• Asian Pacific Journal of Cancer Prevention
• /
• 제15권20호
• /
• pp.9033-9038
• /
• 2014

Background: The purpose of this study was to assess the feasibility of deep inspiration breath-hold (DIBH) based volumetric modulated arc therapy (VMAT) for locally advanced left sided breast cancer patients undergoing radical mastectomy. DIBH immobilizes the tumor bed providing dosimetric benefits over free breathing (FB). Materials and Methods: Ten left sided post mastectomy patients were immobilized in a supine position with both the arms lifted above the head on a hemi-body vaclock. Two thermoplastic masks were prepared for each patient, one for normal free breathing and a second made with breath-hold to maintain reproducibility. DIBH CT scans were performed in the prospective mode of the Varian real time position management (RPM) system. The planning target volume (PTV) included the left chest wall and supraclavicular nodes and PTV prescription dose was 5000cGy in 25 fractions. DIBH-3DCRT planning was performed with the single iso-centre technique using a 6MV photon beam and the field-in-field technique. VMAT plans for FB and DIBH contained two partial arcs ($179^{\circ}-300^{\circ}CCW/CW$). Dose volume histograms of PTV and OAR's were analyzed for DIBH-VMAT, FB-VMAT and DIBH-3DCRT. In DIBH mode daily orthogonal ($0^{\circ}$ and $90^{\circ}$) KV images were taken to determine the setup variability and weekly twice CBCT to verify gating threshold level reproducibility. Results: DIBH-VMAT reduced the lung and heart dose compared to FB-VMAT, while maintaining similar PTV coverage. The mean heart $V_{30Gy}$ was $2.3%{\pm}2.7$, $5.1%{\pm}3.2$ and $3.3%{\pm}7.2$ and for left lung $V_{20Gy}$ was $18.57%{\pm}2.9$, $21.7%{\pm}3.9$ and $23.5%{\pm}5.1$ for DIBH-VMAT, FB-VMAT and DIBH-3DCRT respectively. Conclusions: DIBH-VMAT significantly reduced the heart and lung dose for left side chest wall patients compared to FB-VMAT. PTV conformity index, homogeneity index, ipsilateral lung dose and heart dose were better for DIBH-VMAT compared to DIBH-3DCRT. However, contralateral lung and breast volumes exposed to low doses were increased with DIBH-VMAT.

• 대한관절경학회지
• /
• 제9권1호
• /
• pp.40-45
• /
• 2005

목적: 본 연구의 목적은 내측 반월상 연골 후방 골 기시부 파열 환자의 임상적 특징과 골 기시부 봉합술 및 그 임상 결과를 알아보고자 한다. 대상 및 방법 2003년 9월부터 2004년 8월까지 본원에서 내측 반월상 연골 후방 골 기시부 파열로 진단받은 환자 27명을 대상으로 하였고 이 중 23명은 봉합술을 시행하였다. 평균 연령은 60.2세였다. 봉합술은 골 기시부 처리시 전외측 창을 이용한 1군(14예)과 후내측 창을 함께 이용한 2군(9예)으로 나누었다. 동반된 관절 연골 손상은 ICRS system을, 술 후 임상결과는 Lvsholm Knee Score를 이용하였다. 결과: 최종 추시상 Lysholm Knee Score는 1군이 77.1점(범위; $58{\sim}97$점), 2군이 81.4점(범위; $72{\sim}94$점)이었다(p>0.05). 봉합술이 실패한 경우는 23예 중 4예였다. 1군은 3예로 반월상 연골 부분 절제술로 치료하였으며 2군은 1예로 장력이 소실되었으나 관찰 중이다. 관절연골 병변은 20예에서 체중 부하 부위에 있었고 Outerbridge 분류상 III기 8예, IV기 5예였다. 결론: 내측 만월상 연골 골 기시부 파열에서 pull-out 봉합술이 원주 테 장력을 복원하고 관절염을 예방하는 데 유용한 치료라고 사료된다.

• 한국병원경영학회지
• /
• 제16권4호
• /
• pp.35-66
• /
• 2011

This study analyzed efficiency by utilizing DEA analytical technique centering on materials for 2009 of 20 major university hospitals in capital area. Input variables were utilized professor & full-time doctor, resident, nurse & number of bed hospitals. Output variables were analyzed by dividing number of annual outpatients & number of annual inpatients, and annually total outpatient profit & inpatient profit into a model of the standard for number of patients and the standard for medical profit. DEA analysis was elicited efficiency score by applying CCR, BCC, BFG, scale profit, and SE model. Through t-test after eliciting efficiency score, the implications were suggested by comparing efficiency between DMU in Seoul and DMU in capital area, by comparing between high-class general hospitals and general hospitals, and by comparing between high-class general hospitals in Seoul and 5 big hospitals. As a result of analysis, the major university hospitals in capital area showed high efficiency as a whole close to "1," but indicated low efficiency relatively in CCR field. Thus, the expansion in scale within capital area was indicated to reach the limit. Second, in a model of analyzing the standard for number of patients, the medical institutions, which are being operated efficiently, were indicated to be 10 DMUs. In the standard for medical profit, 12 DMUs were analyzed to be operated efficiently. Third, the efficiency in general hospital was higher than high-class general hospital. Thus, the efficiency of operation was indicated to be more important than scale. Also, large high-class hospitals(big 5) where are located in downtown Seoul showed the higher efficiency than other general high-class general hospitals, but were indicating very low efficiency in some DMUs. Fourth, as a result of generalizing and evaluating the number of patients and the medical profit, the efficient DMU was indicated to be more when analyzing on the basis of medical profit than the standard for number of patients. Thus, major university hospitals in capital area were indicated to make more effort for section in medical profit. Based on the analytical results of efficiency, a strategy for reinforcing efficiency in inefficient DMU was indicated to be needed a strategy of creating customers for promoting number of patients and a strategy for making operation efficient for increasing profitability.

• 한국병원경영학회지
• /
• 제12권3호
• /
• pp.47-67
• /
• 2007

This paper aims at suggesting several ways lo change financial vulnerability and to improve managerial capability of local public hospitals (LPHs) in Korea through the identification of factors affecting profitability. Several findings of the research are as follows: To begin with, LPHs exhibited a statistically significant difference in their profitability from one another, according to tile analyses of their profitable margins from tile general characteristics. It depends on the number of hospitals in the area, the population of the hospital-built area, the number of competing hospitals, the number of staff per 100 beds, the opening of special clinic, the educational function, and the capacity of rooms. However, there was no variable in the managerial characteristics, presenting a significant difference, in contrast with hospitals which have been managed by private companies and made a great amount of profits. Second, according to the analyses of profit differences in behavioral effort-characteristics, a statistically significant difference was revealed upon the basis of the efforts to improve the clinic service, invite special patients, and shorten the period of being hospitalized. Third, the result of analyses about the difference of profitability from medical care and finance is statistically significant in the rate of labor cost, the rate of management cost, bed-occupancy rate, and the period of being hospitalized. Fourth, according to the analyses of the factors influencing the net profit ratio of the entire capital, Adjusted explanatory power(Adjusted $R^2$) was shown up to 65.2%, which is high. To compare the adjusted explanatory power stage by stage, the first stage model applying only two variables such as structural and strategic characteristics exhibited 23.8%, and the second stage model adding financial characteristics showed 51.5%. The explanatory power was much improved up to 65.2% when the third stage model incorporated the outcome of medical care performance. When the return on investment(ROI) was examined by using the multi-variate linear regression analysis at the final model of third stage, it was found that ROI had a positive relationship with the increase rate of patients, labor costs per doctor, and medical care rate of socially protected inpatients. However, it revealed that ROI had a negative relationship with the ratio of labor costs, the number of patients per managerial staff, and occupancy rate of rooms, respectively. The research suggests that in order for LPHs to increase profitability, LPH, should make efforts not only to attract patients to the hospitals without any discrimination of the patients depending on their financial status, but also to develop efficient management methods to reduce labor costs.

• Radiation Oncology Journal
• /
• 제20권4호
• /
• pp.334-342
• /
• 2002

목적 : 본 연구는 AJCC 병기 II기와 III기의 국소진행성 직장암으로 근치적 절제술을 받은 환자들을 대상으로 각 병기에서 보조 화학요법 단독에 비해 화학방사선 병행요법이 생존율 및 무병생존율을 향상시키는지에 대하여 알아보고자 하였다. 대상 및 방법 : 1989년 1월부터 1999년 12월까지 AJCC 병기 II기와 III기의 직장암으로 근치적 절제술이 시행된 144명을 대상으로 하였다. 그 중 보조 치료방법에 따라 분류를 하면 화학요법 단독군이 72명이었고, 화학방사선 병행요법군은 72명이었다. 화학요법은 수술 후 UFT를 매일 경구복용하거나(중앙값 12개월) 5-FU를 기초로 한 항암제를 4주 간격으로 정맥주사하였고, 투여기간은 $1\~18$차례(중앙값 6차례)이였다. 방사선치료는 직장과 골반 내 영역 림프절 영역에 4,500 cGy를 조사한 후 수술 부위에 $540\~1,440\;cGy$ (중앙값 540 cGy) 추가조사를 시행하였다. 추적관찰 기간은 $20\~150$개월로 중앙값은 44개월이었다. 결과 : 5년 생존율은 화학요법 단독군과 화학방사선 병행요법군에서 각각 $60.9\%$와 $68.9\%$ (p=0.0915)였고, 5년 무병생존율은 각각 $56.1\%$와 $63.8\%$ (p=0.3510)로 두 군사이에 유의한 차이를 보이지 않았다. 병기별로 분석하였을 때 II기에서의 5년 생존율은 화학요법 단독군이 $71.1\%$, 화학방사선 병행요법군은 $92.2\%$로 두 군간에 통계적으로 유의한 차이를 보였으나(p=0.0379), 5년 무병생존율에서는 화학요법 단독군이 $57.3\%$, 화학방사선 병행요법군은 $85.4\%$로 두군간에 통계적으로 유의한 차이를 보이지 않았다(p=0.1482). III기에서는 5년 생존율과 무병생존율이 화학요법 단독군에서는 $52.0\%$와 $47.8\%$였고, 화학방사선 병행요법군에서는 $55.0\%$와 $49.8\%$로 두 군 사이에는 유의한 차이를 보이지 않았다(p=0.4280, p=0.7891). 국소재발율은 화학요법 단독군이 $16.7\%$, 화학방사선 병행요법군은 $12.5\%$였고, 원격재발율은 화학요법 단독군이 $25.0\%$, 화학방사선 병행요법군은 $26.4\%$였다. 결론 : 본 연구에서는 II기에서 보조 화학요법에 방사선치료를 병행함으로써 보조 화학요법 단독 치료시와 비교하여 생존율의 유의한 증가를 보였고, 비록 통계적으로 유의한 차이를 보이지는 못했지만 국소재발율의 감소를 보였다.

• 대한간호
• /
• 제32권5호
• /
• pp.66-77
• /
• 1994

The purpose of this study was to develop a new nursing unit which can meet changing health care needs, enhance patients' satisfaction and nurses' job satisfaction, and finally guarantee quality nursing care with present manpower. For this, one medical unit was selected as a unit for quality care. And one medical unit which is similar in staffing and patients' characteristics was selected as a control unit. To assess present problems and identify the remedies to the problems a hospital-wide survey and a workshop were performed. According to the survey results, educational programs and improvement of the facilities and equipment supply system, managereal support for interdepartmental cooperation and intensification of bed-side nursing care were adopted as main principles for operating model unit, This model unit was operated for 3 months from Sep. 1, 1992 to Nov. 30, 1992. To evaluate the effectiveness of the model unit, derect/indirect nursing care hours, patients' satisfaction to nursing care, nurses' job satisfaction, and quality care index were measured. Direct/indirect nursing care hours were compared with that of the control unit, and patients' and nurses' satisfaction and quality care index were measured before and after operating model unit and compared with each other. The results of the study were as follows; 1. In the model unit mean direct nursing care hours per cach shift was 146.88 minutes and indirect nursing care hours was 354.72 minutes. The ratio of the direct nursing care hour to indirect nursing hour was 29.6 ; 70.4 and that of the control unit was 26.9 : 73.1. Direct nursing care hour in model unit was longer than that of the control unit. But, the difference was not significant. In subcategories of direct nursing care, the time spent in mobility and exercise, conservation of body temperature, hygiene, and communication and health education were longer than that of the con" trol unit. 2. Indirect nursing care hour in model unit was shorter than that of the control unit. But, the difference was not significant. In subcategories of indirect nursing care, the time spent in drug management and ward arrangement was shorter than that of the control unit. 3. Patients' satisfaction to nursing care was increased significantly after operating the model unit (T=-3.48, P=-0.002) and satisfaction to subcategories of physical comfort measure, psychological cate, and unit management components were significantly higher than before. 4. In the model unit, nurses' total job satisfaction was increased significantly after operating the model unit(Z=2.1004, P=.0357) and satisfaction to subcategory of satisfaction to administration was significantly higher than before (Z=-2.0732, P=.0382). 5. After operating the model unit, quality care index was increased from 89 to 93. With this results, it can be summarized that all the measures tried for quality care, such as educational programs, managereal support for interdepartmental cooperation, and improvement of the equipment and facility provision resulted in partial increase in direct nursing care hours, nurses satisfaction to their job and patients' satisfaction to nursing care. In can be postulated that managereal support and motivation without proper staff supplementation is not enough for increasing direct nursing care hours. And for the enhancement of the level in clinical nursing, and staff supplement must be considered sincerely and the measures for reducing indirect nursing care hours, such as computerization of nursing care activities, improvement of facilities and equipment and facilities supply system, must be instituted in addition.

• 정신신체의학
• /
• 제25권2호
• /
• pp.166-175
• /
• 2017

연구목적 교대근무는 수면장애를 포함한 다양한 건강상의 문제와 연관이 있고 결국에는 삶의 질을 떨어뜨리는 것으로 알려져 있다. 그러나 임상현장에서는 주로 대상자의 주관적인 보고에 의하여 수면을 평가하고 있다. 본 연구는 정신과 교대근무 간호사의 수면을 주관적인 수면평가와 활동기록기를 이용한 수면평가를 통해 주간근무자와 비교해 보고자 하였다. 방 법 교대근무 간호사 23명과 주간근무 간호사 25명을 대상으로 하였다. PSQI를 이용하여 주관적인 수면의 질을 평가하였고 기타 자기보고척도를 이용하여 정신사회적 측면을 평가하였다. 객관적인 수면을 측정하기 위해 활동기록기를 총 7일간 착용하도록 하였고, 그 기간 동안 수면일지를 함께 작성하였다. 교대근무군과 주간근무군간에 활동기록기의 수면변수, PSQI 총점과 구성요소 그리고 자기보고척도로 평가한 결과를 비교하였다. 결 과 PSQI 총점은 양군 간 유의한 차이를 보이지는 않았으나 PSQI 구성요소 중에서 교대근무군이 유의하게 수면의 질(C1)이 나쁘고, 수면장애(C5)와 수면제 사용(C6)이 많으며, 주간기능장애(C7)가 심한 것으로 나타났다. 활동기록기로 측정한 수면변수에서 교대근무군이 주간근무군에 비해 유의하게 잠자리에 누워있는 시간과 총 수면시간이 짧으며, 수면효율이 떨어지고, 평균각성시간이 긴 것으로 나타났다. 결 론 교대근무 간호사가 주간근무 간호사에 비해 주관적 수면평가 및 활동기록기를 통한 객관적 지표 모두에서 수면에 문제를 보이는 것으로 나타났다. 본 연구는 활동기록기가 수면장애를 평가하는데 있어 주관적 설문만으로는 측정이 어려운 객관적 수면변수를 측정하는 데 유용한 도구일 가능성을 시사한다.

• 동서간호학연구지
• /
• 제10권1호
• /
• pp.11-26
• /
• 2004

The purpose of this study is to investigate the present conditions of nursing investment contents, its conversion process, and output in Oriental University Medical Center, Korea to get good qualified Oriental nursing result which is the ultimate purpose of the Oriental nursing management, and to develope a matrix of Oriental nursing management system on the basis of that project. The subjects for nursing investment and output contents were eighteen nursing directors in eleven Oriental University Medical Center and two hundred thirty-nine nurses with three years and over experience in Oriental medical center. The subjects for Oriental nursing organization, human affair management, and control function were nineteen Oriental medical center in Oriental University Medical Center, Korea. Data were collected from November, 2002 to February, 2003 with questionnaire. Data analysis was done by SPSS PC+ 12 program. Frequency, percentage, and minimum/maximum values were used for investment contents, and frequency and percentage were used for conversion process and output contents. 1. The input factors of oriental nursing management system The objective's western hospital career was over five years of one hundred and seventy-five(73.2%) persons. Nursing in-service education was performed in fourteen hospitals(77.8%). Two hundreds(83.7%) were pro to oriental nurse system. Only four hospitals(22.2%) had independent budget in nursing division. Nursing staff allocation to the bed was from 2.8:1 to 9.06:1 respectively, with a big gap of the rate following the hospitals. 2. The conversion factors of oriental nursing system 1) Oriental nursing system Oriental hospital nursing system was organized independently in ten hospitals among eighteen hospitals. The recruitment of nurses which was a vital role of the nursing division of the hospital was mostly(79%) opened. The education to develope nursing personnels was through in-service one in 97.4%. Education for oriental nursing and management was performed in 42.1%(eight hospitals) and that for reserves was done in 36.8%(seven hospitals). Administration for nursing education by nursing division was 68.5%(thirteen hospitals). The post education evaluation was performed by report submission in 36.8%(seven hospitals), by written examination in 26.3%, by questionnaires in 21.1%, and by lecture presentation in 15.8% subsequently. The directorial meeting for the nursing directors was attended by 84.2%(sixteen hospitals), and the meeting type was the medical executive and support division executive meeting in 55.6%(ten hospitals) and the personnel management in 39.6%(seven hospitals). 2) The actual conditions of oriental nursing personnel management The reason of working in oriental hospital was by voluntary in 67.1%(a hundred and sixty persons), by nursing department order in 28.0%(sixty-seven persons), and by others in 5.0%(twelve persons) respectively. The shift form was a three-shifts one in 94.7%(eighteen hospitals), a two-shift one in only one hospital. Duty assignment was functional in 52.6%(ten hospitals), team and functional in 26.3%(five hospitals) and no team alone. Promotion manual was present at 68.4%(thirteen hospitals) and the competency essentials comprised of performance evaluation in 79%, interview, written examination, training result, study result subsequently. No labor union existed in 79%(fifteen hospitals) 3) Oriental nursing preceptor system There were five oriental hospitals(27.7%) administering the preceptor utilization model, which showed lower rate than the twenty-two medical university hospitals in Seoul in which fifteen hospitals (72.7%) were having the system. To the question of necessity of oriental nurse system asked to the objectives of two hundred and thirty-nine with more than three year-experience in oriental hospital, two hundred persons(83.7%) answered positively. 4) The control of oriental nursing The evaluation results from the target hospitals were mostly not opened in 89.4% of oriental hospitals. Thirteen hospitals(68.3%) had evaluation system of direct managers and the next were three hospitals(15.8%) of direct managers and selves. There was one hospital(5.3% each) where fellows and superiors, fellows, and inferiors' evaluation was performed and no hospital where superiors, fellows, inferiors and selves, and superiors, fellows and selves' evaluation was performed. The QI activity of nursing was 42.1%(eight hospitals) for nursing service evaluation, 36.8% for survey of ECSI, 26.3% for survey of ICSI, 15.8% for medical visit rate, 10% for hospital standardization inspection in sequence. 3. The output factors of oriental nursing management system The job satisfaction appeared good in general, indicating very good in thirty-seven persons (15.7%), good in one hundred and fourteen persons (48.3%) and fair in eighty-five persons(36.0%).

• 핵의학기술
• /
• 제20권2호
• /
• pp.14-20
• /
• 2016

Tongue cancer는 혀에 생기는 악성종양으로 전체 암의 1.8%, oral cancer의 75%를 차지할 정도로 발생 빈도가 높은 것으로 알려져 있으며 초기 진단, 전이유무, 병기설정 등을 위해 PET/CT 검사를 실시하고 있다. Tongue cancer 환자의 PET/CT 검사 시 close mouth 상태로 Torso를 촬영하고 있으며 그에 따른 겹침이나 인공물의 영향으로 병소부위가 명확히 관찰되지 않는 경우가 발생되었다. 이에 open mouth로 PET/CT 검사 시 발생되는 변화와 그에 따른 유용성을 알아 보고자 한다. 20명의 환자(남 15명, 여 5명)를 대상으로 시행하였으며 먼저 close mouth 상태로 Torso 촬영 후 open mouth 상태로 1bed 추가 촬영하였다. Tumor(T), Normal Tongue(NT), Lymph Node(LN)에 관심영역을 설정하여 표준화섭취계수(standardized uptake value, SUV) $SUV_{mean}$, $SUV_{max}$를 측정하여 Background(Carotid artery) SUV를 빼주었다. Tumor size 변화를 측정하였으며 육안적 영상 해상도 평가는 blind test를 진행하였다. 비모수검정(wilcoxon signed rank test)을 통해 통계 분석하였다. Tumor에서 SUV는 open mouth 검사 시 증가하는 변화를 보였으며, normal tongue과 lymph node에서는 소폭의 변화가 있었으나 유의한 차이는 없었다. tumor size 변화와 blind test를 통해 전체적으로 비슷하거나 높은 영상 해상도를 보여주는 것을 확인할 수 있었다. Open mouth PET/CT 검사가 close mouth시 발생하는 문제점에 대한 완벽한 대안법이 될 수는 없지만 open mouth를 통해 구강 내 다른 구조물과의 겹침이나 tumor의 경계면을 조금 더 명확하게 관찰할 수 있을 것으로 사료된다.

• Tuberculosis and Respiratory Diseases
• /
• 제66권4호
• /
• pp.300-308
• /
• 2009

연구배경: 감염성 질환 중 가장 흔한 질환인 폐렴의 질병부담을 줄이기 위해서 폐렴환자의 진료 과정 개선과 이에 영향을 미치는 요인에 대한 분석이 필요하다. 본 연구에서는 국내 폐렴환자의 진료 과정의 질적 수준을 평가하고, 질적 수준에 영향을 미치는 환자 및 병원 요인을 분석하고자 한다. 방 법: 500병상 이상 병원 21곳의 1989년 12월 31일이전 출생 입원 환자로 청구코드 주진단 기준 폐렴인 환자중 2006년 8월부터 10월 사이 퇴원 환자 중 무작위 표본추출 방식으로 1,001건을 표본으로 추출하였다. 환자 및 병원 요인과 과정 지표의 상관관계를 다중 로지스틱 회귀분석을 통하여 분석하였다. 결 과: 병원 도착 후 24시간 이내 혈중산소포화도 검사 시행률은 69.4%, 24시간 이내 혈액배양검사 시행률은 79.1%, 8시간 이내 항생제 투여율은 82.5%, 항생제 투약전 배양검사 시행률은 60.5%로 대부분의 지표가 높은 충족도를 보였다. 환자 요인 중에서는 연령이 24시간 이내혈중산소포화도 검사 시행률에 영향을 미쳤고, 병원 요인 중에는 병상수, 병상당 간호사수, 연간 응급실 내원자수, 병상가동률, 지역, 입원 시각 및 경로 등이 과정 지표 시행률에 영향을 미쳤다. 결 론: 본 연구에서 드러난 진료 과정상의 질적 수준이 취약한 부분에 대하여 질 개선 활동의 역량을 강화하여 보완할 필요가 있다. 또한, 과정 지표들의 병원 간 변이를 줄이기 위하여 지표 시행률이 낮은 의료기관에서는 진료프로토콜 개선 등의 활동을 통하여 진료 과정을 개선해 나가는 노력이 필요하다.