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박중민,황승연,신태건,조익준,윤희,이태림,차원철,심민섭 대한응급의학회 2017 Clinical and Experimental Emergency Medicine Vol.4 No.1
Objective We aimed to evaluate the knowledge and attitudes of emergency medical service (EMS) personnel pertaining to sepsis. We also compared EMS personnel’s knowledge of sepsis and their intention to engage in prehospital sepsis management. Methods The survey was conducted during education conferences for EMS personnel in December 2013 and January 2015 in Seoul, Korea. The questionnaire composed of 10 questions relevant to sepsis, was distributed on-scene, and was retrieved by investigators after the conference. We classified subjects into active and passive groups based on intent to participate in prehospital sepsis care. Results A total of 271 questionnaires were distributed; 255 EMS personnel (94%) completed the survey, 126 (49%) of whom were first-degree emergency medical technicians (EMTs). Less than 75% of subjects provided clinically relevant responses to questions about the definitions of sepsis, tachycardia, tachypnea, hypotension, hypothermia, fluid resuscitation, and vasopressor. Only 15% of participants had suspected that a patient had sepsis, and 9% reported that they could identify patients with sepsis during transportation. Overall, first-degree EMTs showed higher levels of knowledge and a positive attitude to sepsis compared with non-first-degree EMTs. Sixty percent of the participants reported that they were actively involved in prehospital sepsis care. The active group showed significantly higher levels of knowledge and more positive responses to the clinical impact of prehospital sepsis care. Conclusion Our study showed that is a substantial portion of EMS personnel lacks appropriate level of knowledge on sepsis care. We also found that the intention to engage in sepsis management was associated with appropriate knowledge of sepsis.
Long-limb Roux-en-Y Reconstruction after Subtotal Gastrectomy to Treat Severe Diabetic Gastroparesis
박중민,Jong Won Kim,Kyong-Choun Chi 대한위암학회 2019 Journal of gastric cancer Vol.19 No.3
The role of surgical intervention in patients with diabetic gastroparesis is unclear. We reporta case of a 37-year-old man with a history of recurrent episodes of vomiting and long-standingtype 2 diabetes mellitus. Esophagogastroduodenoscopy did not reveal any findings of refluxesophagitis or obstructive lesions. A gastric emptying time scan showed prolonged gastricemptying half-time (344 minutes) indicating delayed gastric emptying. Laboratory testsrevealed elevated fasting serum glucose and glycosylated hemoglobin (HbA1c, 12.9%) andnormal fasting C-peptide and insulin levels. We performed Roux-en-Y reconstruction aftersubtotal gastrectomy to treat gastroparesis and improve glycemic control, and the patientshowed complete resolution of gastrointestinal symptoms postoperatively. Barium swallowtest and gastric emptying time scan performed at follow-up revealed regular progressionof barium and normal gastric emptying. Three months postoperatively, his fasting serumglucose level was within normal limits without the administration of insulin or oralantidiabetic drugs with a reduced HbA1c level (6.9%). Long-limb Roux-en-Y reconstructionafter subtotal gastrectomy may be useful to treat severe diabetic gastroparesis by improvinggastric emptying and glycemic control.
朴重泯,安鉉植,金道鉉 대한전자공학회 2002 電子工學會論文誌-SC (System and control) Vol.39 No.9
In this paper, an extended type of a direct learning control(DLC) method is proposed for the effective control of systems which perform a given task repetitively. DLC methods have been suggested to overcome the defects of iterative learning control, the learning process should be resumed from the beginning even if a slight change occurs in the desired output pattern. If a given desired output trajectory is "proportional" to the output trajectories which are learned previously, we can obtain the desired control input directly without the iterative learning process by using the DLC. First, most existing DLC methods are shown to be applicable only to single-input single-output systems with the relative degree one and then, an extended type of DLC is proposed for a class of nonlinear systems having the relative degree more than or equal to one by using the known relative degree of a nonlinear system. By the simulation results for the arbitrary nonlinear system with the relative degree more than one, the validity and the performance of the proposed DLC method are examined. 본 논문에서는 주어진 작업을 반복적으로 수행하는 시스템을 효과적으로 제어하기 위하여 확장된 형태의 직접학습제어방법을 제안한다. 직접학습제어는 기존의 반복학습제어에서, 원하는 출력에서의 작은 변화에 대해서도 학습과정을 처음부터 다시 수행해야 한다는 단점을 극복하기 위해 제안되었다. 이미 학습되어 있는 출력궤적과 특별한 비례(proportional)관계를 갖는 새로운 원하는 출력궤적이 주어졌을 때 직접학습제어를 이용하면 다시 반복학습과정을 수행할 필요없이 원하는 제어입력을 직접 구할 수 있다. 우선, 대부분의 기존의 직접학습제어방법은 단일 입출력 비선형 시스템의 상대차수가 1인 경우에만 적용 가능함을 보이고, 시스템의 상대차수에 대한 정보를 이용하여 상대차수가 1이상인 비선형 시스템에 적용할 수 있는 확장된 형태의 직접학습제어를 제안한다. 또한, 상대차수가 2이상인 임의의 비선형 시스템에 대하여 컴퓨터 모의실험을 수행하고 제안된 직접학습제어방법의 타당성 및 성능을 확인한다.
Laparoscopic treatment of annular pancreas in adults: report of a case
박중민,노태호,이승은 한국간담췌외과학회 2012 한국간담췌외과학회지 Vol.16 No.1
The annular pancreas in adults is a rare congenital anomaly that is detected after development of complications, such as gastric outlet obstruction, recurrent pancreatitis, and peptic ulcer. Duodenal bypass is the procedure of choice for treating duodenal obstruction caused by the annular pancreas in both children and adults. Duodenoduodenostomy is routinely performed in neonates and children. In adults, duodenojejunostomy or gastrojejunostomy are recommended, because the duodenum is less mobile. We report a case of annular pancreas in a 33-year-old male that was successfully treated with laparoscopic gastrojejunostomy.