• Title/Summary/Keyword: Procedure Quality

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A Study on Network Hospital and the Ban on Opening and Operating the Muliple Medical Institution (네트워크병원과 의료기관 복수 개설·운영 금지 제도에 관한 고찰)

  • KIM, JOON RAE
    • The Korean Society of Law and Medicine
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    • v.17 no.2
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    • pp.281-313
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    • 2016
  • Our Constitution obliges the state to protect the health of the people, and the Medical Law, which embodied Constitution, sets out in detail the matters related to open the medical institution and one of them is to prohibit the operation of multiple medical institutions In the past, there was a provision stipulating the same purpose. But because the Supreme Court interpreted that several medical institutions could be opened if the medical treatment was not made at the additional medical instition which was opened in the another doctor,s license, multiple medical institutions could be opened and operated. However, some health care providers opened the several medical institutions to another doctor's license just by the excuse of the business management and then did illegal medical cares like the unfair luring of patients, overtreatment, and commition treatment for more profits. So, the health rights of the people came to be infringed on. Accordingly, lawmakers amended the Medical Law for medical personnel not to open and to operate more than one medical institution. As the amended medical law prohibited a medical personnel to open multiple medical institution, some medical personnels insisted that the amended medical law is unconstitutional under which they could not be able to open and operate medical institutions on based on free investment and bring out the benefits of network hospitals. But the regulation to prohibit multiple institutions does not apply only to a medical personnel. Many other experts like lawyer and pharmacist can open only one office under such a restriction. If the regulation goes out of force, the procedure that multiple medical institutions should be opened and operated in the capacity as a medical corporation or a non-profit corporation does not have to be followed. And we should keep in mind that the permission for medical personels to open multiple medical institutions could lead virtually to commercial hospital. If in the nation with a very low rate of public medical service, If only a few medical personnels with capital own many medical institutions and operate commercially them, this could cause a falling-off in quality of medical service, ultimately infringe on the health rights and the life right of the people.

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Environmental effects from Natural Waters Contaminated with Acid Mine Drainage in the Abandoned Backun Mine Area (백운 폐광산의 방치된 폐석으로 인한 주변 수계의 환경적 영향)

  • 전서령;정재일;김대현
    • Economic and Environmental Geology
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    • v.35 no.4
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    • pp.325-337
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    • 2002
  • We examined the contamination of stream water and stream sediments by heavy metal elements with respect to distance from the abandoned Backun Au-Ag-Cu mine. High contents of heavy metals (Pb, Zn, Cu, Cd, Mn, and Fe) and aluminum in the waters connected with mining and associated deposits (dumps, tailings) reduce water quality. In the mining area, Ca and SO$_4$ are predominant cation and anion. The mining water is Ca-SO$_4$ type and is enriched in heavy metals resulted from the weathering of sulfide minerals. This mine drainage water is weakly acid or neutral (pH; 6.5-7.1) because of neutralizing effect by other alkali and alkaline earth elements. The effluent from the mine adit is also weakly acid or neutral, and contains elevated concentrations of most elements due to reactions with ore and gangue minerals in the deposit. The concentration of ions in the Backun mining water is high in the mine adit drainage water and steeply decreased award to down stream. Buffering process can be reasonably considered as a partial natural control of pollution, since the ion concentration becomes lower and the pH value becomes neutralized. In order to evaluate mobility and bioavailability of metals, sequential extraction was used for stream sediments into five operationally defined groups: exchangeable, bound to carbonates, bound to FeMn oxide, bound to organic matter, and residual. The residual fraction was the most abundant pool for Cu(2l-92%), Zn(28-89%) and Pb(23-94%). Almost sediments are low concentrated with Cd(2.7-52.8 mg/kg) than any other elements. But Cd dominate with non stable fraction (68-97%). Upper stream sediments are contaminated with Pb, and down area sediments are enriched with Zn. It is indicate high mobility of Zn and Cd.

SEDATION EVALUATION USING BIS INDEX ASSESSMENT WITH AND WITHOUT THE ADDED SUBMUCOSAL MIDAZOLAM (점막하 Midazolam의 병용투여 시 BIS 분석을 이용한 진정 평가)

  • Lee, Young-Eun;Park, Mi-Kyung;Kim, So-Young;Kim, Yun-Hee;Jung, Sang-Hyuk;Baek, Kwang-Woo
    • Journal of the korean academy of Pediatric Dentistry
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    • v.34 no.1
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    • pp.91-98
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    • 2007
  • The aim of this study was to examine the difference of the depth of sedation using the Bispectral index assessment with and without the added submucosal Midazolam to oral Chloral hydrate and Hydroxyzine for pediatric patients. Twenty seven sedation cases were performed in this study Selection criteria included good health(ASA I), 2 to 6 years of age, the need for sedation to receive dental treatment including anesthesia, and restorative procedure over at least two teeth. Patients were randomly classified into one group taking oral Chloral hydrate(60 mg/kg) and Hydroxyzine(1 mg/kg) and the other group recieving Chloral hydrate(60 mg/kg), Hydroxyzine(1 mg/kg) and submucosal Midazolam(0.1 mg/kg). Nitrous Oxide(50%) was used for both group during sedation. Patients were monitored using a pulse oximeter and a Bispectral monitor. A behavior scale was rated as quiet(Q), crying(C), movement(M), or struggling(S) every 2 minutes watching a recorded videotape. Analysis showed a significant difference in mean Bispectral index and SD during sedation across two groups(P<0.001). The group of patients injected with submucosal Midazolam in addition to oral Chloral hydrate and Hydroxyzine showed a lower mean Bispectral index and a narrower SD. PR and SpO2 for both groups remained within the normal values. Submucosal Midazolam improved the sedation quality by deepening sedation depth without compromising safety and enabled the sedation pattern to be kept more stable.

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Recent study of Acupuncture in Treatment of Urianry Disturbance (배뇨장애(排尿障碍)에 대한 침구치료(鍼灸治療)의 연구동향(硏究動向))

  • Kim, Kyung-tai;Ko, Young-jin;Kim, Yong-suk;Kim, Chang-hwan
    • Journal of Acupuncture Research
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    • v.22 no.3
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    • pp.123-135
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    • 2005
  • Objective : The aim of this study was to rivew systemically literature and clinical trials in the treatment of urinary incontinence or lower urinary tract syndrome(LUTS). Methods : Computerized literature searches were carried out on two electronic database, and computerized searching on some korea oriental medicine journals in library of Kyung-Hee Medical center. Results : 1. Three reports of review study, six reports of experimental study and fourteen reports of clinical trials were collected and reviewed. Three reports of review study were all printed in the korea oriental medicine journal. From 2000, researches and studies have been increased in quantity and improved in quality. 2. Urinary disturbance include variable symptoms of lower urinary tract symptoms, urinary incontinence, in theaspect of Oriental medicine these symptoms are anurin, dysuria, urinary incontinence, nochumal enuresis, uracratia and so on. 3. Roughly physiological procedure of Acupuncture in Treatment of Urianry Disturbance may be that effect of acupuncture stimulation for parasympathetic nerve, sleep-arousal system in cerebrum, pontine/spinal urination center and pudendal/pelvic nerve affect bladder in expansion of bladder capacity, inhibition of urinary contraction and affection in periurethral muscle by continuous excitement of spinal annular circuit and synapse of neuron. 4. Clinical result for acupuncture treatment in urinary disturbance is summarized that acupuncture treatment in urianation disturbance of Neurogenic Bladder, Incontinence, Cycitis, Nocturnal Enuresis, Prostatitis/Pelvic Pain Syndrom and so on is significant clinical trials and technique. Conclusion : Hereafter, in the old age society these variable urinary disturbance patients are increased and desire of treatment may be also increased. So study of various and formal treatment and tecnnique is needed.

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Participation Level in Online Knowledge Sharing: Behavioral Approach on Wikipedia (온라인 지식공유의 참여정도: 위키피디아에 대한 행태적 접근)

  • Park, Hyun Jung;Lee, Hong Joo;Kim, Jong Woo
    • Journal of Intelligence and Information Systems
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    • v.19 no.4
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    • pp.97-121
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    • 2013
  • With the growing importance of knowledge for sustainable competitive advantages and innovation in a volatile environment, many researches on knowledge sharing have been conducted. However, previous researches have mostly relied on the questionnaire survey which has inherent perceptive errors of respondents. The current research has drawn the relationship among primary participant behaviors towards the participation level in knowledge sharing, basically from online user behaviors on Wikipedia, a representative community for online knowledge collaboration. Without users' participation in knowledge sharing, knowledge collaboration for creating knowledge cannot be successful. By the way, the editing patterns of Wikipedia users are diverse, resulting in different revisiting periods for the same number of edits, and thus varying results of shared knowledge. Therefore, we illuminated the participation level of knowledge sharing from two different angles of number of edits and revisiting period. The behavioral dimensions affecting the level of participation in knowledge sharing includes the article talk for public discussion and user talk for private messaging, and community registration, which are observable on Wiki platform. Public discussion is being progressed on article talk pages arranged for exchanging ideas about each article topic. An article talk page is often divided into several sections which mainly address specific type of issues raised during the article development procedure. From the diverse opinions about the relatively trivial things such as what text, link, or images should be added or removed and how they should be restructured to the profound professional insights are shared, negotiated, and improved over the course of discussion. Wikipedia also provides personal user talk pages as a private messaging tool. On these pages, diverse personal messages such as casual greetings, stories about activities on Wikipedia, and ordinary affairs of life are exchanged. If anyone wants to communicate with another person, he or she visits the person's user talk page and leaves a message. Wikipedia articles are assessed according to seven quality grades, of which the featured article level is the highest. The dataset includes participants' behavioral data related with 2,978 articles, which have reached the featured article level, with editing histories of articles, their article talk histories, and user talk histories extracted from user talk pages for each article. The time period for analysis is from the initiation of articles until their promotion to the featured article level. The number of edits represents the total number of participation in the editing of an article, and the revisiting period is the time difference between the first and last edits. At first, the participation levels of each user category classified according to behavioral dimensions have been analyzed and compared. And then, robust regressions have been conducted on the relationships among independent variables reflecting the degree of behavioral characteristics and the dependent variable representing the participation level. Especially, through adopting a motivational theory adequate for online environment in setting up research hypotheses, this work suggests a theoretical framework for the participation level of online knowledge sharing. Consequently, this work reached the following practical behavioral results besides some theoretical implications. First, both public discussion and private messaging positively affect the participation level in knowledge sharing. Second, public discussion exerts greater influence than private messaging on the participation level. Third, a synergy effect of public discussion and private messaging on the number of edits was found, whereas a pretty weak negative interaction effect of them on the revisiting period was observed. Fourth, community registration has a significant impact on the revisiting period, whereas being insignificant on the number of edits. Fifth, when it comes to the relation generated from private messaging, the frequency or depth of relation is shown to be more critical than the scope of relation for the participation level.

Effects of GnRH Agonist Used for Ovarian Hyperstimulation in Human IVF-ET on the Apoptosis of Preovulatory Follicular Cells (인간 체외수정 및 배아이식에 있어서 과배란 유도 과정에 사용한 GnRH Agonist가 배란 전 난포내 과립 세포의 세포자연사에 미치는 영향)

  • Yang, Hyun-Won;Kwon, Hyuck-Chan;Hwang, Kyung-Joo;Park, Jong-Min;Oh, Kie-Suk;Yoon, Yong-Dal
    • Clinical and Experimental Reproductive Medicine
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    • v.26 no.1
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    • pp.55-65
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    • 1999
  • There have been many reports to date regarding the role of GnRH as a local regulatory factor of ovarian function as studies of human and rat ovaries revealed GnRH and its receptor. In recent studies it has been shown that GnRH directly causes apoptosis in the granulosa cells of the rat ovary, and such results leads to the suggestion that the use of GnRH agonist for more stable long term ovarian hyperstimulation in human IVF-ET programs causes granulosa cell apoptosis which may lead to follicular atresia. Therefore this study attempts to determine if granulosa-luteal cell apoptosis occurs in patients during IVF-ET programs in which GnRH agonist is employed for ovarian hyperstimulation. The quality of oocyte-cumulus complexes obtained during ovum pickup procedures were assessed morphologically and then the fertilization rate and developmental rate was determined. Apoptotic cells among the granulosa-luteal cells obtained during the same procedure were observed after staining with Hematoxylin-eosin. The fragmentation degree of DNA extracted from granulosa-luteal cells was determined and comparatively analyzed. There was no difference in the average age of the patients, the number of oocytes retrieved, and fertilization and developmental rates between the FSH/hMG group and GnRH-long group. There was also no difference in the apoptosis rate and pyknosis rate in the granulosa-luteal cells between the two groups. However, when the oocyte-cumulus complexes were morphoogically divided into the healthy group and atretic group without regard for the method of hyperstimulation, the results showed that the number of oocytes obtained averaged $11.09{\pm}8.75\;and\;10.33{\pm}4.53$ per cycle, respectively, showing no significant difference, but the fertilization rate (77.05%, 56.99%, respectively, p<0.01) and developmental rate (65.96%, 41.51%, respectively, p<0.01) was significantly increased in the healthy group when compared to the atretic group. The degree of apoptosis in the granulosa-luteal cells showed that in the healthy group it was 2.25% which was not significantly different from the atretic group (2.77%), but the pyknosis rate in the atretic group (27.81%) was significantly higher compared to the healthy group (11.35%, p<0.01). The quantity of DNA fragmentation in the FSH/hMG group was 32.22%, while in the GnRH-long group it was 34.27%, showing no significant difference. On the other hand the degree of DNA fragmentation was 39.05% and 11.83% in the healthy group and atretic group, respectively, showing significantly higher increase in the atretic group (p<0.01). The above results suggest that death of granulosa-luteal cells according to the state of the oocyte-cumulus complex is more related to pyknosis rather than apoptosis. Also, the GnRH agonist used in ovarian hyperstimulation does not seem to directly affect the apoptosis of retrieved oocytes and granulosa-luteal cells, and which is thought to be due to the suppression of the apoptogenic effect of GnRH agonist as a result of the high doses of FSH administered.

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A STUDY ON THE MEASUREMENT OF THE IMPLANT STABILITY USING RESONANCE FREQUENCY ANALYSIS (공진 주파수 분석법에 의한 임플랜트의 안정성 측정에 관한 연구)

  • Park Cheol;Lim Ju-Hwan;Cho In-Ho;Lim Heon-Song
    • The Journal of Korean Academy of Prosthodontics
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    • v.41 no.2
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    • pp.182-206
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    • 2003
  • Statement of problem : Successful osseointegration of endosseous threaded implants is dependent on many factors. These may include the surface characteristics and gross geometry of implants, the quality and quantity of bone where implants are placed, and the magnitude and direction of stress in functional occlusion. Therefore clinical quantitative measurement of primary stability at placement and functional state of implant may play a role in prediction of possible clinical symptoms and the renovation of implant geometry, types and surface characteristic according to each patients conditions. Ultimately, it may increase success rate of implants. Purpose : Many available non-invasive techniques used for the clinical measurement of implant stability and osseointegration include percussion, radiography, the $Periotest^{(R)}$, Dental Fine $Tester^{(R)}$ and so on. There is, however, relatively little research undertaken to standardize quantitative measurement of stability of implant and osseointegration due to the various clinical applications performed by each individual operator. Therefore, in order to develop non-invasive experimental method to measure stability of implant quantitatively, the resonance frequency analyzer to measure the natural frequency of specific substance was developed in the procedure of this study. Material & method : To test the stability of the resonance frequency analyzer developed in this study, following methods and materials were used : 1) In-vitro study: the implant was placed in both epoxy resin of which physical properties are similar to the bone stiffness of human and fresh cow rib bone specimen. Then the resonance frequency values of them were measured and analyzed. In an attempt to test the reliability of the data gathered with the resonance frequency analyzer, comparative analysis with the data from the Periotest was conducted. 2) In-vivo study: the implants were inserted into the tibiae of 10 New Zealand rabbits and the resonance frequency value of them with connected abutments at healing time are measured immediately after insertion and gauged every 4 weeks for 16 weeks. Results : Results from these studies were such as follows : The same length implants placed in Hot Melt showed the repetitive resonance frequency values. As the length of abutment increased, the resonance frequency value changed significantly (p<0.01). As the thickness of transducer increased in order of 0.5, 1.0 and 2.0 mm, the resonance frequency value significantly increased (p<0.05). The implants placed in PL-2 and epoxy resin with different exposure degree resulted in the increase of resonance frequency value as the exposure degree of implants and the length of abutment decreased. In comparative experiment based on physical properties, as the thickness of transducer increased, the resonance frequency value increased significantly(p<0.01). As the stiffness of substances where implants were placed increased, and the effective length of implants decreased, the resonance frequencies value increased significantly (p<0.05). In the experiment with cow rib bone specimen, the increase of the length of abutment resulted in significant difference between the results from resonance frequency analyzer and the $Periotest^{(R)}$. There was no difference with significant meaning in the comparison based on the direction of measurement between the resonance frequency value and the $Periotest^{(R)}$ value (p<0.05). In-vivo experiment resulted in repetitive patternes of resonance frequency. As the time elapsed, the resonance frequency value increased significantly with the exception of 4th and 8th week (p<0.05). Conclusion : The development of resonance frequency analyzer is an attempt to standardize the quantitative measurement of stability of implant and osseointegration and compensate for the reliability of data from other non-invasive measuring devices It is considered that further research is needed to improve the efficiency of clinical application of resonance frequency analyzer. In addition, further investigation is warranted on the standardized quantitative analysis of the stability of implant.

Development and Application of Training Program for RI-Biomics Manpower through Analysis of Educational Demands (교육수요 분석을 통한 RI-Biomics 전문인력 양성 프로그램 개발 및 적용)

  • Shin, Woo-Ho;Park, Tai-Jin;Yeom, Yu-Sun
    • Journal of The Korean Association For Science Education
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    • v.35 no.1
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    • pp.159-167
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    • 2015
  • RI-Biomics is a promising radiation convergence technology that combines radiation with bio science as new growth power technology. Many developed countries are focusing active support and constant exertion to dominate the RI-Biomics market in advance. In order to achieve global leadership in the RI-Biomics field, we need more highly advanced technologies and professional manpower. In fact, we have less manpower compared to technology we currently hold. In this study, we established a basic infrastructure to train professional manpower in the RI-Biomics field by developing/operating optimum training program through expert interviews and survey. The developed program has four organized sections to understand overall procedure of RI-Biomics. To evaluate our training program, we performed test operations with eight students who have a major related to RI-Biomics for three weeks in KARA (Seoul) and KAERI (Jung-eup). In detail, radioisotope usage and safety management were conducted for one week as basic course, RI-Biomics application technology was conducted for two weeks as professional course. To verify performance results of training program, we conducted to journal research, daily reports, and survey on participants. The results show a high level of satisfaction with training programs and continuous intention of involvement in our program. We also need to develop an intensive course to train high-quality human resources and to operate training program continuously. This training program will be used as basic materials for the development of RI-Biomics curriculum for university. Hence, we will expect that our training program contributes in training a professional manpower and develop RI-Biomics technology.

Complication and Failure Analysis of Fixed Restorations (고정성 보철물과 연관된 합병증과 실패에 관한 조사)

  • Yun, Mi-Jung
    • Journal of Dental Rehabilitation and Applied Science
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    • v.27 no.2
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    • pp.149-159
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    • 2011
  • Restoring and replacing teeth with fixed prostheses commonly used in dental practice. Because of improper oral hygiene care and inaccurate laboratory procedure, complication of fixed prostheses was found in the mouth of patient. Although many efforts have been continually made to obtain the data of long term prognosis of fixed prostheses, it was difficult to do it. The purpose of this study was to evaluate the clinical status of fixed prostheses to improve the quality of dental care. In order to assess the clinical status of fixed prostheses, a total of 154 individuals (aged 22-82, 88 women and 66 men loaded with 578 unit of fixed prostheses, and 423 abutments) who visited the Department of Prosthodontics, Pusan National University Hospital, between January 2009 to December 2009 and removed old fixed prostheses were examined. The results of this study were as follows: 1. Length of service of fixed prostheses was $10.3{\pm}05.5$ years (mean), 10.0 years (median). 2. Location of fixed prostheses was found to have statistically significant influence on longevity of fixed prostheses (P<.05). The longevity of fixed prostheses was high in anterior-posterior combination region (mean:13.1, median:13.5) than anterior and posterior region. 3. Longevity of fixed prostheses made of metal was longest (mean:13.3, median:12.3). 4. Number of units in fixed prostheses was found to have no statistically significant influence on longevity of fixed prostheses (P>.05). 5. Condition of opposing dentition was found to have statistically significant influence on longevity of fixed prostheses (P>.05). The fixed prostheses lasted longest when opposed by complete denture (mean:17.1, median:19.7), removable partial denture, fixed prosthesis and natural dentition trailing behind (P<.05) 6. Periodontal disease (37.5%), dental caries (19.0%), defective margin (18.4%) were frequent complications. In 33.1% of the cases, abutment state after removing fixed prostheses was needed to be extracted.

The Learning Curve of Laparoscopy-assisted Distal Gastrectomy (LADG) for Cancer (학습곡선을 기준으로 한 복강경 보조 원위절제술에 대한 결과)

  • Kim, Kab-Choong;Yook, Jeong-Hwan;Choi, Ji-Eun;Cheong, Oh;Lim, Jeong-Taek;Oh, Sung-Tae;Kim, Byung-Sik
    • Journal of Gastric Cancer
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    • v.8 no.4
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    • pp.232-236
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    • 2008
  • Purpose: Laparoscopic surgery for gastric cancer was introduced in the past decade because it was considered less invasive than open surgery, and this results in less postoperative pain, faster recovery and an improved quality of life. Several studies have demonstrated the safety and feasibility of this procedure. We examined the outcome of performing laparoscopic surgery for gastric cancer over the last two year. Materials and Methods: From April 2004 to December 2006, 329 patients with gastric adenocarcinoma underwent a laparoscopy-assisted distal gastrectomy with lymph node dissection. The data was retrospectively reviewed in terms of the clinicopathologic findings, the perioperative outcomes and the complications. Results: The total patient group was comprised 196 men (59.6%) and 133 women (40.4%). The mean BMI was 23.6 and the mean tumor size was 2.7 cm. The mean number of harvested lymph node was 22.7, and this was 18.6 before 30 cases and 23.1 after 30 cases, and the difference was significant (P=0.02). The mean operation time was 180.9 min, and this was than 287.9 min before 30 cases and 170.2 min after 30 cases. After 30 cases, there was a significant improvement of the operation time (P<0.01). The mean incision length after 30 cases was shorter than that before 30 cases (P<0.01). Postoperative complications occurred in 24 (7.3%) of 329 patients and there was no conversion to open surgery. Conclusion: Even though the LADG was accompanied by a difficult learning curve, we successfully performed 329 LADG procedures over the past 2 years and we believe that LADG is a safe, feasible operation for treating most early gastric cancers (EGC).

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