• 의료법학
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• 제20권3호
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• pp.235-262
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• 2019

전통적으로 인류를 위협해 오던 감염성 질환이 줄어드는 반면, 심뇌혈관 질환을 포함하여 암, 당뇨와 같은 만성질환이 빠른 속도로 퍼져나가고 있다. 오랜 시간에 걸쳐 발병하며 증세가 장기간 지속되지만 치료가 어려운 만성질환의 특성을 반영, 그 위험요인의 관리와 이에 대응하는 건강증진정책의 마련은 세계 각국의 중요 관심사로 부상하게 되었다. 일차 의료 시스템이 점점 더 복잡한 형태로 변화하는 현대사회의 건강요구에 부합, 건강증진 및 질병 예방 정책, 지역사회에 대응 솔루션 등 이른바 환자 중심의 다 부문 접근방식을 제공하면서 변화된 의료 환경에서 일차 의료의 가치는 다시 한 번 부각 되고 있다. 기존의 의료전달체계로는 급속한 고령화 및 질병 패러다임의 변화, 삶의 질 향상을 향한 민중의 욕구를 감당하기 어려워지면서 유럽연합국가들은 지속적이며 포괄적이고 조정된 관리를 제공하는 일차 의료 시스템을 구축, 그 품질 향상을 위하여 다각적인 노력을 기울이고 있다. 본 논문은 우리나라 보건의료 전달체계의 현황 및 문제점 등을 검토하고, 일차 의료 강화와 관련된 유럽연합의 예를 중심으로 그 시사점을 도출, 환자 중심의 미래형 의료전달체계 구축 방안에 관하여 논의하고자 한다.

• 보건행정학회지
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• 제23권1호
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• pp.3-18
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• 2013

This paper investigates the possibility of expanding pay-for-performance (P4P) program as a provider payment system, in terms of financial, economical, and political sustainability. In order to expand the sustainable P4P, P4P should have usefulness in terms of economic value as well as efficiency in the financial aspects of health care. More importantly, the P4P would be politically sustainable only when both providers and consumers can accept. Korea's healthcare system seems to have logical ground for the P4P program financially and economically. However, how well the P4P can work remains to be proven in its implementation. After 43 tertiary hospitals applied the P4P program for acute myocardial infarction (AMI) and C-section in 2007, the number of hospitals adopting the P4P program for AMI and C-section has increased to 316 in 2011, and an incentive for hospitals applying the P4P has risen to 2% from 1% of health insurance benefits. This shows that the P4P program introduced by Health Insurance Review and Assessment Service is quite successful. In addition, people are aware of the need for improved P4P program and policy alternatives have been already made. Therefore, it is very important to come up with politically supportable strategies that can make providers and consumers accept the P4P program while maintaining the governance of the existing health insurance policy. To this end, there are some tasks to be considered. First, the expansion of the P4P program should be placed on the agenda of the Health Insurance Policy Review Committee, the highest decision-making body, and a separate agency for P4P planning should be established. Second, for more efficient P4P program, the processes of review and assessment, currently carried out separately, should be integrated into a single process. Third, infrastructure to measure the quality of medical services should be sharply expanded. Fourth, the current paradigm for the assessment should be changed. Lastly, a P4P program for consumers should be considered. Given that the consumers in Korea can use medical services freely, the National Health Insurance Corporation could initiate the P4P program for consumers as a means of controlling excessive use of medical services and adjusting consumer's moral hazard.

• 대한한방내과학회지
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• 제37권6호
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• pp.929-939
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• 2016

Objectives: Strokes have diverse symptoms and signs. One of ten stroke patients has chronic pain after a stroke. Pain after a stroke interrupts rehabilitation and worsens quality of life, but there is no efficient treatment for this pain. This study surveyed and reports on the clinical studies of treatment for chronic pain after a stroke. Methods: We searched journals for reports on clinical studies of treatment for chronic pain after a stroke through the databases OASIS (http://oasis.kiom.re.kr), NDSL (ndsl.kr), Kmbase (http://kmbase.medric.or.kr/), and PubMed (http://www. pubmed.com). The search words were "stroke & pain", "jungpung中風 & pain", "pungbi風痺", "cerebral hemorrhage & pain", and "cerebral infarction & pain". Results: Twenty-nine studies of treatment for chronic pain after a stroke were found. Of these, 15 were randomized controlled trials, 10 were nonrandomized controlled trials, and 4 were "before and after" studies. Treatments were diverse, including acupuncture, electroacupuncture, herbal acupuncture, herbal medicine, and more. The treatment periods were longer than 3 weeks on average. Conclusions: These results show that good quality randomized controlled trials of treatment for chronic pain after a stroke are small in number. We need larger and more diverse studies of treatment for chronic pain after a stroke.

• 성인간호학회지
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• 제13권4호
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• pp.571-580
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• 2001

"Journal of Korean Academy of Adult Nursing" has been published since 1989 and more than 330 articles have been published up 2000. We reviewed all the articles published in this journal to analyze the contents and trend of published articles and to find out the way of improvement both in quantity and quality of studies in this area. The results are as follows; 1) Ninety percent of articles were quantitative studies. Experimental design was used in 16.1% and quasi-experimental design was adapted in 73.6% of articles. Qualitative research were 10.3% of total articles reviewed. 2) Only 5.1% of articles described theoretical framework and 73.6% of experimentally designed articles included research hypotheses. 3) Among experimental studies, only one was true experimental studie design. Eighty nine point three persent had descriptive survey method among non-experimental studies. Amog the thirty four qualitative studies, phenomenologic(73.5%), grounded theory(14.7%), and ethnographic (11.8%) design were used. 4) Most of research subject were patients and few healthy people, healthcare worker, and patient family. 5) Psychosocial data collection method which used questionnaire were 53.7% and interview, physical measurement, observation were used in 22.8%, 8.2%, 5.4% of articles respectively. 6) Total number of keywords were 692, and average number of key words per article was 2.2. Health-related keyword was the most frequently used according to four metaparadigm of nursing (human, health, nursing, and environment). Environment related keyword was rarely appeared. The number and quality of nursing research in "Journal of Korean Academy of Adult Nursing" have been improved continuously. It is difficult to find out special trend or characteristics which is unique in this journal because of relatively short history of adult nursing studies. This review study was performed to analyze adult nursing studies only in the view of quantitative aspect, but it is needed to analyse qualitatively to find philosophical or theoretical trend in nursing.

• 인터넷정보학회논문지
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• 제15권5호
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• pp.107-121
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• 2014

분산 시스템은 물리적으로 분산된 컴퓨터들이 네트워크에 의해 유기적으로 연결된 것을 의미한다. 유무선 인터넷의 보편적인 사용으로 인해 사용자는 언제 어디서나 분산 서비스의 이용이 가능하게 되었다. 분산 서비스의 폭발적인 증가는 서비스의 기능적 측면에서의 검증뿐만 아니라 서비스 품질과 관련된 비기능적 요소의 검증도 강하게 요구하고 있다. 분산 서비스를 검증하기 위해서는 분산 시스템에 맞는 테스트 환경을 구축해야 한다. 하지만 분산 시스템은 물리적으로 분산된 노드로 구성되기 때문에 테스트 환경을 구축함에 있어서 단일 시스템의 테스트 환경보다 많은 노력이 요구된다. 이 논문에서 우리는 분산 시스템의 기능 및 비기능 요소의 검증을 위한 테스트 프레임워크를 제안한다. 제안하는 테스트 프레임워크는 메시지 시퀀스 차트(Message Sequence Chart)를 기반으로 테스트 케이스를 자동 생성하며, 물리적으로 분산된 노드를 흉내 낼 수 있는 가상의 분산 노드로 구성된 테스트 드라이버를 포함한다. 테스트 수행 결과는 다양한 그래프와 GUI를 통해서 쉽게 확인할 수 있다. 이 논문에서 제안하는 테스트 프레임워크를 통해 분산 시스템 테스트에 드는 노력을 감소할 수 있고 시스템의 신뢰성을 향상 시킬 수 있을 것이다.

• 한국조리학회지
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• 제18권4호
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• pp.47-58
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• 2012

본 연구는 부산지역 K대학교 학생들을 대상으로 식생활 라이프스타일유형에 따른 군집을 도출하고 각 집단과 외식선택속성과 비만도와의 차이를 고찰하고자 연구를 진행하였다. 연구의 목적을 달성하기 위하여 통계프로그램 PASW Statistic 18.0(Predictive Analytics Software)을 이용하여 빈도분석, 요인분석 및 신뢰도분석, t-test, ${\chi}^2$-test, 비 계층적 군집분석과 ANOVA을 실시하였다. 남자 대학생들의 평균키는 175.59 cm, 체중은 69.53kg이고, 여자 대학생들의 평균키는 162.81 cm, 체중은 53.42kg으로 나타내었다. 남학생 체질량지수를 저체중이 1.7%, 정상체중은 64.6%, 과체중 19.7%이고, 비만은 14.0%로 나타났다. 여학생 체질량지수는 저체중이 22.9%. 정상체중은 62.7%, 과체중이 8.5%, 비만은 5.9%를 나타내었다. 식생활라이프스타일 항목은 건강추구, 안전성추구, 분위기추구, 미각추구, 서양음식추구요인으로 추출되었고, 외식선택속성은 음식의 질과 서비스, 합리적인가격, 접근성과 분위기, 먹어본 경험 요인으로 추출되었다. 식생활라이프스타일은 군집1은 [식생활 무관심형 집단] 군집2는 [건강지향형 집단] 군집3은 [건강무관심형 집단]으로 군집 명을 부여하였다. 식생활라이프스타일 군집과 외식선택속성 요인간의 차이분석에서 군집1은 먹어본 경험에서 높은 평균값을 나타내었고, 군집2는 음식과 서비스의 질에서 높은 평균값을 나타내었고, 군집3은 접근선과 이미지에서 높은 평균값을 나타내었다.

• 한국의료질향상학회지
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• 제9권2호
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• pp.116-133
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• 2002

Background : It is very common in Korea to take care of non-acute patients in an acute setting, due to the lack of long-term facilities. Long term hospitalization increase medical expenses and decreases the bed utilization, which can affect the urgent and emergent admissions, and eventually jeopardize the hospital financially. In this study, strategies for effective transfers to the lower levels of care, and to decrease the length of stay were presented by surveying and analyzing the patient's knowledge of the transfer needs, and the willingness to transfer those whose hospital length of stay was more than 30days. Method : The survey is subject to a group of 251 patients who have been hospitalized over 30 days in a general hospital in Seoul. Excluding those that were in the Intensive Care Unit and psychiatric ward, 214 in-patients were used as participants. They were surveyed from April 9, 2002 to April 17, 2002. One hundred and thirty seven out of 214 were responded which made the response rate 64%. Data were analyzed by SAS and SPSS. Result : Multi-variable Logistic Regression Analysis showed a significant effect in medical expenses, knowledge of referral system and the information of the receiving hospital. The financial burden in medical expenses made the patient 10.7 times more willing to be transferred, knowledge of the referral system made them 5 times more willing to be transferred, and the information of receiving hospital makes 6.5 times more willing to be transferred. Reasons for willing to be transferred to a lower level of care were the phase of physical therapy, the distance from home, the attending physician's advice and being unable to be treated as an out patient. Reasons for refusing to be transferred were the following. The attending physician's competency, not being ready to be discharged, not trusting the receiving hospital's competency due to the lack of information, or never hearing about the referring system by the attending physician. Conclusion : Based on this, strategies for the effective transfer to the lower levels of care were suggested. It is desirable for the attending physician to be actively involved by making an effort to explain the transfer need, and referring to the Healthcare Coordinating Center, which can help the patient make the right decision. Nationwide networking for the referral system is the another key factor that may need to be suggested as an alternative to decrease the medical expenses. Collaborating with the Home Health Agency for the early discharge planning and the Social Service Department for financial aid are also needed. It is recommended that the hospital should expedite the transfer process by prioritizing the cost and the information as medical expenses, knowledge of referring system and the information of the receiving hospital, are the most important factors to the willingness to transfer to a lower level of care.

• 전기학회논문지
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• 제62권6호
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• pp.803-810
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• 2013

The purpose of this research is to analyze the effect of shape of the inductive textile electrode on the non-contact heart activity sensing, based on the magnetic-induced conductivity principle. Four types of the inductive textile electrodes were determined according to the combinations of the two shape features. A fiber-metal hybrid-typed conductive thread was developed and applied to materialization of the textile electrodes by embroidery method. The heart activity was extracted through the textile electrode sewn on a T-shirt. The experiments were implemented to constantly measure the heart activity for 20 seconds, in each case of 5 healthy male subjects. The heart activity signals acquired in each type of the inductive textile electrode were analyzed, 1)by drawing a comparison of morphology with those of ECG signal (LeadII), and 2)by calculation of the normalized mean and standard deviation of magnitude of the heart activity signals. The analysis resulted that the relatively better quality of signals were acquired in the 'square' types in the matter of whole shape, while the better results were obtained in 'donut' types in the matter of center hole. Accordingly, the relatively best quality of signals was obtained in the case of 'Square-Donut' type of the inductive textile electrode.

• 융합신호처리학회논문지
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• 제20권1호
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• pp.16-23
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• 2019

PM 2.5로 불리는 초미세먼지는 인간의 건강을 해치는 2.5 ㎛ 이하 직경의 입자크기를 갖는 공기 중의 미세먼지를 말하며, 미세먼지 집중도는 공기 질 정보로 사용할 수 있다. 사람은 일반적으로 90% 이상을 실내에서 거주하며 실내에 대한 공식적인 먼지 집중도 자료는 제공되지 않기 때문에, 본 연구는 실내의 관점에서 공기 질 측정에 초점을 두었다. 실내 먼지데이터 모니터링은 병원과 같은 환경에서 매우 중요할 뿐만 아니라 교실, 시멘트 공장, 컴퓨터 서버 룸, 석유화학 저장고 등의 장소에서도 유용하게 사용할 수 있다. 본 논문에서는 전자기파로부터 자유로운 실내 먼지 모니터링을 위해 맨체스터 코딩기법을 이용한 가시광 통신 시스템을 제안한다. 넓은 범위의 먼지 집중도를 포함한 중요한 실내 환경정보가 가시광 채널을 통해 전송된다. 강력한 주변광 및 저주파 잡음 제거를 위해 평균전압트레킹 기법을 사용한다. 입력광은 광다이오드에 의해 수신되고, 동시에 수신 마이크로콘트롤러에 의해 신호처리 한다. 사용자는 실시간으로 실내 공기 질 정보를 모니터링 할 수 있으며, 공기 질 정보에 따라 미리 적합한 대처를 할 수 있다.

• 대한임상검사과학회지
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• 제37권3호
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• pp.178-184
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• 2005

Carry over contamination has been reduced in some systems by flushing the internal and external surfaces of the sample probe with copious amount of diluent. It between specimens should be kept as small as possible. A built-in, continuous-flow wash reservoir, which allows the simultaneous washing of the interior and exterior of the syringe needles, addresses this issue. In addition, residual contamination can further be prevented through the use of efficient needle rinsing procedures. In discrete systems with disposable reaction vessels and measuring cuvets, any carry over is entirely caused by the pipetting system. In analyzers with reuseable cuvets or flow cells, carry over may arise at every point through which high samples pass sequentially. Therefore, disposable sample probe tips can eliminate both the contamination of one sample by another inside the probe and the carry over of in specimen into the specimen in the cup. The results of the applicative carry over experiment studied on 21 items for total protein (TP), albumin (ALB), total bilirubin (TB), alkaline phosphatase (ALP), aspratate aminotranferase (AST), alanine aminotranferase (ALT), gamma glutamyl transferase (GGT), creatinine kinase (CK), lactic dehydrogenase (LD), creatnine (CRE), blood urea nitrogen (BUN), uric acid (UA), total cholesterol (TC), triglyceride (TG), glucose (GLU), amylase (AMY), calcium (CA), inorganic phosphorus (IP), sodium (Na), potassium (K), chloride (CL) tests in chematology were as follows. Evaluation of process performance less than 1% in all tests was very good, but a percentage of ALB, TP, TB, ALP, CRE, UA, TC, GLU, AMY, IP, K, Na, and CL was 0%, implying no carry over. Other tests were ALT(-0.08%), GGT(-0.09%), CK(0.08%), LD(0.06%), BUN(0.12%), TG (-0.06%), and CA(0.89%).