1,721,764 research outputs found
Kim, Bo Hyeong
No full text학위논문(석사)--아주대학교 일반대학원 :간호학과,2009. 8경장영양의 주입방법에 따른 설사발생 양상과 영양상태 비교
영양집중지원(nutrition support)은 중환자 관리에서 기본적 구성요소 중 하나이다. 경장영양이 중환자에게 가장 우선되어야 할 영양집중지원 경로로 권장되고 있지만 경관급식을 공급받는 중환자에게 흔히 나타나는 설사로 인하여 50% 이상에서 영양요구량이 충족되지 못하고 있다. 이러한 영양불량은 합병증, 병원감염, 의료비, 재원일수, 사망률 증가를 초래하므로 경장영양에 대한 중환자의 적응력을 높여서 섭취열량은 증대시키고 궁극적으로 영양상태를 호전시키는 것이 중요하다. 본 연구는 섬유소가 혼합된 경장영양액을 간헐적 주입과 지속적 주입으로 공급하였을 때 설사발생 양상과 영양상태를 비교하는 비동등성 대조군 전후설계를 적용한 유사실험연구이다.
연구대상은 일개 대학병원 내과계중환자실에 입원한 환자 중 중증도 5군이면서 기계환기를 적용하고 입원 후 최초로 경관급식을 공급 받는 18세 이상 환자, 항균제를 사용한 자로 실험군 32명, 대조군 32명인 최종 64명을 대상으로 하였다.
섬유소가 혼합된 경장영양액을 실험군은 지속적 주입, 대조군은 간헐적 주입하였다. 모든 대상자는 경관급식 첫날부터 5일간 King's Stool Chart를 이용하여 설사발생 양상을 측정하였고, 경관급식 주입 전일과 주입 5일 후 다음 날에 자동분석장치를 이용하여 생리적 지표인 알부민, 헤모글로빈, 총임파구수를 측정하였다. 자료수집은 2008년 7월부터 2009년 5월 6일까지 이루어졌으며, 수집된 자료는 SPSS WIN 12.0 프로그램을 이용하여 Chi-square test, Mann Whitney U test, Independent sample t-test 및 Repeated measures ANOVA를 사용하여 분석하였다.
연구의 결과를 요약하면 다음과 같다.
1. 본 연구의 실험군 32명, 대조군 32명 가운데 설사를 한 경우는 실험군 10명(31.3%), 대조군 9명(28.1%)이었으나 통계적으로 유의한 차이를 보이지 않았 다.
2. 설사를 한 두 군 간에 설사시작일과 설사지속일은 통계적으로 유의한 차이를 보이지 않았다.
3. 주입방법에 따른 설사점수의 차이와 주입방법 및 시기에 따른 설사점수는 각 군간에 통계적으로 유의한 차이를 보이지 않았다.
4. 주입방법에 따른 대변빈도는 제1일에 통계적으로 유의한 차이를 보였고(t=2.189, p=.034) 주입방법에 따른 대변경도는 제4일(t=-2.563, p=.014)과 제5일(t=-2.225, p=.032)에 통계적으로 유의한 차이를 보였다.
5. 일반적 특성인 성별, 연령, 진단명, 의식수준, 금식기간, 위관 크기, H₂수용체 길항제 사용 여부에 따른 설사점수는 통계적으로 유의한 차이를 보이지 않았다.
6. 주입방법에 따른 영양상태의 변화는 두 군 간에 통계적으로 유의한 차이를 보이지 않았다.
본 연구결과를 통해 경관급식을 공급받는 중환자에서 설사발생을 감소시키기 위한 방안으로 간헐적 주입방법과 섬유소가 혼합된 경장영양액을 사용할 필요성을 확인하였다. 주입방법에 따른 영양상태의 변화는 유의한 차이를 보이지 않았지만 추후 다양한 측정도구를 이용하여 중환자의 영양상태를 평가하는 연구가 필요할 것이다.또한 중환자에서 경장영양의 적응을 돕기 위해 다양하고 실제적인 방안들에 관한 후속 연구가 필요함을 제언한다.
주요 핵심어: 경장영양, 경관급식, 설사, 영양상태, 중환자차 례
차례 ⅰ
표 차례 ⅲ
그림 차례 ⅲ
부록 차례 ⅳ
국문 요약 ⅴ
Ⅰ. 서 론=1
연구의 필요성=1
연구목적= 3
용어의 정의=3
Ⅱ. 문헌고찰=6
중환자의 영양집중지원=6
설사 정의와 설사 발생률=7
설사의 유발요인=9
경관급식 중환자의 설사와 영양상태=12
Ⅲ. 연구방법=15
연구설계= 15
연구대상= 15
연구도구= 16
경장영양 주입방법=17
자료수집 방법=17
자료분석 방법=18
Ⅳ. 연구결과=20
A. 대상자의 동질성 검증=20
B. 주입방법에 따른 설사발생 양상=22
1. 주입방법에 따른 설사 발생률 =22
2. 주입방법에 따른 설사 시작일, 설사 지속일=22
3. 주입방법에 따른 설사점수 비교=23
4. 주입방법에 따른 대변빈도, 대변경도 비교=25
C. 일반적 특성에 따른 설사점수 차이=26
D. 주입방법에 따른 영양상태 변화=28
Ⅴ. 논의=30
Ⅵ. 결론 및 제언=35
참고문헌=37
Astract=47
부록=50
표 차례
대상자 동질성 검증=21
주입방법에 따른 설사 발생률=22
주입방법에 따른 설사 시작일, 설사 지속일=23
주입방법에 따른 시기별 설사점수=24
주입방법 및 시기에 따른 설사점수의 반복측정 분산분석=24
주입방법에 따른 시기별 대변빈도, 대변경도=25
일반적 특성에 따른 설사점수 차이=27
주입방법에 따른 영양상태 변화=29
그림 차례
연구 진행순서=18
부록 차례
연구설명서 및 동의서=50
심의결과 통지서=52
프로토콜=53
연구도구=54MasterComparison of the incidence of diarrhea to nutrition status
related with enteral nutrition feeding method
Kim, Bo Hyeong
Department of Nursing
The Graduate School
Ajou University
Enteral nutrition is recommended as a preferred method of nutrition support for the critically ill patients. However, more than 50% of the nutritional requirement is not fulfilled due to diarrhea that frequently occurs in the critically ill patient who is dependent on tube feeding. This Study, which is a quasi-experimental research conducted under the application of a nonequivalent control group pre-test post-test design, aims to compare the incidence of diarrhea and nutrition status when a dietary fiber enteral formula is fed intermittently and continuously to a critically ill patient.
In this study, 64 patients consisting of 32 patients from an experimental group and 32 patients from a control group were involved. These patients are the ones belonging to the severity score of 5, and 18 years old and above age group. These patients who have adopted mechanical ventilation and are being tube-fed with antibiotics for the first time after hospitalization are selected out of the patients hospitalized in the medical intensive care unit of a university hospital.
The dietary fiber enteral formula was continuously fed to the experimental group, while intermittently fed to the control group. For all the subject patients, the incidence of diarrhea were determined from Day 1 up to Day 5 since the time tube feeding began using King's Stool Chart, and the biochemical data including the count of serum albumin, hemoglobin, total lymphocyte count were checked using an automatic analyzer on the day before tube feeding and 5days after tube feeding. The data have been collected during the period from July 2008 up to May 6, 2009, and were analyzed using Chi-square test, Mann Whitney U test, Independent sample t-test and Repeated measures ANOVA with SPSS WIN 12.0 program.
The result of study can be outlined as follows;
1. From experimental group (32 patients) and control group (32 patients) involved in this study, the incidence of diarrhea in the experimental group (10; 31.3%) and the incidence of diarrhea in the control group (9; 28.1%) didn't show a statistically significant difference.
2. For the date when diarrhea began and the elapsed period during which diarrhea occurred for both the experimental group and control group, it did not show a statistically significant difference.
3. For the difference of diarrhea score according to the feeding method, and the diarrhea score according to its feeding method and period, it did not show a statistically significant difference.
4. For stool frequency related with the feeding method, it showed a statistically significant difference on Day 1 (t=2.189 p=.034), while for stool consistency related with the feeding method, it showed a statistically significant difference on Day 4 (t=-2.563, p=.014) and Day 5 (t=-2.225, p=.032).
5. For the diarrhea score related with general characteristics such as sex, age, diagnosis, mental status, period of fasting, nasogastric tube size, usage of H₂-receptor antagonists, it did not show a statistically significant difference.
6. For the change in nutrition status related with the feeding method, it did not show a statistically significant difference between the two groups.
Through the result of this study, the necessity of adopting the method of intermittent feeding of dietary fiber enteral formula for a tube-fed patient was confirmed as a method of reducing the incidence of diarrhea. The nutrition status related with the feeding method was not significantly changed. However, it would be necessary to address the evaluation on nutrition status of a critically ill patient using measurement scales when conducting further studies. In addition, it is suggested that diversified and actual methods should be studied to help critically ill patients for adapting enteral nutrition.
Keywords: enteral nutrition, tube feeding, diarrhea, nutrition status, critically ill patien
Effective supply chain strategy to enhance firm's responsiveness: Empirical evidence from the bmw leipzig plant
No full textWe investigate how the firm's supply chain strategy can enable the firm to achieve responsiveness, i.e., ability to respond to the changes in the customer's requirements rapidly. To answer the research question, we visited the latest assembly plant at BMW and interviewed the managers in charge of plant operations. Applying the grounded theory method, we collected data by interviewing the managers in direct charge of and with thorough knowledge about the assembly operations at the plant. Then, we related empirical observations of the plant's phenomena to each other, to support our propositions. There are several key findings. First, BMW is making a great stride in pursuing mass customisation, i.e., customisation on a large scale. The company exerts enormous flexibility in its assembly operations so as to accommodate fast-changing requirements of the customers. Second, BMW's responsiveness is made possible with coordinated efforts by the company's suppliers, many of whom stay close to the company's assembly plant. Finally, such coordination between BMW and its suppliers will be crucial to enhancing BMW's competitive advantage, not only in terms of market responsiveness, but also in terms of technological innovation in the future
등류에서의 연성체 고리 진동
No full text학위논문(석사) - 한국과학기술원 : 기계공학전공, 2011.2, [ v, 51 p. ]An improved version of the immersed boundary (IB) method is developed for simulat-ing bendable ring clamped at one point with tension and bending stiffness in a uniform flow. The boundary of the ring consists of a flexible filament with tension and bending stiffness, which can be modeled as a linear spring with spring constant k and unstretched initial length. The internal area of the ring is conserved through the penalty method. For the Reynolds number of 100, resonance is observed at specific tension stiffness with fixed bending stiffness and also at specific bending stiffness with fixed tension stiffness in the same manner. The vibration phenomena and drag forces abruptly change through the resonance. The optimal tension and bending coefficient that minimize the drag force of the bendable ring is found. In our simulation we observe bistable states, one stationary and another oscillatory, that coexist over a range of flow velocities.한국과학기술원 : 기계공학전공
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Coordinating decisions by supply chain partners in a vendor-managed inventory relationship
No full textWe look into the linked decision making in the vendor-managed inventory (VMI) relationship. It is a supply chain management model, where the retailer decides the retail price while the vendor determines its capacity commitment. In this model, the retailer and the vendor should coordinate their decisions in order to maximize their individual profit or the total profit combining the two participants together. The vendor has to take into account the demand pattern throughout the product life cycle (PLC) when it decides its capacity commitment, which will affect its inventory management cost during the PLC, while the retailer should change the retail price over the PLC so as to maximize the revenues and minimize the inventory cost at the same time. Employing a system dynamics simulation approach based on differential game theory, which also takes into account the product characteristics such as the demand's innovation and imitation effects, we analyze and confirm the dynamic coordination of key decision variables by the supply chain partners in the VMI relationship. (c) 2010 The Society of Manufacturing Engineers. Published by Elsevier Ltd. All rights reserved
Effects of target firm's inventory turnover on post-merger and acquisition performance
No full textFirms use merger and acquisition (M&A) as a strategic tool to restructure their business. We explore the factors that determine the success of M&A in manufacturing. The literature has highlighted financial variables as success factors. However the literatures have not considered how operational factors of target firm have effects on the post-M&A performance of the buyer firm. Thus, we hypothesise that operational factors of the target firm also affect the M&A performance. In particular, we look into three different types of inventory, i.e., raw material, work-in-process, and finished goods, simultaneously. Then, we put forth that the turnover of the target firm's work-in-process inventory, which directly reflects its operational efficiency, is the most important factor. Thus, we conclude that in addition to financial factors, the target firm's operational efficiency determines the M&A performance. We elaborate on the analysis results and discuss economic as well as managerial implications. © 2018 Inderscience Enterprises Ltd.
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Consumers' preferences for facets of green supply chain management
No full textThis study explores the relationships between facets of a firm's green supply chain management (GSCM) efforts and the preferences expressed by its consumers for its products. Data obtained from over 300 consumers indicate that they find products more desirable when they perceive that a firm uses green management systems, engages in resource recovery efforts, and behaves in socially responsible ways. However, in some cases consumers' affinities for these efforts diminish for much higher priced products. Interestingly, the results provide no support for a relationship between a firm's internal management commitment to GSCM and consumers' preferences. In addition, consumers' preferences are significantly decreased by a firm's green (environmentally friendly) product design efforts. This negative relationship is even stronger for high priced products. We discuss consumers' possible assumptions and expectations regarding GSCM, and offer explanations for these contrasting relationships. We also discuss managerial implications of these findings, including the potential for firms to focus on specific GSCM activities that tend to be more effective in enhancing the consumer's value proposition. Such a strategy might be used to justify investments in GSCM that are repaid by increased revenues
- …
