• 제어로봇시스템학회:학술대회논문집
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• 제어로봇시스템학회 1991년도 한국자동제어학술회의논문집(국제학술편); KOEX, Seoul; 22-24 Oct. 1991
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• pp.1796-1800
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• 1991

Picture Archiving and Communication Systems(PACS) provide an integration of digital imaging information in a hospital, which encompasses various imaging equipment, viewing workstations, database archive systems, and a high speed fiber optic network. One of the most important requirements for integration is the standardization of communication protocols to connect devices from different vendors. Since 1985, the ACR-NEMA standard provides a hardware interface, a set of software commands, and a consistent set of data formats for point-to-point interconnection of medical equipment. However, it has been shown to be inadequate for PACS networking environments, because of its point-to-point nature and its inflexibility to allow other services and protocols in the future. Based on previous experience of PACS developments in The University of Arizona, a new communication protocol for PACS networks has been suggested to the ACR-NEMA Working Group VI. The defined PACS protocol is intended to facilitate the development of PACS's capable of interfacing with other hospital information systems. Also, it is intended to allow the creation of diagnostic information data bases which can be interrogated by a variety of distributed devices. A particularly important goal is to support communications in a multivendor environment. The new protocol specifications are defined primarily as a combination of the International Organization for Standardization / Open Systems Interconnection (ISO/OSI) protocols and the data format portion of ACR-NEMA standard. This paper addresses the specification and implementation of the proposed PACS protocol into network node. The protocol specification, which covers Presentation, Session, Transport, and Network layers, is summarized briefly. The implementation has natural extentions to Global PACS environments. The protocol implementation is discussed based on our implementation efforts in the UNIX Operating System Environment. At the same time, results of performance evaluation are presented to demonstrate the implementation of defined protocol. The testing of performance analysis is performed on the PACS prototype node.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제27권3호
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• pp.164-172
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• 2016

Objectives: This study attempted to evaluate the usefulness and direction of development of post-traumatic assessment and interventions based on the opinions of psychiatrics and disaster and trauma-related experts using the Delphi survey technique. Methods: In-depth individual interviews served as the pre-survey and were followed by Delphi primary and secondary surveys. Specialists in child and adolescent mental health, psychological support professionals specialized in disasters and related practitioners with experience of disasters in Korea completed a set of questionnaires and participated in focus group interviews and in-depth individual interviews on post-traumatic assessment and intervention. Results: We found that the following issues have a significant impact on the interventions after disasters: the proper time of the initial interview in the event of a disaster, assessment notices, aged assessment services, mandatory enforcement measures, scale screening and treatment intervention elements, symptoms degree classification, intervention standardization, the use of a levelled program, care unit environment, and operation plan. Conclusion: This study proposed effective mental health intervention measures and has implications for the development of evaluation treatment protocols after disasters.

• Asian Pacific Journal of Cancer Prevention
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• 제15권13호
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• pp.5487-5492
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• 2014

Ultrasonography is non-invasive and can give useful clues in the diagnosis of cervical lymphadenopathy, However, differential diagnosis is difficult in some situations even combined with color Doppler imaging. The present study was conducted to evaluate the clinical value of real time elastography in patients with unexplained cervical lymphadenopathy using a quantitative method. From May 2011 to February 2012, 39 enlarged lymph nodes from 39 patients with unexplained cervical lymphadenopathy were assessed. All the patients were examined by both B-mode ultrasound, color Doppler flow imaging and elastography. The method of analyzing elasto-graphic data was the calculation of the 10 parametres ("mean", "sd", "area%", "com", "kur", "ske", "con", "ent", "idm", "asm") offered by the software integrated into the Hitachi system. The findings were then correlated with the definitive tissue diagnosis obtained by lymph node dissection or biopsy. Final histology revealed 10 cases of metastatic lymph nodes, 11 cases of lymphoma, 12 cases of tuberculosis and 6 cases of nonspecific lymphadenitis. The significant distinguishing features for conventional ultrasound were the maximum short diameter (p=0.007) and absent of echogenic hilum (p=0.0293). The diagnostic accuracy was 43.6% (17/39 cases) and there were 17 patients with equivocal diagnosis. For elastography, "mean" (p=0.003), "area%" (p=0.009), "kurt" (p=0.0291), "skew" (p=0.014) and "cont" (p=0.012) demonstrated significant differences between groups. With 9 of the 17 patients with previous equivocal diagnoses (52.9%) definite and correct diagnoses could be obtained. The diagnostic accuracy for conventional ultrasound combined elastography was 69.2% (27/39 cases). There were differences in the diagnostic sensitivity of the two methods (p=0.0224). Ultrasound combined with elastography demonstrated higher rates of conclusive and accurate diagnoses in patients with unexplained cervical lymphadenopathy than conventional ultrasound. The quantitative program showed good correlation with the pathology of different lymph node diseases.

• Journal of Trauma and Injury
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• 제26권3호
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• pp.89-98
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• 2013

Purpose: The assessment of trauma patients in the prehospital setting is difficult, but appropriate field triage is critical to the prognosis of trauma patients. We sought to evaluate the triage given by the emergency medical technicians (EMTs) using the trauma score to patients injured in motor vehicle collisions (MVCs). Methods: From June 2012 to July 2012, questionnaires were distributed to EMTs, who had transported injured patients to the study hospital. Scene records, photos of the damaged vehicle, and ambulance run sheets were used to provide physiologic, physical, and mechanistic information about the MVC. To evaluate the appropriateness of the injury assessment by EMTs, we compared their impressions with the hospital's final diagnosis within a 3 level triage system comprising both the maximum abbreviated injury scale (MAIS) and the injury severity score (ISS). Kappa (k) was calculated to evaluate the agreement between the triage by EMTs and the triage based on hospital's final diagnosis. Results: A total of 91 patients were analyzed by 31 EMTs. The percentage of males was 57.1%, the mean age was 44.5, and the mean MAIS and ISS were 2.7 and 16.6 respectively. While EMTs correctly diagnosed patient injuries to the extremities in 35.7%, and to the neck in 32.1%, pelvic injuries were missed in 80.0%. The agreement between the triage by the EMTs and the triage based on the hospital's final diagnosis was 62.6%(k=0.366) by the MAIS and 50.5%(k=0.234) by the ISS. The kappa value was higher in EMT-I than in EMT-II. Conclusion: In MVC, the assessment of injured patients by EMT-I was more appropriate, and the 3-level triage method based on the MAIS could contribute to a more accurate triage. Prospective studies to search for appropriate methods of field triage are required for programming practical education for EMTs.

• 한국의료질향상학회지
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• 제30권1호
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• pp.33-43
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• 2024

Purpose:The acute hospital accreditation program launched in South Korea has shown positive effects on safety culture and quality of care. However, relative weights have not yet been investigated for accreditation criteria with a hierarchical structure. This study aimed to derive the relative weights of acute-care hospital accreditation criteria. Methods: We conducted an online survey using the analytic hierarchy process (AHP) technique to assess the validity, importance, and urgency of acute hospital accreditation criteria. The AHP online survey link was distributed in November 2022 after obtaining informed consent from 10 experts in hospital accreditation. Results: 'Basic value system' ranked highest, while 'patient care system' ranked second in terms of validity, importance, and urgency. 'Performance management system' had the lowest validity and urgency, while 'organizational management system' carried the lowest importance. Within the 'patient care system' domain, 'surgery and anesthesia sedation management' scored highest in validity and importance, and 'patient care' scored highest in urgency. 'Care delivery system and evaluation' received the lowest scores for all three aspects. In the 'organizational management system' domain, infection control ranked highest in terms of validity, importance, and urgency. The lowest validity was observed for 'management and organizational operation' and the lowest importance and urgency were noted for 'human resource management'. Conclusion: The weights for validity, importance, and urgency, as shown in each domain and chapter, and the number of measurable elements included, are largely inconsistent. This study will contribute to the development of the structure and scientific improvement of accreditation standards.

• 보건행정학회지
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• 제9권2호
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• pp.21-39
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• 1999

An increasing number of hospitals are seeking for new or mixed compensation strategies to improve the productivity of their medical staff in the struggle to provide high quality medical services at low costs amid the economic hardship. To motivate physicians toward the right direction, it is necessary to effectively evaluate their performance that provides a basis for compensation. However, productivity has been historically difficult to measure, particularly for physicians in academic medical centers who are expected to engage in research, education, and patient care simultaneously. The objectives of this study were to define performance measures of physicians and clinical departments in academic medical centers. to examine correlations between the measures. and to investigate factors affecting the measures. The performance data of 212 faculty physicians in 17 clinical departments in two university teaching hospitals affiliated to one medical school during the fiscal year 1994 was used for analyses. Patient care revenue, net profit. and adjusted number of patients were defined to measure the performance in patient care. and number of articles published in academic journals and research grant were defined for research activities. Both individual physicians' performance measures and per physician measures of clinical departments were analyzed. All measures defined to evaluate individual physicians' performance were positively related to each other. Clinical department and rank of faculty position were statistically significant predictors of revenue. and hospital. clinical department. and rank were significant predictors of net profit. journal publication. and research grant. Patient care measures defined to evaluate clinical departments were related to each other. so were research measures. and no significant correlations were found between patient care measures and research measures. Also found were large differences in department. ranks when clinical departments were evaluated by absolute per physician performance measures and evaluated by annual rate of changes in performance measures. These findings suggest that departmental performance measures opposed to individual performance measures are relatively free from problems of factors affecting the performance measures that are not in control of clinical departments or individual physicians. Results from the correlation analysis of departmental performance measures indicates that measures of research performance should be included in the evaluation to promote research activities in academic medical centers.

• 모자간호학회지
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• 제4권1호
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• pp.3-11
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• 1994

Presently there is an increasing demand for home health care services due to changes in the demographic structure as a result of an increasing elderly population, socio-economic improvements, and changes in the family structure, as well as the growing number of people with degenerative diseases. In addition to these reasons, rising medical costs and there a shortage of patient beds space in the hospital, particularly since introduction of national medical insurance. There has been an increasing demand for health care health care services. This study was done to identify the basic data for home health care management. It focused on developing client selection criteria, assessment tools, and recording methods. This was accomplished by the researchers visiting the patients in their homes. The research process included preparation investigation, tool development, training of the project researcher, and visiting the clients in their homes. The research tools are as follows : 1. Record development : a) The selection criteria tool for home health care of postpartum women was a structured tool and consisted of four parts. b) The structured assessment tool consisted of a general items, obstetric history, past medical history, methods of feeding, medications taken before admission, laboratory test results, discharge instructions, discharge medications, family tree, economic status, environmental status, a map, health assessment of postpartum women and their newborns. c) The visit note I consisted of the frequency of visits. Visit note II consisted of the date ; nursing problems ; nursing process including the initial assessment ; nursing goal ; visit plan ; postpartum women and their neonate health status, diagnosis, goal, implementation, evaluation, summary, next plan, for visit revision. d) Problem note consisted of the date, problem numbers, nursing diagnosis, problem appearance date problem resolution date. The research results are as follows : 1. Nursing problems : The nursing problems of the postpartum women and their neonates were evaluated by the number of nursing diagnoses and the change in the pattern of nursing diagnosis related to the number of visits. a) Nursing diagnosis The nursing diagnosis was classified according to physical function, psychosocial function, family system maintained function. b) The changes of nursing diagnosis related to the number of visits. As the type of nursing diagnosis changed related to the number of visits the number of nursing diagnoses decreased. 2. Contents of home health care : The content was categorized according to assessment, direct care, counseling, education, family care, reporting to with the attending doctor. The recommendations based on the research results are as follows : 1. Tool development Replication of this study is needed to test the validity of the assessment tools used. 2. Home visit a) Home health care nurses should be licensed and qualified. A referral form from the attending doctor is needed for legal protection of nurses. b) The first home visit need to be within 24 hours of discharge from the hospital to decrease the anxiety of frightened postpartum women. c) When the changes occur in the newborn's status, home health care nurses should consult a pediatrician. Communication within the home healthcare team is essential and needs to consistent and done smoothly. 3. Home health care A Study is required to develop protocols for education of staff and for operation of all aspects of this program.

• 한국응급구조학회지
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• 제12권3호
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• pp.55-69
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• 2008

Purpose : The purpose of this study was to analyze the prehospital care report prepared by EMS squads of 119 center in Gyeonggi area and to identify the status of prehospital care activities, problems and improvement possibilities of the emergency care. Method : Five hundred copies of prehospital care report prepared by EMS squads in thirty-eight 119 centers under 18 fire stations in Gyeonggi area from March to April in 2008 were randomly chosen for the analysis. Data abstracted according to the purpose of the study were input and the analysis of prehospital care activities were performed using SPSS-WIN(ver. 16) statistics package. Results : 1. Total 500 cases of prehospital emergency care activities were reviewed. By sex, females were 219 (43.8%) and males were 281 (56.2%). The places of reporting were home (57.8%). According to the type of emergency, 281 cases (56.2%) were caused by disease and 291 (43.8%) were from other causes such as traffic accidents or incidental injuries. 2 The average time needed for the 119 EMS squad to arrive at the scene after being reported was 7.29 minutes. The time used at the scene for the emergency care was 7.3 minutes in average and the time to arrive at the hospital was 25.4 minutes in average. 3. In patient evaluation, in 68% of the cases more than two vital signs were measured at one time and emergency patients were 31%, and non-emergency patients were 69%. 4. In one EMS activity, average 2.15 cases of emergency care were provided to a patient. The cases where two kinds of emergency care were given were 14.4%, which is the most frequent cases. When reviewing the details of the emergency cares given to the patient including multiple cares, trivial cards (taking it easy and giving comfort) were the most frequent one as 40.6% and the medical direction of the doctor was given in only one case out of 500 cases. 5. In patient evaluation and emergency care, vital signs were provided to emergency patients at significantly higher rate comparing to the non-emergency patients. The number of emergency care performance was significantly higher in emergency cases. In emergency dispatch, the cases that EMT (1st class) was on board was 86.2%. When comparing the cases when the 1st class EMT was on board and otherwise, the cases with the presence of 1st class EMT showed more vital signs were detected but there was no significant difference in the number of emergency cares provided. Conclusion : It seemed that the on-scene emergency care did not satisfy the expectations. So it is necessary to enforce the cooperation between the elements, the qualifications of the 119 EMS squads and to improve the prehospital working environment in order to provide the better medical service at any time.

• Asian Pacific Journal of Cancer Prevention
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• 제14권4호
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• pp.2159-2165
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• 2013

Cancer registries help to establish and maintain cancer incidence reporting system, serve as a resource for investigation of cancer and its causes, and provide information for planning and evaluation of preventive and control programs. However, their wider role in directly enhancing oncology drug access has not been fully explored. We examined the value of cancer registries in oncology drug access in the Asia-Pacific region on three levels: (1) specific registry variable types; (2) macroscopic strategies on the national level; and (3) a regional cancer registry network. Using literature search and proceedings from an expert forum, this paper covers recent cancer registry developments in eight economies in the Asia-Pacific region - Australia, China, Hong Kong, Malaysia, Singapore, South Korea, Taiwan, and Thailand - and the ways they can contribute to oncology drug access. Specific registry variables relating to demographics, tumor characteristics, initial treatment plans, prognostic markers, risk factors, and mortality help to anticipate drug needs, identify high-priority research area and design access programs. On a national level, linking registry data with clinical, drug safety, financial, or drug utilization databases allows analyses of associations between utilization and outcomes. Concurrent efforts should also be channeled into developing and implementing data integrity and stewardship policies, and providing clear avenues to make data available. Less mature registry systems can employ modeling techniques and ad-hoc surveys while increasing coverage. Beyond local settings, a cancer registry network for the Asia-Pacific region would offer cross-learning and research opportunities that can exert leverage through the experiences and capabilities of a highly diverse region.

• Journal of Korean Dental Science
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• 제7권1호
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• pp.6-15
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• 2014

Purpose: The purpose of this retrospective study is to investigate the degree of coincidence between the peer assessment rating (PAR) index and American Board of Orthodontics objective grading system (ABO-OGS) in the assessment of orthodontic treatment outcomes of Class I malocclusion cases. Materials and Methods: The sample consisted of 26 Class I patients. The PAR index was used for evaluation of pre-(T0) and posttreatment (T1) casts, and the ABO-OGS for assessment of T1 casts. If there was a reduction in PAR scores from T0 to T1 of more than 30%, the label 'PAR+' was given to the case, and if not, it was labeled 'PAR-'. If the ABO-OGS was less than 27, the label 'OGS+' was given to the case and if not, it was labeled 'OGS-'. 'A PAR-only qualified group' (PAR+), 'ABO-OGS-only qualified group' (OGS+), 'both indices qualified group' (PAR+/OGS+), and 'both indices disqualified group' (PAR-/OGS-) were compared with a Wilcoxon rank-sum test, sensitivity/specifi city test and Spearman's correlation test. Result: PAR scores for T0, T1, and percentage reduction were 21.1, 6.4, and 65.9%, respectively, and 35.4 for ABOOGS. The distribution of the 'PAR+/OGS+', 'PAR+', and 'PAR-/OGS-' group was 19.3%, 76.9%, and 3.8%, respectively. The T0-PAR, T1-PAR and PAR point reductions for the 'PAR+' group were significantly higher than those of 'PAR+/OGS+' groups (23.1 vs. 15.6; 6.7 vs. 4.6; and 16.5 vs. 11.0; all P<0.05). However, the PAR-percentage reduction and treatment duration between the two groups were not statistically different (70.0% vs. 67.0%, P=0.4325; 24.1 months vs. 25.0 months, P=0.4057). The T1-ABO-OGS score for 'PAR+' group was significantly higher than that of the 'PAR+/OGS+' groups (38.2 vs. 24.0, P<0.001). Conclusion: Since the fraction of the 'PAR+/OGS+' group was less than 20% and there was no significant correlation between PAR-percentage reduction and T1-ABO-OGS, development of a new index system for the accurate evaluation of treatment outcome is needed.