• Health Policy and Management
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• v.29 no.2
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• pp.105-111
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• 2019

On December 31, 2018, an incident occurred where a doctor was attacked and killed by a patient carrying a lethal weapon in the outpatients' clinic of the psychiatric department of a tertiary general hospital. The suspect was diagnosed with bipolar affective disorder (manic depressive disorder) and has been hospitalized and cared for in the psychiatric ward of this hospital. This incident illustrates the necessity of more active cures and therapeutic intervention for mental patients with intellectual developmental disorders who require treatment considering the fact that a radical outcome has been caused by such a patient. However, on the other hand, there is also a need for an approach and analysis from the perspective of crime prevention for all medical departments. The reason for this is that even a tertiary general hospital equipped with the largest human resources, medical devices, facilities, and so forth, is susceptible to violence. As for illegal actions perpetrated against health and medical service personnel in medical institutions, such as verbal abuse, assault, injury, etc. there have neither been understanding shown for the current extent of damage in detail, nor discussions of active institutional improvement related to the seriousness of the act. It can be said that violence in the field of medical treatment is a realm requiring serious discussion and appropriate remedial actions. This is because when such incidents take place, if a patient who is supposed to get treatment from the damaged health care provider is in an urgent situation or on the waiting list of serious cases, he or she could suffer serious damage caused by deprivation of treatment opportunity, or secondary damage might be caused to the patient and/or a guardian who can hardly have an opportunity to take action. Accordingly, in this review, we would like to help create the necessary conditions for both health and medical service personnel and patients/guardians, respectively, to provide and receive medical treatment in a more secure environment. Therefore, objective assessment of the institution and issues relating to this aforementioned incident and general cases of violence occurring in medical institutions, and by suggesting legal and institutional improvements and solutions.

• Journal of Yeungnam Medical Science
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• v.39 no.3
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• pp.223-229
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• 2022

Background: The first large coronavirus disease 2019 (COVID-19) outbreak outside China occurred in Daegu. In response, we developed infection prevention measures for surgical patients during the outbreak at our hospital and retrospectively reviewed the outcomes of COVID-19-related surgical patients. Methods: We reviewed the medical records of 118 COVID-19-related surgical patients and monitored their clinical outcomes until March 31, 2021. We also interviewed healthcare workers who participated in their perioperative care at Kyungpook National University Chilgok Hospital. The perioperative management guidelines for COVID-19-related patients were prepared through multidisciplinary discussions, including the infection control department, surgical departments, and anesthesiology department before and during the COVID-19 outbreak. Results: One standard operating room was temporarily converted to a negative-pressure room by increasing the exhaust air volume, creating a relative pressure of -11.3 Pa. The healthcare workers were equipped with personal protective equipment according to the patient's classification of the risk of COVID-19 transmission. The 118 COVID-19-related patients underwent emergent surgery in the negative-pressure room, including three COVID-19-confirmed patients and five COVID-19-exposed patients. Conclusion: All surgeries of the COVID-19-related patients were performed without specific adverse events or perioperative COVID-19 transmission. Our experience setting up a negative-pressure operating room and conservative perioperative protocol to prevent COVID-19 transmission will help plan and execute infection control measures in the future.

• The Korean Journal of Emergency Medical Services
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• v.13 no.2
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• pp.17-59
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• 2009

Purpose : This study is to provide the basic data for developing the curriculum standardization of emergency medical technology by analyzing the three-year and four-year period curriculum and high-advanced major course to bring up highly qualified paramedics. Method : This study was analyzed, divided in 3 sections, majors, teaching profession subjects and liberal arts of 18 three-year curriculum universities and 7 four-year curriculum universities. Majors were analyzed, departmentalized in the national examination for license, the clinical and on-the-job training(OJT) and other major-related subjects. It is descriptive study, analyzed by dividing high-advanced major course into majors and liberal arts. Result : 1) The average number of subjects established in three-year-course college were 58.1. The completion credit was 130.1 in average. Also, the average number of established subjects at four-year-course were 61.1. The average completion credit was 141. 2) Three-year-course college professors give lecture in theory for 95.4 hours on average, which account for 59.9% of overall lecture, and 63.8 hours for practical training that takes 40.1% of the hours lectures are given. Meanwhile, four-year-course give lecture in theory for 111 hours on average, taking a part of 59.5%, and 76.5 hours for practical training, 40.5%. 3) In regard to liberal arts, at three-year-course college, the average credit was 16 but the proportion that liberal arts charge among the completion credit was 11.6. Meanwhile, at four-year-course universities, the average credit was 28.4 and the percentage that the liberal arts took part in the completion credit was 20.1. 4) Looking over national examination subjects among majors at three-year-course college, basic medicine's average credit was 17.2, introduction to advanced emergency care's average credit was 15.5, Special advanced emergency care's average credit was 28, emergency patient management's average credit was 9.2 and emergency medicine statute's average credit was 3.6. Meanwhile, in case of four-year-course universities, basic medicine's average credit was 14.3, introduction to advanced emergency care's average credit was 12.7, special advanced emergency care's average credit was 31, emergency patient management's average credit was 8.3 and emergency medicine statute's average credit was 2.9. 5) Among national examination subjects, in case of three-year-course, the range of basic medicine credits was 6 to 23, the average credit showed 17.2. The range of introduction to advanced emergency care credits was 9 to 21, the average credit showed 15.5. The range of special advanced emergency care credits was 19 to 36, the average credit showed 28. The range of emergency patient management credits was 5 to 12, the average credit was 9.2. The range of legal medicine credits was 3 to 6, the average was 3.6 credit. In case of four-year-course the range of basic medicine was 12 to 17, the average of the credit was 14.3. The range of introduction to advanced emergency care was 9 to 19, and the average of the credit was 12.7. The range of special advanced emergency care was 18 to 41, and the average of the credit was 31. The range of emergency patient management was 7 to 12, and the average of the credit was 8.3. The range of legal medicine was 3 to 4, and the average of the credit was 2.9. So except special advanced emergency care, all the other subjects had higher score in three-year-course than four-year-course. 6) About the other major-related subjects, the completion credit was 23 on average at three-year-course and 13.5 at four-year-course. 7) The clinical and on-the-job training(OJT), In the case of three-year-course, the average completion credit was 13.5 and 13.5 at four-year-course. 8) The teaching profession subject, In the case of three-year-course, the average credit was 3 and the percentage that the teaching profession subject took part in the completion credit was 2.3% on average. Four-year-course established the subject only at one university. 9) In high-advanced major process, the entire established subjects on average were 12.8 and the average completion credit was 36.3. In liberal arts, the average established subjects were 6.5 and the completion credit was 19.5. The number of majors were 9.5 on average and the credit was 26.5 Conclusion : According to the aforemention results, the curriculum for emergency medical technology needs to be developed and standardized.

• The Journal of Internal Korean Medicine
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• v.33 no.4
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• pp.543-557
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• 2012

Objectives : The purpose of this study which adopted a qualitative method was to evaluate blood pressure management behaviors of pre- and stage 1 hypertension patients and to provide fundamental data for developing a strategy about proper oriental medical treatment through analyzing factors related to a moxibustion clinical trial. Methods : Semi-structured interviews that focused on personal experiences with hypertension and its management were conducted with 10 hypertensive patients. The interviews lasted for approximately 50 minutes. Results : Most participants recognized that the direct cause of high blood pressure was unhealthy behavior rather than inheritance. Thus, the hypertensive patient believed they could recover their blood pressure to a normal level through removing the direct cause of hypertension instead of taking drugs. The reasons for these statements were that the drugs for controlling hypertension are not natural and they may have side effects. On future management plan of patients, most of them will continue to keep moxibustion and healthy behavior in the well-controlled blood pressure group. However in the uncontrolled blood pressure group, there was an increasing tendency to begin medication. Conclusions : For developing a strategy for an individual approach to hypertension management, we need to develop a client-centered attitude and strategy. That is, we need to tailor our approach to individual cases to avoid generalizations and stereotyping when developing an adherence increasing strategy.

• Quality Improvement in Health Care
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• v.8 no.2
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• pp.186-207
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• 2001

Background : This study presented an analysis of healthcare quality indicators using data mining and a development of decision support system for quality improvement. Method : Specifically, important factors influencing the key quality indicators were identified using a decision tree method for data mining based on 8,405 patients who discharged from a medical center during the period between December 1, 2000 and January 31, 2001. In addition, a decision support system was developed to analyze and monitor trends of these quality indicators using a Visual Basic 6.0. Guidelines and tutorial for quality improvement activities were also included in the system. Result : Among 12 selected quality indicators, decision tree analysis was performed for 3 indicators ; unscheduled readmission due to the same or related condition, unscheduled return to intensive care unit, and inpatient mortality which have a volume bigger than 100 cases during the period. The optimum range of target group in healthcare quality indicators were identified from the gain chart. Important influencing factors for these 3 indicators were: diagnosis, attribute of the disease, and age of the patient in unscheduled returns to ICU group ; and length of stay, diagnosis, and belonging department in inpatient mortality group. Conclusion : We developed a decision support system through analysis of healthcare quality indicators and data mining technique which can be effectively implemented for utilization review and quality management in a healthcare organization. In the future, further number of quality indicators should be developed to effectively support a hospital-wide Continuous Quality Improvement activity. Through these endevours, a decision support system can be developed and the newly developed decision support system should be well integrated with the hospital Order Communication System to support concurrent review, utilization review, quality and risk management.

• Journal of Digital Convergence
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• v.16 no.5
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• pp.267-276
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• 2018

The purpose of this study was to identify the categories and frequencies of communication of students in nursing simulation using standard patient. Data were collected through questionnaires and video recording of communication process of 41 nursing students in simulation related to pediatric enteritis from March to June, 2017. The data were analyzed the contents and frequencies of completed communication forms by trained researcher based on Interaction Process Analysis. In result, students used communication skills in task area frequently. Communication skills, such as orientation, open question, identification, giving information, opinion, and suggestion, and eye contact, were used frequently. In an uncomfortable atmosphere such as listening to the nursing client's complaints, students showed tension and stiff appearance. Students used high quality communication skills such as empathic understanding and therapeutic touch restrictively. In conclusion, we need education strategies relating to therapeutic communication for nursing professionalism and qualitative improvement of nursing service.

• The Journal of the Korean dental association
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• v.53 no.2
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• pp.82-95
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• 2015

Background: Interest in medical malpractice claims and accidents is a day-to-day social issue to general public as well as medical personnel. Related laws and regulations already have been established, and institutions based on the laws and regulations also have been founded. However, in our dental community, interest and response to the issue seem insufficient. Methods: We searched four medical literature databases that are mainly cited in the medical community. Keywords including 'dental malpractice claims', 'patient safety' and 'medical accident' were used for the search. Among the selected literatures, we chose specific ones separately whose content is authentic and easily approachable. Results: Medical malpractice claims and accidents tend to increase around the world. As the cost or the difficulty level of surgery increases, the dispute rate also increases, which appears even more apparent in developed countries. Preventive measures to prevent the disputes and accidents are not significantly different. Three critical of them include relationship of doctor with patient, the informed consent and medical record. Conclusion: Tools for accident occurrence or communication improvement have been introduced. All of those cost time and money. However, education or professional request of liability insurance companies, self-education and provision of guidelines can be immediately implemented. To implement those, dentists' promotion at the regional or national level is imperative. rhBMP-2 is widely used at sinus augmentation, alveolar bone defect, and socket preservation.

• Journal of The Korean Society of Clinical Toxicology
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• v.1 no.1
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• pp.6-11
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• 2003

Various forms of dialytic techniques are available for detoxification. Hemodialysis, hemoperfusion and hemofiltration (hemodialfiltration) are the main treatment modalities. Because these modalities are rather invasive and expensive, it must be decided in balance of the risk and benefit to the patient. The prime consideration in the decision is based on the clinical features of poisoning; hemodialysis or hemoperfusion should be considered in general if the patient's condition progressively deteriorates despite intensive supportive therapy. The hemodialysis technique relies on passage of the toxic agent through a semipermeable membrane so that it can equilibrate with the dialysate and subsequently removed. It needs a blood pump to pass blood next to a dialysis membrane, which allows agents permeable to the membrane to pass through and reach equilibrium. Solute (or drug) removal by dialysis has numerous determinants such as solute size, its lipid solubility, the degree to which it is protein bound, its volume of distribution etc. The technique of hemoperfusion is similar to hemodialysis except there is no dialysis membrane or dialysate involved in the procedure. The patient's blood is pumped through a perfusion cartridge, where it is in direct contact with adsorptive material (usually activated charcoal) that has a coating material such as cellulose. This method can be used successfully with lipid-soluble compounds and with higher-molecular-weight compounds than for hemodialysis. Protein binding does not significantly interfere with removal by hemoperfusion. In conclusion, hemodialysis, hemoperfusion and hemofiltration can be used effectively as adjuncts to the management of severely intoxicated patients.

• Journal of Korean Neurosurgical Society
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• v.61 no.1
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• pp.60-65
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• 2018

Objective : Choroidal metastases (CMs) are the most common intraocular tumor. Management is mainly radiation therapy with goals of pain control and visual improvement. However, many radiation-related complications are reported. Since gamma knife radiosurgery (GKS) for CM was first reported in 1995, few cases have been reported. We report 7 cases of CMs treated with GKS. Methods : From April 2011 to November 2014, 7 patients with CM underwent GKS. Their median age at treatment was 64 years (range, 51-71 years). Four males and three females were treated. Lung cancer was the most common primary pathology, followed by renal cell carcinoma and stomach cancer. Four patients had multiple cerebral lesions and were treated simultaneously for choroidal lesions. The median marginal dose of 20 Gy (range, 15-25 Gy) was administered at the 50% isodose line. Results : Median follow-up period after GKS was 8 months (range, 2-38.3 months). Four patients expired due to underlying malignancy progression. Except for two patients who were not followed with magnetic resonance image after GKS, all patients showed size reduction in the treated lesions, but a new choroidal lesion appeared in one patient and one recurred. Six of seven patients reported subjectively improved visual symptoms. Visual acuity improved in 2 patients, and 2 were stable upon objective examination. One patient showed no improvement in visual acuity, but ocular pain was relieved; another patient showed improved vision and tumor remission, but visual deterioration recurred. Conclusion : GKS was shown to be safe and effective and should be considered for CM treatment.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.7
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• pp.4339-4345
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• 2013

Background: The purpose of this study was to evaluate the prevalence of BRCA1 (MIM: 113705) founder mutations in familial breast cancer (BC) patients with high risks in Iran. BRCA1 is among the cancer susceptibility genes best known for high penetrance mutations. BRCA1 genotyping is now used to determine patient counseling, management decisions, and prognosis of this syndrome. Materials and Method: Thirty nine patients with clinical BC and 29 high risk healthy women, related to the patients, participated in the study. DNA from blood samples was extracted and analyzed by PCR and SSCP methods in order to find 185delAG and 5382insC founder mutations. In addition, a 251bp fragment of BRCA1's exon 11 was amplified and analyzed for determination of new mutations. Results: The data indicated the presence of 185delAG and 5382insC founder mutations in both groups studied. Two out of 39 BC patients (5.1%) and one out of 29 relatives (3.4%) were suspected to be carriers of 185delAG mutations. However, we found only one patient (2.6%) to be a carrier of a 5382insC mutation. Also, 2 women (5.1%) of the patient group and 3 n (10.3%) of relatives group were identified as carriers of unclarified mutations in the 251bp fragment of the BRCA1 gene. The carriers of BRCA1 founder mutations have a high lifetime risk of breast cancer. Conclusions: Therefore, these data are useful in counseling of individuals with a significant family history of breast cancer.