• Journal of Korean Neurosurgical Society
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• 제56권2호
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• pp.130-134
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• 2014

Objective : A groove technique for securing an electrode connector was described as an alternative surgical technique in deep brain stimulation (DBS) surgery to avoid electrode connector-related complications, such as skin erosion, infection, and migration. Methods : We retrospectively reviewed 109 patients undergoing one of two techniques; the standard technique (52 patients using 104 electrodes) and the groove technique (57 patients using 109 electrodes) for securing the electrode connector in DBS surgery, regardless of patient disease. In the standard percutaneous tunneling technique, the connector was placed on the vertex of the cranial surface. The other technique, so called the groove technique, created a groove (about 4 cm long, 8 mm wide) in the cranial bone at the posterior parietal area. Wound erosion and migration related to the connectors were compared between the two techniques. Results : The mean follow-up period was 73 months for the standard method and 46 months for the groove technique. Connector-related complications were observed in three patients with the groove technique and in seven patients with the standard technique. Wound erosion at the connector sites per electrode was one (0.9%) with the groove technique and six (5.8%) with the standard technique. This difference was statistically significant. The electrode connector was migrated in two patients with the groove technique and in one patient with the standard technique. Conclusions : The groove technique, which involves securing an electrode using a groove in the cranial bone at the posterior parietal area, offers an effective and safe method to avoid electrode connector-related complications during DBS surgery.

• 의학교육논단
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• 제21권1호
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• pp.22-30
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• 2019

Team communication, teamwork, and interprofessional collaboration are critical and the basis for patient safety in a more diverse and complex clinical environment. This study explored the current status of teamwork, team communication, and interprofessionalism in the context of patient safety within undergraduate medical education. A scoping review of the literature published since 2010 was undertaken. Fifteen papers were included for final review. The most commonly used educational methods were off-line lectures and simulations. Standard team communication tools suggested in TeamSTEPPS (team strategies and tools to enhance performance patient safety) were covered in some of the research. Knowledge, skills, and teamwork attitudes, interprofessional collaboration, and/or patient safety were improved in most of the papers. In the previous studies of team communication, the content and method of education, and the change in knowledge and attitudes of the individuals have been widely reported, but more research is needed regarding the method of evaluating the teamwork itself. In addition, education on team communication as well as patient safety and interprofessionalism is lacking. As the importance of team communication in patient safety increases, more attention is needed on this topic in undergraduate medical education.

• 척추신경추나의학회지
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• 제9권2호
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• pp.21-33
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• 2014

Objectives : This study was to report the improvement of the patient with multiple sclerosis treated by Korean Medical treatment. Methods : The patient diagnosed as multiple sclerosis treated by acupuncture, bee venom pharmacupuncture, chuna manual therapy, and herbal medicine. To evaluate the effects of korean medicine, we used manual muscle test(MMT), the standard for assessment of the effect of stroke treatment, functional system(FS), visual analog scale(VAS). Results : 1. The patient's pain and optic dysfunction were reduced by the above therapy. 2. There was no change in manual muscle test(MMT), but there was mild improvement in finger joints function in the standard for assessment of the effect of stroke treatment. 3. In functional system(FS) scale, there was enhancement in optic function within a range. And there was improvement in expanded disability statue scale(EDSS) from 4.0 to 3.0. 4. In visual analog scale(VAS), there was considerable improvement from 9 to 6. Conclusions : The korean medical treatment was reduced pain and optic dysfunction.

• PNF and Movement
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• 제14권1호
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• pp.41-47
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• 2016

Purpose: In general, confabulation is defined as confusion of reality with past events without apparent prompting, in association with disruption of the capacity for retrieval and encoding of memory. We report on a patient who showed spontaneous confabulation associated with injury of the Papez circuit following middle cerebral artery (MCA) infarction. Methods: A 67-year-old female patient suffered cerebral infarct resulting from spontaneous MCA territory. After onset of the MCA infarct, she showed severe memory impairment and provoked confabulation. The Papez circuit was reconstructed for evaluation of part of it using diffusion tensor tractography (DTT). Fractional anisotropy (FA), mean diffusivity (MD), and tract volume were measured. Results: The right thalamocingulate tract showed a significant decrement of FA value and tract volume, and an increment of MD value by more than two standard deviations of that of normal control subjects. The tract volume in the left fornix and mammillothalamic tract decreased by more than two standard deviations of that of normal control subjects. Conclusion: Injuries of the Papez circuit were demonstrated in a patient who showed severe memory impairment and provoked confabulation following MCA infarct. We believe that analysis of the Papez circuit tract using DTT is useful in elucidating the cause of provoked confabulation in patients with MCA infarct.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제43권5호
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• pp.318-323
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• 2017

Objectives: Mandibular angle reduction or reduction genioplasty is a routine well-known facial contouring surgery that reduces the width of the lower face resulting in an oval shaped face. During the intraoral resection of the mandibular angle or chin using an oscillating saw, unexpected peripheral nerve damage including inferior alveolar nerve (IAN) damage could occur. This study analyzed cases of damaged IANs during facial contouring surgery, and asked what the basic standard of care in these medical litigation-involved cases should be. Materials and Methods: We retrospectively reviewed a total of 28 patients with IAN damage after mandibular contouring from August 2008 to July 2015. Most of the patients did not have an antipathy to medical staff because they wanted their faces to be ovoid shaped. We summarized three representative cases according to each patient's perceptions and different operation procedures under the approvement by the Institutional Review Board of Seoul National University. Results: Most of the patients did not want to receive any further operations not due to fear of an operation but because of the changes in their facial appearance. Thus, their fear may be due to a desire for a better perfect outcome, and to avoid unsolicited patient complaints related litigation. Conclusion: This article analyzed representative IAN cutting cases that occurred during mandibular contouring esthetic surgery and evaluated a questionnaire on the standard of care for the desired patient outcomes and the specialized surgeon's position with respect to legal liability.

• 한국정보전자통신기술학회논문지
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• 제4권2호
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• pp.96-102
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• 2011

본 연구에서는 현대인의 대표적 발 질환 중 하나인 무지외반증의 증상정도 자동 분류 알고리즘 개발에 대한 연구를 수행하였다. 무지외반증의 치료 및 수술을 위한 기존 아날로그적 진단법이 아닌 디지털 영상처리기법을 사용함으로써 효과적인 자동화 진단법을 제시하였다. 이를 위해 본 연구에서는 각각 정상인과 무지외반증 환자의 X-Ray 영상을 이용하였다. 우선 정상인의 X-Ray 영상에 정상 각도를 오버랩과 애드 방법을 통하여 기준각도를 표시한 후, 윤곽선 검출 알고리즘인 로버츠 필터와 세선화 작업을 거쳐 통칭 정상인 기준 영상을 만들었다. 그리고 진단할 환자의 X-Ray 영상에 윤곽선 검출 알고리즘인 소벨 필터를 거쳐 환자 영상을 만들어 앞서 언급한 정상인 기준 영상과 오버랩과 애드 방법을 통하여 디스플레이 출력 영상을 구현하였다. 디스플레이 출력 영상을 이용하여 무지외반증 진단 각도를 측정하여 화면에 디스플레이 함으로써 기존의 아날로그적 진단법에서 탈피한 디지털적 영상처리 진단법을 제시하였으며 그 실용성과 타 정형외적 질환의 응용성을 확인하였다.

• 한국정보통신학회논문지
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• 제13권3호
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• pp.546-555
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• 2009

HL7은 병원정보 시스템에서 사용되는 정보와 관련된 표준화된 프로토콜이다. 생체 정보 웹 뷰어 시스템 또한 의료 영상 및 전송에 대해 표준화된 프로토콜이다. 본 논문에서는 ICU(Intensive Care Unit)에 설치된 Central Monitor에서 확인할 수 있는 환자의 생체 정보들을 웹상에서 실시간 확인할 수 있는 시스템 구성을 제안하기 위하여 생체정보 수신 모듈과 웹 뷰어 시스템을 구성하였다. 생체정보 수신 모듈은 Central Monitor로부터 수신할 수 있는 Raw Data 형태의 환자의 생체 정보를 생체 정보 웹 뷰어 시스템에서 사용가능 한 데이터로 분석할 수 있도록 설계가 이루어져 있다. 웹 뷰어 시스템은 환자 생체 정보에 대한 실시간성과 생체 정보에 대한 데이터의 연속성을 부여하여 베드 사이트의 환자에게서 발생된 모든 생체정보에 의해 환자 관리를 데이터 베이스를 이용하여 전산화함으로써 환자의 광범위한 자료 검색이 이루어지므로 획기적인 원격 진료로 활용이 가능하다. 또한 적절한 생체 정보데이터의 교환과 정보 관리의 수정을 통해 병원정보 시스템은 모든 병원 관계자의 보다나은 업무처리를 향상시킬 수 있다.

• Communications for Statistical Applications and Methods
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• 제6권2호
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• pp.543-564
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• 1999

The principal aim of a sequential phase I clinical trial in which the toxicity reponses of a group of patient(s) determine the dose level of the next patient(s) group is to estimate the maximal tolerated dose(MTD) of a new drug, In this paper we compared with a simulation study the performance of the MTD estimates that are determined by a stopping rule in a design and also those that are determined by analyzing the data after a clinical trial is terminated. To the latter belong the mean median mode and maximum likelihood estimates. For the Standard Methods the stopping rule MTD is quite inefficient but the median MTD has a best efficiency and is robust with respect to the three different toxicity curves. The problem of non-convergence of MLE MTD is severe. A more improved MTD estimate is produced by combining the advantages of the various MTD estimates and its efficiency is better than the single median MTD estimate especially for the toxicity curve of an unlucky choice of dose levels. The simulation results suggest that simple types of phase I designs can be combined with relatively standard analytic techniques to provide a more efficient MTD estimate.

• 간호행정학회지
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• 제5권1호
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• pp.113-136
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• 1999

There are some new trends in judgments concerning medical malpractice. which include emphasis on medical professionals' explanation duty in order to materialize patient's rights of self-determination. Now, patient is not a mere subject of medical and nursing care any more, but a subject, participating in medical practice on equal terms with medical professionals. Legal accountability is no limited to nurses in advanced practice: it is a recognized fact of life for every practicing nurse. whether she is an RN employed as a staff nurse in a hospital, a Certified Nurse-Midwife in independent practice or a patient's home. Therefore, it is essential for nurses to be as familiar as possible with the legal guidelines that govern their patient care responsibilities. However there are only a few studies focused on nursing negligence. To define nurse's civil liability in medical malpractice, it is necessary to indentify both legal nursing behaviors and nurse's due care in those nursing behaviors. So this paper focused on nurse's due care, especially in nursing malpractice. To clarify nurses' due care. chapter II has focused on nursing behavior and the scope of nursing practice based on the medical law and health care related study results. Chapter III deals with the content and scope of nurse's due care. Generally. negligence is defined as not doing something which a resonable person. guided by those ordinary considerations which or dinarily regulate human affairs. would do. or doing something which a resonable and prudent man would not do. Next. it describes how we can set the standard of due care in nursing practice. There is objective factors and subjective factors. And we also discuss about the limitation of due care in nursing practice. Finally. chapter IV deals with the case studies related to nursing negligence in the situation of determination. Now', patient is not a mere subject of medical and nursing care any more, but a subject participating in medical practice on equal terms with medical professionals. Legal accountability is not limited to nurses in advanced practice; it is a recognized fact of life for every practicing nurse. whether she is an RN employed as a staff nurse in a hospital. a Certified Nurse-Midwife in independent practice or a patient's home. Therefore, it is essential for nurses to be as familiar as possible with the legal guidelines that govern their patient care responsibilities. However. there are only a few studies focused on nursing negligence. To define nurse's civil liability in medical malpractice, it is necessary to identify both legal nursing behaviors and nurse's due care in those nursing behaviors. So this paper focused on nurse's intravenous injection. post operation nursing care. blood transfusion. and patient nursing care. The result of this paper is as follows. First. there are several cases dealing with nurse's negligence in nursing practice. however, those cases didn't judge nurse's due care based on individual -specific standard but general-objective standard. Second, there is a tendency to put an emphasis on the principal of belief to distinguish who has the liability in the case of medical malpractice among medical care team. So nurses shoud practice nursing care more actively to protect themselves and patients because there is an effort to form professional nurse system and the scope of nursing practice will be deeper and broader. Third, standard of care is a necessary element in establishing negligence. If a nurse is able to meet the standard of care, no breach will be found.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제24권2호
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• pp.55-64
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• 2018

Purpose: The ward division is a representative part of the hospital, where a variety of user activities are performed. Users can be broadly categorized as patients and carers, visitors, and medical staff (doctors and nurses). The relationship between these two is a major issue with ward planning as the patient's place of life centers around the hospital room and the task of the clinical workforce centers around the nursing station (NS). Against this backdrop, the study divides the ward units of the General Hospital of China into patient areas, medical team areas, supply areas, and public domain, with the focus on the ward areas affecting most significantly in the hospital patients. Methods: The theoretical advance studies of the standard ward unit are identified by the associated guidelines, articles, and documentation. Results: This study is a summary analysis of relevant regulations, reference literature, and drawing data from the target hospital. Further work is expected to be undertaken, including further surveys and observational surveys, to produce more detailed results. Implications: It is expected that the research in this paper will provide an effective reference for the future research of China General Hospital Ward department, so as to promote and improve the work system of China General Hospital Ward department.