• Title/Summary/Keyword: 1차 의료기관

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Comparison of Outcomes According to the Hospitals of Antenatal Care in Very Low Birth Weight Infants (극소 저체중 출생아에서 산전 관리 기관에 따른 임상 경과 및 예후 비교)

  • Lee, Byoung-Kook;Lee, Heun-Ji;Min, Sung-Joo;Kim, Do-Hyun;Kim, Hee-Sup
    • Neonatal Medicine
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    • v.16 no.2
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    • pp.205-212
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    • 2009
  • Purpose: The purpose of this study was to evaluate the differences according to the hospitals of antenatal care in premature infants. Methods: We retrospectively reviewed the medical records of premature infants with gestational ages <37 weeks and very low birth weights who were admitted immediately after birth to the neonatal intensive care unit (NICU) at the Dongguk University Ilsan Hospital between March 2007 and February 2009. The hospitals of antenatal care were divided into two levels (primary antenatal care hospital: hospitals with less than a level 2 NICU, secondary antenatal care hospital: hospitals with a level 3 NICU) based on the level of NICU in hospitals. In addition, total infants were divided into two groups (Immediate group: infants born within 24 hours of maternal admission, Delayed group: infants born after 24 hours of maternal admission). The differences between maternal and neonatal variables in each groups were studied. Results: Neonates in secondary antenatal care hospitals comprised 11.0% of the study neonates (10 of 91). We compared with two groups (primary antenatal care hospital and secondary antenatal care hospital), but there were no differences in all subjects. However, the 1 minute Apgar score ($\leq3$) was lower in the immediate group than the delayed group. Conclusion: Shorter duration of maternal admission to delivery was associated with a lower 1 minute Apgar score of neonates. These findings suggest that if maintenance of pregnancy is difficult when high-risk gravidas are transferred, clinicians must prepare for emergencies of neonates.

Design and Implementation of Support System for Personalized Medical Service Based on Mobile (모바일 기반 개인 맞춤형 의료서비스 지원 시스템 설계 및 구현)

  • Seo, Jung-Seok;Park, Seok-Cheon
    • The Journal of the Institute of Internet, Broadcasting and Communication
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    • v.13 no.6
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    • pp.37-45
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    • 2013
  • In this paper proposes the latest network-assisted online telemedicine service to coincide with the point being discussed for health care providers to match patients, patients with personalized medical service support system. In order to design the system, to understand the requirements of the patient personalized medical support service system, the data were normalized and were designed architecture client server structure. Further, in order to implement the system that was designed to define the structure of server and client, ontology repository, we implement the system. In this paper, as a result of the test by creating a scenario and prerequisites for testing patient personalized medical service support system that is design and implementation, selecting a patient's condition, department of symptoms by the selected but it was confirmed that the inference is, inference medical institutions that fits department inferred one following upon the items medical patient has the required.

Specialty Hospital and Keyword Searching Ads Regulation (전문병원과 키워드검색광고 규제)

  • Lee, Dongjin
    • The Korean Society of Law and Medicine
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    • v.18 no.1
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    • pp.103-141
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    • 2017
  • The (Korean) Medical Services Act revised in 2009 introduces the accreditation of specialty hospital. When a hospital meets prescribed standards, passes a board review, and is accredited as a specialty hospital by the Minister of Health and Welfare, then it may use 'specialty hospital' in its name and certification mark of specialty hospital. The problem is that the (Korean) Fair Trade Commission and the (Korean) Ministry of Health and Welfare, both of which have authorities to regulate advertising in general and in health care service in turn, announced the guidelines to prohibit internet (portal) service providers to provide keyword search ads service using key-words such as 'specialty' or 'specialized in' for those who are not accredited by the Minister of Health and Welfare. In this article, whether these guidelines can be justified by the current regime and whether the current specialty hospital policy is agreeable would be examined. To do this, the legal nature of accreditation of specialty hospital, the limit of advertisement regulation, the law of keyword search ads, and the liability of internet service providers also would be analyzed.

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Working Conditions that Impact the Workload of Cytotechnologists: A Study Calculating the Actual Man Power Required (세포병리사의 업무량에 따른 적정인력 산정을 위한 업무실태 조사 연구)

  • Jee, Soo Il;Ahn, Yong Ho;Ha, Hwa-Jeong;Kang, Jeong Eun;Won, Jun Ho
    • Korean Journal of Clinical Laboratory Science
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    • v.53 no.2
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    • pp.174-187
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    • 2021
  • Cytotechnologists evaluate and analyze disorders of cells that constitute the human body, and are involved in the primary assessment of diverse diseases, including cancer. However, the employment conditions and workload of cytotechnologists are poorly understood. This study was undertaken to provide basic data for establishing the criteria for quality control certification factors based on the scope of effective task performance of cytotechnologists, and to provide results of their workload analysis according to the type of medical institution. The study was conducted by enrolling certified cytotechnologists working at various nationwide medical institutions. Our analysis revealed that 178 personnel (72.7%) were involved in primary screening of samples. On an average, the daily number of primary screening of samples performed per cytotechnologist (76 respondents) was determined to be 75.4 chapters (16.8 chapters/hours) at the university hospital level, 72.4 chapters (18.6 chapters/hours) at the general hospital level, and 231 chapters (32.6 chapters/hours) at professional trust institutions. Our results indicate the necessity to establish a consultant with the Korean Cell Pathology Association, to enable finding solutions to solve existing issues by establishing accurate standard guidelines for assessing cell screening.

The Recent Trends in Telemedicine in the era of COVID-19 and Policy Recommendations for the Balanced growth of Healthcare Service Industry in Korea (COVID-19 시대 국내외 원격의료 동향과 의료서비스산업의 균형 성장을 위한 정책 제언)

  • Lee, Jaehee
    • The Journal of the Convergence on Culture Technology
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    • v.6 no.4
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    • pp.591-598
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    • 2020
  • Since COVID-19's 1st pandemic came in February 2020, the demand for telemedicine grew greatly that in most countries the deregulation for telemedicine policy have been implemented in more countries. Also in Korea, with the name of 'Non-face-to-face Treatment' telemedicine began to be approved. Telemedicine having strength in chronic disease management has been effective in more and more specialties along with the recent development of ICT that it is expected to contribute to the improvement of the quality of healthcare service and creation of new treatment model. On the contrary it may also exacerbate the distortion in the hospital healthcare service industry in Korea, which is the excessive tipping toward large hospitals. So the dual promotion policy approach in which the settlement of family doctors system extensively utilizing telemedicine for chronic disease management and the support for tertiary hospitals and hospitals focusing on treating foreign patients to provide quality service using telemedicine technology are pursued simultaneously are recommended.

Development of a Comprehensive Model of Disaster Management in Korea Based on the Result of Response to Sampung Building Collapse (1995), - Disaster Law, and 98 Disaster Preparedness Plan of Seoul City - (우리나라 사고예방과 재난관리 모형 개발을 위한 연구)

  • Lee, In-Sook
    • Research in Community and Public Health Nursing
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    • v.11 no.1
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    • pp.289-316
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    • 2000
  • 우리나라의 경우 지역사회 재난 관리계획과 훈련이 보건의료적 모형이라기 보다는 민방위 모형에 입각하기 때문에 사고 현장에서의 환자 중증도 분류, 합리적 환자배분 및 이송, 병원 응급실에서의 대처 등이 체계적으로 이루어지지 못하고 있으며, 지역사회가 이에 즉각적으로 반응할 수 없다. 본 연구는 삼풍 붕괴사고 시에 대응방식과 그 후의 우리나라 응급의료 체계를 분석함으로써 대형사고 예방과 재난관리를 위한 우리나라 응급의료체계의 개선방안과 간호교육에서의 준비부분을 제시하고자 한다. 1 삼풍 사고 발생시에는 이를 관장할 만한 법적 근거인 인위적 재해에 관한 재난관리법이 없었다. 따라서 현장에서는 의학적 명령체계를 확보하지 못했기 때문에 현장에서의 응급 처치는 전혀 이루어지지 못하였다. 현장에서의 중증도 분류. 응급조치와 의뢰, 병원과 현장본부 그리고 구급차간의 통신 체계 두절, 환자 운송 중 의료지시를 받을 수 있도록 인력, 장비, 통신 체계가 준비되지 못하였던 점이 주요한 문제였다. 또한 병원 응급실에서는 재난 계획이 없거나 있었더라도 이를 활성화하여 병원의 운영 체계를 변환해가지 못하였다. 2. 삼풍백화점 붕괴사고 한달 후에는 인위적 재해에 대한 재난관리법이 제정되고, 행정부 수준별로 매년 지역요구에 합당한 재난관리 계획을 세우도록 법으로 규정하였다. 재난 관리법에는 보건의료 측면에서의 현장대응, 주민 참여, 응급 의료적 대처, 정보의 배된. 교육/훈련 등이 포함되어 있어야 한다. 그러나 법적 기반이 마련된 이후에도 한국 재난 계획 내에는 응급의료 측면의 대응 영역은 부처간 역할의 명시가 미흡하며, 현장에서의 응급 대응과정을 수행할 수 있는 운영 지침이 없이 명목상 언급으로 그치고 있기 때문에 계획을 활성화시켜 지역사회에서 운영하기는 어렵다. 즉 이 내용 속에는 사고의 확인 /공고, 응급 사고 지령, 요구 평가, 사상자의 중증도 분류와 안정화, 사상자 수집, 현장 처치 생명보존과 내과 외과적 응급처치가 수반된 이송, 사고 후 정신적 스트레스 관리, 사고의 총괄적 평가 부분에 대한 인력간 부처간 역할과 업무가 분명히 제시되어 있지 못하여, 사고 발생시 가장 중요한 연계적 업무 처리나 부문간 협조를 하기 어렵다. 의료 기관과 응급실/중환자실, 시민 안전을 책임지고 있는 기관들과의 상호 협력의 연계는 부족하다. 즉 현재의 재난 대비 계획 속에는 부처별 분명한 업무 분장, 재난 상황에 따른 시나리오적 대비 계획과 이를 훈련할 틀을 확보하고 있지 못하다. 3. 지방 정부 수준의 재난 계획서에는 재난 발생시 보건의료에 관한 사항 전반을 공공 보건소가 핵심적 역할을 하며 재난 관리에 대처해야 된다고 규정하고 있다. 그러므로 보건소는 지역사회 중심의 재난 관리 계획을 구성하고 이를 운영하며, 재난 현장에서의 응급 치료 대응 과정은 구조/ 구명을 책임지고 있는 공공기관인 소방서와 지역의 응급의료병원에게 위임한다. 즉 지역사회 재난 관리 계획이 보건소 주도하에 관내 병원과 관련기관(소방서. 경찰서)이 협동하여 만들고 업무를 명확히 분담하여 연계방안을 만든다. 이는 재난관리 대처에 성공여부를 결정하는 주요 요인이다. 4 대한 적십자사의 지역사회 주민에 대한 교육 프로그램은 연중 열리고 있다. 그러나 대부분의 교육주제는 건강증진 영역이며. 응급의료 관리는 전체 교육시간의 8%를 차지하며 이중 재난 준비를 위한 주민 교육 프로그램은 없다. 또한 특정 연령층이 모여있는 학교의 경우도 정규 보건교육 시간이 없기 때문에 생명구조나 응급처치를 체계적으로 배우고 연습할 기회가 없으면서 국민의 재난 준비의 기반확대가 되고 있지 못하다. 5. 병원은 재난 관리 위원회를 군성하여 병원의 진료권역 내에 있는 여러 자원을 감안한 포괄적인 재난관리계획을 세우고, 지역사회를 포함한 훈련을 해야 한다. 그러나 현재 병원은 명목상의 재난 관리 계획을 갖고 있을 뿐이다. 6. 재난관리 준비도를 평가할 때 병원응급실 치료 팀의 인력과 장비 등은 비교적 기준을 충족시키고 있었으나 병원의 재난 관리 계획은 전혀 훈련되고 있지 못하였다 그러므로 우리나라 재난 관리의 준비를 위해서는 현장의 응급의료체계, 재난 대응 계획, 이의 훈련을 통한 주민교육이 선행되어야만 개선될 수 있다. 즉 민방위 훈련 모델이 아닌 응급의료 서비스 모델에 입각한 장기적 노력과 재원의 투입이 필요하며, 지역사회를 중심으로 대응 준비와 이의 활성화 전략 개발, 훈련과 연습. 교육에 노력을 부여해야 한다. 7. 현장의 1차 응급처치자에 대해서는 법적으로 명시하고 있는 역할이 없다. 한국에서는 응급구조사 1급과 2급에 대한 교육과 규정을 1995년 이후 응급의료에 관한 법률에서 정하고 있다. 이 교육과정은 미국이 정하고 있는 응급구조사 과정 기준과 유사하지만 실습실이나 현장에서의 실습시간이 절대적으로 부족하다. 덧붙여 승인된 응급구조사 교육 기관의 강사는 강사로서의 자격기준을 충족할 뿐 아니라 실습강사는 대체적으로 1주일의 1/2은 응급 구조차를 탑승하여 현장 활동을 끊임없이 하고 있으며, 실습은 시나리오 유형으로 진행된다. 그러므로 우리나라의 경우 응급 구조사가 현장 기술 인력으로 역할 할 수 있도록 교과과정 내에서 실습을 강화 시켜야하며, 졸업생은 인턴쉽을 통한 현장 능력을 배양시키는 것이 필요하다. 8. 간호사의 경우 응급전문간호사의 자격을 부여받게 됨에 따라, 이를 위한 표준 교육 지침을 개발함으로써 병원 전 처치와 재난시 대응할 수 있는 역량을 보완해야 한다. 또한 현 자격 부여 프로그램 내용을 고려하여 정규자격 간호사가 현장 1차 치료자(first responder)로 역할 할 수 있도록 간호학 교과과정을 부분 보완해야한다.

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Response Bias and Reliability of Patient Satisfaction Survey (환자만족도 조사의 응답편견과 신뢰도)

  • Cho, Young-Sik
    • Journal of dental hygiene science
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    • v.3 no.2
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    • pp.83-88
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    • 2003
  • Patient satisfaction is now recognized as a outcome indicator of health care quality. The objective of this research was to evaluate a patient satisfaction survey instrument specially applicable to dental care, and to examines the reliability and the effect of response biases on reported satisfaction. The acceptability of satisfaction as a quality indicators was qualified by several measurement problems. The patient questionnaire was administered in four different study samples to examine the consistency of data. Cronbach's alpha was used as the measure of internal consistency. A aquiesent bias was found in the sample of 80(20%) respondents. Response biases affacted level of measured satisfaction. Highly acquiesent respondents were older, less well educated than nonaquiesent subject.

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Convergence Evaluation of Indoor Air Measurement in Medical Institution (의료기관 실내공기 측정의 융합적 평가)

  • Lee, Yu-Hee;Choi, Yu-Jin;Choi, Jung-OK
    • Journal of the Korea Convergence Society
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    • v.8 no.1
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    • pp.71-76
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    • 2017
  • The purpose of this study was to investigate the indoor air quality of medical institutions and to present the detailed management plan by analyzing the actual situation of management and analyzing the difference according to the place in a convergent. ($PM_{10}$), carbon dioxide ($CO_2$), formaldehyde (HCHO), total aerobic bacteria (TAB) and carbon monoxide (CO) were investigated in 153 hospitals in Busan. As a result, The overall output average did not exceed the maintenance criteria, but the maximum values for each item were 91% for $PM_{10}$, 97% for $CO_2$, 96% for HCHO, and 99% for bioaesol. And It is confirmed that this is very close to the standard. In addition, the results of each place showed different values according to each feature, but there was no significant difference in the results of five measurements. In conclusion, Indoor air in medical institution considering the characteristics should be performed systematic and detailed management of ventilation facilities and energy problems.

Comparative Analysis of Delivery Management in Various Medical Facilities (의료기관별 분만관리 양상의 비교 분석)

  • Park, Jung-Han;You, Young-Sook;Kim, Jang-Rak
    • Journal of Preventive Medicine and Public Health
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    • v.22 no.4 s.28
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    • pp.555-577
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    • 1989
  • This study was conducted to compare the delivery management including laboratory tests, medication and surgical procedures for the delivery in various medical facilities. Two university hospitals, two general hospitals, three hospitals, two private obstetric clinics, and two midwifery clinics in a large city were selected as they permitted the investigators to abstract the required data from the medical and accounting records. The total number of deliveries occurred at these 11 facilities between 15 January and 15 February, 1989 was 789 among which 606(76.8%) were vaginal deliveries and 183 (23.3%) were C-sections. For the normal vaginal deliveries, CBC, Hb/Hct level, blood typing, VDRL, hepatitis B antigen and antibody, and urinalysis were routinely done except the private clinics and midwifery clinics which did not test for hepatitis B and Hb/Hct level at all. In one university hospital ultrasonography was performed in 71.4% of the mothers and in one general hospital liver function test was done in 76.7% of the mothers. For the C-section, chest X-ray, bleeding/clotting time and liver function test were routinely done in addition to the routine tests for the normal vaginal deliveries. Episiotomy was performed in 97.2% of the vaginal deliveries. The type and duration of fluid infused and antibiotics administered showed a wide variation among the medical facilities. In one university hospital antibiotics was not administered after C-section at all while in the general hospitals and hospitals one or two antibiotics were administered for one week on the average. In one private clinic one pint of whole blood was transfused routinely. A wide variation was observed among the medical facilities in the use of vitamin, hemostatics, oxytocics, antipyreptics, analgesics, anti-inflammatory agents. sedatives. digestives. stool softeners. antihistamines. and diuretics. Mean hospital day for the normal vaginal deliveries of primipara was 2.6 days with little variation except one hospital with 3.5 days. Mean hospital day for the C-section of primipara was 7.5 days and that of multipara was 7.6 days and it ranged between 6.5 days and 9.4 days. Average hospital fee for a normal vaginal delivery without the medical insurance coverage was 182,100 Won for the primipara and 167,300 Won for the multipara. In case of the primipara covered by the medical insurance a mother paid 82,400 Won and a multiparous mother paid 75,600 Won. Average hospital fee for a C-section without the medical insurance was 946,500 Won for the primipara and 753,800 Won for the multipara. In case of the primipara covered by the medical insurance a mother paid 256,200 Won and a multiparous mother paid 253,700 Won. Average hospital fee for a normal vaginal delivery in the university hospitals showed a remarkable difference, 268,000 Won vs 350,000 Won, as well as for the C-section. A wide variation in the laboratory tests performed for a normal vaginal delivery and a C-section as well as in the medication and hospital days brought about a big difference in the hospital fee and some hospitals were practicing the case payment system. Thus, standardization of the medical care to a certain level is warranted for the provision of adequate medical care for delivery.

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Analysis of the Influence of Examination Gowns on the Image and the Suitable Fabrics for Chest AP Examinations on DR X-ray Systems (디지털 X-선 시스템에서 흉부 전·후 방향 검사 시 검사복이 영상에 미치는 영향과 적정 검사복 원단의 분석)

  • Eun-Bi Baek;Yoo-Jin Jeong;Su-Bin Lim;Sang-Jo Park;Yeong-Cheol Heo
    • Journal of the Korean Society of Radiology
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    • v.17 no.6
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    • pp.865-872
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    • 2023
  • The purpose of this study was to analyze fabrics suitable for use as examination gowns to determine whether examination gowns affect imaging during anterior to posterior chest examinations(Chest AP) on a digital X-ray system. Examination gowns in use at five medical centers in Seoul were collected and included modal, tencel, cotton, and rayon fabrics. The selection of fabrics was based on studies that reported fabrics with good tactile, absorbent, stretchable, and wrinkle resistance. Phantoms of five hospital gowns and four fabrics, arranged in overlapping layers from one to eight, were created and examined on a digital X-ray system in both Chest AP examination. The images examined were subjected to a first-step profile analysis, a second-step signal intensity averaging analysis, and a third-step microscopic analysis. The results showed that all nine materials had an increasing impact on the image as the number of layers of fabric increased, with the modal fabric having the least impact on the image in the first, second, and third analyses. In conclusion, as the resolution of digital x-ray systems increases, the impact of examination clothing on the image will increase, and research to find suitable materials for examination clothing will continue to be necessary.