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We investigated the use of ulinastatin in association with the suppression of polymorphonuclear leukocyte elastase (PMNE), tumor necrosis factor alpha (TNF-a)and interleukin 6 (IL-6), and its effects on the prognosis of patients with traumatic hemorrhagic shock. Nineteen patients who visited the emergency department for traumatic hemorrhagic shock were enrolled. Eleven patients were randomly selected to receive a total of 300,000 IU of ulinastatin. Measurements of serum PMNE,TNF-a and IL-6 were taken before ulinastatin treatment at 24 hr, two days, three days, and seven days after admission. We compared the Systemic Inflammatory Response Syndrome scores, Multiple Organ Dysfunction Syndrome scores and Acute Physiology, age, Chronic Health Evaluation III scores of the control and ulinastatin groups. There were no significant differences in baseline values, laboratory data, treatment or mortality between the two groups. The serum PMNE levels in the ulinastatin group were lower than in the control group on the second hospitalized day. Serum TNF-a and IL-6 levels in the ulinastatin group decreased 24 hr after admission but had no significance. It is suggested that ulinastatin treatment could decrease the serum PMNE levels in trauma patients with hemorrhagic shock at 48 hr after treatment.
Globalization changes in market structures and consumer needs, as well as technology innovations force organizations to adopt new structures and collaborative networks to cope with rapidly changing environments. These Collaborative Networks are based on the idea of virtual enterprise. A virtual enterprise(VE) is a temporary alliance of globally distributed independent enterprises that share core competencies and computer networks. This paper presents a proposal for a methodology to measure a key factor of success and risk. First of all, we chose thirty experts' defines on virtual enterprise, fifteen are academic specialist and other fifteen are from industry. For this study we define twenty two factors determining VE's success and seventeen factors determining VE's risk using by Delphi method. And we built the influence model on virtual enterprise. A research model was established according to preceeding research and consensus on experts then the revised model of key factors on virtual enterprise. This survey was based on the Analytical Hierarchy Process (AHP). AHP is an approach to decision making that involves structuring multiple choice criteria into a hierarchy, the assessing the relative important of these criteria, comparing alternative for each criteria, and determining an overall ranking of the alternatives. A model was constructed as 3 level hierarchy. The hierarches are organizational, strategic, technical criteria. For success model on VE has 22 factors and 17 factors for risk model. They are selected by all 30 experts. 14 copies among 30 copies distributed to carry out on the Analytical Hierarchy Process (AHP). Consistency ratio confirm high validity and reliability of instrument and support theoretical model. The results of this study are summarized as follows. (1) This study presented success on VE influenced strategic criteria, and essential factor is Creating a value. Risk on VE influenced strategic criteria, and essential factor is Outcome/Distribution. (2) Its enable that ranking the criteria influence on VE. These are supported VE management and using guideline of VE.
Understanding the basic qualities of communication between emergency physicians (EPs) and patients could improve communication in the emergency department (ED). The objectives are to map the literature about the gaps in communication between EPs and patients in the ED, and make recommendations for further research. The articles were searched for using two-keyword combinations of the keywords joined by “AND”: “communication,”“patient,”“emergency physician,”“emergency department/emergency room/accident and emergency room.”through Pubmed, Scopus, and SocINDEX. Finally, seventeen articles were included. Five issues were found: patient-centered communication, information sharing, bad news delivery, shared decision making, and physicians'perspectives on communication. EPs'communication characteristics were doctor-driven decision making, focusing on efficient information gathering, immature communication techniques, and obstacles to overcoming miscommunication. Patients' characteristics were active participation in medical encounters, expectation of physician as a reliable guide, understanding physicians'difficulties, and factors that contribute to understanding. Further research is required to consider diverse patient needs in the ED. Training programs for EPs to improve the quality of communication should be developed and implemented in line with our findings.
응급실은 24시간 쉬는 날 없이 응급 환자를 진료하는 곳이다. 응급실 의사는 교대 근무를 하면서 낮 또는 밤에, 그리고 평일 또는 주말에도 환자를 보게 된다. 특히 밤 근무와 밤 근무 전후의 수면은 정상적인 생체 리듬을 거스르기 때문에 응급의학과 의사들은 만성적인 피로와 수면 장애에 시달리기 쉽다. 미국 응급의학 전문의협회에서 시행한 2008년 Longitudinal Study of Emergency Physicians (LSEP)의 결과에 따르면 야간 근무는 직업 만족도를 떨어뜨리고 건강(피곤함, 낮은 수면의 질, 기분 감소)에 부정적인 영향을 주며, 은퇴를 고려하는 주요 원인이라고 한다. 의사의 수면 부족이나 수면 장애는 환자의 안전, 의료 과실과 연결된다. 국내에서는 아직 응급의학과 의사들의 수면의 질이나 수면 장애에 대한 연구가 없었다. 2005년 응급의학과 전문의 총조사에서 응답자들의 수면에 대해 분석해보고 수면의 질에 영향을 주는 요소들을 알아보고자 한다.