• Title/Summary/Keyword: Referral system

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Management of Severe Trauma Patients in the Emergency Intensive Care Unit (응급중환자실에서의 중증외상환자 치료)

  • Kim, Ji-Ju;Suh, Gil-Joon;Jeong, Ki-Young;Kwon, Woon-Yong;Kim, Kyung-Su;Lee, Hui-Jai;Kim, Yeong-Cheol;Choi, Seok-Ho;Lee, Young-Ho;Lee, Kyung-Hag;Han, Kook-Nam;Jae, Hwan-Jun;Kim, Hyo-Cheol
    • Journal of Trauma and Injury
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    • v.24 no.2
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    • pp.98-104
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    • 2011
  • Purpose: The aim of this study was to evaluate the quality of the trauma care system of our hospital, in which emergency physicians care for major trauma patients in the emergency intensive care unit (ICU) in consultation with intervention radiologists and surgeons. Methods: This was a retrospective observational study conducted in an emergency ICU of a tertiary referral hospital. We enrolled consecutive patients who had been admitted to our emergency ICU with major trauma from March 2007 to September 2010. We collected data with respect to demographic findings, mechanisms of injury, the trauma and injury severity score (TRISS), emergency surgery, angiographic intervention, and 6-month mortality. Then, we compared the observed and predicted survivals of the patients. The Hosmer-Lemeshow test and calibration plots by using 10 groups, one for each decile, of predicted mortality were used to evaluate the fitness of TRISS. P-values of greater than 0.05 represent a fair calibration. Results: Among 116 patients, 12 (10.34%) were dead within 6 months after admission to the ICU, and 29 (25.00%) and 38 (32.80%) patients received emergency surgery and angiographic intervention, respectively. The mean injury severity score and revised trauma score were $36.97{\pm}17.73$ and $7.84{\pm}6.75$, respectively. The observed survival and the predicted survival of the TRISS were 89.66% (95% confidence interval [CI]: 84.03~95.28%) and 69.85% (95% CI: 63.80~75.91%), respectively. The calibration plots showed that the observed survival of our patients was consistently higher than the predicted survival of the TRISS ($p$ <0.001). Conclusion: The observed survival for the trauma care system of our hospital, in which emergency physicians care for major trauma patients in the emergency ICU in consultation with intervention radiologists and surgeons, was higher than the predicted survival of the TRISS.

A Study on the Factors which influenced the Performance of Community Health Practitioners' Function -Around the CHPs in Kyonggi-province Area- (보건진료원 직무수행에 영향을 미치는 요인에 관한 연구 - 경기도 관내 보건진료원을 중심으로 -)

  • Lee Myoung-sook
    • Journal of Korean Public Health Nursing
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    • v.3 no.1
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    • pp.18-37
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    • 1989
  • This study was done in order to analyze the factors which influenced the performance level of community health practitioners' task. Interview survey was done during the period from August to October, 1986. Interviewee were 166 CHPs among total of 217 CHPs in Kyonggi province area. Multiple stepwise regression and canonical correlation analysis were used to identify major factors influenced to perform community health practitioners' task. The results of this study were summarized as follows: 1. General characteristics of CHPs 1) Personal characteristics The average age of CHPs was 37.8 years and their marital status was $77.6\%$ of married, educational back-ground was $65.3\%$ of junior college graduation. Their job career was $38.6\%$ of between 1-3 years, $33.3\%$ of between 3-5 years, $22.2\%$ of less than 1 years. Most of CHPs$(62.8\%)$ were fully satisfied with their job, $33.3\%$ were moderately, and $3.8\%$ were not satisfied. 2) Working environmental condition Only $31.7%$ of CHPs were satisfied with their working condition of primary health post, $26.6\%$ were not satisfied. Half of CHPs$(52.5\%)$ replied having good cooperation with health center, $10.1\%$ replied bad. Cooperation with health subcenter was good in $32.9\%$, and bad in $21.9%$. Cooperation with private health institutions was good in $34.2\%$, bad in $21.6%$. 2. Performance level of community health practitioners' task Among a total of 52 contents of their functions medical history taking. physical examination, referral of diagnostic laboratory work-up($(86.4\%)$, health assessment of pregnant women$(82.1\%)$, development of health information system$(79.4\%)$, supervision of health workers $(78.4\%)$, follow-up of family planning acceptors$(77.3\%)$, and follow-up of family planning acceptors' side effects$(77.3\%)$ were actively performed. Diagnosis of pregnancy$(62.1\%)$, sampling of drinking water for quality test$(52.5\%)$, making list of equipment' & supplies $(51.5\%)$, evaluation of primary health post activities $(37.6\%)$, organization of village health workers$(32.4\%)$ and management of village health workers $(30.1\%)$ were poorly performed. 3. Stepwise multiple regression analysis of job function The factors which influenced the performance level of community health practitioners' function were age, marital status, educational level, job career, job satisfaction, satisfaction of working environment of primary health post, cooperation of health center, cooperation of health center, cooperation of private health instiutions in orders. These 9 variables were able to explain job function from $25.7\%$ of program planning to $6.7\%$ of management of common disease. 4. Canonical correlation analysis between the performance of function and general characteristics of CHPs. Cooperation of private health institutions was found to be the factor influencing task performance of community organization, management of primary health post, technical supervision of health personnels. Job satisfaction of CHPs was also found to be the factor influencing task performance of family planning, management of common disease and maintenance of health information system.

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Historical Review of Modern Public Health Nursing (근대 보건간호의 역사적 고찰)

  • Lee, Bong-Suk;Han, Young-Ran;Yang, Sook-Ja
    • Journal of agricultural medicine and community health
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    • v.43 no.2
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    • pp.114-124
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    • 2018
  • Objectives: The purpose of this study is to examine the modern history of public health(PH) and suggest a way forward for PH nursing(PHN). Methods: This paper is a review article that derives results from literature review. Results: In the period of beginning (up to 1944), PHN began as the PH Department was created in the Hygiene Bureau in 1908 and tasks about nurses were legislated. PHN was limited to infectious disease tasks and performed mostly by missionaries. In the period of foundation formation (1945 to 1961), the Republic of Korea was founded, and PH policies and tasks were defined with the establishment of the central government organization and the applicable laws. In the period of foundation establishment (1962 to 1979), the Regional PH Act was amended, and as a result, PH Centers(PHCs) spread across the country. In the period of foundation expansion (1980 to 1994), the PH referral system of PHCs, PH Units, and Primary Health Care Post was established. In the period of organization in each area (1995 to 2005), PH programs reflecting changes in disease structure and public needs for the quality of life. A regional health care plan was launched. In the period of funtion expansion (2006 to present day), Centers for support health living were established. Conclusions: In the future, PH nurses need to have a macroscopic perspective that views PH through the overall PH system, and to expand from the existing healthcare concept to the national and global healthcare one.

Distribution Characteristics of the Medical Services in Korea (한국 의료서비스의 분포 특징 분석)

  • Lee Keumsook
    • Journal of the Korean Geographical Society
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    • v.40 no.2 s.107
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    • pp.242-251
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    • 2005
  • This study investigates the distribution characteristics of medical services in Korea. For the purpose this paper examines the spatial discordance between the provisions of the medical services and the need for them, and analyzes the spatial distribution patterns of medical service in both inter- and intra-regional levels. Disclosed is a severe regional disparity problem in the provision of medical facilities at both inter-regional and intra-regional levels. In recent years people's interest gets increased more in the social well-being of the community, and the resulting strong request makes it desirable to restructure the healthcare service system. This study has thus attempted to draw out the distribution function of the medical facilities, based on the examination of the real data. A particular attention has been paid to whether there exists any hierarchical structure in their size distribution. Quite remarkably, no appreciable hierarchical structure has been observed in the scale of the medical facilities in Korea, in sharp contrast to of the three-level hierarchical structure assumed in the three-level referral system adopted widely. Remarkably, it is revealed that medical facilities in Korea are described by scale-invariant distribution functions. Instead, scale-invariant power-law behavior has been found in the size distribution, which is expected to be rather generic and applicable to other countries as well.

Survey on Sexually Transmitted Infection Test of One Referral Laboratory in Seoul: Focused on Multiple Sexually Transmitted Diseases (서울 소재 일개 수탁 검사 기관에서 성병 검사의 실태조사: 다발성 성매개 감염병 중심으로)

  • Seok, Dong-In;Sung, Hyun Ho;Park, Chang-Eun
    • Korean Journal of Clinical Laboratory Science
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    • v.52 no.3
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    • pp.237-244
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    • 2020
  • Currently, sexually transmitted diseases (STD) are referred to as "sexually transmitted infections" (STIs) in the sense of including asymptomatic infections. STIs have a range of interrelationships. This study used the STI defined by the Minister of Health and Welfare of the Republic of Korea, and targeted syphilis, gonorrhea, chlamydia infection, chancroid, genital herpes simplex, condyloma, human papillomavirus, and non-gonococcal urethritis. The factors were characterized by identifying multiple and simultaneous STIs. This study used the data from the laboratory information system of a consigned inspection institution located in Seoul from 2014 to 2019. In this study, multiple STIs were identified as overlapping STIs of a double infectious source (10 types) and multiple STIs of a third infectious source (6 types). Among the 16 types of multiple STIs, U. urealyticum (9 types), HSV-2 (8 types), C. trachomatis (7 types), HPV 6, 11 (7 types), N. gonorrhoeae (6 types), and T. pallidum (1 type) were included. Therefore, additional research on interrelationship studies, such as STIs, which has the highest proportion of multiple STIs, will be necessary.

Video-Assisted Thoracoscopic Decortication for management of Postpneumonia Empyema (폐렴후 합병된 농흉 치료에 대한 비디오 흉강경적 박피술)

  • 김보영;오봉석;양기완;임진수;서홍주;박종철
    • Journal of Chest Surgery
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    • v.36 no.1
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    • pp.21-25
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    • 2003
  • Video-assisted thoracoscopic surgery (VATS) for decortication or debridement in the management of empyema thoracis has increased the available treatment options but requires validation. We present and evaluate our technique and experience with thoracoscopic management of pleural empyema, irrespective of chronicity. Material and Method : VATS debridement or decortication was performed with endoscopic shaver system in 40 consecutive patients presented with pleural space infections. A retrospective review was performed and the effect of this technique on perioperative outcome was assessed. Result : VATS evacuation of infected pleural fluid and decortication was successfully performed in 35 of 40 patients. The mean duration of preoperative symptoms before referral was 23$\pm$1.8 days. The mean duration of hospitalization before transfer was 13.5$\pm$1.5 days. Blood loss was 250 to 200 mL. Intercostal drainage was required for 5$\pm$3 days. The postoperative hospital stay was 5 $\pm$0.7 days. There were no operative mortalities. Conclusion : Video-assisted evacuation of infected pleural fluid and decortication is an effective modality in the management of the fibropurulent stage of empyema. An organized empyema should be approached thoracosco-pically, but may require open decortication.

Implementation and Design of motorcar consumption management iOS based software with OBD-II and WiFi network (OBD-II WiFi를 이용한 iOS 기반의 자동차 소모품관리 소프트웨어 설계 및 구현)

  • Jeong, Da-Woon;Nam, Jae-Hyun;Jang, Jong-Wook
    • Proceedings of the Korean Institute of Information and Commucation Sciences Conference
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    • 2011.10a
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    • pp.475-478
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    • 2011
  • driver for safety always check the status of their vehicle, and it is essential to understand. But if you want to know the status of the driver of the vehicle in specialist referral time and money because it costs the operator shall be paid. Today's rapidly changing IT technology with the development of the various features of your phone to check the status of the vehicle was able to do. However, the car's existing phone system, car diagnostic expertise must be learned because it will reveal the status of the vehicle do not have the expertise to not highlight the need for diagnostic. To reflect these points in smartphone users to easily use their own vehicles at a time to determine the status of a system that is required. In this paper, OBD-II protocol conversion WiFi OBD-II connector, retrieving information from the driver of the vehicle replacement cycle of consumables required vehicle inspection, vehicle problems in real-time diagnostic information to the user ease of use shows the IOS implementation in the automotive supply was implemented based on the smartphone.

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The Effects of Consumption Value on Satisfaction and Loyalty: Focusing on Chinese Smartphone Users (소비가치가 만족과 충성도에 미치는 영향: 중국 스마트폰 이용고객을 중심으로)

  • Cho, Hyun-Jin
    • Journal of Distribution Science
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    • v.12 no.8
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    • pp.123-132
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    • 2014
  • Purpose - Recently, Korean companies have been struggling to perform well in the larger smartphone market in China, which is regarded as a blue ocean area. First, it is very important to accurately understand the Chinese consumers, who have a different consumption culture and value system from the Korean culture and system. This would help to identify priorities for the Chinese market. Further, considering the smartphone industry, where technological change is rapid, Korean companies will need to take prompt measures about market trends in order to establish strong competitiveness. Consequently, this study focused on analyzing the relationship between the variables of consumption value, satisfaction, and loyalty in the Chinese smartphone market. The principal dimensions of consumption value, which smartphones have, was analyzed, and the influence on satisfaction was identified. Moreover, the relationship among the variables of satisfaction, attitudinal loyalty, and behavioral loyalty was empirically analyzed. Research design, data, and methodology - This study examined the relationships between various consumption values (functional value, emotional value, social value, epistemic value, and economic value), along with satisfaction and loyalty. The data were collected through a questionnaire survey that was circulated to 310 customers who were users of smartphones in Chingdao and Yeontae regions in China. The survey was conducted from June 23 to August 4, 2013. A total of 301 responses to the questionnaires were collected and used for the data analysis. Moreover, a path analysis based on Lisrel 8.54 was used for the hypothesis test. Results - The variables of functional value, emotional value, social value, and epistemic value were revealed to have positive effects on satisfaction related to smartphone usage. However, the variables of monetary cost and psychological cost were not found to have negative effects on satisfaction related to smartphone usage. Moreover, satisfaction positively influenced attitudinal loyalty related to smartphone usage, but did not have a significant influence on behavioral loyalty related to smartphone usage. Specifically, satisfaction is essential, but not a sufficient condition for building behavioral loyalty in relation to smartphone usage. In addition, attitudinal loyalty positively influenced behavioral loyalty in relation to smartphone usage. Conclusions - First, this study shows that functional value, emotional value, social value, and epistemic value in relation to smartphone usage are important for marketing in the Chinese smartphone market. Particularly, functional value and emotional value play pre-eminent roles as regards customer loyalty in the use of smartphones. Second, the results of this study reveal that the variables of monetary cost and psychological cost are not important to the Chinese consumers. Specifically, the smartphone price and cognitive effort are not perceived as value barriers. Third, satisfaction did not guarantee behavioral loyalty in relation to smartphone usage, and the strategic approach for improving the repurchase and referral action in relation to smartphones based on solid attitudinal loyalty would be desirable and should be the focus of the marketing activities of Korean smartphone companies.

A RURAL HEALTH SERVICE MODEL FOR KOREA BASED OH A PRIMARY CARE NURSING SERVICE SYSTEM

  • Hong, Yeo-Shin
    • Journal of Korean Academy of Nursing
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    • v.11 no.2
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    • pp.5-8
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    • 1981
  • This study concerns itself with the development of a new model of comprehensive health service for rural communities of Korea. The study was conceived to resolve the problems of both underservice in rural communities and underutilization of valuable health manpower, namely the nurses, the disenchanted elite health personnel in Korea. On review of the current situation, the greatest deficiencies in the Korean health care system were found in the availability of primary care at the peripheries of md communities, in the dissemination of knowledge of disease prevention and health care, and in the induction of and guidance for active participation by the clientele in health maintenance at the personal, family and community level Abundant untapped health resources were identified that could be brough to bear upon the national effort to extend health services to every member of the Korean Population. Therefore, it was Postulated that the problem of underservice in rural communities of Korea can be structurcturally resolved by the effective mobilization and organization of untapped health resources, and that. a primary care Nursing Service System offers the best possibility for fulfillment of rural health service goals within the current health man-power situation. In order to identify appropriate strategies to combat the present difficulties in Korean rural health services and to utilize nurses and other health personnel in community-centered health programs, a search was made for examples of innovative service models throughout the world. An extensive literature survey and field visits to project sites both in Korea and in the United States were made. Experts in the field of world health, health service, planners, administrators, and medical and nursing practitioners in Korea, in the United States as well as visitors from other Asian countries were widely consulted. On the basis of information and inputs from these experts a new rural health service model has been constructed within the conceptual framework of community development, especially of the innovation diffusion Model. It is considered especially important that citizens in each community develop capacities for self-care with assistance and supports from available health professionals and participate in health service-related decisions that affect their own well-being. The proposed model is based upon the regionalization of health care planning utilizing a comprehensive Nursing Service System at the immediate delivery level The model features: (1) a health administration unit at each administrative level; (2) mechanisms for community participation; (3) a continuous source of primary health care at the local community level; (4) relative centralization of specialty care and provision of tertiary or super-specialty care only at major national metropolitan centers; and (5) a system for patient referral to the appropriate level of care. This model has been built around professional nurses as the key community health workers because their training is particularly suited and because large numbers of well-trained nurses are currently available and being trained. The special element in this model is a professional nurse-guided, self-care facilitating primary care Community Nursing Service System. This is supported by a Nursing Extension Service as a new training and support structure. (See attached diagrams). A broad spectrum of programs was proposed for the Community Nursing Service System. These were designed to establish a balance of activities between the clinic-centered individual care component and the field activity-centered educational and supportive component of health care services. Examples of possible program alternatives and proposed guidelines for health care in specific situations were presented, as well as the roles and functions of the key health personnel within the Community Nursing Service System. This Rural Health Service Model was proposed as a real alternative to the maldistributed, inequitable, uncoordinated solo-practice, physician-centered fee-for-service health care available to Koreans today.

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The Medicare Service Facility Location Problem (의료서비스시설 입지문제)

  • 이금숙
    • Journal of the Economic Geographical Society of Korea
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    • v.1 no.2
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    • pp.71-84
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    • 1998
  • Health has been seen as a resource necessary for both maintaining oneself and for living in a society pursuing high quality of life. Therefore, the medicare provision takes place of one of the most significant indexes for evaluating the regional welfare level. The purpose of this study is to investigate the locational characteristics of medicare service facilities. For the purpose, the distribution patterns of the medicare resources are analyzed both at the regional and local scales. The medicare resources are concentrated at the Metropolitan Seoul area in the regional scale, and they are also concentrated at the economic core areas in the local scale. Especially, higher level medicare resources, such as the general hospitals and medical specialists, show more concentration at the economic core areas than lower level services. This means that access to opportunities to receive higher level medicare is poorer in a more socially disadvantaged area. Since medicare service facilities are invested and operated by both private and public sectors, whose locational mechanisms are deferent, we analyzed the distribution patterns. Most medicare facilities are invested and managed by private sector in Korea, which is operated by market mechanism. This is related with the fact that the medicare facilities are concentrated at the economic core areas. The proportion of private sector is higher in the Metropolitan Seoul area, and thus this region shows stronger spatial disparity of medicare provision. In general, the medicare service facilities are located in the hierarchical structure, and thus the services levels and facility scales are differentiated by the hierarchy. We examined the hierarchical structure in the medicare service facilities in Korea. The referral medicare system has been applied with the assumption of the three level hierarchical structures in Korea. However, we could not find any distinct hierarchical structure in the scales of the medical service facilities.

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