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김은희,김철규,이순교,김순덕,이혜옥,권정순,이경미,이민미,심순미,유용만,신종식,강은희,이상일,김병식,오성태,육정환,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.2
Background : Gastric cancer is the most common malignant tumor in Korea. surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for recucing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and unplanned readmission rate between the pre-pathway group(n=67) and the post-pathway group(n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days(p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was of satistically significant(p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korea hospital settings.
Assessment of Nakdong River Basin Management: Target Water Quality Achievement and Future Challenges
Kang, Kyeong Hwan,Kim, Junghyeon,Jeon, Hyeonjin,Kim, Kyoungwoo,Byun, Imgyu 한국방재학회 2020 한국방재학회논문집 Vol.20 No.2
2006년, 환경부에서는 <제1차 물환경관리 기본계획>을 수립하였다. 이 계획은 “Clean Water, Eco River 2015”를 목표로 수질을 보호하고 수자원의 관리를 강화하기 위하여 수립되었다. 본 연구는 낙동강 대권역 내 33개 중권역의 목표수질 달성 여부 및 미달성 중권역의 원인을 분석, 평가 하였다. 2015년 수질 데이터에 따르면, 낙동강 대권역 내 33개 중권역 중 16개 중권역이 계획수립 시 목표수질을 달성하였다. 이러한 낮은 목표수질 달성율은 계획 수립 당시 오염물질 부하 예측, 지류관리 문제, 4대강 사업 및 수질측정 대표지점에 대한 타당성 등의 문제점으로 인해 발생된 것으로 분석되었다. 또한 각 중권역 내 수질측정 대표지점에 대한 타당성을 조사한 결과, 일부 중권역에는 수질측정 대표지점 개선 및 변경이 필요한 것으로 분석되었다. 본 연구는 현재 진행중인 <제2차 물환경관리 기본계획>의 높은 달성율을 위한 오염 물질 부하 관리와 본류 및 지류 관리, 수질 측정 지표에 대한 연구와 같은 수질 개선을 위한 추가 연구도 제안하였다. In 2006, the Korean Ministry of Environment established <The 1st Water Environment Management Master Plan>. The plan aimed at “Clean Water, Eco River 2015” and guided water quality protection and strengthened water management. This study evaluated the achievement of the target water quality among the 33 mid-level basins in the Nakdong River basin and assessments of the causes of non-achievement of the target water quality by mid-level basins. According to the 2015 water quality data, only 16 of the 33 mid-level basins achieved the target water quality. The low achievement of the target water quality was attributed to the failure to predict the pollutant load at the time of planning, problems with the management of tributaries, implementation of the <Four major river restoration project>, and problems with the representativeness of the water quality representative points. In addition, feasibility studies on the water quality monitoring representative point used in each mid-level basin were also performed; some mid-level basins required improvement or change of the representative points. This study also suggested further research to improve water quality, such as detailed studies of the management of pollutant load, mainstream tributaries, and water quality indicators, for the revision of the current ongoing <The 2nd Water Environment Management Master Plan>.
Kyeong Hwan Kang,Geon Lee,Joong Kyun Kim 대한환경공학회 2015 Environmental Engineering Research Vol.20 No.1
To treat leather industry wastewater (LIW) containing high nitrogen concentration, eight aerobic denitrifiers were isolated from sludge existing in an LIW-treatment aeration tank. Among them, one strain named as KH8 had showed the great ability in denitrification under an aerobic condition, and it was identified as Pseudomonas aeruginosa R12. The aerobic denitrification ability of the strain KH8 was almost comparable to its anaerobic denitrification ability. In lab-scale aerobic denitrifications performed in 1-L five-neck flasks for 48 hr, denitrification efficiency was found to be much improved as the strain KH8 held a great majority in the seeded cells. From the nitrogen balance at the cell-combination ratio of 10:1 (the strain KH8 to the other seven isolates) within the seeded cells, the percentage of nitrogen loss during the aerobic denitrification process was estimated to be 58.4, which was presumed to be converted to N2 gas. When these seeded cells with lactose were applied to plant-scale aeration tank for 56 day to treat high-strength nitrogen in LIW, the removal efficiencies of CODCr and TN were achieved to be 97.0% and 89.8%, respectively. Under this treatment, the final water quality of the effluent leaving the treatment plant was good enough to meet the water-quality standards. Consequently, the isolated aerobic denitrifiers could be suitable for the additional requirement of nitrogen removal in a limited aeration-tank capacity. To the best of our knowledge, this is the first report of aerobic denitrifiers applied to plant-scale LIW treatment.