy diagnosed by molecular genetic method (분자 유전학적 방법으로 진단된 선천성 근육긴장성 이영양증 환자의 임상 양상)

  • Nam, Sook Hyun;Son, Young Bae;Lee, Bo Lyun;Lee, Jeehun;Ki, Chang-seok;Lee, Munhyang
    • Clinical and Experimental Pediatrics
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    • v.50 no.9
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    • pp.868-874
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    • 2007
  • Purpose : We performed this study to investigate the perinatal and developmental features of the patients with congenital myotonic dystrophy (CDM) confirmed by the molecular genetic method and the clinical characteristics of their mother, and to identify the relation between the number of CTG repeats and the clinical severity.Methods : A retrospective review of the medical records and the results of the dystrophia myotonica protein kinase (DMPK) gene test was done for the patients who were confirmed as CDM through gene analysis from January 2001 to September 2006. Results : All of the eight patients (male 2, female 6) showed moderate to severe degree of perinatal distress and feeding difficulty associated with profound hypotonia. Three patients had the history of polyhydramnios and two patients had equinovarus deformity. The developmental milestones were delayed in all patients, which improved gradually with age. All of their mothers demonstrated myotonic symptoms and typical myopathic face. The number of CTG repeats in DMPK gene analysis ranged 1,000-2,083, and there was no significant correlation between the number of CTG repeats and the time of walking alone. Conclusion : All patients with CDM presented with severe hypotonia in perinatal period, and developmental delay thereafter, which were improved with age. All of their mothers manifested myotonic symptoms with typical myopathic face, and the identification of such features greatly contributed to the diagnosis of the patients. The number of CTG repeats had no significant influence on the motor development.

The experimental study of early loading on the Miniplate in the beagle dog (성견의 하악골에 식립된 Miniplate에 가한 조기 부하의 영향에 관한 실험적 연구)

  • Chung, Yong-Koo;Lee, Young-Jun;Chung, Kyu-Rhim
    • The korean journal of orthodontics
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    • v.33 no.4 s.99
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    • pp.307-317
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    • 2003
  • Conventional osseointegrated titanium implants have many limitations; large size, limited location for placement of the implant, severity of the surgery, discomfort of initial healing, difficulty of oral hygiene and uncontrollable force direction. Recently titanium miniscrew and miniplate have been used for an alternative to conventional dental implant. But in relation to miniplate, miniscrew has disadvantages in that more potential inflammation, light orthodontic force application and limited orthodontic application. This study was conducted to evaluate the effectiveness of miniplate by observing the reactions of peri-implant tissues to early orthodontic and orthopedic loading of titanium miniplate. In four adult beagle dogs 10 miniplates were inserted into the alveolar bone using 20 osseointegrated titanium screws. 4 miniplates were placed in two dogs(dogA, B) and 6 miniplates in two dogs(dogC, D). In dogA, B miniplates were loaded with 200gm of force immediately after placement for 15 weeks. In dogc, D, miniplates were loaded with 400gm of force immediately after placement for 8 weeks. Miniplates of dogA were removed, dogA was healed for 4 weeks, and the area which was removed of miniscrew was examined. Following an observation period, the miniplates including miniscrews and the surrounding bone of dogB and dogC, D were removed, respectively. Undecalcified section along the long axis of miniscrews were made and the degree of osseointegration was examined under the light microscope. The results were as follows. 1. In the histologic features there was direct contact between bone and miniscrew in all groups except one, dogC control group. The loaded miniscrew demonstrated only a slight increase of the osseous proximaty when compared with unloaded miniscrew 2. There was no significant difference of the osseointegration of Peri-miniscrew surface between dogB and dogC, D. But dogB showed slightly more increased bone apposition than dogC, D 3. The gingiva overlapping the miniplate and miniscrew showed no inflammatory sign in clinical and histological aspects. 4. The impaled hard and soft tissues at the area which was removed of miniscrews showed good healing without inflammatory reaction. 5. The mobility showed slight increase in un-loaded miniplate but that was insignificant. Based on the results of this study, miniplate(C-tube) can be used as a firm osseous orthodontic and orthopedic anchorage unit immediately after insertion.

A study on The Pulse taking diagnostics of Nan Jing 1-23 Nan (난경(難經) 1-23난중(難中) 맥학조(脈學條)에 관한 연구(硏究))

  • Kim, Bup-Jin;Park, Won-Hwan
    • The Journal of Dong Guk Oriental Medicine
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    • v.8 no.2
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    • pp.131-154
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    • 2000
  • Nan Jing(Difficult Classic), as a catechism, describes in detail and deeply the ideas in Nei Jing(Huangdi's Internal Classic). The description of Nan Jing is focused on basic theories including theories about some disease and is excellent in identification and analysis. The contents of Nan Jing are as follows: 1-23 Nan-pulse and pulse condition, 24~29 Nan-channels and collaterals, 30~47 Nan-viscera and bowels(Zang Fu organs), 48~61 Nan-disease, 62~68 Nan-acupuncture points, 69~91 Nan-acupuncture. Especially, diagnosis techniques in Nan Jing make 'Only method of cunkou pulse taking' that is a technique for feeling the pulse widely applied in these days in Oriental medicine clear. Thus, this book adjusts the theory of pulse and pulse condition given in 1~23 Nan of 'The Study of Nan Jing' in order to enhance an understanding about the theory of pulse and pulse condition. The text of 1~23 Nan about pulse lore centers on all pulse of human body interconnected each other and cunkou, both ends of the pulse, and contrasts regular pulse with irregular pulse. 1. 10 Nan describes the theory about five kinds of evils and hardness and softness, and unique pulse condition of each bowels. 2. 13 Nan explains that the relative difficulty of medical treatment is determined by the degree of balance or unbalance among three factors-colors, pulse and pulse condition, flesh shape. 3. 14 Nan divides pulse and pulse condition into slow pulse and rapid pulse, and explains separately abnormality, great loss of semen, death caused by slow pulse, and abnormality, great loss of semen, death caused by rapid pulse. 4. 15 Nan about taut pulse(弦), full pulse(鉤), floating pulse(毛), deep pulse(石脈) describes that pulse and pulse condition differs according to four seasons. Therefore, Nan Jing establishes clearly techniques of feeling the pulse in 'Only method of cunkou pulse taking(獨取寸口)' and advances the theory of Nei Jing. Futhermore, Nan Jing is more valuable in that it suggests unique theory different with Nei Jing.

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Development of Elite Lines with Improved Eating Quality Using RIL Population Derived from the Korean Weedy Rice, Wandoaengmi6 (국내 잡초벼(완도앵미6) 유래 RILs 집단의 식미 관련 특성분석 및 우량계통 선발)

  • Kim, Suk-Man;Park, Seul-Gi;Park, Hyun-Su;Baek, Man-Kee;Jeong, Jong-Min;Cho, Young-Chan;Suh, Jung-Pil;Lee, Keon-Mi;Lee, Chang-Min;Kim, Choon-Song
    • Journal of the Korean Society of International Agriculture
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    • v.31 no.4
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    • pp.428-436
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    • 2019
  • As the main objective of rice breeding programs, rice eating quality is one of critical factors directly determining the market price and the consumer preference. However, the genetic complexity of eating quality and the difficulty in accurate evaluation often constrain improvement of the eating quality in rice breeding programs. In addition, given that the rice eating quality of current cultivars has already reached some high-level, diversifying of genetic resources are demanded more than ever to improve the rice eating quality. In this study, we developed a recombinant inbred lines (RILs) population derive from Wandoaengmi6, a japonica-type Korean weedy rice with high eating quality and a high degree of glossiness of cooked rice. Year-to-year correlations between the traits in three years were shown normal distribution for major agronomic traits and physicochemical characteristics. After evaluating tested traits related to eating quality procedure, a total of ten lines were ultimately selected from the population. Increasement of the taste of cooked rice (TA) and the overall eating quality (OE) were confirmed in the selected lines, which are caused by alleles derived from Wandoaengmi6 without any linkage drag. These results indicate that the utility of wide genomic resources in Korean landrace could be of application in various rice breeding programs and countermeasure to contribute to properly response to climate change.

The Need for Child Hospice Care in Families of Children with Cancer (암 환아 가족의 아동 호스피스 요구도)

  • Kang, Kyung-Ah;Kim, Shin-Jeong;Kim, Young-Soon
    • Journal of Hospice and Palliative Care
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    • v.7 no.2
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    • pp.221-231
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    • 2004
  • Purpose: The purpose of this study was to analyze the need for child hospice care programs in families of children with cancer. Methods: The survey of 104 families who were taking care of children with cancer was conducted. This survey was conducted from February 2004 to July 2004 at two general hospitals in Seoul. The data were collected through a self-reporting questionnaire of 22 items. The items were classified into five areas by factor analysis to identify the construct validity. The reliability of the tool was established by Cronbach's alpha as .94 and the data collected were analyzed by descriptive statistics, t-test and ANOVA. Results: 1) The degree of need for hospice care of the subjects showed a high average of 3.40 (${\pm}3.8$). The need for 'emotional care of children' showed the highest mean (M=3.55), 'management of terminal physical symptoms'(M=3.49), 'control of secondary physical problems' (M=3.41), 'acceptance of the family's difficulty' (M=3.20), 'spiritual care for preparing for death'(M=3.17), respectively. 2) With respect to the demographic characteristics of the subjects, there were statistically significant differences in hospice care needs, according to the child's mother's age (F==4.980, P=.009), whether or not there were cancer patients among their siblings or relatives (t=2.423, P=.017). Conclusion: The family of children with cancer have a heavy burden of ambivalence, especially in relieving the anxiety and fear of their children, communicating about death, and managing physical symptoms. Child hospice care must be provided considering the needs of families of children with cancer. Thus popular needs as well as hospice nurses' higher concern and support for hospice care of children require further education and program development to meet the current demands.

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A Study on the Cost Analysis of Service Export - K SME Case of MICE-related Industry - (서비스 수출원가 분석 - MICE 산업 관련 중소기업 사례연구 -)

  • Park, Moon-Suh
    • International Commerce and Information Review
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    • v.13 no.4
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    • pp.485-516
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    • 2011
  • Republic of Korea is small nation that is comprised of 0.7% of the world population and occupying just 0.07% of the world territory. Despite this, Republic of Korea once again proved herself to be as the world's major economic powerhouse by becoming the world's 7th largest exporter in 2010. However, the reality is that Republic of Korea is still significantly concerned about the volatile economic nature and anxiety that is spread across the globe since the global depression that began at the end of 2008 and the financial crisis that has been threatening the Euro-Zone recently. This has resulted in the nation reaching the limitation in significant economic growth and limited creation of jobs within the nation and due to such circumstances, the nation is becoming more aware of the fact that she needs to pay more attention on the service sector and service exports if she was to see a more positive economic outlook in the upcoming future. This research is aimed to analyse the cost that is associated with the service export sector, by examining a number of enterprises in relation to the MICE(Meeting Incentives Convention Exhibition) industry which certainly has both direct and indirect influences on the service exports of the nation Further, the prime goal of the research is to encourage the SMEs of Korea, who have substandard experience associated to foreign exports, to intensify and increase service exports and also the goal extends to the degree to suggest appropriate assistance measures to aid these enterprises to achieve such goals. This research is fundamentally designed and based on the literature research associated with the MICE industry and also, this research is premeditated through the analysis of the case of exports to Vietnam. As the result of research, it has been found out that SMEs in the MICE industry and those of in service export sector are reluctant or even feel insecure to attempt any kind of export of their services mainly due to; the lack of foreign market information and also the lack of experience associated with service exports. Furthermore, it has also been revealed that the difficulty to estimate the validity and profitability of service the export is a significant factor withholding those enterprises from attempting any service export to the foreign markets. Henceforth, in order to aid and stimulate service export to the foreign markets by these SMEs (including those in association with the MICE industry), it is imperative to prepare an one-stop service export assistance program which would provide the information associated with marketing, law and legislation, taxation system and financial area in regard to the global markets.

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A Study on the Resilience Process of Persons with Disabilities (중도장애인의 레질리언스(Resilience) 과정에 관한 연구)

  • Kim, Mi-Ok
    • Korean Journal of Social Welfare
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    • v.60 no.2
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    • pp.99-129
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    • 2008
  • This study analyzed the resilience process of persons with disabilities using the grounded theory approach. To conduct this study, the researcher conducted in-depth interviews with 8 persons with disabilities. In data analysis, this study identified 393 concepts on the resilience process of persons with disabilities and the concepts were categorized into 45 sub-categories and 18 primary categories. In the paradigm model on the resilience process of persons with disabilities, it was identified that casual conditions included 'unawareness of disability before being disability', 'extreme pain', 'repressing psychological pain', and the contingent conditions were 'dis-empowerment by staying in home', 'isolation by himself with difficulty in accepting the disability', 'experience of frustration from social barriers with prejudice against persons with disabilities'. Also, it was identified that the resilience process could be dependent on the type and the degree of the disability, the gender, and the length of time being disability. In spite of the casual and contingent conditions, the central way in which persons with disabilities could acquire resilience was identified as 'enhancement of the power of positive thinking'. The control conditions which accelerate or retard central phenomenon were 'the awareness of not being alone through family, friends, neighborhood and the social system' externally and 'finding purpose in life through religion and help from other persons with disabilities', internally. The action/interactional sequences enhanced the efforts, self searching and active acting, and as a result, persons with disabilities could find comfort in life, participate in society and change the perspective of disability in society. The core categories of resilience process in persons with disabilities were a belief in affirmation and choice of life by initiative. In the process analysis, stages developed in the following: 'pain', 'strangeness', 'reflection', 'daily life'. This stage was more continuous and causal than discrete and complete. In this process, the types of resilience of persons with disabilities are divided into 'existence reflection', 'course development', 'implicit endeavor', and 'active execution'. This study showed the details of the paradigm models, the process and types with an in-depth understanding of the resilience process of persons with disabilities using grounded theory as well as theory construction and policy and clinical involvement on the study of persons with disabilities.

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A Study on the Application of RTLS Technology for the Automation of Spray-Applied Fire Resistive Covering Work (뿜칠내화피복 작업 자동화시스템을 위한 RTLS 기술 적용에 관한 연구)

  • Kim, Kyoon-Tai
    • Journal of the Korea Institute of Building Construction
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    • v.9 no.5
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    • pp.79-86
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    • 2009
  • In a steel structure, spray-applied fire resistive materials are crucial in preventing structural strength from being weakened in the event of a fire. The quality control of such materials, however, is difficult for manual workers, who can frequently be in short supply. These skilled workers are also very likely to be exposed to environmental hazards. Problems with construction work such as this, which are specifically the difficulty of achieving quality control and the dangerous nature of the work itself, can be solved to some degree by the introduction of automated equipment. It is, however, very difficult to automate the work process, from operation to the selection of a location for the equipment, as the environment of a construction site has not yet been structured to accommodate automation. This is a fundamental study on the possibility of the automation of spray-applied fire resistive coating work. In this study, the linkability of the cutting-edge RTLS to an automation system is reviewed, and a scenario for the automation of spray-applied fire resistive coating work and system composition is presented. The system suggested in this study is still in a conceptual stage, and as such, there are many restrictions still to be resolved. Despite this fact, automation is expected to have good effectiveness in terms of preventing fire from spreading by maintaining a certain level of strength at a high temperature when a fire occurs, as it maintains the thickness of the fire-resistive coating at a specified level, and secures the integrity of the coating with the steel structure, thereby enhancing the fire-resistive performance. It also expected that if future research is conducted in this area in relation to a cutting-edge monitoring TRS, such as the ubiquitous sensor network (USN) and/or building information model (BIM), it will contribute to raising the level of construction automation in Korea, reducing costs through the systematic and efficient management of construction resources, shortening construction periods, and implementing more precise construction