• Title/Summary/Keyword: Patient management system

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The Attitude of Medical Practitioners to the Chronic Disease Care System (개원의의 만성질환관리제도에 대한 수용태도)

  • Hwang, Byung-Deog
    • The Korean Journal of Health Service Management
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    • v.6 no.2
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    • pp.193-200
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    • 2012
  • The purpose of this study was to research the opinion and acknowledgement about the clinical chronic disease care system subject to Medical Practitioners that copied the internal medicine and family medicine as a treatment subject and was fulfilled in the purpose of providing a basic data for the improvement and stable establishment of the chronic disease care system and the high blood pressure and diabetes mellitus patient's promotion of health. Results from the research the internal medicine was 79% and the subject's average age was 52.3 years, the proportion that the high blood pressure and the diabetes mellitus took was average 28% and the interest about the system was 65.9%. In the chronic disease care system expansion status the opposition was 75.7%, and the detail field knowledge level was 56.9%. In the opinion field about the system, all fields were shown negative. The chronic disease care system is an important government policy enforcing purposed to effectively manage the yearly increasing chronic disease, but the due to the cold attitude of Medical Practitioners that must actively accept it, the stable establishment of the system is being concerned. Therefore even if it's a good policy if it cant gain the support and agreement of the accepter, in the future when trying to implement a system there should be no idleness in the effort to gain cooperation and understanding to relevant involved ones.

Automated Diagnosis of Disease in Medical Information Management System (의료용 정보처리시스템에서 질환해석)

  • Kim, Hie-Sik;Choi, Gi-Sang;Kim, Gyu-Sik;Choi, Jin-Uk;Park, Jong-Sung;Lee, Pyong-Won;Kim, Eul-Sik;SeoMun, Jun
    • Proceedings of the KOSOMBE Conference
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    • v.1997 no.11
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    • pp.193-196
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    • 1997
  • This paper proposes a new medical information management system to be used or small to medium sized clinics and hospitals. The system is designed to process, analyze and manage each patient's clinical record using database technique. The structure of the database was determined and implemented through careful and rigorous study of medical practices in Korea and, therefore, reflects the needs of information management in Korean medical community. Furthermore, a sophisticated inference engine that can deduce possible disease from the result of medical examination is added to the system to provide doctors with a guideline in medical diagnoses.

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Labia Majora Share

  • Lee, Hanjing;Yap, Yan Lin;Low, Jeffrey Jen Hui;Lim, Jane
    • Archives of Plastic Surgery
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    • v.44 no.1
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    • pp.80-84
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    • 2017
  • Defects involving specialised areas with characteristic anatomical features, such as the nipple, upper eyelid, and lip, benefit greatly from the use of sharing procedures. The vulva, a complex 3-dimensional structure, can also be reconstructed through a sharing procedure drawing upon the contralateral vulva. In this report, we present the interesting case of a patient with chronic, massive, localised lymphedema of her left labia majora that was resected in 2011. Five years later, she presented with squamous cell carcinoma over the left vulva region, which is rarely associated with chronic lymphedema. To the best of our knowledge, our management of the radical vulvectomy defect with a labia majora sharing procedure is novel and has not been previously described. The labia major flap presented in this report is a shared flap; that is, a transposition flap based on the dorsal clitoral artery, which has consistent vascular anatomy, making this flap durable and reliable. This procedure epitomises the principle of replacing like with like, does not interfere with leg movement or patient positioning, has minimal donor site morbidity, and preserves other locoregional flap options for future reconstruction. One limitation is the need for a lax contralateral vulva. This labia majora sharing procedure is a viable option in carefully selected patients.

Transfer Patterns of Multiple Trauma Patients in University Hospital after Acute Phase Management (대학병원에서 급성기 치료가 완료된 다발성 외상환자의 전원 패턴)

  • Lee, Jong Min;Jang, Ji Young;Lee, Seung Hwan;Lee, Jae Gil
    • Journal of Trauma and Injury
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    • v.26 no.4
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    • pp.261-265
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    • 2013
  • Purpose: The aim of this study is to evaluate the transfer pattern of multiple trauma patients after acute phase management and to determine whether the time between the surgeon's decision and the actual transfer correlates with the patient's insurance type. Methods: Three hundred ninety-two(392) multiple trauma patients visited the emergency room from January 2011 to April 2013. Among the 143 patients who were admitted by a trauma surgeon, 47 were transferred to another hospital after acute phase management. The age, gender, trauma mechanism, Revised trauma score (RTS), Injury severity score (ISS), insurance type, length of ICU stay and hospital stay were analyzed through a retrospective chart review. Results: The mean age was 47.7 years, and traffic accident was the most common mechanism(26, 55.3%). The mean RTS and ISS were 6.93 and 22.7, respectively. Twenty-five patients(53%) were covered by National health insurance, and 20 patients(42.6%) were covered by automobile insurance. Patients were transferred to primary (4.3%), secondary(80.9%), tertiary(4.3%) and care(10.6%) hospitals. The mean time from transfer decision to actual transfer was significantly longer for patients who were covered by automobile insurance than it was for patients who were covered by national health insurance (p=0.038). Conclusion: An appropriate transfer system at the end of acute phase care is essential for managing trauma centers with limited staffing and facilities. In addition, the mean time from transfer decision to actual transfer seemed to be definitely related to the type of insurance covering the patient.

Improvement of Transfusion Practice in Cardiothoracic Surgery Through Implementing a Patient Blood Management Program

  • Hee Jung Kim;Hyeon Ju Shin;Suk Woo Lee;Seonyeong Heo;Seung Hyong Lee;Ji Eon Kim;Ho Sung Son;Jae Seung Jung
    • Journal of Chest Surgery
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    • v.57 no.4
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    • pp.390-398
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    • 2024
  • Background: In this study, we examined the impact of a patient blood management (PBM) program on red blood cell (RBC) transfusion practices in cardiothoracic surgery. Methods: The PBM program had 3 components: monitoring transfusions through an order communication system checklist, educating the medical team about PBM, and providing feedback to ordering physicians on the appropriateness of transfusion. The retrospective analysis examined changes in the hemoglobin levels triggering transfusion and the proportions of appropriate RBC transfusions before, during, and after PBM implementation. Further analysis was focused on patients undergoing cardiac surgery, with outcomes including 30-day mortality, durations of intensive care unit and hospital stays, and rates of pneumonia, sepsis, and wound complications. Results: The study included 2,802 patients admitted for cardiothoracic surgery. After the implementation of PBM, a significant decrease was observed in the hemoglobin threshold for RBC transfusion. This threshold dropped from 8.7 g/dL before PBM to 8.3 g/dL during the PBM education phase and 8.0 g/dL during the PBM feedback period. Additionally, the proportion of appropriate RBC transfusions increased markedly, from 23.9% before PBM to 34.9% and 58.2% during the education and feedback phases, respectively. Among the 381 patients who underwent cardiac surgery, a significant reduction was noted in the length of hospitalization over time (p<0.001). However, other clinical outcomes displayed no significant differences. Conclusion: PBM implementation effectively reduced the hemoglobin threshold for RBC transfusion and increased the rate of appropriate transfusion in cardiothoracic surgery. Although transfusion practices improved, clinical outcomes were comparable to those observed before PBM implementation.

Clinical features and surgical outcomes of complete transposition of the great arteries

  • Hong, Suk Jin;Choi, Hee Joung;Kim, Yeo Hyang;Hyun, Myung Chul;Lee, Sang Bum;Cho, Joon Yong
    • Clinical and Experimental Pediatrics
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    • v.55 no.10
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    • pp.377-382
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    • 2012
  • Purpose: This single-center study aimed to assess the clinical features and surgical approaches and outcomes of complete transposition of the great arteries (TGA). Methods: TGA patients who had undergone surgical correction at the Kyungpook National University Hospital from January 2000 to December 2010, were retrospectively evaluated for patient characteristics, clinical manifestation, preoperative management, intraoperative findings, postoperative progress, and follow-up status. Results: Twenty-eight patients (17 boys and 11 girls, mean age=$10.6{\pm}21.5$ days) were included and were categorized as follows: group I, TGA with intact ventricular septum (n=13); group II, TGA with ventricular septal defect (VSD, n=12); and group III, TGA/VSD with pulmonary stenosis (n=3). Group I underwent the most intensive preoperative management (balloon atrial septostomy and prostaglandin E1 medication). Group II showed the highest incidence of heart failure (P<0.05). Usual and unusual coronary anatomy patterns were observed in 20 (71%) and 8 patients, respectively. Arterial and half-turned truncal switch operations were performed in 25 and 3 patients (Group III), respectively. Postoperative complications included cardiac arrhythmias (8 patients), central nervous system complications (3 patients), acute renal failure (1 patient), infections (3 patients), and cardiac tamponade (1 patient), and no statistically significant difference was observed between the groups. Group II showed the mildest aortic regurgitation on follow-up echocardiograms (P<0.05). One patient underwent reoperation, and 1 died. The overall mortality rate was 4%. Conclusion: Our study showed favorable results in all the groups and no significant difference in postoperative complication, reoperation, and mortality among the groups. However, our results were inadequate to evaluate the risk factors for reoperation and mortality owing to the small number of patients and short follow-up duration.

Automatic real-name registration mark examiner research and development of special medical equipment for patient safety (환자 안전을 위한 특수의료장비의 검사자 실명제 자동 표식 등록 개발 연구)

  • Yoo, Se-Jong;Park, Jong-Bae;Kim, Jeong-Ho;Kim, Ki-Jin;Lim, Jae-Dong
    • Journal of the Korea Safety Management & Science
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    • v.17 no.2
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    • pp.147-152
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    • 2015
  • Through the inspector's real name to improve the quality of inspection is to show the design Radiological examination pursuant to the Ordinance of the Ministry of Health and Welfare for patient safety in the Image. However, the use of existing and in EMR, equipment within the handwriting input, the individual initial use has a problem. In this study, increasing the stability of the patient and the precise inspection, In order to increase the efficiency and convenience than the real-name system for quality control inspectors of medical equipment, Using the EMR and PACS developed and applied to evaluate the usefulness of automatic enrollment. Enter your information in the EMR, which was developed markers that inspectors use to compare the before and after images PACS satisfaction. Convenience than using traditional, consistency, the entry of the missing were higher as a statistically significant difference. A test strip automatic enrollment programs are developed in this study. You can increase the stability of the patient by checking the image to show the real tester, we expect the quality of care would be improved.

Determination of Cost and Measurement of nursing Care Hours for Hospice Patients Hospitalized in one University Hospital (일 대학병원 호스피스 병동 입원 환자의 간호활동시간 측정과 원가산정)

  • Kim, Kyeong-Uoon
    • Journal of Korean Academy of Nursing Administration
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    • v.6 no.3
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    • pp.389-404
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    • 2000
  • This study was designed to determine the cost and measurement of nursing care hours for hospice patients hostpitalized in one university hospital. 314 inpatients in the hospice unit 11 nursing manpower were enrolled. Study was taken place in C University Hospital from 8th to 28th, Nov, 1999. Researcher and investigator did pilot study for selecting compatible hospice patient classification indicators. After modifying patient classification indicators and nursing care details for general ward, approved of content validity by specialist. Using hospice patient classification indicators and per 5 min continuing observation method, researcher and investigator recorded direct nursing care hours, indirect nursing care hours, and personnel time on hospice nursing care hours, and personnel time on hospice nursing care activities sheet. All of the patients were classified into Class I(mildly ill), Class II (moderately ill), Class III (acutely ill), and Class IV (critically ill) by patient classification system (PCS) which had been carefully developed to be suitable for the Korean hospice ward. And then the elements of the nursing care cost was investigated. Based on the data from an accounting section (Riccolo, 1988), nursing care hours per patient per day in each class and nursing care cost per patient per hour were multiplied. And then the mean of the nursing care cost per patient per day in each class was calculated. Using SAS, The number of patients in class and nursing activities in duty for nursing care hours were calculated the percent, the mean, the standard deviation respectively. According to the ANOVA and the $Scheff{\'{e}$ test, direct nursing care hours per patient per day for the each class were analyzed. The results of this study were summarized as follows : 1. Distribution of patient class : class IN(33.5%) was the largest class the rest were class II(26.1%) class III(22.6%), class I(17.8%). Nursing care requirements of the inpatients in hospice ward were greater than that of the inpatients in general ward. 2. Direct nursing care activities : Measurement ${\cdot}$ observation 41.7%, medication 16.6%, exercise ${\cdot}$ safety 12.5%, education ${\cdot}$ communication 7.2% etc. The mean hours of direct nursing care per patient per day per duty were needed ; 69.3 min for day duty, 64.7 min for evening duty, 88.2 min for night duty, 38.7 min for shift duty. The mean hours of direct nursing care of night duty was longer than that of the other duty. Direct nursing care hours per patient per day in each class were needed ; 3.1 hrs for class I, 3.9 hrs for class II, 4.7 hrs for class III, and 5.2 hrs for class IV. The mean hours of direct nursing care per patient per day without the PCS was 4.1 hours. The mean hours of direct nursing care per patient per day in class was increased significantly according to increasing nursing care requirements of the inpatients(F=49.04, p=.0001). The each class was significantly different(p<0.05). The mean hours of direct nursing care of several direct nursing care activities in each class were increased according to increasing nursing care requirements of the inpatients(p<0.05) ; class III and class IV for medication and education ${\cdot}$ communication, class I, class III and class IV for measurement ${\cdot}$ observation, class I, class II and class IV for elimination ${\cdot}$ irrigation, all of class for exercise ${\cdot}$ safety. 3. Indirect nursing care activities and personnel time : Recognization 24.2%, house keeping activity 22.7%, charting 17.2%, personnel time 11.8% etc. The mean hours of indirect nursing care and personnel time per nursing manpower was 4.7 hrs. The mean hours of indirect nursing care and personnel time per duty were 294.8 min for day duty, 212.3 min for evening duty, 387.9 min for night duty, 143.3 min for shift duty. The mean of indirect nursing care hours and personnel time of night duty was longer than that of the other duty. 4. The mean hours of indirect nursing care and personnel time per patient per day was 2.5 hrs. 5. The mean hours of nursing care per patient per day in each class were class I 5.6 hrs, class II 6.4 hrs, class III 7.2 hrs, class IV 7.7 hrs. 6. The elements of the nursing care cost were composed of 2,212 won for direct nursing care cost, 267 won for direct material cost and 307 won for indirect cost. Sum of the elements of the nursing care cost was 2,786 won. 7. The mean cost of the nursing care per patient per day in each class were 15,601.6 won for class I, 17,830.4 won for class II, 20,259.2 won for class III, 21,452.2 won for class IV. As above, using modified hospice patient classification indicators and nursing care activity details, many critical ill patients were hospitalized in the hospice unit and it reflected that the more nursing care requirements of the patients, the more direct nursing care hours. Emotional ${\cdot}$ spiritual care, pain ${\cdot}$ symptom control, terminal care, education ${\cdot}$ communication, narcotics management and delivery, attending funeral ceremony, the major nursing care activities, were also the independent hospice service. But it is not compensated by the present medical insurance system. Exercise ${\cdot}$ safety, elimination ${\cdot}$ irrigation needed more nursing care hours as equal to that of intensive care units. The present nursing management fee in the medical insurance system compensated only a part of nursing car service in hospice unit, which rewarded lower cost that that of nursing care.

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A Comparison of Interventions Recorded in Nursing Notes between Actue and Subacute Stage after a Cerebrovascular Accident (신경과 병동에 입원한 노졸중환자의 간호일지에 나타난 급성기와 아급성기의 간호중재 비교)

  • Choi, Ja-Yun;Park, Soon-Joo
    • Journal of Korean Academy of Nursing
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    • v.36 no.2
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    • pp.227-235
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    • 2006
  • Purpose: This study aimed to: 1) determine the core nursing interventions, and 2) compare acute interventions with subacute interventions recorded in the nursing notes of patients with cerebrovascular accidents (CVA). Methods: The nursing records covering the first 10 days of 30 patients with a CVA who were admitted from January to December 2004 at C University Hospital in Korea were examined. Data was collected using the nursing interventions classification (NIC) from January to April 2005. Finally, data analysis was carried out using mean, SD, and paired t-test according to domains, classes, and interventions. Results: The most frequent nursing intervention at both stage was 'Neurologic monitoring'. There were differences in interventions belonging to the 'Physiological: complex,' 'Behavioral,' 'Safety,' and 'Health system' domains between the acute and subacute stages. The frequency of interventions belonging to the 'Immobility management,' 'Neurological management,' 'Tissue perfusion management,' 'Patient education,' 'Risk management,' 'Health system mediation,' and 'Information management' classes at the acute stage was higher compared to the subacute stage. Conclusions: This study found out that nurses relatively recorded more nursing interventions during the acute stage hence the unsuccessful documentation of the subacute stage particularly in describing the specific nursing interventions at this stage.

The Study of Comparison Satisfaction and Re-use Intention between Central and Ward Reception Desk Users (입.퇴원 수속창구 중앙화와 분산화에 따른 이용자의 만족도와 재이용 의사)

  • Ham, Tae-Hoon;Lee, Kyung-Woo;Sohn, Tae-Yong;Yu, Seung-Hum
    • Korea Journal of Hospital Management
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    • v.14 no.4
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    • pp.149-162
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    • 2009
  • The purpose of this study is to design strategic hospital service based on each hospital's features. For this study, an assessment was conducted by 398 in-patents of one university hospital located in Seoul. The self-questionnaires, which were investigated from Oct. 15th to 29th in 2008, compared central reception desk with ward reception desk in satisfaction and re-use rate of patients. The major results of this study are as follow. First, according to each reception desk user, they have different satisfaction of it. As for the staff kindness, admission procedure, discharge procedure and manner of staff, those made patients be gratified as well. Second, when it comes to the intention of re-use, there were no significant features between them. Only convenience in admission and discharge procedure, however, was an attractive factor for the recommendation. Third, this study found out the reasons for higher re-use rate of central reception desk users. Regarding service, they were contented with the time for test and treatment. As for the hospital service, they would like to re-use this hospital because of convenient steps of paying interim fee and getting certificates. Forth, this study found out the reasons for higher re-use rate of ward reception desk users. As a point of hospital service view, they responded that respected privacy, hospital facility and general service were good for staying. As for the manner of staff, they mentioned nurses and staff in charge and whole staff members were kind. When it comes to the procedures of patient management, steps of discharge and paying interim fee were convenience. In conclusion, the results of this study suggest that providing a ward reception desk service can boost the satisfaction and re-use rate of in-patients. Furthermore, this strategic management method would be good for not only cutting the moving line but also efficient in-patient care system. These results can be used for the strategic hospital marketing field, as well. Even though this study has a limitation of the targeted populations which were only in a ward reception desk running hospital, it can say that having competitiveness in satisfaction of hospital service is good for promoting and differencing each hospital. Consequently, whole general management system would be adjusted first for differencing each hospital; however, this sort of additional factor should be concerned as well. I expect that this study would give meaningful data for designing strategic and differencing marketing method to lots of hospitals.

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