• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제29권1호
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• pp.53-62
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• 2023

Purpose: Recently, the number of severely mentally ill patients has been increasing rapidly in Korea, but there are no design guidelines for spatial planning of Korea's acute psychiatric wards. The study aims to clarify the areas and required rooms in Korea's acute psychiatric wards which are important in establishing the design guidelines for Korea's acute psychiatric wards. Methods: This study proposed a structural framework based on the results of investigating and analyzing the acute psychiatric ward guidelines in the UK, Australia, and the U.S. and the areas and the required rooms of the wards stipulated in the basic data for establishing acute psychiatric ward design guidelines in Korea. The design guidelines for overseas acute psychiatric wards are 'Adult Acute Mental Health' in the UK, 'Adult Acute Mental Health Inpatient Unit' in the Australia, and 'Specific Requirements for Mental Health Hospitals' in the United States. Results: As a result of investigating and analyzing the design guidelines for overseas acute psychiatric wards, the areas of wards applicable to acute wards in domestic psychiatric wards were access, patient, treatment, support, and employee areas. In addition, the required rooms for each area were defined around major considerations such as visibility, convenience, comfort, security, safety, patient observation, barrier-free design, and privacy protection. Implications: The results of the study will be presented as a structural framework and basic data for establishing design guidelines for Korea's acute psychiatric wards, which is still absent.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제34권2호
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• pp.141-149
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• 2023

Objectives: Most developmental screening tests have been built as parent-performed questionnaires. However, they often do not guide parents on how to answer the questionnaire. This study aimed to develop easily applicable parent guidelines. Methods: We implemented the Delphi procedure with 20 panelists. The development of the initial questionnaire was based on the results of two surveys of parents and experts provided by a policy research report that investigated the item adequacy of the Korean Developmental Screening Test. Round one included 33 items comprising all possible measurements in six categories that were identified as difficult to understand or confusing. Round two merged and modified some items and included 32 items. We defined consensus as a median agreement value of one or less and convergence and stability values of 0.5 or less. The subjective usefulness of the parent guidelines was examined based on their previous test experiences. Results: Consensus was reached after the second round, reflecting the items with the highest level of accuracy in each category. Of the 167 parents who participated in the survey, 113 (67.7%) affirmed the usefulness of the guidelines, while 10 (6.0%) answered that they were not useful. Items that recommended a different scoring strategy in answering the questionnaire from their previous measurements were found to be more useful by the parents. Conclusion: The parent guidelines, composed of five bullet points, drew on the consensus of the experts. Further studies are required to assess whether these guidelines improve the accuracy of screening tests in clinical settings.

• Journal of Gastric Cancer
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• 제23권4호
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• pp.535-548
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• 2023

Purpose: This study evaluated real-world compliance with surgical treatment according to Korea's gastric cancer treatment guidelines. Materials and Methods: The 2018 Korean Gastric Cancer Treatment Guidelines were evaluated using the 2019 national survey data for surgically treated gastric cancer based on postoperative pathological results in Korea. In addition, the changes in surgical treatments in 2019 were compared with those in the 2014 national survey data implemented before the publication of the guidelines in 2018. The compliance rate was evaluated according to the algorithm recommended in the 2018 Korean guidelines. Results: The overall compliance rates in 2019 were 83% for gastric resection extent, 87% for lymph node dissection, 100% for surgical approach, and 83% for adjuvant chemotherapy, similar to 2014. Among patients with pathologic stages IB, II, and III disease who underwent total gastrectomy, the incidence of splenectomy was 8.08%, a practice not recommended by the guidelines. The survey findings revealed that 48.66% of the patients who underwent gastrectomy had pathological stage IV disease, which was not recommended by the 2019 guidelines. Compared to that in 2014, the rate of gastrectomy in stage IV patients was 54.53% in 2014. Compliance rates were similar across all regions of Korea, except for gastrectomy in patients with stage IV disease. Conclusions: Real-world compliance with gastric cancer treatment guidelines was relatively high in Korea.

• 생태와환경
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• 제36권3호통권104호
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• pp.356-368
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• 2003

본 연구에서는 국제적으로 사용하고 있는 농업용수 재이용 수질기준을 검토하고 우리나라 하수처리 방류수의 재이용 가능성에 대하여 고찰하였으며, 재이용수로이용하기 위해 필요한 처리대안에 실험 ${\cdot}$ 연구한 결과이다. Biofilter 유출수를 17, 25, 40W의 3가지 램프로 UV소독한 결과 40W 램프에서는 모든 경우에 100%소독되었으며, 25 W와 17 W에서는 전반적으로 97%이상 소독효율을 나타내었으며, 적절하게 설계된 UV소독을 거친 하수처리장 유출수는 USEPA와 WHO의 가장 엄격한 수질기준을 충분히 만족시켜서 보건 ${\cdot}$ 위생적인 문제를 일으키지 않을 것으로 판단된다. 간헐 분사방식의 완속모래여과 처리후 미생물의 처리효율은 TC, FC, E. coli 모두 평균 95% 이상 높은 처리 효율을 나타내었으며, 완속모래여과 후의 평균 농도는 각각 330, 207, 154 MPN/100 mL이었고 탁도와 SS는 모두 약 50%의 처리효율을 나타내었는데, 이는 WHO의 수질기준을 충분히 만족시켰으며, USEPA의 수질기준인 200FC/100mL의 경우에도 적절한 관리가 이루어 질 경우 만족시킬 수 있을 것으로 판단된다. 탁도는 평균 0.8NTU로써 먹는물 수질기준인 INTU수준이었고, SS의 경우에도 50% 이상의 처리효율을 나타내어 USEPA의 가장 엄격한 수질기준을 충분히 만족하였으며, 영양물질의 제거에도 기여를 하기 때문에 수계의 오염부하를 줄이는 측면에서도 유리할 것으로 생각된다. 연못시스템을 거치면서 TC, FC, E. coli 모두 85%정도 제거되어 평균미생물농도가 1,000MPN/100 m1 이하이었다. 우리나라의 수질기준으로 WHO 수질기준이 논농사에 적용될 경우 소독이나 여과처리 없이도 재이용할 수 있을 것이라 판단되나, USEPA의 수질기준이 적용될 경우에는 연못시스템만으로도 부족하여 추가적인 처리가 필요할 것으로 생각된다. 과거 US EPA의 위험을 완전히 배제한 수질기준을 여러 국가에서 받아들여 사용하고 있으나, WHO에서는 이수질기준이 경제 ${\cdot}$ 사회적으로 불합리한 기준이라 판단하고 보다 완화된 수질기준을 제시하였다. 우리나라에서도 수질기준을 결정할 때 논농사라는 특수한 실정에 맞는 수질 기준을 정해 경제적이고 실용적인 처리방법을 선정하는 것이 중요하다고 할 수 있다. 벼의 경우는 껍질과 추가적인 처리 후 섭취하는 작물이기 때문에 엄격한 수질기준이 필요하지 않을 수 있으나, 장기간 담수상태를 유지함으로써 농민을 포함한 공중보건에 위해성을 줄 가능성이 크므로 세균성미생물 등에 대한 신중한 결정이 필요하다.

• 의료법학
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• 제23권2호
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• pp.39-65
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• 2022

진료가이드라인은 의료행위 전의 비법적 통제로서 작용하는 측면과 의료행위 후의 법적인 통제기준으로 작용하는 두 가지 측면이 있다. 진료가이드라인의 본질적 목적은 전자이지만, 후자의 작용을 배제할 수 없다. 진료가이드라인은 법과 의료를 연결하는 수단이다. 진료가이드라인의 제정에 의해 의료전문가의 자율성이 침해될 수 있다는 진료가이드라인에 대한 부정적 인식은 진료가이드라인에 대한 지나친 부정적 평가이다. 오히려 진료가이드라인에 의한 사법판단은 의료전문가의 자율성을 존중하는 역할을 한다. 즉 진료가이드라인은 의료에 대한 법적 규제를 최대한 억제하고, 의사의 직업윤리 및 자기규율과 환자의 자각 및 협력을 바탕으로 하는 것이다. 의사와 환자의 협력이라는 이상적인 관계를 정립하기 위해서는 「의료윤리」를 법적 수단으로 편입해야 한다. 이러한 의료윤리의 법적 절차에의 편입작업에 가장 적절한 수단이 의료가이드라인이다. 법률가는 규범을 정립하고, 그것에 사실을 적용하여 결론을 내리는 법적 삼단논법으로 사안을 해결한다. 의료분쟁의 해결은, 의사가 특정 질환에 어떠한 의료행위를 해야 하는가라는 규범을 정립할 때에 진료가이드라인을 사용하며, 정립된 규범을 구체적인 진료행위에 적용하여 결론을 도출한다. 정립된 규범을 구체적인 진료행위에 적용하는 것이 쉽지 않은 때에는 감정이나 전문가 증언, 전문위원의 설명과 같은 전문가의 의학적 판단을 이용한다. 이처럼 사법(司法)은 규범의 정립이나 규범의 적용에도 의료의 자율성을 존중하고 있다. 특히 법적 삼단논법의 대전제인 규범의 정립에는 의료계가 자주적으로 작성한 진료가이드라인을 참고하고 있다. 이는 의료인이 판례의 형성에 참가하여 규범형성에 기여하는 모습이다. 진료가이드라인이 재판에 이용되는 것은 의료의 자율성에 대한 존중과 배려이다. 진료가이드라인에 의해 개개의 의사의 자율성이 제약되는 측면은 있을 수 있지만, 집단으로서의 의사의 자율성은 존중된다고 보아야 한다. 이처럼 진료가이드라인은 「법」의 논리에서 보면, 「의료」 집단의 자율성을 보호하는 역할을 한다.

• 한국의료질향상학회지
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• 제4권1호
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• pp.82-103
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• 1997

Background : With increased concerns about variation among physician's practice pattern and their impact on the quality of care, clinical practice guidelines have been developed by many different organizations, with differing aims and incentives. From the same point of view, there is growing interest in the development of clinical practice guidelines in Korea, but with only a few examples. As a result, there is not much exploration on the incentive and barrier to develop guidelines as well as description on the development process. The purposes of this study are to describe the process of the four different clinical practice guidelines in a hospital setting, and to identify incentives and barriers in the development of guidelines. Methods : For this research, a clinical practice guideline development committee and four clinical practice guideline development teams were organized in a university hospital which has more than 1,200 bead. Twenty eight doctors, three nurses, and one technician participated as members of development teams for eight months. Four to six meetings were held, and three to seven departments in the hospital were involved. Results : The topics which developed into clinical practice guidelines were cardiopulmonary resuscitation(CPR), blood transfusion, anticoagulation, and angiography. The main goals set by teams were education(CPR, angiography), risk management(blood transfusion), and to enhance quality of care(anticoagulation). Among four teams, only in the team for anticoagulation guideline medical record review and pilot-testing were performed. Also literature review was not carried out systematically. However, all the guidelines were developed by multidisciplinary be used as standard protocols in the practice. Conclusion : Experience and skill in developing process has to be improved to have a more valid and useful practice guideline. In particular, literature review and problem identification by examining medical record should be emphasized. Also further studies on the clinical outcomes of the guidelines application and changes in physicians' behaviors would be required.

• Nutrition Research and Practice
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• 제14권6호
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• pp.621-636
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• 2020

BACKGROUND/OBJECTIVES: The Seoul Metabolic Syndrome Management (SMESY) program is a 1-yr lifestyle modification program targeting metabolic syndrome (MetS) in Seoul residents. This study investigated the associations between adherence to dietary guidelines and MetS among the SMESY program participants. SUBJECTS/METHODS: Data of 54,385 participants aged 20-64 yrs who completed the SMESY program in 2015, had information on adherence to dietary guidelines, and were not medicated for diabetes, hypertension, or dyslipidemia were analyzed. Participants underwent MetS screening and completed a lifestyle questionnaire including adherence to 10 dietary guidelines before and after participation. Participants were classified according to the number of MetS risk factors at baseline (MetS group, ≥ 3; risk group, 1-2; healthy group, none). Adherence to dietary guidelines was determined from the number of "yes" responses regarding the fulfillment of each guideline on ≥ 5 days/week. Multiple logistic regression was used to evaluate associations between newly diagnosed MetS and changes in adherence to dietary guidelines. RESULTS: In the MetS group, MetS prevalence decreased after the SMESY program (men, -41.9%p; women, -48.7%p), and all risk factors were significantly improved (P < 0.0001). All groups exhibited improved adherence to all dietary guidelines after participation (P < 0.0001). In the MetS group with positively changed adherence scores, the MetS prevalence decreased by -44.1%p for men and -49.5%p for women, whereas the prevalence in those with negative changes decreased by -38.1%p for men and -48.6%p for women. In the risk group, those with positively changed adherence scores had significantly decreased odds ratios (ORs) for newly diagnosed MetS compared with those with negative changes (OR, 0.70; 95% confidence interval [CI], 0.61-0.80 for men; OR, 0.88; 95% CI, 0.79-0.99 for women). CONCLUSIONS: The SMESY program may effectively reduce the risk of MetS among adults with risk factors by improving adherence to dietary guidelines.

• 한방안이비인후피부과학회지
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• 제31권2호
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• pp.40-59
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• 2018

Objectives : We report on the contents and reviews of the guidelines for clinical trials of herbal medicine for psoriasis. Methods : After reviewing the existing reports, the guidelines were drafted by the writing committee on guidelines for Korean medicine clinical trial center in Kyung Hee university Korean medicine hospital. Since then, the guidelines have been consulted by the experts in diseases, clinical trials and pharmaceuticals. In addition, the guidelines have been certified by the Korean medicine clinical trial center association and Korean Medicine Ophthalmology & Otolaryngology & Dermatology Society. Results : The guidelines for clinical trials are divided into 8 categories: (1) general contents, (2) evaluation standards of effectiveness, (3) outcome valuables, (4) selection of study participants, (5) designs of clinical trials, (6) safety evaluations, (7) combination therapies in psoriasis treatment and (8) Korean medical considerations. Conclusions : There are 3 major contents for discussion: (1) obscurity of Korean medical considerations to differentiate from existing guidelines, (2) the absence of Korean version of PASI and DLQI, which are validity parameters and (3) realistic institutional problem using the herbal medicine.

• 한국산학기술학회논문지
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• 제17권6호
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• pp.113-120
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• 2016

본 연구의 목적은 유치도뇨관, 중심정맥관 및 인공호흡기 감염관리지침에 대한 중환자실 간호사의 지식과 수행도 정도를 파악하고자 하였다. 대상자는 2개의 상급종합병원과 3개의 종합병원의 중환자실에서 근무하는 간호사 175명이다. 자료수집은 2013년 7월 1일부터 7월 31일까지로, 수집된 자료는 SPSS 18.0 통계 프로그램을 사용하여 기술통계, t-test, ANOVA로 분석하였다. 각 지식수준은 유치도뇨 관리관(평균 0.87점), 중심정맥관(0.82점), 인공호흡기(0.82점)순으로 나타났으며, 수행도는 유치도뇨 관리관(평균 4.18점), 인공호흡기(4.04점)중심정맥관(4.07점)순이었다. 지식과 수행도에서는 유치도뇨관(r=.72, p<.00), 중심정맥관(r=.54, p<.001), 및 인공호흡기(r=.30, p<.001) 감염관리간 순 상관관계를 나타냈다. 유치도뇨관 감염관리지침에 대한 지식과 수행도는 성별, 최종학력, 근무경력, 담당환자 수, 병원규모, 세미나 참석 여부에 따라 통계적으로 유의한 차이가 있었다. 중심정맥관 감염관리지침에 대한 지식과 수행도는 최종학력, 근무경력, 담당환자 수, 병원규모, 세미나 참석 여부에 따라 통계적으로 유의한 차이가 있었다. 인공호흡기 감염관리지침에 대한 지식은 근무경력에 따라 통계적으로 유의한 차이가 있었다. 본 연구결과를 기초로 감염관리지침에 대한 지식과 수행을 향상 시킬 수 있는 교육 및 훈련 프로그램이 개발되어야 할 것이다.

• 근관절건강학회지
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• 제24권3호
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• pp.227-237
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• 2017

Purpose: The purpose of this study is to analyze the suitability and applicability of the recommendations for the exercise intervention program in fall prevention guidelines for the elderly. Methods: We searched systematically RISS, KISS, National Assembly Library, KoreaMed, and KM base for Korean guidelines and used OVID-MEDLINE, EMBASE, Cochrane library, Trip database, GIN, NGC, WHO, and CDC for international guidelines including fall prevention exercises for the elderly until August 2016. Results: A total of 11 guidelines were selected as the result of the literature search. After evaluating the quality of guidelines, 9 guidelines were used to analyze the recommendations. A total of 19 recommendations were derived from 9 guidelines. Of 19 recommendations, 12 recommendations were considered to be appropriate and applicable. As a result, we recommend for the elderly to do a single type of balance exercise, strength exercise, aerobic exercise or multiple forms of exercise for 20~30 minutes per a day, 2~3 days or more than 3 days per a week, and consistently for more than 10 weeks. Conclusion: To prevent falls in the elderly, it is important for the elderly to perform a regular balance, strength, or aerobic exercise for 20~30 minutes per a day, 2~3 days per a week.