• 대한간호학회지
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• 제30권6호
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• pp.1543-1555
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• 2000

Home health care is moving into a set of new realities. An era of competition and cost containment has arrived. Before nurses are able to contain costs or describe the relationship between nursing activities, cost must be accurately measured based on the nurse's workload. Nurses in home health care usually desire to measure expenses for one of three reasons : reimbursement, management, or research. The purpose of the study was to investigate the work input by Registered Nurse in each of the home health care activities by relative value units and identify the factors affecting the nurses' total work input in health care services. To measure the work input by nurses, work was defined by four dimensions: time, physical effort, mental effort, and stress. This study used a descriptive-correlational design. Data collection consisted of two phases. In phase I, data on home health activities performed by nurses were collected. In phase II, data on nurses' time, physical effort, mental effort, and stress in each of home health care activities discovered phase I were collected. In this method, the respondent was asked to rate a service in relation to a reference service using a ratio scale. The sample included 39 home health care nurses. The results of the study indicated that home health care activities performed by the nurses were in 10 categories and 69 items. Measuring the relative work inputs in each of home health care activities, and foley catheterization was selected as the reference to service. In terms of time and physical effort dimensions, full bath service was rated as the most strenuous among 69 activities by the respondents, and intramuscular injection was rated as least. It was found that emergency treatment required the highest mental effort and the highest stress, while blood sugar tests required the lowest mental effort. Approximately 91.3% of the variance in total work input was accounted for by the linear combination of time, physical effort, mental effort judgement, and stress. Examining the regression coefficients of those variables, physical effort, time, and stress were found as the predictors which were significantly associated with the total work of nurses in home health care. Professional nursing's next step in the conundrum of economic volatility is to develop a tool to reflect the interaction of functional deficiency and direct professional nursing care. And this will be a more accurate predictor of nursing resource use and ultimately a great forcaeter cost.

• 디지털융복합연구
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• 제13권11호
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• pp.149-156
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• 2015

식생활의 변화로 인하여 고혈압, 심장병, 뇌출혈, 암 질환 등 다양한 질환을 앓고 있는 환자들이 점점 증가하고 있다. 그러나, 병원에서는 환자 치료에 앞서 환자들이 의료 서비스를 제공받기 위해서는 많은 병원 행정 업무를 처리해야 한다. 본 논문에서는 다양한 질환을 앓고 있는 환자 중 체내삽입장치를 부착한 환자를 대상으로 체내삽입장치에 RFID 칩을 이식하여 환자가 병원에 외래왔을 경우 RFID 리더를 통해 환자를 자동인식하여 병원 행정업무 처리를 간소화함으로써 환자가 불편없이 의료 서비스를 제공받을 수 있는 m-헬스케어 서비스 모델을 제안한다. 특히, 제안 모델은 응급상황의 환자가 환자의 질병 종류 및 상태를 의료 담당자에게 알려주지 않아도 자동으로 환자의 상태 정보를 확인할 수 있도록 의료담당자의 진료시간을 단축함으로써 기존 의료 시스템의 업무 효율성을 향상시킨다. 실험결과, 서비스 지연시간, 업무 효율성, 환자의 의료 서비스 만족도 등에서 기존 의료 시스템과 비교 평가한 결과, 제안 모델은 기존 모델보다 서비스 지연시간은 평균 16.5% 향상되었고, 업무 효율성은 27% 높았으며, 환자의 서비스 만족도는 평균 22.4% 향상되었다.

• Journal of Trauma and Injury
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• 제29권4호
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• pp.204-208
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• 2016

For an orthopaedic surgeon, the critical decisions to either amputate or salvage a limb with severe crushing injury with progressive ischemic change due to arterial rupture or occlusion can become a clinical dilemma at the Emergency Department (ED). And reperfusion injury is one of the fetal complications after vascular reconstruction. The authors present a case which was able to save patient's life by rapid vessel ligation at bedside to prevent severe reperfusion injury. A 43-year-old male patient with no pre-existing medical conditions was transported by helicopter to Level I trauma center from incident scene. Initial result of extended focused assessment with sonography for trauma (eFAST) was negative. The trauma series X-rays at the trauma bay of ED showed a multiple contiguous rib fractures with hemothorax and his pelvic radiograph revealed a complex pelvic trauma of an Anterior Posterior Compression (APC) Type II. Lower extremity computed tomography showed a discontinuity in common femoral artery at the fracture site and no distal run off. Surgical finding revealed a complete rupture of common femoral artery and vein around the fracture site. But due to the age aspect of the patient, the operating team decided a vascular repair rather than amputation even if the anticipated reperfusion time was 7 hours from the onset of trauma. Only two hours after the reperfusion, the patient was in a state of shock when his arterial blood gas analysis (ABGA) showed a drop of pH from 7.32 to 7.18. An imminent bedside procedure of aseptic opening the surgical site and clamping the anastomosis site was taken place rather than undergoing a surgery of amputation because of ultimately unstable vital sign. The authors would like to emphasize the importance of rapid decision making and prompt vessel ligation which supply blood flow to the ischemic limb to increase the survival rate in case of profound reperfusion injury.

• 한국농공학회논문집
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• 제58권4호
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• pp.21-35
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• 2016

This study is to evaluate the applicability of SWAT (Soil and Water Assessment Tool) model for multi-purpose dams and multi-function weirs operation in Namhan river basin ($12,577km^2$) of South Korea. The SWAT was calibrated (2005 ~ 2009) and validated (2010 ~ 2014) considering of 4 multi-purpose dams and 3 multi-function weirs using daily observed dam inflow and storage, evapotranspiration, soil moisture, and groundwater level data. Firstly, the dam inflow was calibrated by the five steps; (step 1) the physical rate between total runoff and evapotranspiration was controlled by ESCO, (step 2) the peak runoff was calibrated by CN, OV_N, and CH_N, (step 3) the baseflow was calibrated by GW_DELAY, (step 4) the recession curve of baseflow was calibrated by ALPHA_BF, (step 5) the flux between lateral flow and return flow was controlled by SOL_AWC and SOL_K, and (step 6) the flux between reevaporation and return flow was controlled by REVAPMN and GW_REVAP. Secondly, for the storage water level calibration, the SWAT emergency and principle spillway were applied for water level from design flood level to restricted water level for dam and from maximum to management water level for weir respectively. Finally, the parameters for evapotranspiration (ESCO), soil water (SOL_AWC) and groundwater level fluctuation (GWQMN, ALPHA_BF) were repeatedly adjusted by trial error method. For the dam inflow, the determination coefficient $R^2$ was above 0.80. The average Nash-Sutcliffe efficiency (NSE) was from 0.59 to 0.88 and the RMSE was from 3.3 mm/day to 8.6 mm/day respectively. For the water balance performance, the PBIAS was between 9.4 and 21.4 %. For the dam storage volume, the $R^2$ was above 0.63 and the PBIAS was between 6.3 and 13.5 % respectively. The average $R^2$ for evapotranspiration and soil moisture at CM (Cheongmicheon) site was 0.72 and 0.78, and the average $R^2$ for groundwater level was 0.59 and 0.60 at 2 YP (Yangpyeong) sites.

• 의학교육논단
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• 제11권2호
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• pp.15-24
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• 2009

Medical Students' competencies depend on the medical school curriculum. Basic medical education, in particular, is an important starting point for further medical competency development. We aimed to identify the most important areas of reform in the basic medical education curriculum of Yonsei Medical School. To accomplish this, we sought case studies of different medical schools and discussion points for quality improvement methods. A qualitative comparison method saturated through the systematic discussions on the emerging thematic approaches to determine the current directions in medical school curriculum reform. The discussions, which involved 7 experts, spanned 8 months and were based on a literature review, with focus on the 7 selected case studies. From the discussions, we concluded that in order to improve basic medical education curriculum, the following measures need to be carried out. First, an outcome-based curriculum is to be designed. The expected outcome is to be deliberately and succinctly defined and should be expressed as teaching and learning objectives. Second, the core subjects and elective subjects are to be classified on the basis of the aim, content, and passage level of the subjects. Hence, the core curriculum must be treated as a standard part of medical knowledge, and the elective curriculum must be richer and more in-depth. Third, universities should institutionalize regular evaluation of their departments. Appropriate and just evaluations should be made, and feedback given to the school's administrative department. Fourth, the departmental and administrative management of the basic medical education curriculum should be harmonized with each other. Finally, teaching and learning resources are to be increased and diversified and made available to professors and students for basic medical education.

• 구강회복응용과학지
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• 제31권4호
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• pp.364-370
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• 2015

최근 구치부 부분 무치악 환자의 임플란트 보철 수복은 기능적뿐만 아니라 심미적으로도 환자의 만족을 이끌어내야 하는 과제를 안고 있다. 이렇게 환자의 요구가 높아지면서 상실된 자연치아와 유사한 형태의 임플란트 보철을 사용한 구강회복이 보철수복의 중요한 이슈가 되고 있다. 이를 위해서는 기성 지대주 보다는 더 넓은 customized CAD/CAM 지대주를 사용함으로써 자연스러운 출현윤곽을 재현할 수 있다. 넓은 지대주를 지지해주기 위해서는 충분한 폭과 높이를 가지는 각화치은이 존재해야 하는데, 만약 긴 치아상실기간이나 골이식술 등으로 인해 임플란트 주위에 각화치은이 부족한 경우에는 연조직 증대술을 시행하는 것이 추천된다. 이러한 과정을 통해 심미적이고 기능적인 임플란트 보철 제작이 가능하며 구강위생관리를 용이하게 하고 향후 임플란트 주위염의 발생 가능성을 감소시킨다. 본 증례는 구치부 부분 무치악 환자에서 골이식술, 상악동 이식술, 임플란트 식립술 및 연조직 이식술을 사용하여 부족한 치조골과 각화치은 및 협측전정을 회복하였으며, customized CAD/CAM 지대주와 지르코니아 보철물을 이용하여 수복한 증례로 주기적인 내원 및 검사를 통해 기능적, 심미적으로 만족할만한 결과를 얻었기에 이 사례를 보고하고자 한다.

• Tuberculosis and Respiratory Diseases
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• 제68권1호
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• pp.6-9
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• 2010

Background: The efficacious use of interventional bronchoscope for patients with central airway obstruction due to malignant or benign lesions has been proven. Among many therapeutic bronchoscopic procedures, endobronchial cryotherapy is an established recanalization method for the obstruction of the respiratory tract. Recently, the use of this procedure has been increasing in Korea. However, limited data are available in the literature regarding its efficacy in Korea. Methods: Thirty patients, who had been treated with a flexible cryoprobe for cryotherapy were enrolled; clinical characteristics and treatment outcomes were analyzed. The patients had been treated with the technique using nitrous oxide as a cryogen under local anesthesia. Objective outcomes were 3 different degrees of therapeutic success by use of follow-up bronchoscopic findings as follows: successful, partially successful, and unsuccessful response. Subjective outcomes were evaluated as an improvement in symptoms. Results: The mean age of enrolled patients was $59{\pm}11$ years and there was a male (22/30) dominance. Twenty-three patients had malignant tumor and 7 patients had benign lesions with central airway obstruction. Successful recanalization was achieved in 11 (37%) patients, and partially successful response was achieved in 15 (50%) patients. Dyspnea was improved in 84.2% (16/19) of patients. At least one respiratory symptom was resolved in 91.3% (21/23) patients. Seven patients (23.3%) needed additional bronchoscopic electrocautery because of the bleeding as a complication of cryotherapy. Conclusion: Endobronchial cryotherapy is an effective and less expensive procedure for the management of central airway obstruction. However, the procedure should be performed under the preparing for an emergency situation, such as massive bleeding.

• Journal of Trauma and Injury
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• 제33권1호
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• pp.1-12
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• 2020

Purpose: Despite recent developments in the management of trauma patients in South Korea, a standardized system and guideline for trauma treatment are absent. Methods: Five guidelines were assessed using the Appraisal of Guidelines for Research and Evaluation II instrument. Results: Restrictive volume replacement must be used for patients experiencing shock from trauma until hemostasis is achieved (1B). The target systolic pressure for fluid resuscitation should be 80-90 mmHg in hypovolemic shock patients (1C). For patients with head trauma, the target pressure for fluid resuscitation should be 100-110 mmHg (2C). Isotonic crystalloid fluid is recommended for initially treating traumatic hypovolemic shock patients (1A). Hypothermia should be prevented in patients with severe trauma, and if hypothermia occurs, the body temperature should be increased without delay (1B). Acidemia must be corrected with an appropriate means of treatment for hypovolemic trauma patients (1B). When a large amount of transfusion is required for trauma patients in hypovolemic shock, a massive transfusion protocol (MTP) should be used (1B). The decision to implement MTP should be made based on hemodynamic status and initial responses to fluid resuscitation, not only the patient's initial condition (1B). The ratio of plasma to red blood cell concentration should be at least 1:2 for trauma patients requiring massive transfusion (1B). When a trauma patient is in life-threatening hypovolemic shock, vasopressors can be administered in addition to fluids and blood products (1B). Early administration of tranexamic acid is recommended in trauma patients who are actively bleeding or at high risk of hemorrhage (1B). For hypovolemic patients with coagulopathy non-responsive to primary therapy, the use of fibrinogen concentrate, cryoprecipitate, or recombinant factor VIIa can be considered (2C). Conclusions: This research presents Korea's first clinical practice guideline for patients with traumatic shock. This guideline will be revised with updated research every 5 years.

• 유기물자원화
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• 제20권3호
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• pp.27-33
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• 2012

환경부 통계에 의하면 하수슬러지의 배출량은 연 7~9% 증가되고 있다. 향후에도 하수처리장 증설과 질소 및 인 제거를 위한 고도처리 시행에 따라 지속적으로 증가할 것으로 예상되고 있다. 그간은 상당량 매립에 의존해 처리해 오고 있었고, 일부는 해양배출에 의해 처리하고 있었으나, 현재는 유기성폐기물 직 매립금지와 해양배출마저 금지될 상황인지라 슬러지 처리에 비상사태라 할 수 있을 것이다. 재활용을 위해 혐기성 소화공법을 적용하여 바이오가스를 생산하거나 탄화공법을 적용하여 고형연료화를 할 수 있으나, 이 또한 공정이 만만치 않으며 악취발생과 2차 폐기물이 되어 버리므로, 사실상 실용적인 방법이라 할 수 없다. 본 연구는 유동층 연소로를 적용한 하수슬러지 처리에 대하여 실제적으로 활용가능한 기술임을 검증하기 위해 핵심 기술을 선정하여 입증하는데 그 목적이 있다. 하수슬러지 처리에 있어 유동층 연소로를 적용한다면 우리나라와 같이 에너지 부존자원이 부족한 나라에서의 대체에너지원(연료)으로 쉽게 활용할 수 있게 될 것이다. 특히 본래의 유동층 연소로의 장점만을 골라 충분히 활용하게 된다면 하수슬러지를 친환경적으로, 위생적으로, 그리고 경제적으로 간단하게 처리하게 될 것이다.

• 터널과지하공간
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• 제9권4호
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• pp.306-314
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• 1999

핵폐기물 저장공간과 같이 대규모 터널형 지하공간내에서의 환기량, 온/습도, 오염물질 농도 예측은 공간건설 및 운영을 위하여서 뿐만 아니라 화재등과 같은 비상시의 대처방안 강구를 위하여 반드시 필요하다. 본 연구에서는 압축성 가정하에서 autocompression의 영향을 고려한 자연환기압 계산 fan 및 regulator의 최적 위치 및 용량 결정, 암반 열물성 및 암반 표면으로부터의 증발, 응축에 의한 수분함유량 변화를 고려한 온/습도 계산, 이류확산에 기초한 오염물질 농도 분포 계산 기능을 갖춘 네트워크형 지하공간 환경예측 모델을 개발하였다. 온/습도 예측 모델을 군수물자 지하 저장공간에 적용한 결과 실측값과 상대오차는 건구온도 1.5~2.9%, 습도온도 0.6~6.1%로 나타났다. 도로터널 2개소를 대상으로한 실험결과 외부 입기만에 의한 확산계수는 9.78과 17.35$m^2$/s 큰 편이었으나 차량 운행과 환기설비의 작동시에는 이류확산만을 고려한 경우 CO 및 매연 농도의 상대오차가 5.88과 6.62%로 비교적 작게 나타났다. 이는 대부분의 터널형 지하공간에서의 농도 분포는 이류확산만에 의하여 추정이 가능함을 의미한다.