• 한국의료질향상학회지
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• 제10권2호
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• pp.204-215
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• 2003

Background : ICD-10 Classification, which is used domestically as well as internationally, has limited use in the clinical practice since it is developed for at disease statistics and epidemiology. Therefore, the purposes of this study were to improve the quality of diagnosis by constructing a new disease classification based on the diagnoses doctors currently make in the clinical setting and connecting this classification with OCS and EMR, and to meet the demands of doctors for high quality medical study data in medical research. Methods : The specialists in each ophthalmic subfield collected clinical diagnoses and abbreviations based on the ophthalmology textbooks and confirmed the classifications. Total number of clinical diagnoses collected was totaled 672, for which ideal diagnoses had been selected and a new model of disease classification model in connection with ICD-10 was constructed. The constructed classification of clinical diagnoses consisted of six steps: the first step was the classification by ophthalmic subspecialty field; the second to fifth steps were the detailed classification by each specialty field; the sixth step was the classification by site. Results : After introducing the new disease classification, research on the use and a pre-post comparison was conducted. The result from the research on the use of the clinical diagnoses in inpatient and outpatient care has shown a gradually increasing tendency. From the pre-post comparison of EMR discharge summary diagnoses, the result demonstrated that the diagnosis was stated correctly and in detail. Since the diagnosis was stated correctly, code classification became correct as well, which makes it possible to construct high quality medical DB. Conclusion : This construction of clinical diagnoses provides the medical team with high quality medical information. It is also expected to increase the accuracy and efficiency of service in the department of medical record and department of insurance investigation. In the future, if hospitals wish to construct a classification of clinical diagnosis and a standard proposal of clinical diagnosis is presented by a medical society, the standardization of diagnosis seems to be possible.

• 간호행정학회지
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• 제5권1호
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• pp.113-136
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• 1999

There are some new trends in judgments concerning medical malpractice. which include emphasis on medical professionals' explanation duty in order to materialize patient's rights of self-determination. Now, patient is not a mere subject of medical and nursing care any more, but a subject, participating in medical practice on equal terms with medical professionals. Legal accountability is no limited to nurses in advanced practice: it is a recognized fact of life for every practicing nurse. whether she is an RN employed as a staff nurse in a hospital, a Certified Nurse-Midwife in independent practice or a patient's home. Therefore, it is essential for nurses to be as familiar as possible with the legal guidelines that govern their patient care responsibilities. However there are only a few studies focused on nursing negligence. To define nurse's civil liability in medical malpractice, it is necessary to indentify both legal nursing behaviors and nurse's due care in those nursing behaviors. So this paper focused on nurse's due care, especially in nursing malpractice. To clarify nurses' due care. chapter II has focused on nursing behavior and the scope of nursing practice based on the medical law and health care related study results. Chapter III deals with the content and scope of nurse's due care. Generally. negligence is defined as not doing something which a resonable person. guided by those ordinary considerations which or dinarily regulate human affairs. would do. or doing something which a resonable and prudent man would not do. Next. it describes how we can set the standard of due care in nursing practice. There is objective factors and subjective factors. And we also discuss about the limitation of due care in nursing practice. Finally. chapter IV deals with the case studies related to nursing negligence in the situation of determination. Now', patient is not a mere subject of medical and nursing care any more, but a subject participating in medical practice on equal terms with medical professionals. Legal accountability is not limited to nurses in advanced practice; it is a recognized fact of life for every practicing nurse. whether she is an RN employed as a staff nurse in a hospital. a Certified Nurse-Midwife in independent practice or a patient's home. Therefore, it is essential for nurses to be as familiar as possible with the legal guidelines that govern their patient care responsibilities. However. there are only a few studies focused on nursing negligence. To define nurse's civil liability in medical malpractice, it is necessary to identify both legal nursing behaviors and nurse's due care in those nursing behaviors. So this paper focused on nurse's intravenous injection. post operation nursing care. blood transfusion. and patient nursing care. The result of this paper is as follows. First. there are several cases dealing with nurse's negligence in nursing practice. however, those cases didn't judge nurse's due care based on individual -specific standard but general-objective standard. Second, there is a tendency to put an emphasis on the principal of belief to distinguish who has the liability in the case of medical malpractice among medical care team. So nurses shoud practice nursing care more actively to protect themselves and patients because there is an effort to form professional nurse system and the scope of nursing practice will be deeper and broader. Third, standard of care is a necessary element in establishing negligence. If a nurse is able to meet the standard of care, no breach will be found.

• Korean Circulation Journal
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• 제52권9호
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• pp.659-679
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• 2022

Efforts to improve end-of-life (EOL) care have generally been focused on cancer patients, but high-quality EOL care is also important for patients with other serious medical illnesses including heart failure (HF). Recent HF guidelines offer more clinical considerations for palliative care including EOL care than ever before. Because HF patients can experience rapid, unexpected clinical deterioration or sudden death throughout the disease trajectory, choosing an appropriate time to discuss issues such as advance directives or hospice can be challenging in real clinical situations. Therefore, EOL issues should be discussed early. Conversations are important for understanding patient and family expectations and developing mutually agreed goals of care. In particular, high-quality communication with patient and family through a multidisciplinary team is necessary to define patient-centered goals of care and establish treatment based on goals. Control of symptoms such as dyspnea, pain, anxiety/depression, fatigue, nausea, anorexia, and altered mental status throughout the dying process is an important issue that is often overlooked. When quality-of-life outweighs expanding quantity-of-life, the transition to EOL care should be considered. Advanced care planning including resuscitation (i.e., do-not resuscitate order), device deactivation, site for last days and bereavement support for the family should focus on ensuring a good death and be reviewed regularly. It is essential to ensure that treatment for all HF patients incorporates discussions about the overall goals of care and individual patient preferences at both the EOL and sudden changes in health status. In this review, we focus on EOL care for end-stage HF patients.

• Korean journal of medical education
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• 제30권4호
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• pp.309-315
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• 2018

Purpose: The introduction of community-based medical education would help improve the quality of primary care. This paper suggests learning objectives and an educational program for community-based medical education. Methods: The educational program was developed in a 1-day consensus workshop. Twenty experts, including faculty members from family medicine department of a college of medicine in Seoul and community-based preceptors, participated in the program. A needs-assessment survey was conducted among community-based preceptors before the workshop. Through this workshop, we derived learning objectives and a standardized curriculum for community-based medical education. Results: In the questionnaire before the workshop, community-based preceptors voiced concerns over the program's potential costs and the time required for teaching. The learning objectives and educational programs derived from the workshop's consensus were consistent with the characteristics of the primary care. Based on the results of this workshop, the joint expert team developed a standard educational program on two core topics: clinical teaching and mentoring. Conclusion: From this curriculum development process, participants could construct a more standardized curriculum for community-based medical education. Future studies are needed to evaluate the long-term outcomes of these educational programs, such as the learners' satisfaction and achievement.

• 산업진흥연구
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• 제3권2호
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• pp.21-31
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• 2018

본 연구는 간호 간병 통합서비스 품질이 의료서비스 성과에 미치는 영향을 알아보기 위해 가설 검정을 실시했다. 연구 결과는 간호 간병 통합서비스 품질의 반응성, 확신성, 공감성, 계산적 몰입, 신뢰성, 감정적 몰입은 의료서비스 성과의 지각된 성과, 충성도, 지각된 성과, 성과의 충성도와 의료서비스 성과의 지각된 성과는 충성도에 긍정적인 영향은 채택으로 나타났다. 즉, 통합서비스 품질은 의료서비스 역량에 매우 중요함을 검증하였다. 이를 위해서는 간호팀원의 인력확충을 위한 제도적 노력이 우선되어야 하며, 우수한 간호팀원 양성을 위해서 전문적 간호능력 외에도 환자와의 공감을 통해 긍정적 관계 형성을 위한 인성 교육에도 중점을 두어야 할 것이다. 본 연구에서 통합서비스 품질이 의료서비스 성과에 미치는 영향을 검중 하였다는데 연구의 의미를 찾을 수 있다.

• 한국컴퓨터정보학회논문지
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• 제13권5호
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• pp.117-124
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• 2008

편재형 컴퓨팅 환경에서 보다 편리하게 의료 서비스를 받는 것은 인간의 삶의 질을 향상시키는 방법이다. 이를 위해 본 연구에서는 헬스 케어 응용의 일환으로 심장병 환자를 위한 편재형 헬스 케어 시스템을 구현하였다. 이 시스템은 온도, 습도, 조도 등 실내의 인간의 외적 환경과 심전도 센서를 인체에 부착하여 인간의 내적 환경을 감시하는 센서, 이들을 상호 연결시키는 센서 네트워크, 그리고 의료 정보 서버로 구성된다. 단순히 사람이 머무는 공간 혹은 생체정보를 센싱하고 이를 의료진에게 전달하는 것은 비교적 단순한 수준의 헬스 케어 시스템이다. 보다 높은 수준의 의료 서비스를 제공하기 위하여 본 연구에서는 BPNN(back propagation neural network)를 이용하여 감시 대상자의 상황을 인식하는 서비스 모델을 개발하였다. 실험 결과감시 대상자의 활동을 보다 정확하게 인식하여 고수준의 의료 서비스를 제공할 수 있는 헬스 케어 시스템 구현이 가능함을 확인하였다.

• Journal of Nutrition and Health
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• 제44권5호
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• pp.384-393
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• 2011

The objective of this study was to determine the nutritional support in patients treated in medical intensive care units (MICUs) by evaluating the extent of current nutritional support using the patient care plan and considering the association between nutritional status and the amount of nutrition supplied. From April to December 2010, 114 patients (age ${\qeq}$ 18 years) admitted to the MICU and who underwent nutritional support for > 5 days were included. Descriptive statistics showed that the 114 patients received nutritional support within 1.2 ${\pm}$ 0.7 days and for 16.2 ${\pm}$ 11.7 days in the MICUs. The total delivered/required caloric ratio was 81.08 ${\pm}$ 27.31%, and the protein ratio was 80.32 ${\pm}$ 28.93%. Patients who received > 80% of required calories and protein showed improved nutritional status (p < 0.05). The results showed that adequate nutritional support is crucial to critically ill patients. We suggest early nutritional screening using simple tools such as periodic monitoring and management to recalculate nutritional status and nutritional requirements and nutritional support using a multidisciplinary method. Systematic nutritional support teams are needed to provide adequate nutritional support for patients in the MICU.

• 대한치과의사협회지
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• 제53권2호
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• pp.111-119
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• 2015

The importance of effective communication is increasingly stressed in the medical sector. This is crucial for the resolution of medical accidents and conflicts, and that can contribute to the prevention of the two as well. The careful attitude of the medical team toward patient safety and their communication with colleagues and other departments are mandatory for the successful decrease of dental accidents. The good communication within of the hospital organization is one of vital ways to ensure accurate diagnosis and successful treatment. In the field of health care, effective teamwork requires a shared goal, superb work skills, communication and cooperation, but this fact has been overlooked so far. Among those factors, communication is indispensable to the achievement of organizational goals, and how to boost communication by acquiring diverse skills and using appropriate tools in the dentistry should discreetly be considered. This study explared how to improve the teamwork and communication of organization in an effort to seek specific ways of reducing medical conflict in dental.

• Journal of Hospice and Palliative Care
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• 제2권2호
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• pp.138-143
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• 1999

Accurately estimating survival times in terminal cancer patients is very difficult for palliative care clinicians. But a reasonably accurate estimate of survival would permit the medical team to : Plan the ideal therapeutic strategy between overtreatment and too early discontinuation of specific therapy. Answer any questions asked by the patient or family. Organize adequate assistance for the patient concerned. Decide on the eligibility of the patient for clinical trials and whether to begin a treatment, the effects of which will not be immediate. This case was a 79 year-old male patient with colon cancer. He complained of dry mouth, anorexia, weight loss and showed KPS $40{\sim}50$ on admission day. 40 days later he died. To improve patient/family quality of life, it is necessary to improve the ability to estimate accurately a patient's length of survival.

• 한국의료질향상학회지
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• 제22권2호
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• pp.95-108
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• 2016

Purpose: Ancillary tests such as immunohistochemistry or molecular testing for pathologic diagnosis are performed using ready-made tissue blocks for a histological examination. Various methods and processes during ancillary testing cause some of issues, particularly in the time required and the results reporting scheme. Methods: To solve these issues, we constructed real-time management software. When a pathologist or a clinician had ancillary tests examined using this software by selecting the codes of the needed ancillary tests on site and the system assigned the tests to each laboratory. Then, pathology technologists checked the referred tests and performed the examination. In clinical departments, serial number of each ancillary test can be matched the original pathologic ID. In the department of pathology, numbers of tissue blocks that needed additional tests could be indicated and detected using one-click detection system when a clinician referred the test. Results: Using this system resulted in simplifying the referral procedures from nine-steps to three-steps in each clinical department and from seven-steps to two-steps in department of pathology. Errors that happened on the paper-based request system were also reduced. Furthermore, the time required was saved by seven hours in pathologic laboratory on average. Mean durations from requesting to reporting of the ancillary test was reduced by three days for specimens of health promotion center. Conclusion: Construction of an effective information transfer system may be helpful for shortening the time required, reducing errors, and checking processing information of the tests in real time.