• Title/Summary/Keyword: 환자의 만족도

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A study for the factors on choosing hospitals and patients satisfaction between Geriatric Hospitals and General Hospitals (노인병원과 종합병원의 선택요인 및 환자만족도 분석)

  • Yoon, Seo-Jung;Yu, Seung-Hum;Kim, Young-Hoon;Lee, Ji-Jeon
    • Korea Journal of Hospital Management
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    • v.9 no.2
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    • pp.46-75
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    • 2004
  • This research anticipated on acknowledging the inpatients factors in choosing which hospital for the geriatric hospital and general hospital they would prefer to go to the analization of different factors in patients satisfaction, and the relation between satisfactory standards and the patients intentions on recommendation or re-visiting the hospital. The statistical data was based upon the 359 question and answer papers that were done by inpatients that were hospitalized in two geriatric hospitals and two general hospitals, and the methods used for analyzing were frequency, t-test, factor analysis, and hierarchical multiple regression. The results are as follows. 1. The factors on choosing hospitals between geriatric hospital and general hospitals were different. The priority for the geriatrics was kindness, and then considerate nursing, and the reliance of treatment. The patients of general hospitals looked first for reliance of treatment, reputation and history of the hospital, and the kindness of the staff. The kindness of the staff, good nursing, and easy procedures were the primary factors of choosing geriatric hospital. 2. The four primary factors in choosing which hospital patients would go to were the predominance of the facilities, kindness and convenience, the reliance and proximity of medical treatment, and recommendation. The patients in the geriatric hospital first looked for kindness and convenience, second the reliance and proximity of medical treatment, third predominance of facilities, and last recommendation. The general hospitals main priority was the reliance and proximity of medical care, second predominance of facilities, kindness and hospitality, and last recommendation. 3. The satisfaction rate was higher in the geriatric hospital compared to general hospitals, but the satisfactory of factors were very similar. Patients in the geriatric hospital were pleased with the hospital staffs kindness, quick nursing and the improvement of inconvenient matters, and clear diagnosis of the doctors. The general hospital patients were satisfied with the hospital staffs clear explanation and accurate diagnosis 4. The analysis in the satisfactory factors turned out to be the environment of the hospital, kindness of the staff, and convenience. Both the patients of the geriatric hospital and general hospitals were very pleased with the kindness of the hospital staff. Ranking second and third was convenience and service for the geriatric hospital, and environment of the hospital and convenience for the general hospital. 5. According to a rank of multiple recurrent analysis of the patients satisfaction and the intention of re-visiting in addition to intention of solicitation, in the case of a geriatric hospital, when the intention of re-visiting is the dependent variable, the first stage shows that the less insurance the patient has, the higher was the intention of re-visiting. In the second stage, the more satisfied the patient is of the staffs kindness, the higher was the intention of re-visiting. Further more, when the intention of solicitation is the dependent variable, the first stage shows that not all the independent variables were significant, but the second stage shows that the more satisfied the patient is of the staffs kindness and the hospital along with the medical treatment expenses, the higher was the intention of solicitation. 6. In the first stage of a rank of multiple recurrent analysis of the satisfaction of the general hospital and the intention of re-visiting, not all the variables were significant, but in the second stage, all the satisfaction by factors were significant. Moreover, when the intention of solicitation was the dependent variable, the first stage shows not all the variables were significant, but in the second stage, all the satisfaction by factors were significant. That is to say, in the case of a general hospital, the satisfaction of the hospital and the medical treatment expenses were high, and the more satisfied the patient is of the hospitals environment and the staffs kindness, the intention of re-visiting and the intention of solicitation was higher.

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ATM Cell Encipherment Method using Rijndael Algorithm in Physical Layer (Rijndael 알고리즘을 이용한 물리 계층 ATM 셀 보안 기법)

  • Im Sung-Yeal;Chung Ki-Dong
    • The KIPS Transactions:PartC
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    • v.13C no.1 s.104
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    • pp.83-94
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    • 2006
  • This paper describes ATM cell encipherment method using Rijndael Algorithm adopted as an AES(Advanced Encryption Standard) by NIST in 2001. ISO 9160 describes the requirement of physical layer data processing in encryption/decryption. For the description of ATM cell encipherment method, we implemented ATM data encipherment equipment which satisfies the requirements of ISO 9160, and verified the encipherment/decipherment processing at ATM STM-1 rate(155.52Mbps). The DES algorithm can process data in the block size of 64 bits and its key length is 64 bits, but the Rijndael algorithm can process data in the block size of 128 bits and the key length of 128, 192, or 256 bits selectively. So it is more flexible in high bit rate data processing and stronger in encription strength than DES. For tile real time encryption of high bit rate data stream. Rijndael algorithm was implemented in FPGA in this experiment. The boundary of serial UNI cell was detected by the CRC method, and in the case of user data cell the payload of 48 octets (384 bits) is converted in parallel and transferred to 3 Rijndael encipherment module in the block size of 128 bits individually. After completion of encryption, the header stored in buffer is attached to the enciphered payload and retransmitted in the format of cell. At the receiving end, the boundary of ceil is detected by the CRC method and the payload type is decided. n the payload type is the user data cell, the payload of the cell is transferred to the 3-Rijndael decryption module in the block sire of 128 bits for decryption of data. And in the case of maintenance cell, the payload is extracted without decryption processing.

Outcome of Arthroscopic Suture Bridge Technique for Rotator Cuff Tear: Short Term Clinical Outcome In Full-thickness Tear With Fatty Degeneration Less Than Moderate Degree (회전근 개 파열에 대한 관절경적 교량형 봉합술의 결과: 지방 변성이 중등도 이하인 전층 파열에 대한 단기 추시 임상적 결과)

  • Cheon, Sang-Jin;Hur, Joon-Oh;Suh, Jeung-Tak;Yoo, Chong-Il
    • Clinics in Shoulder and Elbow
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    • v.12 no.2
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    • pp.180-188
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    • 2009
  • Purpose: We evaluate the short-term clinical outcome of arthroscopic rotator cuff tendon repair with suture-bridge technique in patients with full thickness rotator cuff tear. Materials and Methods: 29 (male:17, female:12) consecutive shoulders treated with this index procedure and early rehabilitation were enrolled. Mean age was 56.4 years (range, 34~73 years) and mean follow-up period was 13 months (range, 12-15 months). Clinical outcomes were evaluated by using the University of California Los Angeles (UCLA) score, the Korean Shoulder Scoring System (KSS) and Visual Analogue Scale (VAS). Postoperative cuff integrity was evaluated through magnetic resonance imaging (MRI) and categorized by Sugaya classification. Results: Postoperative UCLA scores improved from 16.4 to 31.6 (p< 0.05) and KSS scores showed 88 at 6 months and 92 at last follow up. Preoperative VAS score was 8.6, which was decreased to 2.1 at 3 months and 1.4 at 6 months postoperatively. 28 patients (96.5%) had increase in range of motion. The follow up MRI was taken in 15 shoulders and the cuff integrity was type I in 6 cases, type II in 7, type III in 1 and type V in 1 by Sugaya classification. Conclusion: Arthroscopic suture-bridge technique resulted in good or excellent clinical outcome in 96.5% of the cases, so we think this technique is one of the reliable procedure for full-thicknes rotator cuff tear.

Comparison of Volumetric Modulated Arc Therapy and Non-coplanar Fixed-field Intensity Modulated Radiation Therapy for Irregular Target adjacent to Organ At Risk (손상위험장기에 인접한 불규칙한 모양의 타겟 치료 시, 용적변조회전 방사선치료와 비동일평면상의 빔을 이용한 세기변조 방사선치료의 유용성 평가 및 비교)

  • Kim, Kyung Ah;Na, Kyung Soo;Seo, Seok Jin;Lee, Je Hee
    • The Journal of Korean Society for Radiation Therapy
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    • v.29 no.1
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    • pp.57-68
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    • 2017
  • Purpose: The purpose of this study was to compare volumetric modulated arc therapy(VMAT) with fixed-field intensity modulated radiation therapy(IMRT) using non-coplanar beam when the shape of target is irregular and the location is adjacent to organ at risk(OAR). Materials and Methods: The subjects of this study were a total of 6 patients who had radiation therapy for whole scalp(2 patients), partial scalp(2 patients), and whole ventricle(2 patients) by True Beam STX(Varian Medical Systems, USA). VMAT plans consisted of coplanar or non-coplanar arcs which can minimize the volume of OAR included in beamlets. All fixed-field IMRT plans consisted of non-coplanar beams using more than 2 angles of Couch. Results: The VMAT and IMRT plans were compared with regard to the maximum dose of both lens, both optic nerves, optic chiasm, and brain stem and the mean dose of both eyeballs and hippocampus. VMAT plans showed higher dose than ncIMRT plans at more than 6 of all OARs in every patient, and the ratio was from 1.1 times to 8.2 times. In case of total scalp and partial scalp, the volume of brain which received more than 20 Gy in the VMAT plans was 2 times larger than the volume in the ncIMRT plans. In case of whole ventricle, there was no significant difference. Target coverage was satisfied in both plans($PTV_{100%}=95%$). The maximum dose in target volume and required monitor unit(MU) of ncIMRT were higher than them of VMAT plans. Conclusion: Even though ncIMRT is less efficient than VMAT with regard to required MU and treatment time, the dose to OARs is much lower than VMAT and PTV Coverage is similar with VMAT. If the shape of target is irregular and location is adjacent to OAR, comparison VMAT plan with ncIMRT plan deserves to be considered.

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Clinical Experiences of Congenital Aortic Stenosis (선천성 대동맥 판막협착증의 임상 경험)

  • Jeong, Dong-Seop;Ra, Yong-Joon;Lee, Jeong-Ryul;Kim, Yong-Jin;Lee, Chang-Ha;Lee, Cheul;Lim, Hong-Gook;Hwang, Seong-Wook;Kim, Woong-Han
    • Journal of Chest Surgery
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    • v.40 no.1 s.270
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    • pp.17-24
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    • 2007
  • Background: The aim of this study is to assess the clinical results of various procedures in congenital aortic stenosis. Material and Method: From August 1987 to June 2004, 53 patients of congenital aortic stenosis underwent procedures such as percutaneous balloon valvuloplasty, aortic valvuloplasty, Ross procedure, and aortic valve replacement. The mean age of initial procedures was $8.2{\pm}6.0$ years. Percutaneous balloon valvuloplasty was peformed in sixteen patients, aortic valvulopiasty in thirty two patients, Ross procedure in nineteen patients, and aortic valve replacement in fourteen patients. The mean follow duration was $80.6{\pm}60\;(0{\sim}207)$ months. Result: There was 15.1% (8/53) of early mortality and no late mortality. The six patients with critical aortic stenosis were died of left ventricular dysfunction in early series (before 1 year; 4 cases) and two patients died after the Ross procedure and aortic valve replacement respectively. After percutaneous balloon valvuloplasty, most patients needed reoperations (14/16). Thirteen patients needed reoperation, after aortic valvuloplasty. After Ross procedure, two patients needed reoperation due to aortic regurgitation caused by progressive aortic root dilatation. The actuarial survival rate after Ross procedure at 7 years was 90.5%. Conclusion: In young children before the age of one, percutaneous balloon valvuloplasty was considered as :he safe initial palliative procedure. But children over one year-old, aortic valvuloplasty were the effective procedure. Ross procedure can be preformed safely with good results.

Arthroscopic Repair of Traumatic Subscapularis Tendon Tear (외상성 견갑하건 파열의 관절경하 봉합술)

  • Cho, Su-Hyun;Cho, Hyung-Lae;Ku, Jung-Hoei;Hwang, Tae-Hyok;Park, Man-Jun;Choi, Jae-Hyuk
    • Journal of the Korean Arthroscopy Society
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    • v.14 no.3
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    • pp.180-187
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    • 2010
  • Purpose: Rotator cuff tears involving the subscapularis are less common than those involving the superior and posterior rotator cuff. The purpose of the present study was to report the clinical results of repair of isolated traumatic tears of the subscapularis tendon. Materials and Methods: Fifteen patients (13 males, 2 females; mean age 46.2 years; range 35 to 52) with unilateral ruptures of the subscapularis tendon after trauma who underwent arthroscopic repair between February 2003 and October 2008 were reviewed retrospectively. All the cases were isolated tears of the subscapularis without the involvement of any other rotator cuff tendon and were followed for at least two years (mean 28 months). The entire subscapularis was involved in 9 cases and the tear was localized to the upper two thirds in 6 cases. The preoperative and postoperative status of patients with isolated subscapularis tears were analyzed using the Constant Score, American Shoulder and Elbow Society Index (ASES Index) and postoperative integrity was determined through magnetic resonance imaging. Results: The average clinical outcome scores and strength were all improved significantly at the time of the final follow-up. The constant shoulder score improved from 41.5 to 81.3 points (P<0.05) compared to before surgery and ASES index improved from 46.4 to 89.6 points (P<0.05) postoperatively. Thirteen patients (87%) were satisfied with the result of the treatment. The total tears were significantly more improved by surgery than the partial tears. In 12 of 15 patients (80%) were judged to reveal healed tendon on magnetic resonance imaging at a mean of 13 months postoperatively. The postoperative score was significantly lower for the patients with a failed repair than it was for those with an intact repair (P<0.05). Conclusion: Repair of traumatic isolated subscapularis tears through arthroscopic techniques effectively restores patient function with regard to pain, mobility, strength and postoperative tendon integrity. The postoperative integrity of the repair correlates with the functional results and the total tears were more improved by surgery than the partial tears, but future studies may be needed.

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Comparison of Thyroid Doses for Shielding Material Changes in Neck Computed Tomography (Neck CT에서 차폐체 재료 변화에 따른 Thyroid 선량 비교 연구)

  • Kang, Eun Bo
    • Journal of the Korean Society of Radiology
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    • v.13 no.1
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    • pp.65-71
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    • 2019
  • With regard to current Neck CT, Bismuth shielding boards are often being used to reduce exposure to superficial organs such as the thyroid. However, beam hardening often occurs near superficial organs with Bismuth shielding boards and variations in CT Number, Noise, and Uniformity values occur severely. This study looked into the usefulness of shielding boards made from aluminum and silicone that can be easily obtained and have good machinability by comparing them to the existing Bismuth shielding board. An Aluminum 7.3mm and a Silicone 21.5mm were made with shielding ratios similar to that of the Bismuth(0.06 mmPb). TLD (TLD-100) was placed on the thyroid area of the Phantom (RS-108T) and 5 doses were measured for each. To compare image quality, CT Number and Noise variations in axial images of the thyroid area in Neck CT images were compared. Also, variations in CT Number, Noise, and Uniformity were measured in the AAPM phantom images and compared. In the results, when thyroid doses for each shielding board were compared, the Bismuth shielding board showed a 14% reduction, the Silicone 21.5mm showed a 15% reduction, and the Aluminum 7.3mm showed a 13% reduction compared to the Non-Shield. Statistically, there were no significant differences in comparison with the Bismuth shielding board. In CT Number variations of thyroid area images, variations were largest for the Bismuth shielding board. With Uniformity evaluations of the AAPM phantom, the Bismuth shielding board was found unsuitable and the Aluminum 7.3mm and Silicone 21.5mm satisfied the acceptance criteria. Research results show that the Aluminum 7.3mm and Silicone 21.5mm have a similar shielding ratio to the high-priced Bismuth shielding board that is currently being used clinically and in comparison tests of CT Number attenuation coefficient variations, Noise, and Uniformity which are phantom image evaluation items, they proved to be better than Bismuth shielding boards. If various shielding boards are made using aluminum and silicone, sized appropriately for superficial organs, it would be useful in decreasing patient doses.

Literature review and future tasks necessary to establish of Korean Dietary Reference Intake for choline (콜린의 한국인 영양소 섭취기준 제정 검토를 위한 문헌 고찰 및 향후 과제)

  • Shim, Eugene;Park, Jae-Hee;Lee, Yunjung;Park, Eunju
    • Journal of Nutrition and Health
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    • v.55 no.2
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    • pp.211-226
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    • 2022
  • Choline, an essential nutrient for humans, is required for the structural integrity of the cell membranes, methyl-group metabolism, synthesis of the neurotransmitter acetylcholine, synthesis of the membrane phospholipid components of the cell membranes, and the transport of lipids and cholesterol. Choline can be synthesized in the body, but it is insufficient to meet the daily requirements and hence it must be obtained through the diet. In the United States/Canada, Australia/New Zealand, Europe, China, and Taiwan, the adequate intake (AI) and tolerable upper intake level (UL) of choline have been established, while the establishment of the 2020 Dietary Reference Intakes for Koreans (KDRI) for choline was postponed due to the lack of a choline database for Korean foods and studies on the choline intake of Koreans. However, as part of the preparation work for the 2020 DRI revision and finalization, choline intake and the possibility of disease occurrence were verified through analysis of published data. The groundwork for the subsequent establishment of a choline DRI was laid through a literature search, evaluation, and review of the literature reported from 1949 up to 2019. This can be regarded as the culmination of this project. According to the results of randomized controlled trials (RCTs), cohort studies, case-control studies, and cross-sectional observational studies in humans, approximately 400-500 mg/day of choline intake was effective in preventing liver function damage (fatty liver), neural tube damage, cardiovascular disease, breast cancer, and cognitive function improvement. The same amount of choline intake, however, also correlated with the risk of prostate and colorectal cancer. At present, there is limited information available on choline intake and health outcomes, particularly for the Korean population. More human studies, including clinical trials on the requirements and the physiological benefits associated with dietary intake, are needed to establish the KDRI for choline.

Long-Term Results of Surgical Treatment for the Idiopathic Clubfoot (선천성 만곡족의 장기 수술적 치료 결과)

  • Kim, Hui Taek;Kim, In Hee;Cho, Yoon Je;Ahn, Tae Young
    • Journal of the Korean Orthopaedic Association
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    • v.54 no.6
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    • pp.547-556
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    • 2019
  • Purpose: This study evaluated the results of surgical treatment for residual or recurrent deformity after the conservative treatment of idiopathic clubfoot. Materials and Methods: Fifty-one cases (32 patients), who were followed up to skeletal maturity, were reviewed retrospectively. The mean age at the last follow-up was 18.7 years. The surgical options included selective or comprehensive soft tissue release, tendon lengthening and transfer, and various types of osteotomy. The radiology measurements included the talocalcaneal angle and talo-first metatarsal angle in the anteroposterior (AP) view, and the talocalcaneal angle and calcaneal pitch in the lateral view. The radiology measurements were compared with the normal values for adults. The clinical evaluations were made using the ankle-hindfoot score and the midfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS): excellent (>85), good (71-85), pair (56-70), and poor (<56). Results: At the last follow-up, the percentages of the 51 cases, whose parameter values fell within the normal ranges were as follows: in the AP view, 41.2% (talocalcaneal angle); and 90.2% (talo-first metatarsal angle). In the lateral view, the percentage was 84.3% (talocalcaneal angle). For the calcaneal pitch, the percentages were 61%. The mean AOFAS score was 88.1±10.7 on the ankle-hindfoot score and 86.7±11.5 on the midfoot score. Conclusion: The long-term outcome of patients with idiopathic clubfoot, who underwent surgical treatment after conservative treatment, was found to be 43%-90% of the normal range of radiographic indices. Clinically, the mean AOFAS scores were "excellent". Therefore, a satisfactory result can be obtained by analyzing the elements of deformity more accurately and then using the selective operation method, even if the non-surgical correction method fails.

The effects of fluoride releasing orthodontic sealants on the prevention and the progressive inhibition of enamel demiheralization in vitro (광중합형 및 자가중합형 교정용 전색제의 치아우식예방 및 진행억제효과에 관한 실험적 연구)

  • Chae, Seung-Won;Cho, Jae-O;Yoon, Young-Jooh;Kim, Kwang-Won
    • The korean journal of orthodontics
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    • v.27 no.6 s.65
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    • pp.979-995
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    • 1997
  • The purpose of this study was to identify the preventive and the progressive inhibitory effects of enamel demineralization with fluoride releasing light-and self-cured orthodontic sealants(FluoroBond), in vitro, under the polarizing light microscope and the scanning electon microscope. The polarizing light microscopic group was subdivided into seven groups(Group A-Group G). The scanning electron microscopic group was also subdivided into seven groups(Group A'-Goup G'). For polarizing light microscopic evaluation, longitudinal sections were made longitudinally by Maruto cutter(Maruto Co., Japan) and Maruto grinding machine(Maruto Co., Japan). Sections were examined and photographed by the polarizing light microscope(Olympus Optical Co., Japan) using crossed polars and with the enamel rod longitudinal axis oriented at $45^{\circ}$ to the extinction position. For scanning electron microscopic evaluation, the specimens were coated with a highly conducting layer of gold palladium in a model Hus-4 high-vacuum evaporator and examined in an ISI-100B scanning electron microcope operated at 20kV. The results of this study were as follows : 1. The mean depths of artificial carious lesions under a polarized light microscope were $Group\;A(5.08{\mu}m),\;Group\;B(47.82{\mu}m,\;Group\;C(8.42{\mu}m),\;Group\;D(7.20{\mu}m),\;Group\;E(85.41{\mu}m),\;Group\;F(60.38{\mu}m),\;Group\;G(60.13{\mu}m)$. 2. There were statistically significant differences in Group B compared with Group A, C, and D(p<0.05), and also, in Group I compared with Group F and Group G(p<0.05). 3. Light-and self-cured orthodontic sealants had the preventive effects of enamel demineralization. 4. Light-and self-cured orthodontic sealants had the progressive inhibitory effects of enamel demineralization. 5. The time progress of demineralizing agent had no influence on the samples of light-and self-cured orthodontic sealants under the scanning electron microscope. 6. There was no difference between the specimens of light-and self-cured orthodontic sealants both in the polarized light microscopic group and in the scanning electron microscopic group.

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