• 제목/요약/키워드: medical mistake

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Computed Radiography의 방사선종양학과로의 적용 (Computed Radiography applied to the Department of Radiation Oncology)

  • 홍성일;송종남;김영재
    • 한국정보통신학회:학술대회논문집
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    • 한국해양정보통신학회 2011년도 추계학술대회
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    • pp.547-550
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    • 2011
  • 본 논문에서는 의료용 선형가속기를 이용하여 현재 시행하고 있는 정도관리 중 Gantry, Collimator Star Shot, Light vs. Radiation Field Accuracy, HDR QA(Dwell position accuracy)를 시행하여 PACS 상에 구현하였고 모니터 상에서 디지털 영상을 통한 QA가 가능한지 확인하였다. 또한, 현재 본원에서 사용 중인 OCS system과 연동하여 치료에 필요한 코드를 각각의 치료에 부과하여 네트워크로 연결, CR상에 입력한 Order가 나타나도록 하였으며, Planning System인 Pinacle과 PACS상의 지원 data 오류를 해결하여 PACS 상에서도 Planning 영상을 볼 수 있도록 하였다.

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퍼지 클러스터링을 이용한 심전도 신호의 라벨링에 관한 연구 (A Study on Labeling of ECG Signal using Fuzzy Clustering)

  • 공인욱;이정환;이상학;최석준;이명호
    • 대한의용생체공학회:학술대회논문집
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    • 대한의용생체공학회 1996년도 추계학술대회
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    • pp.118-121
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    • 1996
  • This paper describes ECG signal labeling based on Fuzzy clustering, which is necessary at automated ECG diagnosis. The NPPA(Non parametric partitioning algorithm) compares the correlations of wave forms, which tends to recognize the same wave forms as different when the wave forms have a little morphological variation. We propose to apply Fuzzy clustering to ECG QRS Complex labeling, which prevents the errors to mistake by using If-then comparision. The process is divided into two parts. The first part is a parameters extraction process from ECG signal, which is composed of filtering, QRS detection by mapping to a phase space by time delay coordinates and generation of characteristic vectors. The second is fuzzy clustering by FCM(Fuzzy c-means), which is composed of a clustering, an assessment of cluster validity and labeling.

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기성한약서(旣成韓藥書) 11종의 기원(起源)에 대한 서지학적(書誌學的) 근거(根據)와 개정(改正) 방안(方案)에 대한 연구(硏究) (The study on bibliography register basis and Revision plan about origin that 'The 11 established formularies of Korean traditional herbal medicine volumes')

  • 신현규;황대선;권삼수;김용진
    • 대한한의학원전학회지
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    • 제20권1호
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    • pp.103-111
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    • 2007
  • 1. "Regulation for about kind of formularies of Korean traditional herbaland preparation method"(Ministry of Health and Welfare No. 1995-15, 95. 3. 15) and "Regulation for review safety and efficacy of drugs. Article 2. 1 Clause 10." should revise "Sasanguihak(四象醫學)" by "Donguisusebowon(東醫壽世保元)" that is the name of book. 2. "Regulation for review safety and efficacy of drugs. Article 2. 1 Clause 10." was defining 'The 11 established formularies of Korean traditional herbal medicine volumes' "Donguisusebowon" that is defined as "The 11 established formularies of Korean traditional herbal medicine volumes" is "Susebowon(壽世保元)" that the Ming period Gong jung-hyun writes. Otherwise, mistake that "Donguisusebowon" of Lee Jema(李濟馬) was recorded 2 times occurs. Therefore, "Susebowon" of "The 11 established formularies of Korean traditional herbal medicine volumes" is that "Susebowon" of the Ming period Gong Jung-hyun writes 3. "yaksungga(藥性歌)" is nonbook in "The 11 established formularies of Korean traditional herbal medicine volumes" and should be erase. Because basis is ambiguous. 4. "The 11 established formularies of Korean traditional herbal medicine volumes" must revise by 10 kinds in "Regulation for about kind of formularies of Korean traditional herbaland preparation method" and "Regulation for review safety and efficacy of drugs. Article 2." The kinds should be revised by "Donguibogam(東醫寶鑑)", "jejungsinpyeon(濟衆新編)", "Euihakipmoon(醫學入門)", "kyungakjeonse(景岳全書)", "Susebowon", "Bonchogangmok(本草鋼目)", "Bangyakhappyeon(方樂合編)", "Hyangyakjipseongbang(鄕樂集成方)", "Gwangjebigeup" and "Donguisusebowon".

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미국의 사과법 및 디스클로져법의 의의와 그 시사점 (An Overview and Implication of Apology Law and Disclosure Law in U.S.A.)

  • 이원;박지용;장승경
    • 의료법학
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    • 제19권1호
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    • pp.81-111
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    • 2018
  • 최근 우리나라에서는 연속적으로 발생한 환자안전사건으로 인해 환자안전에 대한 사회적 관심이 높아졌다. 더불어 환자안전사건 발생 후 의료인 및 의료기관의 대응방식이 논란이 되면서, 사과법 및 디스클로져법 도입의 필요성이 제기되고 있다. 본 연구에서는 미국의 사과법과 디스클로져법 내용을 분석하고, 우리나라의 입법 움직임에 대하여 비판적으로 검토하고자 한다. 먼저 사과법은 의료인 등이 환자측에게 불편감, 통증, 손상, 사망 등에 대해 사과나 위로, 공감 등을 표하는 경우, 사과 등의 표현은 민사재판 및 행정절차에서 법적인 증거로 사용할 수 없도록 하는 것을 그 주요 내용으로 한다. 사과법은 실수, 오류, 잘못, 책임, 법적 책임의 표현과 같은 규범적 평가요소를 증거법의 보호 범위에 포함하는지 여부에 따라 '완전한 사과법'과 '부분적 사과법'으로 구분된다. 한편, 디스클로져법은 의료기관이 심각한 위해가 발생한 사건 등에 있어 사건의 공개, 발생원인, 보상계획, 재발방지대책 등에 관하여 환자 측과 소통하는 것을 법률상 강제하거나 자율적으로 유도하는 것을 그 주요 내용으로 한다. 한편, 최근 우리나라에서도 환자안전사고에 관한 관심이 증폭되고, 의료인 측과 환자측의 의사소통의 중요성이 인식되면서, 위와 같은 미국의 사과법 또는 디스클로져법을 수용한 "환자안전법" 개정법률안이 국회에 제출되기도 하였다. 본 연구에서는 미국의 사과법 및 디스클로져법의 분석을 토대로 위 개정법률안의 내용을 비판적으로 검토함으로써 향후의 입법방향에 시사점을 제시하고자 한다.

자연피임법으로서의 배란법의 피임효과 (Preliminary Report of Use-Effectiveness of Ovulation Method in Korea)

  • 배석천;정윤조;나종구;오원섭;김승조
    • Clinical and Experimental Reproductive Medicine
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    • 제3권1호
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    • pp.27-32
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    • 1976
  • In recent years, explosive increase in population has been damaging mankind in terms of deprivation of natural resources and more of economical demands. Therefore, we have thought about problems as to counter-balance the increasing population, and reached a resolution of artificial methods of controlling birth. In the past, though now used in some of contraceptive methods, extravaginal ejaculation, condom were commonly used. But recently, pills, IUD and several kinds of operative procedures are quite popular. Though the recent methods are known to be effective compared with the traditional methods, a certain unwanted side effects as well as limited value of usages now must be discussed. On this aspect, we are trying to research for a ideal methods such as symptom free, more of natural way of family planning and try to zero the failure rate. And also it has been suggested that only if those scientific methods of controlling birth can be base on religious concepts of moral being, it will be enlightened. At the Happy Family Planning Clinic of St. Mary's Hospital, we apply Billing's ovulation method to out-patients who want contraception and usually advise them to use it on a self-care basis. For a retrospective study of the presurvey data analysis and use-effectiveness of the ovulation method from April 1, 1975 to Nov., 30, 1975, we have dealt with a total of 1,383 women (urban areas 465, rural areas 918). The results of preliminary survey were as follows; 1) Among 465 women in Seoul areas, the failure rate was 10.3, which signified unplanned pregnancies of 32 women. 27 of the 32 women were pregnant due to the users own failure and the remaing 5 due to the failure of the method. Therefore, the failure of the method accounted for 1.6. 2) Among 918 women in rural areas, the failure rate was 15.2 signifing unplanned pregnancies in 93 women. The cause of the failure in 81 of the 93 women was attributable to the user's own mistake and that in the remaing 12 to the default of the method. Therefore, the failure attributable to the method accounted for 2.0.

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농촌지역(農村地域) 주민(住民)들의 보건의료원(保健醫療院) 이용양상(利用樣相)과 관련요인(關聯要因) (Health Medical Center Utilization Pattern and Its Related Factors among the Rural Inhabitants)

  • 황병덕;박재용
    • 농촌의학ㆍ지역보건
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    • 제18권1호
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    • pp.77-91
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    • 1993
  • 농촌지역 주민들의 보건의료원에 대한 인식도 및 이용양상을 파악하여 보건의료원 제도와 관련된 연구에 기초자료를 제공하고자 1990년 9월 24일부터 90년 9월 28일 까지 5일간 정상북도 울진군 소재 국민학교 3개교와 중학교 3개교의 학부모들에게 설문지를 배부, 회수된 832가구의 가구원 754명을 대상으로 분석한 결과를 요약하면 다음과 같다. 응답자는 남자 60.3%, 여자 39.7%였고 연령은 30, 40대가 81.3%로 대부분을 차지하였으며, 교육수준은 고졸이 40.3%, 의료보장형태로는 지역의료보험이 44.1%를 차지하였다. 응답자의 58.4%가 보건의료원이라는 명칭을 알고 있었는데, 응답자의 학력과 수입이 높을 수록 그리고 거주지역이 보건의료원에 근접한 지역일수록 보건의료원에 대한 인식도가 높았다(p<0.01). 보건의료원의 진료사업 내용중에서 의료보호대 상자 진료와 치과진료를, 각각 35.1%와 31.0%가 알고 있었으며, 보건예방서비스 사업에서는 예방접종사업을 36.1%로 가장 많이 인지하고 있었는데, 학력과 지리적 근접도가 높을수록 보건의료원의 사업내용 인지도는 높게 나타났다. 보건의료원의 연간 외래이용율과 예방서비스 이용율은 대상자 100명당 11.1회 및 4.5회였으며, 입원이용율은 10,000명당 34.6회였다. 보건의료원 이용동기는 잘나아서(45.7%), 약이 좋아서 (45.2%), 거리가 가까워서(42.9%) 순이었다. 일반병의원과 비교해서 보건의료원의 진료수준이 더 좋다고 응답한 이용자는 16.3% 였고, 더 못하다는 19.0%였다. 또한 보건의료원의 진료비가 저렴하다고 한 응답자는 61.5%인데 비해 비싸다고한 경우는 3.9%였다. 보건의료원 이용시의 교통수단으로는 도보가 55.0%, 버스가 35.5%로 대부분이었다. 보건의료원 이용시 느낀 불편사항으로는 장시간 대기가 46.7%로 가장 많았고, 그 다음으로 이용시간이 제한되어 있어서가 17.8%였다. 보건의료원을 한번도 이용하지 않은 이유로는 아픈적이 없어서가 33.5%, 교통이 불편하고 거리가 멀어서가 28.0%, 장시간 대기한다고 해서가 12.8%순으로 나타났다. 이상과 같이 아직도 보건의료원에 대한 인식이 낮고, 잘못 인식하고 있는 주민이 많기 때문에 보건의료원에 대한 전반적인 홍보가 필요할 것으로 보이며, 보건의료원의 이용율을 높이기 위해서는 의료시설, 장비확충과 더불어 의료진의 보강이 필요하고 관리의 효율성도 고려해야 할 것으로 생각된다.

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관상동맥 중재술후 추적 관상동맥조영술 실천에 대한 조사연구 (A survey on Patients' Compliance with Follow-up Coronary Angiogram after Coronary Intervention)

  • 김유정;박오장
    • 성인간호학회지
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    • 제12권1호
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    • pp.30-39
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    • 2000
  • Coronary intervention is now a well established method for the treatment of coronary artery disease. Coronary restenosis is one of the major limitations after coronary intervention. So medical teams advise the patients to get the follow-up coronary angiogram in 6 months after coronary intervention to know if the coronary artery stenosis recurs or not. This study was done in order to know how many patients complied with the advice, and to identify the relative factors to the compliance with getting the follow-up coronary angiogram. The subjects were 101 patients (male: 58 female: 22, mean age: $61{\pm}15$), who received coronary interventions from Jan. 1st to Mar. 31st 1997, and their data were collected from them by questionnaires one year after intervention. The questionnaires consisted of family support scale, self efficacy scale and compliance with sick role behavior scale. The result may be summarized as follows. 1. The number of patients who complied with getting the follow-up coronary angiogram were 37 people(36.6%) and did not comply with it were 64 people(63.4%). All scores of family support(t=5.56, p<.0001), self efficacy (t=4.13, p<.0001) and compliance with sick role behavior(t=5.66, p<.0001) were significantly higher in the patients who got the follow-up coronary angiogram than in those who did not get it. But there was not any relative factor in demographic variables (p>.05). 2. The major motivations for getting follow-up coronary angiogram were recurrence of subjective symptom(40.5%), the advice of medical team(32.4%), and fear of recurrence (27.1%). The restenosis rate in patients who got the follow-up coronary angiogram was 37.8%. 3. The restenosis rate was higher in the patients who had subjective symptoms than in those who did not have any subjective symptom. So subjective symptom and restenosis rate showed a high positive correlation(r=39.9, p<.001). However, 27.2% of the patients who did not have any subjective symptom showed coronary restenosis. 4. The reasons why they did not get the follow-up coronary angiogram were economic burden(37.5%), improved symptom(34.4%), busy life schedule(10.9%), fear of invasive procedure(9.4%), negative reaction of family member(3.1%), no helper for patient(3.1%) and worry about medical team's mistake (1.6%). The relative fators on compliance with getting the follow-up coronary angiogram after coronary intervention were family support, self-efficacy and Compliance with sick role behavior. And the most important reason why the patients did not get the follow-up coronary angiogram after coronary intervention was an economic burden.

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침구 의료행위에 기인하는 의료사고 예방에 관한 기초적 연구 (I) - 금침혈가에 관한 문헌적 고찰 - (The Basic Study on the Preventive Measures against Medical Accident Induced by Acupuncture and Moxibustion Therapy I. A Literature Research on the Essence of Prohibitive Acupuncture Point, Jīn-Zhėn-Xué-Gė (禁鍼穴歌))

  • 문진영
    • 동국한의학연구소논문집
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    • 제8권2호
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    • pp.175-199
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    • 2000
  • 침구요법은 한국을 비롯한 중국, 일본 등의 아시아권 국가들에서 전통 의학의 주된 치료법으로 사용되어 왔고 최근에는 미국, 독일, 프랑스 등의 서구 여러 국가들에서도 침구요법의 유효성에 관한 연구가 지속적으로 진행되고 있으며 그 결과 세계보건기구에서는 침구요법의 유효성이 이미 검증된 임상영역들을 발표 공인하기에 이르렀다. 한편 의료행위는 사람을 대상으로 하기 때문에 그 자체가 어느 정도의 위험성을 항상 내포하고 있으며 침구 의료행위 또한 예외일 수는 없다. 또한 과거와는 달리 환자들은 의료정보를 취득할 수 있는 기회가 증가하고 있으며 권리의식도 신장되어 최근에는 의료분쟁의 발생이 급증하고 있는 추세이다. 그러나 현재까지 국내에서는 침구시술과 관련한 의료분쟁의 발생 및 그 대책에 관한 연구보고는 실로 미비한 실정이다. 따라서 본 연구는 이러한 제반 상황을 배경으로 침구 의료행위로 인한 의료사고를 예방할 수 있는 대책을 강구하기 위한 기초적 연구로서 침구취영, 의학입문, 침구대성 및 의종금감에 수록된 금침혈가에서 제시하고 있는 자침 금지혈들의 시술 위험성을 문헌적으로 규명하고자 하였다.

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119구급대의 법적분쟁 예방에 관한 연구 (Research on the prevention of legal dispute over 119 rescue team)

  • 임재만
    • 한국응급구조학회지
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    • 제13권1호
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    • pp.19-33
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    • 2009
  • Purpose : To check the legal relation between rescue team and patient as well as legal responsibility for patient's damage intentionally or erroneously caused by rescue member, a public official, in the performance of relevant job ; to prevent legal dispute over rescue team and to present program for fair settlement of dispute and equitable and feasible burden of damage. Method : First, the legal principle of Civil Law, Criminal Law and Administrative Law related to the theme of this research will be investigated around research by literature. Second, the case of dispute related to rescue team will be introduced. Result: 1. If 119 rescue members as a public official intentionally or erroneously cause damage to patient in the performance of job, they shall bear civil, criminal and administrative responsibility. They shall bear civil responsibility for indemnity for damage due to default or tort. The typical criminal responsibility includes accidental homicide arising out of duty, preparing falsified official document, dereliction of duty, etc. In the administrative side, the state is responsible for indemnity for peculiar status of the rescue member, public official. 2. Though raising civil petition or legal dispute over unsatisfactory rescue service may be reasonable to guarantee the right of nation, such action may cause stress to rescue member as well as may lead to mental shrinking and defensive attitude only to take the basic first aid treatment which has low possibility of mistake instead of active first aid treatment so as to avoid legal responsibility. 3. The program that may prevent legal dispute over 119 rescue team includes expansion of manpower specialized in first aid treatment, enhancement of education on legal environment, development and application of standard job guideline, formation of mutual trust with patient, detailed explanation, preparing and keeping minute record, improvement of the rescue members' ability of first aid treatment and development of medical instruction mode. Conclusion : The best policy is to prevent legal dispute. If it is impossible to basically exclude the possibility of dispute, however, we need to make effort to minimize the occurrence, settle fairly and divide damage equitably and feasibly. To improve the preventible death rate of our first aid system to the level of advanced country, 119 rescue team which is in charge of the stage before hospital needs to positively enforce special first aid by improving the qualitative level of rescue service and to strive to prevent legal dispute that may occur in the process.

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${\ll}$영추(靈樞).전광편(癲狂篇)${\gg}$에 대(對)한 연구(硏究) (A Study on the Jeon Kwang Pyun (癲狂篇) of the Young Chu(靈樞))

  • 서명진;육상원
    • 대한한의학원전학회지
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    • 제11권1호
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    • pp.361-394
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    • 1998
  • Jeon Kwang(癲狂), term of oriental medicine, corresponds to psychopathy. This is recorded in the 22th chapter of Young Chu(靈樞). Jeon and Kwang come under Eum(陰) and Yang(陽) respectively. The symptoms of Jeon have silence, cry and giggle alternately, muttering, and so on. And those of Kwang have quick-tempered, absurd remarks, slander, and so on. The contents of this chapter are divided into three volumes. The first is descriptive of paroxysmal causes and various symptoms of Jean and methods of acupuncture and moxibustion. The second stales causes, symptoms, and remedy methods of Kwang. And the third describes about Pung Youk(風逆), Kweol Youk(厥逆), So Ki(少氣), and Tan Ki(短氣). A paragraph concerning of Mok Ja(目眥), so to speak side of pupil, is mentioned at the begginning of this chapter incomprehensibly. Si Ma(馬蒔) asserted that this one is not a pleonasm because mental condition is seen at Mok Ja. But Sa-Deok Jeong(程士德) decided this one doesn't relation to Jeon Kwang. In my opinion, both views have proprieties. It is in a controversy whether Jeon Kwang has somthing to do with Pung Youk, Kweol Youk, etc. Tan Pa(丹波) asserted that these don't have connection each other. But JI-Chong Jang(張志總) explained Jeon Kwang originates in Kweol Youk with a basis of So Mun(素門). It is difficult to judge which opinion is right, but I am of the opinion that paragraphs of Pung Youk and downward mentioned those of other chapter with a mistake in the process of transcription. On accout of not only shortage contents but also ancient writings of this chapter we cannot understand all about Jeon Kwang. In addition, each woodblock-printed book has different letters and every commentaries aren't the same. Till now, therefore, basic study hasn't been done enough to offer a foundation to the theory of medical treatment. The purpose of this study is to correct wrong letters, to take out right commentaries, and then to interpret the accurat meaning of this chapter. I think this bibliographic study is quite meaningful because of hardship to cure psychopathy in clinic as well as of a viewpoint of basic study. However as this thesis is insufficient, so I expect many studies come out later.

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