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ANALYSIS OF ER:YAG LASER IRRADIATION ON CUTTING EFFICACY AND TEMPERATURE CHANGES OF DENTIN (Er:YAG 레이저의 상아질 삭제효과 및 이에 따른 온도변화)

  • Im, Kwang-Ho;Lee, Chang-Seop;Lee, Sang-Ho
    • Journal of the korean academy of Pediatric Dentistry
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    • v.28 no.1
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    • pp.32-44
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    • 2001
  • The purpose of this study was to investigate the effects of Er : YAG laser on cutting efficacy and temperature changes of dentin. We used the dentin specimens of human premolars and molars which contain the physiologic saline and maintain the pulpal pressure in dentinal tubules. Each specimen was exposed to Er : YAG laser with non-contact handpiece type delivery system under different treatment condition of irradiation energy, pulse repetition rate, and exposure time. Two procedures were conducted by the presence of water flow during lasing. The specimens were grouped by thickness of dentin. We investigated the cavity pattern, volume, and temperature change of dentin specimen to determine the cutting efficacy and temperature rise of Er : YAG laser, and obtained following results. 1. Cutting volume of dentin was increased by increasing the irradiation energy, pulse repetition rate, and exposure time(P<0.05). 2. Margins of abulated cavities were sharp and clean and floors of cavities were conical in shape and showing smooth surfaces. Upper diameter of abulated cavities were increasing as laser parameter of irradiation energy, pulse repetition rate, and exposure time were increased. A few cracks were observed on abulated surfaces under treatment condition of laser parameter with 150mJ, 5Hz, and 5sec. 3. Temperature was increased as laser parameter of irradiation energy, pulse repetition rate, and exposure time were increased, and temperature rise was decreased as dentin thickness was increased(P<0.05). 4. Temperature rise was decreased under water flow compared with no water flow during laser exposure(P<0.05). From these results, we think that the method of using a Er:YAG laser would be effective and safe in cutting dentin for clinical application.

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Evaluation of 3DVH Software for the Patient Dose Analysis in TomoTherapy (토모테라피 환자 치료 선량 분석을 위한 3DVH 프로그램 평가)

  • Song, Ju-Young;Kim, Yong-Hyeob;Jeong, Jae-Uk;Yoon, Mee Sun;Ahn, Sung-Ja;Chung, Woong-Ki;Nam, Taek-Keun
    • Progress in Medical Physics
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    • v.26 no.4
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    • pp.201-207
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    • 2015
  • The new function of 3DVH software for dose calculation inside the patient undergoing TomoTherapy treatment by applying the measured data obtained by ArcCHECK was recently released. In this study, the dosimetric accuracy of 3DVH for the TomoTherapy DQA process was evaluated by the comparison of measured dose distribution with the dose calculated using 3DVH. The 2D diode detector array MapCHECK phantom was used for the TomoTherapy planning of virtual patient and for the measurement of the compared dose. The average pass rate of gamma evaluation between the measured dose in the MapCHECK phantom and the recalculated dose in 3DVH was $92.6{\pm}3.5%$, and the error was greater than the average pass rate, $99.0{\pm}1.2%$, in the gamma evaluation results with the dose calculated in TomoTherapy planning system. The error was also greater than that in the gamma evaluation results in the RapidArc analysis, which showed the average pass rate of $99.3{\pm}0.9%$. The evaluated accuracy of 3DVH software for TomoTherapy DQA process in this study seemed to have some uncertainty for the clinical use. It is recommended to perform a proper analysis before using the 3DVH software for dose recalculation of the patient in the TomoTherapy DQA process considering the initial application stage in clinical use.

Analytical studies of bovine mastitis management by standard plate counts(SPC) and somatic cell counts(SCC) (젖소 유방염 관리에 따른 세균 및 체세포수 등급 실태 조사 분석)

  • 허정호;정명호;박영호;조명희;이주홍
    • Korean Journal of Veterinary Service
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    • v.21 no.3
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    • pp.285-300
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    • 1998
  • 1. The number of average milking cows, clinical forms of mastitis, mastitis-developing cows, and cows killed by mastitis a year were 25.7, 1.8(7%), 6.3(26%), and 2.7(10.1%)heads, respectively. The annual grade changes of standard plate counts(SPC) and somatic cell counts(SCC) showed the grade 1A of SPC diminished sharply from April to August, we think it was due to the lack of proper management in farming season and the grade 3 of SCC indirectly influenced increased in huge during August. 2. The average number of parturitions of farms was 2.3, but 50% of below 1 parturition were 22 farms(31%), 50% of above 3 parturitions were 16(23%) out of 71 farms. According to grades of the number of parturitions of milking cows per each farm, the farms' grades recording 3 parturitions and 50% were little bit excellent. 3. The actual situation research of foremilking CMT revealed 35 out of 74 farmer didn't do CMT Among them(35 out of 74 farmers), 80% did not test thanks to the troublesome process of the CMT. SCC grade 3, among farms who did foremilking CMT once or twice a month and who did not were 29% and 40% respectively and SPC grade 1A were 55% and 9%, respectively. 4. The research of actual situation on milking management let us know 29 farms(39%) did not do lastmilking, 37 farms(49%) usually did overmilking, and 34 farms(46%) did milking for 4 or 5 minutes. Grades according to average requiring times of milking showed SCC grade 1 of farms milking within 7 minutes was 11% and SPC grade 1A was 34%, on the other side, farms milking more than 7 minutes were 0% in SCC grade 1 and 13% in SPC grade 1A. Grades according to the starting time of milking after rubbing teats showed SPC grade 1A of farms starting milking at about 1 minute and over 2 minutes were 50% and 20%, respectively. 5. The research of actual situation on hygienic milking management uncovered 65 farms(88%) were using one towel which was used in washing teats and udders to wash more than 3 to 4 cows, and 53 farms(72%) were using one dried towel to dry udders not for each cow but for more than 3 to 4 cows after washing. Also, on milking turns disclosed 30 farms(40%) were milking cows in the order of incoming without isolation of a dominant group. According to grades of towels used in washing teats and udders, farms using a towel for each cow were 56% and a towel for over 3 cows were 31% in SPC grade 1A. According to using-or-not grades of dried towels after washing udders, farms using a towel for each cow were 79% and a towel for over 3 cows were 21% in SPC grade 1A. 6. Farms doing teat-dipping before milking were 7(10%), not doing teat-dipping after milking, or doing sometimes were 9(12%), and doing right after milking were 57(77%). And farms doing teat-dipping after dry cows and before delivery were 21(28a ). Farms using bethadine as an antiseptic solution were 70(95%), 40 farms(59%) diluted it with water as weak as 5 to 10 times, and on drying cows 64 farms(87%) slowly did it more than 2 days. Grade 1A of SPC of farms doing teat-dipping at every milking was 38%, farms doing occasionally or not was 33%, and farms doing it right after milking was 37% and doing after milking more than 5 cows was 20%. Grade 1A of SPC among farms diluting bethadine 5 times and diluting 5 to 10 times with water were 36% and 33%, respectively, and Grade 3 of SCC were 35% and 32%, respectively. 7. Studies on nonlactating period medical treatment, as the cows were on dry, 54 farms treated with their own hands.73 farms(98%) had bovine mastitis treated for themselves. And on applying medicines against mastitis, 55 farmers chose them on the basis of their own experience, 42 farms(57%) were treated more than 3 days. 41 farms(55%) dumped away the mastitis infected milk separately, 24 farms(32%) were feeding and milking at the same time. 8. Fifty-six farms(76%) always washed and disinfected milking machines after milking. Farms using the milking machines at low, or variable vacuum pressures, or at the vacuum pressure, set at the moment of its installation were 31(42%), and farms that did not know pulsation ratio were 27(37%). Farms changing liners when they were torn 8(11%), 58 farms(78%) said they checked milking system when there were wrong with them, 31 farms(42%) changed milking hoses when they found out problems, and 42 farms(57%) cleaned vacuum and milking systems when they felt dirty. The SPC grade 1A of farms washing and sterilizing milking machines was 38% and farms only washing was 28%.

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A Study Analyzing Nursing Diagnoses and Nursing Interventions used in a Demonstration Home Care Project (가정간호 시범사업 간호진단 및 간호중재 분석 연구)

  • Suh, Mi-Hae;Lee, Hae-Won;Chun, Choon-Young
    • The Korean Nurse
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    • v.34 no.5
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    • pp.52-67
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    • 1996
  • As home care in developing and becoming part of the health care delivery system in Korea, it is necessary to examine the use of nursing diagnoses and related nursing interventions with a view to increasing the standardization of nursing recording. This study was done to examine the nursing diagnosis and related nursing interventions used in home care. Data were collected using a chart review of the nursing notes written for the home care given to 38 patients who had pulmonary diseases or traumatic brain or spinal cord injuries and who had received home care as part of a demonstration home care project in a college of Nursing in Seoul. Early on in the project discussions as to format and use to nursing diagnosis was done and a tool was developed based on Gordon's eleven functional catergories with the addition of categories to cover family and environment. This tool was used in the data collection. Data included nursing diagnosis, etiologies and interventions. Real numbers and percentages were used in the analysis. The results show that the most frequently used diagnoses were in the category of physical function (75.6%), followed by the category of emotional and social function (21.8%). The least frequently used category was the one for family and environment (2.6%). The order of the frequency of recorded nursing interventions was the same, 82.3% for physical function, 16.2% of emotional and social function and 1.5% for family and environment. Under the category of physical functioning the most frequently used nursing diagnoses were related to mobility (62.2%), nutrition (23.6%) and elimination (11.9%). The frequencies of nursing interventions for these three diagnostic categories were 69.8%, 16.0% and 10.8% respectively. For emotional and social functioning, the most frequently used diagnoses were for cognition-perception (37.1%), self-perception (30.6%) and perception of health (23.7%). The ordering of the frequency of nursing interventions varied slightly. The most frequently used interventions were for the category of self-perception (31.7%) followed by cognition-perception (24.1%) and perception of health (22.9%). Looking at individual diagnoses, it was found that within the categroy of physical functioning, the most frequently used diagnosis was "impaired physical mobility" (29.5%) and this diagnosis involved 43.9% of the interventions. This was followed by "ineffective breathing pattern" (19.4%) with 17.7% of interventions, and "alteration in nutrition, less than body requirements" (11.2%) with 8.1% of the interventions. For the emotional social category, noncompliance was the most frequently used nursing diagnosis (18.2%) with 19.2% of the interventions. This was followed by "anxiety" (13.4%) with 13.6% of the interventions and by "knowledge deficit" (13.4%) but with only 5.5% of the interventions. The other diagnoses and interventions did not follow this pattern of frequency. Although there were a large number of diagnostic and intervention events, the number of actual diagnoses and interventions used were relatively small ranging from six interventions for "knowledge deficit" to 40 interventions for "imparied physical mobility". From this it can be concluded that the results of this study could be used as basic data for the development of standardized charts with respect to nursing diagnosis and interventions for clients with pulmonary disease and clients with traumatic brain or spinal cord injuries. Interventions that were direct care activities (1178) were much more frequent that education (430), and assessment and observation (148). There were also few diagnoses or interventions related to the family and the environment. This suggests two areas that need to be developed in home care and that need to be considered in the development of standardized records for use in home care.

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A Study on Perception on Development about Han River Citizen Parks according to Leisure Constraints (여가제약에 따른 한강시민공원 여가공간개발에 대한 인식연구)

  • Kim, Hyeon-Jee;Lee, Yong-Hak;Kang, Eun-Jee;Kim, Yong-Geun
    • Journal of the Korean Institute of Landscape Architecture
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    • v.42 no.5
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    • pp.52-63
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    • 2014
  • This is the study on users' perception gap about the effects of leisure space development of the Han River Citizen Park according to leisure constraints and was to identify leisure constraints expressed when using Han River Citizen Park and identify perception on positive and negative impacts according to use behavior characteristics of Han River Citizen Park and leisure space development. In order to compare and analyze the perception gap about the leisure space development of Han River Citizen Park users according to leisure constraints, we classified information and resources, economic affordability, free time on leisure activities in Han River Citizen Park into high influence group and low influence group and did an in-depth analysis. The results are as follows. First, Han River Citizen Park has the nature of neighborhood use with little influence on leisure constraints such as jogging and marathon, biking etc. including walking and relaxation and was a place to visit for simple exercises. Second, in the effects according to leisure space development of Han River Citizen Park, affordable leisure activity costs and ease of access were evaluated the most highly and congestion due to increasing users, increase in administrative operating budget and management personnel were concerned the most. Third, the leisure constraints in Han River Citizen Park were affected in the order of free time, economic affordability, information and resources. There were also perception gaps in congestion due to an increase in administrative operating budget and management personnel, increase in users including improvement of various leisure opportunities and leisure levels, encouragement of pride and attachment for Han river, affordable leisure activity costs depending on the degree of the influence of leisure constraints. Therefore, this study can be said to have the meaning in that we could identify leisure constraints affecting Han River Citizen Park users and resulting perception in leisure space development and revealed that the degree of the influence of leisure constraints varies in the use behavior of leisure space development of Han River Citizen Park and perception of positive and negative development impact. In addition, in order to resolve leisure complaints according to leisure constraints, we studied the need of accompaniment of leisure space operation and management system, development of various customized programs, introduction of recreational space and facilities prioritizing public interest rather than private interest with public relations and information delivery about leisure space of Han River Citizen Park.

Quality Assurance of Volumetric Modulated Arc Therapy Using the Dynalog Files (다이나로그 파일을 이용한 부피세기조절회전치료의 정도관리)

  • Kang, Dong-Jin;Jung, Jae-Yong;Shin, Young-Joo;Min, Jung-Whan;Kim, Yon-Lae;Yang, Hyung-jin
    • Journal of radiological science and technology
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    • v.39 no.4
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    • pp.577-585
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    • 2016
  • The purpose of this study is to evaluate the accuracy of beam delivery QA software using the MLC dynalog file, about the VMAT plan with AAPM TG-119 protocol. The Clinac iX with a built-in 120 MLC was used to acquire the MLC dynalog file be imported in MobiusFx(MFX). To establish VMAT plan, Oncentra RTP system was used target and organ structures were contoured in Im'RT phantom. For evaluation of dose distribution was evaluated by using gamma index, and the point dose was evaluated by using the CC13 ion chamber in Im'RT phantom. For the evaluation of point dose, the mean of relative error between measured and calculated value was $1.41{\pm}0.92%$(Target) and $0.89{\pm}0.86%$(OAR), the confidence limit were 3.21(96.79%, Target) and 2.58(97.42%, OAR). For the evaluation of dose distribution, in case of $Delta^{4PT}$, the average percentage of passing rate were $99.78{\pm}0.2%$(3%/3 mm), $96.86{\pm}1.76%$(2%/2 mm). In case of MFX, the average percentage of passing rate were $99.90{\pm}0.14%$(3%/3 mm), $97.98{\pm}1.97%$(2%/2 mm), the confidence limits(CL) were in case of $Delta^{4PT}$ 0.62(99.38%, 3%/3 mm), 6.6(93.4%, 2%/2 mm), in case of MFX, 0.38(99.62%, 3%/3 mm), 5.88(94.12%, 2%/2 mm). In this study, we performed VMAT QA method using dynamic MLC log file compare to binary diode array chamber. All analyzed results were satisfied with acceptance criteria based on TG-119 protocol.

Dosimetric Characteristics on Penumbra Regions of the Multileaf Collimator as Compared with the Lead Alloy Block (다엽 콜리메이터(Multileaf Collimator)와 합금납 차폐물(Lead Alloy Block)의 반 그림자영역의 선량 분포상의 특성 비교)

  • Lee Sang Wook;Oh Young Tack;Kim Woo Cheol;Keum Ki Chang;Yoon Seong Ick;Kim Hyun Soo;Park Won;Chu Seong Sil;Kim Gwi Eon
    • Radiation Oncology Journal
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    • v.13 no.4
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    • pp.391-396
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    • 1995
  • Purpose : The Conformal Radiation Therapy has bee widely used under favour of development of computer technologies. The delivery of a large number of static radiation fields are being necessary for the conformal irradiation. In this paper we investigate dosimetric characteristics on penumbra regions of a multileaf collimator(MLC), and compare to those of lead alloy block for the optimal use of the system in 3-D conformal radiotherapy. Materials and Methods : The measurement of penumbra by MLC or lead alloy block was performed with 6 or 10 MV X-rays. The film was positioned at a dmax depth and 10 cm depth, and its optical density was determined using a scanning videodensitometer. The effective penumbra, the distance from $80{\%}$ to $20{\%}$ isodose lines and $90{\%}$ to $10{\%}$ were analyzed as a function of the angle between the direction of leaf motion and the edge defined by leaves. Results : Increasing MLC angle ($0-75^{\circ}$) was observed with increasing the penumbra widths and the scalloping effect. There was no definite differences of penumbra width from $80{\%}$ to $20{\%}$ isodose lines, while being the small increase of penumbra width from $90{\%}$ to $10{\%}$ isodose line varing the depth and energy. The effective penumbra width of lead alloy block are agree resonably with those of MLC within 4.8mm. Conclusion : The comparative qualitative study of the penumbra between MLC and lead alloy block demonstrate the clinical acceptability and suitability of the multileaf collimator for 3-D conformal radiotherapy.

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Fractionated Stereotactic Radiation Therapy for Intracranial Benign Tumor : Preliminary Results of Clinical Application (양성 뇌종양의 분할정위 방사선치료 : 임상적 응용의 예비적 결과)

  • Kim Dae Yong;Ahn Yong Chan;Huh Seung Jae;Choi Dong Rak;Nam Jong Hyun;Lee Jung Il;Park Kwan;Nam Do-Hyun;Kim Moon Kyung
    • Radiation Oncology Journal
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    • v.16 no.2
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    • pp.185-194
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    • 1998
  • Purpose : With the development of stereotactic immobilization systems capable of reliable serial repositioning, fractionated stereotactic radiation therapy (FSRT) offers the Potential for an improved treatment outcome by excellent dose delivery, and dose distribution characteristics with the favorable radiobiological properties of fractionated irradiation. We describe our initial experience using FSRT for the treatment of intracranial benign tumor. Materials and Methods : Between August 1995 and December 1996. 15 patients(7 males and 8 females aged 6-70 years) were treated with FSRT. The patients had the following diagnosis pituitary adenoma(10) including one patient who previously had received radiotherapy, craniopharyngioma (2), acoustic neurinoma (1), meningioma (2). Using the Gill-Thomas-Cosman relocatable head frame and multiple non-coplanar therapy, the daily dose of 2Gy was irradiated at 90% to 100% isodose surface of the isocenter The collimator sizes ranged from 26mm to 70mm. Results : In all patients except one follow-up lost, disease was well-controlled. Acute complication was negligible and no patient experienced cranial nerve neuropathies and radiation necrosis. In overall patient setup with scalp measurements, reproducibility was found to have mean of $1.1{\pm}0.6mm$ from the baseline reading. Conclusion : Relocatable stereotactic system for FSRT is highly reproducible and comfortable. Although the follow-up period was relatively short. FSRT is considered to be a safe and effective radiation technique as the treatment of intracranial tumor. But the fractionation schedule(fraction size, overall treatment time and total dose) still remains to be solved by further clinical trials.

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Effects of Donor Cells and Estrus Synchronization on the Production of Cloned Korean Native Goat (공핵 세포 및 발정 동기화가 복제 재래 산양 생산에 미치는 영향)

  • Park H.S.;Kim T.S.;Jung S.Y.;Park J.K.;Lee J.S.;Jung J.Y.
    • Journal of Embryo Transfer
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    • v.21 no.2
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    • pp.137-146
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    • 2006
  • The objective of this study was to examine the effect of donor cell types, the source of recipient oocytes and estrous synchronization on pregnancy and delivery rates of somatic cell nuclear transfer (SCNT) embryos in Korean native goats. Recipient oocytes were surgically collected after superovulation. Ear cells and fetal fibroblasts were collected and cultured in serum-starvation condition (TCM-199 + 0.5% FBS) for cell confluence. The zonae pellucidae of in vivo- and in vitro-matured oocytes were partially drilled using a laser system. Single somatic cell was transferred into the enucleated oocyte. The reconstructed oocytes were electrically fused with 0.3 M mannitol. After the fusion, embryos were activated by Ionomycin+6-DMAP. NT embryos were cultured in mSOF medium supplemented with 0.8% BSA at $39^{\circ}C$ in an atmosphere of 5% $CO_2$, 5% $O_2$, 90% $N_2$ for 12 to 20 hr. One hundred and two SCNT embryos were transferred into 20 recipients and pregnancy rate at days 30 was 20.0%. Of them, one developed to term and delivered 1 kid. Ear cells showed significantly higher fusion (63.8 vs. 26.5%) and pregnancy rates (20.0 vs. 0.0%) than those of fetal fibroblast (p<0.05). The recipients synchronized by CIDR showed significantly lower pregnancy rates compared to that of recipient in natural estrus ($0.0{\sim}25.0%$ vs. 100%) (p<0.05). Cloned kid was born from the recipient in natural estrus. For the synchronization of estrus between recipient and donor, there was no difference between treatments (${\pm}0$ vs. +12 hr) in pregnancy rate. The first healthy cloned kid (Jinsoonny) was produced by transfer of SCNT embryos derived from in vivo oocytes and ear cells into a recipient goat whose estrus was synchronized with the donor. These results imply that donor cells for nuclear transfer may affect the success rate, and the estrus synchronization between donor and recipient animals can also be important.

Needs on Management Development Program for Head Nurse (간호 관리 능력 개발을 위한 교육 연구)

  • Park, Jeong-Sun
    • Journal of Home Health Care Nursing
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    • v.5
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    • pp.84-99
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    • 1998
  • The objectives of this study are to identify the actual educational contents of management for head nurse and to propose the educational subjects according to identity the needs of head, charge, and staff nurses. The subjects were investigated the actual Management Development Programs and educational needs of head nurses and prospective nurse manager(charge nurse, staff nurse with a lot of clinical experiences) in general hospitals. The tools were composed of two questionnaires: One was developed from the literature review for making items to measure actual situation. The other was revised Katz's model for measurement of educational needs. The first respondents of actual situation were 27 general hospitals with over 400 beds in Seoul and the second respondents were 89 head nurses, 67 charge nurses and 136 nurses at 3 hospitals by convenient sampling out of 27 general hospitals. Data were collected by telephone interview, mail questionnaire and visiting from 7th of October through 30th of November in 1997. In data analysis, general characteristics of the respondents and actual status of Management Development Programs were analyzed by frequency and percentage. Educational needs according to general characteristics were analyzed by ANOVA The results were as follows: 1. Actual situation of Management Development Program 1) Seven hospitals(26%) had Management Development Program for prospective managers and 14 hospitals (52%) for head nurses. 2) Education Department existed in 14 hospitals (52%). 3) One hospital(4%) had top level managers took part in the Management Development. 4) Two hospitals selected head nurse, who had finished courses of Management Development. Eight hospitals(30%) assessed educational needs. The assessment tools consisted of making a question via questionnaire(75%), determining at department meeting(12%) and interview(13%). 5) Educational programs had 3 types: 10 lecture type, 7 discussion type and 4 role play type programs. 6) One hospital evaluated the change of learner's attitude. 7) Four hospitals scored educational point, but that was measured only by attending. 8) Actual Management Development Programs were as follows. parenthesis indicates the number of hospitals. (1) Management Development Programs for Prospective manager. Role perception of Middle level Manager (1) . Role reconstruction of Nurse Manager (1). Workshop for Charge Nurse (1). Nursing Delivery System and Nursing Process (1). Communication (1). Motivation (1) (2) Management Development Programs for Head nurse.. Head nurse's Role (5). Administrative Work (7). Service Education (4). Prevention and Countermeasure of Nursing Incidence (3). Appraisal (3) 2. The results of needs on Management Development subject 1) The educational needs of all respondents on 3 skill domains showed positive agreement to strongly positive agreement. 2) High priority(more than 4.5) items were 12 of 24 Human skill items(50%), 1 of 6 Technical skill items(16%), and 2 of 13 Conceptual skill items (15%). 3) Out of high priority items, 8 items were instituted. 4) All respondents showed high needs on 3 skill domains regardless of 3 positions (head nurse, charge nurse, and nurse). Educational needs of Human skill domain, according to position were 108. S, 108.7, 106.8 (mean score = 72) , needs of Technical skill domain were 26.5, 26.6, 26.I(mean score=18), and needs of Conceptual skill domains were 56.9,56.7, 55.1(mean score=39). 5) Needs of 3 skill domains according to clinical career showed significant difference. Out of respondents, nurses with career of over 16years showed lowest degree of needs in Human skill domains(F=4.47, P=.004) and Conceptual skill domain(F=2.93, P=.034). 6) Educational needs according to educational background were not significant difference. But out of respondents, nurses educated at 3-year junior college relatively showed lowest needs in all of the 3 skill domains. With the above-mentioned findings, further study is necessary for generalization of this study at hospitals with different bed size and location. Also it is needed to study about management skill of nurse and charge nurse, and effective educational method.

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