• Title/Summary/Keyword: Request a discharge

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Treatment of Gastroesophageal Reflux Disease in 2 Young Dogs

  • Han, Jihee;Kim, Yeonsoo;Seo, Kyoungwon;Song, Kunho
    • Journal of Veterinary Clinics
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    • v.38 no.5
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    • pp.231-234
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    • 2021
  • A 14-month-old, intact female Maltese (case 1) and a 26-month-old, spayed female Dachshund (case 2) had persistent regurgitation over 1 year and 2 years, respectively. In both cases, there were not specific findings in blood examination. Diagnostic imaging and fluoroscopy revealed that gastroesophageal reflux (GER) occurred when the patients ate a barium meal without abdominal contraction. They were treated with proton-pump inhibitor (esomeprazole), sucralfate and prokinetics (cisapride) while in a standing position for an hour after every meal, according to the gastroesophageal disease (GERD) suggested treatment. The case 1 dog was discharged with improved clinical signs, and the case 2 dog also had been improved clinical signs; however, aspiration pneumonia occurred in case 2, which was thought to be a complication from GERD. After receiving treatment for aspiration pneumonia, the case 2 dog was discharged from the hospital. Since there was no further improvement in symptoms after discharge, the case 1 dog was euthanized by owner's request, and the case 2 is alive, having only mild clinical signs upon the writing of this paper.

A Review of the Right to Terminate a Contract by a Medical Institution - Focusing on the Case that Treatment is Completed - (상급종합병원의 입원계약 해지권 행사에 대한 검토 -해당 의료기관에서의 치료가 종결된 경우를 중심으로-)

  • Park, Darae
    • The Korean Society of Law and Medicine
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    • v.22 no.4
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    • pp.89-115
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    • 2021
  • Korea's health care delivery system is based on the Medical law and the National Health Insurance Act. In order to efficiently operate limited medical resources, it is classified to use medical institutions according to the severity of the disease. The question is whether a tertiary care hospital can terminate a medical contract for a patient, if treatment for severe diseases has already been performed at a tertiary care hospital. In the case of termination of treatment, the Korean court has both a judgment that recognizes the right to terminate and a judgment that denies the termination. Among the U.S. rulings, there are rulings that order transfer to a skilled nursing facility or nursing home or home if acute treatment is no longer needed. Considering that medical resources are limited, it is necessary to acknowledge the right to terminate the contract of the medical institution when treatment by a medical institution is completed.

A Task Assignment Rule for the Registered Nurses of the Emergency Department of Hospital Using Multiple System Attributes (병원 응급실에서 여러 속성을 고려한 간호사 치료태스크 할당 규칙에 관한 연구)

  • Kim, Dae-Beom
    • Journal of the Korea Society for Simulation
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    • v.18 no.4
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    • pp.107-116
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    • 2009
  • Overcrowding in an Emergency Department (ED) of hospital is a common phenomenon. To improve the service quality and system performance of the ED, a task assignment rule for the Registered Nurses (RNs) is proposed in this paper. At each task assignment point, the rule prioritizes all treatment requests based on the urgency which is determined by the multiple attributes such as accomplishment time of treatment task, elapsed time of treatment request, total remain time to patient discharge, and number of remain treatments. The values of partial urgency with a single criterion are determined and then overall urgency is computed to find the most urgent one among current requests with the importance weights assigned to the criteria. Through computer simulation, the performance of the proposed rule is compared with current rule in terms of the length of stay and system throughput in a simplified ED system of the hospital M.

Antidotes Stocking and Delivery for Acute Poisoning Patients at 20 Emergency Departments in Korea 2015-2017 (2015-17년 전국 20개 거점병원 응급해독제 비축 및 제공 결과)

  • Lee, Seungmin;Youn, Han Deok;Chang, Hanseok;Won, Sinae;Kim, Kyung Hwan;Oh, Bum Jin
    • Journal of The Korean Society of Clinical Toxicology
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    • v.16 no.2
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    • pp.131-140
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    • 2018
  • Purpose: The National Emergency Medical Center has been running a project for the storage and delivery of antidotes for acute poisoning patients of the Department of Health and Welfare, Korea. This study analyzed the results of this project over the past two years. Methods: The requests received by the National Emergency Medical Center and the data on the delivery process were analyzed. Results: This study analyzed a total of 121 patients with acute poisoning, who were requested to receive an antidote reserved at 20 key hospitals in 2015-2017, and whose age was $52.3{\pm}23.5\;years$; old; 54 were women. Intentional poisoning were 58.7%, and the home was the most common place of exposure (66.9%). The toxic substances were chemicals (32.2%), pesticides (27.3%), medicines (24.8%), and snake venom (4.1%). The patient's poison severity score was $2.4{\pm}0.7$ (median 3) indicating moderate-to-severe toxicity. Antidote administration was the cases treated in key hospitals 67.8% (82/121), in which transferred patients accounted for 57.3% (47/82). After receiving an antidote request from a hospital other than the key hospitals, the median was 75.5 minutes (range 10 to 242 minutes) until the antidote reached the patient, and an average of 81.5 minutes was required. The results of emergency care were intensive care unit (70.3%), general wards (13.2%), death (10.7%), and discharge from emergency department (5.0%). Conclusion: This study showed that the characteristics of acute poisoning patients treated with an antidote were different from previous reports of poisoned patients in the emergency department, and basic data on the time required for delivery from key hospitals was different.

Consideration on Shielding Effect Based on Apron Wearing During Low-dose I-131 Administration (저용량 I-131 투여시 Apron 착용여부에 따른 차폐효과에 대한 고찰)

  • Kim, Ilsu;Kim, Hosin;Ryu, Hyeonggi;Kang, Yeongjik;Park, Suyoung;Kim, Seungchan;Lee, Guiwon
    • The Korean Journal of Nuclear Medicine Technology
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    • v.20 no.1
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    • pp.32-36
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    • 2016
  • Purpose In nuclear medicine examination, $^{131}I$ is widely used in nuclear medicine examination such as diagnosis, treatment, and others of thyroid cancer and other diseases. $^{131}I$ conducts examination and treatment through emission of ${\gamma}$ ray and ${\beta}^-$ ray. Since $^{131}I$ (364 keV) contains more energy compared to $^{99m}Tc$ (140 keV) although it displays high integrated rate and enables quick discharge through kidney, the objective of this study lies in comparing the difference in exposure dose of $^{131}I$ before and after wearing apron when handling $^{131}I$ with focus on 3 elements of external exposure protection that are distance, time, and shield in order to reduce the exposure to technicians in comparison with $^{99m}Tc$ during the handling and administration process. When wearing apron (in general, Pb 0.5 mm), $^{99m}Tc$ presents shield of over 90% but shielding effect of $^{131}I$ is relatively low as it is of high energy and there may be even more exposure due to influence of scattered ray (secondary) and bremsstrahlung in case of high dose. However, there is no special report or guideline for low dose (74 MBq) high energy thus quantitative analysis on exposure dose of technicians will be conducted based on apron wearing during the handling of $^{131}I$. Materials and Methods With patients who visited Department of Nuclear Medicine of our hospital for low dose $^{131}I$ administration for thyroid cancer and diagnosis for 7 months from Jun 2014 to Dec 2014 as its subject, total 6 pieces of TLD was attached to interior and exterior of apron placed on thyroid, chest, and testicle from preparation to administration. Then, radiation exposure dose from $^{131}I$ examination to administration was measured. Total procedure time was set as within 5 min per person including 3 min of explanation, 1 min of distribution, and 1 min of administration. In regards to TLD location selection, chest at which exposure dose is generally measured and thyroid and testicle with high sensitivity were selected. For preparation, 74 MBq of $^{131}I$ shall be distributed with the use of $2m{\ell}$ syringe and then it shall be distributed after making it into dose of $2m{\ell}$ though dilution with normal saline. When distributing $^{131}I$ and administering it to the patient, $100m{\ell}$ of water shall be put into a cup, distributed $^{131}I$ shall be diluted, and then oral administration to patients shall be conducted with the distance of 1m from the patient. The process of withdrawing $2m{\ell}$ syringe and cup used for oral administration was conducted while wearing apron and TLD. Apron and TLD were stored at storage room without influence of radiation exposure and the exposure dose was measured with request to Seoul Radiology Services. Results With the result of monthly accumulated exposure dose of TLD worn inside and outside of apron placed on thyroid, chest, and testicle during low dose $^{131}I$ examination during the research period divided by number of people, statistics processing was conducted with Wilcoxon Signed Rank Test using SPSS Version. 12.0K. As a result, it was revealed that there was no significant difference since all of thyroid (p = 0.345), chest (p = 0.686), and testicle (p = 0.715) were presented to be p > 0.05. Also, when converting the change in total exposure dose during research period into percentage, it was revealed to be -23.5%, -8.3%, and 19.0% for thyroid, chest, and testicle respectively. Conclusion As a result of conducting Wilcoxon Signed Rank Test, it was revealed that there is no statistically significant difference (p > 0.05). Also, in case of calculating shielding rate with accumulate exposure dose during 7 months, it was revealed that there is irregular change in exposure dose for inside and outside of apron. Although the degree of change seems to be high when it is expressed in percentage, it cannot be considered a big change since the unit of accumulated exposure dose is in decimal points. Therefore, regardless of wearing apron during high energy low dose $^{131}I$ administration, placing certain distance and terminating the administration as soon as possible would be of great assistance in reducing the exposure dose. Although this study restricted $^{131}I$ administration time to be within 5 min per person and distance for oral administration to be 1m, there was a shortcoming to acquire accurate result as there was insufficient number of N for statistics and it could be processed only through non-parametric method. Also, exposure dose per person during lose dose $^{131}I$ administration was measured with accumulated exposure dose using TLD rather than through direct-reading exposure dose thus more accurate result could be acquired when measurement is conducted using electronic dosimeter and pocket dosimeter.

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