• Korean Journal of Radiology
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• 제22권5호
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• pp.742-750
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• 2021

Objective: To assess the safety and clinical efficacy of percutaneous transhepatic enteral stent placement for recurrent malignant obstruction in patients with surgically altered bowel anatomy. Materials and Methods: Between July 2009 and May 2019, 36 patients (27 men and 9 women; mean age, 62.7 ± 12.0 years) underwent percutaneous transhepatic stent placement for recurrent malignant bowel obstruction after surgery. In all patients, conventional endoscopic peroral stent placement failed due to altered bowel anatomy. The stent was placed with a transhepatic approach for an afferent loop obstruction (n = 27) with a combined transhepatic and peroral approach for simultaneous stent placement in afferent and efferent loop obstruction (n = 9). Technical and clinical success, complications, stent patency, and patient survival were retrospectively evaluated. Results: The stent placement was technically successful in all patients. Clinical success was achieved in 30 patients (83.3%). Three patients required re-intervention (balloon dilatation [n = 1] and additional stent placement [n = 2] for insufficient stent expansion). Major complications included transhepatic access-related perihepatic biloma (n = 2), hepatic artery bleeding (n = 2), bowel perforation (n = 1), and sepsis (n = 1). The 3- and 12-months stent patency and patient survival rates were 91.2%, 66.5% and 78.9%, 47.9%, respectively. Conclusion: Percutaneous enteral stent placement using transhepatic access for recurrent malignant obstruction in patients with surgically altered bowel anatomy is safe and clinically efficacious. Transhepatic access is a good alternative route for afferent loop obstruction and can be combined with a peroral approach for simultaneous afferent and efferent loop obstruction.

• Journal of Internet Computing and Services
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• 제21권4호
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• pp.25-34
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• 2020

In the current medical information system, a system environment is constructed in which Biometric data generated by using IoT or medical equipment connected to a patient can be stored in a medical information server and monitored at the same time. Also, the patient's biometric data, medical information, and personal information after simple authentication using only the ID / PW via the mobile terminal of the medical staff are easily accessible. However, the method of accessing these medical information needs to be improved in the dimension of protecting patient's personal information, and provides a quick authentication system for first aid. In this paper, we implemented an automatic authentication system based on the patient's situation and evaluated its performance. Patient's situation was graded into normal and emergency situation, and the situation of the patient was determined in real time using incoming patient biometric data from the ward. If the patient's situation is an emergency, an emergency message including an emergency code is send to the mobile terminal of the medical staff, and they attempted automatic authentication to access the upper medical information of the patient. Automatic authentication is a combination of user authentication(ID/PW, emergency code) and mobile terminal authentication(medical staff's role, working hours, work location). After user authentication, mobile terminal authentication is proceeded automatically without additional intervention by medical staff. After completing all authentications, medical staffs get authorization according to the role of medical staffs and patient's situations, and can access to the patient's graded medical information and personal information through the mobile terminal. We protected the patient's medical information through limited medical information access by the medical staff according to the patient's situation, and provided an automatic authentication without additional intervention in an emergency situation. We performed performance evaluation to verify the performance of the implemented automatic authentication system.

• IE interfaces
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• 제24권4호
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• pp.274-280
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• 2011

Delayed access to surgery may lead to deterioration in the patient condition, poor clinical outcomes, increase in the probability of emergency admission, or even death. The purpose of this work is to decide the number of patients selected from a waiting list and to schedule them in accordance with the operating room capacity in the next period. We formulate the problem as an infinite horizon Markov Decision Process (MDP), which attempts to strike a balance between the patient waiting times and overtime works. Structural properties of the proposed model are investigated to facilitate the solution procedure. The proposed procedure modifies the conventional value iteration method along with the binary search technique. An example of the optimal policy is provided, and computational results are given to show that the proposed procedure improves computational efficiency.

• Journal of Chest Surgery
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• 제53권6호
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• pp.417-419
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• 2020

Surgeons avoid creating arteriovenous fistulae in obese patients owing to deep vessels, cannulation complications, and inconsistent outcomes. We describe placing an arteriovenous polytetrafluoroethylene (PTFE) graft between the brachial artery and axillary vein to avoid these complications. A 39-year-old super-obese woman with end-stage renal disease had undergone several hemodialysis access procedures on both arms. We traced the course of the arteriovenous graft course with the patient sitting and lying down. The ideal course was more accurate with the patient sitting; thus, the patient sat when the course was drawn, before lying on the operating bed. The PTFE graft was placed between the right brachial artery and axillary vein, according to the course in the opposite arm. No anastomotic dehiscence or pseudoaneurysm has taken place during 2 years of follow-up. In super-obese patients, the ideal course for arteriovenous grafts should be drawn while they are sitting, avoiding skin folds. This tip could avoid anastomotic dehiscence and pseudoaneurysm between the axillary vein and a PTFE graft.

• Proceedings of the Korean Society for Information Management Conference
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• 한국정보관리학회 2006년도 제13회 학술대회 논문집
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• pp.191-196
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• 2006

Traditionally, nurses keep the written patient records, which are referred as nursing care plan. Nursing care plan reports are one of the most important documents in the application of nursing processes. Typically, nurses prepare the plans by including general patient information as well as the patient's medical history information. In addition, the patient's developmental history and other specific health related information are part of the plans. The plans are usually concluded with the goals of the nursing care plan, nursing diagnoses, expected outcomes of the care, and possible nursing interventions. The nursing diagnoses, outcomes, and interventions are defined by North American Nursing Diagnosis Association (NANDA). This means that the nurses will select the appropriate diagnoses, outcomes, and interventions from an approved set. We developed a web-based nursing care plan generation system. In this paper, we report our work on developing a visual interface to the NANDA nursing diagnoses, outcomes, and interventions database as a part of the web-based nursing care plan generation system.

• Korean Journal of Radiology
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• 제22권1호
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• pp.72-85
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• 2021

Transfemoral access (TFA) is a widely used first-line approach for most peripheral vascular interventions. Since its introduction in cardiologic and neurointerventional procedures, several advantages of transradial access (TRA) over TFA have been demonstrated, such as patient preference, lower complication rates, early ambulation, and shorter hospital stay. However, studies reporting the safety and efficacy of this approach for peripheral vascular interventions performed by interventional radiologists are relatively few. This review aimed to summarize the technique and clinical applications of TRA in percutaneous transcatheter visceral artery embolization and the management of complications.

• Journal of the Korea Society of Computer and Information
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• 제20권1호
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• pp.185-195
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• 2015

During hospital peak times of outpatients, an effective mechanism that informs the newly receipted patient information to corresponding medical departments is lacking in current hospital reception systems. Since every department repeatedly searches entire patient reception database in sequential manner to acquire its reception information, this is a significant performance degradation factor in hospital information system. To improve hospital reception system efficiency, we developed two web socket based systems, a primary key transmitting batch system and a reception information transmitting real time system. The former reduced database access time compared to sequential search system as well as kept search time low regardless of receipted patient number. The latter effectively reduced waiting list updating time in request/response patient reception system by eliminating database access.

• Proceedings of the Korea Information Processing Society Conference
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• 한국정보처리학회 2012년도 추계학술발표대회
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• pp.1321-1322
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• 2012

With the advance of Information Technology (IT) and dynamic requirements, diverse application services have been provided for end users. With huge volume of these services and information, users are required to acquire customized services that provide personalized information and decision at particular extent of time. The case is more appealing in healthcare, where patients wish to have access to their medical record where they have control and provided with recommendation on the medical information. PHR (Personal Health Record) is most prevailing initiative that gives secure access on patient record at anytime and anywhere. PHR should also incorporate decision support to help patients in self-management of their diseases. Available PHR system incorporates basic recommendations based on patient routine data. We have proposed decision support service called "Smart CDSS" that provides recommendations on PHR data for diabetic patients. Smart CDSS follows HL7 vMR (Virtual Medical Record) to help in integration with diverse application including PHR. PHR shares patient data with Smart CDSS through standard interfaces that pass through Adaptability Engine (AE). AE transforms the PHR CCR/CCD (Continuity of Care Record/Document) into standard HL7 vMR format. Smart CDSS produces recommendation on PHR datasets based on diabetic knowledge base represented in shareable HL7 Arden Syntax format. The Smart CDSS service is deployed on public cloud over MS Azure environment and PHR is maintaining on private cloud. The system has been evaluated for recommendation for 100 diabetic patients from Saint's Mary Hospital. The recommendations were compared with physicians' guidelines which complement the self-management of the patient.

• Journal of The Korea Institute of Healthcare Architecture
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• 제20권4호
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• pp.49-56
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• 2014

Purpose : This purpose of this study is to make a better public hospital patient room to reflect the views of the patient. Methods: Survey to examine patient experience on healing environment in public hospital have been conducted for the data collection. 229 open-ended answers have been analysed statistically by MS Excel program. Results : 1) If there is no toilet space in the six-patient room, installation of toilet in the patient room is necessary. 2) The most Frequently used patient furnitures are necessary to accomodate the patients needs. Depending on the patient condition, installation of a portable or fixed the room furniture for the convenience to the using furniture. 3) According to the flow of modern times, wireless internet access is required to install of expand the space. Also be used to establish a regulations of internet space. 4) To create healing environment infection free environment should be provided. 5) Need for improvements of patient room for relatives of patient. It is necessary to secure a comfortable space to stay. 6) Separation is needed among the patients through therapeutic classification. Implication : In order to provide a better patient room environment, it is necessary to reflect the patient's opinion.

• Journal of Internet Computing and Services
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• 제16권1호
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• pp.47-55
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• 2015

Recently, the environment of a hospital information system is a trend to combine various SMART technologies. Accordingly, various smart devices, such as a smart phone, Tablet PC is utilized in the medical information system. Also, these environments consist of various applications executing on heterogeneous sensors, devices, systems and networks. In these hospital information system environment, applying a security service by traditional access control method cause a problems. Most of the existing security system uses the access control list structure. It is only permitted access defined by an access control matrix such as client name, service object method name. The major problem with the static approach cannot quickly adapt to changed situations. Hence, we needs to new security mechanisms which provides more flexible and can be easily adapted to various environments with very different security requirements. In addition, for addressing the changing of service medical treatment of the patient, the researching is needed. In this paper, we suggest a dynamic approach to medical information systems in smart mobile environments. We focus on how to access medical information systems according to dynamic access control methods based on the existence of the hospital's information system environments. The physical environments consist of a mobile x-ray imaging devices, dedicated mobile/general smart devices, PACS, EMR server and authorization server. The software environment was developed based on the .Net Framework for synchronization and monitoring services based on mobile X-ray imaging equipment Windows7 OS. And dedicated a smart device application, we implemented a dynamic access services through JSP and Java SDK is based on the Android OS. PACS and mobile X-ray image devices in hospital, medical information between the dedicated smart devices are based on the DICOM medical image standard information. In addition, EMR information is based on H7. In order to providing dynamic access control service, we classify the context of the patients according to conditions of bio-information such as oxygen saturation, heart rate, BP and body temperature etc. It shows event trace diagrams which divided into two parts like general situation, emergency situation. And, we designed the dynamic approach of the medical care information by authentication method. The authentication Information are contained ID/PWD, the roles, position and working hours, emergency certification codes for emergency patients. General situations of dynamic access control method may have access to medical information by the value of the authentication information. In the case of an emergency, was to have access to medical information by an emergency code, without the authentication information. And, we constructed the medical information integration database scheme that is consist medical information, patient, medical staff and medical image information according to medical information standards.y Finally, we show the usefulness of the dynamic access application service based on the smart devices for execution results of the proposed system according to patient contexts such as general and emergency situation. Especially, the proposed systems are providing effective medical information services with smart devices in emergency situation by dynamic access control methods. As results, we expect the proposed systems to be useful for u-hospital information systems and services.