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Huh Yo,Kwon Junsik,Moon Jonghwan,Kang Byung Hee,Kim Sora,Yoo Jayoung,Song Seoyoung,Jung Kyoungwon 대한의학회 2021 Journal of Korean medical science Vol.36 No.22
Background: This study examined the impact of the performance improvement and patient safety (PIPS) program implemented in 2015 on outcomes for trauma patients in a regional trauma center established by a government-led project for a national trauma system in Korea. Methods: The PIPS program was based on guidelines by the World Health Organization and American College of Surgeons. The corrective strategies were proceeded according to the loop closure principle: data-gathering and monitoring, identification of preventable trauma deaths (PTDs), evaluation of preventable factors, analysis of findings, and corrective action plans. We established guidelines and protocols for trauma care, conducted targeted education and peer review presentations for problematic cases, and enhanced resources for improvement accordingly. A comparative analysis was performed on trauma outcomes over a four-year period (2015–2018) since implementing the PIPS program, including the number of trauma team activation and admissions, time factors related to resuscitation, ventilator duration, and the rate of PTDs. Results: Human resources in the center significantly increased during the period; attending surgeons responsible for trauma resuscitation from 6 to 11 and trauma nurses from 85 to 218. Trauma admissions (from 2,166 to 2,786), trauma team activations (from 373 to 1,688), and severe cases (from 22.6 to 33.8%) significantly increased (all P < 0.001). Time to initial resuscitation and transfusion significantly decreased from 120 to 36 minutes (P < 0.001) and from 39 to 16 minutes (P < 0.001). Time to surgery for hemorrhage control and decompressive craniotomy improved from 99 to 54 minutes (P < 0.001) and 181 to 135 minutes (P = 0.042). Ventilator duration and rate of PTDs significantly decreased from 6 to 4 days (P = 0.001) and 22.2% to 8.4% (P = 0.008). Conclusion: Implementation of the PIPS program resulted in improvements in outcomes at a regional trauma center that has just been opened in Korea. Further establishment of the PIPS program is required for optimal care of trauma patients.
강병희,최동환,조자윤,권준식,Yo Huh,문종환,김영환,정경원,John Cook-Jong Lee 대한의학회 2017 Journal of Korean medical science Vol.32 No.12
A new blood bank system was established in our trauma bay, which allowed immediate utilization of uncross-matched type O packed red blood cells (UORBCs). We investigated the efficacy of UORBC compared to that of the ABO type-specific packed red blood cells (ABO RBCs) from before the bank was installed. From March 2016 to February 2017, data from trauma patients who received UORBCs in the trauma bay were compared with those of trauma patients who received ABO RBCs from January 2013 to December 2015. Propensity matching was used to overcome retrospective bias. The primary outcome was 24-hour mortality, while the secondary outcomes were in-hospital mortality and intensive care unit (ICU) length of stay (LOS). Data from 252 patients were reviewed and UORBCs were administered to 64 patients. The time to transfusion from emergency room admission was shorter in the UORBC group (11 [7–16] minutes vs. 44 [29–72] minutes, P < 0.001). After propensity matching, 47 patients were included in each group. The 24-hour mortality (4 [8.5%] vs. 9 [13.8%], P = 0.135), in-hospital mortality (14 [29.8%] vs. 18 [38.3%], P = 0.384), and ICU LOS (9 [4–19] days vs. 5 [0–19] days, P = 0.155) did not differ significantly between groups. The utilization of UORBCs resulted in a faster transfusion but did not significantly improve the clinical outcomes in traumatic shock patients in this study. However, the tendency for lower mortality in the UORBC group suggested the need for a large study.
토양검정(土壤檢定)에 의한 채소류(菜蔬類)의 삼요소(三要素) 시비량(施肥量) 조정(調整)
이춘수,허범량,송요성,곽한강,Lee, Choon-Soo,Huh, Beom-Lyang,Song, Yo-Sung,Kwak, Han-Kang 한국토양비료학회 1994 한국토양비료학회지 Vol.27 No.2
1980~'90년대(年代)의 토양화학(土壤化學) 성분함량(成分含量) 및 기존(旣存) 시비량(施肥量) 성적(成績)을 이용(利用)하여 채소류(菜蔬類)에 대한 시비기준량(施肥基準量)을 보완조정(補完調整)한 결과(結果)를 요약(要約)하면 다음과 같다. 1. 연대별(年代別) 토양화학(土壤化學) 성분(成分)의 변화를 보면 1980~'90년대(年代)가 1960~'70년대(年代)에 비해 토양(土壤)의 인산(燐酸)과 가리(加里)가 축적(蓄積)되었으며, 전체(全體) 재배면적(栽培面積)에 대해 축적(蓄積)된 유효인산(有效燐酸)(400ppm이상(以上)) 및 치환성가리(置換性加里)(0.7me/100g이상(以上))의 면적(面積) 비율(比率)은 각각 70.5, 59.2%이었다. 2. 1980~'90년대(年代)의 토양화학성분(土壤化學成分)을 토대로 채소류별(菜蔬類別) 시비기준량(施肥基準量)을 하향조정(下向調整)하였으며, 그 결과(結果) 질소(窒素) 0~6.0kg/10a, 인산(燐酸) 0.7~12.3kg/10a, 가리(加里) 2.0~9.0kg/10a의 절감(節減)이 가능하였다. 3. 채소류(菜蔬類)에 대한 현행(現行) 시비추천(施把推薦) 공식(公式)을 종합적(綜合的)으로 보완(補完)해 토양화학성분(土壤化學咸分) 함량(含量)에 의한 필지(筆地)별 시비량추천(施肥量推薦)의 정확도(正確度)를 더욱 높였다. An attempt to adjust the standard levels of NPK fertilizers application was made with the analytical data of soil and the results of field experiments on 18 vegetable crops 1. There was a remarkable accumulation of available $P_2O_5$ and exchangeable K of soil in the periods of 1980~1990 comparing with 1960~1970. 2. New fertilizer recommendations based on the accumulation of soil components enabled to decrease fertilizer requirements of major vegetable crops. It was founded that if such new recommendations were adopted by the farmer, 0~6.0kg N/10a, 0.7~12.3kg $P_2O_5/10a$ and 2.0~9.0kg $K_2O/10a$ could be saved without affecting the yield of crops 3. The formulas of fertilizer application for crops were corrected in order to determine optimal rate of each farmer field according to chemical properties of soil.