• Journal of Gastric Cancer
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• v.5 no.2
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• pp.95-100
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• 2005

Purpose: Critical pathways (CP), also known as clinical pathways, are management plans that display goals for patients and have led to improved outcomes for many disease entities. This study was aimed at developing a critical pathway for the surgical treatment of gastric cancer patients and evaluating its usefulness. Materials and Methods: A CP was developed and implemented by a team of surgeons, nurses, nutritionists, and administrative officials. Among the 117 patients who received curative gastrectomies for gastric cancer at Kangnam St. Mary's Hospital, The Catholic University of Korea, between October 2003 and August 2004, 26 patients were treated according to the CP. We evaluated its usefulness by comparing the clinical characterisctics, postoperative progress, hospital stays, and costs between the CP and the non-CP groups. Patient satisfaction was also surveyed with questionnaires. Results: Of the initial 26 patients in the CP group, two were excluded from the final evaluation; one patient had a duodenal stump leakage, and the other had a gastric stasis postoperatively. In 8 patients, protocol violation occurred; six patients refused to be discharged on the $7^{th}$ postoperative day, one patient who had an gastric staisis postoperatively stayed for 2 additional days, and one patient who needed ICU care stayed for 4 additional days. The drop-out rate was $7.7\%$ (2/26), and the variance rate was $30.8\%$ (8/26). The mean hospital stay was 11.3 days ($10\~15$ days) for the CP group compared with 17.5 days ($9\∼68$ days) for the non-CP group, resulting in a difference of about 6 days (P<0.05). The mean hospital stays after surgery were 10.3 days ($7\∼68$ days) and 8.3 days ($7\∼12$ days) for the non-CP and the CP groups, respectively, but the difference was statistically not significant (P>0.05). The mean charge during the hospital stay was higher in the non-CP group ( $\\$ 6,292,200) than in the CP group ( $\\$ 4,863,685). The charge per hospital day was higher in the CP group ( $\\$ 430,414) than in the non-CP group ( $\\$ 359,554). Patient satisfaction was higher in the CP group than in the non-CP group. Conclusion: By developing and applying a critical pathway in the surgical treatment of stomach cancer patients, we could reduce the length of hospital stay as well as the cost. A multi-centered prospective study to establish a standard treatment pathway and to demonstrate its effectiveness is needed in the future.

• Journal of dental hygiene science
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• v.15 no.4
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• pp.399-406
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• 2015

The purpose of this study was to investigate the performance of dental infection control. This survey was performed on 158 of the dental hygienist in certain areas. The research was performed using a self-reported questionnaire and interview method from June to July, 2014. The collected data was analyzed by PASW Statistics ver. 18.0. Guideline of infection management, infection controller, regular infection control training, Sterilization of the handpiece/per head resulted 57~74% for dental hospital. It was higher than 13~20% for dental clinics (p<0.05). Infection control guidelines and vaccination recognition of dental were more performed in dental hospital. Patient's hand hygiene performed, tooth brushing before treatment, cross infection educational experience was less than 20%, research cooperation of medical history was over 90% (p<0.05). Performing rate of the dental hospital workers were investigated higher in protective personal devices, infection control of treatment room. A correlation analysis about institutional support, infection control of dental hygienists, patients with infection control cooperation showed a positive correlation statistically significant. Infection control can be enhanced when the medical staff, the patient, the organization combined cognitive and practice. Dental hygienist is required to recognize and practice the infection control guidelines through continuing education.

• Journal of Hospice and Palliative Care
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• v.19 no.3
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• pp.201-210
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• 2016

Delirium is a common symptom in patients with terminal cancer. The prevalence increases in the dying phase. Delirium causes negative effects on quality of life for both patients and their families, and is associated with higher mortality. However, some studies reported that it tends to remain unrecognized in palliative care setting. That may be related with difficulties to distinguish the symptom from others with overlapping characteristics such as depression and dementia, and a lack of knowledge regarding assessment and diagnostic tools. We suggest that accurate recognition with validated tools and early diagnosis of the symptom should be highly prioritized in delirium management in palliative care setting. After diagnosing delirium, it is important to identify and address reversible precipitants such as medication, dehydration, and infection. Non-pharmacological interventions including comfortable environment for the patient and family education are also essential in the management strategy. If such interventions prove ineffective or insufficient to control hyperactive symptoms, pharmacologic interventions with antipsychotics and benzodiazepine can be considered. Until now, low levels of haloperidol remains the standard treatment despite a lack of evidence. Atypical antipsychotics such as olanzapine, quetiapine and risperidone reportedly have similar efficacy with a stronger sedating property and less adverse effect compared to haloperidol. Currently, delirium medications that can be used in palliative care setting require more clinical trials, and thus, clinical guidelines are not sufficiently available. We suggest that it is warranted to develop clinical guidelines based on well-designed clinical studies for palliative care patients.

• Journal of the Korea Convergence Society
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• v.11 no.12
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• pp.309-317
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• 2020

In the post-corona era, telemedicine is becoming more important. This is the case in which it is written, in terms of this study, and in relation to the relationship between the Koreans and the Korean government. In addition, the aim is to prepare effective measures and seek policy suggestions for expanding the introduction of domestic telemedicine in the future. Although Japan has insisted on the necessity of introducing telemedicine in the medical community, it has institutionalized it with a cautious attitude until the establishment of telemedicine. On the other hand, South Korea lacks clear provisions on medical fees for telemedicine and legal measures regarding the responsibility for medical malpractice. Therefore, a clear legal interpretation of the telemedicine subject is needed, and a strategic approach is prioritized, including guidelines and measures for the legal responsibilities and limitations of physicians and patients.

• Journal of Korean Academy of Dental Administration
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• v.5 no.1
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• pp.45-54
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• 2017

The purpose of this article is to cope with the abuse of antibiotics in the clinic, to determine the necessity of antibiotic administration, to share information on the selection and proper use of appropriate antibiotics, and to increase the appropriateness of antibiotic prescription through continuous monitoring. In line with the latest research and guidelines trends of various agencies, we will supplement the antibiotic prescription guidelines and use them for the treatment in Apple Tree Dental Hospital. Specially, by history taking and the penicillin allergy test, amoxicillin is prescribed as a primary selective antibiotic for 1 day. The complaints and treatment effects of the first antibiotic should be evaluated at the next visit. If the primary antibiotic was ineffective, we replaced it with a broad-spectrum antibiotic. If there was no improvement in symptoms, the patient would be referred to upper grade hospital. The staff of the Apple Tree Dental Hospital regularly monitored and educated antibiotic prescriptions. The current guidelines should be supplemented continually and positively affect the abuse of antibiotics and the habit of dental practice.

• Childhood Kidney Diseases
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• v.16 no.2
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• pp.95-101
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• 2012

Purpose: Recently, many evidence-based guidelines for the management of urinary tract infection (UTI) have been developed because of the importance of proper management. However, there is a lack of data regarding how pediatricians manage UTIs in Korea. Therefore, we surveyed pediatricians to determine whether they manage UTIs in an appropriate manner. Methods: A postal questionnaire survey of 78 pediatricians practicing in Daegu city was performed. Subjects were asked about diagnosis, imaging studies, treatment, and prevention of UTIs. Results: Most of the respondents (94.8%) performed urinalysis to diagnose UTI in febrile children with an unknown fever focus. However, many preferred inaccurate collection methods, such as bagged urine collection, and did not obtain urine cultures. The most frequently performed imaging modality was renal-bladder ultrasonogram. Orally administered antibiotics were preferred unless admission was needed. After diagnosis of UTI, the pediatricians usually provided information to caregivers about the disease itself and supplementary treatment. Of the respondents, only 28.6% had their own guidelines for management of vesicoureteral reflux. Conclusion: Most pediatricians suspected UTI in febrile children with an unknown focus appropriately. Nevertheless, the fact that many pediatricians preferred inaccurate urine collection methods and did not perform sufficient imaging studies to detect associated abnormalities likely resulted in overtreatment due to false-positive diagnosis of UTI and a low probability of ruling out genitourinary anatomical problems. To improve the quality of management of UTI, pediatricians should follow scientific and evidence-based guidelines.

• Journal of dental hygiene science
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• v.16 no.2
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• pp.183-192
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• 2016

A total of 228 dental hygienists working in dental hospitals and clinics in the Busan and Gyeongnam areas were surveyed between August 1, 2015, and October 15, 2015. The factors influencing infection control awareness and implementation levels among the dental hygienists were investigated to prepare basic data with the goal of establishing guidelines for systemic infection control. Treatment preparation support for infection control positively correlated with equipment and facility support (r=0.4343, p<0.01), treatment skill and information support (r=0.231, p<0.01), infection control education support (r=0.266, p<0.01), infection control awareness (r=0.354, p<0.01), and infection control implementation levels (r=0.442, p<0.01). Equipment and facility support positively correlated with treatment skill and information support (r=0.418, p<0.01), infection control education support (r=0.422, p<0.01), infection control awareness (r=0.404, p<0.01), and infection control implementation levels (r=0.454, p<0.01). Infection control education support positively correlated with infection control awareness (r=0.348, p<0.01) and infection control implementation levels (r=0.405, p<0.01). Infection control awareness positively correlated with the infection control implementation level (r=0.879, p<0.01). The factors influencing the awareness of infection control include treatment preparation support, equipment and facility support, treatment skill and information support, and infection control education support. The influencing the infection control implementation level include treatment preparation support, equipment and facility support, infection control education support, and treatment skill and information support. To enhance the awareness of infection control and implementation levels amongdental hygienists, an infection control system must be established and implemented A rigorous system for evaluating dental clinics must also be established to ensure an ideal dental treatment environment and to protect patients' health and safety.

• Annals of Clinical Microbiology
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• v.21 no.4
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• pp.69-74
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• 2018

Laboratory medicine is a specialized division that supports physicians in the care of patients by providing rapid and accurate in vitro diagnostic tests. Standardization of every component of a specific test is essential for producing accurate results. The Clinical and Laboratory Standards Institute (CLSI) was founded to develop a formal consensus process for standardization in 1968, and has been publishing standards and guidelines covering all aspects of clinical, research, and other laboratory work. CLSI guidelines are widely used around the world for standardization. The CLSI antimicrobial susceptibility testing subcommittee (AST SC) consists of 6 standing and many ad hoc working groups. Members of the AST SC review submitted proposals and suggestions, decide on approving these submissions in face-to-face meetings held twice a year, and revise CLSI documents accordingly. As these face-to-face meetings are open to anyone who registers to attend, I strongly encourage the members of our Society to attend and actively participate in document development.

• The Journal of the Korea Contents Association
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• v.14 no.10
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• pp.562-569
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• 2014

The purpose of this study was to investigate the determinants of total payment for mental and behavioral disorders patients admitted through the emergency room. Study data was selected from the Korean National Health Insurance sample data in 2009. This data was consisted of 753 inpatients who are 331 inpatients with only main sick(F31-F39) and 422 inpatients with main sick codes(F31-F39) and sub sick(F00-F99) admitted through the emergency room. SPSS v.18 was used for the statistical analysis such as descriptive analysis, t-test, ANOVA, and multiple regression analysis. In multiple regression analysis, significant variables affecting total payment of main sick patients were gender(p<.01), treatment result(p<.001), path of the emergency room(p<.001), and length of stay(p<.001). Also, main sick patients with sub sick were gender(p<.01), age(p<.001), treatment result(p<.001), path of the emergency room(p<.001), and length of stay(p<.001). These findings implied that it is necessary to build short, middle, and longterm program and system for high risk mental and behavioral disorders groups.

• Quality Improvement in Health Care
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• v.7 no.1
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• pp.46-58
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• 2000

Background : Despite favorable effects of guidelines on patient care, guidelines often fail to achieve their objectives. Poorly implemented medical practice guidelines can produce only weak effects on the process of health care delivery. Therefore, we performed this study to investigate barriers related development of clinical practice guidelines. Methods : Cardiopulmonary resuscitation was selected as a target problem. Self questionnaires about management of cardiopulmonary resuscitation were developed by a researcher with advisory 8 experts. The questionnaires were designed as a unstructured methods. The data were collected from March 1 to May 31, 1999. A total 50 death case admitted inpatient to Inha University Hospital were subjected to evaluate the development and application of clinical practice guidelines for cardiopulmonary resuscitation. The data were examined by frequency, t-test with SPSS. Result : The article reviewed several common barriers that might limit successful implementation of guidelines in clinical practice, as illustrated by evaluating recommendations for cardiopulmonary resuscitation clinical practice guidelines. Some major problems with guidelines were characterized as follows (1) ethical problem : euthanasia, (2) occurrence on various emergency event and setting, (3) non-medical problems (4) unreliable of medical record etc. Conclusion : Careful analysis of guideline attributes, anticipated effect on medical care, and organizational factors revealed several barriers to successful guideline implementation that should be addressed in the design of future guideline-based interventions.