• 한국노년학
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• 제29권3호
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• pp.1043-1061
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• 2009

본 연구의 목적은 현재 실시되고 있는 장기요양보호서비스에 대하여 유형별로 비용측면에서 경제성을 분석하고 정책적 함의를 논의하는 것이다. 조사대상자는 2008년 7월부터 시행되고 있는 노인장기요양제도의 적용대상자로 인정받은 65세 이상 노인과 그 부양가족이었고, 주부양자를 대상으로 요양보호서비스유형별로 구분하여 설문조사하였다. 회수된 설문지 중에서 방문요양 155부, 방문간호 67부, 요양시설 108부, 요양병원 92부 총 422부가 본 연구의 분석 표본으로 사용되었다. 조사결과 다음과 같은 사실을 확인할 수 있었다. 첫째, 부양 가계의 가계소득이 높지 않았다. 둘째, 장기요양보험제도가 실시되고 있음에도 불구하고 노인부양가계가 노인을 위하여 직접 지불하는 금액이 여전히 높은 편이다. 셋째, 부양가계가 노인을 위하여 수발하는 데 소요되는 간접비용이 아주 높은 편이다. 특히 재가서비스인 방문요양의 경우엔 평균 756,947원, 방문간호인 경우 594,807원으로 시설서비스에 비하여 간접비용이 상대적으로 아주 더 높았다. 넷째, 장기요양보호 노인에 대한 사회적 비용이 아주 높다. 이 금액은 본 조사에서 확인한 부양가계의 평균가계소득과 비슷한 수준이다. 다섯째, 요양보호서비스 유형별로 부양가계가 부담하는 서비스 비용에서 유의한 차이를 보였다. 여섯째, 부양가계의 직접 비용에서도 요양보호서비스 유형별로 유의한 차이를 보였지만 서비스이용비용보다는 그 차이가 작았다. 일곱째, 사회적 직접 비용은 요양보호서비스 유형별로 아주 유의한 차이를 보였다. 여덟째, 요양보호서비스를 이용하는 노인에 대한 사회적 비용금액이 아주 크고 서비스 유형별 총 사회적 비용이 전체 서비스 이용노인의 평균적인 사회적 비용에 수렴하는 경향을 보였다.

• 간호행정학회지
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• 제16권2호
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• pp.143-151
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• 2010

Purpose: This study was conducted to define nurses' level of self-leadership, self-esteem, and organizational effectiveness, and to examine relationships among above variables. Methods: The subjects of this study were 313 nurses from two general hospitals located in Seoul Metropolitan area in Korea. The data was collected by self-reported instruments: Self-leadership scale, Self-esteem scale, Job satisfaction scale, Organizational commitment scale, and Turnover intention scale, Data was analyzed by descriptive statistics, Pearson correlation coefficient, and stepwise multiple reg res don u dng SPSS-PC program, Results: The average scores of variables were; self-leadership, 3,72/5,00 self-esteem, 3,76/5,00 Job satisfaction, 3,36/5.00 organizational commitment, 3.29/5.00 and turnover intentioncri 2.94/5,00, Self-leadership was dgnificantly correlated to self-esteem, job satisfaction, organizational commitment, and turnover intention. Self-leadership, job satisfaction, and turnover intention explained 52.3% of organizational commitment. Self-leadership and organizational commitment explained 43% of turnover intention. Conclusions: It is recommended to develop standardized self-leadership curriculum in the nursing school to build a foundation of self-leadership from undergraduate nursing students, Educational programs are needed that promote nurses' self-leadership as regular continuing education. Organizational effectiveness would be improved by providing programs to enhance nurses' self-esteem, educational motivation, and organizational commitment, which boost self-leadership.

• 대한예방한의학회지
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• 제19권3호
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• pp.77-90
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• 2015

Objective : The purpose of this study is to discuss the role and ways to improve the position and rights of Korean Medicine Doctors (KMDs) working at long-term care hospitals (LTCHs) through survey analysis. Method : (1) The legal and institutional position of KMDs is studied using current law and related papers. (2) The online survey was conducted through KMD community websites, targeted at KMDs working at LTCHs. Results : (1) Whereas there is perceived added benefit for the eight specializations for a specialist of Western medicine at LTCHs, in the case of a specialist of Korean Medicine, their value is not institutionally recognized at all. (2) A Western inpatient's medical fee is more than a Korean inpatient's medical fee, and the individual fee for the same medical treatment is also higher in Western hospitalization. So, Korean medical hospitalization actually cannot be made. Because of that, Korean Medicine Doctors find it difficult to be primary care physicians. (3) Musculoskeletal diseases and the aftereffects of cerebrovascular diseases were the most common chief complaints addressed in Korean medical consultations. Conclusion : This study shows that KMDs working at LTCHs have suffered many kinds of inequality. That is because of the limited medical scope of the current medical system and real constraints from the gap in Korean-Western medical fees by the National Health Insurance Corporation. Therefore, it is necessary to eliminate these variations along with revising the statute with continuous research.

• Journal of Periodontal and Implant Science
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• 제30권3호
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• pp.609-619
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• 2000

Cyclosporin A(CsA) is now widely used to treat organ transplant recipients. But CsA has various short-and long-term side effects. Especially, gingival hyperplasia is not easy to resolve since its nature is still unknown. This study discusses the pathogenesis of CsA-induced gingival hyperplasia on the basis of data obtained from light and electron microscopic studies of biopsis from patients on CsA treatment after kidney transplantation. Light microscopically, the multilayered squamous epithelium showed an irregular surface of parakeratosis and deep invaginations in the subepithelial tissue. At lamina propria, we observed bundles of irregularly arranged collagen fiber, some fibroblasts, numerous capillary vessels and a large diffuse infiltration of plasma cells. Ultrastructurally, many fibroblasts, collagen fibers, collagen fibrils were present in lamina propria. On the basis of the data collected, we propose that the morphological features of the dimensional increase in gingival tissue associated with CsA treatment in kidney transplant patients may be considered proliferative fibroblasts, collagen fibers, collagen fibrils in lamina propria.

• 한국임상약학회지
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• 제14권2호
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• pp.61-70
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• 2004

Heptaplatin is a new platinum derivative with antitumor activity against gastric cancer. Preclinical studies showed that it is less toxic than other platinum analogues. The purpose of this study is to evaluate the efficacy and toxicity of the combination therapy of heptaplatin and 5-fluorouracil in Korean advanced gastric cancer patients. This study was investigated retrospectively. The patients group consisted of 65 advanced gastric cancer patients with no prior radiotherapy. All patients received heptaplatin $400\;mg/m^2$ by 2-3 hour infusion on Day 1 and 5-FU $1000\;mg/m^2by 12-24 hour continuous infusion for 5 days. After the first cycle, subsequent doses were adjusted according to the toxicity. Courses were repeated every 28 days. As results, objective response occurred in 16 patients $(24.6\%)$. Two were complete and 14 were partial response. Median progression free survival was 32 weeks with $29\%$ of patients progression free at 1 year. The most common hematologic toxicity was anemia. Grade 3 or 4 anemia was seen at $2.7\%$ of treatment cycles. Grade 3 or higher leucopenia was seen at $1.2\%$ of cycles. Grade 3 or 4 neutropenia and thrombocytopenia occurred at $6.1\%\;and\;1.5\%$ of cycles, respectively. The most common nonhematologic toxicity was proteinuria. Though no patients experienced grade 3 or 4 proteinuria, proteinuria was a considerable factor for this chemotherapy. Grade 3 or higher gastrointestinal toxicities were nausea and vomiting ($4.6\%$ of patients) and diarrhea ($1.5\%$ of patients). Grade 2 renal toxicity with elevation of serum creatinine was seen in $0.3\%$ of cycles, which is less than that of other platinum analogues. This study showed that combination therapy of heptaplatin and 5-FU have modest antitumor activity against advanced gastric cancer without severe renal toxicity.

• Journal of Korean Neurosurgical Society
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• 제49권4호
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• pp.212-216
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• 2011

Objective : It is well known that plate-to-disc distance (POD) is closely related to adjacent-level ossification following anterior cervical plate placement. The study was undertaken to compare the outcomes of two different anterior cervical plating methods for degenerative cervical condition. Specifically, the new method involves making holes for plate screws first with an air drill and then choosing a plate size. The other method was standard, that is, decide on the plate size first, locate the plate on the anterior vertebral body, and then drilling the screw holes. Our hypothesis was that the new technical tip may increase POD as compared with the standard anterior cervical plating procedure. Methods : We retrospectively reviewed 49 patients who had a solid fusion after anterior cervical arthrodesis with a plate for the treatment of cervical disc degeneration. Twenty-three patients underwent the new anterior cervical plating technique (Group A) and 26 patients underwent the standard technique (Group B). POD and ratios between POD to anterior body heights (ABH) were measured using postoperative lateral radiographs. In addition, operating times and clinical results were reviewed in all cases. Results : The mean durations of follow-up were $16.42{\pm}5.99$ (Group A) and $19.83{\pm}6.71$ (Group B) months, range 12 to 35 months. Of these parameters mentioned above, cephalad POD (5.43 versus 3.46 mm, p=0.005) and cephalad POD/ABH (0.36 versus 0.23, p=0.004) were significantly greater in the Group A, whereas operation time for two segment arthrodesis (141.9 versus 170.6 minutes, p=0.047) was significantly lower in the Group A. There were no significant difference between the two groups in caudal POD (5.92 versus 5.06 mm), caudal POO/ABH (0.37 versus 0.32) and clinical results. Conclusion : The new anterior cervical plating method represents an improvement over the standard method in terms of cephalad plate-to-disc distance and operating time.

• Clinical and Experimental Pediatrics
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• 제56권7호
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• pp.282-285
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• 2013

Purpose: Recent studies have established the association between hypotonic fluids administration and hospital-acquired hyponatremia in children, and have contended that hypotonic fluids be removed from routine practice. To assess current intravenous fluid prescription practices among Korean pediatric residents and to call for updated clinical practice education Methods: A survey-based analysis was carried out. Pediatric residents at six university hospitals in Korea completed a survey consisting of four questions. Each question supposed a unique scenario in which the respondents were to prescribe either a hypotonic or an isotonic fluid for the patient. Results: Ninety-one responses were collected and analyzed. In three of the four scenarios, a significant majority prescribed the hypotonic fluids (98.9%, 85.7%, and 69.2%, respectively). Notably, 69.2% of the respondents selected the hypotonic fluids for postoperative management. Almost all (96.7%) selected the isotonic fluids for hydration therapy. Conclusion: In the given scenarios, the majority of Korean pediatric residents would prescribe a hypotonic fluid, except for initial hydration. The current state of pediatric fluid management, notably, heightens the risk of hospital-acquired hyponatremia. Updated clinical practice education on intravenous fluid prescription, therefore, is urgently required.

• Archives of Plastic Surgery
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• 제38권6호
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• pp.903-906
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• 2011

Purpose: Accessory tragus is a fairly common congenital malformation and usually located at pretragal area. Surgical removal is a common treatment of accessory tragus irrespective of location and morphology. Most accessory tragi do not have depression site around them, but some do. So in those cases, simple surgical excision was not enough to promote the aesthetic facial appearance. For depression site remodeling, the excess amount of skin and cartilage need to be remained partially instead of total excision. This method can achieve the symmetric contour of pretragal area. The authors excised the epidermis and cartilaginous tissue totally and remained the dermis for reconstruction of the depression site around accessory tragus. The depression site is filled with dermal turnover flap. The purpose of this report is to present new idea to promote cosmetic result in treatment of accessory tragus containing the depression site. Methods: Two patients had a pair of accessory tragi at pretragal area. One was a common featured accessory tragus, but the other was different. Depression site was found around accessory tragus. After epidermis and cartilaginous tissue were removed from it, dermis component was used as turnover flap for reconstruction of depression site. Results: After accessory tragus was removed and depression site was reconstructed, facial contour and cosmetic result was achieved. Complication such as flap necrosis and wound dehiscence was not observed. Conclusion: The accessory tragus has variant morphology and degree of invasive depth. And some has a depression site around them. In those cases, simple surgical removal results in morphological distorsion and do not promote facial symmetry. The authors suggest dermal turnover flap as reconstruction method of the depression site. This method improves both surgical outcome and cosmetic result.

• Journal of Preventive Medicine and Public Health
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• 제39권5호
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• pp.427-432
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• 2006

Objectives: This study was to investigate if the dipstick proteinuria can predict cardiovascular mortality in a population of Korean men. Methods: We measured urine protein and other cardiovascular risk factors in 100059 Korean men, aged between 35-59 years in 1990 and 1992. Levels of proteinuria measured by dipstick method were trace or less, 1+, 2+, and 3+ or greater. The primary outcomes were deaths from all causes, cardiovascular disease, cancer, and others in a 12 year follow-up from 1993 to 2004. Results: The multivariate-adjusted relative risks (95% CI) for cardiovascular death according to the level of proteinuria (1+, 2+, 3+ and more) in 1990 examination were 2.18 (1.36-3.48), 2.55 (1.37-4.78), and 4.57 (2.16-9.66) respectively. The corresponding relative risks according to the level of proteinuria in 1992 examination were 2.49 (1.71-3.64), 2.64 (1.53-4.58), and 2.78 (1.15-6.73). The relative risks for cardiovascular death of men with proteinuria (1+ or greater) once and twice among the examinations were 2.18 (1.63-2.92) and 3.75 (2.27-6.18), compared with men without proteinuria in 1990 and 1992 examinations. Conclusions: Our results showed that dipstick proteinuria is associated with cardiovascular mortality in Korean men. Dipstick proteinuria could be a predictor for cardiovascular mortality.

• Archives of Plastic Surgery
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• 제33권5호
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• pp.676-679
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• 2006

Purpose: Breast volume is one of the crucial measurements in preoperative planning and postoperative evaluation of the results in mammoplasty. There are several methods suggested by different authors, but there is still no commonly accepted standard methods for measuring breast volume. To help the surgeons to base their estimation on an objective evaluation, we developed a simple method using Polyethylene bag and plaster molding. Methods: After Polyethylene bags were put in suitable size on both breasts of the patient in upright position, silk plaster was molded on the surface evenly. Then molds can be obtained after marking boundaries of breasts with a pen. Breast volume measurement can be done by filling water in the molds and measuring it. Moreover, postoperative design for natural skin brassier was possible using the molds. Results: This method was applied to 2 patients for reduction mammoplasty and the breast volume measurement was simple, hygienic and accurate, done within 10 minutes. Conclusion: This method using Polyethylene bag and plaster molding has several advantages. 1. It is comparatively accurate regardless of the size and shape of patient's breasts in upright position. 2. Measurement time is short and inconvenience and shame of patients can be reduced by making molds after putting on Polyethylene bags. 3. It is relatively economical and uses easily available hygienic materials. 4. The postoperative shape and volume of breasts can be predicted by using molds preoperatively.