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Application of Patient Safety Indicators using Korean National Hospital Discharge In-depth Injury Survey (퇴원손상심층자료를 이용한 환자안전지표의 적용)

  • Kim, Yoo-Mi
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.14 no.5
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    • pp.2293-2303
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    • 2013
  • Objective: This study aims to determine whether national patient safety indicators (PSIs) can be calculated. Methods: Using PSI criteria from Organization for Economic Co-Operation and Development (OECD) Health Technical Papers 19 based on the Agency for Healthcare Research and Quality (AHRQ), PSIs were identified in the Korean National Hospital Discharge In-depth Injury Survey (KNHDIIS) database for 875,622 inpatient admissions between 2004 and 2008. Logistic regression was used to estimate factors of variations for PSIs. Results: From 2004 to 2008, 3,084 PSI events of 8 PSIs occurred for over 80 thousands discharges. Rates per 1,000 events for decubitus ulcer (PSI3, 4.88), foreign body left during procedure (PSI5, 0.05), postoperative sepsis (PSI13, 1.32), birth trauma-injury to neonate (PSI17, 7.92) and obstetric trauma-vaginal delivery (PSI18, 32.81) are all identified between ranges from maximum to minimum of OECD rates, respectively. However, rates per 1,000 events for selected infections due to medical care (PSI7, 0.22), postoperative pulmonary embolism or deep vein thrombosis (PSI12, 0.90) and accidental puncture or laceration (PSI15, 0.71) are below the minimum of OECD range. 7 PSIs except PSI 18 showed statistically significant relationship with number of secondary diagnoses. When adjusting patient characteristics, there are statistically significant different rates according to bed size or location of hospitals. Conclusion: This is the first empirical study to identify nationally number of adverse events and PSIs using administrative database. While many factors influencing these results such as quality of data, clinical data and so on are remain, the results indicate opportunities for estimate national statistics for patient safety. Furthermore outcome research such as mortality related to adverse events is needed based on results of this study.

Endocrine Function and Growth in Children with Craniopharyngioma (소아 두개인두종 환자에서 치료 전후의 뇌하수체 기능과 성장 및 체중 변화)

  • Chung, Yoo Mi;Shin, Choong Ho;Yang, Sei Won
    • Clinical and Experimental Pediatrics
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    • v.46 no.3
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    • pp.277-283
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    • 2003
  • Purpose : Craniopharyngiomas are often accompanied by severe endocrine disorders. Although there is universal growth hormone deficiency(GHD), the resulting growth pattern is very heterogeneous. We report the growth and endocrine outcome of 44 children with craniopharyngioma, with emphasis on initial symptoms, growth before and during growth hormone(GH) treatment and spontaneous growth in spite of GHD. Methods : We performed a retrospective study of 44 children treated at our centre between 1984 and 2002. Results : About 30% of patients had symptoms suggesting endocrine disorder at diagnosis. After surgery, multiple endocrinopathies were almost universal. Before GH therapy, height velocity was $8.00{\pm}2.71cm/yr$ in the normal growth group(n=11) and $1.79{\pm}1.10cm/yr$ in the subnormal growth group(n=7) during the first year and during the second year, $6.76{\pm}2.49cm/yr$ and $2.29{\pm}1.33cm/yr$, respectively. There was no difference of body mass index(BMI) change between before and after surgery in the two groups. Height standard deviation score(SDS) was $-1.46{\pm}0.74$ in the normal growth group and $-0.43{\pm}0.97$ in the subnormal growth group. Before GH treatment height SDS was $-1.31{\pm}1.25$ and BMI was $20.46{\pm}3.60$. During GH treatment, height SDS increased to $-0.60{\pm}1.37$ in the first, and to $-0.41{\pm}1.54$ in the second year(P<0.05), but BMI did not change significantly. Conclusion : The endocrine morbidity could develop in most children with craniopharyngioma before and after the operation and should be managed properly. Although all treated patients benefit from GH therapy, further studies are necessary to find out the possible mechanism of growth regulation in normally growing children, despite GH deficient.

The Consideration about Heavy Metal Contamination of Room and Worker in a Workshop (공작실에서 실내 및 작업종사자의 중금속 오염도에 관한 고찰)

  • Kim Jeong-Ho;Kim Gha-Jung;Kim Sung-Ki;Bea Suk-Hwan
    • The Journal of Korean Society for Radiation Therapy
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    • v.17 no.2
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    • pp.87-94
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    • 2005
  • Purpose : Heavy metal use when producing the block from the workshop. At this time, production of heavy metal dust and fume gives risk in human. This like heavy metal to improve seriousness through measurement and analysis. And by the quest in solution is purpose of this thesis. Materials and Methods : Organization is Inductively Coupled Plasma Atomic Emission Spectrometer, and the object is Deajeon city 4 workshops in university hospital radiation oncology (Bismuth, Lead, Tin and cadmium). Method is the ppb the pumping it does at unit, comparison analysis. And the Calculation heavy metal standard level in air through heavy metal standard level in body and blood, so Heavy metal temporary standard set. Results : Subterranean existence room air quality the administration laws appointed Lead and Cadmium's exposure recommend that it is $3{\mu}g/m^3\;and\;2{\mu}g/m^3$. And Bismuth and Tin decides $7{\mu}g/m^3\;and\;6{\mu}g/m^3$ through standard level in air heavy metal and standard level in body and blood. Heavy metal measurement level of workshops in 4 university hospital Daejeon city compares with work existence and nonexistence. On work nonexistence almost measurement level is below the recommend level. But work existence case express high level. Also consequently in composition ratio of the block is continuous with the detection ratio. Conclusion : Worker's heavy metal contamination imbrued serious for solution founds basic part. In hospital may operation on local air exhauster and periodical efficiency check, protector offer, et al. And worker have a correct understanding part of heavy metal contamination, and have continuous interest, health control. Finally, learned society sphere administer to establishment standard level and periodical measurement. And it founds basic solution plan of periodical special health checkup.

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Autogenous Osteochondral Grafts for the Osteochondritis dissecans of the Knee (슬관절 박리성 골연골염에 대한 자가 골연골 이식술)

  • Hahn Sung-Ho;Yang Bo-Kyu;Yi Seung-Rim;Chun Shun-Wook;Seo Ji-Hyun
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.2 no.2
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    • pp.142-148
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    • 2003
  • Purpose: This study was performed to evaluate the operative results of osteochondritis dissecans treated with autogenous osteochondral grafts. Materials and Methods: From May 1990 to May 2000, this study included 13 patients, 17 cases treated with autogenous osteochondral grafts. The mean age of patients at operation was 23.4 years (range,20 to 32 years), all cases were men, and the mean follow-up was for 24.2 months (range, 12 to 110 months). Treatment was done by open or arthroscopic method using with Osteochondral Autograft Transfer System (OATS, Arthrex, USA). Results: Trauma history existed in all cases, and major trauma history in 7 cases, and minor repetitive in 10 cases. The involved sites of lesion were medial femoral condyle in 11 cases, in which extended classic site was 9 cases, inferocentral site was 2 cases, and lateral femoral condyle in 6 cases, in which all cases were inferocentral site. Magnetic resonance imaging (MRI) staging was stage II in 1 case, stage III in 11 cases, stage IV in 5 cases, and arthroscopic staging was stage III in 12 cases, stage IV in 5 cases. The mean lesion size was 3.19$cm^2$ (range, 1 to 8$cm^2$). Clinical results evaluated with grading system by Aichroth, were excellent in 3 cases (18$\%$), good in 11 cases (65$\%$), moderate in 2 cases (12V), poor in 1 case (5$\%$), which revealed satisfactory results in 83$\%$. Congruent articular surface, satisfactory articular thickness, and no loosening or subsidence was evidenced by follow-up MRI or arthroscopic finding. Conclusion: Autogenous osteochondral grafts can be an alternative treatment in lesions larger than 1$cm^2$ in size, unstable lesion, and involvement of weight-bearing articular surface. Long term follow-up will be needed for the final efficacy of autogenous osteochondral grafts.

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Surgical Treatment of Loculated Empyema - Closed Rib Resectional Drainage (국소화 농흉의 외과적 치료 - 폐쇄식 늑골절제 배농술 -)

  • 허진필;이정철;정태은;이동협;한승세;선기남
    • Journal of Chest Surgery
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    • v.31 no.11
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    • pp.1063-1069
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    • 1998
  • Background: Multi-loculated empyema makes treatment difficult, and more so when thoracentesis or chest tube drainage fails. Materials and methods: From December 1991 to December 1997, we performed closed rib resectional drainage for 18 cases of loculated empyema on the fibrinopurulent or early chronic phase. Results: Surgery was performed on patients with loculated empyema complaining of persistent symptoms due to failure of treatment by thoracentesis(8 cases) or chest tube drainage(10 cases). Predisposing factors of empyema were pneumonia in 13 cases, clotted hemothorax in 3 cases, cholecystectomy, and tuberculous pleurisy in 1 case. Causal organisms were cultured in 8 cases(42.1%), and methicillin-resistant staphylococcus aureus was found in 3 cases, pseudomonas aeruginosa in 2 cases, and enterococcus aerogens, α-hemolytic streptococcus, and acinetobacter baumannii were found in 1 case. Size of loculations was various, and computed chest tomogram showed multiple loculations of empyema numbering 1∼4(mean 1.78±1.00). Operating time was relatively short, about 55∼140 mins(mean 102.8±30.8). All toxic symptoms including fever disappeared postopratively and general conditions improved very quickly in all patients. Length of chest tube indwelling time and hospital stay after surgery were 3∼42 days(mean 11.4±11.5) and 6∼36 days(mean 12.9±8.1), respectively. Complications of prolonged drainage occurred in 2 cases and no death occurred. There were no recurrences and chest x-rays taken 3∼6 months after surgery showed normal findings in 14 cases and slight pleural thickening in 4 cases. Conclusions: Closed rib resectional drainage requires very simple techniques and has excellent outcomes and little complications, therefore, we think that it is the choice of operation for patients with loculated empyema on the fibrinopurulent or early chronic phase.

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Characterization of Cement Solidification for Enhancement of Cesium Leaching Resistance (세슘 침출 저항성 증진 시멘트 고화체의 제조 및 특성 평가)

  • Kim, Gi Yong;Jang, Won-Hyuk;Jang, Sung-Chan;Im, Junhyuck;Hong, Dae Seok;Seo, Chel Gyo;Shon, Jong Sik
    • Journal of Nuclear Fuel Cycle and Waste Technology(JNFCWT)
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    • v.16 no.2
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    • pp.183-193
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    • 2018
  • Currently, the Korea Atomic Energy Research Institute (KAERI) is planning to build the Ki-Jang Research Reactor (KJRR) in Ki-Jang, Busan. It is important to safely dispose of low-level radioactive waste from the operation of the reactor. The most efficient way to treat radioactive waste is cement solidification. For a radioactive waste disposal facility, cement solidification is performed based on specific waste acceptance criteria such as compressive strength, free-standing water, immersion and leaching tests. Above all, the leaching test is important to final disposal. The leakage of radioactive waste such as $^{137}Cs$ causes not only regional problems but also serious global ones. The cement solidification method is simple, and cheaper than other solidification methods, but has a lower leaching resistance. Thus, this study was focused on the development of cement solidification for an enhancement of cesium leaching resistance. We used Zeolite and Loess to improve the cesium leaching resistance of KJRR cement solidification containing simulated KJRR liquid waste. Based on an SEM-EDS spectrum analysis, we confirmed that Zeolite and Loess successfully isolated KJRR cement solidification. A leaching test was carried out according to the ANS 16.1 test method. The ANS 16.1 test is performed to analyze cesium ion concentration in leachate of KJRR cement for 90 days. Thus, a leaching test was carried out using simulated KJRR liquid waste containing $3000mg{\cdot}L^{-1}$ of cesium for 90 days. KJRR cement solidification with Zeolite and Loess led to cesium leaching resistance values that were 27.90% and 21.08% higher than the control values. In addition, in several tests such as free-standing water, compressive strength, immersion, and leaching tests, all KJRR cement solidification met the waste acceptance or satisfied the waste acceptance criteria for final disposal.

Posterior Cruciate Ligament Reconstruction by Tibial Inlay Technique (Tibial Inlay 방법을 이용한 후방 십자 인대 재건술의 결과)

  • Song Eun Kyoo;Yoon Taek Rim;Jung Jong Wook;Kim Jong Seon
    • Journal of the Korean Arthroscopy Society
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    • v.5 no.2
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    • pp.80-84
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    • 2001
  • Purpose : To evaluate the clinical and radiological results of posterior cruciate ligament reconstruction(PCL) by tibial inlay technique. Materials and Methods : Twenty four patients(25 cases), who underwent reconstruction of posterior cruciate ligament by tibial inlay technique and were followed up for at least 2 years, were reviewed retrospectively. Mean age at operation was 35 years and mean period of follow up was 34 months. Clinically Lysholm knee socre, posterior drawer test and step off sign were evaluated. Instrumented posterior laxity test with $Telos^{\circledR}$ device(Telos stress device; Austin & Associates, Inc., Polston, US) was performed. Results : Lysholm knee score was improved from 56.9 points preoperatively to 94.6 points at fellow up. Posterior drawer test showed grade II instability in 1 case, grade III in 18 and Grade IV in 6 preoperatively and improved to grade I In 12, grade II in 10 and grade III in 3 at follow up. Step off signs were changed from -10mm in 6 cases, -5mm in 18 and flush in 1 preoperatively to -5mm in 3, flush in 10 and +5mm in 12 at follow up. Side to side difference of instrumented posterior laxity test was improved front 13.6mm preoperatively to 4.3mm at follow up. Conclusions : PCL reconstruction by tibial inlay technique is considered to be a good treatment method to restore posterior stability of the knee, which could result in satisfactory clinical and radiological results at more than 2 years' follow up.

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Clinicopathological Characteristics of Superficially Spreading Early Gastric Cancer (표층 확장형 조기위암의 임상병리학적 특성)

  • Kwon, Sung-Joon;Kim, Hyoung-Ju
    • Journal of Gastric Cancer
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    • v.5 no.4 s.20
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    • pp.288-294
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    • 2005
  • Purpose: Superficially spreading (SS) early gastric cancer (EGC) is characterized by wide horizontal extension without deep vertical invasion. It is a relatively rare form of EGC, and it's clinicopathological (C-P) characteristics are not evident. This study aimed to clarify their C-P characteristics. Materials and Methods: We defined SS EGC as invading less than the submucosal layer that measured more than 60 mm in diameter or wider than $5{\times}5cm \;(25cm^2)$ in width. The C-P characteristics and prognosis were compared between 69 patients with SS EGC and 319 patients with the common type EGC (EGC except SS type). Results: For SS EGC lymph node metastases, Lauren's diffuse type, lymphatic invasion were significantly higher than in common type EGC. In patients with SS EGC, all of the metastatic lymph nodes were anatomically distributed within the paragastric region, with fewer along the left gastric artery and common hepatic artery. In 6 cases of SS EGC with resection marqins less than 10 mm, there was no death during the follow-up period (4 to 13 years after operation) if margins were not involved. Age (>58 yrs), tumor site (upper 1/3), lymph node metastasis, submucosal invasion were statistically significant poor prognostic factor in univariate survival analysis. In multivariate survival analysis, age and lymph node metastasis were independent prognostic factors. However, tumor diameter or width was not a significant prognostic factor. Conclusion: Although SS EGC has histologically distinct properties, gastrectomy with free surgical margins and appropriate lymph node dissection $(D1+{\beta})$ could be a suitable treatment.

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Development Process and Methods of Audit and Certification Toolkit for Trustworthy Digital Records Management Agency (신뢰성 있는 전자기록관리기관 감사인증도구 개발에 관한 연구)

  • Rieh, Hae-young;Kim, Ik-han;Yim, Jin-Hee;Shim, Sungbo;Jo, YoonSun;Kim, Hyojin;Woo, Hyunmin
    • The Korean Journal of Archival Studies
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    • no.25
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    • pp.3-46
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    • 2010
  • Digital records management is one whole system in which many social and technical elements are interacting. To maintain the trustworthiness, the repository needs periodical audit and certification. Thus, individual electronic records management agency needs toolkit that can be used to self-evaluate their trustworthiness continuously, and self-assess their atmosphere and system to recognize deficiencies. The purpose of this study is development of self-certification toolkit for repositories, which synthesized and analysed such four international standard and best practices as OAIS Reference Model(ISO 14721), TRAC, DRAMBORA, and the assessment report conducted and published by TNA/UKDA, as well as MoRe2 and current national laws and standards. As this paper describes and demonstrate the development process and the framework of this self-certification toolkit, other electronic records management agencies could follow the process and develop their own toolkit reflecting their situation, and utilize the self-assessment results in-house. As a result of this research, 12 areas for assessment were set, which include (organizational) operation management, classification system and master data management, acquisition, registration and description, storage and preservation, disposal, services, providing finding aids, system management, access control and security, monitoring/audit trail/statistics, and risk management. In each 12 area, the process map or functional charts were drawn and business functions were analyzed, and 54 'evaluation criteria', consisted of main business functional unit in each area were drawn. Under each 'evaluation criteria', 208 'specific evaluation criteria', which supposed to be implementable, measurable, and provable for self-evaluation in each area, were drawn. The audit and certification toolkit developed by this research could be used by digital repositories to conduct periodical self-assessment of the organization, which would be used to supplement any found deficiencies and be used to reflect the organizational development strategy.

Analysis of Waterbody Changes in Small and Medium-Sized Reservoirs Using Optical Satellite Imagery Based on Google Earth Engine (Google Earth Engine 기반 광학 위성영상을 이용한 중소규모 저수지 수체 변화 분석)

  • Younghyun Cho;Joonwoo Noh
    • Korean Journal of Remote Sensing
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    • v.40 no.4
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    • pp.363-375
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    • 2024
  • Waterbody change detection using satellite images has recently been carried out in various regions in South Korea, utilizing multiple types of sensors. This study utilizes optical satellite images from Landsat and Sentinel-2 based on Google Earth Engine (GEE) to analyze long-term surface water area changes in four monitored small and medium-sized water supply dams and agricultural reservoirs in South Korea. The analysis covers 19 years for the water supply dams and 27 years for the agricultural reservoirs. By employing image analysis methods such as normalized difference water index, Canny Edge Detection, and Otsu'sthresholding for waterbody detection, the study reliably extracted water surface areas, allowing for clear annual changes in waterbodies to be observed. When comparing the time series data of surface water areas derived from satellite images to actual measured water levels, a high correlation coefficient above 0.8 was found for the water supply dams. However, the agricultural reservoirs showed a lower correlation, between 0.5 and 0.7, attributed to the characteristics of agricultural reservoir management and the inadequacy of comparative data rather than the satellite image analysis itself. The analysis also revealed several inconsistencies in the results for smaller reservoirs, indicating the need for further studies on these reservoirs. The changes in surface water area, calculated using GEE, provide valuable spatial information on waterbody changes across the entire watershed, which cannot be identified solely by measuring water levels. This highlights the usefulness of efficiently processing extensive long-term satellite imagery data. Based on these findings, it is expected that future research could apply this method to a larger number of dam reservoirs with varying sizes,shapes, and monitoring statuses, potentially yielding additional insights into different reservoir groups.