비외상성 급성 복부 통증 환자에게 시행한 복부 전산화단층촬 영과 복부 단순 촬영의 적정성 비교

송정흡,염헌규,Song, Jung-Hup,Ryeom, Hun-Kyu 한국의료질향상학회 2018 한국의료질향상학회지 Vol.24 No.2

Purpose: To compare the Appropriateness of abdominal CT to abdominal radiography as an imaging modality in terms of the diagnostic value, medical costs and decision making times for patients presented to the emergency department with nontraumatic abdominal pain. Methods: This study used the records of 530 cases presented to the emergency department(ED) with nontraumatic abdominal pain from February to March 2012. Imaging modalities were categorized into abdominal radiography and CT (radiography first or CT first) or radiography alone or CT alone. The diagnostic value, total medical costs and effect on decision making time of the each imaging modalities were compared. Especially, in retrospective review, to evaluate the predictability of the abdominal radiography, alit was assumed that all the 530 cases performed that exam as initial imaging. Results: Among 530 cases, 255 cases underwent abdominal radiography only, 28 cases underwent abdominal CT only and the remnant 247 cases underwent abdominal CT with plain abdominal radiography. The diagnostic value was higher in the cases with abdominal CT (268/275, 97.5%) than in the cases with plain abdominal radiography (19/255, 7.5%).The number of cases predicted by abdominal radiography only as initial imaging were 39/530 (7.4%). In cases where the patients performed the abdominal CT as the first imaging modality thereby omitting the abdominal radiography, the total diagnostic imaging fee was lower than in cases with plain abdominal radiography first followed by the abdominal CT (277,140 vs. 284,226(mean, Korean Won)). Although diagnostic value of the plain abdominal radiography as first imaging modality was lower than the abdominal CT, Decision making time, average duration of hospital stay was longer and the total medical costs was higher than abdominal CT. Conclusion: As an imaging modality in the ED for patients with acute nontraumatic abdominal pain, plain abdominal radiography is an avoidable procedure when viewed in terms of the diagnostic value and total medical costs and decision making times comparing with abdominal CT.

입.퇴원 module 시스템의 효과 분석 -ocs 입원 관리 시스템 효과 분석-

송정흡,Song, Jung Hup 한국의료질향상학회 2006 한국의료질향상학회지 Vol.12 No.1

Background : There were so many patients who are waiting for admission in Emergency room in spite of more than one hundred empty beds everyday. This study was conducted to evaluate admission-discharge module system by OCS which reduce empty beds. Methods : The data of bed utilization in general beds from 2004 were reviewed. For evaluation of performance at admission-discharge module system by OCS, the change of Occupancy of bed were calculated. Results : The percentage of Average Bed Emptiness was changed from 13.8% to 9.2%. The residents in surgery(100%) and in internal medicine(75.5%) approved this system. Conclusion : The personnel in hospital recognized that it was very important to manage bed. The management of beds by OCS was helpful to reduce empty beds and was important.

대구시내 각급 의료기관에서 분만하는 산모들의 특성 및 출산결과의 비교 분석

송정흡,박정한,김귀연,김장락,Song, Jung-Hup,Park, Jung-Han,Kim, Gui-Yeon,Kim, Jang-Rak 대한예방의학회 1988 예방의학회지 Vol.21 No.1

각 의료기관에서 분만하는 산모와 신생아의 특성을 비교분석하고 의료기관별 산모와 신생아의 위험수준을 조사하여 특정 의료기관에서 관찰한 연구결과를 해석하는데 참고 자료를 제공하기 위하여 대구시내 3개 대학병원, 2개 종합병원,2개 개인의원, 1개 조산소, 그리고 1개 모자보건센터에서 1987년 4월 1일 부터 4월 30일 까지 1개월간(1개 대학병원은 2개월간) 분만한 산모 1,410명을 대상으로 산모의 연령, 교육수준, 의료비 지불방법, 산과력 및 특정의료기관을 선택한 이유를 면담 조사하고 병원기록지에서 신생아의 출생시 체중의 조사하였다. 대학병원과 종합병원을 이용한 산모의 평균 연령은 각각 27.5세, 26.7세로 조산소(25.4세)와 모자보건센터(26.1세)를 이용한 산모보다 많았고, 교육수준은 대학병원(평균 12.7년)과 종합병원(평균 12.2년) 산모가 조산소(평균 9.2년) 및 모자보건센터(평균 9.3년) 산모보다 월등히 높았다. 그리고 의료보험 대상자도 대학병원(78.1%)과 종합병원(82.9%) 산모가 개인의원(44.3%), 조산소(29.1%)나 모자보건센터(5.4%) 보다 많았다. 모자보건센터는 2번째 출산이 47.3%로 가장 많았으나 다른 의료기관은 모두 초산부가 $56.0{\sim}61.7%$로 제일 많았다. 산모의 산과력 비교에서는 대학병원 산모가 자연유산 경험율이 상대적으로 다른 의료기관 산모보다 높았고 사산 경험자도 소수였으나 조산소와 모자보건센터에서 분만한 산모는 사산 경험자가 1명도 없었다. 대학병원 산모의 경우 37주 이하의 조산아 출생율(11.4%)과 2,499gm이하의 저체중아 출생율($5.8{\sim}13.0%$)은 타 의료기관 보다 현저히 높았다. 이에 따라 제왕절개술에 의한 분만율은 의료기관간에 차이가 많았다. 결국 대구시내 대학병원과 종합병원에서 분만하는 산모들은 사회경제적으로 중, 상류층과 소득고하를 막론하고 고위험산모들이 많고 조산소와 모자보건센터는 저소득충의 산모 가운데 산과적으로 저위험군들이 많이 이용하고 있다. 따라서 특정 의료기관을 대상으로 조사한 자료를 해석하는데 많은 제한성이 있으며 전체 산모의 특성으로 일반화하는 것은 불가능한 것으로 생각된다. This study was conducted to compare the maternal charactristics, and birth weight of infants delivered at five different categories of medical facility in Taegu to examine the risk level of pregnant women and children by the medical facility for delivery. The study population included 1,410 pregnant women who delivered a baby at one of nine medical facilities (3 university hospitals, 2 general hospitals, 2 private clinics, 1 midwife clinic, 1 MCH center) in Taegu in April, 1987(April and May, 1987 for K university hospital), Pregnant women were interviewed to ask the age and educational level of woman, payment of medical fee, birth order, delivery method. Birth weight of infant was obtained from medical record. Mean ages of the women delivering at the university hospitals(27.5 years) and at general hospitals(26.7 years) were higher than those at midwife clinic(25.4 years) and at MCH center(26.1 years). Also, mean years of school education were higher in women of university hospitals(12.7 years) and general hospitals (12.2 years) than in women of midwife clinic(9.2 years) and MCH center (9.3 years). The percentages of women covered by the medical insurance were far greater in the university hospitals(78.1%) and general hospitals(82.9%) than in private clinics(44.3%) , midwife clinic(29.1%) and MCH center (5.4%). Infants born at the MCH center were mostly the second birth (47.3%) while 56.0% to 61.7% of infants born at all the other medical facilities were the first birth more women delivering at the university hospitals had history of spontaneous abortion as well as still birth than the women delivering at the other medical facilities. The preform birth rate (11.4%) and low birthweight incidence rates(5.8-13.0%) in university hospitals were significantly higher than those of other medical facilities. Accordingly, c-section rates showed a wide variation among the medical facilities. Study findings revealed that most of women delivering at the university hospitals and general hospitals are in the middle of or upper socio-economic class and obstetrically high risk group regardless of socioeconomic class while the wome delivering at the midwife clinic and MCH center are low risk group of low socioeconomic class. Therefore, the data of a specific medical facility are highly limited in interpretation and can not be generalized.

Web 및 OCS(Order communication system)를 활용한 직원 건강검진 프로그램의 효과분석

송정흡,하태희,Song, Jung Hup,Ha, Tae Hi 한국의료질향상학회 2009 한국의료질향상학회지 Vol.15 No.2

Objectives : To evaluate the effect of heath examination program which introduce web-based input system, OCS(Order communicating system) and interface with national health insurance corporation, this study was done. Method : To Exam/Order and tests separately at anytime, the experimental health examination program which had web-based questionnaire input system, on-line measurement input system, interface program with national health insurance corporation and introduced OCS was developed. Experiment and old examination program were compared in terms of satisfaction and cost. Result : The 95.7% of respondents were satisfied with web-based input system, the 95.4% satisfied with OCS use, and 97.8% satisfied with test at anytime they want. The cost and time reduction between experiment and old program were 4,159,000won and $600.3{\pm}5.75$(seconds) per man input-time. Conclusion : The experimental health examination program is good for employee and hospital. If the health examination program for non-employee will be developed, it will be done efficiently and effectively, but Internet securities will be considered.

주차시간을 이용한 외래환자 대기시간 추정

송정흡,Song, Jung-Hup 한국의료질향상학회 1996 한국의료질향상학회지 Vol.2 No.2

Background : Theoretically as the waiting-time of patient is estimated in queueing, many men and much money are needed. But being the estimation of patient s waiting-time very important in hospital service, so the continuous monitoring of waiting-time is inevitable. To verify that the estimation of waiting-time using parking time is economical, effective and continuous monitoring method and to develop utilizing the method, this study was done. Method : In parking confirmation office, the personnel of parking office wrote parking confirm time, chart number and whether medical examination and treatment finish or not in parking ticket. The next day the parking tickets were gathered and the above data were input. The input parking data were connected with the hospital outpatient file indexing chart number. Then the patient' s data for department, new patient or not, reservation or not, receipt time and payment time were retrieved. The group for finishing medical treatment were compared with that for not finishing in average time lag between confirmation and out-time for hospital. And In-time for hospital, receipt time, payment and out-time for hospital were also analyzed. Result : Confirming parking ticket, the group for finished medical treatment left hospital after 7 minutes. This result showed that the patient for finished medical treatment left hospital immediately. So parking time was reasonable to estimation of hospital-time was concluded. The time for medical treatment, diagnosis and test was constant for all patients and short for waiting time, Then I concluded that the parking time was reasonable for estimation patient's waiting time. Overall patient's waiting time was 113 minutes and new patient's time was 149 minutes, old patient's times was 109 minutes. Waiting time for reservation patient was 98 minutes and for non reservation patient was 122 minutes. The time from hospital arrival to payment was 50 minutes for the group of reservation patient and 69 minutes for non-reservation group. The time from payment to hospital leaving was 51 minutes and 56 minutes for non reservation group. The short time difference between reserved group and not reserved group from payment to hospital leaving time was due to bottle neck effect. Conclusion : The estimation of patient's waiting time using parking time was reasonable because the possession of car was common and the time for medical treatment was equal and the patient after treatment left hospital immediately. Using this method, timely, fast evaluation and continuous monitoring of the intervention effect were possible.

위 절제술 환자의 진료계획표 개발 및 전자 의무 기록화

배명순,송정흡,Bae, Myung Sun,Song, Jung Hup 한국의료질향상학회 2012 한국의료질향상학회지 Vol.18 No.1

Objectives : This study was conducted to evaluate the effect of fixed critical pathway with emr (electronic medical record) on the length of hospital stay, the cost and quality of care provided to gastrectomy patients in a university hospital and to develop flexible critical pathway with emr which can be used excluded or drop-out patients. Methods : Thirty-eight patients with gastrectomy were included as case group and Thirty-four patients included as control group. The comparison between control and case with using fixed critical pathway were done. To develop and to evaluate usefulness of flexible critical pathway with flexible data base, simulation was done for flexible critical pathway with drop-out patients. Result : The major results of this study were as follows: There were no significant differences in patient clinical conditions and no sign of deterioration of quality from critical pathway. The length of hospital stay was 11 days in control group, 8 days in path group(P<0.01). The total costs during the hospital stay were reduced in path group. However the cost per day was significantly increased from reduction of hospital stay(554,352 won in control, 645,669 won in path group). One hundred percentage of drop out patients(60) in the simulation of flexible critical pathway was successful. Conclusion : Computerized critical pathway reduced the length of hospital stay, total hospital costs and resource utilization without harming quality of patient care. The flexible critical pathway program can be used as one of the powerful management tools for reducing the practice variations and increasing the efficiency of care process and decreasing the workload of doctors and nurses in Korean hospital settings.

대구시내(大邱市內) 의과대학생(醫科大學生)들의 B형(型)바이러스성(性) 간염감염율(肝炎感染率)

박정한,윤태현,천병렬,송정흡,Park, Jung-Han,Youn, Tae-Hyun,Chun, Byung-Yeol,Song, Jung-Hup 대한예방의학회 1987 예방의학회지 Vol.20 No.1

의대생들의 B형바이러스성 간염의 감염율을 조사하고 그 예방대책을 강구하기 위하여 경북의대 1, 2, 3학년 가운데 B형 간염 백신 예방접종을 받은 학생을 제외한 자원자 385명을 대상으로 HBsAg, anti-HBs, anti-HBc를 RIA방법으로 측정하여 B형간염 감염율을 조사하고 설문지로 수혈력, 침술력, 수술력을 조사하고 HBsAg양성인 사람은 16개월 후에 재검사하여 변화양상을 조사하였다. HBsAg양성율은 6.8%이었으며 연령에 대한 보정을 했을 때 남자가 7.2%로 여자의 4.9%보다 높았으며, anti-HBs양성율은 35.8% (남자 36.1%, 여자 37 9%), anti-HBc양성율은 45.5% (남자 46.5%, 여자 44.5%)이었다. 따라서 B형간염 감염율은 49.1%로서 역시 남자(50.3%)가 여자보다(46.5%) 높았다. 학년별 HBsAg양성율 및 HBV감염율의 차이는 연령구성의 차이에 기인된 것 이었으며 연령별 HBsAg양성율은 20세가 1.7%, 21세 6.6%, 22세 6.1%, 23세 12.2%, 24세 이상에서 6.4%로 23세에서 가장 높게 나타났다. HBV감염율은 20세에서 45.8%, 21세 41.5%, 22세 49.5%, 23세 55.4%, 24세이상에서 59.6%로 나타나 연령이 증가할수록 감염율은 증가하였다. 이와같은 연령별 차이는 통계적으로 유의한 것은 아니었으나 타 연구결과와 종합해 볼 때 연령별 차이가 있을 것으로 생각되므로 같은 연령의 다른 학교 및 다른 계층을 대상으로 조사해 보고 연령에 따른 차이가 생기는 이유를 규명한다면 이 연령층에서 B형간염의 주요전파 경로를 밝힐 수 있을 것으로 생각된다. HBsAg양성인 26명가운데 1명만이 B형간염을 않고 있는 환자로 밝혀졌고 이들은 16개월 후에 재경사한 결과 검사에 응한 24명 중 22명이 계속 HBsAg양성이고 2명은 음성으로 되고 anti-HBs가 양성으로 나타났다. 본 연구 결과로 보아 20세 이전에 약 반이 B형간염에 감염되었고 재학중에도 감염이 일어나고 있으므로 입학 즉시 감염여부를 확인하고 미감염자에 대해 예방접종을 실시하고 임상에 종사하기 시작할 때 추가접종하는 것이 이상적일 것으로 생각된다. To determine the hepatitis 8 virus infection rate of the medical school students and appropriate time for immunization with hepatitis B vaccine,355 students in the 1st, 2nd and 3rd grades of Medical School of Kyungpook National University who had not been vaccinated and volunteered to participate in this study were tested for HBsAg, anti-HBs and anti-HBc with radioimmunoassay method (Abbott Lab. kit). A questionnaire was administered to ask the history of transfusion, acupuncture and surgery. HBsAg positive students were retested 16 months after the initial test. Overall HBsAg positive rate was 6.8% and the age adjusted rate for male (7.2%) was higher than that for female (4.9%). Anti-HBs positive rate was 35.3% (36.1% for male, 37.9% for female) and anti-HBc positive rate was 45.5% (46.5% for male,44.7% for female). Overall hepatitis B virus (HBV) infection rate was 49.1% and the infection rate for male (50.3%) was slightly higher than that for female (46.5%). HBsAg positive rate and infection rate were increased as the grade increased but it was attributed to the age distribution of the students. HBaAg positive rate for 20 years old students was 1.7%; 21 years, 6.6%; 22 years, 6.1%; 23 years, 12.2%; and 24 years and older, 6.4%. HBV infection rate showed an increasing trend as age increased; 45.8% for 20 years,41.5% for 21 years, 49.5% for 22 years, 55.5% for 23 years and 59.6% for 24 years and older. The age differences in HBsAg positive rates and HBV infection rates did not reach the statistical significance level of 0.05. However, these findings and similar age differences in HBsAg positive rates and HBV infection rates observed in other study suggest that there is a significant age differences. Study of the same age group in other schools and different social classes is warranted to confirm the age difference. Clarification of the reason for such differences would provide a clue to identify the major route of HBV transmission in this age group. Among 26 HBsAg positive students in the initial test, only one student was active hepatitis patient. Out of 24 students who had follow-up test after 16 months 22 students were positive for HBaAg and two students became HBsAg negative and anti-HBs positive. It is obvious that nearly one-half of the medical school students were infected with HBV before 20 years of age and the HBV infection occurs in medical school. Thus, it is recommended to test all the students for HBV infection soon after the admission to the medical school and immunize all the susceptible students with hepatitis B vaccine and give booster as they start to practice at a hospital.

농촌지역의 법정-기간내 출생신고율과 신고된 생년월일의 정확도

박정한,이창익,김장락,송정흡,예민해,조성억,Park, Jung-Han,Lee, Chang-Yik,Kim, Jang-Rak,Song, Jung-Hup,Yeh, Min-Hae,Cho, Seong-Eok 대한예방의학회 1988 예방의학회지 Vol.21 No.1

우리 나라의 최근 농촌 지역에서의 출생 신고의 법정 기간내 신고율과 출생 신고의 정확도를 알아보기 위해 경북 군위군에 거주하는 모든 유배우 가임 여성 4,014명을 1985년 4월 1일부터 1987년 3월 31일까지 2년간 면보건요원들이 추적 조사하여 찾아낸 모든 출생아 766명의 출생일자와 1987년 9월 30일자로 면사무소의 주민 등록 대장을 열람하여 얻은 동기간내 출생한 것으로 신고된 944건의 출생 신고 기록을 대조하였다. 추적 조사한 766명중 576명(75.2%)이 출생후 6개월 이내에 신고된 것으로 확인되었으며 96명 (12.5%)은 출생신고를 하였다고 진술하였으나 기록이 없었다. 추적 조사에 등록되어 있고 생후 6개월 이내에 출생신고가 확인된 576명의 법정 신고 기간인 30일 이래 신고율은 61.3%였다. 법정 기간내 신고율은 산모의 연령이 20세 미만이거나 35세 이상인 경우, 교육 수준은 국민학교 졸업자에서 그리고 출산 순위가 늦을수록 낮았다. 출생 월별 신고율은 10월부터 3월 시아의 출생아가 4월에서 9월 사이의 농번기의 출생아에 비해 높았다. 신생아기에 사망한 7명은 모두 출생 신고를 하지 않았다. 추적 조사에 등록되어 있고 6개월 이내에 출생 신고가 확인된 576명의 실제 출생 연월일과 주민등록표의 출생 연월일의 일치율은 78.0%였고 6.8%는 실제 출생일보다 더 이른 날짜로 신고되어 있고 15.3%는 더 늦은 날짜로 신고되어 있었다. 일치율은 산모의 연령이 35세 이상인 경우에 54.5%로 그리고 출산 순위가 4순위 이상일 때 56.3%로 특별히 낮았다. 또 산모의 학력이 높을수록 일치율이 높았으며, 남아가 여아보다 높았다. 3월에 출생한 경우에 실제 출생일보다 이른 날짜로 신고하는 율이 17.4%로 다른 달에 비해 높았고 이들은 대부분이 음력으로 신고하였는데 이것은 취학 연령을 고려한 것으로 생각된다. 최근 우리 나라 농촌 지역의 법정 기간내 신고율 및 신고의 정화도는 향상되고 있으나 아직도 선진국에 비해 낮은 편이며 출생 신고 자료에 의한 영아 사망률은 매우 부정확한 실정이다. 법정 기간내 신고율과 신고 내용의 정확도를 높히기 위해 분만 개조를 한 의료인으로 하여금 부모의 주소지로 직접 출생 신고를 하도록 하고 비의료인에 의한 가정 분만의 경우에는 현행 신고 제도대로 하는 것이 권장된다. To measure the birth registration rate and the validity of birth registration data in rural area, all of the 4,014 married women under 49 years of age who had not been sterilized in Gunwee county of Kyungpook province were followed by Myun health workers for 2 years from April 1, 1985 to March 31, 1987 and 766 births were detected. All of the birth registration records of Myun offices were reviewed on September 30, 1987 and 944 births which occurred within the above mentioned period were found. Actual birth date obtained by follow-up study were compared with the birth date on registration card. Among 766 births detected by follow-up study,576 births(75.2%) which were reported within 6 months after birth were ascertained on the official registration records and 96 births(12.5%) were not found on the records although mother stated that the birth was registered. The registration rate within legal due date was 61.3% among 576 births detected by follow-up study and also ascertained on the official records. The registration rate within legal due date was lower in mothers under 20 years of age and above 35 years and in mothers who had only primary education. It was decreased as the birth order increased. The registration rate was higher in births occurred from October to March than births occurred from April to September. All of the births of 7 neonatal deaths were not reported. The registered birth date was consistent with the actual birth date in 78.0%. Birth date on record was earlier than the actual birth date in 6.8% and later in 15.3%. The consistency rate was lower in mothers above 35 years of age(54.5%), and in infants of 4th birth order and above(56.3%). The rate was increased as the maternal education level increased. The rate of boys was higher than that of girls. A higher percentage(17.4%) of infants born in March was registered with earlier date than the actual birth date and most of these registered birth dates were lunar calendar date. This might be related with the age for entering the primary school. The study findings revealed that the birth registration rate within legal due date and accuracy of report have been increased in recent years, but the infant mortality rate derived from the birth registration seems to be very inaccurate. It is suggested to let the medical personnel who delivered the baby report the birth by mail directly to the current address of parent while infants delivered at home without professional attendant may comply with the present registration system.

대구광역시 5년간 연평균 암 발생률과 연간 암 발생률 추이, 1997~2001

천병렬(Byung-Yeol Chun),양진훈(Jin-Hoon Yang),송정흡(Jung-Hup Song),임지선(Ji-Seun Lim) 한국역학회 2007 Epidemiology and Health Vol.29 No.1

  Purpose: This study is conducted to identify the annual average cancer incidence and the trend of cancer incidence in Daegu during the 5-year period from 1997 to 2001.   Method: Data on newly diagnosed cancer patients from 1997 to 2001 were collected with a standard registration form. Medical record reviewers visited hospitals if necessary, to detect missing cancer patients.   Results: The annual average overall number of cancer patient was 4,606 (male 2,529 and female 2,077). The crude average annual incidence of cancer in male were 211.8 (ASR 251.4) and 169.8 (ASR 151.3) in female. Five major cancers in male were stomach (ASR 60.3), bronchus and lung (ASR 44.8), liver and intrahepatic bile ducts (ASR 40.7), rectum (ASR 11.2), and colon (ASR 10.8). However, in women, those were stomach (ASR 25.3), breast (ASR 19.8), cervix (ASR 14.9), bronchus and lung (ASR 12.7), liver and intrahepatic bile ducts (ASR 11.1). Increases in incidence were found for colon cancer for both sexes, rectal cancer for males, and lung and breast cancer for females. Decreaseswere shown for liver cancer for both sexes and stomach and cervical cancer for females.   Conclusions: Primary prevention of cancer based on results of this study remains important.

다목적 환자복 개발을 위한 연구

송정흡,송정아 한국의료QA학회 1999 한국의료질향상학회지 Vol.6 No.1-2

Background : The clothing is considered as second skin. The patient clothing needs basic clothing demands which arc comfortable, functional and aesthetical and special demeands which are associated with medical examination, treatment and management of daily-life inconveniences. The patient is weak and labile to psychic trauma and has limitation of movement. So the help of others is needed. But recent patient clothing does not satisfy above demands. So the design, making and management of patient clothing to satisfy those demands are very important. The purpose of this study is to develop multipurpose clothing which is comfortable, functional, aesthetical and satisfying patients and medical personnels. Method : The questionnaires of existing patient clothing were tested by patients,medical doctors, and nurses. After analyzing two types of questionnaires, eight types of experimental patient clothing were made. After preference test, shortcomings were removed and merits were adapted. One type of multipurpose patient clothing mixing eight above experimental clothing was made. The state of wearing and moving were videotaped. The videotape-recoding was watched by patient, caregivers(medical doctors, nurses) and clothing specialists. Result : The general reaction for experimental clothing were positive by the group of patients, medical personnels and clothing specialist, there were significant differences among three groups. Conclusion : It was thought that to develop one type of multipurpose clothing is possible. If the studys for patient clothing which are free-size and economic matters that are type of clothes and method of washing are made in depth, the desirable patient clothing will appear.