• 제목/요약/키워드: Patient guideline

검색결과 311건 처리시간 0.026초

족관절염좌 환자 관리를 위한 한의표준임상경로 개발 연구 (A Study on the Development of a Clinical Pathway of Korean Medicine for the Management of Patients with Ankle Sprain)

  • 윤상도;송미연;정원석;김형석;신우철;김태오;조휘성;서연호;서상우;서준원;강준혁;유승호;김세윤;조재흥
    • 한방재활의학과학회지
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    • 제32권3호
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    • pp.141-151
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    • 2022
  • Objectives The purpose of this study is to improve the accessibility of Korean medicine by standardizing managements, improving quality of medical services, and reducing medical costs in ankle sprain by develop clinical pathway (CP). Methods The development of CP in this study is based on clinical practice guideline (CPG) for ankle sprain, and aims to maximize the quality of treatment, such as reducing treatment time and medical costs, and increasing patient satisfaction through standardized pathway. The CP was revised after consultation and review by the advisory committee. The advisory committee is consisted of a stakeholder group applying the CP. Results In previous research studies, there were no Korean medicine CP studies on ankle sprain. Based on CPG for ankle sprain and analysis of medical records, 6 types of time task matrix type CP (for Korean medicine doctors, medical assistant, patients) and 4 types of algorithm type CP (for Korean medicine clinics, Korean medicine hospitals, and cooperative practicing hospitals, public medical centers) were derived as a result. Conclusions Ankle sprain CP is expected to not only increase patient satisfaction and maximize the quality of treatment, but also reduce the financial burden of health insurance by reducing medical costs.

Guidelines for Transrectal Ultrasonography-Guided Prostate Biopsy: Korean Society of Urogenital Radiology Consensus Statement for Patient Preparation, Standard Technique, and Biopsy-Related Pain Management

  • Myoung Seok Lee;Min Hoan Moon;Chan Kyo Kim;Sung Yoon Park;Moon Hyung Choi;Sung Il Jung
    • Korean Journal of Radiology
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    • 제21권4호
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    • pp.422-430
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    • 2020
  • The Korean Society of Urogenital Radiology (KSUR) aimed to present a consensus statement for patient preparation, standard technique, and pain management in relation to transrectal ultrasound-guided prostate biopsy (TRUS-Bx) to reduce the variability in TRUS-Bx methodologies and suggest a nationwide guideline. The KSUR guideline development subcommittee constructed questionnaires assessing prebiopsy anticoagulation, the cleansing enema, antimicrobial prophylaxis, local anesthesia methods such as periprostatic neurovascular bundle block (PNB) or intrarectal lidocaine gel application (IRLA), opioid usage, and the number of biopsy cores and length and diameter of the biopsy needle. The survey was conducted using an Internet-based platform, and responses were solicited from the 90 members registered on the KSUR mailing list as of 2018. A comprehensive search of relevant literature from Medline database was conducted. The strength of each recommendation was graded on the basis of the level of evidence. Among the 90 registered members, 29 doctors (32.2%) responded to this online survey. Most KSUR members stopped anticoagulants (100%) and antiplatelets (76%) one week before the procedure. All respondents performed a cleansing enema before TRUS-Bx. Approximately 86% of respondents administered prophylactic antibiotics before TRUS-Bx. The most frequently used antibiotics were third-generation cephalosporins. PNB was the most widely used pain control method, followed by a combination of PNB plus IRLA. Opioids were rarely used (6.8%), and they were used only as an adjunctive pain management approach during TRUS-Bx. The KSUR members mainly chose the 12-core biopsy method (89.7%) and 18G 16-mm or 22-mm (96.5%) needles. The KSUR recommends the 12-core biopsy scheme with PNB with or without IRLA as the standard protocol for TRUS-Bx. Anticoagulants and antiplatelet agents should be discontinued at least 5 days prior to the procedure, and antibiotic prophylaxis is highly recommended to prevent infectious complications. Glycerin cleansing enemas and administration of opioid analogues before the procedure could be helpful in some situations. The choice of biopsy needle is dependent on the practitioners' situation and preferences.

과거력 의무기록 정보의 기재정도 및 일치도 분석 (A Study on the Level of Medical Record Documentation and Agreement in the Information on the Patient's Past History)

  • 서정숙;유승흠;오현주;김용욱
    • 한국병원경영학회지
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    • 제13권1호
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    • pp.42-64
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    • 2008
  • This study was conducted to evaluate the quality in medical records by analyzing its completeness through setting up the level of record on the patient's past history and through examining the actual medial records. Targeting the information on the patient's past history in interns' records, residents' records and nurses' records toward 403 inpatients who were admitted first in 2004 at an university hospital due to stomach cancer. We analyzed whether the charts were recorded or not, recording level, the satisfaction with the expectant level of the records in the hospital targeted for a research and the level of agreement. The results were as follows; first, as for the rate of recording those each items, they were high in the chief complaint & present illness and the past illness history. Depending on the group of recorders, the recording rate showed big difference by items. Second, as a result of measuring the level after dividing the recording level of items for the patient's past history from Level 1 to Level 4 by each item, the admission history, the past illness history, and the family history were about Level 3, and the smoking history, the medication history, the chief complaint & present illness, the drinking history and allergy were about Level 2. In the admission department, it was excellent in the interns' records for the medical department. Third, as a result of its satisfactory level by comparing the expect level of a record and the actual record by item in information on the patient's past history, which was expected by the medical-record committee members of the hospital targeted for a study. And forth, we analyzed the level of agreement with Kappa score in the level of 'Yes' or 'None' related to the corresponding matter in Level 1, in terms of information on the past history in the intern's record, the resident's record, and the nurse's record. The level of agreement in the resident's record & the nurse's record, and in the intern's record & the resident's record was from "excellent" to "a little good". There were differences in the level of completeness and in reliability for the information on the past history by the recorder group or by the admission department. The encounter process that was performed by the admission department or the recorder group, indicated the result that was directly reflected on the quality of medical records, thus it was required further study about the medical record documentation process and quality of care. The items that showed the high recording rate quantitatively were rather low, consequently we'd should develop the tool for the qualitative inspection and evaluate the medical records further. And the items were needed to be detailed in the record level were rather low, and hence there needed to be a documentation guideline and education by the clinical departments.

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국가지정입원격리병상의 시설별 면적구성에 관한 연구 - 2016년 국가지정입원격리병상 확충사업대상을 중심으로 (A Study on the Area Composition Analysis of the National Designated Isolation Unit Wards(NDIUs) - Focused on the NDIU wards issued in 2016)

  • 윤형진;권순정
    • 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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    • 제23권2호
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    • pp.73-82
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    • 2017
  • Purpose: Since the facility guidelines for National Designated Isolation Unit wards(NDIUs) had been edited since 2016, all hospital who want to expand or install NDIU should adapt the new guidelines. Instead of providing area requirement, by the way, only essential or optional facility requirements are suggested except patient bedroom in the guidelines. So, as analyze area and area composition of the NDIUs, it could be expected that this study has a role as an area planing reference for not only NDIU but also another airborne infection isolation room. Methods: For the area analysis, 18 sample hospitals are selected among 2016 year applicants. All rooms in NDIUs are grouped as zones whether those are negative air pressurized or not and programed room or not. At the end, area of the zones are summarized and analysed a relationship between area increase and bed number by both correlation analysis and regression analysis. In addition, department usable and gross area per bed, N/G ratio, G/N ratio, and average area ratio of each zone is calculated. Results: First of all, rooms in none negative air pressurized zone of the NDIUs haven't shown a regular installation so that only those in negative air pressurized zone are targeted for the area analysis. Second of all, patient room unit(0.92) and support area(0.79), by correlation analysis, are correlated with total net area. Patient room unit(0.94) and total net area(0.79) are also shown a correlation with bed number. Department usable area($R^2=0.63$, y=36.278x + 102) and patient room unit area($R^2=0.89$, y= 27.993x - 0.8924) has a relationship with bed number by regression analysis. Average N/G is shown as 0.85 and G/N 1.36. Average area ratio of circulation, doffing area, patient room unit, and support area are 25.4%, 9.1%, 50.9%, and 14.6% in order. Implications: This study is a basic research for exploring the NDIUs guidelines to find resonable evidence to develop it for its practical use. Still, it is possibly expected that the guideline is to be developed by post occupancy evaluation in the area of where minimum requirement or facility grade needs to be defined, and by further studies with various perspectives.

환자 개인정보보호에 관한 치과종사자의 인식 및 실천 (Knowledge and Practice of Dental Practitioners Regarding Patient's Personal Information)

  • 이수영;소지현
    • 치위생과학회지
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    • 제17권2호
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    • pp.99-107
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    • 2017
  • 개인정보보호에 대한 관심이 높아지고 있는 현재, 치과종사자의 개인정보보호에 대한 지식, 실천 인식 정도를 파악하기 위하여 치과 종사자 550명을 대상으로 자기기입식 설문조사를 시행하였고, 그 중 총 506부(92.0%)가 자료 분석에 사용되었으며 본 연구의 결과는 다음과 같다. 개인정보보호법에 관한 치과종사자의 정답률은 전체 평균 64.2%로 나타났으며 일반적 특성에 따른 개인정보보호법에 관한 지식의 차이는 연령, 근무경력 문항에서 통계적으로 유의한 차이가 나타났다. 일반적 특성에 따른 환자 개인정보보호행위에 관한 인식도에서는 성별, 학력, 근무경력, 근무기관에서 차이가 있었고, 실천도에서는 연령, 성별, 학력, 근무경력, 근무기관, 직종에서 유의한 차이가 있었다. 직종에 따른 개인정보보호법에 관한 인식의 차이에서는 개인정보처리자 인식, 개인정보보호 책임감 문항에서 직종 간 통계적으로 유의한 차이가 있었다. 개인정보보호 교육 관련요인은 교육 참여 횟수, 교육방법에서 직종 간에 유의한 차이가 있었다. 개인정보보호법 인식에서 치과의사는 가장 높게 나타났으며 치과위생사는 가장 낮은 인식도를 나타냈고, 개인정보보호 교육경험이 1번 있는 치과의사는 54.5%로 다른 직종보다 높게 나타났으며 반면에 치과위생사의 50.2%는 교육경험이 없는 것으로 나타났다. 개인정보보호에 관한 지식, 인식과 실천과의 상관관계는 인식이 높을수록 실천이 높은 것으로 나타났다. 결론적으로 치과종사자들은 다른 종사자들에 비해 지식, 교육경험, 인식에 비해 실천도가 낮았으며 그 중 치과위생사는 전반적 부분에서 낮은 점수를 나타냈다. 몇 년간 지속되어온 개인정보 유출의 심각성에 대해서 인식은 하고 있으나 진료실에서 체감하는 개인정보보호에 대한 인식이 부족하고 대부분 병원 내에 개인정보보호에 대한 가이드라인이 명확히 규정되어 있지 않으며 원내교육이나 보수교육 등 교육기회와 교육경험의 부족으로 생각된다. 이에 치과종사자들은 접수를 포함한 모든 진료 과정에서의 개인정보보호 필요성을 인식해야 하며 개인정보보호 실천을 위한 체계적이고 효과적인 반복교육과 그에 따른 노력이 필요하다고 생각된다.

대장암 항암 화학요법의 처방 오류 평가 및 개선안 제시 (Guideline of Improvement and Evaluation of Prescribing Errors in Colorectal Chemotherapy)

  • 임현수;임성실
    • 한국임상약학회지
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    • 제23권2호
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    • pp.158-166
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    • 2013
  • Background: Colorectal cancer shows a significant increase in South Korea due to westernization of diet, lack of dietary fiber, drinking and smoking, irregular defecation. There are surgery, chemotherapy, radiation therapy in treatment of colorectal cancer. There may be a medication errors in the process of chemotherapy because of its high toxicity, narrow therapeutic index and the health status of cancer patients. Consequently medication errors can cause increasing the risk of death, prolonging hospital stay and increasing the cost. Among medication errors on medication use process, prescribing errors are of particular concern due to higher risk of serious consequences. It is important for pharmacist to prevent the prescribing errors before reaching patient. Therefore we analyzed the prescriptions of colorectal cancer, classified prescribing errors, suggested guideline to reduce prescribing errors and verified the importance of pharmacist's role in prevention of medication errors activity. Methods: We collected the numbers of prescriptions of colorectal cancer(n=2,373) through anti cancer management program and EMR and analyzed the errors of prescriptions by categories from Oct 1st 2011 to Sep 30th 2012 at Chungbuk National University Hospital. We reviewed the prescriptions as follows - patients' characteristics, the result of test, previous prescriptions, characteristics of antineoplastic agents and patients' allergy, drug sensitivity, adverse events. Prescriptions are classified into inpatient and outpatient and analyzed the errors of prescriptions by categories (dosage form, dose, input, diluents, regimen, product). Results: Total prescription number of inpatient and outpatient of colorectal cancer was 1,193 and 1,180 and that of errors was 107(9%) and 22(1.9%), respectively. In case of errors of categories, the number of errors of dosage form is 69 and 8, errors of dose is 15 and 5, errors of input is 9 and 9 in inpatient and outpatient prescriptions, respectively. Errors of diluents is 8, errors of regimen is 3, errors of product is 3 in only inpatient prescriptions. In case of errors of categories by inpatient department, the number of errors of dosage form is 34 and 35, errors of dose is 7 and 8, errors of input is 6 and 3, errors of diluents is 4 and 4, errors of regimen is 2 and 1, errors of product is 2 and 1 in SG and HO, respectively. In case of outpatient department, the number of errors of dosage form is 8 in HO, errors of dose is 5 in HO, errors of input is 5 and 4 in SG and HO, respectively. Conclusions: The rate of errors of inpatient is higher than that of outpatient. Junior doctors are engaged in prescriptions of inpatient and pharmacist need to pay attention to review all prescriptions. If prescribing errors are discovered, pharmacist should contact the prescriber and correct the errors without delay. The guideline to reduce prescribing errors might be upgrading software of anti cancer management program, education for physicians as well as pharmacists and calling prescriber's attention to preventing recurrence of errors.

Clinical Practice Guidelines for the Medical and Surgical Management of Primary Intracerebral Hemorrhage in Korea

  • Kim, Jeong Eun;Ko, Sang-Bae;Kang, Hyun-Seung;Seo, Dae-Hee;Park, Sukh-Que;Sheen, Seung Hun;Park, Hyun Sun;Kang, Sung Don;Kim, Jae Min;Oh, Chang Wan;Hong, Keun-Sik;Yu, Kyung-Ho;Heo, Ji Hoe;Kwon, Sun-Uck;Bae, Hee-Joon;Lee, Byung-Chul;Yoon, Byung-Woo;Park, In Sung;Rha, Joung-Ho
    • Journal of Korean Neurosurgical Society
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    • 제56권3호
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    • pp.175-187
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    • 2014
  • The purpose of this clinical practice guideline (CPG) is to provide current and comprehensive recommendations for the medical and surgical management of primary intracerebral hemorrhage (ICH). Since the release of the first Korean CPGs for stroke, evidence has been accumulated in the management of ICH, such as intracranial pressure control and minimally invasive surgery, and it needs to be reflected in the updated version. The Quality Control Committee at the Korean Society of cerebrovascular Surgeons and the Writing Group at the Clinical Research Center for Stroke (CRCS) systematically reviewed relevant literature and major published guidelines between June 2007 and June 2013. Based on the published evidence, recommendations were synthesized, and the level of evidence and the grade of the recommendation were determined using the methods adapted from CRCS. A draft guideline was scrutinized by expert peer reviewers and also discussed at an expert consensus meeting until final agreement was achieved. CPGs based on scientific evidence are presented for the medical and surgical management of patients presenting with primary ICH. This CPG describes the current pertinent recommendations and suggests Korean recommendations for the medical and surgical management of a patient with primary ICH.

스마트올인원 심폐순환보조장치의 안전성 및 성능평가에 관한 연구 (A Study on Safety and Performance Evaluation of Smart All-in-one Cardiopulmonary Assist Device)

  • 박준현;호예지;이예림;이덕희;최재순
    • 대한의용생체공학회:의공학회지
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    • 제40권5호
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    • pp.197-205
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    • 2019
  • The existing Extracorporeal membrane oxygenation(ECMO) and Cardiopulmonary bypass system(CPB) have been developed and applied to various devices according to their respective indications. However, due to the complicated configuration and difficult usage method, it causes inconvenience to users and there is a risk of an accident. Therefore, smart all-in-one cardiopulmonary circulation device is being developed recently. The smart all-in-one cardiopulmonary assist device consists of a blood pump for cardiopulmonary bypass, a blood oxidizer for cardiopulmonary bypass, a blood circuit for cardiopulmonary bypass, and an artificial cardiopulmonary device. It is an integrated cardiopulmonary bypass device that can be used for a variety of purposes such as emergency, intraoperative, post-operative intensive care, and long-term cardiopulmonary assist, combined with CPB used in open heart surgery and ECMO used when patient's cardiopulmonary function does not work normally. The smart all-in-one cardiopulmonary assist device does not exist as a standard and international standard applicable to advanced medical devices. Therefore, in this study, we will refer to the International Standard for Blood Components, the International Standard for Blood, the Guideline for Blood Products, and prepare applicable performance and safety guidelines to help quality control of medical devices, and contribute to the improvement of the health of people. The guideline, which is the result of conducted a survey of the method of safety and performance test, is based on the principle of all-in-one cardiopulmonary aiding device, related domestic foreign standards, the status of domestic and foreign patents, related literature, blood pump(ISO 18242), blood oxygenator (ISO 7199), and blood circuit (ISO 15676) for cardiopulmonary bypass.The items on blood safety are as follows: American Society for Testing and Materials ASTM F1841-97R17), and in the 2010 Food and Drug Administration's Safety Assessment Guidelines for Medical Assisted Circulatory Devices. In addition, after reviewing the guidelines drawn up through expert consultation bodies including manufacturers / importers, testing inspectors, academia, etc. the final guideline was established through revision and supplementation process. Therefore, we propose guidelines for evaluating the safety and performance of smart all-in-one cardiopulmonary assist devices in line with growing technology.

한방 치료로 고안드로겐혈증을 개선한 다낭성 난소 증후군 연속증례연구 (A Case Series of Polycystic Ovary Syndrome with Improved Hyperandrogenism Treated with Korean Medicine)

  • 신혜규;배지용;지영근;안해인;윤영흠;김남권
    • 대한한방부인과학회지
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    • 제34권3호
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    • pp.175-191
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    • 2021
  • Objectives: This study aims to analyze the medical record of eight cases of polycystic ovary syndrome (PCOS) in a local Korean medicine clinic, in order to provide evidence on Korean medicine treatment of PCOS and to suggest the direction of future studies. Methods: The medical records of eight cases diagnosed with PCOS based on 2003 Rotterdam Criteria and whose total testosterone level was 0.53 ng/ml and over were retrospectively analyzed. The primary outcome was total testosterone level, and the secondary outcomes included luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels, LH/FSH ratio, weight, last mentrual period (LMP), numerical rating scale (NRS) score of dysmenorrhea, and other associated symptoms pre- and post-treatment. Korean medicine treatment consists of the complex herbal prescription consisting of Yukmijihwang-tang, Baekho-tang, Daesiho-tang, and Gyejibokryeong-hwan, modified according to symptoms; acupuncture and electroacupuncture on 中脘 (CV12), 下脘 (CV10), 關元 (CV4), 石門 (CV5), 合谷 (LI4), 太衝 (LR3), 三陰交 (SP6), and 懸鍾 (GB39); and indirect moxibustion on 神闕 (CV8). Results: The average total testosterone level lowered statistically significantly after the treatment. The average FSH and LH levels lowered with insignificance, while the average LH/FSH ratio and weight lowered statistically significantly. During the treatment period of three to six months, every patient had the menstrual cycle shortened except for one case; and two cases with infertility problem succeeded in being pregnant. There was no adverse event. Conclusions: The Korean medicine treatment was found effective in treating PCOS, especially regarding hyperandrogenism, amenorrhea or oligomenorrhea, and infertility.

지역 EMS의 현장검사 혈당측정기 사용에 대한 실태조사 (Survey of Point-of-Care Testing Devices for Pre-hospital EMS Equipment of Glucometer on Local Area)

  • 김병현;최대해;하경임
    • 농촌의학ㆍ지역보건
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    • 제47권4호
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    • pp.220-228
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    • 2022
  • 119 구급대원들이 사용하는 현장 검사 장비 중 하나인 자가 혈당측정기는 결과 값이 정확해야 환자에게 적절한 처치를 제공할 수 있다. 연구 최초 조사 시점 이후 현재까지도 119 구급대원 현장업무 지침에 현장 검사 장비의 작동 유무, 수량 등을 확인하는 것은 있으나, 장비의 점검에 수량, 작동 여부 등은 있으나 본 연구에서 분석한 정도관리 내용은 없다. 현장검사 장비의 질 관리가 되지 않고 있다는 것은 환자에 대한 부정확한 평가와 이로 인한 불필요한 처치와 과소, 과대처치 또는 환자 상태가 악화될 가능성을 높일 수 있다. 본 연구를 통해, 앞으로 119 구급대원의 혈당측정기를 포함한 모든 현장검사 장비의 사용실태조사가 이루어져야 하고, 119 구급대 현장 업무 지침에 현장 검사 장비 정도관리를 추가하여야 하겠다. 또한, 현장 검사 장비가 관련 지침에 따라서 적절한 질 관리가 이루어져야 하고, 지역에서 관련 업무 전문가나 응급의료지도를 담당하고 있는 지도의사에게 관리되는 것이 합당하겠다.