• 한국의학물리학회지:의학물리
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• 제21권2호
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• pp.127-136
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• 2010

최근 시행되고 있는 호흡동조 방사선치료는 환자의 호흡의 주기를 이용하여 일정 주기에만 방사선을 조사하는 최신 방사선치료기술로 4D Computed Tomography와 RPM (Real-time Position Management) 시스템과 같은 호흡 모니터링 시스템의 개발로 환자들에게 시행이 되고 있다. 그러나 이러한 호흡동조 방사선치료에 대한 정도 관리는 아직 체계적으로 수행되고 있지 않으며 특히 환자에게 계획된 방사선치료선량이 환자의 호흡에 따라서 치료계획된 대로 조사되는지에 대한 정도관리에 대한 필요성이 요구되고 있다. 따라서 본 기관에서는 환자의 호흡신호를 사용하여 환자의 움직임을 동일하게 모사할 수 있는 팬텀을 제작하여 호흡동조 방사선치료의 2차원적 선량 분포를 평가할 수 있는 시스템을 구축하였고 특정환자의 호흡신호와 방사선치료계획을 이용하여 검증하였다. 환자의 호흡신호는 LabVIEW 7.0을 이용하여 모사하였고, 자체 제작한 팬텀 및 Kodak EDR2 필름을 사용하여 방사선을 조사한 뒤 gamma index를 사용하여 2차원 선량 분포를 비교 분석하였다. 본 연구에서 개발된 4D 정도관리 시스템을 좀 더 보완하여 호흡동조 방사선치료 과정에 있어서 조사선량의 적정성을 평가할 수 있는 정도관리 시스템으로 사용할 수 있을 것이라 생각된다.

• 산업융합연구
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• 제22권2호
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• pp.97-103
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• 2024

본 연구의 목적은 비만 뇌졸중 환자의 균형 훈련이 체성분과 균형 능력 회복에 미치는 영향을 살펴보는 것이었다. 운동 프로그램은 비만군과 정상 체중 군을 동일하게 실험군(obesity)과 대조군(정상체중)으로 나누어 하루 30분, 일주일에 5일 동안 균형 훈련을 실시했다. 실험군과 대조군 모두 사전, 사후 체성분과 BSS(Biodex Medical Systems)를 8주간 수집하였다. 그 결과 그룹 내 체성분 자료를 비교해 보면 비만군은 모든 매개변수에서 유의한 차이를 보였다(p<.05). 또한 그룹 간 모든 매개변수 간에도 통계적인 차이를 보였다(p<.05). LOS(Limits Of Stability)의 그룹 내 자료를 비교해 보면, 비만군은 '후면'과 '좌측'을 제외한 모든 매개변수에서 유의한 차이를 보였다(p<.05). 그룹 간 자료에서 '전방' 매개변수는 유의한 차이를 보였다. PS(Posture Stability)의 그룹 내 자료를 비교해 보면, 비만군은 모든 매개변수에서 유의한 차이를 보였고(p<.05), 그룹 간 PS(Posture Stability) 결과는 'Med/lat'(p=.000)만으로 유의한 차이를 보였다. 이상의 결과를 종합해 보면, 균형 훈련이 비만이 있는 뇌졸중 환자의 균형 능력 및 체성분에 영향을 미치는 것으로 나타났다.

• 한국의료질향상학회지
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• 제30권1호
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• pp.120-131
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• 2024

Purpose: This study aimed to evaluate the impact of implementing a clinical pathways (CPs) on the clinical outcomes and costs of patients undergoing breast cancer surgery. Methods: This retrospective cohort study included patients who were newly diagnosed with primary breast cancer at the Samsung Medical Center between 2014 and 2019 (N=8482; 2931 patients in the pre-path and 5551 patients in the post-path). Clinical outcomes included reoperation during hospitalization, readmission, and emergency room visits within 30 days of discharge. The cost data for each unit were obtained from an activity-based management accounting system. We performed an interrupted time series analysis. Results: The post-path period showed a significantly shorter hospital length of stay (LOS) than the pre-path period (6.3 days in pre-path vs. 5.0 days in post-path; -1.3 days' difference; p=.001), and fewer reoperations during hospitalization and within 30 days after discharge than the pre-path period. After adjusting for inflation rates and relative value scores, the model demonstrated savings of $146 per patient in the post-path for total costs, and $537 per patient for patient out-of-pocket costs (p=.001). Conclusion: CPs can help reduce costs without compromising the quality of care by reducing the number of reoperations, readmissions, and complications.

• Journal of Trauma and Injury
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• 제26권4호
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• pp.273-279
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• 2013

Purpose: In patients with splenic trauma, Computed Tomography (CT) scan is helpful in selecting treatment options and evaluating resolution after NOM (Non-Operative Management). The purpose of this study was to suggest a CT based hemoperitoneum (HP) scoring system that can easily be used by clinicians to evaluate the severity of injury and recovery. Methods: A retrospective review of patients with splenic trauma admitted to our hospital between May 2003 and January 2013 was conducted. Patients diagnosed with isolated spleen injury who had a CT scan on admission were included. 1 or 2 points were given according to location and amount of hematoma in the CT image. Using the existing ultrasonography (US) based HP scoring system, the same method was applied to obtain our CT based HP scoring (CBHS) system, which ranges from 0 to 8 points. The CBHS system can be easily used by clinicians for a quick assessment of splenic injury. Results: Of the 39 patients meeting the inclusion criteria, 6 patients were managed operatively and 33 nonoperatively. There was a significant difference in CBHS between the OM (operative management) group and the NOM group.(p=0.03) CBHS showed correlation with Hb (hemoglobin), Hct (hematocrit), spleen injury grade(AAST), and Hounsfield unit of ROI (Region of interest). (p=0.17, p=0.18, p<0.000, p=0.02, respectively) After successful NOM with stabilized Hb level, the amount of hemoperitoneum was scored in the follow-up CT. CBHS demonstrated correlation with decreased spleen injury grade, decreased Hounsfield unit of ROI (Region of interest) (p=0.039, p=0.049, respectively), and also objectively reflected patient recovery. Conclusion: CBHS can be used as an objective and intuitive tool for clinicians in grading the severity of splenic injury by scoring the amount of hemoperitoneum, and in assessing recovery.

• 보건행정학회지
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• 제9권4호
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• pp.41-64
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• 1999

The major concern for this research is to discuss and to offer some solutions to bring the effectiveness of existing notifiable diseases reporting system over the physicians' attitudes of reporting, the actual condition of performance and the reasons of inertia in notifiable diseases reporting through examining the physicians of medical institutions in nationwide such as pediatrics, internal medicine and family medicine. The actual conditions of notifiable communicable diseases(NCD) reporting was surveyed by mail objectifying an internal medicine, pediatrics and family medicine in nationwide on the basis of stratified random sampling method divided into the classification of medical institutions and areas. As a result of survey. the rate of respondents showed 145 persons from physicians, 105 persons from hospitals. 120 persons from general hospitals, and 51 persons from tertiary hospitals. The total number of respondents were 421 and was rated 59.0 %. The analysis of collected survey went through a descriptive analysis primarily to grasp physicians' attitudes on the notifiable communicable diseases reporting, and then upon the dependent variables. Following are major findings obtained form the data analysis. 1. The results of a descriptive analysis on physicians' attitudes towards reporting NCD were as follows: First, the respondents who didn't know that yellow fever is reporting NCD were 11.0% of clinic, 10.5% of hospital. 5.0% of general hospital. 11.8% of tertiary hospital. and in case of hepatitis B, were 26.9% of clinic, 35.2% of hospital. 35.0% of general hospital. 23.5% of tertiary hospital. Second, The rate of physicians' knowledge on penalties of not reporting the NCD by their medical institution were 35.2% of clinic, 45.7% of hospital. 36.7% of general hospital. 62.7% of tertiary hospital. Third, among the no-reporting physicians in whole, the major reason of not reporting NCD were uncertainty of diagnosis(78.9%), no need to report(46.4%), no adequate actions from PHC(29.1%), no knowledge of the cases being notifiable ones in the order of their frequencies(30.4%), meddling from PHC(29.1%), concerning of patient's privacy(26.3%). 2. To analyze the characteristics related to the physicians' behaviors to report NCD, univariate and multiple logistic regression analyses were applied to the variables related to physician, 4 medical facility, PHC, and reporting system. The result were as follows: First, the result of the univariate analysis on physicians' attitude to report NCD and characteristics related to reporting in odds ratio was in the case of hospital. 3.4 times higher positive responses on physicians' attitude to report NCD came up as compared to the clinic. Second, the result of the univariate analysis on physicians' action of reporting NCD and characteristics related to reporting by the classification of medical institutions showed that the odds ratio of hospital was 2.3 times, the odds ratio of general hospital was 2.0 times, the odds ratio of tertiary was 6.8 times significantly higher than clinic. And the medical institution with significantly higher positive attitudes rate by multiple logistic regression analysis was hospital that rated 2.5 times significantly higher than clinic. Also in the PHC related characteristics of reporting, the rate of action in reporting NCD was significantly higher in medical institution that were endowed with the good condition of reporting. In multiple logistic regression analysis, the medical institution that has a good conditions of reporting showed a significantly higher positive rate on the action of reporting than the others.

• 한국치위생학회지
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• 제10권4호
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• pp.555-565
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• 2010

Objectives : This study was intended to examine job satisfaction in dental hygienists working in the Gwangju Jeonnam area and provide basic materials for the efficient management of dental clinics and the improvement of working conditions in dental hygienists. Methods : In order to achieve this purpose, the questionnaire survey was conducted from August 13 to October 6, 2007. Of a total of 394 questionnaires, 34 was excluded because of poor responses and finally 360(Gwangju 296, Jeonnam 64) were analyzed. Results : For job satisfaction associated with the total career and turnover, satisfaction was increased with the total career. Job satisfaction associated with working conditions became higher as a monthly mean paycheck was increased or when an incentive, in the annual pay system and long-service men preference was provided(p<0.05). Job satisfaction was 3.26. The highest satisfaction at detailed factors was found in patient relation(3.85), colleague relation(3.40), prospects(3.26), dentistry organization(3.17), autonomy(3.10), and pay(2.78). For detailed factors of job satisfaction, the most influential factor was monthly mean paycheck, followed by incentive, age and marriage(p<0.05). Conclusions : When dental hygienists' working environment is planned and improved in the rational and desirable direction, their job satisfaction will be improved. As a result, it will contribute to a decrease in the jobless rate and an increase in the productivity of oral care and the efficiency of hospital management.

• 대한안전경영과학회지
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• 제15권4호
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• pp.113-121
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• 2013

The rate that women's EMTs(emergency medical technicians) in fire department occupy is increasing, but my general plan is aimed at suggesting the improving plan for the working environment of women's EMTs paying attention to the duty stresses of increasing women's EMTs, because improvement for the working environment of women's EMTs is being proceeded slowly. I suggested my improving plan for solving the working stress on the basis of a survey of the Recognition against women's EMTs as follows. Firstly, I suggested that physical strength of women's EMTs should be managed well continually via program establishment and a defined evaluation not only by employing a professional person in charge for physical strength in firehouse, but also by replenishing the suitable number for the urgent mobilization. Secondly, I suggested that the suitable number for the urgent mobilization should be increased to 3 including an ambulance driver. Thirdly, I suggested necessity such as the fruitful education and the creation of circumstances that can focus on education for improving participation rate, development of various new educational program, incentive program and penalty. finally, I suggested the fact that is related to the actual re-amendment of the concerned law and ordinance such as not only the smooth treatment of penalty for a traffic signal violation of ambulance and the legal remedy system due to aggravation of a patient's condition during a first-aid course, but also workshop and meeting among the periodical EMTs and administration of special therapy program and sufficient recess.

• 대한장애인치과학회지
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• 제13권2호
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• pp.104-107
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• 2017

본 증례는 가부키 증후군 환아의 상악 좌측 제2유구치의 심한 우식으로 인하여 좌측 협부 종창이 관찰되었고, 물리적 속박 하에 절개 및 배농술을 시행 후 유구치는 발거되었다. 이후 전신마취 하에 남은 우식치아의 치료가 진행되었다. 가부키 증후군은 환자에 따라 다양한 의학적 소견을 보이므로 전신마취 하 치과 치료가 계획 될 경우, 의과와의 협진 및 철저한 치료계획이 필수적이다.

• 대한통합의학회지
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• 제3권2호
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• pp.63-72
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• 2015

Purpose: The purpose of this study was to investigate the foot pressure of subjects with hallux valgus following conservative management. Methods: The subjects (20 females) were divided into 2 groups; Hallux valgus group (10) and Control group (10) who could evaluate questionnaire & weight bearing X-ray. All the participants were evaluated distribution of foot pressure by Zebris FDM-S system with conservative management (taping therapy and hallux valgus device) during single-limb stance. Results: The Hallux valgus group (HVG) was significantly different than Control group (CG) in hallux valgus angle(p<0.05). The Hallux valgus group with Foot Device (HVG-FD), Hallux valgus group with Taping (HVG-Tp) and Hallux valgus group with Foot device and Taping (HVG-FD&Tp) was not significantly different than CG in hallux valgus angle (p<0.05). The HVG was not significantly different than CG in forefoot (p1, p2, p3), significantly different than CG in rearfoot (p7) about foot pressure during single-limb stance (p<0.05). The HVG-FO and HVG-FO and TP was significantly different than HVG in forefoot (p1, p2, p3), on significantly different than HVG in rearfoot (p7) about foot pressure during single-limb stance (p<0.05). There was significantly correlation HVG-FO and HVG-FO & TP in forefoot (p1, p2, p3) was negative correlation (p<0.05) and in rearfoot (p7) was positive correlation (p<0.05). Conclusion: This study showed that hallux valgus were effected hallux valgus angle and foot pressure by various treatment methods during single-limb stance. Further study is needed to measure various age and work with hallux valgus for clinical application.

• 보건의료산업학회지
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• 제10권3호
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• pp.85-97
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• 2016

Objectives : In this study, the awareness of hospice and the perceptions on the need for visiting palliative care and what constitutes a good death of the citizens of Busan were investigated. The purpose of this study was to develop a hospice system based on the needs of the citizenry of Busan by seeking solutions for current hospice strategies. Methods : One thousand Busan citizens from 20 to 80 years of age were surveyed in this study. Results : Busan citizens defined a good death as spending less than one month of time in the actual process of dying at home between the ages of 80-89 years. They knew about hospice a little and were aware of its necessity. They also knew about the necessity of visiting palliative care and were interested in receiving it when appropriate but did not know much about it. Conclusions : First, there is a large difference between Busan citizens' expectations on what constitutes a good death and what a good death really is. Second, Hospice palliative care should be provided to the community. Third, the older the patient is, the more palliative care visits are necessary. Fourth, 40s and 50s must make preparations for hospice palliative care in their future.