ICU 방법을 활용한 신호교차로 운영분석

김영찬(Kim Young Chan),전재현(Jeon Jae Hyeon),정영제(Jeong Young Je),김은정(Kim Eun Jeoung) 대한토목학회 2009 대한토목학회논문집 D Vol.29 No.1D

신호교차로 용량분석 방법은 국내외에서 주로 사용하고 있는 HCM 방법과 본 연구에서 제시하고자하는 ICU 방법이 있다. HCM 방법은 교통량, 신호운영, 기하구조 자료에 의해 교차로의 지체를 산정하는 운영 분석에 초점이 맞춰져 있고, 계획 및 설계 분석은 반복적인 운영분석을 통해 이루어져 복잡하다. 반면 ICU 방법은 기하구조 및 교통량 자료만으로 교차로 계획 및 설계 분석이 가능하고 용이하며 최소녹색시간을 고려하는 장점이 있다. 본 연구에서는 ICU 방법에 대해 살펴보고, 교통량 시나리오를 구성하여 HCM 방법과 ICU 방법을 비교 분석하였다. 또한 중요교차로 설정을 위한 도시간선도로 축 상의 교차로 용량분석, 횡단보도 유형, 차로수, 차로이용, 좌회전 운영방식 변경의 효과분석에 ICU를 적용 분석함으로써 계획 및 설계 분석 시 ICU 적용의 효율성을 살펴보았다. 분석결과 ICU 방법이 최소녹색시간의 영향을 반영하여 광로로 이루어진 도시 교차로의 정확한 용량상태를 파악할 수 있고, 신호시간 등의 상세한 자료 없이 간편하게 적용할 수 있어 계획 및 설계 분석에 효율적인 것으로 나타났다. 본 연구결과를 토대로 기하구조나 운영방식 변경 등의 계획 분석에 ICU 방법을 유용하게 적용하여 계획 교차로의 정확한 용량상태를 파악함으로써 적절한 계획 및 개선이 이루어질 수 있을 것으로 기대된다. The capacity analysis of signalized intersection usually includes a HCM method used at home and abroad and a ICU method this study presents. The HCM method focuses on operation analysis measuring an intersection's delay in terms of given traffic volume, signal operation, and intersection structure data. This method includes planning and design analysis, but these analyses are complex due to being possible through repetitive operation analysis. However the ICU method is a powerful tool for planning and design analysis, because these are possible through brief traffic volume and geometry structure data and consider minimum green time. In this study, the authors studied the ICU method and compared the HCM and ICU by analyzing traffic volume scenarios. Also to consider effectiveness for application of the ICU method, the authors applied the ICU to capacity analysis of intersections on urban arterial for setting major intersection and effect analysis for changing crosswalk type, the number of lane, lane use and operation form of left turn. The result of the analyses shows that the ICU method can measure correct capacity of intersection consist of a broad road in urban area, and is effective for planning and design analysis. This study is expected that traffic experts can grasp correct intersection's capacity and carry out a proper planning or improvement by applying the ICU method to planning and design analysis.

Unplanned ICU readmission is related more medical care cost and poorer prognosis

( Seok Jeong Lee ),( Yun Kyeong Yi ),( Sang-ha Kim ),( Beomsu Shin ),( Ji-ho Lee ),( Myeong Kyu Lee ),( Saebyol Kim ),( Suk-joong Yong ),( Won-yeon Lee ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

The purposes of this study were to compare the difference in mortality rate and medical care cost between the patients with unplanned ICU readmission(RA) group and non-readmission(non-RA) group, and to evaluate whether unplanned ICU readmission rate is considered to be one of surrogates to qualify the ICU. This study is at questionnaire and the health insurance statement by the Korean Health Insurance Review & Assessment Service. A total of 39,576 patients were analyzed. ‘Unplanned ICU readmission’ was defined as the admission within 72 hours without planning the readmission in advance after discharge form the ICU. Unplanned ICU RA rate was 1.5%(589 patients among 39,576 patients admitted at the ICUs). The mortality rate in the ICU was 19.19% and 10.87% in the unplanned ICU RA group and the non-RA group, respectively. The unplanned ICU RA rates were higher in the institutes with more the number of total beds(p=0.001) more ICU beds(p=0.002) RRT(p=0.016) lower number of ICU patients to nurses(p=0.010) and full time intensivist(p=0.001). The institutes placed full-time intensivist or RRT had more severe patients, but lower mortality rate. The incidence of unplanned ICU RA is increased in ventilator use(OR=2.143, p= <.0001), cardiovascular comorbidity (OR=2.961, p=<.0001), more ICU beds(OR=1.004, p=0.009). The risk factors for unplanned ICU readmission were ventilator use, cardiovascular comorbidity, more ICU beds. The average of medical care cost was $19013 in the unplanned ICU RA group, which was 1.75 folds higher than that in the non-RA group(p=<.0001). The medical care cost per days was $660 in the unplanned ICU readmission group, which was 12%(1.12 folds) higher than that in the non-readmission group(p=<.0001). Unplanned ICU readmission was associated negative impacts on patient outcomes, such as more hospital days and increasing medical care cost. Unplanned ICU readmission rate is considered to be one of surrogates to evaluate the quality of ICU.

소아 환아에서 분리된 Vancomycin 내성 장구균에 대한 임상적 고찰

이동우,이경재,장광천,김동수,이경원,박은숙,Lee, Dong Woo,Lee, Kyung Jae,Jang, Gwang Choen,Kim, Dong Soo,Lee, Kyung Won,Park, Eun Suk 대한소아감염학회 2001 Pediatric Infection and Vaccine Vol.8 No.2

목 적 : 1986년 vancomycin 내성 장구균(이하 VRE)이 보고된 이후 10여년간 빈도는 급격한 증가 추세에 있다. 이에 저자 등은 본 병원에 입원한 소아환자들의 임상검체에서 분리된 VRE의 양상과 해당 환자들의 사용형태에 대한 조사를 시행하여 VRE의 증가양상에 적절히 대처할 수 있는 방안을 모색하고자 본 연구를 시행하였다. 방 법 : 1998년 1월부터 2000년 12월까지 연세의료원 세브란스병원에 입원한 소아 환자에서 분리된 VRE 36주를 대상으로 하여 검체 종류 및 균종, 항균제 감수성과 사용양상을 조사하였고, ICU 환자군과 Non ICU 환자군으로 분류하여 두 군간에 있어서 수술이나 중재적 시술을 시행한 경우와 내과적인 투약처치만을 시행한 경우 등의 분리 전 처치형태를 조사하였고 항균제 감수성을 파악하였으며 중복감염의 여부가 ICU군과 Non ICU군간에서 차이를 보이는지 조사하였다. 결 과 : 본 연구에서, VRE가 분리된 수가 급속히 증가함을 알 수 있었고, ICU 환아군과 수술이나 중재적 시술을 한 경우에서 높은 빈도를 보였으며, E. faecium이 E. faecalis 보다 많이 분리되었다. VRE 항균제 감수성 검사에서 tetracyclin을 제외한 항생제에 높은 내성을 지니고 있었고, 검출된 cephalosporin의 투여비율이 가장 높았으며 검출 후에는 teicoplanin의 투여비율이 증가함을 볼 수 있었고, teicoplanin에 대한 항균제 감수성 결과에 따른 투여비율의 차이는 없었다. 또한, ICU 환자군이 Non ICU 환자군에 비해 중복감염의 경우가 많았다. 결 론 : 증가하고 있는 VRE의 집단 발생과 전파에 이은 합병증을 막기 위해서, 본 연구에서 ICU 단위로 분류하였던 병동과 같은 병원내 VRE의 상재 위험지역에 대한 집중 감시조사와 이의 관리를 위한 여러 행정적 문제의 해결, 적절한 항생제의 사용과 철저한 관리가 필요하리라 사료된다. Purpose : Since the first report of vancomycin-resistant enterococci(VRE) in 1986, the resistance to vancomycin in enterococci has been increasingly rapidly. In this study, we investigated the clinical manifestations of pediatric patients with VRE and the pattern of the antibiotic use with increasing the rate of VRE in pediatrics Methods : We studied retrospectively 36 pediatric patients who were isolated VRE from January 1998 to December 2000. We classified patients into ICU and non ICU groups and reviewed species of VRE, specimens in which VRE were first detected and procedures performed before VRE detected. Results : We have found that the number of pediatric patients isolated VRE is increasingly annually in this study. In addition, the number of VRE-isolation in the ICU group and in patients who were operated or who underwent active procedures is much higher than that of in the non ICU group and in patients who were taken medication only. Enterococcus faecium is the main species of VRE. VRE showed high resistance to almost all antibiotics except tetracycline, and resistance was closely related to the duration of hospitalization and history of the antibiotic use. The proportion of the cephalosporin use was higher than any other antibiotic before VRE detection. In contrast, that of teicoplanin was higher than any other antibiotic after VRE detection(P<0.05). The cases of superinfection is higher in the ICU group than in non ICU group. Conclusion : In the hospital level, prevention of nosocomial infection through proper administrative policies, through surveillance of high risk VRE regions and prudent antibiotic use can prevent VRE outbreaks and corresponding side effects.

계획에 없던 중환자실 재입실 실태 및 원인

송동현,이순교,김철규,최동주,이상일,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.1

Background : Because unplanned readmissions to intensive care unit(ICU)might be related with undesirable patient outcomes, we investigated the pattern of and reason for unplanned ICU readmission to provide baseline data for reducing unplanned returns to ICU. Methods : The subjects included all patients who readmitted to ICU during the same hospitalization at a tertiary referral hospital between January 1st and June 30th 2002. Quality improvement(QI) nurse collected the data through medical records and a medical director reviewed the data collected. Results : 1)The average unplanned ICU readmission rate was 5.6%(gastroenterology 14.6%, pediatrics 12.7%, pulmonology 11.9%, neurosurgery 6.3%, general surgery 5.3%, chest surgery 3.9%, and cardiology 3.3%). 2)Among the unplanned readmissions, more than 50% of cases were from patients older than 60 years, and the main categories of diagnose at hospital admission were neurologic disease(29.9%) and cardiovascular disease(27.6%). 3)Of unplanned ICU readmissions, 41.8% had recurrence of the initial problems, 44.8% had occurrence of new problems. And 9.7% required post-operative care after unplanned operations. 4)The most common cause responsible for unplanned ICU readmission were respiratory problem(38.3%) and cardiovascular problem(14.3%). 5)About 40% of unplanned ICU readmission occurred within 3 days after ICU discharge. 6)Average length of stay of the readmitted patients to ICUs were much longer than that of non-readmitted patients. 7)Hospital mortality rate was much higher for unplanned ICU readmitted patients(23.6%) than for non-readmitted patients(1.5%)(P<0.001). Conclusions : This study showed that the unplanned ICU readmitted patients had poor outcomes(high morality and increased length of stay). In addition study results suggest that more attention should be paid to patients in ICU with poor respiratory function or elderly patients, and careful clinical decisions are required at discharged from ICU to general ward.

Functional status in ICU survivor living with a partner

한송이,양혜주,임성윤,박연경,이용희,조준연,박종선,조영재,윤호일,이재호,이춘택,이연주 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.-

Introduction: Recently, the role of family members has been emphasized to solve the decrease of physical and mental status of ICU survivors. However, little research has been done on it. Therefore, we aimed to investigate the role of family members, especially a partner, in the outcome of ICU survivors. Methods: This study prospectively analyzed medical ICU survivors from March, 2016 to August, 2018 in Seoul National University Bundang hospital. A total of 47 patients were enrolled and divided into two groups, one with partner (n=34) and the other with no partner (n=13). ICU survivors were assessed at 1 week, 1 month, and 3 months after discharge from the hospital. We performed the evaluation of Physical function, cognitive function, mental health, and quality Of Life. Results: The group living with a partner was significantly higher in male sex ratio and height, and the use of mechanical ventilator was also significantly higher at admission (p=0.004, p=0.004, p=0.028, respectively). In the patients with no partner, the Barthel index and hand dynamometry was significantly decreased at 1 week and 1 month after discharge from ICU. Also, in ICU memory questionnaire test, patients with a partner had a clearer memory of the situation at the time of the ICU admission and were more likely to share memories of ICU admission with others. Conclusion: In ICU survivors, the partner can be a predictor of the patient’s functional status. Therefore, if the intensivist closely communicates with the partner, it may help to improve the patient’s long term prognosis.

한국판 자기보고식 냉담-무정서 특질 척도(ICU) 타당화 연구 : 탐색적 구조방정식 모형(ESEM)의 적용

최재란 ( Jaeran Choi ),서종한 ( Jong-han Sea ) 대한범죄학회 2021 한국범죄학 Vol.15 No.3

본 연구는 청소년 사이코패시의 하위 차원인 냉담-무정서 특질(Callous-Unemotional traits; CU)을 측정하는 ICU(Inventory of Callous-Unemotional traits) 척도를 국내 타당화하기 위해 실시되었다. 국내외 선행연구 결과를 보완하여 ICU 척도의 요인구조를 탐색하고, 다른 청소년 사이코패시 척도들 간 상관을 통해 준거타당도를 검증하였다. 이를 위해 전국 만 15세∼18세 일반 청소년 400명을 대상으로 평행분석, 탐색적 요인분석(EFA), 탐색적 구조방정식 모형(ESEM) 분석을 실시하였고, YPI(Youth Psychopathic traits Inventory)와 CUE(Caring-Uncaring Emotional Inventory)를 준거 척도로 사용하였다. 분석 결과를 종합적으로 고려했을 때 ICU 척도는 기존 선행연구와 달리 4요인 모형이 가장 적절한 것으로 나타났고, 이와 관련하여 ICU 타당화 선행연구 결과들을 비교하여 제시하였다. 각각의 요인은 ‘무책임성’, ‘감정표현 결여’, ‘냉담성’, ‘죄책감 결여’로 명명하였다. ICU와 YPI, CUE 간 관계는 일부 중간에서 높은 수준의 유의미한 상관을 보였다. 기존 국내외 ICU 타당화 연구들은 고전적 요인분석에 근거하였기에 본 연구에서 최신 통계적 기법인 ESEM을 통해 타당화 연구를 확장하고 보다 엄격한(robust) 요인 모형을 제시하였다는 데 의의를 가진다. 마지막으로 추후 연구를 위한 방향과 연구의 제한점을 논의하였다. The purpose of this study was to examine the factor structure of the Inventory of Callous-Unemotional traits (ICU) in a community sample of adolescents in Korea. For this, 400 adolescents aged 15 to 18 in community sample were recruited from a total of 17 regions in Korea. The factor structure of the ICU scale was explored with Parrallel Analysis, EFA and ESEM, supplementing the results of previous validation studies. The result showed unlike previous studies, the four-factor model was found to be the most appropriate for the ICU. Each factor was named ‘Uncaring’, ‘Unemotional’, ‘Callousness’, ‘Lack of guilt’. Then, in order to analyze the correlation between other youth psychopathic scales, YPI and APSD were used as reference scales. The relationship between ICU, YPI, and APSD showed some significant correlation. It is meaningful that this study expanded the validation study through the latest statistical technique, ESEM, with robust factor model compared to previous validation studies based on classical factor analysis. Finally, we discussed the direction for future research and the limitations of the study.

중환자실에서 분리된 methicillin내성 포도상구균의 분자 역학적 조사

서을주,배직현 대한임상병리학회 1996 대한임상병리학회지 Vol.16 No.4

중환자실 병원감염에 대한 다기관 공동 조사연구

박은숙,박미라,진혜영,김정은,최정실,송영구,최영화,이위교,홍성관,허애정,양동규,김준명 대한병원감염관리학회 2003 의료관련감염관리 Vol.8 No.1

소음과 수면양상에 관한 연구 : 중환자실을 중심으로

손연정 성인간호학회 2001 성인간호학회지 Vol.13 No.2

The environment in the ICU leads to negative changes in a patient's usual sleep pattern and so contributes negatively to the patient's health wards. Therefore, it is thought that an important nursing intervention would be to identify the relation between noose and sleep patterns which play an important role in illness recovery. The purpose of the present study was to explore the relationship between noise in the ICU and the sleep pattern of patients admitted to the ICU. A descriptive correlation design was used to examine the relationship. Thirty-four subjects were recruited from a Medical ICU (MICU), Surgical ICU (SICU) and Coronary Care Unlt (CCU) at a large university hospital in Suwon. Data were collected from September 28 to October 31 in 1999. In the present study. noise was categorized into noise level and patients' perception of noise. The objective noise level was measured using the A-Weighted Sound Level Meter. The patients' preception of noise was measured using a self-reported questionnaire developed by the researcher. Sleep patterns in this study includes both quantity and quality of sheep. These were measured using open ended questionnaires and the 'Korean Sleep Scale A developed by Oh, Song, Kim(1998). The data was analyzed using the SPSS-WIN to test the research questlon. Pearson moment correlation coefficient was run. Ancillary analysis were conducted with demographic vairables to determine their relation to the malts study variables. For the ancillary analysis, t-test and one-way ANOVAs were performed. The results of the present study are summerized as follows : 1. The total mean of objective noise level (10pm-yam) was 56.2dB. The means for night time noise level in individual ICUs for the SICU, MICU and CCU, were 58.7dB, 58.6dB and 48.3dB, respectively. The total mean for patlents' noise perception was 42.8 out of a maximum possible score of 76. For item means of noise perception, the one ranked hightest was "conversations" between doctors and nurses″(3.2). The one ranted lowest was ″noise from the radio″(1.2). Regarding the degree of perception for each type of noise source, the one ranked highest was ″equipment noise″(2.6), the second was the third was ″conversation between patients, caregivers and visitors″(2.3), and the one ranked lowest was ″environment noise″(1.8). 2. Looking at quantity of sleep of ICU patients, the mean nocturnal sleep time was found to be 4.9 hours. The total mean of sleep quality for ICU patients was 21.0 out of a maximum possible score of 40. 3. The relationship between perception of noise and quantity or sleep was statistically significant(r= -.41, p<05). The relationship between perception of noise and quality of sleep was also statistically significant(r= - .47, p<.01). The results of the study indicate that personal perception of noise is related to patterns. Therefore, it is suggested that nursing interventions be developed to reduce the degree of personal perception of noise and, thus, decrease sleep pattern disturbances in patients in the ICU.

분산 네트워크 환경하에서 TMO를 이용한 ICU 실시간 생체정보 전송 시스템

김광준(Gwang-Jun Kim),임세정(Se-Jung Lim) 한국정보기술학회 2009 Proceedings of KIIT Conference Vol.2009 No.-

분산 네트워크 시스템에서 실시간 객체 지향 모델 TMO를 이용하여 메시지를 실시간으로 전송하기 위해 시간 구동과 메시지 구동(TMO : Time-triggered Message-triggered Object Model)에 대한 구조를 일반적인 형태의 구조로 모델링 하였으며, 이러한 모델링은 분산된 실시간 통신 객체와 비실시간 객체를 포함하여야 한다. 메시지 구동 메소드와 시간 구동 메소드를 모든 객체 구조 형태에 적용함으로서 메시지를 실시간적으로 전송 할 수 있다. 본 논문에서는 이러한 TMO 구조를 이용하여 실시간 통신을 하기 위해 ICU(Intensive Care Unit) 환자 모니터 원격진료 시스템 응용 환경에 적용하였다. ICU의 Central Monitor로부터 전송되어진 환자의 생체정보 Raw Data가 HIS의 TMO 파싱 데이터 수신 모듈을 통해 사용가능한 데이터로 재구성될 수 있도록 설계가 이루어져 있다. The TMO may contain two types of methods, time-triggered methods(also called the spontaneous methods of SpMs) which are clearly separated from the conventional service methods (SvMs). The SpM executions are triggered upon design time whereas the SvM executions are triggered by service request message from clients. In this paper, we describes the application environment as the patient monitor telemedicine system with TMO structure. Vital sign information web viewer systems is also the standard protocol for medical image and transfer. We have to design to obtain useful vital sign information, which is generated at parsing data receiver modulor of HIS with TMO structure, that is offered by the central monitor of ICU. In order to embrace new technologies as telemedicine service, it is important to develope the standard protocol between different systems in the hospital, as well as the communication with external hospital systems.