• Title/Summary/Keyword: High cost patients

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Conscious sedation in dentistry: knowledge and practice among dental professionals in Tanzania

  • Sales, Nicco;Sohal, Karpal Singh;Moshy, Jeremiah Robert;Owibingire, Sira Stanslaus;Deoglas, David K;Laizer, Paulo J
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.21 no.6
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    • pp.557-564
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    • 2021
  • Background: Conscious sedation is a useful adjunct in the treatment of patients in dentistry; however, a lack of knowledge among the dental profession regarding sedation is a restricting factor in the practice of dental sedation. Therefore, this study was conducted to assess the knowledge and practice of sedation in dentistry among dental professionals in Tanzania. Methods: This was a cross-sectional study conducted for five months targeting all practicing dental professionals in Tanzania. A modified questionnaire contained 14 questions regarding knowledge about sedative agents and a section on the practice of sedation. The data obtained from this study were coded and entered into a computer program and analyzed using SPSS software version 23.0. The data are presented as frequencies and percentages in tables and charts. Statistical significance was set at P < 0.05. Results: The age range of participants was between 24 and 63 years (mean 36.6 ± 7.7 years). There were 107 men (78.1%), and the male-to-female ratio was 3.6:1. The majority (76.6%) of participants only had an undergraduate dental degree. Thirty-one percent of participants only worked in publicly owned health facilities. Slightly more than half (59.9%) of participants had satisfactory knowledge regarding sedation in dentistry. There was no statistically significant association between the level of sedation-related knowledge and the demographic characteristics of the participants. Only 21.9% reported using sedation in their practice, and the most commonly used sedative drug was diazepam. The reasons for not using dental sedation in clinical practice included a perceived lack of knowledge on sedation, lack of equipment, and cost. Conclusion: Most dental professionals in Tanzania have basic knowledge of sedation in dentistry, although knowledge regarding sedative agents is generally low. The practice of sedation in dentistry in Tanzania is very low compared to that in middle- and high-income countries. Inadequate knowledge, lack of equipment, and the cost of practicing sedation are the main reasons for not practicing sedation.

Leision Detection in Chest X-ray Images based on Coreset of Patch Feature (패치 특징 코어세트 기반의 흉부 X-Ray 영상에서의 병변 유무 감지)

  • Kim, Hyun-bin;Chun, Jun-Chul
    • Journal of Internet Computing and Services
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    • v.23 no.3
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    • pp.35-45
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    • 2022
  • Even in recent years, treatment of first-aid patients is still often delayed due to a shortage of medical resources in marginalized areas. Research on automating the analysis of medical data to solve the problems of inaccessibility for medical services and shortage of medical personnel is ongoing. Computer vision-based medical inspection automation requires a lot of cost in data collection and labeling for training purposes. These problems stand out in the works of classifying lesion that are rare, or pathological features and pathogenesis that are difficult to clearly define visually. Anomaly detection is attracting as a method that can significantly reduce the cost of data collection by adopting an unsupervised learning strategy. In this paper, we propose methods for detecting abnormal images on chest X-RAY images as follows based on existing anomaly detection techniques. (1) Normalize the brightness range of medical images resampled as optimal resolution. (2) Some feature vectors with high representative power are selected in set of patch features extracted as intermediate-level from lesion-free images. (3) Measure the difference from the feature vectors of lesion-free data selected based on the nearest neighbor search algorithm. The proposed system can simultaneously perform anomaly classification and localization for each image. In this paper, the anomaly detection performance of the proposed system for chest X-RAY images of PA projection is measured and presented by detailed conditions. We demonstrate effect of anomaly detection for medical images by showing 0.705 classification AUROC for random subset extracted from the PadChest dataset. The proposed system can be usefully used to improve the clinical diagnosis workflow of medical institutions, and can effectively support early diagnosis in medically poor area.

A Study on the Nurses' Contingent Employment and Related Factors (간호사의 비정규직 고용실태 및 관련요인에 관한 연구)

  • Choi, Sook-Ja
    • Journal of Korean Academy of Nursing Administration
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    • v.5 no.3
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    • pp.477-500
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    • 1999
  • Korean labor market has showed remarkable change of the increase in the amount of unemployment and contingent employment since IMF bailout agreement. There is a theoretical position to explain this increase in contingent employment at hospitals with the notion of flexibility. The high flexibility of employment due to the increase of contingent employees is becoming very important part in new business strategy of hospitals. The types of contingent employment of the nurse are part-time employment temporary employment, fixed-term employment, and internship which was introduced in early 1999. Recently, Korean health care industry managers have paid attention to the customer oriented service, rationalization of business administration, service quality control so that they can adjust their business to outer environment. Especially their efforts concentrate on the wage reduction through efficient and scientific control of man power because wage shares about 40% of total cost. This dissertation aims at verifying the phenomena of the contingent employment of the nurse and analyzing the related factors and problems. To rephrase these aims in ordinal: First, verifying the phenomena of contingent employment of the nurse. Second, verifying the problems of that phenomena. Third, analyzing the related factors of the contingent employment of the nurse. To accomplish these research goals, a statistical survey was executed. in which 384 questionnaires-66 for manager nurses, 318 for contingent nurses - were given to nurses working at 66 hospitals-which have at least 100 beds-in Seoul. Among them, 187 questionnaires-38 from manager nurses, 149 from contingent nurses'- 'were returned. Then, the data coded and submitted to T-test, $X^2$ -test, variance analysis(ANOVA), correlation analysis, multiple regression analysis, Logistic Regression with SAS program. The research results of the contingent nurses are followings: 1. The average career term at the present hospital 8.4 months: duty-on days per month are 24.2 days: working time per day is 7.9 hours. These results showed little difference from regular nurses. 2. Their wage level is about 70% of regular nurses except for internship nurses whose wage level is 41% of regular nurses. To break down the wage composition, part-time nurses and internship nurses get few allowance and bonus. And contingent nurses get very low level of additional pay except for fixed-term nurses who are under similar condition of employment to regular nurses. These results show that hospital managers are trying to reduce the labor cost not only through the direct way of wage reduction but through differential treatment of bonus, retirement allowance, and other additional pay. 3. The problem of contingent employment: low level of pay; high level of turn-over rate: weakening of union; low level of working condition: heavy burden of work; inhuman treatment. The contingent nurses consider these problems more seriously than manager nurses do. What manager nurses regard problematic is the absence of feeling-belonged and responsibility of the contingent nurses. 4. The factors strongly related with the rate of the number of contingent nurses for the number of regular nurses; gross turn-over nurses; average in-patients per day; staring wage of graduate from professional college: the type of hospital ownership; the number of beds; the gap between gross newcomer nurses and gross turn-over nurses. The factors related with their gross wage per month; the number of beds; applying of health insurance; applying of industrial casualty insurance; applying of yearly-paid leave; the type of hospital ownership; average out-patients per day; gross turn-over nurses. The meaningful factors which make difference by employment type: monthly-paid leave; physiological leave. The logistic regression analysis using these two factors shows that monthly-paid leave is related with the type of hospital ownership; the number of beds; average out-patient per day, and physiological leave is related with the gross newcomer nurses; gross turn-over nurses; the number of beds.

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Investigation of Stress-Inducing Factors and Occupational Stress Levels in General and Pediatric Dentists (일반 진료 치과의사와 소아 진료 치과의사의 스트레스 유발 요인과 직무 스트레스 정도에 대한 연구)

  • Seunghyun, Kim;Jaesik, Lee
    • Journal of the korean academy of Pediatric Dentistry
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    • v.49 no.4
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    • pp.481-496
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    • 2022
  • The purpose of this study was to compare factors causing stress in pediatric and general dentists when treating pediatric patients and to evaluate their overall occupational stress level. A total of 191 dentists participated in the online survey, consisting of 66 pediatric dentists and 125 general dentists. The questionnaire was conducted using Google Form. Both groups were stressed due to poor cooperation of patient and caregiver, uncertain prognosis of treatment, and low cost of pediatric dental treatment. The pediatric dentists felt relatively high stress due to poor cooperation from caregivers and an uncertain prognosis of treatment (p < 0.05). Overall occupational stress was high in both groups in the order of patient, time, job environment, and income-related stress, and the degrees of pediatric dentists were lower than general dentists. Among the 3 sub-factors of occupational burnout, more than 98% of both groups showed burnout in "depersonalization", and more than 69% of both groups showed burnout in "emotional exhaustion". Both groups showed a low burnout rate in "reduced sense of accomplishment" and pediatric dentists showed a higher sense of accomplishment than general dentists (p < 0.05). This study showed that both groups were under high occupational stress due to various factors, and efforts were required to relieve stress.

New Processing Technology For Steamed-mature Silkworms (HongJam) to Reduce Production Costs: Employing a High-Speed Homogenization and Spray Drying Protocol (생산비용 절감을 위한 익힌숙잠(홍잠, 弘蠶) 신 가공기술: 초고속 균질화와 분무건조 활용법)

  • Kee-Young, Kim;Phoung, Nguyen;Nam-Suk, Kim;Sang-Kug, Kang;Yoo, Hee, Kim;Young Ho, Koh
    • Korean journal of applied entomology
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    • v.61 no.4
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    • pp.675-688
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    • 2022
  • Produced by steaming mature silkworms, HongJam is a natural functional food with various health-promoting effects. The current standard HongJam production protocol involves freezing and freeze-drying steamed mature silkworms for convenient long-term storage and/or selling it to customers. However, freeze-drying HongJam requires a range of processes and costs, which have contributed to its high resale value. In this study, we found that the cost of manufacturing HongJam powder could be reduced by homogenizing steamed mature silkworms using a high-speed blender and digital homogenizer, followed by spray drying. After the homogenized HongJam solution was digested by directly adding food-graded proteases, food-graded protease-digested homogenized HongJam solution was spray-dried. Food-graded digested protease or non-digested homogenized HongJam solutions could be used to produce food for special medical use for patients with general or specific diseases. This more efficient HongJam processing protocol proposed in this study can facilitate the development of sericulture farms and related industries by reducing the production costs of HongJam and its associated products.

Research for Network on Medical Association and International Medical Tourism - Based on Centum Medical Partners - (의료협력과 국제 의료관광 네트워크에 관한 연구 - 센텀 메디컬 파트너스를 중심으로 -)

  • Park, Ki-Soo;Bae, Jong-Cheol;Choi, Bong-Joon
    • Journal of Korean Clinical Health Science
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    • v.2 no.1
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    • pp.59-71
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    • 2014
  • Purpose. Medical tourism is recently becoming a new industry with great growth potential. The South Korean government is shifting medical tourism from simple cultural tourism to a high value-added industry with a new paradigm. Methods. The government has been providing positive support and marketing policies since the introduction of the article concerning foreign patient attraction to the medical law in 2009, and various types of medical institutions around the country has participated actively in medical tourism by themselves or in cooperation of government bodies and made increasingly greater performance. Results. This study obtained the following results. The medical institutions in Korea have been making efforts to see more development and profitability in diverse ways, including medical tourism for foreign patients and the advance of the Korean medical institutions into foreign markets. However, many local governing bodies and medical institutions participating in medical tourism around the country have primarily focused on examination and treatment on the basis of foreign patients' visit to South Korea and rarely built a medical network with other countries directly for medical tourism. This study presents a case of building a local medical network and a network for international medical tourism successfully on the basis of the local medical association, CMP, which has been formed naturally in Busan. The success factors for CMP included 1) enthusiasm of the official in charge; 2) the medical level, the service level, and open-mindedness of participant medical institutions; 3) cost efficiency due to executive office management with no costs, no conflicts, and constant partnership; 4) security of non-competitive expertise for participants; 5) local factors of CMP; 6) participation of good agencies; 7) reinforcement of participation networks; and 8) post facto management and local doctor management. Conclusions. Its positive effects included patient introduction and greater profitability on an internal basis as well as construction of the collaboration system with the institutions related to medical tourism and confidence. However, there are some limitations: it is still difficult to predict performance due to the short period of their activities, and it is necessary to continue to observe their constant activities since a single medical association was involved.

The Effect of Therapy Oriented CT in Radiation Therapy Planning (치료 계획용 전산화 단층촬영이 방사선 치료계획에 미치는 효과)

  • Kim, Sung-Kyu;Shin, Sei-One;Kim, Myung-Se
    • Radiation Oncology Journal
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    • v.5 no.2
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    • pp.149-155
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    • 1987
  • The success of radioation therapy depends on exact treatment of the tumor with significant high dose for maximizing local control and excluding the normal tissues for minimizing unwanted complications. To achieve these goals, correct estimation of target volume in three dimension, exact dose distribution in tumor and normal critical structures and correction of tissue inhomogeneity are required. The effect of therapy oriented CT (plannng CT) were compared with conventional simulation method in necessity of planning change, set dose, and proper distribution of tumor dose. Of 365 new patients examined, planning CT was performed in 104 patients $(28\%)$. Treatment planning was changed in $47\%$ of head and neck tumor, $79\%$ of intrathoracic tumor and $63\%$ of abdmonial tumor. in breast cancer and musculoskeletal tumors, planning CT was recommended for selection of adequate energy and calculation of exact dose to critical structures such as kidney or spinal cord. The average difference of tumor doses between CT planning and conventional simulation was $10\%$ in intrathoracic and intra-abdominal tumors but $20\%$ in head and neck tumors which suggested that tumor dose may be overestimated in conventional simulation Although some limitations and disadvantages including the cost and irradiation during CT are still criticizing, our study showed that CT Planning is very helpful in radiotherapy Planning.

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Non-radiologic Methods for Predicting Vesicoureteral Reflux in Childhood Urinary Tract Infection (요로감염 환아에서 비방사선학적 방법에 의한 방광요관역류의 조기 예측에 관한 연구)

  • Jeon Seong-Hoi;Lee K.C.;Yoo Kee-Hwan
    • Childhood Kidney Diseases
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    • v.1 no.1
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    • pp.38-45
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    • 1997
  • Purpose : Vesicoureteral reflux(VUR) in childhood may be the primary cause of recurrent urinary tract infection and renal scarring. Renal ultrasonography, DMSA, and voiding cystourethrogram are the standard clinical methods for detection of vesicoureteral reflux. But these methods have many disadvantages such as invasiveness and high cost. So, we studied to observe the significance of urine ${\beta}_2$-microglobulin in association with other non-radiologic methods for predictng vesicoureteral reflux. Methods : We evaluated 40 patients with urinary tract infection who were admitted to Korea university Hospital from July 1993 to June 1994. Among them, 24 patients revealed urinary tract infection and vesicoureteral reflux(group A), 16 patients revealed only urinary tract infection(group B). Both groups were compared by presence of fever, hematuria, and proteinuria, positivity of CRP, and level of BUN, Cr, GFR by 99mTc-DTPA, urine ${\beta}_2$-microglobulin, 24 hours urine albumin. Results : 1) Among 24 patients who had vesicoureteral reflux, 14 had unilateral VUR, 10 had bilateral VUR, three kidneys with grade I, nine with grade II, eleven with grade III, eleven with grade IV by classification of International Reflux Study Committee. Among them, 14 patients had renal scar, five with type A, five with type B, four with type C, none with type D by Smellie's classification. 2) The mean of GFR, BUN, Cr, 24hrs urine albumin and the presence of hematuria and proteinuria showed no significant difference between group A and group B. The mean of urine ${\beta}_2$ microglobulin in group A and group B were $283.6{\pm}195.8{\mu}g/l$ and $78.7{\pm}48.5{\mu}g/l$ respectively, showing that group A had a higher value than group B (p<0.01). In case of ${\beta}_2$ microglobulin > $120{\mu}g/l$ and CRP(+), the sensitivity was 93.3% and the specificity is 77.8% for detecting of VUR. In case of ${\beta}_2$-microglobulin>$120{\mu}g/l$ and fever(+), the sensitivity was 92.2%, and the specificity was 62.5% for detecting of VUR Conclusions : If the level of urinary ${\beta}_2$-microglobulin is more than 120ug/l in children with urinary tract infection in association with fever(+) or CRP(+), it can predict VUR. So we can use it for early detection of VUR.

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A Study on measurement of scattery ray of Computed Tomography (전산화 단층촬영실의 산란선 측정에 대한 연구)

  • Cho, Pyong-Kon;Lee, Joon-Hyup;Kim, Yoon-Sik;Lee, Chang-Yeop
    • Journal of radiological science and technology
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    • v.26 no.2
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    • pp.37-42
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    • 2003
  • Purpose : Computed tomographic equipment is essential for diagnosis by means of radiation. With passage of time and development of science computed tomographic was developed time and again and in future examination by means of this equipment is expected to increase. In this connection these authors measured rate of scatter ray generation at front of lead glass for patients within control room of computed tomographic equipment room and outside of entrance door for exit and entrance of patients and attempted to ind out method for minimizing exposure to scatter ray. Material and Method : From November 2001 twenty five units of computed tomographic equipments which were already installed and operation by 13 general hospitals and university hospitals in Seoul were subjected to this study. As condition of photographing those recommended by manufacturer for measuring exposure to sauter ray was use. At the time objects used DALI CT Radiation Dose Test Phantom fot Head (${\oint}16\;cm$ Plexglas) and Phantom for Stomache(${\oint}32\;cm$ Plexglas) were used. For measurement of scatter ray Reader (Radiation Monitor Controller Model 2026) and G-M Survey were used to Survey Meter of Radical Corporation, model $20{\times}5-1800$, Electrometer/Ion Chamber, S/N 21740. Spots for measurement of scatter ray included front of lead glass for patients within control room of computed tomographic equipment room which is place where most of work by gradiographic personnel are carried out and is outside of entrance door for exit and entrance of patients and their guardians and at spot 100 cm off from isocenter at the time of scanning the object. The results : Work environment within computed tomography room which was installed and under operation by each hospital showed considerable difference depending on circumstances of pertinent hospitals and status of scatter ray was as follows. 1) From isocenter of computed tomographic equipment to lead glass for patients within control room average distance was 377 cm. At that time scatter ray showed diverse distribution from spot where no presence was detected to spot where about 100 mR/week was detected. But it met requirement of weekly tolerance $2.58{\times}10^{-5}\;C/kg$(100 mR/week). 2) From isocenter of computed tomographic equipment to outside of entrance door where patients and their guardians exit and enter was 439 cm in average, At that time scatter ray showed diverse distribution from spot where almost no presence was detected to spot with different level but in most of cases it satisfied requirement of weekly tolerance of $2.58{\times}10^{-6}\;C/kg$(100 mR/week). 3) At the time of scanning object amount of scatter ray at spot with 100 cm distance from isocenter showed considerable difference depending on equipments. Conclusion : Use of computed tomographic equipment as one for generation of radiation for diagnosis is increasing daily. Compared to other general X-ray photographing field of diagnosis is very high but there is a high possibility of exposure to radiation and scatter ray. To be free from scatter ray at computed tomographic equipment room even by slight degree it is essential to secure sufficient space and more effort should be exerted for development of variety of skills to enable maximum photographic image at minimum cost.

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A Study on Customer Loyalty and Word-of-Mouth Effect according to Character Trait of Patient in Dental Clinics (치과내원환자의 성격특성에 따른 고객충성도 및 구전효과 연구)

  • Yang, Hae-Young
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.12 no.12
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    • pp.5819-5826
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    • 2011
  • Recently in the dental world, competition in the medical industry has been intensified due to the prolonged economic stagnation, the quantitative expansion of medical institutions, the enhancement of medical consumers'awareness of rights, and the diversity of medical consumer needs. Dental institution management of the difficulties is the requirement for dental institution to ensure competitiveness. So Word-of-Mouth marketing, which creates high marketing effectiveness with low cost, needs to be actively utilized as a new alternative to mass communication marketing. This research is to accurately grasp the target group of dental medical marketing activities through research on the degree of customer loyalty and Word-of-Mouth effects according to character trait of the patients visiting dental clinics, and to present the basic data for Word-of-Mouth marketing strategies from a viewpoint of practical business through presenting Word-of-Mouth promotion factors. To achieve this, questionnaire survey was conducted on 10 dental clinics located in Daegu for 4 weeks from April 11, 2011 to May 6, 2011 and 612 copies of responses to the questionnaires for final data for analysis were obtained. The results of the analysis are as follows. There were no significant differences in the degree of customer loyalty according to character trait of the subjects between the introverts and the extroverts, and the subjects with high market mavens propensity were found to show high degree of customer loyalty (F=5.243, p=.006). In the differences in Word-of-Mouth effectiveness according to character trait, there were greater differences in Word-of-Mouth experiences in the extrovert subjects ($x^2$=6.738, p=.006) and the subjects with high market mavens propensity ($x^2$=17.251, p=.000). The results of this research clarifies the degree of customer loyalty according to character trait of the patients visiting dental clinics and the differentiated influences of Word-of-Mouth effectiveness, and through this, they will become basic data for presenting ways to establish strategies from the viewpoint of practical business that should be considered in establishing dental medical marketing strategies.