• 제목/요약/키워드: managed care

검색결과 303건 처리시간 0.024초

지방자치단체 미술장식품 설치의 개선방안 (A Study on Reforming the Adornment of Buildings in the Provinces)

  • 조정송;이유직
    • 한국조경학회지
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    • 제31권2호
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    • pp.36-47
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    • 2003
  • The purpose of this study is to examine the present problems relating to the legislation and execution of adornment of buildings in the provinces, and to explore ways to improve the role and function of adornment of buildings in terms of public art. In order to do that, the related national law and enforcement decree and the local regulations and rules were analysed. In addition the catalogues on the adornments of buildings that are managed by 31 cities and counties of Gyeonggi-Province were also compared and analysed. As a result of our survey, it has been determined that the reform of the adornments of buildings must be executed on the national and local levels. On the local level, the revision of regulations must occur simultaneously with the changes of national law and enforcement decrees. In many local self-governing bodies, there are quite a lot of discrepancies between their regulations and the upper law. Therefore, people can be confused regarding the sensitive problems such as the types of buildings that are required to display adornments and the proportion of the cost to the construction cost. In addition the effects of the improvements to national laws are often delayed. For example, the updated national law requires committee members to be appointed on the basis of merit, the announcement of the deliberation results, and the establishment of provisions regarding the management of existing structures. Unfortunately, improvements to the national law are not followed through on a local level. Concerning national legislation, the following improvements are necessary to minimize these problems. First, the western concept of‘public art’must be imported to Korea and applied to future legislation regarding adornment of buildings. Second, the perception of the purpose of adornment of buildings must be changed from‘art promotion’to‘improvement of the urban environment’Third, it is impractical to require private citizens to fund public worts of In. Korea requires an organized federal funding system for the commission of public art, which is to be controlled by committee. Finally, the definition of public artwork must be enlarged to include a more broad range of art, such as landscape architecture. In addition, continuing care of existing public worts of art must be managed systematically and strengthened.

Closure of Myelomeningocele Defects Using a Limberg Flap or Direct Repair

  • Shim, Jung-Hwan;Hwang, Na-Hyun;Yoon, Eul-Sik;Dhong, Eun-Sang;Kim, Deok-Woo;Kim, Sang-Dae
    • Archives of Plastic Surgery
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    • 제43권1호
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    • pp.26-31
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    • 2016
  • Background The global prevalence of myelomeningocele has been reported to be 0.8-1 per 1,000 live births. Early closure of the defect is considered to be the standard of care. Various surgical methods have been reported, such as primary skin closure, local skin flaps, musculocutaneous flaps, and skin grafts. The aim of this study was to describe the clinical characteristics of myelomeningocele defects and present the surgical outcomes of recent cases of myelomeningocele at our institution. Methods Patients who underwent surgical closure of myelomeningocele at our institution from January 2004 to December 2013 were included in this study. A retrospective chart review of their medical records was performed, and comorbidities, defect size, location, surgical procedures, complications, and the final results were analyzed. Results A total of 14 patients underwent surgical closure for myelomeningocele defects. Twelve cases were closed with direct skin repair, while two cases required local skin flaps to cover the skin defects. Three cases of infection occurred, requiring incision and either drainage or removal of allogenic materials. One case of partial flap necrosis occurred, requiring secondary revision using a rotational flap and a full-thickness skin graft. Despite these complications, all wounds eventually healed completely. Conclusions Most myelomeningocele defects can be managed by direct skin repair alone. In cases of large defects, in which direct repair is not possible, local flaps may be used to cover the defect. Complications such as wound dehiscence and partial flap necrosis occurred in this study; however, all such complications were successfully managed with simple ancillary procedures.

유소아 기도 이물의 임상 양상과 환기형 기관지 내시경술의 결과 : 서울대 병원의 경험 120례 (Clinical Analysis for 120 Cases with Pediatric Airway Foreign Bodies)

  • 차원재;최효근;문성중;하정훈;성명훈;김광현
    • 대한기관식도과학회지
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    • 제12권2호
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    • pp.26-30
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    • 2006
  • Backgroud and Objectives: Inhalation of foreign bodies in respiratory tract can be fatal to infants and child. After ventilating bronchoscopy technique was widelyused, most of the pediatric airway foreign bodies could be managed effectively. In this study, we aimed to analyze clinicalfeatures and outcomes of ventilating bronchoscopic removal of pediatric airway foreign bodies. Materials and Methods: One hundred twenty cases of ventilating bronchoscopy for pediatric airway foreign bodies at Seoul National University Hospital for the past 15 years were analyzed retrospectively. Results: In 120 cases, sex ratio (male: female) was 2.2:1 and mean age was 27.0 months. Most frequent type of airway foreign was peanut (60.2%). One hundred thirteen patients, in whom a foreign body was confirmed in the airway, were successfully managed by ventilating bronchoscopy. Delayed diagnosis and management made a significantly long postoperative hospital stay. Conclusion: Great care must be given when feeding young children, especially younger than 36 months, with nuts. Early intervention with ventilating bronchoscopy following a clinical suspicion is critical to successful treatment.

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Soft-tissue Sarcomas in the Asia-Pacific Region: A Systematic Review

  • Ngan, Roger;Wang, Edward;Porter, David;Desai, Jayesh;Prayogo, Nugroho;Devi, Beena;Quek, Richard
    • Asian Pacific Journal of Cancer Prevention
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    • 제14권11호
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    • pp.6821-6832
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    • 2013
  • Background: Soft-tissue sarcomas require tailored and multidisciplinary treatment and management. However, little is known about how sarcomas are treated and managed throughout the Asia-Pacific region. Materials and Methods: MEDLINE was systematically searched using prespecified criteria. Publications (previous 10 years) that reported tumour characteristics, treatment patterns, survival outcomes, and/or safety outcomes of patients with soft-tissue sarcoma were selected. Exclusion criteria were studies of patients <18 years of age; ${\leq}10$ patients; countries other than Australia, Hong Kong, Indonesia, Korea, Malaysia, New Zealand, Philippines, Singapore, Taiwan, or Thailand; >20% benign tumours; sarcomas located in bones or joints; gastrointestinal stromal tumour; Kaposi's sarcoma; or not reporting relevant outcomes. Results: Of the 1,822 publications retrieved, 35 (32 studies) were included. Nearly all patients (98%, 1,992/2,024; 31 studies) were treated with surgery, and more studies used adjuvant radiotherapy than chemotherapy (24 vs 17 studies). Survival outcomes and recurrence rates varied among the studies because of the different histotypes, sites, and disease stages assessed. Only 5 studies reported safety findings. Conclusions: These findings highlight the lack of specific data available about soft-tissue sarcomas in the Asia-Pacific region. Better efforts to understand how the sarcoma is managed and treated will help improve patient outcomes in the region.

Preemptive pyloroplasty for iatrogenic vagus nerve injury in intrahepatic cholangiocarcinoma patients undergoing extensive left-sided lymph node dissection: a retrospective observational study

  • Hwang, Shin;Jung, Dong-Hwan;Jwa, Eun-Kyoung;Kim, Yumi
    • Journal of Yeungnam Medical Science
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    • 제39권3호
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    • pp.235-243
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    • 2022
  • Background: Intrahepatic cholangiocarcinoma (ICC) of the left liver often shows left-sided lymph node (LN) metastasis. If gastric lesser curvature is extensively dissected, it can induce an iatrogenic injury to the extragastric vagus nerve branches that control motility of the pyloric sphincter and lead to gastric stasis. To cope with such LN dissection-associated gastric stasis, we performed pyloroplasty preemptively. The objective of this study was to analyze our 20-year experience of preemptive pyloroplasty performed in 10 patients. Methods: We investigated clinical sequences of 10 patients with ICC who underwent preemptive pyloroplasty following left hepatectomy and extended left-sided LN dissection. Incidence of gastric stasis and oncological survival outcomes were analyzed. Results: All 10 patients were classified as stage IIIB due to T1-3N1M0 stage according to the 8th edition of American Joint Committee on Cancer staging system. The overall patient survival rate was 51.9% at 1 year, 25.9% at 2 years, and 0% at 3 years. Seven patients showed uneventful postoperative recovery after surgery. Two patients suffered from gastric stasis, which was successfully managed with supportive care. One patient suffered from overt gastric paresis, which was successfully managed with azithromycin administration for 1 month. Conclusion: We believe that preemptive pyloroplasty is an effective surgical option to prevent gastric stasis in patients undergoing extensive left-sided LN dissection. Azithromycin appears to be a potent prokinetic agent in gastroparesis.

C소아치과의원의 개량형 Dentocult-SM검사를 이용한 계속관리에 관한 조사 연구 (A study on the incremental oral health care of C pediatric clinic using a Dentocult-SM test)

  • 우희선
    • 한국치위생학회지
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    • 제8권2호
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    • pp.39-51
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    • 2008
  • The research was conducted to 100 child patients selected by random sampling, which got a Dentocult-SM test in the first visit and then was being continuously managed, out of child patients of a pediatric clinic located in Gyeonggi-do. The period of there search is one year from June 2007 to May 2008, Using Dentocult-SM test, we analyzed the correlation between the distribution of dental plaque, a streptococcus mutans in saliva and condition of dental caries cavity in the teeth of child patients, then we measured the distribution of a streptococcusmutans. According to SM score, we applied incremental oral heath care for child patients to clinical and obtained the following results, 1. In terms of the age of child patients in research, the number of 3 years old patients was 29(lst ranked), the number of 2 years old patients was 28(2nd ranked). 2. The result of SM score showed that female child patients(52.0%) was higher than male ones in negative, male child patients(52.0%) was higher than female ones in mild, female child patients(68.2%) was higher than male ones in moderate, male child patients(57.1%) was higher than female ones in severe. 3. At the first visit, the SM score showed statistically remarkable difference between dt and dmft. We can also confirm the average of severe is the highest. 4. At the second visit, the SM score showed statistically remarkable difference among dt, ft, and dmft index We can also confirm the average of severe is the highest. 5. At the third visit, The SM score showed statistically remarkable difference among dt, ft, and dmft index We can also confirm the average of severe is the highest. 6. The comparison of dmft index differences to SM score showed statistically no remarkable difference in incremental oral heath care for negative and mild, In addition to that, we can confirm that the incremental oral heath care makes statistically remarkable differences in moderate and severe. 7. The comparison of dt index differences to SM score showed statistically no remarkable difference in incremental oral heath care for negative, mild, and moderate, In addition to that, we can con firm that the incremental oral heath care makes statistically remarkable differences in severe. 8. The comparison of mt index differences to SM score showed statistically no remarkable difference in incremental oral heath care for mild and moderate, In addition to that, we can confirm that the incremental oral heath care makes statistically remarkable differences m severe. 9. The comparison of ft index differences to SM score showed statistically no remarkable difference in incremental oral heath care for mild, In addition to that, we can confirm that the incremental oral heath care makes statistically remarkable differences in negative, moderate, and severe. 10. According to the comparison of dmft index to the age, the 4 years old patients showed the highest number(5.50 in the first visit and 6,08 in the second one). In the third visit, the 6 years old patients showed the highest number(7.00). By the above results, we can find that the incremental oral heath care by SM score makes the results of oral care better. Therefore, the improvement or maintenance in oral health of child patients needs continuing personal oral health management and regular systematic management focused on prevention by the specialist.

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하인두암에서 후두인두 및 경부 식도 전 적출술 후 유리 공장 이식술의 합병증에 대한 후향적 분석 (Retrograde Analysis of Complications of Jejunal Free Flap after Total Pharyngo-Laryngo-Cervical Esophagectomy in Advanced Hypopharyngeal Cancer Treatment)

  • 민현진;현동우;김영호;최은창;김광문;김세헌
    • 대한두경부종양학회지
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    • 제24권1호
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    • pp.43-46
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    • 2008
  • 진행된 하인두암의 수술 후 시행한 유리 공장 이식술을 시행한 본원의 경험에서 수술 후 누공 형성, 수술 부위 협착 등의 다양한 합병증과 그 치료방법을 경험하였다. 수술 방법에 있어서 한 개의 동맥과 정맥을 연결하였고 이식한 혈관의 혈전에 의한 이식 실패는 없었다. 수술 후 연하 기능에 있어서 영향을 주는 가장 중요한 요인은 이식 부위 협착이 었으며 협착의 치료 결과에 따라 술 후 연하 기능의 회복에 차이가 있음을 확인하였다.

지역 EMS의 현장검사 혈당측정기 사용에 대한 실태조사 (Survey of Point-of-Care Testing Devices for Pre-hospital EMS Equipment of Glucometer on Local Area)

  • 김병현;최대해;하경임
    • 농촌의학ㆍ지역보건
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    • 제47권4호
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    • pp.220-228
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    • 2022
  • 119 구급대원들이 사용하는 현장 검사 장비 중 하나인 자가 혈당측정기는 결과 값이 정확해야 환자에게 적절한 처치를 제공할 수 있다. 연구 최초 조사 시점 이후 현재까지도 119 구급대원 현장업무 지침에 현장 검사 장비의 작동 유무, 수량 등을 확인하는 것은 있으나, 장비의 점검에 수량, 작동 여부 등은 있으나 본 연구에서 분석한 정도관리 내용은 없다. 현장검사 장비의 질 관리가 되지 않고 있다는 것은 환자에 대한 부정확한 평가와 이로 인한 불필요한 처치와 과소, 과대처치 또는 환자 상태가 악화될 가능성을 높일 수 있다. 본 연구를 통해, 앞으로 119 구급대원의 혈당측정기를 포함한 모든 현장검사 장비의 사용실태조사가 이루어져야 하고, 119 구급대 현장 업무 지침에 현장 검사 장비 정도관리를 추가하여야 하겠다. 또한, 현장 검사 장비가 관련 지침에 따라서 적절한 질 관리가 이루어져야 하고, 지역에서 관련 업무 전문가나 응급의료지도를 담당하고 있는 지도의사에게 관리되는 것이 합당하겠다.

의료급여환자의 요양병원 이용에 관한 연구 (Utilization of Medical Assistance Patients in Nursing Hospital)

  • 이용재
    • 한국콘텐츠학회논문지
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    • 제17권5호
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    • pp.366-375
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    • 2017
  • 본 연구는 의료급여환자와 가족 3인, 요양병원에 4년 이상 근무한 경험이 있는 종사자 5인에 대한 심층면접조사를 통하여 도덕적해이가 우려되고 있는 의료급여환자의 요양병원 이용과정과 입원, 의료서비스, 퇴원과 전원 등에 대하여 분석하였다. 주요 분석결과와 함의는 다음과 같다. 첫째, 요양병원 입원은 의료급여환자의 선택보다는 의료기관간의 연계와 유치를 위한 경쟁적 홍보에 의해서 이루어지고 있었다. 둘째, 의료급여환자의 요양병원 장기입원의 원인은 본인부담이 적어서 도덕적 해이를 유발할 수도 있었지만 거주지 부재, 간병인 부재 등 퇴원 후 사회적인 보호수단이 없는 것도 주요 원인이었다. 셋째, 대다수 의료급여환자들이 치료가 필요한 상태이지만, 건강보험환자에 비해 필요성이 높지 않음에도 입원을 유지하는 경우가 있었다. 넷째, 요양병원의 의료서비스는 재활서비스가 주를 이루고 있으며, 간호인력과 간병인의 역할이 중요하였다. 다섯째, 의료급여환자들은 요양병원 의료비를 수급비와 가족지원 등으로 부담하고 있지만, 일부 환자들은 병원에서 간병비나 본인부담을 면제 혹은 감면받고 있었다. 여섯째, 공공기관과 사회복지기관은 요양병원에 환자를 의뢰한 이후 지속적인 관리를 하지 않고 있으며, 퇴원 후 지역사회서비스 연계가 필요한 것으로 나타났다.

일 지역 중년여성의 폐경증상과 폐경관리와의 관계에 대한 연구 (An Analysis of the Relationship between Climacteric Symptoms and Management of Menopause in Middle-aged Women)

  • 송애리
    • 한국간호교육학회지
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    • 제7권2호
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    • pp.308-322
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    • 2001
  • The purpose of this study was to investigate the relationship between climacteric symptoms and management of menopause of middle -aged women. The subjects of this study were 261 women(40 to 60 years old). Data were collected from Jun. 1 to Jul. 15, 2001 by a structured questionnaire. The instruments employed were : 1) The Climacteric Symptoms Scale developed by Aeri Song and Eun soon Chung(1998). 2) The Management of Menopause Scale developed by Aeri Song(1997). The data were analyzed by the SPSS p.c. program using t-test, ANOVA and Pearson correlation coefficient. The results of the study were as follows : 1. Mean score of climacteric symptoms was $2.18{\pm}0.39$(Maximum 4, Minimum 1). The mean scores among the categories of climacteric symptoms, in descending order, were : a) physical and physiological reactions ($2.62{\pm}0.53$), b) social and family relationships ($2.23{\pm}0.50$), c) psychiatric and psychological reactions ($2.08{\pm}0.49$), d) relationship with sexual partner($1.73{\pm}0.54$), e) genitourinary reactions ($1.72{\pm}0.55$). 2. Mean score of management of menopause was $1.79{\pm}0.45$ (Maximum 4, Minimum 1). The mean scores among the categories of management of menopause, in descending order, were : a) dietary management($2.57{\pm}0.52$), b) self control ($2.24{\pm}0.57$), c) management of exercise and physical activity($2.14{\pm}0.75$), d) management of sex life($1.71{\pm}0.47$), e) management of professional health maintenance($1.61{\pm}0.59$). 3. There were statistically significant differences in the score of middle-aged women's self reported climacteric symptoms according to : a) occupation (t=-2.79, p<0.001) b) marriage state (t=-2.29, p<0.05) c) age of menarche (F=4.66, p<0.001) d) method of Sanhujori (post natal care & treatment) (F=4.22, p<0.001) e) hormone replacement therapy (t=-3.09, p<0.05). From the above statistics, several significant findings were noted : a) There were more climacteric symptoms from those who were unemployed, those who had no partner or were divorced and those who started a menarche earlier. b) There were less climacteric symptoms reported from those on hormone replacement therapy and those who followed their parents or parents-in-law advice regarding Sanhujori (postnatal care) 4. There were statistically significant differences in the score of middle-aged women's self reported management of menopause according to : The educational background (F=7.63, p<0.001), religion (F=3.74, p<0.001), income (F=3.65, p<0.001), number of parity (F=4.87, p<0.001), method of Sanhujori(postnatal care) (F=5.73, p<0.001), period of Sanhujori (postnatal care) (F=2.81, p<0.05), hormone replacement therapy (t=3.81, p<0.001). Women with higher educational background, strong religion, higher income, large number of parity, managed their post natal care well, were on HRT, managed their menopause significantly better than the others who took part in the survey. 5. It will be noted from the above that women's degree of climacteric symptoms showed a negative correlation to the management of menopause(r=-0.2146, p<0.001). The findings shown above suggest the need to develop a variable management of menopause, in order to improve climacteric symptoms of middle-aged women. It is hoped that the above findings will stimulate more detailed research into this matter, and thereby enable guidance to be given to women going through the menopause to cope with it in a less stressful way.

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