Background: Surgical correction needs to be considered when diaphragm eventration leads to impaired ventilation and respiratory muscle fatigue. Plication to sufficiently tense the diaphragm by VATS is not as easy to achieve as plication by open surgery. We used pneumatic compression with carbon dioxide ($CO_2$) gas in thoracoscopic diaphragmatic plication and evaluated feasibility and efficacy. Methods: Eleven patients underwent thoracoscopic diaphragmatic plication between January 2008 and December 2013 in Pusan National University Hospital. Medical records were retrospectively reviewed, and compared between the group using $CO_2$ gas and group without using $CO_2$ gas, for operative time, plication technique, duration of hospital stay, postoperative chest tube drainage, pulmonary spirometry, dyspnea score pre- and postoperation, and postoperative recurrence. Results: The improvement of forced expiratory volume at 1 second in the group using $CO_2$ gas and the group not using $CO_2$ gas was $22.46{\pm}11.27$ and $21.08{\pm}5.39$ (p=0.84). The improvement of forced vital capacity 3 months after surgery was $16.74{\pm}10.18$ (with $CO_2$) and $15.6{\pm}0.89$ (without $CO_2$) (p=0.03). During follow-up ($17{\pm}17$ months), there was no dehiscence in plication site and relapse. No complications or hospital mortalities occurred. Conclusion: Thoracoscopic plication under single lung ventilation using $CO_2$ insufflation could be an effective, safe option to flatten the diaphragm.
Objectives : This study was carried out to measure perceptions about Traditional Korean Medicine hospitals and provide data for improvement of TKM hospital management. Methods : We surveyed the general population from 1st to 17th December, 2008, and patients visiting a TKM hospital from 1st June to 9th December, 2008. Results : Result as follows. 1. The response ratio for the generally preferred medical institution was in the order of western medical clinic, pharmacy, general hospital, TKM clinic, TKM hospital. 2. The response ratio for the preferred medical institution for herbal medicine treatment was in the order of TKM clinic, herbal medicine store, TKM hospital, pharmacy. The preferred medical institution for acupuncture treatment was in the order of TKM clinic, TKM hospital, acupuncture clinic, public health center. 3. The most common response to reason for receiving traditional Korean medical care was "traditional Korean medical care is more effective than western medical care." 4. The proportion of first treatment and second treatment of patients visiting at TKM hospital was about 1:1. 5. 72.3% of patients had been to another medical institution. 6. The response ratio for the first visited medical institution for the same disease was in the order of general hospital, western medical hospital, western medical clinic, TKM clinic. 7. The response ratio for the concern about TKM treatment was in the order of expensive charge for TKM treatment, uncertainty of TKM treatment effect. Conclusions : Through this research, we can understand the perception about TKM hospital treatment of the general population and patients visiting TKM hospitals.
A column-switching semi-micro HPLC method with fluorescence detection was developed for the direct analysis of rebamipide in human plasma. Plasma was filtered through a 0.45 $\mu\textrm{m}$ membrane filter and 5 ${\mu}\ell$ of the filtrate was directly injected onto the pre-column. After elution of the plasma proteins to waste, the retained rebamipide and internal standard(ofloxacin) were transferred to a C18 semi-microcolumn (5$\mu\textrm{m}$, 150 ${\times}$2.0mm) where they were separated using acetonitrile-1.4% acetic acid (40:60, v/v) as mobile phase. (omitted)
"Sikui-simgam ("食醫心鑑", Book for Alimentotherapist)" written by Jameun, a doctor of Tang (唐) in the 9th century, propagated alimentotherapy in Korea, China, and Japan for a long time. In this study, Sikui-simgam medical theories were studied and the medicinal ingredients and types of food therapy were analyzed to understand alimentotherapy characteristics. "Sikui-simgam" is the first food therapy formulary diverged from herbal therapy forms. Various ingredients from "Sikui-simgam" show the food culture of the Tang age and report much about cooking and cultural history. Many prescriptions in the books are the origins of present-day food culture; thus, they are important clues to understand the present food culture. This book also describes actual prescriptions in detail. Various types of prescriptions with different ingredients are unique characteristics of food therapy and show the various possibilities for food therapy prescriptions. The food therapy prescriptions of "Sikui-simgam" were designed for medical specialists, as the book contains doses and incompatibilities for food therapy. Such food therapy prescriptions were used to treat diseases, so they were used with strict standards.
Toe objective of this study is to verify the factors influencing the taxation cognition of medical institutions and to verify the difference of taxation cognition among the interest groups in medical services. The factors that influence taxation cognition are supposed to be five: cognition of public benefits on medical services, cognition of profits from medical institutions, cognition of self-responsibility of medical institutions, cognition of distinction of medical institutions, and cognition of the importance of medical services. The interest groups are divided into four: medical institution employees, medical treatment consumers, taxation experts, and tax officials. As a result of this study, first, cognition of public benefits, cognition of profits, and cognition of distinction are verified to have statistical significance as factors for taxation cognition. It means that cognition of the public benefits of medical services is low, while cognition of profits is high, and taxation cognition such as tax supports and tax exemption appears low in accordance with lowness of cognition of distinction of medical institutions. Second, taxation cognition of the interest groups about medical service shows statistical significance between the group of medical institution employees and the group of tax officials, and between the group of medical institution employees and the group of taxes experts. This study is expected to contribute to tax policy, which can support medical institutions to provide medical consumers with good medical services, by analyzing the factors that influence taxation cognition on medical institutions.
Inter-hospital transfer, depending on its medical and legal appropriateness, affect the prognosis of patients and can even lead to legal disputes. As Emergency Medical Service Act, any physician shall, in case where deemed that pertinent medical service is unavailable for such patient with the capacities of the relevant medical institution, transfer without delay such patient to another medical institution where a pertinent medical service is available. For medico-legally appropriate inter-hospital transfer, the head of a medical institution shall, in case where he transfers an emergency patient provide medical instruments and manpower required for a safe transfer of the emergency patient, and furnish the medical records necessary for a medical examination at the medical institution in receipt of such patient. And transfer process must comply with the requirements prescribed by executive rule such as attachment of the referral, provision of ambulance, fellow riders and informed consent of transfer. Those engaged in emergency medical service shall explain an emergency medical service to an emergency patient and secure his consent. In addition to the duty to inform about emergency medical service to the patient and his or her legally representative, there is also a duty for doctors to sufficiently explain to the patient and his or her legally representative during inter-hospital transfer that the need for the transfer, the medical conditions of the patient to be transferred and emergency treatment that will be provided by the hospital from which the patient is going to transferred. Likewise, the hospital to which the patient is transferred must be thoroughly informed about matters such as the patient's conditions, the treatment the patient was given and reasons for transfer by transferring doctors.
You, Chang Hoon;Kang, Sungwook;Choi, Ji Heon;Kwon, Young Dae
Korea Journal of Hospital Management
/
v.22
no.2
/
pp.58-69
/
2017
Recently, with the increase in the number of private health insurance subscribers, interest in overuse of the medical service is increasing. This study analyzed the impacts of private health insurance (PHI) on medical institution selection in outpatient service utilization among persons with arthritis. In order to control patients' health status, we extracted outpatient episodes with the same disease (KCD6, M13) from Korea Health Panel. The unit of analysis was an outpatient visit with arthritis in 2014 (n=23,363). In the light of insurance coverage, we redefined three type of private health insurance (ex, indemnity, fixed benefit, and non-insured) as a test variable and two type of medical institution (ex, hospital and physician visit) as a dependent variable. We conducted a probit regression analysis to identify the impacts of PHI on medical institution selection controlling for heteroscedasticity. The results of this study showed that the insured with indemnity were more likely to choose hospital departments than clinics (marginal effect=0.0475, p=0.000). The impact of participation of fixed benefit PHI was not as clear as that of indemnity type (marginal effect=0.0162, p=0.047). In conclusion, this study confirmed that PHI, particularly indemnity type has a significant impact on the selection of medical institutions. Healthcare policy makers should consider that PHI not only affects the overall quantitative increase in healthcare utilization, but also influences the selection of medical institutions.
This research analyzed Raise Capital type and Investment Efficiency for non-profit hospitals in Korea. 152 cases of financial information from 2007 to 2010 were utilized for analysis. As a result of analysis, Raise Capital for Borrowings to total assets was primarily used, taking around 40% on average, and the method of Raise Capital with significant difference among Medical Institutions was Liabilities in Excluded Borrowings to Total Assets and Capital Stock & Capital Reserves to Total Assets. Besides, the relation between Invested capital and Investment efficiency was opposite each other in the non-profit hospitals, and Region was an important element influencing over Productivity per Value Added. In addition, in the investment activity of non-profit hospitals in the light of Investment Efficiency, only hospitals among Medical Institution types had a character of Capital Intensive, and General Hospital and Geriatric & Long-term Medical Care Hospital among Medical Institution types showed a character of Labor Intensive in the light of Performance.
Our Constitution obliges the state to protect the health of the people, and the Medical Law, which embodied Constitution, sets out in detail the matters related to open the medical institution, and one of them is to prohibit the operation of multiple medical institutions. By the way, virtually multiple medical institutions could be opened and operated because the Supreme Court had interpreted that several medical institutions could be opened if medical activities were not performed directly at the additional medical institution which was opened under the another doctor's license. However, some health care providers opened the several medical institutions with another doctor's license for the purpose of the maximization of profit, and did illegal medical cares like the unfair luring of patients, over-treatment, and commission treatment. Also, realistic problems such as the infringed health rights have arisen. Accordingly, lawmakers had come to amend the Medical Law to readjust the system of opening for medical institution so that medical personnel could not open or operate more than one medical institution for any reason. For this reason, the Constitutional Court recently declared a constitutional decision through a long period of in-depth deliberation because the constitutional petition and the adjudication on the constitutionality of statutes had been filed on whether Article 33 paragraph 8 of the revised medical law is unconstitutional. The Constitutional Court acknowledged the "justice of purpose" in view of the importance of public medical institutions, of the prevention from seduction of for-profit patients and from over-treatment, and of the fact that health care should not be the object of commercial transactions. Given the risk that medical personnel might be subject to outside capital, the concern that the holder of the medical institution's opening certificate and the actual operator may be separated, the principle that the human body and life should not be just a means, and the current system's inability to identify over-treatment, it also acknowledged the 'minimum infringement'. Furthermore, The Constitutional Court judged it is constitutional in compliance with the principle of restricting fundamental rights, such as 'balance of legal interests'. In this regard, legislative complements are needed in order to effectively prevent the for-profit management and the over-treatment the Constitutional Court is concerned about. In this regard, consumer groups actively support the need for legislation, and health care providers groups also agree on the need for legislation. Therefore, the legislators should respect the recent Constitutional Court's decision and in the near future complete the complementary legislation to reflect the people's interests.
Objective : In this study, we try to identify the herbal formulated by Heo Im from Kyeongheombang(經驗方), and investigate its medical property. Method : Those articles referenced from Heo Im's herbal formulas in "Sauikyeongheombang(四醫經驗方)" were extracted and results were quantitatively analyzed. From extracted empirical formulas, those categorized as externally applicable formulas were grouped by several standards and their medical significance was analyzed. Results and Conclusions : 85 and 66 articles were designated to be referred from Heo(許) in "Sauikyeongheombang" and "Uibanghapbu(醫方合部)" in each category, and 263 and 155 were identified to be Heo Im formulas, respectively. Externally applicable formulas in Heo Im's empirical recipes have following characteristics. First, various methods were used by Heo Im. Second, Heo Im's empirical formulas suggest useful clinical information maximizing therapeutic effect, which is of much value, originated from his practical experiences as a clinician. Third, Heo Im's therapy favorably succeeds the tradition of Hyangyak-medicine and Empirical -medicine. From this information, Heo Im is thought to have had rich insight and experience, not only in acupuncture but also in the prescription of herbal formulas at those days.
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