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A Coexistence Model in a Dynamic Platform with ICT-based Multi-Value Chains: focusing on Healthcare Service (ICT 기반 다중 가치사슬의 동적 플랫폼에서의 공존 모형: 의료서비스를 중심으로)

  • Lee, Hyun Jung;Chang, Yong Sik
    • Journal of Intelligence and Information Systems
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    • v.23 no.1
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    • pp.69-93
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    • 2017
  • The development of ICT has leaded the diversification and changes of supplies and demands in markets. It also caused the creations of a variety of values which are differentiated from those in the existing market. Therefore, a new-type market is created, which can include multi-value chains which are from ICT-based created markets as well as the existing markets. We defined the platform as the new-type market. In the platform, the multi-value chains can be coexisted with multi-values. In true market, when a new-type value chain entered into an existing market, it is general that it can be conflicted with the existing value chain in the market. The conflicted problem among multi-value chains in a market is caused by the sharing of limited market resources like suppliers, consumers, services or products among the value chains. In other words, if there are multi-value chains in the platform, then it is possible to have conflictions, overlapping, creations or losses of values among the value chains. To solve the problem, we introduce coexistence factors to reduce the conflictions to reach market equilibrium in the platform. In the other hand, it is possible to lead the creations of differentiated values from the existing market and to augment the total market values in the platform. In the early era of ICT development, ICT was introduced for improvement of efficiency and effectiveness of the value chains in the existing market. However, according to the changed role of ICT from the supporter to the promotor of the market, ICT became to lead the variations of the value chains and creations of various values in the markets. For instance, Uber Taxi created a new value chain with ICT-based new-type service or products with new resources like new suppliers and consumers. When Uber and Traditional Taxi services are playing at the same time in Taxi service platform, it is possible to create values or make conflictions among values between the new and old value chains. In this research, like Uber and traditional taxi services, if there are conflictions among the multi-value chains, then it is necessary to minimize the conflictions in the platform for the coexistence of multi-value chains which can create the value-added values in the platform. So, it is important to predict and discuss the possible conflicted problems between new and old value chains. The confliction should be solved to reach market equilibrium with multi-value chains in the platform. That is, we discuss the possibility of the coexistence of multi-value chains in the platform which are comprised of a variety of suppliers and customers. To do this, especially we are focusing on the healthcare markets. Nowadays healthcare markets are popularized in global market as well as domestic. Therefore, there are a lot of and a variety of healthcare services like Traditional-, Tele-, or Intelligent- healthcare services and so on. It shows that there are multi-suppliers, -consumers and -services as components of each different value chain in the same platform. The platform can be shared by different values that are created or overlapped by confliction and loss of values in the value chains. In this research, as was said, we focused on the healthcare services to show if a platform can be shared by different value chains like traditional-, tele-healthcare and intelligent-healthcare services and products. Additionally, we try to show if it is possible to increase the value of each value chain as well as the total value of the platform. As the result, it is possible to increase of each value of each value chain as well as the total value in the platform. Finally, we propose a coexistence model to overcome such problems and showed the possibility of coexistence between the value chains through experimentation.

On the present bamboo groves of Cholla-nam-do and their proper treatment -No. 1. On the growing stock of reprsentative phyllostachys reticulata grove by county (전라남도(全羅南道)의 죽림현황(竹林現況)과 그 개선대책(改善對策) -제일(第一), 각군별대표고죽림(各郡別代表苦竹林)의 몇가지 죽간형질(竹桿形質)과 축적(蓄積)에 대하여)

  • Chung, Dong Oh
    • Journal of Korean Society of Forest Science
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    • v.2 no.1
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    • pp.19-28
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    • 1962
  • Total area of bamboo groves in Korea which is limited to $37^{\circ}$ north latitude, i.e., to southern part of Chungchung-nam-do Province and Kangwon-do Province, is 3,235ha., but this country must import about 3,000 metric ton's bamboo culms from Japan every year. It may be true that the country is not so fit for economical cultivation of bamboo groves from the view point of climatic condition, but the author believes that self-sufficiency in bamboo is not impossible if some scientific method for improving bamboo groves is introduced to our primitive groves. Keeping this point in his mind the auther tried to study on the bamboo groves in the country, and as the first step set about to investigate the actual state of twenty good bamboo groves located in Cholla-nam-do Province from March, 1961 to January, 1962. This is a report on some characters of bamboo culms and growing stock with samples collected in the present investigation. 1) Numbers of bamboo culm per 0.1ha. are 1,183 in average, 1,840 in maximum and 87.5 in minimum before harvesting. 2) According to owners' saying, 1960 was such an off-year that they could hardly see any yearling bamboos in groves, but in 1961 very many new bamboos are produced as follows: the proportion of the number of yearling bamboos produced this year to that of mature bamboos (over 2 years old) is 58.7% in average; the highest 110.5% and the lowest 16.8%. 3) the average diameter of culms at eye height is 6.5cm, but the biggest diameter comes to 11.2 cm, and the average diameters of yearling and mature bamboos are 6.5cm and 6.6cm respectively. 4) Internode length records 29.4 cm in average, the shortest 21.3 cm and the longest 38.4 cm. Average internode lengths of new culms and mature culms are 27.6 cm and 29.4 cm respectively. This shows that the internode length of new culms is in the decrease to that of maturer's. 5) Through this investigation, it was found that internode length is in the influence of the exposure and density of bamboo groves, i. e., the more the dencity of bamboo groves is and the more the exposure nears the north-east, the longer the internode length becomes (see Table 7 and 8). 6) In the growing stock of bamboo groves, bundles per 0.1ha. amount to 271 sok (unit of bundle) in total average, 445 sok in maximum and 126 sok in minimum. 7) Among twenty typical bamboo groves, chosen in each County in Cholla-nam-do Province, only one passes perfectly by Veda's standard rule* prescribing the good bamboo grove, but the eight groves shown in Table 9 could be recommended as good ones in Cholla-nam-do Province, because the auther believes that those groves may be improved better, if we pay more attention to the management of them. 8) Considering that they have managed their groves carelessly and primitively, and that unfortunately their groves must have faced almost on clear felling over the entire area at the time of the Korean War, we can surely expect much more increments in bamboo groves, if we introduce some scientific methods in managing their groves.

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Facters Affecting Recurrence after Video-assisted Thoracic Surgery for the Treatment of Spontaneous Pneumothotax (자연기흉에 대한 비디오흉강경수술후 재발에 영향을 미치는 요인들)

  • 이송암;김광택;이일현;백만종;최영호;이인성;김형묵;김학제
    • Journal of Chest Surgery
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    • v.32 no.5
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    • pp.448-455
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    • 1999
  • Background: Recent developments in techniques of video-assisted thoracic surgery(VATS) and endoscopic equipment has expanded the application of video-assisted surgical procedures in the field of thoracic surgery. Especially, it will probably become the treatment of choice of spontaneous pneumothorax(SP). There is, however, a high recurrence rate, high cost, and paucity of long-term results. We report the results of postoperative follow-up and analyze perioperative parameters affected to recurrence, retrospectively. Material and Method: From march 1992 to march 1997, 276 patients with spontaneous pneumothorax underwent 292 VATS procedures. Conversion to open thoracotomy was necessitated in eight patients, and this patients excluded from the study. Result: The sex distribution was 249 males and 31 females. The mean age was 28.1 12.2 years(range, 15 to 69 years). Primary SP was 237cases(83.5%) and secondary SP was 47cases(16.5%). The major underlying lung diseases associated with secondary SP were tuberculosis 27cases(57.4%) and emphysema 8cases (38.3%). Operative indications included Ipsilateral recurrence 123(43.9%), persistent air-leak 53(18.9%), x-ray visible bleb 40(14.3%), tension 30(10.7%), contralateral recurrence 21(7.5%), uncomplicated first episode 8(2.9%), bilateral 3(1.1%), complicated episode 2(0.7%). Blebs were visualized in 247cases(87%) and 244cases(85.9%) performed stapled blebectomy. Early postoperative complications occurred in 33 cases(11.6%): 16 prolonged air-leak more than 5 days(four of them were required a second operation and found missed blebs); 5 bleeding; 5 empyema; 2 atelectasis; 1 wound infection. No deaths occured. The mean operative time was 52.8 23.1 minutes(range, 20 to 165 minutes). The mean d ration of chest tube drainage was 5.0 4.5 days(range, 2 to 37 days). The mean duration ofhospital stay was 8.2 5.5 days (range, 3 to 43days). At a mean follow-up 22.3 18.4 months(range, 1 to 65 months), 12 patients(4.2%) were lost to follow-up. There were 24 recurrences and seven patients underwent second operation and 6 patients(85.7%) were found the missed blebs. 12 perioperative parameters(age, sex, site, underlying disease, extent of collapse, operative indication, size of bleb, number of bleb, location of bleb, bleb management, pleural procedure, prolonged postoperative air-leak) were analyzed statistically to identify significant predictors of recurrence. The significant predictors of recurrence was the underlying disease[17.0%(8/47): 6.8%(16/237), p=0.038], prolonged postoperative air-leakage[37.5%(6/16): 6.7%(18/268), p=0.001], and pleural procedure [11.4%(19/167): 4.3%(5/117), p=0.034]. Blebectomy has less recurrence rate then non-blebectomy [8.2%(20/244) : 10.0%(4/40), p>0. 5]. However, this difference was not statistically significant(p=0.758). Conclusion: We conclude that it is important that we shoud careful finding of bleb during VATS due to reducing of recurrnece, and cases of no bleb identified and secondary spontaneous pneumothorax were indicated of pleurodectomy. VATS is a valid alternative to open procedure for the treatment of spontaneous pneumothorax with less pain, shorter hospital stay, more rapid return to work, high patient acceptance, less scar and exellent cosmetics. But, there is high recurrence rate and high cost, and than it is necessary to evaluate of long-term results for recurrence and to observate carefully during VATS.

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Recognition and Attitude to Implement at ion of Service Area Assigned System of Public Health Programs among the Health Officer (공공보건사업의 지역담당제 실시에 관한 보건기관 근무 공무원의 인식과 태도)

  • Kim, Mi-Soon;Lee, Moo-Sik;Kim, Nam-Song
    • Journal of agricultural medicine and community health
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    • v.26 no.2
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    • pp.15-41
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    • 2001
  • Since medical clients and the community they live in are expected to be center of future public health and medical care system, new service programs must be developed with patients focused on in line with widening public access of information and social participation. Patients- focused service shall mean the area- oriented provision of public health service. In this study, health officers working at public health centers, public health sub- centers and medical offices in Jeonbuk- do area were taken for population in order to investigate their attitudes toward and knowledge about the service area assigning system under the public health programs. Findings from the survey to 260 health officers, divided by general category, are as follows : Government officers at public health organizations appeared to have high grade of understanding to the service area assigning system and also great appreciation for the necessity of it. Regarding the timing for the system to be introduced, they support the gradual implementation and, as for the type of service to be provided, they preferred home nursing and treatment of chronic diseases. Highly positive responses were centered on the health classes under the health promotion projects, and as far as health projects for the old are concerned, services for home nursing, for the disabled and for home- alone people are favored most. On the other hand, budgeting, manpower and reorganization are rated as prerequisite to establishment of the service area assigning system. From the viewpoint of system side, the improvement of working conditions is rendered as most urgent, while the information system for establishing the service area assigning system is conceived far from satisfactory. Proper assignment of specialists was noted as mostly important to establish the delivery system for medical service through the service area assigning system by team. As merits of the service area assigning system, it is pointed out that, through the system, health clients can better be managed and the nursing quality will be improved thank to the enhanced specialization. It is also perceived that the district health service is not well prepared to respond to the increased and diversified needs of community people and, furthermore, service programs of health centers have not been fully developed. The most serious problem standing in the way to expansion of health projects is, it is noted, uniformity (formality) of the project. Based on the results of the survey which suggest time has ripen to introduce the service area assigning system, following strategies are proposed to anchor down the system as soon as possible: First, we should introduce the system gradually, starting from the area selected, and in consideration of area specialities, refraining from the hitherto stereotyped way of providing health service. Second, we should seek to properly assign the specialists and improve the working conditions of the assigned officers by securing sufficient budget, since it is a most urgent step to lay foundation for the service area assigning system. Third, best service program should be developed to meet the satisfaction of community people by responding to their needs and solidifying the management of medical clients. Fourth, wide scope of study should further be conducted in order to help this system take roots in the central living of community residents since pilot project on the experimental base attended by specialists only can not win popularity among the masses.

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A Study on the Prediction Model of Stock Price Index Trend based on GA-MSVM that Simultaneously Optimizes Feature and Instance Selection (입력변수 및 학습사례 선정을 동시에 최적화하는 GA-MSVM 기반 주가지수 추세 예측 모형에 관한 연구)

  • Lee, Jong-sik;Ahn, Hyunchul
    • Journal of Intelligence and Information Systems
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    • v.23 no.4
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    • pp.147-168
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    • 2017
  • There have been many studies on accurate stock market forecasting in academia for a long time, and now there are also various forecasting models using various techniques. Recently, many attempts have been made to predict the stock index using various machine learning methods including Deep Learning. Although the fundamental analysis and the technical analysis method are used for the analysis of the traditional stock investment transaction, the technical analysis method is more useful for the application of the short-term transaction prediction or statistical and mathematical techniques. Most of the studies that have been conducted using these technical indicators have studied the model of predicting stock prices by binary classification - rising or falling - of stock market fluctuations in the future market (usually next trading day). However, it is also true that this binary classification has many unfavorable aspects in predicting trends, identifying trading signals, or signaling portfolio rebalancing. In this study, we try to predict the stock index by expanding the stock index trend (upward trend, boxed, downward trend) to the multiple classification system in the existing binary index method. In order to solve this multi-classification problem, a technique such as Multinomial Logistic Regression Analysis (MLOGIT), Multiple Discriminant Analysis (MDA) or Artificial Neural Networks (ANN) we propose an optimization model using Genetic Algorithm as a wrapper for improving the performance of this model using Multi-classification Support Vector Machines (MSVM), which has proved to be superior in prediction performance. In particular, the proposed model named GA-MSVM is designed to maximize model performance by optimizing not only the kernel function parameters of MSVM, but also the optimal selection of input variables (feature selection) as well as instance selection. In order to verify the performance of the proposed model, we applied the proposed method to the real data. The results show that the proposed method is more effective than the conventional multivariate SVM, which has been known to show the best prediction performance up to now, as well as existing artificial intelligence / data mining techniques such as MDA, MLOGIT, CBR, and it is confirmed that the prediction performance is better than this. Especially, it has been confirmed that the 'instance selection' plays a very important role in predicting the stock index trend, and it is confirmed that the improvement effect of the model is more important than other factors. To verify the usefulness of GA-MSVM, we applied it to Korea's real KOSPI200 stock index trend forecast. Our research is primarily aimed at predicting trend segments to capture signal acquisition or short-term trend transition points. The experimental data set includes technical indicators such as the price and volatility index (2004 ~ 2017) and macroeconomic data (interest rate, exchange rate, S&P 500, etc.) of KOSPI200 stock index in Korea. Using a variety of statistical methods including one-way ANOVA and stepwise MDA, 15 indicators were selected as candidate independent variables. The dependent variable, trend classification, was classified into three states: 1 (upward trend), 0 (boxed), and -1 (downward trend). 70% of the total data for each class was used for training and the remaining 30% was used for verifying. To verify the performance of the proposed model, several comparative model experiments such as MDA, MLOGIT, CBR, ANN and MSVM were conducted. MSVM has adopted the One-Against-One (OAO) approach, which is known as the most accurate approach among the various MSVM approaches. Although there are some limitations, the final experimental results demonstrate that the proposed model, GA-MSVM, performs at a significantly higher level than all comparative models.

Experiment for Various Soils on Economic Duty of Water in Paddy Fields (각종토성별 경제적용수량 결정시험연구)

  • Hwang, Eun
    • Magazine of the Korean Society of Agricultural Engineers
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    • v.11 no.1
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    • pp.1561-1579
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    • 1969
  • In Korea, the duty of water in paddy fields was measured at the Agricultural Experimental Station in Suwon about 60 years ago. After that time some testing has been made in several places, but the key points in its experiment were the water depth of evapo-transpiration. Improved breeds, progress in cultivation and management techniques as well as development of measuring apparatus in recent years have necessitated the review of the duty of water in paddy fields. The necessity of reviewing the conventional methods has become even more important, as no source of information has been made available through survey of water utilization on a soil use basis which requires data on peculiar features of the water depth of evapo-transpiration. For example, the duty of water in paddy field is largely affected by the water depth of evapo-transpiration in connection with the wetted paddy field, whereas in connection with the normal paddy fields without this characteristic the vertical percolation become the predominant factor in measuring the decreasing depth of water. Therefore, it becomes important. that not only the water depth of evapotranspiration but also the vertical percolation process should also be observed in order to arrive at a realistic conclusion. As the vertical percolation has aclose relationship to the height of the underground water, the change of the latter can be measured. As the conclusion of this experiment, the following subjects are indicated. 1. In order to determine the economic duty of water in paddy fields on a basis of varying soil features, the varying soil features in the benifited area should be investigated thoroughly. The water depths of evapo-transpiration(ET) ratio to evaporation in the evaporator(V) on a basis of the varying soil features are as follows: clay loam ET/V = 1.11, loam ET/V = 1.64, sandy loam ET.V = 1.63 2. The decreasing depth of water consists of the water depth of evapotranspiration, the vertical per colation and the percolation of foot path. Among these three, the percolation of foot path can be utilized again. 3. As the result of this experiment, it shows the decreasing depth of water as follows. clay loam 9.3 mm/day, loam 13.5mm/daty, sandy loam 15.3mm/day 4. On a basis of the varying soil features and the height of the underground water, the vertical percolation varies. 5. The change of the vertical percolation on a basis of the varying soil features shows as follows: clay loam $1{\sim}2$ mm/day, loam $2{\sim}3$mm/day, sandy loam $3{\sim}4$mm/day 6. The level of the underground water changes sensibly by priority of clay loam, loam, sandy loam. When it rains, the level of the underground water rises fast and falls down slowly. 7. The level of the underground water changes within the scope of 25cm 8. The transpiration ratio is given in table 8 and their value are as follows: clay loam 168.8, loam 255.6, sandy loam 272.5

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Effects of Lime and NPK Application Rates on the Soil Characteristics after a 10-year Experiment in Oversown Hilly Pasture of Mixed Grass-Clover Sward I. Changes in the pH, contents of T-N, organic matter and available $P_{2}O_{5}$, coefficient of $P_{2}O_{5}$ absorption, and lime requirement by the soil depth (겉뿌림 산지초지에서 석회 및 3요소 시용수준이 10연후 토양특성에 미치는 영향 I. 토심별 pH, T-N, 유기물 및 유효인산 함량, 인기흡수계수와 석회소요량)

  • Jeong, Yeon-Gyu;Lee, Hyeok-Ho
    • Journal of The Korean Society of Grassland and Forage Science
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    • v.13 no.1
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    • pp.49-57
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    • 1993
  • The main experiment related to this report was undertaken to assess the effects of two rates of $Ca(OH)_2$ (0, 250 kg/10a only at establishment) and five rates of N-$P_{2}O_{5}$-$K_2O$ (0-0-0, 0-10-10, 6-15-15, 12-20-20, 24-25-20 kg/10a/year) on the pasture establishment, on forage yield and quality, vegetation etc. After this 10-year main experiment, this pasture had been used to assess the effects of the above treatments on the soil characteristics in oversown hilly pasture of a grass-clover sward. This 1st part is concerned with the soil properties of pH-value. OM, T-N, avail. $P_{2}O_{5}$ and $P_{2}O_{5}$ absorption coefficient, and lime requirement by the soil depth. 1. The pH of the topsoil(0~l5 cm) was lowered from pH 5.12 of before the experiment to 4.90 of when $Ca(OH)_2$ was applied and to 4.68 of when $Ca(OH)_2$ was not applied. The pH decrease was more evident with the increase of NPK application rate and in the upper part of the top soil(0.0~7.5 cm). The additional application of lime was necessary in all the experiment blocks due to the strong acidity of the soil, and the amounts of lime requirement were increased with increased application rates of NPK and soil depth. 2. The contents of organic matter and T-N were increased in all the blocks by the establishment of the hilly pasture, and were higher in $Ca(OH)_2$ applied blocks than non-applied blocks. The contents were inversely correlated with the soil depth. No correlation was observed between the contents and the application rates of NPK. 3. The content of available $P_{2}O_{5}$-$K_2O$, was increased with the increased application of P, especially in the upper part of top soil. The content in the upper part(0.0~7.5 cm) was about twice of that in the lower part(7.5~15.0 cm). Since the contents of available $P_{2}O_{5}$$P_{2}O_{5}$/10a/year were applied, respectively), it is necessary to decrease the application rate of $P_{2}O_{5}$, gradually. The $P_{2}O_{5}$ absorption coefficient in topsoil (0.0~15.0 cm) was more or less higher when no lime and less $P_{2}O_{5}$, was applied. No correlation was observed in subsoil. 4. Further studies on the methods, rates, time of additional application of lime, and on the methods of decreased apllication of $P_{2}O_{5}$ should be performed for better management of oversown hilly pasture.

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Breast Conservation Therapy Versus Mastectomy - Preliminary Results of Pattern of Failure and Survival Rate in Early Breast Cancer (조기유방암에서 유방보존치료와 유방전절제술의 치료결과 및 실패양상 비교)

  • Kim Yeon-Sil;Yoon Sei-Chul;Chung Su-Mi;Ryu Mi-Ryeong;Jung Sang-Sul;Choi Ihl-Bohng
    • Radiation Oncology Journal
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    • v.22 no.2
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    • pp.115-123
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    • 2004
  • Purpose : This retrospective study was conducted to compare early preliminary results of breast conservation therapy (BCT) with mastectomy In early breast cancer. Materials and Methods : We evaluated 171 women with AJCC stage I and II breast cancer who had been treated at Kangnam St. Mary's Hospital from March 1989 to August 1996. Eighty-eight patients underwent mastectomy and 85 patients did conservative surgery with breast irradiation. in the BCT group, all patients received whole breast irradiation to a total dose of 45$\~$50 Gy/5$\~$6 wks, followed by a boost to the original tumor site at least 60 Gy. Chemotherapy was administered to 29 (34.1$\%$) patients in BCT and 40 (45.5$\%$) in mastectomy, with various sequencing of surgery and/or radiation. We compared survival rate, patterns of failure in each treatment group and the prognostic factors that had a significant effect on treatment failure. The median follow-up time was 63 months (19$\~$111 months). Log rank test was used to estimate the prognostic factors for treatment failure. Results : Overall survival, disease free survival, locoregional recurrence and distant metastasis rates were not significantly different between the two treatment groups. During the follow-up period, 11 patients (12.5$\%$)in the mastectomy group and 10 patients (11.8%$\%$ in the BCT group were failed. Six local recurrences occurred after mastectomy and 5 after BCT Five patients fatted at distant site in mastectomy and 4 in BCT. Of the local recurrence cases, five of 6 mastectomy patients and 3 of S BCT patients were alive with no evidence of disease after salvage surgery and/or chemoirradiation. Our results indicated that the major influence on survival was distant metastasis. Unfortunately, control of distant metastasisis was not frequently achieved. Even with salvage systemic therapy or radiotherapy, most of distant metastasis patients died or had uncontrolled disease in both treatment groups: only one of 4 BCT patients and none of mastectomy patients were alive without disease. There was no apparent difference in the incidence rate of contralateral breast cancer and non-breast 2$^{nd}$ primary tumor between the two treatment groups. Univariate Log-rank test identified the N stage and the involved axillary LN number as distinct prognostic factors that were highly predictive of treatment failure in both treatment groups. Additionally, marginal status in BCT and histologic nuclear grade In the mastectomy group were risk factors for treatment fallure (p < 0.05). Concousion : Although further careful follow-up is necessary to confirm the trends evident In this serles, it would appear that patterns of failure and survival rate following conservative surgery and radiotherapy in early breast cancer are similar to those following mastectomy. The great majority of patients with local recurrence had an exellent salvage rate in both treatment groups. Therefore, these preliminary short term results support BCT as an equally effective management for early breast cancer as an alternative to mastectomy.

The Jurisdictional Precedent Analysis of Medical Dispute in Dental Field (치과임상영역에서 발생된 의료분쟁의 판례분석)

  • Kwon, Byung-Ki;Ahn, Hyoung-Joon;Kang, Jin-Kyu;Kim, Chong-Youl;Choi, Jong-Hoon
    • Journal of Oral Medicine and Pain
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    • v.31 no.4
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    • pp.283-296
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    • 2006
  • Along with the development of scientific technologies, health care has been growing remarkably, and as the social life quality improves with increasing interest in health, the demand for medical service is rapidly increasing. However, medical accident and medical dispute also are rapidly increasing due to various factors such as, increasing sense of people's right, lack of understanding in the nature of medical practice, over expectation on medical technique, commercialize medical supply system, moral degeneracy and unawareness of medical jurisprudence by doctors, widespread trend of mutual distrust, and lack of systematized device for solution of medical dispute. This study analysed 30 cases of civil suit in the year between 1994 to 2004, which were selected among the medical dispute cases in dental field with the judgement collected from organizations related to dentistry and department of oral medicine, Yonsei university dental hospital. The following results were drawn from the analyses: 1. The distribution of year showed rapid increase of medical dispute after the year 2000. 2. In the types of medical dispute, suit associated with tooth extraction took 36.7% of all. 3. As for the cause of medical dispute, uncomfortable feeling and dissatisfaction with the treatment showed 36.7%, death and permanent damage showed 16.7% each. 4. Winning the suit, compulsory mediation and recommendation for settlement took 60.0% of judgement result for the plaintiff. 5. For the type of medical organization in relation to medical dispute, 60.0% was found to be the private dental clinics, and 30.0% was university dental hospitals. 6. For the level of trial, dispute that progressed above 2 or 3 trials was of 30.0%. 7. For the amount of claim for damage, the claim amounting between 50 million to 100 million won was of 36.7%, and that of more than 100 million won was 13.3%, and in case of the judgement amount, the amount ranging from 10 million to 30 million won was of 40.0%, and that of more than 100 million won was of 6.7%. 8. For the number of dentist involved in the suit, 26.7% was of 2 or more dentists. 9. For the amount of time spent until the judgement, 46.7% took 11 to 20 months, and 36.7% took 21 to 30 months. 10. For medical malpractice, 46.7% was judged to be guilty, and 70% of the cases had undergone medical judgement or verification of the case by specialists during the process of the suit. 11. In the lost cases of doctors(18 cases), 72.2% was due to violence of carefulness in practice and 16.7% was due to missing of explanation to patient. Medical disputes occurring in the field of dentistry are usually of relatively less risky cases. Hence, the importance of explanation to patient is emphasized, and since the levels of patient satisfaction are subjective, improvement of the relationship between the patient and the dentist and recovery of autonomy within the group dentist are essential in addition to the reduction of technical malpractice. Moreover, management measure against the medical dispute should be set up through complement of the current doctors and hospitals medical malpractice insurance which is being conducted irrationally, and establishment of system in which education as well as consultation for medical disputes lead by the group of dental clinicians and academic scholars are accessible.

Postoperative Clinical Courses According to the Length of Preoperative Drug Therapy in Pulmonary Tuberculosis (폐결핵 환자의 수술전 항결핵제 투여기간에 따른 수술후 임상경과)

  • Kwon, Eun-Su;Kim, Dae-Yun;Park, Seung-Kyu
    • Tuberculosis and Respiratory Diseases
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    • v.47 no.6
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    • pp.775-785
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    • 1999
  • Background : Though surgery plays an important role in the management of patients with Mycobacterium tuberculosis infection, there is little information regarding the timing of resection. We tried to find out the ideal timing of operation. Method: A retrospective review was performed in 69 patients underwent pulmonary resection for pulmonary tuberculosis between January 1993 and December 1997. They were categorized into various groups according to the length of preoperative specific drug therapy. The rates of treatment failure, realpse and complication in each group were compared statistically by $x^2$-test. Results: Eighty one point two percent were men and 18.8 % women with a median age of 33 years(range, 16 to 63 years). The mean number of resistant drugs was 3.l(range, 0 to 9). Patients were treated preoperatively with multidrug regimens, which mean number of preoperative specific drugs was 4.6, in an effort to reduce the mycobacterial burden with the mean length of preoperative drug therapy, 5.0 months. Postoperative treatment was conducted for a mean period of 13.0 months with a mean number of postoperative specific drugs, 4.4. Postoperative treatment failures were confirmed in 8 among 69 patients(11.6%). 2 of these 8 patients were showed up in the preoperative 3 to 4 months medication group and each of the rest was occurred in the preoperative 2 to 3, 5 to 6, 6 to 7, 12 to 13, 17 to 18 months, less than one month medication group, respectively. 59 of 69 patients were available for evaluation of the relapse rate with the mean duration of the postoperative follow-up, 19.8 months. In 4 patients bacterial relapse was confirmed(6.8%). Each of these 4 was in the preoperative 1 to 2, 2 to 3, 3 to 4, 5 to 6 months medication group. Categorized into various groups according to the length of preoperative specific therapy, there were no statistical significances of the treatment failure rate, relapse rate and complication rate in the groups. There were seven treatment failures of 28 who were AFB culture positive until the time of operation(25%, p<0.01). Categorized the preoperative AFB culture positive group into various groups according to the length of preoperative drug therapy, there were no statistical significances, either. Conclusion: We believe that operation plays an important ancillary role in the treatment of pulmonary tuberculosis. Our results indicate that the timing of resection according to the length of preoperative drug therapy may not cause trouble.

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