• 대한의용생체공학회:의공학회지
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• 제14권4호
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• pp.321-326
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• 1993

Recently, microcomputer technology has been developed rapidly and it provides not only graphic user interface that can be fraendly accessable but also large storage capacity to han- dle much hospital information. Almost all the order communication system for hospital has been developed under the concept of host and terminal environment since last 20 years. However, host-terminal system has not been successful in korea simply because most of physicians prescibe for rrlany patients a day(sometimes more than 150 patients a day). Also, under the host-terminal environment, programs are not friendly implemented for users. Since March 1991, we had developed order communication system for out-patients(named YONSEI-PC) using personal computer(PC) and local area network(LAN) . Since September 1992, we has applied succesfully in the Yonsei Cardiovascular Center, Sevrance Hospital, Yonsei University College of Medicine. This system consisted with Server and Clients which is communicated through LAN(Ethernet). The system also use the Host computer(IBM 9221 170) as a data bank and communicates to the Server with emulation card(3270 emulator, Interlink Inc., Korea) . After introducing this system, it enables patients to receive drugs witllin 20 minutes after prescription of 300-400 patients per day and it seemed to be effective system not to reduce waiting time for the patients but also to remove charge-troubling(due to His-entry of prescription) . This system also seems to be effective in terms of office automatism for hospital management. However users, usually physitions, required more friendly and easy system to operate and we thought that the most important one to successfully introduce order communication computer system in the hospital is user interface.

• 한국병원경영학회지
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• 제5권1호
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• pp.105-128
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• 2000

This study was conducted to investigate the prospects and issues for the implementation of the annual salary system in Korean hospitals. Data were collected from the top management of 669 hospitals in Korea through the self-administerd questionnaires. Of the 175 respondents, 171 questionnaires were used as final data and analyzed using $X^2$ test. The results of the study are as follows. 1) It is found that 49.7% of the study hospitals are operating the annual salary system. 2) Among the hospitals which are not operating the annual salary system, 49.2% have the plan to implement the system and 44.5% have not decided yet whether they introduce the system or not. 3) The proportion of the hospitals which have the plan to implement the annual salary system within 5 years is 96.8%. 4) The proportion of the hospitals which will begin the system only with full-time physicians and middle level managers is 36.2%, while that of the hopsitals which will apply the system to all employees is 30.5%. 5) Hospital Administrators seems to prefer to 10-20% salary gap for the introduction period among the employees with same salary. 6) Most of the respondents are willing to accept the payment system based on the performance. 7) The major issues which should be dealt with before the implementation of the annual salary system are the establishment of the objectivity of performance evaluation criteria, the improvement of teamwork, and the maintenance of organizational commitment. 8) The desirable criteria for employee evaluation are found to be the mixture of the ability, job position, tenure, and the job difficulty.

• 보건행정학회지
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• 제24권3호
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• pp.205-218
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• 2014

Background: Most studies on the national health insurance benefit expansion policy have focused on policy tools or decision-making process. Hence there was not enough understanding on how policies are actually implemented within the specific policy context in Korea which has a national mandatory health insurance system with a dominant proportion of private providers. The main objectives of this study is to understand the implementation process of the benefit coverage expansion policy. Unlike other implementation studies, we tried to examine both the process of implementation and decision making and how they interact with each other. Methods: Interviews were conducted with the ex-members of the Health Insurance Policy Review Committee. Medical doctors who implement the policy at the 'street-level' were also interviewed. To figure out major variables and the degree of their influences, the data were analyzed with Winter's Policy Implementation Model which integrates the decision making and implementation phases. Results: As predicted by the Winter model, problems in the decision making phase, such as conflicts among the members of committee, lack of applicable causal theories application of highly symbolic activities, and limited attention of citizen to the issue are key variables that cause the 'implementation failure.' In the implementation phase, hospitals' own financial interests and practitioners' dependence on the hospitals' guidance were barriers to meeting the policy goals of providing a better coverage for patients. Patients, the target group, tend to prefer physicians who prescribe more treatment and medicine. To note, 'fixers' who can link and fill the gap between the decision-makers and implementers were not present. Conclusion: For achieving the policy goal of providing a better and more coverage to patients, the critical roles of medical providers as street-level implementers should be noted. Also decision making process of benefit package expansion policy should incorporate its influence on the implementation phase.

• 종양간호연구
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• 제7권2호
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• pp.119-130
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• 2007

Purpose: The purpose of this study was to analyze the data regarding questions raised by women with breast cancer through Internet counseling in Korea. Methods: The data were collected from one internet web-site, providing counseling by physicians. A total of 617 questions were analyzed by content analysis method. Results: About 90 percent of the counselees were patients themselves. But most of the general and health-related characteristics of them were not known from the data. As a result of content analysis, 617 questions were grouped into 9 major categories. The most common major category was identified as "life after treatment" (212 questions, 34.2%), followed by "chemotherapy" (139 questions, 22.3%) and "hormone therapy" (115 questions, 18.9%). Questions regarding "physical symptoms" were the most frequent one in the major categories of "life after treatment", "chemotherapy", and "radiotherapy", while questions regarding "psychological problems" were the least. Conclusion: The findings of this study indicate that it is important for health professionals to provide continuous on-line informational support to women with breast cancer, even after all the treatment is over, especially focusing on physical symptoms. In addition, off-line program needs to be reinforced to provide emotional support that is not well delivered by on-line program.

• 임상간호연구
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• 제23권2호
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• pp.222-235
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• 2017

Purpose: The purpose of this study was to investigate the reality, status of clinical nurses' emotional labor and the relationship with physical discomfort, burnout, depression and social support. Methods: A thousand three hundred sixteen clinical nurses from 42 hospitals nationwide participated in this study. Questionnaires were developed for evaluating the reality and status of emotional labor of clinical nurses after interviewing focus groups and reviewing literatures. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficient. Results: Ninety eight percent of nurses had answered having emotional labor and they experienced 82 times per year, 9.6 times during last a month which means they experience it every other day. The one who provoke emotional labor were patients, guardians, physicians, supervisor, and colleagues in sequence. Eighty percent of nurses had intention to leave their jobs after experiencing emotional labor. They were doing more surface acting than deep acting of emotional labor. Conclusion: Clinical nurses in Korea experienced excessively high level of emotional labor and delayed responding to clients' requests due to lack of time for caring each patient was revealed as one of the main causes of emotional labor.

• 한국정보처리학회:학술대회논문집
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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.

• 대한임상독성학회지
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• 제20권2호
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• pp.51-57
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• 2022

Purpose: Despite previous studies reporting the development of rhabdomyolysis (RM), this affliction tends to be neglected as an envenomation sign in South Korea. The current retrospective study investigates the prevalence and prognosis of RM after a snakebite. We further searched for predictors of snakebite-induced RM, which can be observed at presentation. Methods: This study included 231 patients who presented to the ED within 24 hours after a snakebite. The patients were classified according to the severity of RM, and the data, comprising baseline characteristics and clinical course including the level of creatine kinase (CK), were collected and compared according to the severity of RM. Results: The prevalence of RM and severe RM were determined to be 39% and 18.5%, respectively. Compared to the group without RM or with mild RM, the group with severe RM had a higher grade of local swelling, a higher frequency of acute kidney injury and neurotoxicity, and a greater need for renal replacement therapy and vasopressor administration. However, the incidence of acute renal injury in the RM group was 7.7%, with two patients needing renal replacement therapy. No mortalities were reported at discharge. Results of the multinomial logistic regression model revealed that the WBC levels are significantly associated with the risk of severe RM. Conclusion: RM should be considered the primary clinical sign of snake envenomation in South Korea, although it does not seem to worsen the clinical course. In particular, physicians should pay attention to patients who present with leukocytosis after a snakebite, which indicates the risk of developing RM, regardless of the CK level at presentation.

• Tuberculosis and Respiratory Diseases
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• 제70권3호
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• pp.199-205
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• 2011

Social welfare services for respiratory-disabled persons in Korea are offered based on the respiratory impairment grade, which is determined by 3 clinical parameters; dyspnea, forced expiratory volume in 1 second ($FEV_1$), and arterial oxygen tension. This grading system has several limitations in the objective assessment of respiratory impairment. We reviewed several guidelines for the evaluation of respiratory impairment and relevant articles. Then, we discussed a new grading system with respiratory physicians. Both researchers and respiratory physicians agreed that pulmonary function tests are essential in assessing the severity of respiratory impairment, forced vital capacity (FVC), $FEV_1$ and single breath diffusing capacity ($DL_{co}$) are the primarily recommended tests. In addition, we agreed that arterial blood gas analysis should be reserved for selected patients. In conclusion, we propose a new respiratory impairment grading system utilizing a combination FVC, $FEV_1$ and $DL_{co}$ scores, with more social discussion included.

• Tuberculosis and Respiratory Diseases
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• 제67권2호
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• pp.88-94
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• 2009

Background: From November 2006, The national health insurance system in the Republic of Korea began to cover prescribed long-term oxygen therapy (LTOT) in patients with chronic respiratory insufficiency. This study examined the current status of LTOT after national health insurance coverage. Methods: Between November 1, 2006 and June 30, 2008, the medical records of patients who were prescribed LTOT by chest physicians were reviewed. The data was collected from 13 university hospitals. Results: 197 patients (131 male and 66 female) were prescribed LTOT. The mean age was 64.3${\pm}$13.0 years. The most common underlying disease was chronic obstructive pulmonary disease (n=103, 52.3%). Chest physicians prescribed LTOT using arterial blood gas analysis or a pulse oxymeter (74.6%), symptoms (14%), or a pulmonary function test (11.2%). The mean oxygen flow rate was 1.56${\pm}$0.68 L/min at rest, 2.08${\pm}$0.91 L/min during exercise or 1.51${\pm}$0.75 L/min during sleep. Most patients (98.3%) used oxygen concentrators. Only 19% of patients used ambulatory oxygen supplies. The oxygen saturation before and after LTOT was 83.18${\pm}$10.48% and 91.64${\pm}$7.1%, respectively. After LTOT, dyspnea improved in 81.2% of patients. The mean duration of LTOT was 16.85${\pm}$6.71 hours/day. The rental cost for the oxygen concentrator and related electricity charges were 48,414${\pm}$15,618 won/month and 40,352${\pm}$36,815 won/month, respectively. Approximately 75% of patients had a regular visit by the company. 5.8% of patients had personal pulse oxymetry. 54.9% of patients had their oxygen saturation checked on each visit hospital. 8% of patients were current smokers. The most common complaint with LTOT was the limitation of daily activity (53%). The most common complaint with oxygen concentrators was noise (41%). Conclusion: The patients showed good compliance with LTOT. However, only a few patients used an ambulatory oxygen device or had their oxygen saturation measured.

• 한국임상약학회지
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• 제25권2호
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• pp.120-129
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• 2015

Objectives: Drug utilization review program in Korea has provided 'drug combinations to avoid (DCA)' alerts to physicians and pharmacists to prevent potential adverse drug events or inappropriate drug use. Seven hundred and six DCA pairs have been announced officially by the Ministry of Food and Drug Safety (MFDS) by March, 2015. Some DCA pairs could be grouped based on the drug interaction mechanism and its consequences. This study aimed to investigate the drug-drug interaction (DDI) pairs, which may be potential DCAs, generated by the drug class-drug class interaction method. Methods: Eleven additive/synergistic and one antagonistic drug class-drug class interaction groups were identified. By combining drugs of two interacting drug class groups, numerous DDI pairs were made. The status and severity of DDI pairs were examined using Lexicomp and Micromedex. Also, the DCA listing rate was calculated. Results: Among 258 DDI pairs generated by the drug class-drug class interaction method, only 142 pairs were identified as official DCA pairs by the MFDS. One hundred and four pairs were identified as potential DCA pairs to be listed. QT prolonging agents-QT prolonging agents, triptans-ergot alkaloids, tricyclic antidepressants-monoamine oxidase inhibitors, and dopamine agonists-dopamine antagonists were identified as drug class-drug class interaction groups which have less than 50 % DCA listing rate. Conclusion: To improve the clinicians' adaptability to DCA alerts, the list of DCA pairs needs to be continuously updated.