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교정시설 내 응급의료체계 발전방안 (The Developmental Program of Emergency Medical System in Correctional Facilities)

  • 김수일
    • 대한수사과학회지
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    • 제3권1호
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    • pp.60-73
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    • 2008
  • 응급의료체계(Emergency Medical System)의 목적은 응급환자에게 신속하고 적절한 응급처치를 제공함으로써, 환자의 생명을 구하고 환자의 상태를 최단 시간 내에 정상상태로 회복시켜서 사회로 복귀시키는 것이며 교정행정(矯正行政)의 목적은 범죄자를 사회로부터 격리하여 이들 수형자에게 형기동안 교육, 교화활동 및 직업훈련 등을 실시함으로써, 이들이 출소 후 사회에 복귀하여 다시는 범죄를 저지르지 않고 성공적으로 사회에 정착하도록 하는 것이다. 이렇듯 교정행정과 응급의료체계의 목적이 국민을 안전하게 사회에 복귀시키는 것으로 상호 부합된다 할 것이다. 따라서 본 연구는 교정시설 내 하위문화의 특수성으로 인한 신체적 손상과 질병에 노출될 기회가 많은 수용자와 그 곳에서 근무하고 있는 직원들의 안전을 위해 교정시설 내 다양한 응급상황 발생요인과 제도, 인력, 시설, 장비, 예산현황 및 문제점 등을 통해 효율적인 교정시설 내 응급의료체계 발전방안을 다음과 같이 제시하고자 한다. 첫째, 각 교정시설 보안근무체계에 맞게 적정인원의 응 급구조사의 채용을 확대하여야 한다. 둘째, 수용자의 중증도분류에 따른 이송체계를 완비하고 응급의료장비를 갖추어야 한다. 셋째, 교정공무원과 수용자에 대해 실습 위주의 현실적이고 체계적인 응급처치교육을 실시하여야 한다. 넷째, 1339응급의료정보센터와 같은 사회 내 응급의료체계와 협력체계를 구축하여야 한다. 다섯째, 보건복지부는 응급의 료기금의 지원을 교정시설로 확대하여야 한다.

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간호학교수 임상연수프로그램 효과 분석 (The Effect of Clinical Training Program for Nursing Faculty)

  • 서문자;도복늠;박춘자;김성실;전시자;이선옥;임난영;박영임;정은순;김순례;최스미;조남옥
    • 한국간호교육학회지
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    • 제6권2호
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    • pp.247-261
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    • 2000
  • It is important for nursing faculties to try to improve their professional knowledge and skill in nursing education. Thus it is essential for them to participate in clinical training program. The purpose of this study was to identify the effect and satisfaction of faculty clinical training programs which were managed by Korean Academic Society of Nursing Education and 4 Hospitals(Samsung Medical Center, Seoul National University Hospital, Seoul, Asan Medical Center, Yeonsei Sebrance Medical Center) in Seoul. The data collection was done from July, 1999 to December, 1999 and the 125 subjects were used for the analysis. The purpose of participation of professor to clinical training course was found that to observe of up-to-date treatment method($3.57{\pm}.60$) and to connect between knowledge and practice ($3.63{\pm}.50$). The professors were highly satisfied with 'can see the high-tech institution and facilities($3.45{\pm}.62$)' and 'can confirm in advanced nursing field and practice ($3.38{\pm}.58$)' in clinical training program. And it was found that nursing professors applied the experience of participation in clinical training program to lecture and clinial practice for students. But they were dissatisfied with 'they had no or not enough time to practice'. In conclusion, the clinical training program was useful for nursing professor to educate and instruct the students. It is suggested that the more advanced course and practical program have to be developed for nursing faculties.

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Efficient Verification of X-ray Target Replacement for the C-series High Energy Linear Accelerator

  • Cho, Jin Dong;Chun, Minsoo;Son, Jaeman;An, Hyun Joon;Yoon, Jeongmin;Choi, Chang Heon;Kim, Jung-in;Park, Jong Min;Kim, Jin Sung
    • 한국의학물리학회지:의학물리
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    • 제29권3호
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    • pp.92-100
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    • 2018
  • The manufacturer of a linear accelerator (LINAC) has reported that the target melting phenomenon could be caused by a non-recommended output setting and the excessive use of monitor unit (MU) with intensity-modulated radiation therapy (IMRT). Due to these reasons, we observed an unexpected beam interruption during the treatment of a patient in our institution. The target status was inspected and a replacement of the target was determined. After the target replacement, the beam profile was adjusted to the machine commissioning beam data, and the absolute doses-to-water for 6 MV and 10 MV photon beams were calibrated according to American Association of Physicists in Medicine (AAPM) Task Group (TG)-51 protocol. To verify the beam data after target replacement, the beam flatness, symmetry, output factor, and percent depth dose (PDD) were measured and compared with the commissioning data. The difference between the referenced and measured data for flatness and symmetry exhibited a coincidence within 0.3% for both 6 MV and 10 MV, and the difference of the PDD at 10 cm depth ($PDD_{10}$) was also within 0.3% for both photon energies. Also, patient-specific quality assurances (QAs) were performed with gamma analysis using a 2-D diode and ion chamber array detector for eight patients. The average gamma passing rates for all patients for the relative dose distribution was $99.1%{\pm}1.0%$, and those for absolute dose distribution was $97.2%{\pm}2.7%$, which means the gamma analysis results were all clinically acceptable. In this study, we recommend that the beam characteristics, such as beam profile, depth dose, and output factors, should be examined. Further, patient-specific QAs should be performed to verify the changes in the overall beam delivery system when a target replacement is inevitable; although it is more important to check the beam output in a daily routine.

Risk Factors for Clinical Metastasis in Men Undergoing Radical Prostatectomy and Immediate Adjuvant Androgen Deprivation Therapy

  • Taguchi, Satoru;Fukuhara, Hiroshi;Kakutani, Shigenori;Takeshima, Yuta;Miyazaki, Hideyo;Suzuki, Motofumi;Fujimura, Tetsuya;Nakagawa, Tohru;Igawa, Yasuhiko;Kume, Haruki;Homma, Yukio
    • Asian Pacific Journal of Cancer Prevention
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    • 제15권24호
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    • pp.10729-10733
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    • 2015
  • Background: Adjuvant androgen deprivation therapy (ADT) is a treatment option for prostate cancer (PC) patients after radical prostatectomy (RP). Although it can achieve a good progression-free survival rate, some patients still develop clinical metastasis. We here investigated risk factors of clinical metastasis in post-prostatectomy patients who received immediate adjuvant ADT. Materials and Methods: We identified 197 patients with non-metastatic PC who underwent RP at our institution between 2000 and 2012, followed by adjuvant ADT. The associations of various clinicopathologic factors with clinical metastasis (primary endpoint) and cancer-specific survival (secondary endpoint) were assessed. Multivariate analysis was conducted using a Cox proportional hazards model. Median follow-up was 87 months after RP. Results: Nine (4.6%) patients developed clinical metastasis and six (3.0%) died from PC. Eight of nine metastatic patients had a pathologic Gleason score (GS) 9 and developed bone metastasis, while the remaining one had pathologic GS 7 and developed metastasis only to para-aortic lymph nodes. On multivariate analyses, pathologic GS ${\geq}9$ and regional lymph node metastasis (pN1) were independent predictors of clinical metastasis and pathologic GS ${\geq}9$ was an independent predictor of cancer-specific death. Conclusions: Pathologic GS ${\geq}9$ and pN1 were independent predictors of clinical metastasis in post-prostatectomy patients who received immediate adjuvant ADT. Furthermore, pathologic GS ${\geq}9$ was an indispensable condition for bone metastasis, which may imply that patients with GS ${\leq}8$ on adjuvant ADT are unlikely to develop bone metastasis.

화재에 대한 부모경험을 통한 인식도와 부모교육 요구도 분석 (Analysis of perception and parent education demand through parent experience of fire)

  • 김인정
    • 대한안전경영과학회지
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    • 제15권2호
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    • pp.85-93
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    • 2013
  • This study is based on parents that have preschool children of age 4~5, and analyzes the perception and parent education demand through parent experience of fire. As a result of the study about perception through parent experience about safety life, safety accidents, safety education of fire, the effect of parents' safety consciousness to fire safety life turned out to be moderate for fathers and large for mothers. The safety education method was mostly done in speaking than experience for fathers, while mothers did education through experience in daily life. Also the difficulties in safety education was lack of educating time for fathers while it was lack of knowledge and methods for mothers. Perception through parent experience of fire safety accidents showed that fathers did not have experience of fire safety accidents while mothers did. The locations perceived by parents where fires mostly occurred showed to be within home for both parents, and both administered first aid in managing fires. Perception through parent experience of fire safety education showed the importance of fire safety education to be important in both parents, and both parents had no experience in fire safety education. Also the fire safety education knowledge acquisition method was TV or the Internet for fathers, while it was participating in seminars or lectures for mothers. Fathers were moderately satisfied of the fire safety education instruction of childhood education centers, while mothers were slightly dissatisfied. For the demand of parent education about fire safety education, fathers were moderate while mothers thought it necessary of parent education necessity. The reason why parent education was needed was to be able to know immediate and prompt measures and first aid treatment in emergency situations for fathers, while it was to figure out the cause of fire safety accidents and prevent it beforehand for mothers. For the education institution of fire safety education, fathers demanded it for safety related institutions while mothers demanded it for children education institutions, and the number of times for parent education was once or twice a year for fathers while it was once a month for mothers. For the parent education instructor of fire safety education, fathers demanded safety education experts while mothers demanded infant teachers that completed the safety education course. For the fire safety education method of parent education, fathers demanded Internet searching while mothers demanded seminars or lectures.

Nasal Anthropometry on Facial Computed Tomography Scans for Rhinoplasty in Koreans

  • Moon, Kyung Min;Cho, Geon;Sung, Ha Min;Jung, Min Su;Tak, Kyoung Seok;Jung, Sung-Won;Lee, Hoon-Bum;Suh, In Suck
    • Archives of Plastic Surgery
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    • 제40권5호
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    • pp.610-615
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    • 2013
  • Background Cephalometric analysis is essential for planning treatment in maxillofacial and aesthetic facial surgery. Although photometric analysis of the Korean nose has been attempted in the past, anthropometry of the deeper nasal structures in the same population based on computerized tomography (CT) has not been published. We therefore measured three anthropometric parameters of the nose on CT scans in our clinical series of patients. Methods We conducted the current retrospective study of a total of 100 patients (n=100) who underwent a CT-guided radiological measurement at our institution during a period ranging from January of 2008 to August of 2010. In these patients, we took three anthropometric measurements: the nasofrontal angle, the pyramidal angle, and the linear distance between the nasion and the tip of the nasal bone. Results The mean nasofrontal angle was $131.14^{\circ}$ in the male patients and $140.70^{\circ}$ in the female patients. The mean linear distance between the nasion and the tip of the nasal bone was 21.28 mm and 18.02 mm, respectively. The mean nasal pyramidal angle was $112.89^{\circ}$ and $103.25^{\circ}$ at the level of the nasal root, $117.49^{\circ}$ and $115.60^{\circ}$ at the middle level of the nasal bone, and $127.99^{\circ}$ and $125.04^{\circ}$ at the level of the tip of the nasal bone, respectively. Conclusions In conclusion, our data will be helpful in the preparation of silicone implants for augmentation and/or corrective rhinoplasty in ethnic Korean people.

한의약건강증진사업 발전을 위한 공중보건한의사 역할 탐색 (Exploring the roles of Korean public health doctors in the development of Korean medicine health promotion project)

  • 진성미;박선주
    • 대한예방한의학회지
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    • 제21권3호
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    • pp.11-18
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    • 2017
  • Objectives : In an effort to suggest a developmental plan of Traditional Korean Medicine health promotion project(TKM-HPP), this study was conducted to identify the problems experienced by public health Traditional Korean Medicine(PH-TKM) doctors in duty and to analyze successful cases of the health promotion project. Methods : Two PH-TKM doctors in duty at the Public Health Centre branch and Public Health Centre respectively, and one TKM doctor in charge of Public Health Centre participated in the in-depth interview. The research procedure was as follows; 1) inform study objectives and interview questions to participants, 2) in-depth interview with semi-structured questions, and 3) post-confirmation and verification. The interview was recorded and transcripted. In-depth interview was composed of 6 subsections: 1) Introducing participants and share purpose of interview, 2) Confirmation of the job status and difficulty of public health centre, 3) Reflecting and sharing experiences of public health clinic job performance cases, 4) Current status and improvement needs of TKM-HPP, 5) Discussions on improvement of TKM-HPP in public health center, 6) Sharing and reconfirmation of interview results. Thematic analysis was conducted from the narratives. Results : The study showed that; 1) the support from the local government was critical for the successful TKM-HPP and participation of the PH-TKMs; 2) the major problems experienced by PH-TKMs were lack of training for TKM-HPP in the field and lack of knowledge at local government level; 3) the suggestions to provide PH-TKMs with manual to educate residents effectively and redefine roles of PH-TKMs in the project. It also suggests that TKM-HPP model should be developed by the district in a way of reflecting regional characteristics. Conclusions : Firstly, more efforts should be made on the projects rather than medical treatment in public health centers, except for areas where medical institutions are scarce. Secondly, in order to facilitate participation of PH-TKM doctors, each local office should reduce medical care and increase efforts related with projects. Thirdly, the institution has to develop feasible TKM-HPP plans that can be carried out by PH-TKMs by the manual. Lastly, pre-training should be provided to PH-TKMs to understand contents of TKM-HPP related to public health centre work before the placement.

원발성 종격동종양 및 낭종의 외과적 치료 (Surgical Treatment of the Primary Mediastinal Tumors and Cysts)

  • 김병구;오태윤;장운하
    • Journal of Chest Surgery
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    • 제29권6호
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    • pp.632-638
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    • 1996
  • 저자는 1985년 1월부터 1995년 12월까지 강북 삼성병원 흉부외과에서 수술치험한 42례의 원발성 종 격동 종양 및 낭종을 대상으로 후향적 임상분석을 실시하였다. 환자는27례의 남자와 15례의 여자로 구성되었다. 10개월의 영아부터 76세의 노인에 이르기까지 평균 연령은 40세 였다. 환자는 흉선종 12례 (28.6 %), 생식세포종 8례 (19.0 %), 원발성 낭종 7례 (16.7 %), 신경 종양 6례 (14.3 %)와 기타 종격동 종양 9례로 구성되었다. 종양의 3)례 (78.6 %)는 조직학적으로 양성이 었고, 9례 (21.4 %)는 악성 이 었다. 임상증세는 흉통, 호흡곤란, 기 침과 같은 호흡기증세로 주로 나타났다. 악성 종양을 지닌 환자는 전례 에서, 양성 환자는 55 %에서 입원당시에 증세가 나타났다. 환자 모두는 조직학적 진단과 절제를 위해 수술을 시행하였다. 2례의 유육종을 제외한 모든 양성의 종격동종양은 완전절제가 가능하였고 경과양호하였다. 그리고 일부 악성종양은 완전절제가 불가능하여 부분절제 및 항암 화학요법 혹은 방사선치료를 병용하였다. 술후 합병증은 7례(18%)였고 사망례는 없다. 결론적으로, 종격동종양은 개흥을 하기전에 다양하고 예측하기 어려운 愎昺㏏\ulcorner\ulcorner오랫동안 흉부외 과 의사에게는 관심의 대상이 되어왔으며, 적극적인 수술 및 다양한 병합요법으로 좋은 결과를 가져올 수 있다고 여겨진다.

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한국노인의 자가보고 치주건강상태와 구강건강관련 삶의 질의 연관성 (Association between the self-reported periodontal health status and oral health-related quality of life among elderly Koreans)

  • 장문성;김혜영;심연수;류인철;한수부;정종평;구영
    • Journal of Periodontal and Implant Science
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    • 제36권3호
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    • pp.591-600
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    • 2006
  • Purpose: This study assessed the impact of self-reported periodontal health on the oral health-related quality of life among elderly Koreans. Methods: Four hundred twenty one elderly Koreans in Seoul and suburban areas were selected with a cluster (institution) sampling method, and were requested to take oral examinations and finish questionnaires on the Oral Health Impact Profile-14(OHIP-14). and self-reported periodontal health status, such as periodontal symptoms, self-rated periodontal health and periodontal treatment need. As the dependent variable, OHIP-14 showed a positive skewed distribution (skewness: 1.17), we transformed to square-root form to apply parametric analyses. Bivariate analysis by t-test and ANOVA, and multivariate analysis with the two-level regression model accounting clusters were implemented. Results: Mean age of the subjects was 74.6 years and 66.5% were women. Fourteen items of OHIP-14 were summarized to one factor explaining 78.6% of total variance and produced the Chronbach alpha coefficient of 0.92. Results from the multivariate model, adjusting for age, sex, type of institutions, ability to pay, and number of teeth present, showed significantly lower OHIP-14 with reporting less than 3 periodontal symptoms (p(O.OOO1), rating their own periodontal health as above average level (p=O.0144), and thinking they don't need any periodontal treatments in the near future (p=O.0148), than their counterparts. The intraclass-corrrelation estimated by the final model was 0.028. Conclusion: This study demonstrates a significant association between self-reported periodontal health status and the oral health-related quality of life.

간질아동 부모의 스트레스에 관한 비교 연구 (A Comparative Study of Parental Stress in Families with Epileptic Children)

  • 김보영;조성민
    • Clinical and Experimental Pediatrics
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    • 제45권10호
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    • pp.1251-1262
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    • 2002
  • 목 적 : 간질아동 부모들이 경험하는 스트레스 수준을 살펴보고 부모 및 아동의 특성과 부모가 겪는 스트레스의 관계를 파악하고자 하였다. 방 법: 부산 대구 경북지역 소재 4개 대학병원 간질클리닉에서 간질로 진단 치료를 받고 있는 간질 아동의 부모를 조사대상으로 구조화된 설문지를 이용한 면접조사 및 반송우편을 이용한 조사를 하였다. 결 과 : 간질아동 부모의 스트레스 수준은 그리 높게 나타나지는 않았으며, 간질아동 부모간에 스트레스 수준의 유의한 차이는 나타나지 않았다. 항경련제 종류의 수와 부모의 스트레스 수준간에는 상관관계를 보였고, 모의 경우에 간질아동을 양육하는 시간이 많을수록 스트레스가 증가하며, 아동의 나이가 어릴수록 모가 느끼는 스트레스가 높은 것으로 나타났다. 항경련제 종류의 수가 증가하거나 환아가 특수학교에 다니는 경우, 환아가 복합 간질을 가졌을 경우, 그리고 환아에게 장애가 동반되었을 때 부와 모 모두에서 스트레스가 높게 나타났다. 또한 모의 경우에는, 간질아동 양육 시간이 많은 경우, 환아의 나이가 어릴 경우, 경련의 빈도가 빈번할 경우, 그리고 아동의 갑작스러운 사망을 우려하는 경우에도 스트레스 수준이 높게 나타났고, 부의 경우에는 간질의 치료기간이 장기간일 경우에도 스트레스 수준이 높게 나타났다. 결 론 : 간질아동의 질병 관련 특성에 의하여 부모의 스트레스 수준이 좌우됨을 알 수 있었고, 주로 난치성 간질이나 장애를 동반한 'epilepsy-plus' 간질아동의 부모에게서 스트레스 수준이 높았으며, 이런 간질아동 부모들에 대한 사회심리학적 접근이 고려되어야 할 것으로 생각된다.