• Journal of Hospice and Palliative Care
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• 제19권3호
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• pp.201-210
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• 2016

섬망은 완화치료를 받는 말기암환자에서 흔히 나타나는 증상으로 임종기에 접어들수록 빈도는 증가한다. 섬망은 환자와 가족의 삶의 질에 부정적인 영향을 줄 뿐 아니라, 높은 사망률과 관련되어 있으나 실제 임상에서 의료진들이 적절히 인지하지 못하고 있다는 연구들이 보고되고 있다. 이는 우울이나 치매와 같은 정신질환과의 중복되는 특성, 섬망에 대한 평가 및 진단에 대한 지식의 부족 등이 원인으로 생각되고 있다. 이를 개선하기 위해 현재까지 알려진 섬망 선별검사를 통해 섬망환자를 정확히 인지하고, 진단하는 것이 완화의료 영역에서 섬망 증상 관리에 우선되어야 할 분야로 생각된다. 섬망이 진단되었을 때는 유발요인을 확인하고 약물이나 탈수, 감염 등의 가역적인 원인에 대해서는 이를 교정하는 것이 섬망을 조절에 가장 중요한 부분이다. 이와 함께 소음을 줄이거나, 적절한 조명을 유지하는 등의 환자의 주변 환경을 안정적으로 유지하는 등의 비약물적 치료가 병행되어야 한다. 비약물적 치료로 효과가 없거나, 증상이 심한 경우에 항정신병 약물과 벤조디아제핀과 같은 진정효과가 있는 약물을 사용할 수 있으며, 현재까지는 저용량의 할로페리돌 투여가 가장 효과적인 치료 약제로 인정되고 있다. 비정형적 항정신병 약물로는 Olanzapine, Quetiapine, Risperidone 등이 있으며 현재까지 보고된 바로는 할로페리돌과 비교하여 섬망 개선 효과는 비슷하나 추체외로 증상이 드물고 진정 효과가 있어 경구 섭취가 가능한 경우 고려해 볼 수 있는 약제로 생각된다. 현재까지 완화의료 영역에서의 섬망에 사용할 수 있는 약물에 대한 연구 결과는 근거가 충분하지 않은 상태이며, 이로 인해 임상에서 활용할 수 있는 임상진료 지침 또한 부족한 상태이다. 현재까지는 중환자실, 노인 환자에서의 연구 결과를 바탕으로 한 결과를 토대로 완화의료 영역에서의 섬망 치료에 이용하였지만 추후 말기암환자에서의 섬망에 대한 연구를 바탕으로 한 임상진료지침의 개발도 필요할 것으로 생각된다.

• 의료법학
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• 제11권2호
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• pp.113-145
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• 2010

Nowadays, it is surely the quack which stands as one of the most controversial, problematic. the quack has been a consistent target of contested public protection strategies in the past few centuries in many countries. Recently, complementary and alternative medicine (CAM) is increasingly utilized and accepted by patients and providers throughout the health care system in the world, most accounts attribute this growing acceptability to the shortcomings of conventional medicine, the appeal of CAM's core beliefs, and the growing body of research indicating that CAM actually works. However, the governments of western countries have called for measures to ensure that the public are protected from incompetent and dangerous practitioners. Common to these controversies has been a suggestion to ban, exclude or limit the medical practice of those deemed to be damaging rather than improving the health of individuals as a measure of public protection. This article describes the experiences of western counties' health care system which is moving in a more pluralistic direction. By examining the ways in which regulatory efforts in the countries have come to address what is invariably described as a growing interest in CAM, this study show how the problem of CAM/quackery today is increasingly located in an ethical field of practitioner competency, qualifications, conduct, responsibility and personal professional development, regardless of the form of therapy in question. Many countries developed a series of measures and strategies to contain the acceptance of CAM groups, such as insisting on scientific evidence of safety and efficacy, resisting integration of CAM with conventional medicine and opposing government support for research and education. In a sense, those countries' movements serve to protect not only patients, but the dominant position of medicine and its allied professions, and to maintain existing jurisdictional boundaries within the healthcare system. The popular support for CAM will require that health professional stakeholders continue to address the challenges this poses, and at the same time protect their position at healthcare system. To cope with the quack, professional body, public sector and health authorities should consider the safety of consumers of healthcare and responding to the demands of the community for CAM therapies as well as the claims of the established healthcare professions. Finally, some implications for future health care were suggested.

• 간호행정학회지
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• 제4권1호
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• pp.247-275
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• 1998

The purpose of this study was to offer the results of content analysis and qualitative study that explored the perceptions about quality nursing care of patients and families as consumers and to identify the implications of this study for quality nursing care management and research. The data was collected from 12 adult patients and 9 families who were admmitted at medical and surgical nursing unit of one university hospital in Seoul from October, 1996 to January, 1997. Research participants were asked to response "what do you think quality nursing care?" and similar questions during the interviews was performed. Data were analyzed using open coding and content analysis with frequencies and percents of attributes of quality nursing care. Attributes of quality nursing care and meaning of quality nursing care that patients and families perceived were explored. 1. The attributes of quality nursing care that patient and families perceived were categorized into 56 attributes. The highest response rate among the attributes was 'one's heart at ease' (76.2%), and the next high response rates were ranked in order 'consideration' , 'care about' (each 61.9% 'expert skill' (57.1%), 'deal with problem promptly' , 'information offer' (42.9%), 'intimate feeling' (38.1%), 'smile' 'service spirit' , 'do one's best' (each 33.3%), 'frequent visit' (23.8%), 'observe the time' (23.8%), 'direct nursing care' , 'speaking warmly' , give a hope' , 'address kindly' , 'a sense of duty' , 'good facilities' (each 19.0%), 'inquire after a patient health' , 'patient-centered nursing care' , 'showing an example' , 'professional knowledge' , 'careless moraly patient' , 'give encourage to patients' , 'good answer a question' (each 14.3%), 'do not imprudently' , 'do not disregard' , 'broad knowledge' , 'emergency treatment skill' , 'dependability' ,'consolation' giving a sense of security' , 'a self sacrificing spirit' , 'a sense of responsibility' 'hard - working', 'enough disposition of nursing staff (each 9.5%), 'improve patient's pride' and the rest attributes exhibited 4.7%, respectively. 2. The attributes that were identified in patients' data only were 8 categories, 'service sprit' (58.3 %) 'expert knowledge' , 'good answer a question' (each 25.0%), 'hard working' (16.7%), 'a warm character', 'professional attainments', 'do without reserve', 'satisfaction' (each 8.3%), 3. The attributes were identified to families' data only were 31 categories, 'speaking warmly' , 'direct nursing care', 'adress kindly', 'patientcentered nursing care', 'showing an example' (each 33.3%). 'do not imprudently' , 'do not disregard' , 'consolation', 'giving a sense of security', 'broad knowledge' , 'emergency treatment skill', 'dependability' ,'a self - sacrificing spirit', 'a sense of responsibility' (each 22.2%), 'improve patient's pride' , 'without discrimination' , 'show kindness' , 'individual nursing care', 'being with patient' , 'helping' , 'accuracy' , 'without any mistake' , 'love' , 'self - confidence', 'self possession', 'a self - denying spirit' , 'a sense of duty' , 'tighten discipline' , 'disposed room with similar patient to diagnosis', 'compensatory relationship between me dical team' , 'role of connection' (each 11.1 %). 4. The attributes of quality nursing care were integrated into 11 categories that they were 'patientcentered nursing care' (25.1%), 'expertise' (22.1%), 'caring'(18.1%), 'kindness'(11.1%L 'nurse attainments(10.1%), 'sincerity' (7.5%), 'good environment' (2.0%), 'effective organizational management', 'coordination', 'enough nursing staff' ( each 1.0%), 'satisfaction' (0.5%) were showed in the order of the highest rate. 5. The concept of quality nursing care were defined as 'give a satisfaction to patients by patientcentered care based on professional skill and caring with kindness and sincerity'. The description of the meaning of quality nursing care provided by this research participants, patients and families can provide important information for quality nursing care management, medical marketing, education and researches of this field. On the basis of the above findings the following recommendations are made: to suggest to utilize this results for patient care in practice setting, development of quality assessment tool in nursing care, repeat study by the same subjects and method, and to a comparative study by the same method to nurse.

• 한국의료질향상학회지
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• 제23권1호
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• pp.11-23
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• 2017

Root Cause Analysis (RCA) has been widely used as a structured approach to investigate patient safety incidents. RCA helps identify what, how, and why something happened, therefore preventing recurrence of incidents. Since many quality tools can be used during RCA, various formats of RCA exist. If RCAs are performed incorrectly or incompletely, they are likely to produce unusable results. To address this issue, RCA software has been developed. The use of RCA software in investigating patient safety incidents may offer several advantages, such as potential reduction in learning time, shortening of the analytic process, facilitation of collection, analysis, and presentation of data and production of meaningful RCA reports. We introduced six healthcare RCA software and compared characteristics. Results from this study will enable the RCA team to choose proper RCA software.

• 대한가정학회지
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• 제37권10호
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• pp.123-133
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• 1999

The purpose of the study was to develop the parenting style scale which is reflecting cultural background of Korean parent's parenting for their children. The instalment was designed based on the literature reviews and on the Baumrind's parenting style. A total of three hundred and sixty two mothers whose children from first and second grade in elementary school completed the Questionnaires. The questionnaires consisted with the items addressing different types of parenting style which include love and care, encouragement of independence, enjoyment in parenting, communication, control, control of aggressiveness, strategies of control , request of maturity. Factor of analysis was applied to examine validity of Korean parenting style scale. Based on the factor analysis, 33 items selected for final questionnaire and two factors discovered. The first factor which named 'warmth'included 20 items such as love and care toward their children, communication, enjoyment in parenting, encouragement toward independency. The second factor which named'control'included 13 items such as control of children's behavior and discipline of children. Warmth factor accounted for 46% of variance and control factor accounted for 18% of variance. Internal consistency was also checked. Although warmth and control factor represented a moderate internal consistency, control factor showed lower correlations then warmth factor. The reliability estimates (Cronbach alpha) were. 87 and 71 for warmth and control factor respectively. Korean parenting style scale can be used to address the appropriateness of Baumrind's theoretical assumptions in parenting style as well as to examine parenting style for Korean population. However, this instalment was developed with Korean mothers only. Further analysis need to be addressed with fathers.

• 의학교육논단
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• 제21권2호
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• pp.63-72
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• 2019

The purpose of this study was to introduce the concept of academic medicine to the medical societies of Korea and to identify any potential obstacles in the establishment of academic medicine in Korea. The core concepts of academic medicine include medical education, research, and patient care. Academic medicine can be practiced in the unique area of healthcare involving medical schools and teaching hospitals by faculty physicians in the academic medicine field. Through academic medicine, the next generation of healthcare professionals is trained, new discoveries can be made, and patients can find new hope for a cure. The flourishing of academic medicine has resulted in substantial advancements in medicine over the past few centuries, but at the turn of the 21st century, there was concern that academic medicine was on the decline. To address this concern, the International Campaign to Revitalize Academic Medicine was established and announced five scenarios to 2025 to debate the future of academic medicine. Although the system resembles that of Western medical societies, Korean medical societies were not familiar with academic medicine, and poor conditions caused by the distorted healthcare system in Korea have actually interfered with the nurturing of academic medicine. One of the main problems may include less interest in medical education and research relative to clinical practice by medical societies and the government. Collaborative efforts from both medical societies and the government are needed to establish academic medicine successfully in Korea for a better future.

• Journal of Yeungnam Medical Science
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• 제41권2호
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• pp.134-138
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• 2024

Lung retransplantation (LRT) involves a second or subsequent lung transplant (LT) in a patient whose first transplanted graft has failed. LRT is the only treatment option for irreversible lung allograft failure caused by acute graft failure, chronic lung allograft dysfunction, or postoperative complications of bronchial anastomosis. Prehabilitation (rehabilitation before LT), while patients are on the waiting list, is recognized as an essential component of the therapeutic regimen and should be offered throughout the waiting period from the moment of listing until transplantation. LRT is particularly fraught with challenges, and prehabilitation to reduce frailty is one of the few opportunities to address modifiable risk factors (such as functional and motor impairments) in a patient population in which there is clearly room to improve outcomes. Although rehabilitative outcomes and quality of life in patients receiving or awaiting LT have gained increased interest, there is a paucity of data on rehabilitation in patients undergoing LRT. Frailty is one of the few modifiable risk factors of retransplantation that is potentially preventable. As such, it is imperative that professionals involved in the field of retransplantation conduct research specifically exploring rehabilitative techniques and outcomes of value for patients receiving LRT, because this area remains unexplored.

• 성인간호학회지
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• 제29권1호
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• pp.22-31
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• 2017

Purpose: The purposes of this secondary analysis study was to examine prevalence, risk factors and unmet healthcare needs among adults with hypertension. Methods: A sample of 3,386 adults over the age of 40 with hypertension were drawn from the Korea Health Panel Study (2013). Using SPSS 22.0 version, descriptive statistics including frequency, percentage, chi-square and logistic regression were performed. Results: Results showed that 18.9% of the sample reported unmet healthcare needs with the most frequently cited one was financial burdens (43.2%). The reported experiences of unmet healthcare needs differed by gender, marital status, vision or hearing impairment, memory problem, impaired mobility, subjective health status, total family income, depressive episode and the difficulty in making decisions. The sample participants were more likely to report unmet healthcare if they had vision impairment, low income and perception that their health status as moderate to poor. Those without vision impairment were less likely to report unmet healthcare needs. Conclusion: The identified risk factors of unmet healthcare needs should be addressed which would enhance access both to health care and to resolution of unmet healthcare needs. Since visual ability seems to impact perception of unmet healthcare needs, it may be useful to find ways to address this factor.

• 대한치과의사협회지
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• 제49권11호
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• pp.670-678
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• 2011

Various sorts of dental devices for the dental treatment have been introduced and adopted during past several years. Dental Laser, among all devices, seems to be possible for applying to over the whole treatments and widely employed. Furthermore, this article is to introduce that Dental Laser is intended to care patients secured with the effectual treatment against Conventional procedures based upon its studies. The advantages of Dental Laser treatment-along with LLLT (Low Level Laser Therapy) effect, biostimulation effect, and minimal invasive technique - make the patients reduce their fear of the operation, lighten the inconvenience of post operation, and shorten the treatment period. In particular, it is worth considering that the use of laser-assisted therapies is associated with a marked reduction in the use of analgesics and anti-inflammatory medications compared with conventional procedures. This article is to state advantages and differences of Dental Laser treatment compared with Conventional procedures, and to emphasize to become well-acquainted with the precautions for safety and effective Dental Laser treatment. In case of operating Dental Laser with lack of the instructions, it will cause the unpredicted fatal results; therefore this treatment requires special care in its operation. Henceforward, it is anticipated that infinite treatment protocols will be introduced by applying Dental Laser, and this is to address the utilization of Dental Laser.

• 토지주택연구
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• 제5권3호
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• pp.131-136
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• 2014

The Hong Kong Housing Authority (HKHA) develops and implements a public housing programme to meet the housing needs of people who cannot afford private rental housing. The HKHA has an existing stock of about 740,000 public rental flats (PRH). According to the 2014 Policy Address, the Government aims to provide an average of about 20,000 PRH units and about 8,000 Home Ownership Scheme (HOS) units per year. We care for the environment. In developing new housing estates, we conduct thorough environmental studies such as microclimate studies and air ventilation assessment, and use passive design to harness the natural characteristics of our sites. We employ environment-friendly design and construction methods, using modular flat design, pre-cast and pre-fabricated construction techniques as well as recycled, green construction materials. We conduct Carbon Emission Estimation for all our projects, conserve the use of natural resources and reduce wastes throughout the life cycle of buildings. We care for people. We adopt the principles of Universal Design and Barrier Free Access for the convenience and welfare of people of all ages and abilities. We carry out Community Engagement to collect stakeholders' views and aspirations, and incorporate them in the design of our projects. We also carry out surveys of residents' views after the occupation of new estates to gauge our success and identify areas for improvement.