• Title/Summary/Keyword: 재원적절성

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Early Tailoring Thoracoplasty in Patients Undergoing Pulmonary Resection (폐의 부분 절제시 조기 변형식 흉곽성형술의 임상적 의의)

  • Lee, Sam-Yun;Yang, Hyeon-Ung;Choe, Jong-Beom;Choe, Sun-Ho
    • Journal of Chest Surgery
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    • v.30 no.4
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    • pp.396-401
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    • 1997
  • Tailoring thoracoplasty is employed prior to, following, or concomitant with pulmonary resection when it is anticipated that insufHclent lung tissue will remain to fill the pleural space following a pulmonary resection. This study reviewed a series of eight patients treated with tailoring thoracoplasty between 1990 and 1995. Indications were to close a persistent space In four patients and to tailor the thoracic cavity to accept diminished lung volume concomitant with a pulmonary resection in the other four patients. The primary underlying disease was lung cancer in three patients and pulmonary tuberculosis In five patients, two of whom had concomitant aspcrgilloma, two, pneumothora , and one, empyema with bronchopleural fistula. In four patients with a prior pulmonary resection, the tailoring thoracoplasty was performed within eight days after the resection surgery. There was no failure to accommodate the thoracic cavity to insufficient lung tissue, even though two patients needed a second thoracoplasty. We conclude that tailoring thoracoplasty may be performed to close anticipated persistent pleural space and to accommodate diminished lung volume with acceptable cosmetic results Early, after, or concomitant with pulmonary resection in selected patients.

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The Medical Disputes and Its Alternative Dispute Resolutions in Germany (독일의 의료분쟁과 대체적 분쟁 해결 기구)

  • Kim, Jang Han;Lee, Seok-Bae
    • The Korean Society of Law and Medicine
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    • v.17 no.1
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    • pp.139-168
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    • 2016
  • Two alternative dispute resolutions for medical dispute have been operated under the States of German Medical Associations. The first is the medical mediation committee of North german area, the other is the advisory committee on medical errors in North-Rhine area. The former has focused on the mediation itself, the latter commission has focused on the expert review itself whether the physician has maintained reasonable care in diagnosis and treatment. Even though these organizations have maintained under the medical associations, to maintain the neutrality on legal and medical decision, the North German mediation committee is composed of a lawyer and a medicine doctor respectively and North-Rhine advisory committee has a lawyer chair person and four medicine doctors. The main difference of Korean Medical Dispute Mediation Agency in respect from the german system is that expert review is subordinated to the mediation process. The neutrality of expert review is suspected from the medicine doctors. The neytrality and the efficiency should be improved to treat the medical disputes. To do so, lawyer and medicine doctor work together in mediation process and lawyer should manage the expert review process but not involved. Mediation process and expert review should be checked and balanced, and they could be developed as a separated process itself.

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Study on the Improvement of Korean Broadcasting Advertising System (방송광고 판매제도 개선방안 연구: 경쟁도입의 효과분석과 보완장치 모색을 중심으로)

  • Shin, Tae-Sub
    • Korean journal of communication and information
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    • v.33
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    • pp.169-191
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    • 2006
  • Changing our monopoly broadcasting advertising system into free competition system may give rise to serious troubles that intensify commercialism of broadcasting and reduce diversity of public opinion. In the boundaries of public interest out of danger, korean broadcasting system should adopt a system that partially adopts the principle of free market. Broadcasting advertising sale system affect the whole broadcasting system because it functions as an effective capital-resource provider. Thus, it affects the broadcasting policies' righteousness and efficiency. Due to the non-elastic nature of the total advertising market, broadcasting advertising's size affects other media's capital allocation process. Therefore, broadcasting advertising sales system not only affects broadcast's social duty and public interest, but also affects the whole media industry. First, provide fair and open-competitive measures to support broadcast sales policy so that the market-based system can be run smoothly. Second, block any un-due influence from advertisers by separating production/programming and advertising sales. Third, sustain public broadcast system, not based on the advertising sales but based on the subscription fee. Fourth, social intervention of the advertising market. Fifth, provide policies that can set up multiple media channels/outlets and public opinion. By providing the minimum capital resources to the public broadcasting system, the broadcasting system can act on its public-interest duty and support the people's right-to-know rights.

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How can the development of neighbourhood renewal strategies in Malaysia be informed by best practice and transferable lessons from developed countries (선진국 도시재생 사례비교를 통한 말레이시아 주거재생 전략의 모색)

  • Tin, Wan Jiun;Lee, Seok-Hwan
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.18 no.4
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    • pp.469-486
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    • 2017
  • Economy-based urban redevelopment is the main priority in Malaysia, but has resulted in social problems such as gentrification, loss of heritage and identity, inequity, etc. Hence, it is crucial for the government to seek other alternatives rather than being solely reliant on urban redevelopment. Neighborhood renewal is a strategy involving the integration of redevelopment, rehabilitation, revitalization and preservation that aims to improve deprived areas using a more holistic approach. The aim of this paper is to review the neighborhood renewal policies in developed countries and to identify those elements that can be adopted in Malaysia. This study is conducted via a literature review. It was found that neighborhood renewal which integrates people-based, place-based and system-based policies highlights the importance of diversity, thereby aiming for resource optimization, community engagement and urban governance with the focal point of the fair, equity and systematic provision of resources. This paper concluded that neighborhood renewal in Malaysia should be initiated by locals with an emphasis on real local participation and a sustainable funding system. The government and local authorities should be observers rather than implementers.

The Policy Package Related to Essential Medical Service: The Key Is Elaboration and Solidification (필수의료 정책 패키지, 내실화가 관건이다)

  • Sun-Hee Lee
    • Health Policy and Management
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    • v.34 no.1
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    • pp.1-3
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    • 2024
  • Currently, the issue of poor accessibility to essential medical services has been brought to light as a social discontent. In order to strengthen the essential medical service system, the government has announced the "the policy package related to essential medical service" as a comprehensive solution and has vowed to invest more than 10 trillion won by 2028. As it contains crucial elements for changing the framework of the healthcare system, I would like to present several points to consider in policy implementation. Given that this package contains important elements for changing the framework of the healthcare system, there are a few issues to consider in policy implementation. First, a mechanism to prevent politicization should be established when designing the physician training system. Second, changing from a hospital centered on residents to one centered on specialists means that the society bears the cost of training residents, while paying a high price for specialist services. The willingness of society to pay for the costs incurred by such a change should be carefully considered, and an appropriate budget must be prepared. Third, as the operation of shared human resources and inter-organizational networking, among other detailed policy measures, are still at a level of conceptual discussion, various issues should be solidly reviewed and considered for in the mid to long term to suit the conditions of the domestic healthcare system.

Inappropriate Care of Oncologic Emergency in Korea (암환자 응급진료의 현황 및 문제점)

  • Heo, Dae-Seog;Yun, Young-Ho;Jeong, Joo-Young;Kim, Hong-Soo;Kim, Sung-Hye;Shin, Sang-Do;Rhee, Joong-Eui;Oh, Eun-Kyung;Yoo, Chul-Gyu;Bang, Yung-Jue;Kim, Noe-Kyeong
    • Journal of Hospice and Palliative Care
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    • v.1 no.1
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    • pp.14-22
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    • 1998
  • Purpose : Cancer is a common cause for admission to emergency room(ER). Cancer patient present to ER with undiagnosed cancer, acute vague problem of cancer, or treatment related complication. But there is little information on the magnitute of the problems in the Korea. The purposes of our study were to evaluate the appropriateness of care for oncologic emergencies in Korea. Materials and Methods : This study was undertaken of all cancer patients above 15 years old presenting to the Seoul National University Hospital ER, who visited during the period from Oct. 16 to Nov. 15, 1997. ER record was reviewed and ER doctors evaluated patients' reason for visiting ER, appropriateness in patients' utilization of ER, oncology emergency Results : 266 cancer patients(17.4% of total patients) visited ER during this period and 166 cancer patients(62.4%) utilized inappropriately ER. Their average stay is 32.0 hours and 65.8% of them stayed for 6 hours. There were complaints of patients such as pain(44.8%), abdomen distension(9.4%), and dyspnea(7.5%). The most common oncologic emergency in ER during this study were gastrointestinal(34.0%), neurologic(21%), hematologic(8.0%), infectious(7.0%), respiratory(6.0%), and genitourinary(5.0%). Conclusion : For the care of symptoms like pain, most of cancer patients utilize ER inappropriately due to lack of attention from primary health delivery system. For the better care, the palliative medicine should be established in Korea.

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Underlying Etiologic Factor of Recurrent Pneumothorax after Bullectomy (원발성 기흉환자에서 재수술의 원인)

  • 윤용한;이두연;김해균;홍윤주
    • Journal of Chest Surgery
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    • v.32 no.6
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    • pp.556-560
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    • 1999
  • Background: The cause of spontaneous pneumothorax is not yet but it is certain that intrathoracic air comes from ruptured bulla. Video-assisted thoracoscopic surgery(VATS) or open thoracotomy is recommended for thoracic incision in recurrent pneumothorax. However, recurrent rate after bullectomy with the VATS is very high compared to mini-thoracotomy, 3% to 20% and below 2%, respectively. Material and Method: This retrospective analysis was performed on 16 re-operated cases among 446 surgically treated pneumothorax of the 737 cases of spontaneous pneumothorax diagnosed at Yongdong Severance Hospital from Nov. 1992 to June 1997. Result: Among the 446 surgically-treated patients in 737 case of spontaneous pneumothorax, 16 patients underwent re-operation, showing a 3.5% re-operation rate. Male-to-female ratio was 15 to 1 and mean age at initial attack was 20.2 years(ranging from 15 to 50). Mean hospital stay was 6.34 days(ranging from 2 to 20 days) and mean chest tube indwelling period was 4.2 days(ranging from 1-10 days). Median follow-up was 46 months(range 10-66 months). Three different surgical methods were applied : video-assisted thoracoscopic surgery(VAST) in 281 cases, of whom 2 underwent local anesthesia; subaxillary mini-thoracotomy in 159 cases and limited lateral thoracotomy in the remaining 6 cases. Three different re-operative surgical methods were applied ; video-assisted thoracoscopic surgery (VAST) in 6 cases, subaxillary mini-thoracotomy in 9 cases, and limited lateral thoracotomy in the remaining 1 case. The underlying etiological factors of the recurrent pneumothorax after bullectomy were o erlooking type(9) and new growing type(7). Mean recurrent period from previous operation was 1 month for overlooking type and 18 months for new growing type. Conclusion: The underlying etiological factors of recurrent pneumothorax lead to re-operation were new-growing and over-looking type. We need additional treatments besides resecting blebs of prevent the recurrence rate and more gentle handling with forceps due to less damage to the pleura.

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Measuring Attitudes and Satisfaction Level towards Military Foodservices (군 급식소의 이용실태 및 만족도 조사)

  • Kang, Bo-Kyoung;Lee, Young-Eun
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.40 no.7
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    • pp.1032-1042
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    • 2011
  • The purpose of this study was to examine the attitudes and satisfaction level towards military foodservices as well as suggest effective ways to increase foodservice quality. A questionnaire survey was administered to 413 subjects, which included 400 soldiers and 13 foodservice managers. The survey period was from August 6 to August 25, 2008. The collected data were statistically treated using SPSS V12.0. Most of the investigated soldiers were 20~25 years old. The foodservice managers were male general officials and the majority of them had no prior food service training. None of the foodservice managers had a dietician certificate. Menu was planned through a local foodservice conference, and most food materials were delivered in the form of center-type and military unit-type. Deficiency and deterioration of food service facilities (28.6%) as well as deficiency in the number of cooking personnel (14.3%) increased the difficulty of operational management. Soldiers expressed a desire for increases in Western (25.7%) and Korean traditional foods (21.5%), which meant menu diversity. To increase the quality of military foodservices, taste of food (40.6%), increased portion size (30.4%), and improvement in hygienic conditions (13.6%) were demanded by the soldiers. Food taste (30.8%), improvement in hygienic conditions (23.1%), and better job management were all demanded by the foodservice managers. After factor analysis, quality attributes were rearranged into five dimensions, including facilities, food, menu, service, and sanitation most attributes were over 4 points out of 5 total in importance, but only 3 points in performance. The importance score was higher than the performance score. Soldiers' overall satisfaction level was on average 3.43 points out of 5 points.

Clinical Features of Sulfite-Sensitive Asthmatics (설파이트(Sulfite) 과민성 천식 환자의 임상적 특성에 관한 연구)

  • Cho, Young-Soo;Baik, Su-Hum;Park, Hae-Sim;Rhu, Nam-Soo;Cho, Dong-Ill;Kim, Jae-Won
    • Tuberculosis and Respiratory Diseases
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    • v.39 no.2
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    • pp.159-166
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    • 1992
  • Background:Sulfiting agents are widely used as preservatives and antioxidants in foods, beverages and drugs including bronchodilators. There have been reports of sulfite-related reactions such as anaphylaxis, urticaria, angioedema, abdominal discomfortness as well as bronchospasm. Several investigators reported that sulfite-sensitive asthmatic patients comprised from 3.9% to 8.2% of all asthmatic patients and its prevalence was higher in steroid-dependent group than in steroid-independent group. Subjects and Method:We performed oral provocation test with sodium bisulfite and aspirin in 17 asthmatic patients who have experienced aggravation of their symptoms after administration of drugs or foods. All of them were steroid dependent asthmatics. We observed clinical symptoms and steroid requirements from 1 to 18 months. Result:Ten of them showed severe bronchoconstriction after the ingestion of sodium bisulfite (50 to 200 mg) within 30 minutes. Concurrent aspirin intolerance was noted by oral provocation test in four cases (40%). Three of them showed positive responses on skin prick test with sulfite (10 or 100 mg/ml). Mean total eosinophil counts was $844/mm^3$ at asthmatic attack. And there was no significant responses on skin prick test and IgE-RAST to common inhalant allergens. After complete avoidance from sulfite containing foods and drugs as well as antiasthmatic medication for 1 to 18 months, nine of them (90%) could stop or reduce the steroid requirements. ConcIusion:It was suggested that severe steroid dependent and intrinsic type of asthmatic patients should be evaluated for sulfite-sensitivity.

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Climatological Characteristics in the Variation of Soil temperature in Korea (우리나라 지중온도 변동의 기후학적 특성)

  • Kim Seoung-Ok;Suh Myoung-Seok;Kwak Chong-Heum
    • Journal of the Korean earth science society
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    • v.26 no.1
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    • pp.93-105
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    • 2005
  • Climatological characteristics in the variation of soil temperatures in Korea were investigated using Korea Meterological Administration's observation data. And the impacts of soil moisture on the variation of soil temperature were examined using observed precipitation data. The climatological averages of soil temperatures are ranged from 14.4 to $15.0^{\circ}C$ regardless of depths. And they showed an latitudinal gradient with a warm temperature at the southern region and 'U' shape as in the air temperature with a high value along the coastal region. The relatively higher heat capacity and low conductivity of soil compared to those of the air resulted in the significant delay of the maximum and minimum date with depth. As a results, soil acts as a heat source during winter while a heat sink during summer. Global warming and urban heat island have increased the soil temperatures with an average rate $0.3\~0.5^{\circ}C/10-year$ as in the air temperature during last 30 years $(1973\~2002)$. However, the warming rate is maximized during spring contrary to the winter in the air temperature. The temporal variation of soil temperatures is strongly affected by that of soil moisture through an modification of the heat capacity and heat convection. In general, the increased soil moisture clearly decreased the temporal variations and increased the deep layer soil temperatures during cold season.