• 지역사회간호학회지
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• 제10권1호
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• pp.80-92
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• 1999

The purpose of this study was to survey appropriateness of admission and days of care for the cerebral ischemia patients as a basis to provide an effectiveness of hospitalization. The authors retrospectively reviewed the medical records of cerebral ischemia patients in two hospitals from November 1997 to February 1998. Of 194 medical records reviewed, there were 2108 medical days. I t is used a 'Appropriateness Evaluation Protocol' previously developed by Gertman and Restuccia (1981) and translated by Department of Health Management, Seoul National University and Korea Institute for Health Services Management (1993), It was found that the 'Appropriateness Evaluation Protocol' had a high inter-rater reliability(k=.92), Statistical significant was tested by using the percentage, mean, and logistic regression by SAS 6.12. The results were as follows; 1. The appropriate admissions were 87.6%, days of care 63.4%, and the average length of stay $10.9{\pm}6.7$ days. 2. The reasons of inappropriate admissions were for work-up(75.0%) and conservative care (25.0%). Major reasons of inappropriate days of care were 'cases in which the medical purpose of hospitalization has been accomplish or can be addressed in a less setting(45.0%)', and 'cases in which there is a delay in performing the work-up or treatment which required patients is hospitalized (44.4%)'. 3. Appropriate days of care were higher as ageing. Appropriate days of care were higher in patients with lower accademic back ground than those of upper college graduates, and in the patients who enter a hospital via emergency room than out-patients department. Appropriate days of care were higher in the patient with MCA infarction, and lower in the patient with cerebellar infarction than the patient with lacunar infarction. Appropriate days of care were higher in attack first than attack above second, in nomortension patients than hypertensive, and lower in groups who engaged in semi-private room and public room than private room in hospital. Appropriate days of care were higher in shorter length of stay than longer length of stay. 4. Diagnosis, admission path, and appropriate days of care explained appropriate admissions. Diagnosis, appropriate admissions, hypertension explained appropriate days of care. According to the above results, author confirms the substantial amount of inappropriate hospital bed utilization. To reduce inappropriateness, it is necessary to develop some alternative services such as home care services or nursing home with which can be replaced inpatient services and to introduce policy such as case management which includes Critical Pathway for consistent management. And, it should be followed the further study for the effectiveness.

• 디지털산업정보학회논문지
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• 제8권2호
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• pp.59-65
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• 2012

Emergency medical information center performs role of medical direction about disease consult and pre-hospital emergency handling scheme work to people. Emergency medical information system plays a major role to be decreased mortality and disability of emergency patient by providing information of medical institution especially when emergency patient has appeared. But, various attacks as a hacking have been happened in Emergency medical information system recently. In this paper, we proposed security structure which can protect the system securely by detecting attacks from outside effectively. Intrusion detection was performed using rule based detection technique according to protocol for every packet to detect attack and intrusion was reported to control center if intrusion was detected also. Intrusion detection was performed again using decision tree for packet which intrusion detection was not done. We experimented effectiveness using attacks as TCP-SYN, UDP flooding and ICMP flooding for proposed security structure in this paper.

• 대한치과의사협회지
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• 제43권1호통권428호
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• pp.41-52
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• 2005

Information Technology has extended its scope to the medical field as well as dental field. Like medical field, network ststem for dental field requires acquisition, storage, and display of images. However, unlike the medical field, the system to integrate several information including medical images has not been developed according to industrial standard for management of digital image for medical use, so called DICOM conformance. which makes the digital environment in dental field more and more difficult and expensive for this standardization and comfortable communication in LAN and WAN. To solve this problem, the DICOM encoder and server has to be developed because the DICOM file can be easily retrieved with patient's information from the DICOM server in the system as DICOM file has the standard specification to integrate the patient's information. The information including image and other discrete data can be easily integrated in DICOM file and can be used without any difficulty for precise diagnosis and for contribution to the decision making for each treatment protocol. Therefore, the system composed of DICOM encoder and server in dental practive for DICOM file must be developed with prudent consideration of the several strategic factors: I) Enhanced diagnostic capability through the integrated information of image and clinical data. ii) Clinician-friendly interface to simulate the systemic treatment procedure in clinical practice iii) Implementation of multidisciplinary treatment protocol The development of DICOM encoder and server based on these strategic considerations will provide paperless and filmless hospital environments by the seamless integration and management of patient's history, several clinical data and clinical images through image processing for quantitative analysis. The system also allows clinicians to provide more predictable dental care for the patients.

• 한국정보전자통신기술학회논문지
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• 제1권3호
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• pp.33-40
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• 2008

TMO 구조는 시간 구동 메소드와 메시지 구동 메소드의 두 가지 형태의 메소드로 이루어져 있으며, 일정한 시간이 지남에 따라 자동적으로 수행되는 시간 구동 메소드와 객체 노드 사이의 실행 결과를 주고받을 수 있는 서비스 메시지 구동 메소드로 명확하게 구분된다. 시간 구동 메소드의 실행은 설계 시간을 설정하는 과정에 결정된 특정한 값에 의해 실시간 통신 클럭의 도착에 따라 이루어지고 반면에 서비스 구동 메소드 실행은 클라이언트로부터 메시지를 요구하는 서비스에 의해서만 실행된다. 본 논문에서는 이러한 TMO 구조를 이용하여 실시간 통신 시뮬레이션 프로그래밍을 하기 위해 환자 모니터 원격진료 시스템 응용 환경에 적용하였다. Central Monitor로부터 전송되어진 환자의 생체정보 Raw Data가 HIS의 데이터 수신 모듈을 통해 사용가능한 데이터로 재구성될 수 있도록 설계가 이루어져 있다. 환자 생체정보에 대한 실시간성과 생체정보에 대한 생체정보 데이터의 연속성을 부여함으로서 베드 사이트의 환자에게서 발생된 모든 생체정보에 의해 환자 관리가 이루어진다.

• Journal of Chest Surgery
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• 제53권2호
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• pp.41-48
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• 2020

Background: Chylothorax after congenital heart surgery is not an uncommon complication, and it is associated with significant morbidity. However, consensus treatment guidelines are lacking. To improve the treatment outcomes of patients with postoperative chylothorax, we implemented a standardized management protocol at Severance Hospital in September 2014. Methods: A retrospective review of patients treated at a single center was done. All corrective and palliative operations for congenital heart disease performed at our institution between January 2008 and April 2018 were reviewed. The incidence and treatment outcomes of postoperative chylothorax were analyzed. Results: The incidence of chylothorax was 1.9%. Sixty-one percent of the patients could be managed with a low-fat diet, while 28% of the patients required complete restriction of enteral feeding. Thoracic duct embolization was performed in 2 patients and chest tube drainage decreased immediately after the procedure. No patient required thoracic duct ligation or pleurodesis. After implementation of the institutional management protocol, the number of chest tube drainage days decreased (median, 24 vs. 14 days; p=0.45). Conclusion: Implementing a strategy to reduce postoperative chylothorax resulted in an acceptable incidence of postoperative chylothorax. Instituting a clinical practice protocol helped to curtail the treatment duration and to decrease the requirement for surgical treatment. Image-guided embolization of the thoracic duct is an effective treatment for postoperative chylothorax.

• 디지털융복합연구
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• 제10권2호
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• pp.153-159
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• 2012

최근 u-헬스케어는 웰빙 시대와 IT 대중화가 맞물려 RFID 기술을 의료 서비스에 접목하는 새로운 비즈니스 모델이 각광을 받고 있다. u-헬스케어 서비스는 RFID 기술이 u-헬스케어에 접목되면서 의료 프로세스 상에 발생하는 수기입력, 중복 데이터 발생, 데이터 위 변조, 정보 버전 상이 등의 품질 저하 요인을 해결할 수 있는 방안이 필요하다. 이 논문에서는 u-헬스케어를 통해 의료 서비스를 제공받는 사용자의 프라이버시를 보호하기 위한 RFID 기반의 사용자 인증 프로토콜을 제안한다. 제안 프로토콜에서는 의료 서비스를 제공받는 사용자의 데이터 위 변조 및 프라이버시와 u-헬스케어 보안시스템의 안전성을 획기적으로 제고하기 위해서 환자에 관한 비밀 정보는 병원에서 생성된 비밀키와 연접하여 DB 테이블 내의 해당 환자의 비밀키 필드에 저장한다. 또한, 불법적인 사용자의 접근이 있을 경우 인증 서버에게 통보하여 u-헬스케어의 불법 유 무 판별한 후 u-헬스케어 서비스 접근을 승인받도록 한다.

• 치위생과학회지
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• 제12권6호
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• pp.545-557
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• 2012

Dental caries is biofilm induced disease throughout life and is recognized significant oral health problem. This article reviewed new trends in dental caries management by risk assessment, including history, protocol/guideline, and collaborated model. Dental caries prevention and treatment according to caries management by risk assessment (CAMBRA) model is patient-centered, risk-based, evidence-based practice. Team approach is necessary and clinician need to integrate science, practice and product. Dental hygienist take a important role in implementing CAMBRA. CAMBRA model could be incorporated into clinical dental hygiene education based on dental hygiene process of care as standard of dental hygiene practice and education. Dentist and dental hygienist able to provide scientific and ethical care managing dental caries by risk assessment.

• 한국간호교육학회지
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• 제29권4호
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• pp.381-394
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• 2023

Purpose: This study aimed to develop an intentional rounding protocol to enhance the clinical competence of nursing students. Methods: An intentional rounding protocol for nursing students' clinical practice was developed following the ADDIE (Analysis, Design, Development, Implementation, and Evaluation) model. A convenient sampling method was used to select 23 junior year university nursing students during their clinical practice in adult nursing. The program evaluation included a quantitative assessment (communication and relationship efficacy, empathy, and patient safety competency) and focus group interviews. Results: The intentional rounding protocol focused on the 4Ps (pain, position, potty, and possessions) and encompassed aspects such as level of consciousness, pain management, personal care needs, intravenous injection, oxygen administration, nasogastric/nasoenteric tube care, maintenance of urine collection bags, and the identification of environmental fall risks. Nursing students performed intentional rounding at least twice a day. Following the implementation of this protocol, nursing students demonstrated a significant improvement in communication and interpersonal efficacy. The focus group interviews revealed four main themes: growth of human relationships, acquiring knowledge in and about the clinical field, becoming a nurse, and barriers in reality. Conclusion: The intentional rounding protocol has the potential to enhance nursing students' communication and interpersonal skills during clinical practice and to provide them with positive experiences in nursing clinical education. Therefore, it is recommended that this protocol be incorporated into nursing clinical practice education.

• Journal of Trauma and Injury
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• 제36권1호
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• pp.49-52
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• 2023

Blunt carotid artery injury can lead to impaired brain perfusion due to ischemic stroke and thromboembolic events. To reduce the risk of potential neurological complications, it is critical to determine the diagnosis and management protocol as quickly as possible after a detailed clinical examination. This report presents successful surgical treatment of a young male patient who developed a traumatic left common carotid artery thrombosis after a motor vehicle accident.

• 한국응급구조학회지
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• 제16권3호
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• pp.29-43
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• 2012

Purpose : The goal of the present study is to provide the basic information to medical control which is the most important improving factor of pre-hospital medical treatment. Method : A total of 749 records of direct medical control were collected from 119 EMTs in emergency medical information center of Daejeon, Chungcheongnam-do and Chungcheongbuk-do from March 1, 2010 to February 28, 2011. Results : The 119 EMTs should record the level of qualification of EMT and general patient history taking precisely when they receive direct medical controls. The doctors should take medical controls within the task range of qualification of EMTs. Conclusion : It is necessary to establish the guideline of medical direction and protocol of prehospital emergency care. The quality improvement of pre-hospital emergency services will be possible by the guideline and protocol.