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      • KCI등재후보

        억제대 적용지침 개발을 통한 불필요한 억제대 적용율 감소활동

        곽경선,김성은,배은경,이은숙,이은혜,최윤정,이윤경 한국의료QA학회 2009 한국의료질향상학회지 Vol.15 No.2

        문제: 억제대 적용에 대한구체적 적용지침 없이 의례적으로 억제대를사용함으로 인해 환자들의 신체적 또는 정신적 안전을 위협할 수 있다. 목적: 완전 진정상태 이거나 근력이 약하여 발관능력이 없는 환자에 대한 예방적 적용, 바빠서 환자를볼수 없 는경우, 간호사본인의 판단이 없이 타인의 요구에 따르는등의 불필요한 억제대 적용이 증가하는 원인을 파악하여 중환자실의 특수성에 맞는 억제대 적용및 제거 지침을 마련하고자 한다. 의료기관: 인천광역시에 소재한 의과대학 소속병원의 집중치료실 개선효과: 억제대 적용에 대한중환자실 간호사에게 미치는 영향을 보면 태도 정도 p=0.09(p<0.1), 올바른 수행 능력은 p= 0.005 (p <0.0히로통계적으로유의한것으로 나타났다. 지식 정도 p=0.172(p<0.05) 통계적으로 유의 하지는 않지만 모든항목이 개선 활동전 에 비해 2,3차 개선 활동후에 향상한 것으로 나타났다. 개선활동전에 8.1%였던 간호 기록, 0.7%였던 간호중재, 0%였던 의사처방율이 3차 개선 활동 후 3가지 모두 100% 달성되었다. 이는 억제대 적용율 갑소 및 부적절한 억제대 적용율은 유의하게 감소하였다. 교훈: 중환자실 간호사의 억제대 적용에 대한태도, 지식, 올바른 간호 수행 능력은 지속적으로 재평가 되어지고, 교육내용은좀더 나은 간호제공을 위하여 개발 되어져야 할 것이다. 억제대 적용 기준과 제거 기준을 Check List 하여 객관성의 유지를 위한 개선 활동은계속적으로 Feedback 되어야 할 것이다.

      • KCI등재
      • 항만하역 근로자들의 직업적 특성과 사회심리적 스트레스에 관한 연구

        최은경,이종태,손혜숙,이성훈 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.5

        Objective : The objective of this study is to evaluate the job characteristics of container terminal workers by applying the Job Strain model, and to assess the relationship among the general characteristics, job characteristics and psychosocial distress. Methods and Material : A self-administrated questionnaire survey was performed in Busan. The subjects were consisted of 100 white-collar workers and 100 blue-collar workers. We used Karaseks Job Content Questionnaire for evaluation of the job characteristics and Psychosocial well-being index (PWI) for measuring the extent of their psychosocial stress. Results : In white-collar workers, the skill discretion, created skill, decision-making authority, decision-making latitude, psychological job demand, and supervisor support of the job characteristics were significantly high, while in blue-collar workers physicalexertion was significantly high. PWl reveals that blue-collar workers were mere stressed than white-collar workers, especially, the factor 2, 3 and 4 were significantly increased; whereas, in white-collar workers, only the index of factor 1 was significantly increased. And PWl scores were significantly increased in the lower social support and psychological job demand. blue-collar workers had increased odds ratio of 2.66(95% CI:1.11-6.41) compared with white-collar workers. The unmarried workers increased odds ratio of 3.54(95% CI;1.18-10.62) compared with married workers. And workers who have not own house increased odds ratio of 2.35(95% CI;1.15-4.79) compared with workers who have own house. Particularly, odds ratio of work-shift in blue-collar workers was 11.10(2.14-57.64). (multiple logistic regression analysis PWI). Conclusion : The results of this study correspond with the fact that The more job demand is high and Job control is low, the more job stress is high. Job stress of blue-collar workers was comparatively higher than that of white-collar workers, sleeping, smoking, and work shifting turned out to be a main cause that increases stress. Therefore, in order to decrease the job stress, a health promotion program to change the health behaviors should be activated and an organized job stress management program should be introduced. Especially, working condition for blue-collar such as physical exertion and work-shift should be improved.

      • 자기공명영상에서 발견된 두개내 해면상 혈관기형의 특징 : 위치와 출혈유무와의 상관관계 Correlation between Hemorrhage and Location

        최혜영,정은철 梨花女子大學校 醫科大學 醫科學硏究所 1996 EMJ (Ewha medical journal) Vol.19 No.1

        The cavernous malformation is increasingly recognized as a vascular malformation of the brain that presents with seizures, hemohhage, or neurologic deficit. We have identified 24 lesions in 12 patients that were diagnosed cavernous malformation of the brain based on the findings of follow-up magnetic resonance image and sugical biopsy. The location of the lesions were the supratentorial area in 20 and infratentorial area in 4. Ten lesions were seen at the periventricular white matter. Combined venous angioma was noted in 4 patients. The app-earance of the lesions classified by signal intensities on MRI was divided into reticular pattern in 11, punctate pattern in 9, hematoma pattern in 3, and cystic pattern in one. Recent hemorrhage was identified at 9 lesions that classified into extralesional type in 5 and intralesion type in 4. Among 9 hemorrhagic lesions, eight lesions were located at the periventricular white matter and six lesions showed reticular patterns. We concludedthat the correlation between the evidence of recent hemorrhage and location and pattern of the lesions should be evaluated to predict possibility of rebleeding of the cavernous malformation.

      • 척수내 종양의 자기공명영상소견

        최혜영,정은철 梨花女子大學校 醫科大學 醫科學硏究所 1996 EMJ (Ewha medical journal) Vol.19 No.3

        Purpose : The purpose of this study was to analyze the MR findings of intramedullary tumors and review the literatures for evaluating of characteristic findings of each intramedullary tumors. Materials & Methods : We experienced eight intramedullary tumors from March 1993 to February 1995, including four astrocytomas two ependymoma, one hemangioblastoma, and one cavernoma. MR images were get by 1.5T GE Signa and analized retrospectively. Results : Intramedullary tumor was demonstrated by MR images in eight patients. They were five men and three women ranging in age from 3 to 56 years and complained both motor and sensory changes and symptom duration was between 6 months and 3 years. Ependymoma showed diffuse homogenous enhancing mass at the level of thoracic cord(T2-3) and thoracolumbar level(T11-L2) without cystic change, One had hemorrhage within the mass and massive leptomeningeal metastasis at all spinal cord and brain. Among astrocystomas, one case at the cervical cord unusually revealed hemorrhage in the mass and regional large syrinx. The other one occured at the conus medullaris portion and showed well-defined mass and intratumoral cystic change. We also experienced rare intramedullary hemangioblastoma, which demonstrated typical signal voided vascular structures revealed homogenous enhancing mass. A very rare intramedullary cavernoma at the level of cervical cord showed typical dark signal hemosiderin rim and variable staged hemorrhage in the mass. Conclusion : Although, MR imaging appearance of intramedullary tumors is nonspecific, and it is often impossible to differentiate with certainty between the various possible tumors, especially ependymomas and astrucystomas. However, MR findings of hemangioblastoma and cavernoma are specific and possible to diagnose. MR imaging is the unquestioned technique of choice in demonstrating and differentiating the intramedullary tumors.

      • KCI등재

        Whole-genome resequencing analysis of 20 Micro-pigs

        Da‑Hye Son,Nam‑Hyun Hwang,Won‑Hyong Chung,Ha‑Seung Seong,Hyungbum Lim,Eun‑Seok Cho,Jung‑Woo Choi,Kyung‑Soo Kang,Yong‑Min Kim 한국유전학회 2020 Genes & Genomics Vol.42 No.3

        Background Miniature pigs have been increasingly used as mammalian model animals for biomedical research because of their similarity to human beings in terms of their metabolic features and proportional organ sizes. However, despite their importance, there is a severe lack of genome-wide studies on miniature pigs. Objective In this study, we performed whole-genome sequencing analysis of 20 Micro-pigs obtained from Medi Kinetics to elucidate their genomic characteristics. Results Approximately 595 gigabase pairs (Gb) of sequence reads were generated to be mapped to the swine reference genome assembly (Sus scrofa 10.2); on average, the sequence reads covered 99.15% of the reference genome at an average of 9.6-fold coverage. We detected a total of 19,518,548 SNPs, of which 8.7% were found to be novel. With further annotation of all of the SNPs, we retrieved 144,507 nonsynonymous SNPs (nsSNPs); of these, 5968 were found in all 20 individuals used in this study. SIFT prediction for these SNPs identified that 812 nsSNPs in 402 genes were deleterious. Among these 402 genes, we identified some genes that could potentially affect traits of interest in Micro-pigs, such as RHEB and FRAS1. Furthermore, we performed runs of homozygosity analysis to locate potential selection signatures in the genome, detecting several loci that might be involved in phenotypic characteristics in Micro-pigs, such as MSTN, GDF5, and GDF11. Conclusion In this study, we identified numerous nsSNPs that could be used as candidate genetic markers with involvement in traits of interest. Furthermore, we detected putative selection footprints that might be associated with recent selection applied to miniature pigs.

      • KCI등재

        복수과 진료 환자의 중복 처방에 대한 분석 및 평가

        이지은,장혜경,오지영,유윤경,김현지,임숙인,연숙희,강진숙,최귀령 한국병원약사회 2003 병원약사회지 Vol.20 No.1

        In an aging society, there is an increasing possibility of the duplication of the drugs given to patients because they take many kinds of drugs. Among the prescriptions given to the patients who was treated at multiple ambulatory clinics in St. Mary's hospital for one month of September, 2002, in which drugs that has identical or similar effects are prescribed, we analysed and evaluated them by patients' characteristics, kinds of medication, severity of side effects on a case by case basis. More, we assessed the potential additional costs. As a result of this study, the duplication rate turned out to be 6.69% and it was shown that the proportion of the elderly patients over 60 was high. The gastro-intestinal medications took up a large part and most of the cases showed that the danger caused by double taking of medicine was slight, but there were some examples in which the serious side effects were predicted. Expected additional costs were the average 11.349 won and it ranges from the minimum of 56 won to the maximum of 135,720 won. In conclusion, the management of drug histories of the patients who need the plural treatments is very important and the necessity of the individual and professional guidance of taking medicines for the elderly patients is emerged, too.

      • 뇌경색증의 급성기에 발생한 변비에 대한 연구

        최윤이,김소이,김성은,정혜경,김태헌 이화여자대학교 의과학연구소 2015 EMJ (Ewha medical journal) Vol.38 No.1

        Objectives: The prevalence of constipation is high after stroke. Multiple factors such as long-term bed-ridden status, comorbidity, medical illnesses are combined in this condition. However, the change of bowel movement during the early stage of stroke remainsuncertain. Methods: Patients with first stroke who admitted in a single institute from 2008 to 2009 were reviewed retrospectively and 36 patients were enrolled. As a control group, 47 consecutive orthopedic patients needing bed rest without surgery in the same period were enrolled. Data of stroke associated factors, frequency of BM (bowel movement) during 5 weeks, use of gastrointestinal medications, and outcomes were collected from the medical records. Results: The cumulative incidence of decreased (<3/week) and severely decreased BM (<1/week) were 80.6% and 69.4% in stroke patients and 53.2% and 14.9% in control group (P<0.05). The cumulative incidence of increased BM (>3/day) was 38.9% in stroke and 14.9% in control group. In acute stroke, 58% of patient showed severely decreased BM in first week, and the proportion was rapidly decreased below 15% from second week. However, laxative use increased with hospital days. The occurrence of severely decreased BM in stroke patients was associated with National Institutes of Health Stroke Scale (NIHSS; P=0.004). Severely decreased BM was not associated with poor outcomes including death, morbidity, and stroke recurrence. Conclusion: Decreased BM is common in acute stroke. The occurrence of severely decreased BM is associated with NIHSS. However, the severe manifestation occurred mainly in the first week, and considered to be well controlled by laxatives.

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