• Title/Summary/Keyword: Managed care

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Recognition and Attitude to Implement at ion of Service Area Assigned System of Public Health Programs among the Health Officer (공공보건사업의 지역담당제 실시에 관한 보건기관 근무 공무원의 인식과 태도)

  • Kim, Mi-Soon;Lee, Moo-Sik;Kim, Nam-Song
    • Journal of agricultural medicine and community health
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    • v.26 no.2
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    • pp.15-41
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    • 2001
  • Since medical clients and the community they live in are expected to be center of future public health and medical care system, new service programs must be developed with patients focused on in line with widening public access of information and social participation. Patients- focused service shall mean the area- oriented provision of public health service. In this study, health officers working at public health centers, public health sub- centers and medical offices in Jeonbuk- do area were taken for population in order to investigate their attitudes toward and knowledge about the service area assigning system under the public health programs. Findings from the survey to 260 health officers, divided by general category, are as follows : Government officers at public health organizations appeared to have high grade of understanding to the service area assigning system and also great appreciation for the necessity of it. Regarding the timing for the system to be introduced, they support the gradual implementation and, as for the type of service to be provided, they preferred home nursing and treatment of chronic diseases. Highly positive responses were centered on the health classes under the health promotion projects, and as far as health projects for the old are concerned, services for home nursing, for the disabled and for home- alone people are favored most. On the other hand, budgeting, manpower and reorganization are rated as prerequisite to establishment of the service area assigning system. From the viewpoint of system side, the improvement of working conditions is rendered as most urgent, while the information system for establishing the service area assigning system is conceived far from satisfactory. Proper assignment of specialists was noted as mostly important to establish the delivery system for medical service through the service area assigning system by team. As merits of the service area assigning system, it is pointed out that, through the system, health clients can better be managed and the nursing quality will be improved thank to the enhanced specialization. It is also perceived that the district health service is not well prepared to respond to the increased and diversified needs of community people and, furthermore, service programs of health centers have not been fully developed. The most serious problem standing in the way to expansion of health projects is, it is noted, uniformity (formality) of the project. Based on the results of the survey which suggest time has ripen to introduce the service area assigning system, following strategies are proposed to anchor down the system as soon as possible: First, we should introduce the system gradually, starting from the area selected, and in consideration of area specialities, refraining from the hitherto stereotyped way of providing health service. Second, we should seek to properly assign the specialists and improve the working conditions of the assigned officers by securing sufficient budget, since it is a most urgent step to lay foundation for the service area assigning system. Third, best service program should be developed to meet the satisfaction of community people by responding to their needs and solidifying the management of medical clients. Fourth, wide scope of study should further be conducted in order to help this system take roots in the central living of community residents since pilot project on the experimental base attended by specialists only can not win popularity among the masses.

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Prospective Study on Preoperative Evaluation for the Prediction of Mortality and Morbidity after Lung Cancer Resection (폐암절제술후 발생하는 사망 및 합병증의 예측인자 평가에 관한 전향적 연구)

  • Park, Jeong-Woong;Suh, Gee-Young;Kim, Ho-Cheol;Cheon, Eun-Mee;Chung, Man-Pyo;Kim, Ho-Joong;Kwon, O-Jung;Kim, Kwan-Min;Kim, Jin-Kook;Shim, Young-Mok;Rhee, Chong-H.;Han, Yong-Chol
    • Tuberculosis and Respiratory Diseases
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    • v.45 no.1
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    • pp.57-67
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    • 1998
  • Purpose : This study was undertaken to determine the preoperative predictors of mortality and morbidity after lung cancer resection. Method: During the period from October 1, 1995 to August 31, 1996, a prospective study was conducted in 92 lung resection candidates diagnosed as lung cancer. For preoperative predictors of nonpulmonary factors, we considered age, sex, weight loss, hematocrit, serum albumin, EKG and concomitant illness, and for those of pulmonary factors, smoking history, presence of pneumonia, dyspnea scale(1 to 4), arterial blood gas analysis with room air breathing, routine pulmonary function test. And predicted postoperative(ppo) pulmonary factors such as PPO-$FEV_1$, ppo-diffusing capacity(DLco), predicted postoperative product(PPP) of ppo-$FEV_1%{\times}ppo$-DLco% and ppo-maximal $O_2$ uptake($VO_2$max) were also considered. Results: There were 78 men and 14 women with a median age of 62 years(range 42 to 82) and a mean $FEV_1$ of $2.37\pm0.06L$. Twenty nine patients had a decreased $FEV_1$ less than 2.0L. Pneumonectomy was performed in 26 patients, bilobectomy in 12, lobectomy in 54. Pulmonary complications developed in 10 patients, cardiac complications in 9, other complications(empyema, air leak, bleeding) in 11, and 16 patients were managed in intensive care unit for more than 48hours. Three patients died within 30 days after operation. The ppo-$VO_2$max was less than 10ml/kg/min in these three patients, but its statistical significance could not be determined due to small number of patients. In multivariate analysis, the predictor related to postoperative death was weight loss(p<0.05), and as for pulmonary complications, weight loss, dyspnea scale, ppo-DLco and extent of resection(p<0.05). Conclusions: Based on this study, preoperative nonpulmonary factors such as weight loss and dyspnea scale are more important than the pulmonary factors in the prediction of postoperative mortality and/or morbodity in lung resection candidates, but exercise pulmonary fuction test may be useful Our study suggests that ppo-$VO_2$max value less than 10ml/kg/min is associated with death after lung cancer resection but further studies are needed to validate this result.

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Dismantling and Restoration of the Celadon Stool Treasure with an Openwork Ring Design (보물 청자 투각고리문 의자의 해체 및 복원)

  • KWON, Ohyoung;LEE, Sunmyung;LEE, Jangjon;PARK, Younghwan
    • Korean Journal of Heritage: History & Science
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    • v.55 no.2
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    • pp.200-211
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    • 2022
  • The celadon stools with an openwork ring design which consist of four items as one collection were excavated from Gaeseong, Gyeonggi-do Province. The celadon stools were designated and managed as treasures due to their high arthistorical value in the form of demonstrating the excellence of celadon manufacturing techniques and the fanciful lifestyles during the Goryeo Dynasty. However, one of the items, which appeared to have been repaired and restored in the past, suffered a decline in aesthetic value due to the aging of the treatment materials and the lack of skill on the part of the conservator, raising the need for re-treatment as a result of structural instability. An examination of the conservation condition prior to conservation treatment found structural vulnerabilities because physical damage had been artificially inflicted throughout the area that was rendered defective at the time of manufacturing. The bonded surfaces for the cracked areas and detached fragments did not fit, and these areas and fragments had deteriorated because the adhesive trickled down onto the celadon surface or secondary contaminants, such as dust, were on the adhesive surface. The study identified the position, scope, and conditions of the bonded areas at the cracks UV rays and microscopy in order to investigate the condition of repair and restoration. By conducting Fourier-transform infrared spectroscopy(FT-IR) and portable x-ray fluorescence spectroscopy on the materials used for the former conservation treatment, the study confirmed the use of cellulose resins and epoxy resins as adhesives. Furthermore, the analysis revealed the addition of gypsum(CaSO4·2H2O) and bone meal(Ca10 (PO4)6(OH)2) to the adhesive to increase the bonding strength of some of the bonded areas that sustained force. Based on the results of the investigation, the conservation treatment for the artifact would focus on completely dismantling the existing bonded areas and then consolidating vulnerable areas through bonding and restoration. After removing and dismantling the prior adhesive used, the celadon stool was separated into 6 large fragments including the top and bottom, the curved legs, and some of the ring design. After dismantling, the remaining adhesive and contaminants were chemically and physically removed, and a steam cleaner was used to clean the fractured surfaces to increase the bonding efficacy of the re-bonding. The bonding of the artifact involved applying the adhesive differently depending on the bonding area and size. The cyanoacrylate resin Loctite 401 was used on the bonding area that held the positions of the fragments, while the acrylic resin Paraloid B-72 20%(in xylene) was treated on cross sections for reversibility in the areas that provided structural stability before bonding the fragments using the epoxy resin Epo-tek 301-2. For areas that would sustain force, as in the top and bottom, kaolin was added to Epo-tek 301-2 in order to reinforce the bonding strength. For the missing parts of the ring design where a continuous pattern could be assumed, a frame was made using SN-sheets, and the ring design was then modeled and restored by connecting the damaged cross section with Wood epos. Other restoration areas that occurred during bonding were treated by being filled with Wood epos for aesthetic and structural stabilization. Restored and filled areas were color-matched to avoid the feeling of disharmony from differences of texture in case of exhibitions in the future. The investigation and treatment process involving a variety of scientific technology was systematically documented so as to be utilized as basic data for the conservation and maintenance.