• The Korean Society of Law and Medicine
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• v.13 no.2
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• pp.11-38
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• 2012

The Supreme Court stand in the position in specific lawsuit that it doesn't allow the discretionary not covered service, but recently in revocation suit of fine disposal that is imposed on medical fee of leukemia patient, it altered the existing adjudgement and admitted the discretionary not covered service exceptionally. It put forward the allowable condition roughly in that case. According as this alteration, it has become more important to embody the allowance conditions of exceptions. The Supreme Court presented three things, which are procedural condition, medical condition and subscriber's agreement. Concerning procedural condition, several present conciliation procedures are as follows: medical care benefit arret request, relative value conciliation etc, prior request on anti-cancer drug among chemicals which exceed acceptance criteria, request of non benefit object on common drugs. To be granted the existence of those system, there should be no obstacle to use that. Even if it were so, we should take circumstances into consideration; individual situation is unescapable concerning substance and urgency of the discretionary not covered service, process of the procedure, time required etc. Regarding medical condition, safety and effectiveness will be verified through evaluation procedures of new medical skill. About the necessity, the Supreme Court made clear through a sentence that it allow the discretionary not covered service, in case that needs to treat a patient out of the standard of medical benefit. Strict interpretation is right and it answer the purpose of the sentence that the supreme court permit the discretionary not covered service, exceptionally. We need to differentiate medical necessity and medical validity. Subscriber's agreement should holds true if it entails full explanation, and if it is preliminary, explicit and individual. On this account, it should be difficult to admit that someone agree effectively when he call for the affirmation that he is recipient of medical care. Reasonable expense needs to be a part of review whether the agreement is valid. Meanwhile If we adjust system of medical expense and eventually reorganize a fee for consultation payment system (Fee-for-service controlled by item to DRG (Diagnosis Related Groups)), controversial area of the discretionary not covered service will be decreased and that will guarantee the discretion of the doctor.

• Korean Journal of Clinical Laboratory Science
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• v.50 no.3
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• pp.359-369
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• 2018

An essential measure to prevent healthcare-associated infections (HAI) is to develop a consistent system of surveillance, thereby promoting a reliable situation diagnosis to perform efficient control for the problem. Patient-to-patient transmission of pathogens within the hospital plays a substantial role in the epidemiology of HAIs. Contamination of healthcare environments commonly occurs, including facilities surfaces (e.g., bed rails, bedside tables), drinking water, cooling tower water, endoscopic instruments, food, airborne, endotoxin test, sterile test and medical equipment, with pathogenic organisms. In addition, epidemiological analysis is performed by multi locus sequence tying, pulsed-field gel electrophoresis for active surveillance. Therefore, an environmental surveillance culture test for prevention improves patient safety and blocks infection agents. Effective infection control and increased safety are possible by controlling the national infection control system. In conclusion, this study contributes to an effective infection control system through the standardization of active surveillance culture laboratory and secure expertise as infection control specialist. The primary objective of the standardization is to improve the safety of the nation's healthcare system by reducing the rates of HAIs.

• Journal of Internet Computing and Services
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• v.16 no.1
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• pp.47-55
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• 2015

Recently, the environment of a hospital information system is a trend to combine various SMART technologies. Accordingly, various smart devices, such as a smart phone, Tablet PC is utilized in the medical information system. Also, these environments consist of various applications executing on heterogeneous sensors, devices, systems and networks. In these hospital information system environment, applying a security service by traditional access control method cause a problems. Most of the existing security system uses the access control list structure. It is only permitted access defined by an access control matrix such as client name, service object method name. The major problem with the static approach cannot quickly adapt to changed situations. Hence, we needs to new security mechanisms which provides more flexible and can be easily adapted to various environments with very different security requirements. In addition, for addressing the changing of service medical treatment of the patient, the researching is needed. In this paper, we suggest a dynamic approach to medical information systems in smart mobile environments. We focus on how to access medical information systems according to dynamic access control methods based on the existence of the hospital's information system environments. The physical environments consist of a mobile x-ray imaging devices, dedicated mobile/general smart devices, PACS, EMR server and authorization server. The software environment was developed based on the .Net Framework for synchronization and monitoring services based on mobile X-ray imaging equipment Windows7 OS. And dedicated a smart device application, we implemented a dynamic access services through JSP and Java SDK is based on the Android OS. PACS and mobile X-ray image devices in hospital, medical information between the dedicated smart devices are based on the DICOM medical image standard information. In addition, EMR information is based on H7. In order to providing dynamic access control service, we classify the context of the patients according to conditions of bio-information such as oxygen saturation, heart rate, BP and body temperature etc. It shows event trace diagrams which divided into two parts like general situation, emergency situation. And, we designed the dynamic approach of the medical care information by authentication method. The authentication Information are contained ID/PWD, the roles, position and working hours, emergency certification codes for emergency patients. General situations of dynamic access control method may have access to medical information by the value of the authentication information. In the case of an emergency, was to have access to medical information by an emergency code, without the authentication information. And, we constructed the medical information integration database scheme that is consist medical information, patient, medical staff and medical image information according to medical information standards.y Finally, we show the usefulness of the dynamic access application service based on the smart devices for execution results of the proposed system according to patient contexts such as general and emergency situation. Especially, the proposed systems are providing effective medical information services with smart devices in emergency situation by dynamic access control methods. As results, we expect the proposed systems to be useful for u-hospital information systems and services.

• Journal of Society of Preventive Korean Medicine
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• v.17 no.3
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• pp.155-164
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• 2013

Purpose : This study was conducted to assess whether Korean medicine doctors' attire influences patients' preference (confidence, comfortability, neatness) in a university hospital. Materials and Methods : Employing a cross-sectional design, outpatients answered a questionnaire in a university hospital of Korean Medicine. Respondents were asked for completing the questionnaire to estimate their preference of doctor's attire for confidence, comfortability and neatness after watching 4 types of attire in both male and female Korean medicine doctors, including white coat, traditional attire, formal suit and casual clothes. Whether Korean medicine doctors' attire on a patients' preference is important was also asked for the respondents using a 5-point Likert scale. Results : All 175 patients were enrolled, of whom 38.9% were male respondents, 46.3% graduated from a university at least and mean age of responders was 47.1. Most had a tendency for preferring white coat followed by traditional attire and only a small portion of respondents preferred for formal suit and casual clothes. When comparing preferences in confidence between white coat and traditional attire only, male patients preferred white coat more than female patients did with statistical significance. In addition, 85.4% of respondents answered that Korean medicine doctors' attire is important to a clinical situation with higher ratio of female respondents (87.9%) than male respondents (80.9%). Conclusion : Patients preferred white coat and traditional attire mostly for the Korean Medicine doctor's attire with only small preference for formal suit and casual clothes. Also, Patients recognized that Korean medicine doctors' attire is important in the clinical situation.

• The Journal of Korean Society for Radiation Therapy
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• v.28 no.1
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• pp.35-46
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• 2016

Purpose : BoS(Base of Skull) Frame, the fixation tool which is used for the proton of brain cancer increases the lateral penumbra by increasing the airgap (the distance between patient and beam jet), due to the collision of the beam of the posterior oblique direction. Thus, we manufactured the fixation tool per se for improving the limits of BoS frame, and we'd like to evaluate the utility of the manufactured fixation tool throughout this study. Materials and Methods : We've selected the 3 patients of brain cancer who have received the proton therapy from our hospital, and also selected the 6 beam angles; for this, we've selected the beam angle of the posterior oblique direction. We' ve measured the planned BoS frame and the distance of Snout for each beam which are planned for the treatment of the patient using the BoS frame. After this, we've proceeded with the set-up that is above the location which was recommended by the manufacturer of the BoS frame, at the same beam angle of the same patient, by using our in-house Bos frame fixation tool. The set-up was above 21 cm toward the superior direction, compared to the situation when the BoS frame was only used with the basic couch. After that, we've stacked the snout to the BoS frame as much as possible, and measured the distance of snout. We've also measured the airgap, based on the gap of that snout distance; and we've proceeded the normalization based on each dose (100% of each dose), after that, we've conducted the comparative analysis of lateral penumbra. Moreover, we've established the treatment plan according to the changed airgap which has been transformed to the Raystation 5.0 proton therapy planning system, and we've conducted the comparative analysis of DVH(Dose Volume Histogram). Results : When comparing the result before using the in-house Bos frame fixation tool which was manufactured for each beam angle with the result after using the fixation tool, we could figure out that airgap than when not used in accordance with the use of the in-house Bos frame fixation tool was reduced by 5.4 cm ~ 15.4 cm, respectively angle. The reduced snout distance means the airgap. Lateral Penumbra could reduce left, right, 0.1 cm ~ 0.4 cm by an angle in accordance with decreasing the airgap while using each beam angle in-house Bos frame fixation tool. Due to the reduced lateral penumbra, Lt.eyeball, Lt.lens, Lt. hippocampus, Lt. cochlea, Rt. eyeball, Rt. lens, Rt. cochlea, Rt. hippocampus, stem that can be seen that the dose is decreased by 0 CGE ~ 4.4 CGE. Conclusion : It was possible to reduced the airgap by using our in-house Bos frame fixation tool for the proton therapy; as a result, it was possible to figure out that the lateral penumbra reduced. Moreover, it was also possible to check through the comparative analysis of the treatment plan that when we reduce the lateral penumbra, the reduction of the unnecessary irradiation for the normal tissues. Therefore, Using the posterior oblique the Brain cancer proton therapy should be preceded by decreasing the airgap, by using our in-house Bos frame fixation tool; also, the continuous efforts for reducing the airgap as much as possible for the proton therapy of other area will be necessary as well.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.27 no.4
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• pp.353-357
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• 2001

The techniques of the dental treatment are well known to common people, but the dental implant as one of the treatment options to rehabilitate patient's mouth is little known to them. Taking these situation into consideration, we, writers made actual analyses of statistics by putting into the form of diagrams based on questionnaires. Three hundreds of common people over 20 years old were picked up and we used convenience sampling method which is one of nonprobability sampling methods. Statistics are about these questions. 1. How much common people know about dental implant as a treatment option. 2. How much common people know about the detailed portions of the dental implant for rehabilitaton. 3. How common people got to know the dental implant. We present actual answers of the common people.

• Journal of Korean Academy of Nursing Administration
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• v.2 no.2
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• pp.43-57
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• 1996

The purpose of this research conducted has been an the development of a computer program to be used for nursing of spinal cord injury patients. The research is also intended to contribute by supplying the basic data, to the development of other programs in relevant areas where similar nursing information system is required. This research used System Development Life Cycle method. Results from the study were as follows : The scope of Information System in nursing practice were based on a wide range of mateials as charts at four hospitals in Pusan that cover the nursing period of spinal cord injury patients from admission to discharge and other sources of reference, the research is done for nursing diagnosis, nursing history, admission and discharge education, and the performing of doctor's order, which were divided into a subsystem that consisted of help, Patient Management, Performing of Docter's Order, and Basic Data Management and then these was analysed systematically using Hierachy Plus Input Process Output, necessary information, data flow diagram, and conceptual designs were developed for chosem system. Furthemore, the system has been programed by a conceptual design that includes the objects of the program and the origins of the sources. The oder to make sure of the proper function, the computer program was actually applied to a nursing practice that had been developed for a hypothetical situation through the two nurses who were in charge of spinal cord injury patients after they were trained to understand the structure and the contents of computer program about the nursing practice from using the computer program developed. Also, the compensatory strategy has been worked out against any problems to arise. It is expected that this kind of nursing practice information system to be used for the spinal cord injury patients that has been developed through the processes shown above will increase the satisfaction for both patients and nurses by enabling them to give more professional advice and service to the development of more information systems for many hospitals.

• Proceedings of the KOSOMBE Conference
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• v.1994 no.12
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• pp.71-74
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• 1994

In cementless total hip arthroplasty(THA), an initial stability of the femoral component is mandatory to achieve bony ingrowth and secondary long term fixation. Bone ingrowth depends strongly on relative micromotion and stress distributions at the interface. Primary stability of the femoral component can be obtained by minimizing the magnitude of relative micromotions at bone-prosthesis interface, Hence an accurate evaluation of interface behavior and stress/strain fields in the bone implant system may be relevant for better understanding of clinical situations and improving THA design. However, complete evaluation of load transfer in the bone remains difficult to assess experimentally, Hence, recently finite element method (FEM) was introduced in orthopaedic research field to fill the gap due to its unique capacity to evaluate stress in structure of complex shape, loading and material behavior. The authors developed the 3-dimensional numerical finite element model which is composed of totally 1179 elements off and 8 node blick. We also analyzed the micromotions at the bone-stem interface and mechanical behavior of existing bone prosthesis for a loading condition simulating the single leg stance. The result indicates that the values of relative motion for this well fit Multilock stem were $150{\mu}m$ in maximum, $82{\mu}m$ in minimum, and the largest relative motion developed in medial region of proximal femur with anterior-posterior direction. The proximal region of the bone was much larger in motion than the distal region and the stress pattern shows high stress concentration on the cortex near the tip of the stem. These findings indicates that the loading in the proximal femoral bone in the early postoperative situation can produce micromotions on the interface and clinically cementless TEA patient should not be allowed weight bearing strictly early in the postoperative period.

• Korean Medical Education Review
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• v.20 no.3
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• pp.164-172
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• 2018

The aim of this study is to determine whether the 65 competencies, defined in "the role of Korean doctor, 2014", are suitable for basic medical education phase in Korea. It seeks to analyze the gap among the educational reality and expectation, assessment situation of the competencies above. We also try to define issues of the development, application and assessment phases of competency-based medical education (CBME) at individual medical schools. We designed survey tools based on the Miller's assessment pyramid (knowledge, explanation, demonstration, and performance) for each of the 65 competencies. The survey distributed to 41 medical schools in April 2015 and 38 replies were received (92.7%). Competencies that matched both the educational reality and expectation were numbers 1 (patient care), 33 (social accountability), and 49 (professionalism). However, all the other competencies ranked lower in current status than that of desirable level. 54 out of 65 competencies (83.07%) remained at the knowledge and explanation level when each competence were assessed. In the development, application, and assessment phases of CBME, common issues that medical schools commonly noted were difficulty linking competencies to curriculum preparation and student assessment, the lack of faculty's understanding, difficulty to reach consensus among faculties, and absence of teaching and learning methods and assessment tools that fits CBME. For the successful settle down of CBME, there is a need for efforts to develop the model of graduate outcomes, to share information and experience, and to operate faculty development program by the medical education communities.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.4
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• pp.2027-2030
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• 2016

Objective: To investigate the effect of peripheral blood CD4 + CD25 + regulatory T cell on postoperative immunotherapy in patients with renal carcinoma. Methods: 38 patients with renal cell carcinoma were recruited, and 20 patients from the operation group purely underwent the radical nephrectomy therapy, 18 patients from the combined group successively underwent the radical nephrectomy therapy and IFN-${\alpha}$ adjuvant immunotherapy. Additionally, 12 healthy subjects were recruited in the same period of time and regarded as the control group. Flow cytometry was used to detect CD4 +, CD8 +, CD4 + CD25+ T lymphocyte subset content and the ratio of all parts in the pre-operative period, in the first post-operative week and in the third post-operative month, compare and analyze its variation trend. Results: The CD4+CD25+ T lymphocyte subset content of individual renal carcinoma patients was significantly higher than that of the control group, also increases with the progression in the tumor stage (P<0.05). The post-operative CD4 + CD25+T lymphocytes of individual operation group and combined group patients showed different degrees of increment, but the increment of the combined group was significantly lower than that of the operation group (P<0.05). For the combined group patients with less pre-operative CD4 + CD25+T lymphocytes, their levels would increase after the immunotherapy, while the pre-operative patients with more CD4 + CD25+ T lymphocytes were the opposite situation. Conclusion: The detection of peripheral blood CD4+CD25+ regulatory T lymphocyte subset can reflect the anti-tumor immune status of renal cell carcinoma patient body. It can contribute to predict the prognosis of immunotherapy and provide reference for the choice of renal carcinoma post-operative adjuvant immunotherapy.