Adoption and Efficacy of ISO 15189 in Medical Laboratories for Diagnostic and Research (메디컬시험기관에서 ISO 15189 도입의 필요성과 시행의 효용성)
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- Korean Journal of Clinical Laboratory Science
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- v.48 no.2
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- pp.158-167
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- 2016
The requirements for medical laboratories ISO 15189 is examined in organization and a quality management system, stressing the importance of evidence, document control, and control of records and clinical material. Medical services are provided from the areas of resource management, and pre-examination, examination and post-examination processes. The main goal of ISO 15189 accreditation is to improve the quality of laboratory services provided for patients and clinical users not only through compliance with consensually developed and harmonized requirements but also by adopting the philosophy of continual improvement using the Plan-Do-Check-Act cycle. Laboratory quality should be evaluated and improved in all steps of the testing process as the state-of-the art indicates that the pre- and post-analytical phases are more vulnerable to errors than the intra-analytical phase. The Korea Laboratory Accreditation Scheme (KOLAS), a national accreditation body, provides medical laboratory accreditations for appropriate approaches to evaluating the competence of a medical laboratory in providing effective services to its customers and clinical users. Adoption of ISO 15189 in 2010s as a government policy has been delayed, and only 5 laboratories have been accredited to date in Korea. The medical laboratories should seek the adoption of ISO 15189 with a positive attitude for quality improvement and strengthening of international competitiveness.
The Nation Geodetic Reference System which presents a consistent location standard used in creating a map or developing national land is defined and managed by the law in a nation. Each nation had used its own geodetic system created by astronomical surveying until recently, when Geodetic Reference System(World Geodetic Reference System) has been developed and used to progress in space and satellite geodetic technologies. Korea also amended its geodetic law in December 2001, converting its national geodetic system whose reference an oval figure is Bessel ellipsoid into the World Geodetic Reference System which uses GRS80 ellipsoid as reference ellipsoid. Accordingly, the National Geography Information Institute improved law and systems related to the change for the effective conversion from its national geodetic system into the World Geodetic Reference System. In addition National geographic information institute of the results of various studies is drawn to the World Geodetic Reference System for switching technology-met some of the institutional foundation Despite of accordance with formalities, National geographic information institute, Ministry of Land, Transport and Maritime Affairs and some local government of the World Geodetic Reference System, and local government has or has not spread in public institutions. Therefore, in order to promote the switch to the World Geodetic Reference System, it is required to analyze current technical and institutional problems and obstacles of the switch to the World Geodetic Reference System and to present the resolutions and to establish policy to achieve them. Accordingly, for the promotion of the switch to the World Geodetic Reference System, this study analyzed the results of previous studies, the current state of the switch to the World Geodetic Reference System and the problems of the switch, and then offered technological and institutional supplements. Furthermore, it standardized the subject and type of the conversion, defined the scope of the tasks of the National Geographic Information Institute and its related organizations, and presented the policy direction for the overall use of the World Geodetic Reference System by 2010.
Experiments were carried out to quantify the topographic effects on attenuation of sunshine in complex terrain and the results are expected to help convert the coarse resolution sunshine duration information provided by the Korea Meteorological Administration (KMA) into a detailed map reflecting the terrain characteristics of mountainous watershed. Hourly shaded relief images for one year, each pixel consisting of 0 to 255 brightness value, were constructed by applying techniques of shadow modeling and skyline analysis to the 3m resolution digital elevation model for an experimental watershed on the southern slope of Mt. Jiri in Korea. By using a bimetal sunshine recorder, sunshine duration was measured at three points with different terrain conditions in the watershed from May 15, 2015 to May 14, 2016. The brightness values of the 3 corresponding pixel points on the shaded relief map were extracted and regressed to the measured sunshine duration, resulting in a brightness-sunshine duration response curve for a clear day. We devised a method to calibrate this curve equation according to sky condition categorized by cloud amount and used it to derive an empirical model for estimating sunshine duration over a complex terrain. When the performance of this model was compared with a conventional scheme for estimating sunshine duration over a horizontal plane, the estimation bias was improved remarkably and the root mean square error for daily sunshine hour was 1.7hr, which is a reduction by 37% from the conventional method. In order to apply this model to a given area, the clear-sky sunshine duration of each pixel should be produced on hourly intervals first, by driving the curve equation with the hourly shaded relief image of the area. Next, the cloud effect is corrected by 3-hourly 'sky condition' of the KMA digital forecast products. Finally, daily sunshine hour can be obtained by accumulating the hourly sunshine duration. A detailed sunshine duration distribution of 3m horizontal resolution was obtained by applying this procedure to the experimental watershed.
Purpose: Fire-fighting organizations are the very first agencies that take actions at a disaster scene, and emergency rescue training is carried out for prompt and systematic response. However, there is a need for a change due to the limitations in emergency rescue trainings such as perfunctory trainings or trainings without considering regional or environmental characteristics. Method: This study is to conduct theoretical review with regard to emergency rescue training and present a measure to improve the emergency rescue training through attitude survey targeting fire-fighting organizations in Gangwon area. Result: Facilities that cause difficulties when doing emergency rescue activity were mostly hazardous material storage and processing facilities. In terms of the level of emergency rescue and response task, most respondents answered that the emergency rescue was insufficient. The respondents answered that the effectiveness of emergency rescue training was helpful, but some responses showed that the training was not helpful because of scenario-based training, seeming training, similar training carried out every year, unrealistic training, and lack of competent authorities' interest and perfunctory participations. Most respondents answered for the appropriateness of emergency rescue training and evaluation that they were satisfied, however, they were not satisfied with the evaluation methods irrelevant to the type of training, evaluation methods requiring unnecessary training scale, and evaluation methods leading perfunctory participations of competent authorities. Lastly, respondents mostly answered that training reflecting various damage situations are necessary regarding the demand on the improvement of emergency rescue training. Conclusion: The improvement measures for emergency rescue training are as follows. First, it is necessary to set and prepare various training contents in accordance with regional characteristics by reviewing major disasters occurred in the region. Second, it is necessary to revise the emergency rescue training guidelines and manuals for appropriate training plan for each fire station, provide education and training for working-level staff members, and establish training in a way that types, tactics, and strategies of emergency rescue training could be utilized practically. Third, it is necessary to prepare a scheme that can lead participation and provide incentive or penalty from the planning stage of training in order to increase the participation of supporting and competent authorities when an actual disaster occurs. Fourth, it is necessary to establish support arrangements and cooperative systems by authority through training by fire stations or zones in preparation for disaster situations that may occur simultaneously. Fifth, it is necessary to put emphasis on the training process rather than the result for emergency rescue training and evaluation, pay attention to the identification of supplement points for each disaster situation and make improvements. Especially, type or form of training should be considered rather than evaluating the execution status of detailed processes, and the evaluation measure that can consider the completeness (proficiency) of training and the status of role performance rather than the scale of training should be prepared. Sixth, type and method of training should be improved in accordance with the characteristics of each fire station by identifying the demand of working-level staff members for an efficient emergency rescue training.
Medical services are a fundamental and essential service in all urban areas. The location and accessibility of medical service facilities and institutions are critical to the diagnosis, control and prevention of illness and disease. The purpose of this paper is to present the results of a study on the location of medical facilities in Kwangju and the utilization of these facilities by the inhabitants. The following information is a summary of the findings: (1) Korea, like many countries, is now witnessing an increase in the age of its population as a result of higher living standards and better medical services. Korea is also experiencing a rapid increase in health care costs. To ensure easy access to medical consultation, diagnosis and treatment by individuals, the hierarchical efficient location of medical facilities, low medical costs, equalized medical services, preventive medical care is important. (2) In Korea, the quality of medical services has improved significantly as evident by the increased number of medical facilities and medical personnel. However, there is still a need for not only quantitative improvements but also for a more equitable distribution of and location of medical services. (3) There are 503 medical facilities in Kwangju each with a need to service 2,556 people. This is below the national average of 1,498 inhabitants per facility. The higher locational quotient and satisfactory population per medical facility showed at the civic center. On the other hand, problem regions such as the traditional residential area in Buk-Gu, Moo-deung mountain area and the outer areas of west Kwangju still maintain rural characteristics. (4) In the study area there are 86 general medicine clinics which provide basic medical services. i. e. one clinic per every 14,949 residents. As a basic service, its higher locational quotient showed in the residential area. The lower population concentration per clinic was found in the civic center and in the former town center, Songjeong-dong. In recently build residential areas and in the civic center, the lack of general medicine clinics is not a serious medical services issue because of the surplus of medical specialists in Korea. People are inclined to seek a consultation with a specialist in specific fields rather than consult a general practitioner. As a result of this phenomenon, there are 81 internal medicine facilities. Of these, 32.1% provide services to people who are not referred by a primary care physician but who self-diagnose then choose a medical facility specializing in what they believe to be their health problem. Areas in the city, called dongs, without any internal facilities make up 50% of the total 101 dongs. (5) There are 78 surgical facilities within the area, and there is little difference at the locational appearance from internal medicine facilities. There are also 71 pediatric health clinics for people under 15 years of age in this area, represents one clinic per 5,063 people. On the quantitative aspect, this is a positive situation. Accessibility is the most important facility choice factor, so it should be evenly located in proportion to demander distribution. However, 61% of 102 dongs have no pediatric clinics because of the uneven location. (6) There are 43 obstetrical and gynecological clinics in Kwangju, and the number of residents being served per clinic is 15,063. These services need to be given regularly so it should increase the numbers. There are 37 ENT clinics in the study area with the lower concentration in Dong-gu (32.4%) making no locational differences by dong. There are 23 dermatology clinics with the largest concentration in Dong-Gu. There are 17 ophthalmic clinics concentrated in the residential area because of the primary function of this type of specialization. (7) The use of general medicine clinics, internal medicine clinics, pediatric clinics, ENT clinics by the inhabitants indicate a trend toward primary or routine medical services. Obstetrics and gynecology clinics are used on a regular basis. In choosing a general medicine clinic, internal medicine clinic, pediatric clinic, and a ENT clinic, accessibility is the key factor while choice of a general hospital, surgery clinic, or an obstetrics and gynecology clinic, thes faith and trust in the medical practitioner is the priority consideration. (8) I considered the efficient use of medical facilities in the aspect of locational and management and suggest the following: First, primary care facilities should be evenly distributed in every area. In Kwangju, the number of medical facilities is the lowest among the six largest cities in Korea. Moreover, they are concentrated in Dong-gu and in newly developed areas. The desired number of medical facilities should be within 30 minutes of each person's home. For regional development there is a need to develop a plan to balance, for example, taxes and funds supporting personnel, equipment and facilities. Secondly, medical services should be co-ordinated to ensure consistent, appropriate, quality services. Primary medical facilities should take charge of out-patient activities, and every effort should be made to standardize and equalize equipment and facility resources and to ensure ongoing development and training in the primary services field. A few specialty medical facilities and general hospitals should establish a priority service for incurable and terminally ill patients. (9) The management scheme for the inhabitants' efficient use of medical service is as follows: The first task is to efficiently manage medical facilities and related services. Higher quality of medical services can be accomplished within the rapidly changing medical environment. A network of social, administrative and medical organizations within an area should be established to promote information gathering and sharing strategies to better assist the community. Statistics and trends on the rate or occurrence of diseases, births, deaths, medical and environment conditions of the poor or estranged people should be maintained and monitored. The second task is to increase resources in the area of disease prevention and health promotion. Currently the focus is on the treatment and care of individuals with illness or disease. A strong emphasis should also be placed on promoting prevention of illness and injury within the community through not only public health offices but also via medical service facilities. Home medical care should be established and medical testing centers should be located as an ordinary service level. Also, reduced medical costs for the physically handicapped, cardiac patients, and mentally ill or handicapped patients should be considered.
The wall shear stress in the vicinity of end-to end anastomoses under steady flow conditions was measured using a flush-mounted hot-film anemometer(FMHFA) probe. The experimental measurements were in good agreement with numerical results except in flow with low Reynolds numbers. The wall shear stress increased proximal to the anastomosis in flow from the Penrose tubing (simulating an artery) to the PTFE: graft. In flow from the PTFE graft to the Penrose tubing, low wall shear stress was observed distal to the anastomosis. Abnormal distributions of wall shear stress in the vicinity of the anastomosis, resulting from the compliance mismatch between the graft and the host artery, might be an important factor of ANFH formation and the graft failure. The present study suggests a correlation between regions of the low wall shear stress and the development of anastomotic neointimal fibrous hyperplasia(ANPH) in end-to-end anastomoses. 30523 T00401030523 ^x Air pressure decay(APD) rate and ultrafiltration rate(UFR) tests were performed on new and saline rinsed dialyzers as well as those roused in patients several times. C-DAK 4000 (Cordis Dow) and CF IS-11 (Baxter Travenol) reused dialyzers obtained from the dialysis clinic were used in the present study. The new dialyzers exhibited a relatively flat APD, whereas saline rinsed and reused dialyzers showed considerable amount of decay. C-DAH dialyzers had a larger APD(11.70
The wall shear stress in the vicinity of end-to end anastomoses under steady flow conditions was measured using a flush-mounted hot-film anemometer(FMHFA) probe. The experimental measurements were in good agreement with numerical results except in flow with low Reynolds numbers. The wall shear stress increased proximal to the anastomosis in flow from the Penrose tubing (simulating an artery) to the PTFE: graft. In flow from the PTFE graft to the Penrose tubing, low wall shear stress was observed distal to the anastomosis. Abnormal distributions of wall shear stress in the vicinity of the anastomosis, resulting from the compliance mismatch between the graft and the host artery, might be an important factor of ANFH formation and the graft failure. The present study suggests a correlation between regions of the low wall shear stress and the development of anastomotic neointimal fibrous hyperplasia(ANPH) in end-to-end anastomoses. 30523 T00401030523 ^x Air pressure decay(APD) rate and ultrafiltration rate(UFR) tests were performed on new and saline rinsed dialyzers as well as those roused in patients several times. C-DAK 4000 (Cordis Dow) and CF IS-11 (Baxter Travenol) reused dialyzers obtained from the dialysis clinic were used in the present study. The new dialyzers exhibited a relatively flat APD, whereas saline rinsed and reused dialyzers showed considerable amount of decay. C-DAH dialyzers had a larger APD(11.70