• Title/Summary/Keyword: 의학적 평가

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Peer Review of Teleradiology at a Teleradiology Clinic: Comparison of Unacceptable Diagnosis and Clinically Significant Discrepancy between Radiology Sections and Imaging Modalities (원격판독 의료기관에서 시행한 원격판독의 동료평가: 세부전공분야와 촬영장비에 따른 판독 불일치 정도와 불일치 판독의 임상적 의의 비교)

  • Hyung Suk Seo;Jai Soung Park;Yu-Whan Oh;Dongwook Sung;A Leum Lee
    • Journal of the Korean Society of Radiology
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    • v.82 no.6
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    • pp.1545-1555
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    • 2021
  • Purpose The purpose of this study was to evaluate the rates of unacceptable diagnosis and clinically significant diagnostic discrepancy in radiology sections and imaging modalities through a peer review of teleradiology. Materials and Methods Teleradiology peer reviews in a Korean teleradiology clinic in 2018 and 2019 were included. The peer review scores were classified as acceptable and unacceptable diagnoses and clinically insignificant and significant diagnostic discrepancy. The diagnostic discrepancy rates and clinical significance were compared among radiology sections and imaging modalities using the chi-square test. Results Of 1312 peer reviews, 117 (8.9%) cases had unacceptable diagnoses. Of 462 diagnostic discrepancies, the clinically significant discrepancy was observed in 104 (21.6%) cases. In radiology sections, the unacceptable diagnosis was highest in the musculoskeletal section (21.4%) (p < 0.05), followed by the abdominal section (7.3%) and neuro section (1.3%) (p < 0.05). The proportion of significant discrepancy was higher in the chest section (32.7%) than in the musculoskeletal (19.5%) and abdominal sections (17.1%) (p < 0.05). Regarding modalities, the number of unacceptable diagnoses was higher with MRI (16.2%) than plain radiology (7.8%) (p < 0.05). There was no significant difference in significant discrepancy. Conclusion Peer review provides the rates of unacceptable diagnosis and clinically significant discrepancy in teleradiology. These rates also differ with subspecialty and modality.

An Intelligent Medical Diagnosis System by Multiple Fuzzy Rule Base of Biological Mineral Information Analysis (생체 미네랄정보의 다중 퍼지규칙베이스 구축에 의한 지능적 의학진단시스템 구축)

  • Jo, Yeong-Im
    • Proceedings of the Korean Institute of Intelligent Systems Conference
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    • 2006.11a
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    • pp.243-246
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    • 2006
  • 본 논문에서는 모발내에 있는 약 30여가지의 생체 미네랄과 8가지의 중금속 정보 분석을 통해 생체내에 양양상태의 과잉, 결핍 및 불균형 상태를 평가하고, 그 결과가 현재 생체에 미치는 영향을 예측하여, 건강을 유지하는 방향을 제시할 수 있는 의료용 지능적 의학진단 시스템을 구축하였다. 이 논문에서는 생체내 미네랄 정보를 다중 퍼지규칙베이스 시스템으로 구축함으로써 환자에게 보다 효율적으로 치료와 예방방법을 제시할 수 있는 의학진단시스템을 구축하였다.

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The Assessment Tools in Palliative Medicine (완화 의학에서의 평가도구)

  • Gwak, Jung-Im;Suh, Sang-Yeon
    • Journal of Hospice and Palliative Care
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    • v.12 no.4
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    • pp.177-193
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    • 2009
  • The assessment of patient status in palliative medicine is essential for determining treatments and for clinical outcomes. The objective of assessment tools is to raise the quality of care for individual patients and their families. There are a number of tools available to assess pain, non-pain symptoms and quality of life. The tools are either uni-dimensional or multi-dimensional measures. Unfortunately, however, no single tool is recommended to be a superior to others in symptoms or quality of life assessment. Therefore, to select an appropriate assessment tool, one should consider the time frame and unique characteristics of tools depending on purpose and setting. The combination of prognostic index is highly recommended in prognostication, and web-based prognostic tools are available. Recently, a new objective prognostic score has been constructed through multicenter study in Korea. It does not include clinicalestimates of survival, but includes new objective prognostic factors, therefore, anyone can easily use it. For beginners in palliative medicine, relatively easy-to-use tools would be convenient. We recommend Eastern Cooperative Oncology Group performance status to assess functional status, numeric rating scale for pain assessment and the Korean version of brief pain inventory for initial pain assessment. Asking directly with numeric rating scale or the Korean version of MD Anderson Symptom Inventory would be desirable to assess various symptoms together. We think that European Organization Research and Treatment Quality of Life Questionnaire Core 15 for Palliative Care is good to assess the quality of life, while Objective Prognostic Score is convenient as prognostic index for beginners.

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History of the National Health Insurance Cost for Radiological Examinations and Value of the Radiological Report Fee (영상의학과 보험수가 역사와 판독료의 가치)

  • Choong Wook Lee
    • Journal of the Korean Society of Radiology
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    • v.81 no.5
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    • pp.1038-1052
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    • 2020
  • Advancements of medical care with the use of new medical technologies have been promoting public health, but they can also place a financial burden on individuals and the country. Since the introduction of the health insurance system in 1977, the South Korean government has been attempting to control medical expenses. Radiological examinations have been a major target for cost reduction. Meanwhile, the radiological report fee has been combined with the technical fee for a long time; hence, its value has not been independently evaluated, and was also decreased proportionally with examination cost reduction. However, in the revised medical fee estimation system for MRI, the report fee has begun to be calculated separately from the technical fee, significantly contributing to the evaluation of the radiologists' work value. In conclusion, radiologists need to know and actively participate in the process of determining the insurance cost of radiological examinations and reports to get a proper value of their professionalism.

An Empirical Study on Quantitative Evaluation of Cognitive Function (인지기능의 정량적 평가를 위한 측정 모델 소프트웨어 개발 및 실험적 검증 연구)

  • Ryu, Wan-Seok;Kim, Hyung-Gun;Chung, Sung-Taek
    • Progress in Medical Physics
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    • v.21 no.1
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    • pp.42-51
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    • 2010
  • Imaging studies using MRI, PET, and/or MEG have been primary evaluation methods to quantitatively assess cognitive function. Recent advances in computational technology and information technology may allow a novel evaluation methodology to quantitate cognitive function more cost-effectively. In this study, we developed a software package composed of a series of tests to evaluate cognitive ability combined with a user-friendly touch screen input device. This cognitive assessment tool can quantitate concentration, numeric memory, associative memory, topological memory, visual and muscular reaction, and acoustic reaction over a relatively short testing time. We performed an empirical study on eighty normal subjects aged 20 and 59 years old using the developed evaluation methods. Age-related cognitive deterioration after 40 years old was confirmed. There was no difference in cognitive ability between male and female in the same age group. This study demonstrates the feasibility of a simple but effective evaluation software tool to quantitatively assess cognitive ability. This methodology may provide improved accessibility and reduced costs to perform cognitive function studies to compare between various subject groups.

QA활동의 작은 경험

  • Gwak, Gyeong-Deok
    • Quality Improvement in Health Care
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    • v.2 no.2
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    • pp.14-18
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    • 1996
  • 1. QA담당자로서 전문적인 지식습득 노력이 필요하다. 2. 직원홍보가 필요하다. QA활동이 자신의 진료내용 및 관련업무를 감시하는 것이 아니라고 홍보할 필요가 있다. 3. 의료인 특히 의사의 의식 및 행동에 변화가 필요하다. 4. 직원교육이 필요하다. QA를 쉽게 할 수 있는 방법을 교육시킬 필요가 있다. 복잡한 통계처리 방법보다는 쉽게 할 수 있는 단순비교방법이 더 효과적이라고 본다. 또 어떤 기준치와 역치를 설정하여 시행하기 보다는 지난번 조사결과와 비교하여 개선되는 정도를 파악하는 것이 방법도 더 쉽고 접근하기도 쉽다. 5. 긍정적인 면의 평가도 필요하다. 예를 들어 과잉치료억제보다 의학발전을 위해서는 최신 치료방법 장점을 파악하는 데에도 역점을 둘 필요가 있다. 6. 직원교육과 심도있는 QA활동을 위해서는 전담인력이 필요할 것으로 본다. 7. 경영진의 확고한 의지가 있어야 한다. 8. 병원 QA활동이 서비스 측면보다는 의학적 측면에 더 역점을 두어야 할 것이다. 9. 일반병원에서 쉽게 시행할 수 있는 평가대상과 항목, 기준을 QA학회와 임상학회차원에서 마련하여 주면 일선에서 QA활동하기가 훨씬 수월할 것으로 본다.

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The Past, Present and Future of Korean Research in Psychosmatic Medicine (한국 정신신체의학연구의 과거와 현재 그리고 미래)

  • Ko, Young-Hoon
    • Korean Journal of Psychosomatic Medicine
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    • v.20 no.1
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    • pp.9-13
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    • 2012
  • Psychosomatic medicine is a part of medicine which is to find the effect of psychological, behavioral, and medical factors on the human body and disease. In the early $20^{th}$ century, the idea of psychogenesis had been developed and resulted in the concept of psychosomatic disease which was believed to be caused by psychological factors. However a multifactorial model of illness developed and it allowed illness to be viewed as a result of biopsychosocial interactions. The following have been highlighted by consultation-liaison psychiatry. Psychosomatic medicine has addressed stress and psychiatric factors which affect the etiology, course, and treatment of medical disorders. Moreover it contributes the growth of other related disciplines such as psychoneuroendocrinology, psychoimmunology, behavioral medicine, health psychology and quality of life research. Nowadays, psychosomatic field becomes enlarged because medical and surgical departments have been developed rapidly, and research methods and tools have brought forth rapid progress and advance in medical science. Therefore the author reviews the past and present psychosomatic researches and suggests the future of psychosomatic research in Korea.

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Introduction of Explanation Meeting in Cadaveric Dissection Using Communication Skill : Correlation between Self-Evaluation Factor and Academic Achievement of Medical Students (의사소통기술을 활용한 해부설명회 적용 후 의학전문대학원생의 자기평가요인과 학업성취도 상관관계 분석)

  • Kim, Kwang-Hwan;Kim, Jee-Hee;Park, Jeong-Hyun
    • Proceedings of the KAIS Fall Conference
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    • 2010.11b
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    • pp.897-900
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    • 2010
  • 본 연구에서는 해부학 실습 교육과정에 해부설명회를 도입에 따른 의학전문대학원생들의 자기평가요인(만족도, 전공 연계성, 운영 적절성, 의사소통)과 학업성취도와의 상관관계를 분석하였다. 2008-2009학년도 1학기 해부학 실습 교육을 받은 의학전문대학원생들(n=102)이 일부 수업시간을 활용하여 해부설명회에 참가하였고, 보건 의료 계통의 학부생들에게 사체를 활용하여 인체 구조에 대한 설명과 토론을 마친 후 설문지와 소감문을 작성하게 하였다. 이를 바탕으로 자기 평가 요인들을 분석하였고, 2008-2009 학년도 해부학 성적과의 상관관계를 조사하였다. 설문 대상자의 일반적 특성에 따른 자기 평가 요인을 분석한 결과, 성별, 연령, 과거 경험 유무 등의 일반적 특성과 상관없이 만족도, 전공 연계성, 운영 적절성, 언어적 및 비언어적 커뮤니케이션 모두에서 높은 수치를 나타내었다. 자기 평가 요인 중 학업성취도와 높은 상관관계를 갖는 요인은 언어적 커뮤니케이션이었다(p<0.05). 또한 언어적 커뮤니케이션은 비언어적 커뮤니케이션과도 높은 상관관계를 가졌다(r=0.580, p<0.01). 결론적으로 커뮤니케이션 기법을 활용한 해부설명회의 도입은 의전원 학생들에게 심화 학습의 기회를 제공하였고 학습동기를 유발시키며, 적극적인 학습태도를 갖게 하였다. 아울러 커뮤니케이션에 대한 중요성을 깨닫게 되었고, 타 전공자와의 상호교류를 통한 학문적 이해의 폭이 확대되었음을 확인하였다. 본 연구 결과를 바탕으로 진행과정에 나타난 문제점을 보완하고 개선한다면 해부학 실습의 개선 방안으로서 해부설명회의 활용가치가 충분하다고 판단되었다.

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The Effect of Leukoaraiosis on the Severity and Course of Delirium (백질변성이 섬망의 심각도 및 경과에 미치는 영향)

  • Choi, Won-Jung;Seok, Jeong-Ho;Oh, Seung-Taek;Chung, Tae-Sub;Kim, Jae-Jin
    • Korean Journal of Psychosomatic Medicine
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    • v.26 no.2
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    • pp.194-200
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    • 2018
  • Objectives : The significance of leukoaraiosis on brain magnetic resonance imaging (MRI) is uncertain, but it is often seen with vascular risk factors or in the context of cognitive impairment. We aimed to investigate the effect of leukoaraiosis on the severity and course of delirium. Methods : Periventricular hyperintensity and deep white matter hyperintensity on brain MRI were rated in 42 patients with delirium by semiquantative visual rating scale. Correlations between their grades and the scores of Korean version of Delirium Rating Scale-Revised-98 (K-DRS-R-98) were analyzed, and the interaction effects between the groups according to the levels of leukoaraiosis and two evaluation points were also analyzed. Results : The grade of deep white matter hyperintensity in the occipital lobe was positively correlated with the scores on the total, severity items, cognitive items, and non-cognitive items of K-DRS-R-98. The cognitive items scores of K-DRS-R-98 in the low grade group of periventricular hyperintensity showed significantly steeper decrease than the high grade group. Conclusions : A difference in severity or recovery speed of delirium according to the level of leukoaraiosis may result from disruption in brain functional connectivity. Our results have a clinical implication in that the severity and course of delirium can be possibly predicted using the level of leukoaraiosis.