• 의료법학
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• 제15권1호
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• pp.335-373
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• 2014

한 자료에 의하면 2011년 미국의 의료비 지출 총액은 국내총생산의 약 18 퍼센트에 달하였으며, 그 비율은 다른 대다수 선진국의 두 배에 해당하는 것이었다. 그중 메디케어 비용은 전체 의료비의 21 퍼센트인 5540억 달러 였는데, 환자의 최후 6 개월에 들어간 의료비는 그 5540억 달러의 28 퍼센트 (전체 의료비의 5.9 퍼센트)인 1700억 달러에 달하였다. 이러한 말기의료의 고비용성은 어떤 사유에 기인하며, 그 해소 방안은 무엇인가. 지난 수십 년 간의 의료경제학적 연구는 말기의료가 일반적으로 공급민감성을 지니며 비용대비 효율성이 매우 낮다는 결론에 도달하였다. 의료서비스 공급의 양은 질병의 정도나 환자의 선호도와는 무관하고, 그보다는 의료서비스 공급자원에 민감하게 반응한다는 것이다. 이는 말기의료에서는 의료자원이 과용된다는 것을 의미한다. 한편 "더 많은 의료처치에 더 나은 효용"이라는 일반적인 추론과는 반대로, 많은 의료처치의 결과는 오히려 매우 부정적인 것이었다. 실제 환자들의 선호와 관심사는 격렬한 말기의료가 기도하는 것과는 아주 달랐던 것이다. 이 논문은 먼저 말기의료에서의 공급민감성의 원인을 분석한다. 그 원인으로는 격렬한 치료와 그 효용성에 대한 일반적인 오해, 의사들의 환자에 대한 직업적인 사명의식, 환자 자신의 말기의료 의향결정의 부재, 의사들의 법적 책임에 대한 우려, 의료기관의 경영차원에서의 관리전략 등을 들 수 있다. 다음으로, 논문에서는 말기의료의 공급민감성에서 연유하는 과잉진료에 대한 현실적 해결책을 제시한다. 그 해결책은 두 가지 측면으로 나누어서 들 수 있는데, 하나는 사전의료의향서 제도의 활성화 방안이고, 다른 하나는 의료기관 경영관리전략적 관점에서의 방안이다. 우선 사전의료의향서의 활용도를 제고하기 위해서 다음과 같은 구체적 노력이 필요하다. 즉 의사들의 말기의료에 대한 태도를 바꾸도록 하는 새로운 의료윤리 교육 실시, 의사와 환자 간 말기의료에 대한 소통 기회의 강화, 환자와 말기의료에 대한 대화를 적극적으로 실천하는 의사에 대한 보상제도 도입, 일반 공공에 대한 관련 교육 확대, 온라인 등록시스템과 같은 용이하고도 공식적인 사전의료의향서 등록체제의 구축 확대 등이 필요하다. 경영관리적 측면에서는 대체 전략이 필요하다. 예컨대 불필요한 비용을 절감하고 의료공급자로서의 가치를 재정립하는 등의 새로운 재무전략과 경영교육계획 등이 고려되어야 할 것이다. 효과적으로 말기의료의 경제적 문제점을 해소하고 환자에게 더 나은 의료경험을 제공하기 위해서는 의료 환자 국가 등 모든 부문에서 관행과 오해에서 비롯된 신조가 시급히 수정되어야 하고, 그 기초 위에서 제도와 문화가 개선되어야 하는 것이다.

• 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.

• 한국지역지리학회지
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• 제4권1호
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• pp.77-98
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• 1998

본 연구는 제조업 중에서도 지역성장 및 연관산업에 대한 파급효과가 가장 큰 부문인 자동차 산업을 대상으로 새로운 조립공장 입지가 지역경제의 성장 및 발전에 미치는 영향을 경계지리학적 관점에서 논의했다. 우리 나라의 대표적 신산업지구로 발전하고 있는 광양만권의 율촌 산업단지를 사례로, 한국 최대의 자동차 조림기업인 현대자동차의 새로운 조립공장 입지가 광주 전남의 자동차산업 전반에 어떠한 영향을 미칠 것인지, 그리고 보다 미시적 수준에서 광양만권에 어떠한 파급효과를 초래할 것인지 탐색해보고자 했다. 노동집약적 특성과 자본 및 기술집약적 특성을 동시에 지니는 자동차 조립 및 부품생산 부문을 대상으로 첫째, 조립부문-부품생산부문의 공간적 비공간적 연계 특성을 규명하고 둘께, 광주 전남지역 자동차산업의 현 주소 및 이에 대한 신설 조립공장의 파급효과를 분석하며 셋째, 신설 조립공장 입지에 따른 광양만권 역내의 부품산업 발전 가능성을 전망함으로써 지역개발의 파급효과를 극대화할 수 있는 방안을 모색해보고자 하는 것이 본 연구의 목적이다.

• 기록학연구
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• 제11호
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• pp.181-214
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• 2005

Metropolitan rapid transit system plays an essential role in the public transportation system of any large city, and its managing agency is usually charged with the responsibility of storing and managing the design drawings of the system. The drawings are important and historically valuable documents that must be kept permanently because they contain comprehensive data that is used to manage and maintain the system. However, no study has been performed in Korea on how well agencies are preserving and managing these records. Seoul Metropolitan Rapid Transit Corporation(SMRT) is the managing agency established by the city of Seoul to operate subway lines 5, 6, 7, and 8 more efficiently to serve its citizens. By the Act on Records Management in Public Institutions(ARMPI), SMRT should establish a records center to manage its records. Furthermore, all drawings produced by SMRT and other third party entities should be in compliance with the Act. However, SMRT, as a form of local public corporation, can establish a records center by its own way. Accordingly, the National Archives & Records Service(NARS) has very little control over SMRT. Therefore, the purpose of this study is to research and analyze the present state of storage and management of the drawings of metropolitan rapid transit in SMRT and is to find a desirable method of preservation and management for drawings of metropolitan rapid transit. In the process of the study, it was found that a records center is being considered to manage only general official documents and not to manage the drawings as required by ARMPI. SMRT does not have a records center, and the environment of management on the drawings is very poor. Although there is a plan to develop a new management system for the drawings, it will be non-compliant of ARMPI. What's happening at SMRT does not reflect the state of all other cities' metropolitan rapid transit records management systems, but the state of creation of records center of local public corporation is the almost same state as SMRT. There should be continuous education and many studies conducted in order to manage the drawings of metropolitan rapid transit efficiently by records management system. This study proposes a records center based on both professional records centers and union records centers. Although metropolitan rapid transit is constructed and managed by each local public corporation, the overall characteristics and processes of metropolitan rapid transit projects are similar in nature. In consideration of huge quantity, complexity and specialty of drawings produced and used during construction and operation of metropolitan rapid transit, and overlap of each local public corporation's effort and cost of the storage and management of the drawings, they need to be managed in a professional and united way. As an example of professional records center, there is the National Personnel Records Center(NPRC) in St. Louis, Missouri. NPRC is one of the National Archives and Records Administration's largest operations and a central repository of personnel-related records on former and present federal employees and the military. It provides extensive information to government agencies, military veterans, former federal employees, family members, as well as researchers and historians. As an example of union records center, there is the Chinese Union Dangansil. It was established by several institutions and organizations, so united management of records can be performed and human efforts and facilities can be saved. We should establish a professional and united records center which manages drawings of metropolitan rapid transit and provides service to researchers and the public as well as members of the related institutions. This study can be an impetus to improve interest on management of not only drawings of metropolitan rapid transit but also drawings of various public facilities.

• 대한물리치료과학회지
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• 제5권1호
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• pp.549-556
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• 1998

To survey the recognition of Community Based Rehabilitation(CBR) by Public Health Center(PHC) Physical Therapists in Seoul Province. This study analysed general characteristic of Physical Therapists and cognition, participation, education, problems and requirements for CBR. The subjects of this study were 31 therapists who work at PHC in Seoul Province and Seoul City Childerns Municipal Hospital. Data was collected for 18 days from April 13 to 31, 1998 and results computed from 25 responses. First, Female therapists outnumber males. The age category 30 to 35 old represented 44.0% of the total number studied. 48.0% of therapists had worked more than 7 years and therapists usually 84.0% worked from 3 to 4 years at the PHC. Junior colleage graduates were 72.0%, and respondents with family responsibility were 52.0%. Second, Recently pain control and therapeutic exercises has become the major requirement of patients at PHC(56.0%). If the offered expanded services, a rehabilitation programe at PHC(36.0%) was highly. When asked about a working guide book, nobody had one. Third, 64.0% of therapists were aware of the present level of CBR, 28.0% of them had gotten an information from newspaper and mass media. Fourth, For CBR, 72.0% had positive ideas in which they could participate. 56.0% wished to compose a team of various rehabilitation specialists. 52.0% wished for the meeting day to be flexible and 64.0% desired to meet once or twice a week. Fifth, Almost all(92.0%) desired more educational opportunity about CBR. Example, once or twice a year(48.0%) and training period of 4 to 7 day(44.0%). They wanted to learn theory and parctice together(88.0%) and 48.0% wanted national mutirehabilitation center as a educational managing organization. Sixth, The most important requirement for accomplishing CBR by Physical Therapists was job security and adequate number of therapists(48.0%). Required number of physical therapists in the PHC was 3(52.0%). The cooperative agency should be the distict govement(32.0%) and community welfare center of the disabled persons(32.0%). Factors inhibiting the execution of CBR were lack of physical therapists(56.0%), and equipments for pain control and for therapeutic exercises(68.0%).

• 한국경제지리학회지
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• 제20권3호
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• pp.287-306
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• 2017

1990년대 이후 정치지리학자들은 경계의 종류와 기능에 초점을 맞추었던 형태론적 경계연구에서 벗어나 접경지역이 구성되는 과정을 이해하기 위해 노력해왔다. 이러한 변화된 연구경향은, 경계를 영토성(territoriality)의 발현으로 보는 시각에서 벗어나 경계와 접경지역을 다양한 관계들이 중첩되고 경합되는 관계론적(relational) 시각으로 이해하고 있다. 또한 접경지역을 구성하는 다차원의 행위주체와 접경지역 고유의 역사 문화적 과정을 강조하는 시각이 강조되고 있다. 본 논문은 이러한 최근의 논의를 기반으로 북한-중국 접경지역인 단둥을 사례로 하여 접경지역이 다양한 행위주체와 이들의 전략에 의해 어떻게 구성되어가는가를 고찰하고 있다. 북한의 핵과 미사일 개발에 따라 여러 차례의 경제제재가 결의되었고 시행되고 있으며, 이는 접경지역에 미치는 다양한 스케일의 행위주체의 전략이 경합되는 "관계로서의 접경"을 이해하기 적절한 사례가 된다. 또한 본 논문은 지정학 연구의 한계로 지적되었던 담론분석 위주의 설명에서 벗어나 지역이 구성되는 과정과 이로 인해 구축되는 물질성의 특성에 대한 사례연구로서의 의의를 가진다.

• The Journal of Korean Physical Therapy
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• 제10권1호
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• pp.75-80
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• 1998

To survey the recognition of Community Based Rehabilitation (CBR) by Public Health Center(PHC) Physical Therapists in Kyoungki Province. This study analysed general characteristic of Physical Therapists and congnition, participation, education, problems and requireanents for CBR. The objects of this study were 37 therapists who work at 27 of 39 PHC in Kyoungki province and data was collected for 20days from Jan. 12 to 31. 1998 and the results computed from 32 responses. First, Female therapists outnumber males. The age category 30 to 35 old represneted $56.2\%$ of the total number studied. $59.4\%$ of therapists had worked more than 7 years and therapists usually$(46.9\%)$ worked from 6 month to 2 years at the PHC. Junior college graduates were $84.4\%$, and respondents with family responsibilirt were $65.6\%$. Second, Recently pain control has become the major requirment of patiants at PH$(53.1\%)$. If they offered expaneded services - a rehabilitation program $(53.1\%)$, home vistation $(31.3\%)$. when asked about a working guide book, nobody had one. Third, $68.7\%$ of therapists were aware of the present level of CBR, $40.9\%$ of them had gotten an information from educated colleagues, and $68.7\%$ of therapists were aware of the present level of CBR, $86.4\%$ of therapists felt responsible to provide rehabilitation Fourth, For CBR, $93.7\%$ had positive ideas in which they could participate. $73.3\%$ wished to composed a team of various rehabilitational specialists. $73.3\%$ wished for the meeting day to be flexible and $86.6\%$ desired to meet once or twice a week. Fifth, Almost all$(96.9\%)$ desired more educational opportunity about CBR. Example, once or twice a year$(56.2\%)$ and training period of 4-7 days $(43.7\%)$. They wanted to learn theory and practice together$(74.2\%)$ and $74.2\%$ wanted the mational multi-rehabilitation center as a educational managing organization. Sixth, The most important requirment for accomplishing CBR by physical therapists was job security and an adequate number of therapists$(84.4\%)$ Required number of physical therapists in the PHC was 3 $(43.7\%)$. The cooperative agency should be the district goverment organization $(56.2\%)$. Factors inhibiting the execution of CBR were lack of administrative support, physical therapists, and equipments for pain control and for therapeutic exercise.

• 한국지구과학회지
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• 제23권8호
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• pp.666-675
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• 2002

본 연구에서는 자기 주도적 학습을 위한 웹기반 수준별 학습 자료를 설계 ${\cdot}$ 개발하고 이를 현장에 적용하여 그 효과를 검증하고자 하였다. 이를 위하여 제7차 교육과정 고등학교 과학10의 ‘일기와 기후’ 단원을 기본 학습자료와 심화 ${\cdot}$ 보충형 학습자료로 설계 ${\cdot}$ 개발하고 이를 적용하여 그 효과를 전통적 수업과 비교한 결과는 다음과 같다. 첫째, 웹 기반수준별 학습은 전통적 수업보다 학생들의 자기 주도적 학습특성 중 자아개념, 학습열성, 미래지향성, 창의성, 자기 평가력에 긍정적인 효과를 나타내었으며 이는 학습자가 주어진 학습체제와의 다양한 교류를 통하여 필요한 정보와 지식을 획득하는 웹 학습의 특성 때문인 것으로 보인다. 웹 기반 수준별 학습이 자기 주도적 학습특성에 미치는 효과를 학습능력별로 살펴본 결과, 학습자의 학습능력 수준에는 무관한 것으로 나타났다. 둘째, 웹 기반 수준별 학습은 전통적 수업보다 학생들의 과학성취도에 긍정적인 효과를 나타내었으며 학습능력 수준이 중위이상인 학습자들에게 더 효과적이었다. 이러한 연구의 결과를 고려할 때, 하위수준 학습자들의 학업성취도를 높이기 위해서는 보충학습의 내용을 더 구체적으로 구성하고 경로 면에서 학습자 편의성을 높이는 웹 설계가 필요하다. 셋째, 웹 기반 수준별 학습에 대한 학습자들의 인식 결과를 보면 시각적 효과와 화면 구성에 대하여 긍정적인 평가를 하였다. 또한 학습 경험을 계획하고 필요한 자원을 자신만의 경로로 찾아서 학습하는 자기 주도적 학습이 수준별 학습에 긍정적인 효과를 미치는 것으로 응답하였다.

• 한국경제지리학회지
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• 제19권4호
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• pp.597-615
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• 2016

영국은 1997년 이후 신노동당 정책에 따라 창조산업육성과 창조도시 발전을 도모하였고, 전통적 제조업 중심 도시에 창조도시 정책을 대입하여 클러스터 정책을 강화하였다. 대표적인 디지털클러스터 성공사례로 꼽을 수 있는 런던의 테크시티는 불모지였던 공간이 자생적으로 발전하기 시작하면서, 벤처기업 집적을 위한 다양한 생태계가 구축된 지역이다. 이를 위해 대학, 민간, 스타트업, 엑셀러레이터 등 유기적 연계와 영국정부의 적극적인 지원이 더해졌다. 이를 기회로 영국의 스타트업 생태계규모가 크게 성장하고, 입지 기업이 급증하고, 브랜드효과가 크게 제고되었다. 테크시티는 해당 지역의 역사적인 배경을 바탕으로 성장과 가능성을 보고 적극적인 지원을 아끼지 않은 공공의 노력과 민간의 거버넌스가 잘 조화를 이룬 사례로서, 공공분야의 정책과 민간의 서비스와 적극적 투자, 산학협력을 통한 기술과 사업화를 위한 시장플랫폼, 그리고 위험을 감수하는 적극적 투자 등이 연계되어 창업, 혁신도시로의 성장을 주도한 사례라고 볼 수 있다. 향후 미래 지향형 디지털 경제 기반 전국적으로 클러스터를 확대하려고 하는 영국의 노력에 주목해야 할 것이다.

• 대한지역사회영양학회지
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• 제22권3호
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• pp.207-217
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• 2017

Objectives: The aim of this study was to examine self-management status, nutritional knowledge, barrier factors in dietary management and needs of nutritional management program for women with Gestational Diabetes Mellitus (GDM). Methods: A total of 100 women with GDM were recruited from secondary and tertiary hospitals in Seoul. The questionnaire composed of general characteristics, status of self-management, dietary habits, nutrition knowledge, barrier factors in dietary management, needs for nutrition information contents and nutritional management programs. Data were collected by a self-administered questionnaire. All data were statistically analyzed using student's t-test and chi-square test using SAS 9.3. Results: About 35% of the subjects reported that they practiced medical nutrition and exercise therapy for GDM control. The main sources of nutrition information were 'internet (50.0%)' and 'expert advice (45.0%)'. More than 70% of the subjects experienced nutrition education. The mean score of nutrition knowledge was 7.5 point out of 10, and only about half of the subjects were reported to be correctly aware of some questions such as 'the cause of ketosis', 'the goal of nutrition management for GDM', 'the importance of sugar restriction on breakfast'. The major obstructive factors in dietary management were 'eating more than planned when dining out', 'finding the appropriate menu when dining out'. The preferred nutrition information contents in developing management program were 'nutritional information of food', 'recommended food by major nutrients', 'the relationship between blood glucose and food', 'tips on menu selection at eating out'. The subjects reported that they need management program such as 'example of menu by calorie prescription', 'recommended weight gain guide', 'meal recording and dietary assessment', 'expert recommendation', 'sharing know-how'. Conclusions: Based on the results of this study, it is necessary to develop a program that provide personalized information by identifying the individual characteristics of the subjects and expert feedback function through various information and nutrition information contents that can be used in real life.