• 한국응급구조학회지
• /
• 제24권1호
• /
• pp.67-76
• /
• 2020

Purpose: Effective time management, as well as life-saving care, are important in maximizing the prognosis of patients who have sustained major traumas. This study evaluated the appropriateness of emergency medical system (EMS) provider's essential care and how this care impacted on-scene time in patients with major traumas. Methods: This retrospective observational study analyzed the EMS major trauma documents, classified according to the physiological criteria (Glasgow coma scale <14, systolic blood pressure <90mmHg, Respiration rate <10 or >29) in Daejeon, from January, 2015 to December, 2018. Results: Of the 707 major trauma cases, the mean on-scene time was 7.75±4.64 minutes. According to EMS guidelines, essential care accuracy was 67.5% for basic airway, 36.4% for advanced airway, 91.2% for cervical collar, 81.5% for supplemental oxygen, 47.0% for positive pressure ventilation, 19.9% for intravenous access and fluid administration, and 96.0% for external hemorrhage control. Factors affecting on-scene time were positive pressure ventilation (p<.004), and intravenous access and fluid administration (p<.002). Conclusion: Adherence to guidelines was low during advanced airway procedures, positive pressure ventilation, intravenous access, and fluid administration. In addition, the on-scene time was prolonged when the practitioner provided positive pressure ventilation, intravenous access, and fluid administration; however, these durations did not exceed the recommended 10 minutes.

• 대한한의학원전학회지
• /
• 제30권2호
• /
• pp.31-43
• /
• 2017

Objectives : Written by Yoongdongri in the 18th century Chosun, Chochangkyeul is a book that specially deals in Ungi. Yoon understood a person's body constitution by taking into factor the person's birth year, and used this information to determine his Ungi type, and understood his disease mechanism. Methods : Following the study on the first part of Chochangkyeul, named Ungiyeonron, the paper tries to study the book's second part, called Yongyakgwon. The book's core messages are summarized upon a thorough inspection. Results & Conclusions : Yoondongri was a highly-acclaimed doctor in the 18th century Chosun, and also an Ungi practitioner who utilized the theory of Ungi in his clinical practices. His practices were mainly based on the prescription of Ungi found in Chenwuze's Sanyinfang, coupled with almost all parts of Donguibogam's Husebang. He had an extensive clinical experience which helped him describe his methods of quickly responding to the side effects that sometimes occur due to misuse of medicine. Such detailed descriptions are never found in past medical books, which gives Yoon's book a great level of historical importance. Yongyakgwon divides the scripts between Gabsin, Muui, Byungye, Gyungjeong, and Yimgi in accordance with the theory of Ounhabgi, and also introduces treatments based on Yukisachun. Jangbupasuyak also introduces about six external organs and six internal organs with relation to treating wind medicine, treating heat medicine, treating cold medicine, treating dry dampness medicine, dryness-moistening medicine, pulling meridian medicine. All of these can be applied to patients easily.

• Journal of mucopolysaccharidosis and rare diseases
• /
• 제2권1호
• /
• pp.23-26
• /
• 2016

Mucopolysaccharidosis (MPS) I is a rare, progressive and multisystemic disease with insidious initial signs and symptoms, and making an early diagnosis can be a challenge for the first-line general medical practitioner. We report a 6-month-old girl who was brought to our well baby clinic for regular immunization with the manifestations of lumbar gibbus, hirsutism, large Mongolian spots over back and buttock, and mild bilateral legs spasticity noticed by the general pediatrician, and then newly diagnosed with MPS I after referral to the geneticist in time. Her surgical history included inguinal hernia repair at 1 month old, $CO_2$ laser supraglottoplasty for laryngomalacia and tracheostomy due to chronic respiratory failure with ventilator dependence at 2 months old. Understanding and identification of the early signs and symptoms of this disease have the potential to early diagnosis and timely appropriate treatment, which could contribute to a better clinical outcome.

• 의학교육논단
• /
• 제20권2호
• /
• pp.72-77
• /
• 2018

Observation of the current Korean medical education and training system shows that certain negative traits of unchangeable solidification engraft themselves so deeply into the overarching system that they are now hampering the state of the national health welfare. Focusing only on undergraduate medical education, we can point out some glaring side-effects that should be of concern to any stakeholder. For instance, a graduate can legally begin his career as an independent practitioner immediately after passing the licensing exam and return to the old stuck school-year system of 2-year-premedical and 4-year-medical programs where outcome-based and integrated curricula are incomplete and unsatisfactory. In terms of learning opportunities, the balance between patient care and public health, as well as that between in-hospital highly specialized practice and community-based general practice, has worsened. Every stakeholder should be aware of these considerations in order to obtain the insight to forge a new direction. Moreover, our medical schools must prepare our students to take on the global roles of patient care within the Fourth Industrial Revolution, health advocacy for the imminent super-aged society, and education and research in the bio-health industry, by building and applying the concept of academic medicine. We will need to invest more resources, including educational specialists, into the current undergraduate medical education system in order to produce proper outcomes, smart curriculum, innovative methods of teaching and learning, and valid and reliable monitoring and evaluation. The improved quality of undergraduate medical education is the starting point for the success of the national system for public health and medical care as a whole, and therefore its urgency and significance should be emphasized to the public. The medical society should go beyond fixing what is broken and usher in a new era of cooperation and collaboration that invites other health professionals, governmental partners, law-makers, opinion leaders, and the general public in its steps toward the future.

• 한국병원경영학회지
• /
• 제26권1호
• /
• pp.71-82
• /
• 2021

Purpose: The purpose of this study is to estimate incomes and costs of the medical clinics by using secondary data. Methodology: The medical incomes and costs were estimated from 405 clinics operated by sole practitioner providing out-patient services among all clinics subject to the Medical Cost Survey on National Health Insurance Patients in 2017, excluding dental clinics and oriental medical clinics. The incomes and costs of the medical clinics were reflected with incomes and costs of health insurance benefits and were calculated by types of medical services (i.e., basic care, surgery, general treatment, functional test, specimen test and imaging test). The costs were classified as follows: labor costs, equipment costs, material costs and overhead costs. Secondary data was used to estimate the incomes and costs of the medical clinics. For allocation bases for costs for each type of the medical service, the ratio of revenue from health insurance benefits by types of medical services was applied. However, labor costs were calculated with the activity ratio by types of medical services and occupations, using clinical expert panel data. Finding: The percentage of health insurance income for all medical income was 73.1%. The health insurance cost per clinic was 401,864 thousand won. Labor cost accounted for the largest portion of the health insurance income was 191,229 thousand won (47.6%), followed by management cost was 170,018 thousand won (42.3%), materials cost was 35,434 thousand won (8.8%), and equipment costs was 5,183 thousand won (1.3%). Practical Implications: This study suggests a method of estimating incomes and costs of medical clinic services by using secondary data. It could efficiently provide incomes and costs to assess an appropriate level of the health insurance fee to the clinics.

• Journal of Oral Medicine and Pain
• /
• 제30권4호
• /
• pp.391-400
• /
• 2005

전문의는 일반의(General Practitioner)와는 차별된 전문성을 가지고 증상의 난이도가 높은 환자를 처리하는 능력이 요구되는 진료과목의 필요성을 기반으로 하고 있다. 또한 전문의제도는 국민의료적인 측면에서 임상 각 분야에 있어 단일과목을 전공하는 의사를 양성하여 그들로 하여금 의료 전 과목에 관한 기본적 이론과 실기를 교육받은 일반의사의 능력에서 벗어나는 진료기능을 의료전달체계에서 담당하도록 하여 국민의료의 향상을 기하는 데 있다. 한편, 구강내과는 악안면 통증, 연조직 질환, 법의치과분야, 구강진단분야를 다루는 전문과목으로서 그 전문성이 매우 중요한데, 구강내과학적 측면에서 비추어 볼 때, 현대화 사회로 갈수록 현대인들은 대도시 중심의 생활환경의 변화와 함께 일상적 스트레스가 증가함에 따라 측두하악장애, 구강내 연조직 질환, 삼차신경통과 같은 신경병변 등의 유병율이 증가하고 있으며, 이에 대한 환자들의 의존도가 높아지고 있는 추세이다. 이에 본 연구는 2004년 8월부터 2005년 4월까지 연세대학교 치과대학병원 구강내과 외래에 내원한 초진환자 3,707명을 대상으로 하여, 의뢰율 및 내원경로를 중심으로 분석한 결과 다음과 같은 결론을 얻었다. 1. 구강내과에 의뢰된 전문 진료분야로는 구강안면통증, 구강 연조직 질환, 법의치과분야, 구강진단분야로 나타났다. 2. 구강내과에 의뢰된 환자의 비율은 58.51%로 과반수를 넘는 환자들이 의뢰되었다. 3. 의뢰환자 중 의뢰기관의 영역분석을 시행한 결과, 치과에서 의뢰된 경우가 83.23%로 가장 많았고 의과 및 한의과 영역에서 의뢰된 경우는 16.78%를 보였다. 4. 자의내원한 환자 중 인터넷 및 매스미디어에서 구강내과 전문분야에 대한 사전 검색 및 주변의 권유에 의해 내원한 환자들이 응답자의 30.52%를 차지하였다. 이상의 결과를 종합해 볼 때, 구강내과는 대부분 의뢰된 환자를 진료하고 있으며, 치과영역 뿐 아니라 의과영역에서의 의뢰율이 높은 것으로 보아 치과영역에서는 일반의들이 치료할 수 없는 수준의 진료영역을 담당하고 있는 것으로 볼 수 있으며 의과학 분야에서는 구강내과학적 전문성을 요하는 질환을 구강내과와 협진하에 해결하려는 것으로 사료되어 전문과목으로서 구강내과학의 역할과 비중이 매우 높음을 확인할 수 있었고, 이는 향후 전문치의제도 인력수급 및 이의 기반이 되는 전공의의 정원책정에서 시장적 접근 및 규범적 접근의 기초자료로 활용되어야 할 것이다.

• 한국콘텐츠학회논문지
• /
• 제17권8호
• /
• pp.610-618
• /
• 2017

한국에서 의료인에 의한 성범죄가 지속적으로 발생하고 있어 환자뿐만 아니라 일반 국민들은 불안감을 호소하며, 의료계에 대한 불신은 더욱 높아지고 있다. 이에 정부는 사회에서의 성범죄에 대한 엄벌주의 요청에 따라 성범죄 관련 범죄의 형량을 높이는 방향으로 법률의 제 개정을 진행하고 있으며, 성범죄 의료인에 대한 행정처분을 활성화하겠다는 의지를 표명하였다. 이러한 사회적 분위기와 달리 실제 법률을 적용하는 사법부는 의료인의 성범죄 사건에 대해서 그 심각성을 크게 인식하지 못한 것으로 보인다. 2016년 12월, 대법원은 소아과 병원 진료과정에서 의사가 여중생을 추행한 혐의에 대해 무죄를 선고하여 국민의 법감정과 상이한 판결을 하였다. 이에 본 연구에서는 해당 사건을 중심으로 의료인의 성범죄 사건에 대한 판례를 분석하고, 그에 따른 시사점을 제시하고자 한다. 이를 통해 성범죄 의료인에 대한 법적용의 미비점을 보완하여 의료계 전반에 대한 불신을 해소하고, 국민이 보다 안전한 환경에서 양질의 의료서비스를 제공받음으로써 국민의 건강권과 행복권을 담보하는데 기초자료를 제공하고자 한다.

• 대한디지털의료영상학회논문지
• /
• 제15권2호
• /
• pp.13-18
• /
• 2013

Purpose : Fluoroscopy equipment, depending on the type of changes that occur in the patient's position ESD and study the patient's scatter ray of ESD Practitioners considered a comparative analysis was to evaluate the correct dose. Materials and Methods : HITACHI four overtube type TU-8000 Flat Detector and Under tube C-Arm Philips' Multi Diagnost Eleva with Flat Detector type were measured by. Each devices is a measure of the patient's esd randophantom position in tabel unfors Xi multi funtion then fixed to the abdomen fluoroscopy and 10 seconds, spot was measured three times, practitioners of the incident surface dose by considering the patient's scatter ray of the table for each device in the average human stomach 21cm thickness acrylic phantom ($25cm{\times}25cm$) Place the practitioner position after position randophantom unfors Xi multi funtion in the thyroid and stomach 1 minute by a fixed one-time fluoroscopy and measured. Results : 10 seconds and the patient perspective of the c-arm ESD 1.2 times smaller on the AP and oblique measurements were measured in the 6-13 times smaller. spot positions to changes in the measured three times on the AP of the abdomen, ESD is 18 times smaller c-arm measurements and the oblique measurement was 19-30 times smaller. And 1 minute at practitioners fluoroscopy esd in the thyroid 2.12 times the c-arm, chest 1.75 times less the dose was measured. On the AP, depending on the device, but the lack of dose difference oblique positions of the two devices depending on changes in the area due to changes in both the AP than on the dose increased, the difference in dose between the two devices, the maximum difference was approximately 27 times. Conclusion : Fluoroscopic equipment at the time of inspection in accordance with changes in dose according to the patient and the patient's positions changes, because the area of the scatter ray considering the change of dose measurements be made, and study of the equipment according to the characteristics of the efficiency and the exposure of the patient and practitioner is considered smooth study equipment manufacturers that can be done is to build the system and think that is also important. Various fluoroscopy when you check future changes in many factors of change in dose for the equipment in the laboratory system by considering the scatter ray radiation shielding for the management to take advantage of reckless undertube have been utilized as more exposure Reduction activities can help is considered as the direction.

• 디지털융복합연구
• /
• 제15권6호
• /
• pp.345-352
• /
• 2017

본 연구의 목적은 드라마 '태양의 후예' 중 의료현장에서 이루어지는 의료인의 역할을 분석하는 것이다. 본 연구설계는 드라마 '태양의 후예' 중 의료현장에서 이루어지는 의료인의 역할을 탐구하기 위한 질적연구이다. 본 연구를 수행하기 위해 '태양의 후예' 중 의료현장에서 이루어지는 의사소통 장면을 본 연구의 분석자료로 선택하여 의료현장에서 의료진의 의사소통 및 역할 등에 대해 분석하였다. 연구분석을 위해 본 연구팀에서는 태양의 후예를 보며 의료현장 장면을 필사하였으며, 필사가 끝난 후 필사내용을 다시 한 번 확인하여 빠진 내용이 없는지 검토한 후 최종 분석자료를 내용분석 방법을 통해 정리하였다. 본 연구 결과 '태양의 후예' 에서 의료진의 역할은 '응급상황에서의 의사결정', '의료팀간의 협력', '환자에 대한 지지', '의료인으로써의 책임감/윤리적 딜레마'로 나타났다. 본 연구는 하나의 드라마를 분석하여 의료진의 역할을 분석하였다는 것에 있어 한계가 있으나, 드라마를 통해 제 3자의 입장에서 의료진의 역할을 탐색하였다는 것에 의의가 있다.

• 대한한의학원전학회지
• /
• 제25권2호
• /
• pp.25-41
• /
• 2012

Objective : Neijingshiyifanglun with additions and emendations was written by Liu Yude, a doctor who lived during Ming period. I researched the origin of the book, and analyzed the features of it as well. I also approximated his birth date and death date. In doing this, I gained a better understanding the practice of medicine in ancient China. Method : I researched the book by comparing its contents, including the causes of diseases, the descriptions of symptoms, the transmissions of diseases, and treatments, with other sources that he had referenced. Result : In understanding Hwangdineijing, Liu Yude was influenced by many medical scholars such as, Wang Bing, Ma Shi, and Wu Kun, but his opinion is most similar to that of Zhang Jiebin. In the field of the Chinese Medical Theory, he was deeply influenced by 'JinYuan-Sidaijia's theories, particularly Li Gao and Zhu Zhenheng. In fanglun, he was greatly influenced by Yifangkao. He concluded that 'aggregationaccumulation' was a disease of stuffiness, and suggested its cure in through 'yangjingzezichu' and 'treatment of blood aspect'. He recognized the disease of 'reversal of qi' as the disease of 'jiaoqi'. He also indicated that the word of 'qi' is not 'rough' but 'tears' or 'yingfengliulei'. Conclusion : 1. He was an excellent medical practitioner and scholar in the history of oriental medicine. 2. He found and corrected errors in the opinions of Wang Bing, Ma Shi, and Wu Kun. 3. He frequently practiced Taipinghuiminhejijufang, and considered Spleen-Stomach, yin-blood, and fire-heat important. 4. He captured the spirit of Huangdisuwenxuanminglunfang, Neijingshiyifanglun, Yifangkao in views of remedy and theory. 5. Neijingshiyifanglun with additions and emendations is the most comprehensive book about fanglun because of its thorough analysis of the Hwangdineijing and its connection to the treatment of ancient diseases in Oriental Medical History.