• 한국화재소방학회논문지
• /
• 제20권2호
• /
• pp.31-43
• /
• 2006

현재 우리나라 응급의료서비스(Emergency Medical Service)의 대부분을 차지하는 119구급대는 구조적인 문제에 봉착해 있다. 119 EMS가 무료로 공급되면서 그에 대한 수요가 비정상적으로 증가하여 119구급대원들의 과부하가 문제시되는 한편 정작 중요한 성과지표인 소생률(resuscitation rate)은 외국에 비해 저조한 수준을 면치 못하고 있다. 이러한 문제를 해결하기 위해서는 예산 및 인력 증원이 필요한데 현 시스템 하에서는 막대한 예산 소요, 소방공무원 표준정원제와 소방력기준과의 불일치 등에 의한 제약 때문에 이마저도 쉽지 않다. 본 연구는 이러한 문제의식 하에서 현행 EMS 시스템이 의료기관이나 민간이송업체를 포괄하는 민관파트너십 시스템으로 이행하는 방식을 간략하게 설계하고, 그 타당성을 검토하고자 한다. 우선 미국 주요도시의 EMS 성과와 관련된 기초 통계를 바탕으로 분석해 본 결과, 소방이던 의료기관이던간에 단일기관이 EMS를 전담하는 경우보다는 복수의 기관이 협력하는 경우가 소생률이 높다는 것을 확인할 수 있었다. 또한 각국의 EMS 체계와 관련된 사례를 수집한 결과 한국과는 달리 대부분의 국가나 지자체들이 민관파트너십을 통해 보다 질 높은 EMS를 제공하고 있었다. 결국 한국의 EMS도 소방 중심에서 탈피하여 의료기관, 민간업체 등과 파트너십을 구축하는 방향으로 EMS 체계를 재설계하는 것이 타당할 것이라는 결론을 얻었다.

• 한국방사선학회논문지
• /
• 제15권5호
• /
• pp.761-770
• /
• 2021

의사의 지도권과 고용권의 남용됨에 따라 직종 간의 독립적인 관계 확립을 위해 각 의사 및 의료기사 단체들의 입장과 일본, 미국, 영국의 교육제도 및 법령을 통해 '지도' 문구 및 의료기사 단독법의 분석을 토대로 국민 보건 향상을 도모하고자 한다. 관련 이해 집단 간의 주요 입장 차이를 분석하였으며, 1963년 이후 발의된 국회 의안 발의 및 판례를 분석하고 선진국의 법과 비교 분석하였다. OECD 회원국 중 우리나라를 제외한 26개국이 의료기사 단독법이 제정된 상황이며, 지도와 감독의 의미는 나라마다 상이하다. 의료기사법 등은 8개 의료기사등의 법을 전부 대변해 주기에는 20세기의 법으로는 시대적 흐름과 상황을 적용하기 부적합하며, 보건의료체계는 전문성, 다양성, 국제화 추세와 발맞춰 나아가야 하며, 더불어 의사의 지배권 아래에 있는 지도 및 감독의 문구를 미래지향적 수평적 관점에서 변화가 불가피할 것으로 사료된다.

• The Korean Journal of Pain
• /
• 제34권4호
• /
• pp.427-436
• /
• 2021

Background: Pharmacological and non-pharmacological therapies have been used to treat patients with chemotherapy-induced peripheral neuropathy (CIPN). However, the effect of therapies in cancer patients has yet to be investigated comprehensively. We hypothesized that cyclic thermal therapy would improve blood flow and microcirculation and improve the symptoms driven by CIPN. Methods: The criteria of assessment were blood volume in region of interest (ROI) in the images, and European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire-Chemotherapy-Induced Peripheral Neuropathy 20 questionnaire scores. The blood volume was quantified by using red blood cell (RBC) scintigraphy. All patients were treated 10 times during 10 days. The thermal stimulations, between 15° and 41°, were repeatedly delivered to the patient's hands. Results: The total score of the questionnaires, the score of questions related to the upper limbs, the score of questions closely related to the upper limbs, and the score excluding the upper limbs questions was decreased. The blood volume was decreased, and the variance of blood volume was decreased. During cooling stimulation, the blood volume was decreased, and its variance was decreased. During warming stimulation, the blood volume was decreased, and its variance was decreased. Conclusions: We suggest that cyclic thermal therapy is useful to alleviate CIPN symptoms by blood circulation improvement. RBC scintigraphy can provide the quantitative information on blood volume under certain conditions such as stress, as well as rest, in peripheral tissue.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제38권1호
• /
• pp.55-63
• /
• 2012

The odontogenic keratocyst (OKC) was originally classified as a developmental cyst, and OKCs were histologically divided into orthokeratotic (O-OKCs) and parakeratotic (P-OKCs) types. Clinical features differ between O-OKCs and P-OKCs with P-OKCs having a tendency to recur after surgical treatment. According to the revised histopathological classification of odontogenic tumors by the World Health Organization (2005), the term keratocystic odontogenic tumor (KCOT) has been adopted to describe P-OKCs. In this retrospective study, we examined 186 KCOTs treated at the Maxillofacial Surgery Department of the Tokyo Medical and Dental University Hospital from 1981 through 2005. The patients ranged in age from 7 to 85 years (mean, 32.7) and consisted of 93 males and 93 females. The most frequently treated areas were the mandibular molar region and ramus. The majority of KCOTs in the maxillary region were treated by enucleation and primary closure. The majority of KCOTs in the mandibular region were enucleated, and the wound was left open. Marginal resection was performed in the 4 patients with large lesions arising in the mandible. In patients who were followed for more than a year, recurrences were observed in 19 of 120 lesions (15.8%). The recurrences were found at the margins of the primary lesion in contact with the roots of the teeth or at the upper margins of the mandibular ramus. Clinicians should consider aggressive treatment for KCOTs because the recurrence rate of P-OKCs is higher than that of other cyst types such as O-OKCs, dentigerous cysts, primordial cysts that were non-keratinized, and slightly keratinized stratified squamous epithelium. Although more aggressive treatment is needed for KCOTs as compared to other cystic lesions, it is difficult to make a precise diagnosis preoperatively on the basis of clinical features and X-ray imaging. Therefore, preoperative biopsy is necessary for selecting the appropriate treatment for patients with cystic lesions.

• 의료법학
• /
• 제9권1호
• /
• pp.385-411
• /
• 2008

The goal of medicine is to contribute to promoting national health by preventing diseases and providing treatment. The scope of modern medicine isn't merely confined to disease testing, treatment and prevention in accordance to that, and making experiments by using the human body is widespread. The advance in modern medicine has made a great contribution to valuing human dignity and actualizing a manly life, but there is a problem that has still nagged modern medicine: treatment and healing for terminal patients including cancer patients. In advanced countries, pain care and hospice medicine are already universal. Offering a helping hand for terminal patients to lead a less painful and more manly life from diverse angles instead of merely focusing on treatment is called the very hospice medicine. That is a comprehensive package of medical services to take care of death-facing terminal patients and their families with affection. That is providing physical, mental and social support for the patients to pass away in peace after living a dignified and decent life, and that is comforting their bereaved families. The National Hospice Organization of the United States provides terminal patients and their families with sustained hospital care and home care in a move to lend assistance to them. In our country, however, tertiary medical institutions simply provide medical care for terminal patients to extend their lives, and there are few institutional efforts to help them. Hospice medicine is offered mostly in our country by non- professionals including doctors, nurses, social workers, pastors or physical therapists. Terminal patients' needs cannot be satisfied in the same manner as those of other patients, and it's needed to take a different approach to their treatment as well. Nevertheless, the focus of medical care is still placed on treatment only, which should be taken seriously. Ministry for Health, Welfare & Family Affairs and Health Insurance Review & Assessment Service held a public hearing on May 21, 2008, on the cost of hospice care, quality control and demonstration project to gather extensive opinions from the academic community, experts and consumer groups to draw up plans about manpower supply, facilities and demonstration project, but the institutions are not going to work on hospice education, securement of facilities and relevant legislation. In 2002, Ministry for Health, Welfare & Family Affairs made an official announcement to introduce a hospice nurse system to nurture nurse specialists in this area. That ministry legislated for the qualifications of advanced nurse practitioner and a hospice nurse system(Article 24 and 2 in Enforcement Regulations for the Medical Law), but few specific plans are under way to carry out the regulations. It's well known that the medical law defines a nurse as a professional health care worker, and there is a move to draw a line between the responsibilities of doctors and those of nurses in association with medical errors. Specifically, the roles of professional hospice are increasingly expected to be accentuated in conjunction with treatment for terminal patients, and it seems that delving into possible problems with the job performance of nurses and coming up with workable countermeasures are what scholars of conscience should do in an effort to contribute to the development of medicine and the realization of a dignified and manly life.

• Parasites, Hosts and Diseases
• /
• 제51권6호
• /
• pp.719-726
• /
• 2013

Mitochondrial genomes have been extensively studied for phylogenetic purposes and to investigate intra- and interspecific genetic variations. In recent years, numerous groups have undertaken sequencing of platyhelminth mitochondrial genomes. Haplorchis taichui (family Heterophyidae) is a trematode that infects humans and animals mainly in Asia, including the Mekong River basin. We sequenced and determined the organization of the complete mitochondrial genome of H. taichui. The mitochondrial genome is 15,130 bp long, containing 12 protein-coding genes, 2 ribosomal RNAs (rRNAs, a small and a large subunit), and 22 transfer RNAs (tRNAs). Like other trematodes, it does not encode the atp8 gene. All genes are transcribed from the same strand. The ATG initiation codon is used for 9 protein-coding genes, and GTG for the remaining 3 (nad1, nad4, and nad5). The mitochondrial genome of H. taichui has a single long non-coding region between trnE and trnG. H. taichui has evolved as being more closely related to Opisthorchiidae than other trematode groups with maximal support in the phylogenetic analysis. Our results could provide a resource for the comparative mitochondrial genome analysis of trematodes, and may yield genetic markers for molecular epidemiological investigations into intestinal flukes.

• 한국응급구조학회지
• /
• 제10권3호
• /
• pp.5-20
• /
• 2006

Purpose: This study examines the degree of empowerment recognized by the 1st paramedics and the trend of their critical thinking, analyzes correlations between empowerment and critical thinking to reveal whether there is statistically significant difference between them and then is to provide basic materials necessary for research on empowerment and critical thinking. Method: This study distributes 105 structured self-report questionnaires to the 1st emergency medical technicians working at fire fighting police boxes, general hospitals, clinics and emergency medical information centers in G Metropolitan City and J province from April 29 to May 28, 2006, collects their responses directly and analyzes results with t-test, F-test(ANOVA) and Pearson's Correlation Coefficient. Result: 1. First, average score of empowerment of subjects was 4.68 out of 6 and according to scores by area, capacity 5.98 was highest, followed by significance 5.41, self- determination 4.44 and effectiveness 3.79. 2. degree of empowerment according to general characteristics of subjects showed statistically significant differences in final education(F=2.714, p= .049), level of salary (F=3.298, p= .014) and satisfaction of current job (F=5.399, p= .001). 3. average score of critical thinking of subjects was 3.28 out of 7 and according to areas, no bias 3.95 was highest, followed by maturity 3.68, structure 3.35, inquisitiveness 3.11, pursuit of truth 3.07, critical thinking and self-confidence 3.00, analyticity 2.98. 4. degree of critical thinking by general characteristics of subjects showed statistically significant differences in age(F=2.577, p= .041), final education (F=7.877, p= .000), current workplace (F=3.513, p= .018), level of salary(F=4.628, p= .002), satisfaction with current job(F=6.879, p= .000) and intention to transfer current job(t=15.21, p=.000). 5. as a result of correlations between empowerment and critical thinking of subjects, Pearson correlation coefficients between whole empowerment and critical thinking were r= .21, p=.013. Conclusion: It is considered that the 1st paramedic managers must seek how to keep and manage empowerment and development of education and training program which can enhance critical thinking is needed. Further, emergency educators must develop educational program based on the concept of empowerment to establish early awareness of a desirable organization culture and increase understanding of empowerment in the process of education.

• Korean Journal of Acupuncture
• /
• 제23권4호
• /
• pp.1-14
• /
• 2006

Objectives : Investigate the situation of Joseon Dynasty's Acupuncture and Moxibustion. Methods : the Acupuncture and Moxibustion methods in UiRimCh'walYo (${\ulcorner}$醫林撮要$\lrcorner$ 'Essentials of Oriental Medical Doctors') were studied. Results and Conclusions : First of all, the Acupuncture and Moxibustion methods in UiRimCh'walYo are narrated according to specific symptoms like diarrhea and stomachache, and not organized by the origin of illness or some abstract nature of a disease. In addition, it excluded complicated Acupuncture and Moxibustion methods, only adopting a couple of Acupuncture Bleeding methods and Moxibustion methods to simplify the technique as much as possible. Secondly, the Acupuncture and Moxibustion methods in UiRimCh'walYo, along with those in DongUiBoCam and Ch'imGuYoGyol introduce ways to perform moxibustion on the Umbilical Middle and Elixir Field. By focusing on the similarities between the three comtemporary medical works, it is possible to assume the existence of a unique acupuncture method using moxibustion on the Umbilical Middle and Elixir Field. Thirdly, the Acupuncture and Moxibustion methods in UiRimCh'walYo didn't go into detailed differentiation of symptoms and just concisely described one or two treatment methods for each symptom and simplified the prescription down to the core acupuncture points. This shows that the Acupuncture and Moxibustion methods in UiRimCh'walYo didn't seek its own cure but was edited in order to act as an appendix to Herbal Medicine. When integrating the conclusions above, it can be said that UiRimCh'walYo strived to use acupuncture and moxibustion simply and effectively inside the Oriental medicine's large boundaries of Herbal Medicine and Acupuncture and Moxibustion. Harmony with Herbal Medicine, an easy-to-find organization, and simple, easy-to-do prescription are what UiRimCh'walYo was about.

• Asian Pacific Journal of Cancer Prevention
• /
• 제16권9호
• /
• pp.3639-3644
• /
• 2015

Oral, cervical and breast cancers, which are either preventable and/or amenable to early detection and treatment, are the leading causes of cancer-related morbidity and mortality in India. In this paper, we describe implementation science research priorities to catalyze the prevention and control of these cancers in India. Research priorities were organized using a framework based on the implementation science literature and the World Health Organization's definition of health systems. They addressed both community-level as well as health systems-level issues. Community-level or "pull" priorities included the need to identify effective strategies to raise public awareness and understanding of cancer prevention, monitor knowledge levels, and address fear and stigma. Health systems-level or "push" and "infrastructure" priorities included dissemination of evidence-based practices, testing of point-of-care technologies for screening and diagnosis, identification of appropriate service delivery and financing models, and assessment of strategies to enhance the health workforce. Given the extent of available evidence, it is critical that cancer prevention and treatment efforts in India are accelerated. Implementation science research can generate critical insights and evidence to inform this acceleration.

• 한국병원경영학회지
• /
• 제14권1호
• /
• pp.123-144
• /
• 2009

Recently, a long strike by hospital labor union emerged as a serious social issue. During the Worldcup Games in June, 2002, labor strikes broke up at 'C', 'K' and other hospitals, and in 2007, 'Y' hospital suffered much from a strike. Such series of extreme labor disputes have awakened people of importance of a more stable labor-management relationship for the medical institutions responsible for people's health than any other business organization. The purpose of this study was to examine the labor-management disputes at 'Y' hospital in 2007 and 'C' and 'K' hospitals in 2002. The results of this study can be summarized as follows; First, requests of the labor union such as pay raise, reemployment of the irregular workers as regular employees and participation of the labor union in personnel affairs are the long-held or core issues suffered by the medical institutions. Such issues are not independent from each other but complicated with each other surrounding the pay raise. Accordingly, it is not easy to determine the genuine bone of issue for labor-management disputes. Second, the model type of disputes between labor and management at medical institutions may be strike. However, it is conceived that the type of disputes would be subject to change as the essential medical service area system began to be operated since 2008. Third, the common characteristic of the labor strike among the 3 sample hospitals was occupation of the hospital lobby for a sit-in strike to maximize the negative effects of strike. Article 42 (Prohibition of Violence) of Labor Union and Labor Relation Coordination Act prohibits occupation of production or other important business facilities. In addition, since Ministry of Labor interprets that the hospital lobby belongs to the important business facilities enumerated by Article 42 of the above act, occupation of the hospital lobby for a sit-in strike may be too controversial to be admitted as a fair act of labor dispute when its legitimacy should be judged. Fourth, the counter-measures taken by the hospitals against the strike were observance of the principle 'no labor no pay,' closure, legal action, accusation, claim for recovery of damage, provisional seizure, disciplinary punishment, etc., but the principle of 'no labor, no pay' was not applied in a fair manner by 'C' and 'K' hospitals. However, 'Y' hospital applied this principle thoroughly to the strike; the hospital conduced to correction of the wrong labor-management relationship by refusing inclusion in the labor collective agreement of a provision about payment of wage during the period of strike or labor union's request to that effect during a strike. In addition, 'Y' hospital took an effective measure to end the strike earlier by notifying the labor union of cancellation of the collective agreement and banning the unionists from entering the hospital.