Analysis of the Current State of Home Health Nursing for Elderly Patients in Advanced General Hospital

Purpose: The purpose of this study was to analyze the current state of home health nursing (HHN) for elders and to provide basic data on policy alternatives for establishing home medical care in the advanced general hospital. Methods: This study was conducted as a secondary data analysis, using electronic medical record (EMR) data of older patients who received HHN more than once from the S advanced general hospital between January 2016 and December 2018. Results: A total of 1,790 patients received HHN visits, with 22,477 visits being made. The mean age was 76.8±7.3 years old, 96.0% of elders had health insurance and 24.6% had orthopedics problems. Of the 1,168 people who visited emergency rooms, the most frequent symptom was pain (23.4%) and all patients visited the hospital at least once and at most 163 times outpatient care during HHN. Causative diseases were degenerative knee joint osteoarthritis (0.6%), surgery for right knee replacement (4.0%), and for dressings (9.7%) in the HHN service content analysis. Conclusion: The progress towards an aging society and the introduction of community care are expected to further enhance the need for HHN which should be able to provide comprehensive and continuous visiting health care services to the older patients. The results of this study are expected to help doctors solve problems not solved by HHN, reduce unnecessary emergency room or outpatient visits, and readmission, while at the same time contributing to the improvement of patient quality of life through efficient patient health care.ope

Knowledge and Practice Behaviors Regarding Urinary Incontinence Among Korean Healthcare Providers in Long-term Care Hospitals

PURPOSE: The purpose of this study was to assess the current management status of patients with urological issues and to examine the level of knowledge and practice behaviors regarding urinary incontinence (UI) among Korean healthcare providers in long-term care hospitals. METHODS: This study used a cross-sectional descriptive design with a written questionnaire to assess knowledge and practice behaviors of 756 healthcare providers in 11 long-term care hospitals in Korean metropolitan areas. RESULTS: A total 42.6% of participants reported that more than 50% of patients had urologic issues, and that 68.1% of patients were regularly sent to urologists; no participants reported an on-site urologist in their facility. Participants identified collaboration with other hospitals and regular consultations by urologists as important factors in improving urologic care. Although the overall UI knowledge score was upper intermediate, a knowledge deficit was found for risk factors of UI. The knowledge level of physicians was significantly higher than that of other healthcare providers. Practice behaviors of nurses seemed to be better than those of other healthcare providers. CONCLUSIONS: Systematic collaboration between healthcare providers and urologic specialists, enhancing staff competence, and patient-tailored intervention should be recommended to improve quality of care for patients with urologic issues in long-term care hospitals.ope

Application and Evaluation of Evidence-based Clinical Practice Guideline for Blood Culture

Purpose: To evaluate the effects of blood culture’s clinical practice guideline on nurse’s knowledge, cognition, practice and false positive rates. Methods: Research instrument was developed to assess knowledge, cognition, practice of nurses regarding blood culture by investigators. It consists of 26 questions and verified validity. One hundred-two nurses participated in this study. A descriptive analysis was conducted to determine the subject’s characteristics and t-test, and Pearson’s correlation were conducted to evaluate the effects of guideline using SPSS 21.0. Results: After educating this guideline, nurse’s knowledge, cognition and practice of nurse significantly improved before education. The relations of correlation among knowledge and cognition, practice and knowledge, practice and cognition were statistically significant. In addition, although it was not statistically significant, false positive rate was decreased (pre-education 1.5%, post education 1%). Conclusion: The clinical practice guideline of blood culture may improve the nurse’s knowledge and nursing practice to decrease false positive rate in this study. The result of this research would provide the evidence-base practice in nursing as well as decline medical cost.ope

Gender differences of health behaviors and quality of life of Koreans with asthma

Purpose: The purpose of this study was to explore gender differences in health-behaviors and quality of life (QOL) in Koreans with asthma. Methods: Participants, selected from the 2009 Korean National Health and Nutritional Examination Survey VI, included 305 individuals (men = 128, women = 177) with asthma and over 19 years old. Health behaviors were measured by questions about disease management, health choices, and functional and psychological status. QOL was measured with the European Quality of Life-5D (EQ-5D). Results: In health behaviors, 51.3% of women and 37.7% of men suffered from wheezing at rest. About 41% of men and 10% of women were smokers. One half of the participants were not taking medication and this was not significantly different by gender. The number of women with symptoms of depression was significantly higher than men. The EQ-5D index score of women was significantly lower than that of men. Conclusion: Women with asthma were more likely to have psychological problems and discomfort than men. Understanding gender differences in asthma is important to the development of effective, tailored asthma management strategies to cope with symptoms and improve health behaviors and QOL for people with asthma.ope

Factors Affecting the Patient Safety Management Activity of Nursing Students : A Quantile Regression approach

Purpose: The purpose of this study was to identify factors affecting the Patient Safety Management Activity (PSMA) of nursing students according to levels of PSMA based on the Theory of Planned Behavior (TPB). Methods: A descriptive study was used. The participants were 135 nursing students from universities in Korea. Data were collected with self-reported questionnaires through online survey. The questionnaire consisted of PSMA scale and modified version of the TBP-based questionnaire. Data were analyzed using multiple linear regression and quantile regression. Results: The average score of PSMA was 4.09±0.44 out of 5 points. In the multiple linear regression, patient safety education, subjective norm, perceived behavioral control and intention were significant factors. In the quantile regression, place of clinical practice (in 75%), patient safety education (in 50% and 90%), subjective norm (in 75%), perceived behavioral control (in 50% and 75%) and intention (in 50%) were significant factors. Conclusion: We confirmed the dynamic influences of all factors according to the levels of PSMA. It is proposed that the affecting factors according to the levels of PSMA should be considered in designing effective programs to enhance PSMA among nursing students.ope

Sex-Based Differences in Asthma among Preschool and School-Aged Children in Korea

The purpose of this study was to explore risk factors related to asthma prevalence among preschool and school-aged children using a representative national dataset from the Korea National Health and Nutrition Examination Survey (KNHANES) conducted from 2009-2011. We evaluated the demographic information, health status, household environment, socioeconomic status, and parents' health status of 3,542 children aged 4-12 years. A sex-stratified multivariate logistic regression was used to obtain adjusted prevalence odds ratios (ORs) and 95% confidence intervals after accounting for primary sample units, stratification, and sample weights. The sex-specific asthma prevalence in the 4- to 12-year-old children was 7.39% in boys and 6.27% in girls. Boys and girls with comorbid atopic dermatitis were more likely to have asthma than those without atopic dermatitis (boys: OR = 2.20, p = 0.0071; girls: OR = 2.33, p = 0.0031). Boys and girls with ≥1 asthmatic parent were more likely to have asthma than those without asthmatic parents (boys: OR = 3.90, p = 0.0006; girls: OR = 3.65, p = 0.0138). As girls got older, the prevalence of asthma decreased (OR = 0.90, p = 0.0408). Girls residing in rural areas were 60% less likely to have asthma than those residing in urban areas (p = 0.0309). Boys with ≥5 family members were more likely to have asthma than those with ≤3 family members (OR = 2.45, p = 0.0323). The factors related to asthma prevalence may differ depending on sex in preschool and school-aged children. By understanding the characteristics of sex-based differences in asthma, individualized asthma management plans may be established clinically.ope

RF MEMS 스위치와 CMOS DC-DC 컨버터의 이종 통합에 관한 연구

학위논문 (박사)-- 서울대학교 대학원 : 전기·컴퓨터공학부, 2017. 2. 전국진.본 논문은 RF(Radio Frequency) MEMS(Micro Electro Mechanical Systems) 스위치와 승압 CMOS(Complementary Metal Oxide Semiconductor) DC-DC(Direct Current-Direct Current) 컨버터 간의 이종 통합(hetero-integration)에 관한 연구 내용을 다룬다. RF MEMS 스위치의 우수한 고주파 특성을 휴대용 통신 기기에 적용하기 위하여 그 동안 많은 연구와 개발이 이루어졌다. 구동 전압이 수십 볼트인 RF MEMS 스위치와 승압 DC-DC 컨버터를 결합하여 사용자에게 제공한다면 사용자는 낮은 전압으로 RF MEMS 스위치를 구동하는 효과를 볼 수 있다. 따라서 본 논문에서는 이종 칩 각각의 최적화가 가능한 이종 통합 방식을 선정하여 재배선층(RDL, Re-Distribution Layer) 위에 RF MEMS 스위치와 DC-DC 컨버터를 결합하는 연구를 진행하였다. 논문은 크게 네 부분으로 구성된다. 첫 번째는 이종 통합을 위한 재배선층 특성 연구, 두 번째는 RF MEMS 스위치와 CMOS DC-DC 컨버터 및 두 칩의 이종 통합 방법 제안, 세 번째는 상용 칩을 이용한 이종 통합 재배선층의 설계, 네 번째는 상용 칩을 이용한 이종 통합 재배선층의 제작 및 검증이다. 기판의 종류, 기판의 두께, 전송 선로, 배선 금속, 임피던스, 기판 구조의 변화에 따른 재배선층의 고주파 특성을 연구하였다. 세 종류의 다른 유전상수의 재배선층 기판을 비교한 결과 기판의 유전상수는 낮을수록, 다섯 가지 두께의 기판을 비교한 결과 기판의 두께는 얇을수록, 두 가지 전송 선로 타입을 비교한 결과 GCPW(grounded coplanar waveguide) 전송 선로가 CPW(coplanar waveguide) 전송 선로보다 신호 분리도 특성이 우수하였다. 또한 네 가지 전송 선로 금속 물질 비교 결과 금속의 전도도가 높을수록 삽입 손실(insertion loss) 특성이 우수하였으며 열한 가지 포트에서의 임피던스 변화를 살펴본 결과 임피던스 매칭이 잘 이루어질수록 반사 손실(return loss) 특성이 우수하였다. MEMS 미세 공정을 적용하여 실리콘 기판에 실리콘 산화막(SiO2)을 증착하고 트렌치(trench)를 형성함으로써 기판 구조에 변화를 준 결과, 목표 대역의 최대 주파수 6GHz에서 반사 손실과 신호 분리도의 특성이 개선되었다. 고주파 특성 개선 효과를 해석하기 위하여 RLC 집중 소자 모델(lumped element model)을 이용하였다. 본 연구실에서 제작된 낮은 구동 전압의 우수한 신호 분리도의 정전 구동 방식의 RF MEMS 스위치와 CMOS DC-DC 컨버터를 소개하고 재배선층을 이용한 두 칩의 이종 통합에 대한 모델링과 시뮬레이션으로 결합 후 고주파 특성을 예측하였다. 상용 칩과 플립칩(flip-chip) 공정으로 재배선층을 이용한 이종 통합의 고주파 특성을 검증하였다. 칩의 성능 변동 폭을 최소화 하고 재현성을 확보하면서 기판과 전송 선로 변화에 의한 영향을 보기 위하여 상용 칩과 플립칩 공정을 이용하였다. 선정한 OMRON RF MEMS 스위치는 직렬 연결된 Dickson 전하 펌프로 구동되었으며 OMRON RF MEMS 스위치의 RLC 집중 소자 모델링 결과는 10GHz 대역에서 실측 결과를 잘 반영하는 것을 확인하였다. 기판의 두께, 기판의 유전 상수, 기판의 트렌치 깊이, 신호선의 총 길이, 신호선 금속의 전도도, 신호선 금속의 높이 변화에 따른 이종 통합 후 RF MEMS 스위치의 고주파 특성 변화 경향성을 수식으로 정리하였다. Conformal mapping 방식으로 재배선층 전송 선로의 집중 소자 모델링을 진행하였으며 재배선층 전송 선로의 집중 소자 성분은 quasi-static TEM 모드에서 신호 전송이 된다는 가정하에 도출되었다. 이후 재배선층 전송 선로의 집중 소자 모델과 RF MEMS 스위치의 집중 소자 모델을 ABCD 행렬로 변환하고 행렬 곱으로 결합하여 이종 통합 후 RF MEMS 스위치의 고주파 특성을 수식으로 표현하고 시뮬레이션과 비교함으로써 검증하였다. 듀로이드 기판, FR4 기판, 실리콘 기판을 재배선층 기판으로 하는 연구를 진행하였다. 듀로이드와 FR4 기판에서는 기판의 종류, 기판의 두께, 전송 선로 타입 차이에 따른 이종 통합 시 고주파 특성을 연구하였고 실리콘 기판에서는 기판의 구조 변화에 따른 이종 통합 특성을 연구하였다. 듀로이드와 GCPW 전송 선로 조합의 재배선층과 FR4와 CPW 전송 선로 조합의 재배선층은 상용 PCB(Printed Circuit Board) 공정을 이용하여 제작하였다. 약 50옴 임피던스 매칭의 경우와 상용 PCB 공정 특성을 반영한 56옴, 59옴 임피던스의 경우 특성을 시뮬레이션으로 비교, 분석하였다. 듀로이드 기판은 유전상수가 작고 두께가 얇으며 GCPW를 적용하였기 때문에 상대적으로 유전상수가 크고 두께가 두꺼우며 CPW 전송 선로를 적용한 FR4 기판보다 6GHz 대역에서 삽입 손실은 약 2.08dB, 반사 손실은 약 3.91dB, 신호 분리도는 약 3.33dB 우수한 것을 확인하였다. MEMS 미세 공정으로 고저항 실리콘 웨이퍼 위에 실리콘 산화막을 올리고 전송 선로 주변에 50㎛ 깊이의 트렌치를 형성함으로써 고주파 신호 전송 특성을 개선하는 방법을 제안하였다. 총 2장의 마스크를 사용하여 4인치 실리콘 웨이퍼 위에 제작하였다. 공정 오차인 기판과 전송 신호선의 두께 및 간격 변화, 측정 환경인 기판 물질 그리고 저온 무연납 범프의 공동이 이종 통합 시 공진과 관련이 있는 것을 확인하였다. 50㎛ 깊이의 트렌치 구조에 의하여 실리콘 기판과 이종 통합된 스위치는 6GHz 대역에서 삽입 손실은 약 0.32dB, 반사 손실은 약 1.38dB, 신호 분리도는 약 0.04dB 개선된 것을 확인하였다. 실리콘 기판과 이종 통합된 RF MEMS 스위치의 DC 포트에서 RF 포트 특성은 3GHz 대역에서 트렌치 유무와 관계 없이 약 32dB 이상의 신호 분리도 특성을 보이는 것을 확인하였다. 스위치와 저온 무연납을 제외한 재배선층 특성 검증을 위한 테스트 패턴에서는 50㎛ 깊이의 트렌치 구조에 의하여 6GHz 대역에서 삽입 손실은 약 0.05dB, 반사 손실은 약 1.66dB, 신호 분리도는 약 1.82dB 개선된 것을 확인하였다. 본 논문에서는 재배선층을 이용한 RF MEMS 스위치와 CMOS DC-DC 컨버터의 통합 방법을 제안하였다. 제안한 방법은 듀로이드, FR4, 고저항 실리콘 기판의 재배선층과 상용 칩을 이용하여 검증하였으며 고저항 실리콘 기판에 산화막과 트렌치 구조를 이용하여 고주파 특성 개선 가능성을 확인하였다.제 1 장 서 론 1 제 1 절 연구 배경 1 제 2 절 연구 동향 2 1.2.1 RF MEMS 스위치-CMOS 통합 2 1.2.2 저전압, 정전 구동 방식의 RF MEMS 스위치 9 1.2.3 정전 구동 방식의 MEMS 기기 구동용 CMOS DC-DC 컨버터 12 1.2.4 정전 구동 방식의 RF MEMS 스위치와 DC-DC 컨버터 이종 통합 15 제 3 절 논문의 동기 18 제 4 절 논문의 목적 19 제 5 절 논문의 구성 20 제 2 장 이종 통합을 위한 재배선층 특성 연구 22 제 1 절 기판과 전송 선로 선정 22 제 2 절 배선 금속 선정 27 제 3 절 임피던스 매칭 29 제 4 절 기판 식각을 통한 고주파 특성 개선 31 제 3 장 RF MEMS 스위치와 CMOS DC-DC 컨버터 개발과 이종 통합 특성 시뮬레이션 41 제 1 절 낮은 구동 전압 및 높은 신호 분리도 특성의 정전 방식 RF MEMS 스위치 41 3.1.1 RF MEMS 스위치 구조 41 3.1.2 RF MEMS 스위치 특성 44 3.1.3 RF MEMS 스위치 모델링 50 제 2 절 정전 방식 RF MEMS 스위치 구동용 전하 펌프 방식 승압CMOS DC-DC 컨버터 60 3.2.1 CMOS DC-DC 컨버터 구조 60 3.2.2 CMOS DC-DC 컨버터 특성 61 제 3 절 재배선층 설계 68 제 4 절 이종 통합 특성 예상 및 분석 69 제 4 장 이종 통합 재배선층 설계 72 제 1 절 칩 선정 72 제 2 절 재배선층 설계 77 4.2.1 설계 변수에 따른 고주파 특성 분석 77 4.2.2 기판과 전송 선로 조합을 통한 특성 개선 93 4.2.3 기판 구조 변경을 통한 특성 개선 99 제 5 장 이종 통합 재배선층 제작 109 제 1 절 재배선층 공정 109 제 2 절 제작 결과 및 측정 분석 110 5.2.1 기판과 전송 선로 조합 110 5.2.2 기판 구조 변경 116 5.2.3 이종 통합 전후 측정 결과 비교 정리 126 제 6 장 결 론 130 참고문헌 134 Abstract 142Docto

Development and Evaluation of a Protocol for Bedside Nursing Handoff with Patient Engagement in a Tertiary Hospital in South Korea

Purpose: This study aimed to develop a bedside nursing shift report protocol and evaluate the effect of the protocol in a tertiary hospital in South Korea. Methods: The bedside nursing handoff protocol with patient engagement was developed based on the literature review and the validation of an expert group. The effect of the protocol on clinical implication was tested in three medical-surgical units in a tertiary hospital. Outcomes were assessed by patient perception, nurse perception, and reporting time. Data collected from June to August in 2018 and analyzed with descriptive statistics and One-way ANOVA using SPSS version 25.0. Results: The bedside nursing shift report protocol with patient engagement consisted of two steps: nurse to nurse report and bedside report with patients. Nurse's perception with patient engagement was significantly increased after applying protocol (F=17.85, p<.001). Patient's perception was significantly improved in the areas of discharge plan (F=7.86, p<.001), health information privacy (F=4.46, p=.012) and identify attending nurse (F=3.19, p=.042). There were no differences in reporting time between the bedside nursing shift report and a traditional shift report (F=0.61, p=.054). Conclusion: Patient perception was significantly increased, while nurse perception was not different after applying this protocol. For the change in the perception of nurses, education may be preceded to improve nurses' competence for the bedside shift report. Furthermore, the support in enough nurse staffing should be needed for encouraging the bedside shift report. The bedside shift report may enhance patient engagement. Therefore it may improve patient safety and health outcome in clinics.ope

A qualitative study of self-management experiences in people with non-alcoholic fatty liver disease

Aim: The aim of the study was to explore the experiences of self-management in patients with non-alcoholic fatty liver disease (NAFLD). Design: The study employed an exploratory descriptive qualitative study using focus group interviews. Methods: Twelve participants with NAFLD were recruited from a university hospital in South Korea. The date of data collection was from November-December 2018, and the data were analysed using Braun and Clarke's thematic analysis. Results: Three themes and seven subthemes were identified. The themes were (1) facing unexpected obstacles, (2) finding my own path and (3) unmet support needs from healthcare providers. Subthemes included (1) ambiguity in changing lifestyle, (2) confusion caused by inconsistent information overload, (3) not knowing much about the liver nor NAFLD, (4) putting small plans into action every day, (5) getting help from family and friends as care partners, (6) needs for tailored medical help and (7) needs for caring and attentive attitudes.ope

Development and Pilot Testing of a Smartphone-Based Self-Care Program for Patients with Chronic Hepatitis B

The purpose of this study is to develop a smartphone-based self-care program (Hep B Care®) for patients with the chronic hepatitis B virus (HBV). To pilot test the feasibility of Hep B Care®, 63 participants with chronic HBV were recruited from an outpatient clinic at S hospital, Seoul, South Korea (experimental group [EG]: n = 30, control group [CG]: n = 33) between February and July 2016. Hep B Care® was developed based on the theory of self-care whilst having a chronic illness. During the 12-week intervention period, the application: (1) provided information about the disease, medication, nutrition, and exercise; (2) encouraged taking medication and exercise using alarms; and (3) enabled the exchange of messages between healthcare providers and patients. Salivary cortisol, fatigue, depression, anxiety, knowledge of the HBV, quality of life, and medication adherence were all measured as outcomes. Cortisol levels were significantly increased, knowledge of the HBV was improved, and the mean anxiety score was significantly decreased in the EG. Thus, Hep B Care ® partially improved health outcomes in the EG. We recommend that large trials be conducted among patients with the HBV. The smartphone-based self-care program for providing education and coaching is effective for improving knowledge and reducing anxiety among patients with the HBV.ope