• 유통과학연구
• /
• 제13권12호
• /
• pp.41-52
• /
• 2015

Purpose - Given globalization, the new niche market of medical tourism is likely to experience sustainable growth for various reasons, such as aging populations and a shift in the medical consumerism paradigm toward prevention. Importantly, understanding medical customers' behavior is necessary to benefit from a competitive advantage in this industry. The existing research primarily accessed the key factors of medical quality and costs to explain health customers' behavior but is limited in terms of enabling an understanding of the decision process. This limitation exists because, given the intangibility and greater associated risks in the highly professional industry of international medical tourism, most customers lack the knowledge and experience needed to evaluate the central factors-such as the medical competence of health care countries-before purchases. Therefore, they actively search for useful information through various distributions to reduce uncertainty and to make better choices. Interestingly, most of these information channels are associated with word-of-mouth (WOM). However, no evidence is found in the literature to estimate the effect of WOM in the medical tourism field. Thus, this study focuses on WOM to explore its interaction with key medical characteristic factors and the attractiveness of destinations referred to by sources. This study also affects customers' evaluations and, in turn, influences their intention to seek health care services abroad. Research design, data, and methodology - The literature review addressed an interesting research model for estimating the relations among WOM, medical characteristics, attractiveness, and customers' choice intention regarding international health care. In the key economic regions in China, such as Beijing, Shanghai, Jiangsu, Shandong, and Guangdong, 2,500 survey questionnaires were distributed to potential customers of different ages, education, and income levels. A resulting 1,717 (68.68 percent of the original 2,500) usable surveys were obtained for analysis. Moderated regression analysis was used to determine the effects of WOM in the decision process regarding international health care destinations. Results - The results indicate that WOM is a good moderator of the relationships between the factors evaluated by sources and customers. More importantly, the WOM effects reflect the factors of tie strength, credibility, and vividness. The results also reveal that, given the moderating role of WOM, the intention of potential Chinese customers to seek the referred health care country varies according to the medical characteristics of medical competency and reputation as evaluated by customers. In contrast, the travel attractiveness of the attractions, facilities, accessibility, and social environment are critical determinants of destination choice intention. Conclusions - The moderating role of WOM has been confirmed through the international healthcare destination selection process. Medical tourism managers should user WOM as an effective marketing tool for industry development. Specially, marketers should consider the effects of WOM determinants, such as tie strength, credibility, and vividness, to develop an effective strategy. Furthermore, this study estimates the factors that affect customers' selection of medical tourism destinations. Health care managers or policy makers should consider a broad variety of variables that may attract more Chinese customers to international health care.

• 모자간호학회지
• /
• 제4권1호
• /
• pp.3-11
• /
• 1994

Presently there is an increasing demand for home health care services due to changes in the demographic structure as a result of an increasing elderly population, socio-economic improvements, and changes in the family structure, as well as the growing number of people with degenerative diseases. In addition to these reasons, rising medical costs and there a shortage of patient beds space in the hospital, particularly since introduction of national medical insurance. There has been an increasing demand for health care health care services. This study was done to identify the basic data for home health care management. It focused on developing client selection criteria, assessment tools, and recording methods. This was accomplished by the researchers visiting the patients in their homes. The research process included preparation investigation, tool development, training of the project researcher, and visiting the clients in their homes. The research tools are as follows : 1. Record development : a) The selection criteria tool for home health care of postpartum women was a structured tool and consisted of four parts. b) The structured assessment tool consisted of a general items, obstetric history, past medical history, methods of feeding, medications taken before admission, laboratory test results, discharge instructions, discharge medications, family tree, economic status, environmental status, a map, health assessment of postpartum women and their newborns. c) The visit note I consisted of the frequency of visits. Visit note II consisted of the date ; nursing problems ; nursing process including the initial assessment ; nursing goal ; visit plan ; postpartum women and their neonate health status, diagnosis, goal, implementation, evaluation, summary, next plan, for visit revision. d) Problem note consisted of the date, problem numbers, nursing diagnosis, problem appearance date problem resolution date. The research results are as follows : 1. Nursing problems : The nursing problems of the postpartum women and their neonates were evaluated by the number of nursing diagnoses and the change in the pattern of nursing diagnosis related to the number of visits. a) Nursing diagnosis The nursing diagnosis was classified according to physical function, psychosocial function, family system maintained function. b) The changes of nursing diagnosis related to the number of visits. As the type of nursing diagnosis changed related to the number of visits the number of nursing diagnoses decreased. 2. Contents of home health care : The content was categorized according to assessment, direct care, counseling, education, family care, reporting to with the attending doctor. The recommendations based on the research results are as follows : 1. Tool development Replication of this study is needed to test the validity of the assessment tools used. 2. Home visit a) Home health care nurses should be licensed and qualified. A referral form from the attending doctor is needed for legal protection of nurses. b) The first home visit need to be within 24 hours of discharge from the hospital to decrease the anxiety of frightened postpartum women. c) When the changes occur in the newborn's status, home health care nurses should consult a pediatrician. Communication within the home healthcare team is essential and needs to consistent and done smoothly. 3. Home health care A Study is required to develop protocols for education of staff and for operation of all aspects of this program.

• Asian Spine Journal
• /
• 제12권6호
• /
• pp.1010-1016
• /
• 2018

Study Design: Retrospective cohort study. Purpose: To report on spinal fusion assessment using computed tomography (CT) after adult spinal deformity (ASD) surgery using ultra-low dose recombinant human bone morphogenetic protein 2 (RhBMP-2). Overview of Literature: The reported dose of RhBMP-2 needed for successful spinal posterolateral fusion in ASD ranges from 10 to 20 mg per spinal level. This study reports the use of ultra-low dose of RhBMP-2 (0.07 mg per facet) to achieve spinal fusion in multilevel ASD surgery. Methods: Consecutive patients who underwent ASD surgery using ultra-low dose RhBMP-2 were recruited. Routine postoperative CT analysis for spinal fusion was performed by two spine surgeons. Inter-observer agreement was calculated for facet fusion (FF) and interbody fusion (IBF) at 6 and 12 months after the procedure. Results: Six consecutive ASD patients with a mean age of 62 years (28-72 years) were examined. Each patient received a total dose of 12 mg with an average dose of $0.69{\pm}0.2mg$ (0.42-1 mg) per single FF and $1.38{\pm}0.44mg$ (0.85-2 mg) for IBF. Total 131 FF and 15 IBF were examined in the study, with 88 FFs and nine IBFs being analyzed specifically at 6 months after the surgery. FF and IBF reported by surgeons A and B at 6 months were 97.7% vs. 91.9% FF, respectively (${\kappa}=0.95$) and 100% vs. 100% IBF, respectively (${\kappa}=1$). Two patients underwent longitudinal follow-up CT at 12 months, and the FF rates reported by surgeons A and B were 100% vs. 95.8%, respectively (${\kappa}=0.96$). Five out of nine facet (56%) non-unions were identified at the cross-links. The remaining four facet pseudarthrosis were noted at 1-2 spinal levels caudal to the cross-links. At the final clinical follow-up, there was no rod breakage, deformity progression, neurological deficit, or symptom recurrence. The Oswestry Disability Index improved by an average of $32.8{\pm}6.3$, while the mental component summary of the 36-item Short-Form Health Survey improved by an average of $4.7{\pm}2.1$, and physical component summary improved by an average of $10.5{\pm}2.1$. Conclusions: To our knowledge, this is the first study to report a CT that defined 92%-98% FF and 100% IBF using the lowest reported dose of RhBMP-2 in multilevel ASD surgery. The use of ultra-low dose RhBMP-2 reduces the RhBMP-2 related complications and healthcare costs.

• 융합정보논문지
• /
• 제9권4호
• /
• pp.1-7
• /
• 2019

의료환경이 IT기술과 접목되어 의료 서비스에 대한 패러다임이 치료에서 예방으로 변화하고 있다. 특히, ICT 융 복합 디지털 헬스케어 기술이 병원 의료 시스템에 접목되면서 빅데이터, 사물인터넷, 인공지능과 같은 기반기술이 클라우드와 함께 사용되고 있다. 특히, 의료 서비스가 IT 기기와 함께 사용되면서 의료 서비스는 점점 더 사용자가 손쉽게 접근할 수 있도록 의료 서비스의 품질이 향상되고 있다. 클라우드 의료 환경 서비스에 IoT 서비스를 접목하려는 의료기관들은 병원 운영 비용 절감 및 서비스 품질 개선을 위해서 노력은 하고 있지만 아직 완벽하게 지원되지는 못하고 있는 상황이다. 본 논문에서는 클라우드 환경을 구축한 병원 IoT 시스템에서의 환자 정보 수집모델을 제안한다. 제안 모델에서는 병원 IoT 시스템을 구축한 클라우드 환경의 병원에서 환자의 질병 정보를 환자신체에 부착된 IoT 장치를 통해서 제3자가 환자의 생체 정보를 불법적으로 도청 및 간섭하는 것을 예방한다. 제안 모델에서는 병원을 방문하는 환자들의 식습관과 관련하여 발생되는 질병을 IoT 장치를 통해 수집하여 치료받을 수 있도록 의료진이 환자의 질병 정보를 분석하도록 한다. 분석된 질병 정보는 환자의 질병 정도에 따라 처방과 관리를 손쉽게 처리하도록 병원 업무를 최소화한다.

• Journal of Nutrition and Health
• /
• 제56권1호
• /
• pp.24-34
• /
• 2023

상지 물추출물의 투여는 STZ 유도 당뇨 마우스의 공복 혈당, 혈중 총 CHO, LDL-CHO, 간 무게 및 간 조직 TG를 NC군 수준으로 감소시키고 혈장 총 CHO대비 HDL-CHO비는 NC군 수준으로 증가시켰으며, 소장 proximal region의 이당류 분해효소인 lactase, sucrase 활성을 억제하였다. 이는 상지를 차로 우려내어 음용할 경우 당뇨 예방 및 증상 개선의 가능성을 기대해 볼 수 있음을 제시한다. 상지는 국내산 뽕나무 부산물로 대량 생산될 뿐만 아니라 식품의 원료로 사용이 가능한 소재이므로 향후 상지 물추출물의 생리활성성분 분리 및 혈당조절기전 연구를 보다 깊이 수행한다면 안전하고 효과적인 고부가가치 혈당조절 기능성식품 개발의 기초자료로 활용될 수 있을 것이다.

• Korean Circulation Journal
• /
• 제53권12호
• /
• pp.829-839
• /
• 2023

Background and Objectives: There is limited data on the impact of type 2 myocardial infarction (T2MI) during the coronavirus disease 2019 (COVID-19) pandemic. Methods: The National Inpatient Sample (NIS) database from January 2019 to December 2020 was queried to identify T2MI hospitalizations based on the appropriate International Classification of Disease, Tenth Revision-Clinical Modification codes. Monthly trends of COVID-19 and T2MI hospitalizations were evaluated using Joinpoint regression analysis. In addition, the multivariate logistic and linear regression analysis was used to compare inhospital mortality, coronary angiography use, and resource utilization between 2019 and 2020. Results: A total of 743,535 patients hospitalized with a diagnosis of T2MI were identified in the years 2019 (n=331,180) and 2020 (n=412,355). There was an increasing trend in T2MI hospitalizations throughout the study period corresponding to the increase in COVID-19 hospitalizations in 2020. The adjusted odds of in-hospital mortality associated with T2MI hospitalizations were significantly higher in 2020 compared with 2019 (11.1% vs. 8.1%: adjusted odds ratio, 1.19 [1.13-1.26]; p<0.01). In addition, T2MI hospitalizations were associated with lower odds of coronary angiography and higher total hospitalization charges, with no difference in the length of stay in 2020 compared with 2019. Conclusions: We found a significant increase in T2MI hospitalizations with higher in-hospital mortality, total hospitalization costs, and lower coronary angiography use during the early COVID-19 pandemic corresponding to the trends in the rise of COVID-19 hospitalizations. Further research into the factors associated with increased mortality can increase our preparedness for future pandemics.

• 보건행정학회지
• /
• 제34권1호
• /
• pp.48-58
• /
• 2024

연구배경: 이 연구는 충청남도 지역 및 환자의 특성과 관외 의료기관 이용과의 연관성을 분석한 연구이다. 충청남도 지역에 거주하는 입원 및 외래 환자들을 통해 도내 진료권을 분석하고, 수도권 및 대전권 의료기관에 대한 관외 의료이용 양상을 파악하여 도내 의료전달체계 개선 및 건강보험 재정 안정 도모를 위한 충청남도 의료정책 사업의 근거적 자료 제공을 목적으로 한다. 방법: 이 연구는 건강보험 코호트 DB 2.0 2016-2019년 자료를 활용하였다. 수집된 원시 자료 중 환자의 거주지가 충청남도 지역이면서, 이용한 요양기관이 상급종합, 종합병원, 병원, 의원인 환자로 한정하였고, 최종적으로 2,570,439건(입원=43,309, 외래=2,527,130)의 자료를 추출하였다. 먼저, 분석대상자의 일반적 특성을 파악하기 위해 각 변수별로 기술통계를 실시하였고, 충청남도 지역 및 환자의 특성과 관외 의료기관 이용과의 연관성을 파악하기 위해 다변량 로지스틱 회귀분석 및 다항 로지스틱 회귀분석을 실시하였다. 또한 관외 의료기관 이용에 따른 입원 및 외래 환자의 진료 1건당 의료비 차이를 파악하기 위해 심사결정 후 건강보험 총요양급여비용을 자연로그값으로 변환하여 분석하였다. 결과: 분석결과, 충청남도 지역 거주 환자들은 충남권, 대전권, 수도권 순으로 의료기관을 많이 이용하였고, 입원 및 외래 환자 모두 천안, 아산 거주 환자들에 비해 모든 권역에서 관외 의료기관을 더 많이 이용하였다. 특히 공주, 부여, 천안(odds ratio [OR], 72.931) 및 계룡, 논산, 금산(OR, 116.817) 거주 입원 환자는 대전권 의료기관 이용과 매우 높은 연관성을 나타냈다. 또한 충청남도 지역 거주 환자들은 충남권 의료기관에 비해 수도권(외래=17.01%, 입원=22.11%)과 대전권(외래=16.63%, 입원=15.41%) 의료기관에서 더 많은 의료비를 지불하였다. 결론: 이 연구는 충청남도 지역 거주 환자들의 관외 의료이용 양상을 분석하고 관련 시사점을 제공하였다. 향후 지역 의료기관과 서비스에 대한 신뢰도 및 만족도와 환자의 주진단과 같은 요인들을 고려한 연구가 추가적으로 진행되어야 하며, 연구결과를 바탕으로 합리적인 의료의 지역화와 의료공급 효율성 및 건강보험 재정 건정성 확보를 위한 정책사업의 기초 자료로 활용되기를 고대한다.

• 의료법학
• /
• 제18권1호
• /
• pp.297-341
• /
• 2017

2016년에 선고된 의료관련 판결들을 법원도서관 검색사이트와 법률전문기사를 통해 검색하여 다음과 같이 분석 소개하였다. 의료민사와 관련하여 (1) 제왕절개 수술 시 불임수술도 함께 청약하였으나 불임수술은 하지 아니한 사례에서는 의료계약체결과정에 판시의 결여에 대한 아쉬움과 함께 침해되는 권리 및 배상범위를, (2) 의료과실 추정 관련에서는 과실추정법리의 한계를 벗어난다는 점과 한의사의 협진의무를 매우 높은 정도로 요구했다는 점을, (3) 병원측 책임을 100% 인정한 사건에서는 의료행위의 선의성과 불확실성에 대한 간과를 지적하면서, (4) 정신과 환자 관련 사고에서 병원책임을 인정한 사건들을 관련판결과 함께 소개하였다. 의료형사와 관련해서는 치과의사의 안면 보톡스 시술이 면허범위 내 의료행위인지 여부에 대한 대법원 전원합의체 판결을 다수의견의 해석이 법문언의 가능한 범위 내에 있는지의 관점에서 분석하였다. 그리고 의료행정과 관련하여 (1) 의료인이 다중으로 의료기관을 운영한 경우 이에 대하여 국민건강보험법상 환수처분을 할 수 있는지 여부를 다중으로 운영된 의료기관이 의료법에 따라 개설된 의료기관에 해당하는지의 관점에서 분석하고, (2) 임의비급여진료 동의의 전제로서 설명의무에 관한 판결을 설명의 대상, 정도, 주체의 면에서 검토하였다. 마지막으로 정신질환자 보호입원 사건에서 제청된 보호의무자 2인의 동의와 정신건강의학과전문의 1인의 진단에 의하여 정신질환자를 입원시킬 수 있도록 한 정신보건법 제24조에 대하여 위헌법률심판결정에 대해 소개하면서 개정된 정신보건법에 대한 문제점을 아울러 제시하였다.

• 마케팅과학연구
• /
• 제20권2호
• /
• pp.199-207
• /
• 2010

"对我们而言, 成为一名负责的公民和一份成功的事业之间没有区别.....他们对今天的沃尔玛是完全一样的." Lee Scott, 沃尔玛的CEO在2005年卡崔琳娜飓风灾难之后(Esty and Winston 2006) Lee Scott的声明标志着可持续发展的一个新的时代. 作为一个被全球生产商和零售商所关注的全世界最大规模的经销商确认了他们的可持续发展的意图. 近十年来, 环保运动不断增长, 并扩展到全世界. 公司已经诞生, 产品已被创造, 学术期刊 已经展开, 政府已经承诺—所有这一切都在追求可持续发展(Peattie and Crane 2005). 虽然进展的确比一些人渴望的慢了一些, 但是很多大规模的经销商已经为环保做出了可持续发展的努力. 为了更好的理解这个运动我们同时提供高管和消费者参与的有包装的消费品产业的角度. 该研究依赖于三个潜在主题: (1)概念和证据表明,公司为很多理由进行可持续发展 (2)在有包装的消费品行业中, 可持续发展活动的数量在持续增长 (3), 因此, 必须探索可持续发展在消费者意识中起的作用. 根据这些主题, 143名大学生和101名企业高管参加了调查来评估一系列的有关可持续发展的变量包括愿意支付, 行为意图, 态度和偏好. 结果显示高层管理者相信可持续发展的三个最主要的原因是(1)盈利能力的机会; (2)以实现对环境的义务; (3)对顾客和股东负责. 大学生的三大原因: (1)对环境的责任; (2)为子孙后代负责, 和(3):一种有效的管理资源. 虽然企业高管和大学生对支持可持续发展的理由不同, 但是企业高管和消费者的报告显示了对剩下大部分的可持续发展问题的相似性. 另外, 当我们要求消费者去评估6个关键问题的重要性时(医疗保健, 经济, 教育, 犯罪, 政府支出, 和环境), 保护环境仅排在第四位(Carlson 2005). 这6个问题都被认为是重要的, 三个最重要的是(1)改善教育;(2)本地区的经济发展,以及(3)卫生保健. 为了可持续发展的持续性, 我们也将预期结果. 反映社会, 企业利益表现的新定义和执行期的延长同样被揭示出来(Ehrenfeld 2005; Hitchcock and Willard 2006). 基于文献我们发现了三个基本范畴的结果:(1)改进组成的满意度, (2)分化的机会, 以及(3)金融奖励. 在每一种分类中, 我们发现从可持续发展活动中导致11种不同结果的几个特定的结果. 我们的调查结果表明,最有可能的结果最高的前五项依序为公司的可持续发展追求的是:(1)绿色的消费者将会更令人满意;(2)公司形象会更好, (3)公司的责任将得到加强, (4)会降低能源成本;(5)产品将会更多的创新. 另外, 为更好的理解消费者的环境 "身份" 和在市场购买中愿意显示出这个 "身份" 的有趣的交集, 我们扩展了以前Experian Research(2008) 的研究. 因此,受访者分为四个不同类型的绿色消费者(行为绿色,想法绿色, 潜在绿色, 或真正褐色)来获得更好的理解绿色消费者. 我们评估这些消费者愿意从事环保行为评估三种选择. (1)购物零售商支持环保措施;(2)支付更多来保护环境, 以及(3)支付更高的税收,政府可以支持环保措施. 想法绿色消费者表示最愿意改变, 紧随其后的是行为绿色消费者, 潜在绿色消费者和褐色消费者. 这些差异都是显著的(p<.01). 结论和启示我们采用描述性研究, 旨在促进我们理解战略领域的可持续性. 确切地说, 该研究以特定的偏好, 意图, 愿意支付, 行为和态度填补了进行比较与对比的持续性的商业管理者和消费者意见的文献的空白, 对从业人员, 能获得一个战略观点. 此外, 许多结果已经说明, 受访者愿意为产品付出更多来保护环境. 其他特定的结果表明, 女性受访者始终比男性强愿意交流, 为这些产品付更多的钱, 在环保的零售商. 了解这些额外的信息, 实践者现在有了更多的特定市场, 对目标和交流他们为可持续发展所做出的努力. 虽然这项研究仅仅是最初的一步了解实践者和消费者对于可持续发展的异同, 我们的结果对实践与研究都有帮助. 未来的研究应向测试其他变量的影响关系, 以及其他特殊行业.