• Journal of Digital Convergence
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• v.19 no.4
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• pp.467-475
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• 2021

Purpose: When a patient with acute deterioration occurs in a ward, the decision to transfer to intensive care unit (ICU) is critical to improve the patient's outcomes. However, when available ICU resources limited, it is difficult to determine which of the deteriorating ward patients to transfer to the ICU. Therefore the purpose of this study was to identify risk factors in predicting deteriorating ward patients transferred to intensive care unit (ICU). Methods: We reviewed retrospectively clinical data of 2,945 deteriorating ward patients who referred medical emergency team. Data were analyzed with multivariate logistic regression. Results: The solid cancer that diagnosed at hospitalization (odds ratio[OR] 0.39; 95% confidence interval [CI] 0.32-0.47), when the cause of deterioration was respiratory problem (1.51; 95% CI 1.17-1.95), high MEWS (1.22; 1.17-1.28) and SpO2/FiO2 score (2.41; 2.23-2.60) were predictive of ICU transfer. Conclusion: These findings suggest that early prediction and treatment of patients with high risk of ICU transfer may improve the prognosis of patients.

• KSCE Journal of Civil and Environmental Engineering Research
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• v.32 no.5B
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• pp.273-285
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• 2012

Current TMDL based on the 'Polluter Pays Principle' in Republic of Korea is individually operated by each local government for the designed allocated pollution load of unit watershed and unit district. However, unlike the motion of the air contaminants, the polluted contaminants in a river move from upstream to downstream, and a river can affect to districts more than two. In addition, a decision making on the construction of a sewage treatment facilities follows the concept of 'economy of scale'. These reasons support the collaboration among local governments in order to reduce the costs in improving water quality. This study suggested a method to reduce water quality management cost by redistributing reduction load considering cost-effectiveness for an entire watershed. The assessment on the suggested method is conducted in Youngsan river watershed. Without variation in total load, reduction load assigned for unit watershed and unit district is retributed in the region where pollutant source is concentrated, and then water quality and cost reduction improved from the redistribution of reduction load is analyzed. The results show that the cost saved by the suggested method is KRW 124 billion for scenario-1 and 172 billion for scenario-2 considering total cost of KRW 788 billion for the existing plan. We expect that the suggested method is a good example to reduce water quality management cost in local governments for TMDL.

• The Korean Society of Law and Medicine
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• v.17 no.1
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• pp.139-168
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• 2016

Two alternative dispute resolutions for medical dispute have been operated under the States of German Medical Associations. The first is the medical mediation committee of North german area, the other is the advisory committee on medical errors in North-Rhine area. The former has focused on the mediation itself, the latter commission has focused on the expert review itself whether the physician has maintained reasonable care in diagnosis and treatment. Even though these organizations have maintained under the medical associations, to maintain the neutrality on legal and medical decision, the North German mediation committee is composed of a lawyer and a medicine doctor respectively and North-Rhine advisory committee has a lawyer chair person and four medicine doctors. The main difference of Korean Medical Dispute Mediation Agency in respect from the german system is that expert review is subordinated to the mediation process. The neutrality of expert review is suspected from the medicine doctors. The neytrality and the efficiency should be improved to treat the medical disputes. To do so, lawyer and medicine doctor work together in mediation process and lawyer should manage the expert review process but not involved. Mediation process and expert review should be checked and balanced, and they could be developed as a separated process itself.

• Korean Journal of Agricultural and Forest Meteorology
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• v.18 no.4
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• pp.253-263
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• 2016

Chrysanthemum production would benefit from crop growth simulations, which would support decision-making in crop management. Chrysanthemum is a typical short day plant of which floral initiation and development is sensitive to photoperiod. We developed a model to predict phenological development and leaf appearance of chrysanthemum (cv. Baekseon) using daylength (including civil twilight period), air temperature, and management options like light interruption and ethylene treatment as predictor variables. Chrysanthemum development stage (DVS) was divided into juvenile (DVS=1.0), juvenile to budding (DVS=1.33), and budding to flowering (DVS=2.0) phases for which different strategies and variables were used to predict the development toward the end of each phenophase. The juvenile phase was assumed to be completed at a certain leaf number which was estimated as 15.5 and increased by ethylene application to the mother plant before cutting and the transplanted plant after cutting. After juvenile phase, development rate (DVR) before budding and flowering were calculated from temperature and day length response functions, and budding and flowering were completed when the integrated DVR reached 1.33 and 2.0, respectively. In addition the model assumed that leaf appearance terminates just before budding. This model predicted budding date, flowering date, and leaf appearance with acceptable accuracy and precision not only for the calibration data set but also for the validation data set which are independent of the calibration data set.

• Clinics in Shoulder and Elbow
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• v.10 no.1
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• pp.84-91
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• 2007

Purpose: The aim of this study was to report seven cases of metallic radial head prosthesis and present the limit of use in Korea. Materials and Methods: Metallic radial head arthroplasty was performed on 7 patients between April 2006 and December 2006, who had complex elbow injury including comminuted radial head fracture. Indication, operative findings and outcome were assessed. Availability and payment of implant were investigated. Results: All of the patients had more than one associated injury including coronoid fracture, olecranoan fracture, and ligament ruptures. According to Mason classification, there were three type III and four type IV fractures. All radial head fractures were too comminuted to reconstruct. There were two excellent results, four good, and one poor, as graded by Mayo score. There were no patient with instability and implant related complications. Insufficient supply of implant did not enable to do scheduled surgery in 2 cases. Current medical insurance did not cover charge for radial prosthesis, five patients could not help paying for that by themselves. Conclusion: Metallic radial head implants are useful when the radial head cannot be repaired reliably. Preoperative preparing and coverage by medical insurance based on appropriate indication are helpful for decision for a treatment option.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.21 no.1
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• pp.604-611
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• 2020

This study was undertaken is to improve the working conditions by improving the job satisfaction of clinical research nurses and clinical nurses involved in and conducting clinical trials. The survey was conducted from November 6 to December 6, 2017 for 100 nurses working in Seoul and Gyeonggi-do. The accumulated data were analyzed by frequency analysis, reliability verification, and t-test using the SPSS program. Our results reveal that job satisfaction was higher for clinical nurses (2.94 ± 0.609 points) as compared to clinical research nurses (2.89 ± 0.620 points). Also, the satisfaction level of salary received was higher amongst the clinical nurses than the clinical research nurses. Furthermore, although career decision was relatively lower for the clinical nurse than the clinical research nurse, the importance of job performance and job stability ranked high. Considering importance of the role of clinical research nurses in clinical trials, it is necessary to enhance their job satisfaction by improving the clinical trial environment such as appropriate treatment and professional role, and the working environment including remuneration, professional status, and administrative work to establish their jobs.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.15 no.4
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• pp.1895-1904
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• 2014

This study explores the way to improve service quality with the application of Service Blueprint and Analytic Hierarchy Process (hereafter, "AHP") in medical tourism. Service Blueprint has been widely accepted to identify the possible fail points in service delivery system, and AHP analysis has been recognized as beneficial method to rate relative importance in multi-criteria decision making process. We try to understand possible pitfalls to enhance Chinese medical tourists, and propose the priority in the resolution process. In the first step, we reviewed the extant literatures about medical tourism of South Korea, and built initial Service Blueprint. Experts who experienced service delivery process towards Chinese patients participated to review the proposed Service Blueprint in the second step. Thirdly, after extracting the possible fail points from revised Service Blueprint, we asked experts to guess the relative importance of Chinese patient by AHP methodology. Four domains (Arrival and Welcoming, Hospitalization, Process before, operations, and after surgery, Recovery and discharge) were emerged with detail criteria. Results show that operations and treatment is the most important domain not to lose Chinese patient's loyalty with following hospitalization process domain. Also, we suggest the priority among sixteen criteria to prevent service failure.

• Journal of the korean academy of Pediatric Dentistry
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• v.36 no.4
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• pp.625-630
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• 2009

Root resorption of primary teeth usually occurs as the succeeding permanent teeth erupt, which induces differentiation of the hemopoietic cells into osteoclasts. Their root resorption pattern reflects the eruption path of the succeeding permanent teeth, and eventually the primary teeth shed as their succeeding permanent teeth erupt. Even when a permanent tooth germ is congenitally missing, root resorption of the corresponding primary tooth may still occur due to various factors, such as inflammation, traumatic occlusal force, and weakness of periodontium etc. Such congenital missing of permanent teeth is a commonly observed phenomenon in human be ing, and it often accompanies delayed retention of primary teeth. The etiologic factors for congenital missing in elude not only systemic diseases, but also local factors and human evolution process. In the radiographs of the cases in this report, the primary teeth without succeeding permanent teeth show pathologic root resorption. Root resorption progressed about 1/2~3/4 of the roots, and the surfaces of the resorption area were irregular. Considering high susceptibility of the periodontal ligament of primary teeth to root resorption, pathologic root resorption of primary teeth with delayed retention can be explained by the increased masticatory muscle force and abnormal occlusion developed during the mixed dentition. When the primary teeth without succeeding permanent teeth are lost, decision for space maintenance is required and long-term treatment plan for further prosthetic or orthodontic treatment should be establsihed.

• The Korean Society of Law and Medicine
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• v.13 no.1
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• pp.199-247
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• 2012

According to the review and analysis of medical cases that are assigned to the Supreme Court and all local High Court in 2011 and that are presented in the media, it was found that the following categories were taken seriously, medical and pharmaceutical product liability, the third principle of trust between medical institutions, negligence and causation estimation, responsibility limit, the meaning of medical records and related judgment of disturbed substantiation, Oriental doctors' duties to explain the procedures, IMS events, whether one can claim for each medical care operated by non-physician health care institutions to the nonmedical domain in the National Health Insurance Corporation, and the basis of norms for each claim. In the cases related to medical pharmaceutical product liability, Supreme Court alleviated burden of proof for accidents with medical and pharmaceutical products prior to the practice of Product Liability Law and onset the point of negative prescription as the time of damage strikes to condition feasibility of the specific situation. In the cases related to the 3rd principle of trust between medical institutions, the Supreme Court refused to sentence the doctor who has trusted the judgment of the same third-party doctors the violations of the care duty. With respect to proof of a causal relationship and damages in a medical negligence case, the Supreme Court decided that it is unjust to deny negligence by the materials of causal relationship rejecting the original verdict and clarified that the causal relationship shall not deny the reasons to limit doctors' responsibilities. In order not put burden on patients with disadvantages in which medical records and the description of the practice or the most fundamental and important evidence to prove negligence and causation are being neglected, the Supreme Court admitted in the hospital's responsibility for the case of the neonate death of suffocation without properly listed fetal heart rate and uterine contraction monitor. On the other hand, the Seoul Western District Court has admitted alimony for altering and forging medical records. With respect to doctors' obligations to description, the Supreme Court decided that it is necessary to explain the foreseen risks by the combination of oriental and western medicines emphasizing the right of patient's self-determination. However, questions have arisen whether it is realistically feasible or not. In a case of an unlicensed doctor performing intramuscular stimulation treatment (IMS), the Supreme Court put off its decision if it was an unlicensed medical practice as to put limitation of eastern and western medical practices, but it declared that IMS practice was an acupuncture treatment therefore the plaintiff's conduct being an illegal act. In the future, clear judgment on this matter should be made. With respect to the claim of bills from non-physical health care institutions, the Supreme Court decided to void it for the implementation of the arrangement is contrary to the commitments made in the medical law and therefore, it is invalid to claim. In addition, contrast to the private healthcare professionals, who are subject to redemption according to the National Healthcare Insurance Law, the Seoul High Court explicitly confirmed that the non-professionals who receive the tort operating profit must return the unjust enrichment and have the liability for damages. As mentioned above, a relatively wide range of topics were discussed in medical field of 2011. In Korea's health care environment undergoing complex changes day by day, it is expected to see more diverse and in-depth discussions striding out to the development in the field of health care.

• Radiation Oncology Journal
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• v.20 no.1
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• pp.1-16
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• 2002

Purpose : Three dimensional conformal radiotherapy planning is being used widely for the treatment of patients with brain tumor. However, it takes much time to develop an optimal treatment plan, therefore, it is difficult to apply this technique to all patients. To increase the efficiency of this technique, we need to develop standard radiotherapy plant for each site of the brain. Therefore we developed several 3 dimensional conformal radiotherapy plans (3D plans) for tumors at each site of brain, compared them with each other, and with 2 dimensional radiotherapy plans. Finally model plans for each site of the brain were decide. Materials and Methods : Imaginary tumors, with sizes commonly observed in the clinic, were designed for each site of the brain and drawn on CT images. The planning target volumes (PTVs) were as follows; temporal $tumor-5.7\times8.2\times7.6\;cm$, suprasellar $tumor-3\times4\times4.1\;cm$, thalamic $tumor-3.1\times5.9\times3.7\;cm$, frontoparietal $tumor-5.5\times7\times5.5\;cm$, and occipitoparietal $tumor-5\times5.5\times5\;cm$. Plans using paralled opposed 2 portals and/or 3 portals including fronto-vertex and 2 lateral fields were developed manually as the conventional 2D plans, and 3D noncoplanar conformal plans were developed using beam's eye view and the automatic block drawing tool. Total tumor dose was 54 Gy for a suprasellar tumor, 59.4 Gy and 72 Gy for the other tumors. All dose plans (including 2D plans) were calculated using 3D plan software. Developed plans were compared with each other using dose-volume histograms (DVH), normal tissue complication probabilities (NTCP) and variable dose statistic values (minimum, maximum and mean dose, D5, V83, V85 and V95). Finally a best radiotherapy plan for each site of brain was selected. Results : 1) Temporal tumor; NTCPs and DVHs of the normal tissue of all 3D plans were superior to 2D plans and this trend was more definite when total dose was escalated to 72 Gy (NTCPs of normal brain 2D $plans:27\%,\;8\%\rightarrow\;3D\;plans:1\%,\;1\%$). Various dose statistic values did not show any consistent trend. A 3D plan using 3 noncoplanar portals was selected as a model radiotherapy plan. 2) Suprasellar tumor; NTCPs of all 3D plans and 2D plans did not show significant difference because the total dose of this tumor was only 54 Gy. DVHs of normal brain and brainstem were significantly different for different plans. D5, V85, V95 and mean values showed some consistent trend that was compatible with DVH. All 3D plans were superior to 2D plans even when 3 portals (fronto-vertex and 2 lateral fields) were used for 2D plans. A 3D plan using 7 portals was worse than plans using fewer portals. A 3D plan using 5 noncoplanar portals was selected as a model plan. 3) Thalamic tumor; NTCPs of all 3D plans were lower than the 2D plans when the total dose was elevated to 72 Gy. DVHs of normal tissues showed similar results. V83, V85, V95 showed some consistent differences between plans but not between 3D plans. 3D plans using 5 noncoplanar portals were selected as a model plan. 4) Parietal (fronto- and occipito-) tumors; all NTCPs of the normal brain in 3D plans were lower than in 2D plans. DVH also showed the same results. V83, V85, V95 showed consistent trends with NTCP and DVH. 3D plans using 5 portals for frontoparietal tumor and 6 portals for occipitoparietal tumor were selected as model plans. Conclusion : NTCP and DVH showed reasonable differences between plans and were through to be useful for comparing plans. All 3D plans were superior to 2D plans. Best 3D plans were selected for tumors in each site of brain using NTCP, DVH and finally by the planner's decision.