• Title/Summary/Keyword: patient priority

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Efficient Transmission Structure and Key Management Mechanism Using Key Provisioning on Medical Sensor Networks (의료 센서 네트워크에서의 효율적인 전송 구조 및 Key Provisioning을 사용한 키 관리 기법 연구)

  • Seo, Jae-Won;Kim, Mi-Hui;Chae, Ki-Joon
    • The KIPS Transactions:PartC
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    • v.16C no.3
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    • pp.285-298
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    • 2009
  • According to the development of ubiquitous technologies, sensor networks is used in various area. In particular, medical field is one of the significant application areas using sensor networks, and recently it has come to be more important according to standardization of the body sensor networks technology. There are special characteristics of their own for medical sensor networks, which are different from the one of sensor networks for general application or environment. In this paper, we propose a hierarchical medical sensor networks structure considering own properties of medical applications, and also introduce transmission mechanism based on hierarchical structure. Our mechanism uses the priority and threshold value for medical sensor nodes considering patient's needs and health condition. Through this way Cluster head can transmit emergency data to the Base station rapidly. We also present the new key establishment mechanism based on key management mechanism which is proposed by L. Eschenauer and V. Gligor for our proposed structure and transmission mechanism. We use key provisioning for emergency nodes that have high priority based on patients' health condition. This mechanism guarantees the emergency nodes to establish the key and transmit the urgent message to the new cluster head more rapidly through preparing key establishment with key provisioning. We analyze the efficiency of our mechanism through comparing the amount of traffic and energy consumption with analysis and simulation with QualNet simulator. We also implemented our key management mechanism on TmoteSKY sensor board using TinyOS 2.0 and through this experiments we proved that the new mechanism could be actually utilized in network design.

Patient Perceptions of Clinical Nutrition Service (임상영양서비스에 대한 환자의 인식 조사)

  • Choi, Ki-Bo;Lee, Song-Mi;Lyu, Eun-Soon
    • Journal of the Korean Dietetic Association
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    • v.18 no.1
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    • pp.59-71
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    • 2012
  • The purpose of this study was to evaluate the patient perception of clinical nutrition service. The research was performed by using questionnaires and conducted from February 14 to March 15 at 42 hospitals (over 400 beds). 41.7% of patients experienced nutritional education and counseling. The mean score of the patients' perception on clinical nutritional service was 4.62/5.00 for "nutrition care is important for treatment of the disease", 4.49/5.00 for "diet therapy is necessary for treatment of the disease", 4.16/5.00 for "nutritional counseling call-centers are necessary", 4.13/5.00 for "nutritional consultation fee is required to apply insurance benefits", 4.12/5.00 for "one-to-one nutrition system is necessary", and 3.56/5.00 for "nutrition services I am willing to pay". The patients who had no past experience in nutritional education and counseling showed significantly higher scores for "nutrition care is important for treatment of the disease", "one-to-one nutritional care system is necessary", and "nutritional counseling call-centers are necessary" (P<0.05). The mean scores for the importance (4.26/5.00) and performance (3.88/5.00) of nutrition counseling service were significantly different (P<0.01). "Nutritional counseling is available whenever I want" had the highest gap score between performance and importance among nutrition counseling service items. The importance and performance grid showed that highly important items had high performance (doing great area) and less important items have low performance (low priority).

The First Psychiatric Interview and Understanding of Psychodynamics; An Experience of Resident Education (첫 면접(面接)과 환자심리역동(患者心理力動)의 이해(理解) -전공의(專攻醫) 교육(敎育) 경험(經驗)-)

  • Cho, Doo-Young;Rhi, Bou-Yong;Kim, Zoung-Soul;Kim, Yong-Sik;Cho, Maeng-Jae;Lyoo, In-Kyoon
    • Korean Journal of Psychosomatic Medicine
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    • v.5 no.1
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    • pp.12-30
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    • 1997
  • The psychiatric interview is not a random or arbitrary meeting between doctor and patient. It is a systematic attempt to understand the relationship of psychopathology to emotional conflicts in patient, and interviewing is an in rather than a science, a skill that can be acquired but probably not taught. The faculty of the Seoul National University Hospital, Department of Psychiatry, have been providing 12 sessions of seminar on Psychiatric Interview and Psychopathology every year for the first year residents for the past 15 years. The authors presented three cases materials with their understandings of psychopathology and psychodynamics, each of which the authors had performed live interviews for 50 minutes in front of the residents. Those are a young male with conversion disorder whose chief complaints was motor aphasia, a young college girl with paranoid schizophrenia whose chief complaints were persecutory and erotic delusions with auditory hallucination, and a climacteric female in delusional disorder who had a delusion of infidelity. The most frequent questions the residents raised after the presentations were on the significances of the first interview, danger of making the diagnoses with short interviews, and methodology of questionings and not-questionings. In reply the authors discussed the importance of understandings of psychopathology and psychodynamics, the flexibility of the techniques of interviewing, and priority-related matters in which the understanding of psychodynamics proceed to the diagnoses.

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The Surgical Treatment of Acute Rupture of the Lateral Ligaments of the Ankle (급성 족관절 외측 인대 파열의 수술적 치료)

  • Lee, Keun-Il;Roh, Su-In;Choi, Ik-Su
    • Journal of Korean Foot and Ankle Society
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    • v.5 no.1
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    • pp.5-12
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    • 2001
  • Purpose: To find out the priority of which procedure has had a better outcome both clinically and radiographically between the two groups, one is treated by primary repair and the other by modified Brostr$\ddot{o}$m's procedure, by comparing the postoperative ankle joint stability and the patient's degree of satisfaction. Material and methods: 16 cases were taken into consideration whose number of severed ligaments were at least two or more of the lateral collateral ligaments of the ankle, and also were confirmed intraoperatively. Among them, 8 cases were treated with primary repair and the other 8 cases were treated with primary repair and the other 8 cases by modified Brostr$\ddot{o}$m's procedure. Results: There was no distinguishable difference for the patient's degree of satisfaction between the two procedures above mentioned. In 3 cases treated with primary repair, functional instability was observed. In case of postoperative ankle joint stability, 7 of 8 cases treated by modified Brostr$\ddot{o}$m's procedure has revealed increased joint stability. And 3 of 8 cases which were treated by primary repair have showed postoperative residual instability. Conclusion: Actually, the severed ligament can not maintain its normal strength though several months has elapsed, and possible residual instability could be remained. Therefore, it can be expected that modified Brostr$\ddot{o}$m's procedure also would be a .good method in obtaining suitable ankle joint stability as well as subtalar joint stability because of its reinforcement using extensor retinaculum.

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A STUDY ON THE CLINICAL ANALYSIS AND PERFORMANCE IN COMPREHENSIVE NURSING CARE (전인간호의 임상학적 분석과 실행에 관한 연구)

  • 전산초
    • Journal of Korean Academy of Nursing
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    • v.4 no.1
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    • pp.1-21
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    • 1974
  • A considerable change of the Korean nursing system has been made during the last decade not only in its philosophy but also in its function and structure to meet political and scientific need of the modern society. The main purpose of this study is to develope the new concept of comprehensive nursing care, both its Philosophy and ethics, as the basic of modern clinical nursing theory and practice. Comprehensive nursing care is the concept of human centered nursing care, and it helps a man to meet the basic physical, psychological, environmental, socioeconomic and teaching needs. It also helps him to help himself to meet these needs. This concept starts from the individualized nursing care and its ultimate goal is to improve a man to have a better position in his own community so that he may able to have a meaningful life. To accomplish this goal, an individualized nursing care plan as a nursing diagnosis and problem solving method should be set up for different patients with similar diagnosis to meet their needs, because each patient has a different social background. from this viewpoint, nursing is a science as well as abstruse humanity. The performance of comprehensive nursing care is a goal and issue of modern clinical nursing care. If nursing is a science and a profession for man, it should have ethics which recognize the dignity of man and offers infinite service voluntarily, and should be able to show leadership in carrying out the nursing responsibility. This leadership finds a person's potential and encourages him to utilize it. Such concepts should develop into a nursing ideology and this ideology should become a priority in comprehensive nursing care. The following statements are the conclusion of this study. 1) Modern nursing has been developed from disease centered nursing care to comprehensive nursing care based on humanity. The primary principle of nursing was to assist in the treatment of disease, but it has been changed to the professional nursing system independently. 2) The concept of nursing is one of continuous or endless scope of dispersion. It proves that nursing is grasping the professional responsibility to be able to coordinate scientific principles Patient health problems are according to scientific principles rather than adhering to nursing technical discipline as a daily work. 3) In chapter I and Ⅱ, the philosophy and ideology of nursing have been discussed and the flow of concept of clinical nursing and the rate of progress which emerges from naturalizing performance of the concept of comprehensive nursing in clinical nursing studied. The discussion developed the theory that a nurse should be to embody nursing ideas and objectives by establishing definite conviction of professions and study. 4) In chapter lil, nursing planning based on nursing diagnosis as a method to attain ideal nursing care for humanity with a definite idea of establishing philosophy of nursing was presented. 5) From the result of survey on patient needs about treatment and nursing, it was observed that all patient had emotional stress from unknown factors. Therefore it was concluded that nurses should not only educate the patient but also give them the opportunity to communicate freely their needs and anxieties. Furthermore complaints and doubts of the patient should be carefully noted and must be considered to meet these needs. 6) Patient teaching is the most important part of comprehensive nursing care. In chapter, Ⅲ, the important of patient teaching was emphasized by demonstrating the effect of patient teaching for diabetic patient. 7) In Chapter Ⅳ, from the result of the study on nurses attitudes to comprehensive nursing care, it was pointed that the evolution of nursing education and the establishment of a complete concept and value of comprehensive nursing was necessary.

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A Research Relative to the Subjective View on the Occupational Consciousness of the Dental Coordinator (Dental Coordinator의 직업의식에 관한 주관성 연구)

  • Han, Gyeong-Soon
    • Journal of Korean society of Dental Hygiene
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    • v.2 no.1
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    • pp.97-113
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    • 2002
  • This research is an attempt to establish a basic material in discovering the subjective types of the dental coordinators occupational consciousness, utilizing the Q-Method Theory, which is capable of measuring the subjective nature of human being by scientific and systematic method. The characteristics of each type were analyzed so as to have the dental coordinator to possess the desirable understanding of the occupational view together for them to have self-confidence as a lifetime specialty occupation. Upon completion of the study, it was found that there are three types of subjective views pertaining to the occupational consciousness on the dental coordinator. The result on the analysis of the characteristics is as follows : Type 1 is the Taking Serious View on the Patient Service, which priority is placed on kindness and looking after any difficulties of the patient, namely, it is the type that puts the importance on the high level medical examination and treatment based on good service. Because of the kind service to the patient, those under this category considered their job satisfaction have been improved. It goes without saying that they were developing the services, which satisfy themselves, and it was confirmed that they thought that they should make things smooth for any development of problems that may arise between the patient and the dentist. Type 2 is the Taking Serious View on Career and Organizational Strength. This is a type that aims on the systematic nature of the internal job, namely, organizational strength itself viewed from the stand point thai either self-confident or work merit is proportional to experience. This type is to actively treat the problem and endeavor to solve the issue when dissatisfaction is held by the dental hospital system, which is either followed according to the work responsibility or by an organization having an appropriate system on remuneration, Type 3 is the Placing of Importance on the Overall Circumstances. This is the type that places importance on the overall now of the dental hospital, and it is the type, that most greatly recognizes the importance of the role of the dental coordinator. The dental coordinator should provide the sense of reliability to both the dentist and to the staff of the medical examination and treatment and should be able to adjust smoothly the overall now of the medical treatment. The dental coordinator is expected to be a medical service specialist, who is capable to solve the problems of the staff of the medical treatment intuitively and to adjust the relation between the employees. With the above result, it was found that although there was no mutual exclusiveness between the respective types, there are particular characteristics among each type. Therefore, this research has discovered and analyzed the subjective view types relative to the occupational consciousness of the dental coordinator for the proper understanding on the characteristics of each type to enable the dental sanitary students and the graduates of the Dental Sanitary Department, who are aspiring to become dental coordinator, as the basic guide material to be actively utilized.

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Advances of Hospice Palliative Care in Taiwan

  • Cheng, Shao-Yi;Chen, Ching-Yu;Chiu, Tai-Yuan
    • Journal of Hospice and Palliative Care
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    • v.19 no.4
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    • pp.292-295
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    • 2016
  • Hospice and palliative care in Taiwan has been growing continuously. The 2015 Quality of Death index, as rated by the Economist Intelligence Unit, ranked Taiwan first among Asian countries and sixth in the world. In this review article, we highlight three particular areas that might have contributed to this success; the laws and regulations, spiritual care and research network. Finally, we discuss the future challenges and prospects for Taiwanese encounters. A systemic review was conducted with the keywords "hospice palliative care Taiwan" using PubMed. The passing of the "Natural Death Act" in 2000 set the example and established a landmark for patient autonomy in Asia; it guarantees the patient's right to request that medical staff do not resuscitate (DNR) them and to reject other futile medical treatments at the end of their life, thus reflecting the importance of palliative care from the policy perspective. In 2015, Taiwan passed another pioneering law entitled the "Patient Autonomy Act". This law states that a patient may decline medical treatment according to his/her own will. Taiwanese indigenous spiritual care was launched in 2000. It requires a Buddhist Chaplain to successfully complete a training program consisting of lectures, as well as bedside practicum before applying Buddhist practices to end-of-life care. The Japan-Korea-Taiwan research network was established for the purpose of enabling collaborative research for the East-Asian collaborative cross-cultural Study to Elucidate the Dying process (EASED) cohort. With consensus from the government and society to make it a priority, hospice and palliative medicine in Taiwan has been growing steadily.

Surrogate and Shared Medical Decision Making for Unrepresented Patients (의료행위에 대한 동의에서 환자 보호자의 법적 지위와 역할 - 대행결정권과 공동의사결정을 중심으로 -)

  • Kim, SooJeong
    • The Korean Society of Law and Medicine
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    • v.20 no.2
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    • pp.43-82
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    • 2019
  • In Korea surrogate medical decision makings happen without legal grounds. The purpose of this article is to research the issues in preparing policies for decision-making on behalf of unrepresented patients. As aspects of comparative law, there are two approaches. One of them is to regulate default surrogate list. If no agent or guardian has been appointed, some legislatures provide that members of patient's family who is reasonably available, in descending order of priority of not, may act as surrogate: (1) the spouse, unless legally separated; (2) an adult child; (3) a parent; or (4) an adult brother or sister. If none of them is eligible to act as surrogate, some legislatures allow close friends to make health-care decisions for adult individuals who lack capacity. On the other hand there are other legislatures which provide no surrogate decision maker list but oblige the responsible authority to determine with advice of family members or friends of the patient. In the end the first approach can not guarantee that the surrogate decision maker like family members or friends will determine in the best interest of the patient.

Study of Failure Mode and Effect Analysis in Brachytherapy (근접방사선치료에 관한 사고유형과 영향분석 연구)

  • Lee, Soon Sung;Park, Dong Wook;Shin, Dong Oh;Kim, Dong Wook;Kim, Kum Bae;Oh, Yoon-Jin;Kim, Juhye;Kwon, Na Hye;Kim, Kyeong Min;Choi, Sang Hyoun
    • 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.

A study for the factors on choosing hospitals and patients satisfaction between Geriatric Hospitals and General Hospitals (노인병원과 종합병원의 선택요인 및 환자만족도 분석)

  • Yoon, Seo-Jung;Yu, Seung-Hum;Kim, Young-Hoon;Lee, Ji-Jeon
    • 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.

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