• Journal of the Korean Society of Radiology
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• v.11 no.7
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• pp.627-635
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• 2017

Brachytherapy is generally performed in conjunction with external radiation therapy, and the treatment course is very complicated, which can lead to radiation accidents. In order to solve this problem, we designed the process map by applying the failure mode and effects analysis (FMEA) method to the Brachytherapy and scored the risk priority number (RPN) for each treatment course based on this process map. The process map consisted of five steps, Patient consulting", "Brachytherapy simulation", "CT simulation", "Brachytherapy treatment planning" and "Treatment". In order to calculate the RPN, doctor, medical physicist, dose planners, therapist, and nurse participated in the study and evaluated occurrence, severity, and lack of detectability at each detail step. Overall, the process map is preceded by a patient identification procedure at each treatment stage, which can be mistaken for another patient, and a different treatment plan may be established to cause a radiation accident. As a result of evaluating the RPN for the detailed steps based on the process map, overall "Patient consulting" and "Brachytherapy treatment planning" step were evaluated as high risk. The nurses showed a tendency to be different from each other, and the nurses had a risk of 55 points or more for all the procedures except "Treatment", and the "Brachytherapy simulation" step was the highest with 88.8 points. Since the treatment stage differs somewhat for each medical institution performing radiotherapy, it is thought that the risk management should be performed intensively by preparing the process map for each institution and calculating the risk RPN.

• Korea Journal of Hospital Management
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• v.9 no.2
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• pp.46-75
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• 2004

This research anticipated on acknowledging the inpatients factors in choosing which hospital for the geriatric hospital and general hospital they would prefer to go to the analization of different factors in patients satisfaction, and the relation between satisfactory standards and the patients intentions on recommendation or re-visiting the hospital. The statistical data was based upon the 359 question and answer papers that were done by inpatients that were hospitalized in two geriatric hospitals and two general hospitals, and the methods used for analyzing were frequency, t-test, factor analysis, and hierarchical multiple regression. The results are as follows. 1. The factors on choosing hospitals between geriatric hospital and general hospitals were different. The priority for the geriatrics was kindness, and then considerate nursing, and the reliance of treatment. The patients of general hospitals looked first for reliance of treatment, reputation and history of the hospital, and the kindness of the staff. The kindness of the staff, good nursing, and easy procedures were the primary factors of choosing geriatric hospital. 2. The four primary factors in choosing which hospital patients would go to were the predominance of the facilities, kindness and convenience, the reliance and proximity of medical treatment, and recommendation. The patients in the geriatric hospital first looked for kindness and convenience, second the reliance and proximity of medical treatment, third predominance of facilities, and last recommendation. The general hospitals main priority was the reliance and proximity of medical care, second predominance of facilities, kindness and hospitality, and last recommendation. 3. The satisfaction rate was higher in the geriatric hospital compared to general hospitals, but the satisfactory of factors were very similar. Patients in the geriatric hospital were pleased with the hospital staffs kindness, quick nursing and the improvement of inconvenient matters, and clear diagnosis of the doctors. The general hospital patients were satisfied with the hospital staffs clear explanation and accurate diagnosis 4. The analysis in the satisfactory factors turned out to be the environment of the hospital, kindness of the staff, and convenience. Both the patients of the geriatric hospital and general hospitals were very pleased with the kindness of the hospital staff. Ranking second and third was convenience and service for the geriatric hospital, and environment of the hospital and convenience for the general hospital. 5. According to a rank of multiple recurrent analysis of the patients satisfaction and the intention of re-visiting in addition to intention of solicitation, in the case of a geriatric hospital, when the intention of re-visiting is the dependent variable, the first stage shows that the less insurance the patient has, the higher was the intention of re-visiting. In the second stage, the more satisfied the patient is of the staffs kindness, the higher was the intention of re-visiting. Further more, when the intention of solicitation is the dependent variable, the first stage shows that not all the independent variables were significant, but the second stage shows that the more satisfied the patient is of the staffs kindness and the hospital along with the medical treatment expenses, the higher was the intention of solicitation. 6. In the first stage of a rank of multiple recurrent analysis of the satisfaction of the general hospital and the intention of re-visiting, not all the variables were significant, but in the second stage, all the satisfaction by factors were significant. Moreover, when the intention of solicitation was the dependent variable, the first stage shows not all the variables were significant, but in the second stage, all the satisfaction by factors were significant. That is to say, in the case of a general hospital, the satisfaction of the hospital and the medical treatment expenses were high, and the more satisfied the patient is of the hospitals environment and the staffs kindness, the intention of re-visiting and the intention of solicitation was higher.

• Advances in pediatric surgery
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• v.18 no.2
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• pp.59-67
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• 2012

Fundoplication is a common surgical procedure for gastroesophageal reflux Disease (GERD). Recently the procedure has been performed with increased frequency laparoscopically. The aim of this study is to compare laparoscopic Nissen fundoplication (LNF) and open Nissen fundoplication (ONF) for GERD in children. We studied retrospectively the 88 pediatric patients who underwent the Nissen fundoplication for GERD as primary antireflux surgery from 1994 and 2009. ONF was performed in 34 cases and LNF was in 54 cases. 58 patients have neurologic impairment. Time to initial food intake after the surgery were reduced in the LNF group (p= 0.032). Recurrent GERD symptom occurred in one patient in LNF group and four patients in ONF group within 1 year after the surgery (p= 0.012). There were no statistically significant differences in post operative morbidity and mortality between both groups. In conclusion, our practice of Nissen fundoplication indicates that LNF takes priority in most pediatric patients.

• The Journal of the Korean dental association
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• v.53 no.2
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• pp.111-119
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• 2015

The importance of effective communication is increasingly stressed in the medical sector. This is crucial for the resolution of medical accidents and conflicts, and that can contribute to the prevention of the two as well. The careful attitude of the medical team toward patient safety and their communication with colleagues and other departments are mandatory for the successful decrease of dental accidents. The good communication within of the hospital organization is one of vital ways to ensure accurate diagnosis and successful treatment. In the field of health care, effective teamwork requires a shared goal, superb work skills, communication and cooperation, but this fact has been overlooked so far. Among those factors, communication is indispensable to the achievement of organizational goals, and how to boost communication by acquiring diverse skills and using appropriate tools in the dentistry should discreetly be considered. This study explared how to improve the teamwork and communication of organization in an effort to seek specific ways of reducing medical conflict in dental.

• Journal of Korean Society for Quality Management
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• v.41 no.4
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• pp.527-539
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• 2013

Purpose: Methods for increasing health-care service quality are considered for a women-centered hospital located on a local city. A walk-through audit is applied to uncover areas for improvement. Methods: A survey questionnaire with 25 questions is constructed based on a service blueprint for a walk-through audit, and a survey is conducted both to patients and service providers to assess a health-care service quality. Frequency analysis, statistical tests and customer-provider analysis are used to analyze surveyed data. Results: According to customer-provider analysis, 6 attributes belong to 'problem unawareness' zone in which they are rated high by service providers but low by patients, and another 6 attributes belong to 'problem awareness' zone in which they are rated low by both groups. These attributes are considered to be improved with priority. Conclusion: Both patient group and service provider group have lots of different perceptions on most attributes that are examined, and the hospital to be studied is, in general, competitive in technical quality and less competitive in functional quality.

• Quality Improvement in Health Care
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• v.19 no.2
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• pp.50-64
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• 2013

Objectives : Suicide is a serious sentinel event in healthcare organization. Suicide and suicidal attempt are fatal and long lasting mental and physical damage to themselves, family, and medical staffs. To develope the system to prevent suicidal accident in hospital, we reviewed and analysed one case of suicidal sentinel event. Methods: The risks of suicidal sentinel event were evaluated and analysed through the root cause analysis and failure mode effects analysis. Result: We found several root causes such as initial assessment of oldest patient and security issues. Couple of action plans to fix the problems were done immediately. According to failure mode, we evaluate the risk priority number to modify the action plans. Conclusion: To reduce the risk of sentinel events, we reviewed the suicidal event and established the new system and action plan to prevent sentinel events.

• Korea Journal of Hospital Management
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• v.17 no.4
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• pp.133-166
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• 2012

Hospitals tend to provide uniformed service to patients despite their various demands stemming from the severity of disease stages or the uncertainties in information of treatment stages. To identify service factors and provide effective contextually aware service models that patients demand depending on their evolving circumstances, the study conducted a survey on service quality based on importance and satisfaction of cancer patients. The study surveyed 286 patients and caregivers on importance and satisfaction through a questionnaire comprising of 17 questions at the outpatient clinic of cancer centers of university hospitals in 5 cities. Based on the risks of the disease and uncertainties in information of treatment stages, the cancer patients were grouped into diagnosis stage; low-risk treatment stage; high-risk treatment stage; stabilization stage. Depending on the patient's situation, the importance and satisfaction of service factors were ranked. These factors were categorized into 4 groups from a managerial perspective into 'keep it up area', 'focus here area', 'low priority area', 'overdone area'. This study provides an effective medical service model that can accommodate patients based on management areas of cancer patients.

• The Korean Journal of Emergency Medical Services
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• v.17 no.2
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• pp.9-20
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• 2013

Purpose: The purpose of this study is to provide basic data to improve prehospital emergency care for patients with labor pain, vaginal bleeding and rape experience by analyzing the reports of 119 emergency medical technicians. Methods: Data were prehospital reports of 190 patients having chief complaints of labor pain, vaginal bleeding and rape in Chungcheongnam-do from January 1, 2012 to December 31, 2012. Data were analyzed using SPSS 21.0 descriptive statistics and $x^2$-test. Results: From the 190 cases of labor pain, vaginal bleeding and rape, labor pain accounted for 57.9% including 75.5% of normal delivery; vaginal bleeding accounted for 35.8% including 26.5% of postpartum hemorrhage; and rape victims accounted for 6.3%. Cases with more than one vital sign accounted for 94.2%, but cases without primary assessment of the obstetrics and gynaecology accounted for 38.4% from gestation weeks, 78.0% from parity, and 87.4% from history taking relating to event. Patient care including emotional support was the first priority care accounted for 78.4% and 60% of care was keeping the patients warm. Conclusion : In order to handle various emergency situations properly, the records must be supplemented by obstetrical and gynaecological rape checklist and rape victims supporting system should be established.

• Toxicological Research
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• v.23 no.3
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• pp.197-205
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• 2007

Cancer metastasis is a major determinant of cancer patient mortality. Mounting evidence favors a strong positive role for $TGF-{\beta}$ in human cancer progression. The complex pattern on cross-talk of $TGF-{\beta}$ and the related other signaling pathways is an important area of investigation that will ultimately contribute to understanding of the bifunctional role of $TGF-{\beta}$ in cancer progression. This review summarizes some of the current understanding of $TGF-{\beta}$ signaling with a major focus in its contribution to the tumor cell invasion and metastasis. Five issues are addressed in this review: (1) $TGF-{\beta}$ signaling, (2) $TGF-{\beta}$ and EMT, (3) $TGF-{\beta}$ and MMP, (4) $TGF-{\beta}$ and Ras, and (5) Role of $TGF-{\beta}$ in invasion and metastasis. Due to the bifunctional cellular effects of $TGF-{\beta}$, as a tumor promoter and a tumor suppressor, more precisely defined $TGF-{\beta}$ signaling pathways need to be elucidated. According to the current literature, $TGF-{\beta}$ is clearly a major factor stimulating tumor progression through a complex spectrum of the interplay and cross-talk between various signaling molecules. Understanding the role of $TGF-{\beta}$ in invasion and metastasis will provide valuable information on establishing strategies to manipulate $TGF-{\beta}$ signaling which should be a high priority for the development of anti-metastatic therapeutics.

• Journal of Korean Society of Industrial and Systems Engineering
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• v.35 no.4
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• pp.33-40
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• 2012

Dentists are known to be highly exposed to the musculoskeletal disorders (MSD). The present study investigated the prevalence of MSD among Korean dentists and association between their MSD and physical workload. In addition, detailed causes related to the physical workloads were identified in dental operation, and needs for improvement of dental instrument and environment were collected from Korean dentists. The standardized Nordic questionnaire was used to survey body troubles and three types of questionnaires were made to investigate the physical workloads, causes of the physical workloads and improvement priority of dental equipments, respectively. A total of 104 Korean dentists were participated in the survey. Neck trouble (82%) was the most prevalent in Korean dentists, and shoulder (68%) and low back trouble (56%) followed, while low back trouble was reported to be most frequent in previous studies. The body troubles were related to the physical workload of the corresponding body parts, although they were not associated with personal characteristics. Most Korean dentists selected 'to keep direct view inside patient's mouth' and 'no support of the hand with dental instruments' as the causes of awkward and strenuous work postures. They wanted design improvement for some equipment in their operating room such as operating light and arrangement of workplace.