• 의료법학
• /
• 제9권2호
• /
• pp.181-207
• /
• 2008

With recent emphasis on evidence based medicine, clinical practice guidelines are seen as a potential mechanism by which unify various managerial and professional approaches to improving the quality of care. The development process of guidelines has been the subject of much research. and it is need translating the medical evidence of research into a clinical practice guidelines. the gathered evidence needs to be interpreted into a clinical, public health, policy, or payment context. The term 'clinical practice guidelines' can evoke a diverse range of responses from healthcare personnel. Clinical practice guidelines are increasingly used in patient management but some clinicians are not familiar with their origin or appropriate applications. Understanding the limitations as well as benefits of CPG could enable clinicians to have clearer view of the place of guidelines in every practice. In the context of increasing complaints and litigation in healthcare, the legal implications of clinical practice guidelines are of increasing importance. Clinical practice guidelines could, in theory, influence the manner in which the courts establish negligence by suggesting the doctor breached the duty of care by failing to provide the required standard of medical care. In several studies, the CPGs were relevent to and played a pivotal role in the proof of negligence. Much depends on the quality of guidelines and the tools developed and the authoritativeness of a guideline. Recently, there are several opinions the court also should review the validity and reliability of expert testimony including medical evidence. and widespread use of guidelines in malpractice lawsuit could lead the physicians to greater compliance with guidelines in the long term. In conclusion, Health care reformers, physicians as well as guidelines developers should understand that guidelines have both medical and legal aspects as a double-edges sword. so clinicians, legal representatives and decision-makers should not defer unduly to guidelines.

• Journal of Dental Anesthesia and Pain Medicine
• /
• 제20권4호
• /
• pp.223-231
• /
• 2020

Background: The most frequent complication of nasotracheal intubation (NTI) is epistaxis. Epinephrine nasal gauze packing has been used conventionally as a pre-treatment for reducing epistaxis, but it carries a disadvantage of pain and anxiety in patients. However, xylometazoline drops are easier to administer and more convenient for patients. We aimed at comparing the effectiveness of xylometazoline drops and epinephrine merocele packing in reducing bleeding and postoperative complications in our population. Methods: Our study enrolled 120 patients in a double-blind randomized controlled trial. We randomly allocated ASA1 or 2 adult patients into 2 groups: Group X and Group E. Group X received 0.1% xylometazoline nasal drops, and epinephrine (1:10,000) merocele nasal packing was used in Group E. The primary outcome was the incidence of bleeding during NTI; the severity of bleeding, navigability, bleeding during extubation, and postoperative complications were secondary outcomes. We used IBM SPSS and Minitab software for statistical analysis, and P < 0.05 was considered statistically significant. Results: We analyzed the data of 110 patients: 55 in Group X and 55 in Group E. The two groups did not have different bleeding incidence (56.4% vs 60.0%; P = 0.70); however, the incidence of severe bleeding was less with xylometazoline than with epinephrine (3.63% vs 14.54%; P < 0.05). We also observed less bleeding during extubation (38.2% vs 68.5%; P < 0.05) with xylometazoline. Other secondary outcomes were akin to both groups. Conclusion: The incidence of severe and post-extubation bleeding was significantly less with xylometazoline. Hence, it may be an effective alternative for reducing the incidence and severity of epistaxis during NTI.

• The Korean Journal of Pain
• /
• 제33권1호
• /
• pp.81-89
• /
• 2020

Background: For children with cleft palates, surgeries at a young age are necessary to reduce feeding or phonation difficulties and reduce complications, especially respiratory tract infections and frequent sinusitis. We hypothesized that dexmedetomidine might prolong the postoperative analgesic duration when added to bupivacaine during nerve blocks. Methods: Eighty patients of 1-5 years old were arbitrarily assigned to two equal groups (forty patients each) to receive bilateral suprazygomatic maxillary nerve blocks. Group A received bilateral 0.2 mL/kg bupivacaine (0.125%; maximum volume 4 mL/side). Group B received bilateral 0.2 mL/kg bupivacaine (0.125%) + 0.5 ㎍/kg dexmedetomidine (maximum volume 4 mL/side). Results: The modified children's hospital of Eastern Ontario pain scale score was significantly lower in group B children after 8 hours of follow-up postoperatively (P < 0.001). Mean values of heart rate and blood pressure were significantly different between the groups, with lower mean values in group B (P < 0.001). Median time to the first analgesic demand in group A children was 10 hours (range 8-12 hr), and no patients needed analgesia in group B. The sedation score assessment was higher in children given dexmedetomidine (P = 0.03) during the first postoperative 30 minutes. Better parent satisfaction scores (5-point Likert scale) were recorded in group B and without serious adverse effects. Conclusions: Addition of dexmedetomidine 0.5 ㎍/kg to bupivacaine 0.125% has accentuated the analgesic efficacy of bilateral suprazygomatic maxillary nerve block in children undergoing primary cleft palate repair with less postoperative supplemental analgesia or untoward effects.

• 한국콘텐츠학회논문지
• /
• 제22권1호
• /
• pp.23-34
• /
• 2022

COVID-19 발병과 장기화로 장시간 마스크 착용으로 인한 피부 트러블 발생으로 셀프 스킨케어에 관심이 급속도로 증가하고 있다. 본 연구는 이러한 시장의 변화에 대응하고자 맞춤형 홈 뷰티 케어 디바이스의 제품디자인을 그 목적으로 한다. 이를 위하여 본 연구자는 디자인씽킹 프로세스 중 더블다이아몬드 모델을 적용하여 발견, 정의, 발전, 전달 단계 순으로 디자인 개발을 진행하였다. 1단계 발견에서는 사전 조사를 통해 도출된 3가지 제품 컨셉 평가와 함께 소비자의 니즈를 파악하기 위해 집단심층면접을 진행하였다. 2단계 정의에서는 제품 컨셉과 디자인 방향성을 설정하였고, 적정성 평가를 진행하였다. 3단계 발전에서는 맞춤형 서비스를 위한 피부 상태 측정 간소화 및 케어 솔루션을 제시하여 제품 컨셉을 정교화 하였다. 그리고, 유니버설 스케일 적용을 위해 한국인 인체측정데이터를 분석하여 추출된 대표 치수를 적용하여 디자인 시안을 제시하였다. 4단계 전달에서는 시안들에 대해 소비자 평가를 시행하여 문제점을 보완하여 최종 시안을 제안하였다. 본 연구는 스타일링 중심의 디자인 프로세스가 아닌 디자인씽킹 프로세스를 융합해 사용자 중심의 디자인 개발에 중점을 두었고, 측정 데이터 기반으로 한 정보들을 활용한 디자인 개발에 새로운 가능성을 제시했다는 의의를 지니고 있다.

• 의료법학
• /
• 제15권1호
• /
• pp.335-373
• /
• 2014

한 자료에 의하면 2011년 미국의 의료비 지출 총액은 국내총생산의 약 18 퍼센트에 달하였으며, 그 비율은 다른 대다수 선진국의 두 배에 해당하는 것이었다. 그중 메디케어 비용은 전체 의료비의 21 퍼센트인 5540억 달러 였는데, 환자의 최후 6 개월에 들어간 의료비는 그 5540억 달러의 28 퍼센트 (전체 의료비의 5.9 퍼센트)인 1700억 달러에 달하였다. 이러한 말기의료의 고비용성은 어떤 사유에 기인하며, 그 해소 방안은 무엇인가. 지난 수십 년 간의 의료경제학적 연구는 말기의료가 일반적으로 공급민감성을 지니며 비용대비 효율성이 매우 낮다는 결론에 도달하였다. 의료서비스 공급의 양은 질병의 정도나 환자의 선호도와는 무관하고, 그보다는 의료서비스 공급자원에 민감하게 반응한다는 것이다. 이는 말기의료에서는 의료자원이 과용된다는 것을 의미한다. 한편 "더 많은 의료처치에 더 나은 효용"이라는 일반적인 추론과는 반대로, 많은 의료처치의 결과는 오히려 매우 부정적인 것이었다. 실제 환자들의 선호와 관심사는 격렬한 말기의료가 기도하는 것과는 아주 달랐던 것이다. 이 논문은 먼저 말기의료에서의 공급민감성의 원인을 분석한다. 그 원인으로는 격렬한 치료와 그 효용성에 대한 일반적인 오해, 의사들의 환자에 대한 직업적인 사명의식, 환자 자신의 말기의료 의향결정의 부재, 의사들의 법적 책임에 대한 우려, 의료기관의 경영차원에서의 관리전략 등을 들 수 있다. 다음으로, 논문에서는 말기의료의 공급민감성에서 연유하는 과잉진료에 대한 현실적 해결책을 제시한다. 그 해결책은 두 가지 측면으로 나누어서 들 수 있는데, 하나는 사전의료의향서 제도의 활성화 방안이고, 다른 하나는 의료기관 경영관리전략적 관점에서의 방안이다. 우선 사전의료의향서의 활용도를 제고하기 위해서 다음과 같은 구체적 노력이 필요하다. 즉 의사들의 말기의료에 대한 태도를 바꾸도록 하는 새로운 의료윤리 교육 실시, 의사와 환자 간 말기의료에 대한 소통 기회의 강화, 환자와 말기의료에 대한 대화를 적극적으로 실천하는 의사에 대한 보상제도 도입, 일반 공공에 대한 관련 교육 확대, 온라인 등록시스템과 같은 용이하고도 공식적인 사전의료의향서 등록체제의 구축 확대 등이 필요하다. 경영관리적 측면에서는 대체 전략이 필요하다. 예컨대 불필요한 비용을 절감하고 의료공급자로서의 가치를 재정립하는 등의 새로운 재무전략과 경영교육계획 등이 고려되어야 할 것이다. 효과적으로 말기의료의 경제적 문제점을 해소하고 환자에게 더 나은 의료경험을 제공하기 위해서는 의료 환자 국가 등 모든 부문에서 관행과 오해에서 비롯된 신조가 시급히 수정되어야 하고, 그 기초 위에서 제도와 문화가 개선되어야 하는 것이다.

• 한국산학기술학회논문지
• /
• 제13권7호
• /
• pp.2886-2894
• /
• 2012

본 연구는 서울소재 대학교에 재학 중인 여대생을 대상으로 피부미용전공과 비전공 여학생들의 피부건강관리의 관심도와 피부상태, 인식 및 관리 행위의 차이점 및 관련성을 파악하고자 하였다. 전공자들과 비전공자들의 대한 비교 분석은 동일한 생활권에서 궁극적으로 전문 학습과 비 전문학습의 일반적인 상태에 대한 지식과 행위를 의미하는 것으로, 연구결과는 다음과 같이 나타났다. 전공 여대생이 비전공 여대생에 비해 피부건강에 대한 관심도가 높은 것으로 유의미한 차이가 있었다(p<.01). 피부미용 전공 여대생은 복합성 피부, 비전공 여대생은 건성 피부가 많은 것으로 유의미한 차이를 보였다(p<.05). 피부 관리 실태에서 색조화장 후 전공여부에 따른 이중세안 정도, 각질 정리 횟수, 마사지나 팩 관리횟수, 선크림 사용 항목에서 각각 유의미한 차이가 있었다(p<.01, p<.001, p<.01, p<.01). 오백식품 및 인스턴트식품의 영향정도와 수분섭취 항목에서 각각 유의미한 차이를 보였다(p<.001).(p<.05). 화장품 사용은 다양한 채널을 통해 효율적인 구매를 하는 경향이었으며, 탁월한 기능이 있을 때는 경제적 부담이 있어도 구입 의향 항목에서 적극적인 성향인 것으로 유의미하게 나타났다(p<.001). 본 연구의 결과는 피부미용 산업 및 교육 분야에 기초자료로 활용되고자 하였다.

• 한국의류학회지
• /
• 제44권3호
• /
• pp.427-440
• /
• 2020

This study developed a vest prototype capable of monitoring body temperature using textile electrodes to prevent the sudden death of babies as well as to determine the quality of developed products by evaluating usability with commercial products. Based on the results of the 7th Size Korea Project, a basic pattern for a vest prototype was drafted by applying the average size of two-year-old Korean babies. Two prototypes were the detachable (VEST I) and integrated textile electrodes vest type (VEST II), which followed the same design. The materials were 100% cotton single jersey (SJ) and double jersey (DJ). Six experts evaluated the usability of the developed vests (VEST I & VEST II) and commercial product (VEST M). The single-layer woven textile electrode appeared to have a slightly higher conductivity than the double-layer one. There was no statistical difference in the body temperature sensing function between VEST I and VEST II. Finally, the superiority of the VEST I was verified through a comparison with commercial products (VEST M). The usability test suggested that a wearable smart clothing system of the integrated conductive textile could be further commercialized for bio-monitor applications in Ubiquitous-health care.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제37권
• /
• pp.35.1-35.7
• /
• 2015

After cleft lip repair, many patients suffer from nasolabial fistulas, asymmetrical nasal floor, or an indistinct nostril sill, as well as intraoral wound dehiscence and subsequent scar contracture of surgical wounds leading to vestibular stenosis. For successful primary nasolabial repair of complete cleft deformity of the primary palate, cleft surgeons need special care in reconstructing the sound nasal floor. Especially when the cleft gap is wide or when any type of nasoalveolar molding therapy was not performed, three-dimensional reconstruction of the nasal floor is critical for a balanced nasal shape. In this study, the author describes an effective method for reconstructing a double-layered nasal floor using two mucosal flaps from both sides of the fissured upper lip. This is a report of six patients with unilateral or bilateral complete cleft of the primary palate with a detailed description of the surgical technique and a literature review.

• Journal of Microbiology and Biotechnology
• /
• 제31권9호
• /
• pp.1323-1329
• /
• 2021

Micro-scale magnetic beads are widely used for isolation of proteins, DNA, and cells, leading to the development of in vitro diagnostics. Efficient isolation of target biomolecules is one of the keys to developing a simple and rapid point-of-care diagnostic. A zinc finger protein (ZFP) is a double-stranded (ds) DNA-binding domain, providing a useful scaffold for direct reading of the sequence information. Here, we utilized two engineered ZFPs (Stx2-268 and SEB-435) to detect the Shiga toxin (stx2) gene and the staphylococcal enterotoxin B (seb) gene present in foodborne pathogens, Escherichia coli O157 and Staphylococcus aureus, respectively. Engineered ZFPs are immobilized on a paramagnetic bead as a detection platform to efficiently isolate the target dsDNA-ZFP bound complex. The small paramagnetic beads provide a high surface area to volume ratio, allowing more ZFPs to be immobilized on the beads, which leads to increased target DNA detection. The fluorescence signal was measured upon ZFP binding to fluorophore-labeled target dsDNA. In this study, our system provided a detection limit of ≤ 60 fmol and demonstrated high specificity with multiplexing capability, suggesting a potential for development into a simple and reliable diagnostic for detecting multiple pathogens without target amplification.

• 가정과삶의질연구
• /
• 제30권3호
• /
• pp.179-192
• /
• 2012

The purpose of this study is to investigate the variable factors influencing children's interpersonal relationship skills and analyze the effects of marital perspective-taking ability, managing responses of young children and emotional intelligence on the interpersonal relationship skills of children. The study subjects were young children aged from four to seven attending private kindergartens or public day care centers in Seoul or Kyeongki-do and their mothers. The results are as follows : 1) First, marital perspective-taking abilities were indicated higher on boys than girls, children in a full-day program than those in a half-day program, university graduates or higher degree holders than collage graduates, single-income families than double-income families. In case of managing responses of young children, boys showed high avoidance of offensive disposition and girls showed high emotions dissipation. Also, young children in a full-day program showed non-responses on managing responses but high responses on emotions dissipation, and children of mothers with bachelor's degree or higher education showed support and children from double-income family showed no responses in high. Moreover, emotional intelligence of young children in a full-day program was higher than that of children in a half-day program, interpersonal relationship skills were showed higher on girls than boys, half-day children than full-day ones, children from single-income family than those from double-income family. 2) Meaningful relationships were indicated between these variables; managing responses of young children, emotional intelligence and interpersonal relationship skills by partly showing correlations. 3) Children in a half-day program with low in emotions dissipation, non-responses, offensive dispositional managing responses but high on Avoid, emotional intelligence showed high interpersonal relationship skills.