• 의료법학
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• 제24권4호
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• pp.37-63
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• 2023

의료소송에서 의사의 환자에 대한 '설명'이 문제되는 경우는 다양하다. 진단의 초기부터 시작하여 수술 등의 치료과정, 치료를 위해 입원이 필요한 경우, 입원 중과 퇴원 시, 그리고 퇴원 후에 이르기까지 의학적인 설명과 지도가 의사에게 요구된다. 나아가 의료행위로 인하여 발생하게 될 경제적 비용에 대하여도 의사 혹은 의료기관의 고지가 요청되기도 한다. 우리나라 사법부는 이와 같은 의사의 설명에 대하여 진료의 단계 및 의료법 등 관계법령을 고려하여 의료행위에 대한 동의를 구하기 위한 설명과 환자의 요양방법 지도와 관련된 진료상 설명을 구분하여 법리를 전개해 오고 있다. 또한 헌법재판소는 경제적 비용에 관한 설명과 연계된 비급여 비용 고지 제도에 관하여 최근 판단하기도 하였다. 그런데 의사의 설명이 불충분하였다는 것만을 이유로 의사에게 책임을 추궁을 하는 것은 임상현실의 실제 상황과 부합하지 않는 측면이 존재하고, 오히려 의권의 위축을 초래하는 반사적인 불이익이 있을 수 있다. 따라서 의사의 설명은 환자의 자기결정권 보장과 의권 보호라는 양측면에서 살펴보아야 할 필요가 있다.

• Journal of Trauma and Injury
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• 제25권4호
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• pp.159-165
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• 2012

Purpose: For trauma patients, an early-transport and an organized process which are not delayed in hospital stage are necessary. Our hospital developed a procedure, the trauma Critical Pathway (CP), through which a traumatic patient has the priority over other patients, which makes the diagnostic and the therapeutic processes faster than they are for other patients. Methods: The records of patients to whom Trauma CP were applied from January 1, 2011 through April 15. 2012. were reviewed. We checked several time intervals from ER visiting to decision of admission-department, to performing first CT, to applying angio-embolization, to starting emergency operation and to discharging from ER. In addition, outcomes such as duration of ICU stay, hospital stay and mortality were checked and analyzed. Results: The trauma CP was applied to a total of 143 patients, of whom, 48 patients were excluded due to pre-hospital death, ER death, transferring to other hospital and not severe injury. Thus 95 patients (male 64, 67.3%) were enrolled in this study. Fifty-nine patients(62.1%) were injured by the traffic accident. The mortality rate was 10.5% and the mean Revised Trauma Score (RTS) of the patients was $6.4{\pm}2.0$. After visiting ER, decision making for admission was completed, on average, in 3 hours 10 seconds. The mean time intervals for the first CT, angio-embolization, surgery and discharge were 1 hour 20 minutes, 5 hours 16 minutes, 7 hours 26 minutes and 6 hours 13 minutes, respectively. Conclusion: The trauma CP did not show the improvement of time interval outcome, as well as mortality rate. However, this test did show that the trauma CP might be able to reduce delays in procedures for managing trauma patients at the university-based hospitals. To find out the benefit of CP protocol, a large scaled data is required.

• 한국산학기술학회논문지
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• 제19권11호
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• pp.126-136
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• 2018

본 연구는 머신러닝을 활용하여 급성 뇌졸중 퇴원 환자의 중증도 보정 사망 예측 모형 개발을 목적으로 시행하였다. 전국 단위의 퇴원손상심층조사 2006~2015년 자료 중 한국표준질병사인분류(Korean standard classification of disease-KCD 7)에 따라 뇌졸중 코드 I60-I63에 해당하는 대상자를 추출하여 분석하였다. 동반질환 중증도 보정 도구로는 Charlson comorbidity index(CCI), Elixhauser comorbidity index(ECI), Clinical classification software(CCS)의 3가지 도구를 사용하였고 중증도 보정 모형 예측 개발은 로지스틱회귀분석, 의사결정나무, 신경망, 서포트 벡터 머신 기법을 활용하여 비교해 보았다. 뇌졸중 환자의 동반질환으로는 ECI에서는 합병증을 동반하지 않은 고혈압(hypertension, uncomplicated)이 43.8%로, CCS에서는 본태성고혈압(essential hypertension)이 43.9%로 다른 질환에 비해 가장 월등하게 높은 것으로 나타났다. 동반질환 중중도 보정 도구를 비교해 본 결과 CCI, ECI, CCS 중 CCS가 가장 높은 AUC값으로 분석되어 가장 우수한 중증도 보정 도구인 것으로 확인되었다. 또한 CCS, 주진단, 성, 연령, 입원경로, 수술유무 변수를 포함한 중증도 보정 모형 개발 AUC값은 로지스틱 회귀분석의 경우 0.808, 의사결정나무 0.785, 신경망 0.809, 서포트 벡터 머신 0.830로 분석되어 가장 우수한 예측력을 보인 것은 서포트 벡터머신 기법인 것으로 최종 확인되었고 이러한 결과는 추후 보건의료정책 수립에 활용될 수 있을 것이다.

• Korean Journal of Radiology
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• 제23권8호
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• pp.811-820
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• 2022

Objective: To develop a model incorporating radiomic features and clinical factors to accurately predict acute ischemic stroke (AIS) outcomes. Materials and Methods: Data from 522 AIS patients (382 male [73.2%]; mean age ± standard deviation, 58.9 ± 11.5 years) were randomly divided into the training (n = 311) and validation cohorts (n = 211). According to the modified Rankin Scale (mRS) at 6 months after hospital discharge, prognosis was dichotomized into good (mRS ≤ 2) and poor (mRS > 2); 1310 radiomics features were extracted from diffusion-weighted imaging and apparent diffusion coefficient maps. The minimum redundancy maximum relevance algorithm and the least absolute shrinkage and selection operator logistic regression method were implemented to select the features and establish a radiomics model. Univariable and multivariable logistic regression analyses were performed to identify the clinical factors and construct a clinical model. Ultimately, a multivariable logistic regression analysis incorporating independent clinical factors and radiomics score was implemented to establish the final combined prediction model using a backward step-down selection procedure, and a clinical-radiomics nomogram was developed. The models were evaluated using calibration, receiver operating characteristic (ROC), and decision curve analyses. Results: Age, sex, stroke history, diabetes, baseline mRS, baseline National Institutes of Health Stroke Scale score, and radiomics score were independent predictors of AIS outcomes. The area under the ROC curve of the clinical-radiomics model was 0.868 (95% confidence interval, 0.825-0.910) in the training cohort and 0.890 (0.844-0.936) in the validation cohort, which was significantly larger than that of the clinical or radiomics models. The clinical radiomics nomogram was well calibrated (p > 0.05). The decision curve analysis indicated its clinical usefulness. Conclusion: The clinical-radiomics model outperformed individual clinical or radiomics models and achieved satisfactory performance in predicting AIS outcomes.

• 환경정책연구
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• 제2권1호
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• pp.31-49
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• 2003

It is difficult to examine the causal relation of pollution damages because the time gap between pollution cause and effect is large and new pollutants are continuously being produced. Their many environmental effects are not promptly studied. As both the study of causal relation about pollution and the pollutant treatment are becoming highly advanced by the development of science and environmental technology, both the economy and balance on environmental regulation may be discussed. It is reasonable to decide environmental policy in consideration of close relation between both the generation and resolution of environmental problems and of technological developments because environmental problems are related to complicated social problems and scientific technologies. First item in policy decision about environmental control and management is preferentially to consider the way of prevention. It is necessary to prevent pollution by regulating the installment of environmental pollution facility into the environmentally sensitive areas, like water supply source and to regulate land utilization as a method to achieve pollution prevention. Second is a consideration of environmental technology development. This is a solution which can accomplish the development of environmental technology and the reinforcement of economic competition. Third is the coexistence of environment and economy. It is necessary to consider economy in connection with environmental problems and environment in economic problem. Then, we can enjoy a healthy life as well as economic affluence. Fourth is the enlargement of environmental management means. Environmental management means must be diversified because environmental cause and effect are varied. For Improving the land use regulation system, it is necessary to consider both land use regulation status and pollutant toxicity with the development of environmental technology. Land use must be approached by classifying land to 3 levels; water source protection zone and water front zone, special zone 1 and 2, rancus and other zones. Land regulation policy to prevent any accident in water source protection zone, waterfront zone, and special zone must be continuously upgraded. However, economical consideration in other zones is required by the development of environmental technology.

• 품질경영학회지
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• 제39권3호
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• pp.391-399
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• 2011

Our study was carried out to analyze the variation factors of severity-adjusted length of stay(LOS) in coronary artery bypass graft(CABG). The subjects were 932 CABG inpatients of the Korean National Hospital Discharge In-depth Injury Survey from 2004 through 2008. The data were analyzed using $x^2$ test and the severity-adjusted model was developed using data mining technique. The results of the study were as follows: male(71.1%), older than 61 years of age(61.6%), more than 500 beds(92.8%) and admitting via ambulatory care(70.0%) appeared to have higher rate than otherwise. In-hospital mortality of CABG inpatients was 2.8%. In addition, 46.4% of the patients received their care in other residence. The angina pectoris(45.6%) was found to be the highest in principle diagnosis, followed by chronic ischemic heart disease(36.9%) and acute myocardial infarction(12.0%). We developed severity-adjusted LOS model using the variables such as gender, age and comorbidity. Comparison of adjusted values in predicted LOS revealed that there were significant variations in LOS by location of hospital, bed size, and whether patients received the care in their residences. The variations of LOS can be explained as the indirect indicator for quality variation of medical process. It is suggested that the severity-adjusted LOS model developed in this study should be utilized as a useful method for benchmarking in hospital and it is necessary that national standard clinical practice guideline should be developed.

• 한국수자원학회:학술대회논문집
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• 한국수자원학회 2006년도 학술발표회 논문집
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• pp.1182-1186
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• 2006

하천유역에 있어 설계홍수량의 결정은 치수적인 측면에서 매우 중요한 일이다. 유역의 대소와 중요도에 따라서 하천의 설계홍수량이 산정이 된다. 갈수록 홍수의 피해정도가 심해지고 홍수에 대한 방어의 중요성이 더욱 가중되고 있는 현실에서 설계홍수량의 추정은 매우 중요하다고 할 수 있다. 특히 홍수량을 산정하는 데 있어 가장 큰 영향을 미치는 것은 강우량이다. 그러나 똑같은 강우량이라 할지라도 유역의 특성에 따라 산정되는 홍수량은 상이하게 된다. 유역의 특성이 홍수량의 산정에 있어 영향이 크다는 것은 선행 연구의 결과와 경험에 의하여 확인이 된 사실이다. 그러나 많은 하천들이 각각의 유역특성을 가지고 있으나 이들과 산정된 설계홍수량의 관계가 어떤 형태로 이루어져 있는 가에 대한 연구는 아직 미흡한 실정이다. 본 연구에서는 기왕에 하천정비기본계획에 의해 산정된 설계홍수량과 지형인자들이 어떤 상관성을 가지고 있는 가에 대하여 연구하여 미계측유역이나 하천계획이 수립되지 않은 중소하천 유역의 설계홍수량 추정에 있어 추가적인 정보의 제공측면에서 유역의 지형인자와 설계홍수량과의 상관성을 조사하였다.

• 물과 미래
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• 제20권4호
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• pp.267-278
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• 1987

본 연구는 유역의 지형인자를 대기행렬이론(Queueing theory)에 적용하여 하천유역의 강우-유출 고나계를 해석하고, 미 계측 유역이나 자료가 결핍된 유역에 적용할 수 있는 GIUH(Geomorphologic Instantaneous Unit Hydrograph) 모델의 매개변수를 결정하는 데 그 목적을 두었다. GIUH모델의 개념은 유역 시스템내의 강우의 지속기간동안 유역의 출구에서 가능한 많은 경로를 추적 할 수 있을 것이라는 강우-대기행렬이론의 원리에 기초를 두었으며, 적용기법은 분할법(Sub-area method)과 평균치법(Mean-value method)을 적용하였다. GIUH모델의 적용성을 증명하기 위해서, 낙동강 ndlcjsdb역(유역면적 472.53$\textrm{km}^2$)에 적용하였으며, 분할법과 평균치법은 유역의 분할을 위해서 채택하였다. 계산된 직접 유출수문곡선과 관측 직접 유출 수문곡선을 비교한 결과는 첨두 유출량, 도달시간, 효율계수가 매우 근접한 결과를 나타내고 있었다. 따라서, GIUH모델은 미 계측 유역이나 자료가 결핍된 유역의 유출량 산정에 광범위하게 적용할 수 있음을 알 수 있었다.

• 한국수자원학회논문집
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• 제40권4호
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• pp.313-324
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• 2007

비정형격자 기반의 수치해석모형을 이용하여 지하공간침수해석모형을 개발하였다. 본 모형은 지하공간의 흐름 특성을 link-node 시스템에 의해 해석하고, 계단 및 벽구조물 등의 지하공간 구조물 배치 영향을 고려한 침수해석을 수행할 수 있다. 흐름은 두가지로 구분하며, 하나는 두 개의 인접한 격자가 지하공간에서의 지하철 노선에 해당되어 수로형 흐름을 나타내는 경우이고, 다른 하나는 지하공간에서의 지하철 노선 이외의 지점 및 지하상가 등으로 물이 확산되는 위어형 흐름인 경우이다. ArcGIS 시스템의 Visual Basic Application을 이용하여 Dual-Drainage 침수해석 모형과 지하공간침수해석 모형이 통합하였다. 개발된 통합모형은 홍수관계기관이 침수 발생이 예상되는 지점에서 홍수피해 방지를 위해 배수시스템의 용량에 대한 재설계 흑은 확장 등과 같은 대책을 수립하는데 도움을 줄 수 있고, 침수위험지도작성 및 홍수경감대책을 수립하는데 이용될 수 있다.

• 한국보건간호학회지
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• 제4권2호
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• pp.15-23
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• 1990

This study was carried out to explore the illness-related activities of the menopaused women. To achieve such a purpose, sixty-six cases of the middle aged women were sampled the naturally and the artificially menopaused group respectively from 1st, Aug. to 31th, Aug. in 1988. For the collection of data, 1, 140 women aged between 45-54 were selected through stratified sampling techniques in urban and rural area. Among them the final subjects for analysis were restricted to only those who had experienced menopause naturally or artificially. And then, after control for age and education analysis was performed. The data was analysed by use of frequency, percentage, $X^2-test,$ t-test, Pearson correlation coefficiency and stop-wise multiple regression. The obtained results were as follows. I. As for the se1f-perception on menopausal symptoms, it was revealed than Korean women, neithe in naturally and artificially, accepted the change of menstruation itself as serious. This shows us that middle-aged women had positively receptive attitudes that the change of menstruation is follwed by amenorrhea. 2. The artificially menopaused group scored more than the naturally one: (I) on the self-control activities such as self-assessment, lay-consultation, fever check, pulse check and observation of vagina discharge, (2) on the self-decision activities such as hospital and pharmacy utilization, (3) on the self maintenance activities such as walking, aerobic, weight check, skin care, skin protect, calori control diet control, milk intake, vegetable intake, cold water drinking before meal, parasol use and BP check The above results lead us that the self care practices of the menopaused women revealed' coping wit I menopausal symptoms at the first level in community and must be developed by the adequate nursin intervention.