• Title/Summary/Keyword: Long-term care Hospital

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농촌보건의료서비스 향상을 위한 제도 개선방안 (Policy Measures for Improving Health Care Services in Rural Areas)

  • 문옥륜;이규식;박재용;고대하;이기효
    • 농촌의학ㆍ지역보건
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    • 제16권2호
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    • pp.97-119
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    • 1991
  • 본 연구는 농촌지역의 보건의료수준이 의료자원의 양적, 질적 격차와 의료이용과 의료접근도 및 건강수준의 면 등에서 도시지역보다 낙후되어 있다는 사실을 각종 통계지표를 이용하여 논증하였다. 다음으로 이러한 격차를 빚은 농촌보건사업의 문제점을 파악하여 이에 대한 대처방안을 농촌보건사업의 조직, 인력, 시설 및 장비, 재원 및 그리고 관리라는 5가지 부문으로 나누어서 모색해 보았는데 구체적으로는 첫째, 농촌보건 인력의 자질향상과 적정배치방안의 수립, 둘째, 농촌보건인력의 생산성 증대, 셋째, 보건소 및 지소의 운영개선, 넷째, 취약지 민간병원의 운영 개선, 다섯째, 사회, 경제여건의 변화에 따른 새로운 보건사업의 개발, 여섯째, 통합적인 보건의료인력관리 전담기관의 설립 등의 정책대안을 제시하고 있다.

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만성폐쇄성폐질환의 자가간호 중재연구(RCT) 효과에 관한 체계적 문헌고찰 (Effects of Self-Care Intervention Study on Chronic Obstructive Pulmonary Disease: Focusing on a Systematic Review of a Randomized Controlled Trials)

  • 문경미;박인희;김현주
    • 산업융합연구
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    • 제21권8호
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    • pp.97-110
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    • 2023
  • 이번 연구는 국내·외 만성폐쇄성폐질환 대상자에게 시행된 다양한 자가간호 중재 프로그램의 내용에 대한 연구결과를 통합하고 분석하기 위해 수행된 체계적 문헌고찰 연구이다. 문헌선정기준은 2000년 1월 1일부터 2022년 9월 30일까지로 PubMed, CINAHL, EMBASE, MEDLINE, RISS, DBpia, KISS 및 KMbase를 통해 검색된 무작위 대조군 실험연구로 사전-사후 설계를 적용한 논문을 채택하였다. 체계적 고찰에 포함된 연구는 총 23편으로 중재 관련 요인으로는 연구대상의 수, 중재자 유형, 중재 제공 횟수 및 기간, 중재효과 관련 요인으로는 중재효과 측정도구, 중재효과 변수 등을 분석하였다. 분석결과 만성폐쇄성폐질환 자가간호 중재 프로그램은 환자의 증상 악화 및 재입원을 예방에 도움이 될 수 있음을 확인하였다. 우리나라 만성폐쇄성폐질환자에게 적합한 자가간호 중재 프로그램 개발이 필요하며 환자의 접근성, 편의성 및 지속을 위한 동기 부여 방법 등을 고려한 중재 프로그램의 개발이 필요하다.

병원정보시스템내의 간호생산성향상효과에 관한 연구 (The effect of the improvement of nursing productivity in Hospital Information System;A Case study on Kwangju Patriots' and Veterans' Hospital)

  • 이병화
    • 간호행정학회지
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    • 제5권2호
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    • pp.237-251
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    • 1999
  • The purpose of this study is to suggest successful strategies through which the effect of the information system of a hospital can be forecasted at the nursing department. In order to set up successful strategies, in the first place, both the methods of CSF(Critical Success Factor: Rockart, 1979) and ULD(User-Led Development) method and the method suggested by the Korea Productivity Center were applied. In order to measure the improvement of nursing productivity, the Dissonance theory was used. The data were collected from 100 employees serving at the clinic department of Kwangju Patriots' and Veterans' Hospital from July 4 to July 25, 1998 with reference to all 222 cases, for sampling work; then the part of the efficiency of the treatment or management of hospital business - simplification of the process of the treatment of hospital business and reduction of the time of the treatment of hospital business were measured; and in order to forecast organizational behavior, 100 cases of organization behavior were analysed, based on the well structured, questionnaires. In order to forecast the user's organizational behavior, a tool(Ronald. 1988; Stephen, 1982: Senn, 1992: Olsen, 1980: Anderson, 1988: Kim. 1992: Cho. 1994) to measure the extent or degree of the user's recognition or understanding whose reliability coefficient is 0.63 was used: and regarding the items expected by the users concerning the convenience of the system, a tool created by Bernadett, Szajna and Richard W. Scamell(1993) whose reliability coefficient is 0.88 was used. And finally, those data were analysed, utilizing the statistical package of SPSS/PC 6.0. successful strategies are suggested as follows: 1. In order that the Kwangju Patriots' and Veterans' Hospital's purpose can be successful through its strategic, information system, the quality of its services should be elevated. and for elevating the quality of medical services, elevation of the quality of medical expertism or specialty is an important factor in determining such quality. 2. In order to make the hospital information system to be successful, the hospital's top manager should participate in the effort making it successful with helping hands of the members or personnel of the hospital. 3. In order to make users participate in the hospital information system, it is prerequisite that all nurses in a hospital should voluntarily participate in the system 4. In order to reduce the expense, the time in coping with business per duty should be reduced by 10${\sim}$33.23%. The time of the direct nursing care which added value is relatively high should be elongated in order to elevate the quality of hospital services. 5. Since the introduction and spread of the hospital information system are influenced by the duration in the experience of computer use, the user of the hospital information system should have a plan to receive well-planned computer education. Finally it is suggested that the forecast of long-term productivity through a review of the user's expectation of the system should be inspected and tested through continuous studies of its effectiveness.

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End Stage Palliative Care of Head and Neck Cancer: a Case Study

  • Shishodia, Nitin Pratap;Divakar, Darshan Devang;Al Kheraif, Abdulaziz Abdullah;Ramakrishnaiah, Ravikumar;Pathan, Akbar Ali Khan;Parine, Narasimha Reddy;Chandroth, Santhosh Vediyera;Purushothaman, Binu
    • Asian Pacific Journal of Cancer Prevention
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    • 제16권3호
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    • pp.1255-1258
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    • 2015
  • Background: Locally advanced head and neck cancer is generally incurable and has a short survival rate. This study aimed to evaluate symptom relief, disease response, and acute toxicity after palliative hypo-fractionated radiotherapy and long-term survival in affected patients. Materials and Methods: Between January 2011 to December 2011, 80 patients who were histopathologically diagnosed as having stage III or stage IV head and neck squamous cell carcinoma based on Eastern Cooperative Oncology Group (ECOG) performance status 1-3, were offered palliative radiotherapy (20 Gy/5Fr/5 Days). Later these patients were evaluated on 30th day after completion of treatment for disease response based on World Health Organisation (WHO) criteria and palliation of symptoms using symptomatic response grading and acute toxicities by the Radiation Therapy Oncology Group (RTOG). Many patients were given post radiation therapy (RT) palliative chemotherapy for appropriate palliative care and a few patients were selected for further curative RT. The overall survival was also evaluated among this group of patients with last follow up date of 1st May, 2014. Results: The most common presenting complaint was pain followed by dysphagia. Most patients (60-70%) had appreciable relief in their presenting symptoms. A good response was observed in the majority following palliative RT; a few patients had progressive disease and some had stable and regressed disease. None of the patients experienced radiation toxicity that required hospital admission. Almost all showed grade one and two acute skin and mucosal toxicity one month after completion of treatment. The mean survival days for patients given only hypofractionated palliative RT was 307 days, those with post palliative RT and palliative chemotherapy was 390 days and patients who went on to receive further palliative RT and curative RT dose had significantly overall survival of 582 days. Conclusions: Advanced head and neck cancer should be identified for suitable palliative hypofractionated radiotherapy to achieve acceptable symptom relief in a great proportion of patients and should be followed by palliative chemotherapy or curative RT in suitable cases for long-term symptom-free survival.

병원감염 사건에서 증명책임 완화에 관한 입법적 고찰 - 개정 독일민법을 중심으로 - (Legislative Study on the Mitigation of the Burden of Proof in Hospital Infection Cases - Focusing on the revised Bürgerliches Gesetzbuch -)

  • 유현정
    • 의료법학
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    • 제16권2호
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    • pp.159-193
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    • 2015
  • 병원감염 사례에 관한 판결의 주류적 태도는 병원감염 발생으로 인한 손해의 분담을 사실상 환자 측에 전가하는 문제가 있다고 판단되므로, 손해의 공평 타당한 분담을 그 지도 원리로 하는 손해배상제도의 이념에 비추어 환자 측의 증명책임을 대폭 완화하기 위한 방법을 강구할 필요성이 있다. 이와 관련하여 진료계약을 민법상 전형계약으로 규정하고, 병원감염과 같은 의료 측이 전적으로 지배할 수 있었던 경우에는 일반적 진료상 위험이 실현된 때 진료자의 오류가 추정된다고 명문으로 과실추정규정을 둔 독일민법을 검토하였다. 진료계약은 매우 빈번하고 광범위하게 일반 국민의 실생활에서 체결되고 있으며, 그로 인한 분쟁도 다양하게 발생하고 있으므로, 진료계약을 독일과 같이 민법의 전형계약으로 규정함으로써 계약 내용과 분쟁 발생 시 증명책임 등에 관해 규율할 필요성이 있다. 병원감염 사건의 경우 법률에 의해 과실을 추정하고, 병원감염 예방을 위한 노력을 철저히 시행한 기관에 한하여 병원감염 사고로 인한 손해가 발생한 경우 그 비용을 지원하도록 사회보험을 통한 제도적 보완이 필요하다고 생각되며, 향후 이에 관한 면밀한 연구와 검토가 요구된다.

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뇌손상 가족 간병인의 근골격계 자각증상과 관련요인 (The Factors Related to Musculoskeletal Symptoms of Family Care-Givers who Have a Patient with Brain Damage)

  • 전은미;이성아;구정완
    • 한국산학기술학회논문지
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    • 제18권1호
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    • pp.336-344
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    • 2017
  • 본 연구는 뇌손상 진단을 받고 병원에서 재활치료를 실시하고 있는 환자의 가족 간병인 340명을 대상으로 근골격계증상을 알아보고 그 관련요인을 파악하고자 자기 기입식 설문조사를 실시하였다. 설문조사 내용은 일반적 특성, 간병활동 특성, 근골격계 자각 증상이였다. 본 연구의 조사 기간은 2014년 3월부터 4월이며, 재활병원 및 요양병원에서 수집하였다. 연구결과 독립변수에 따른 자각증상 호소율은 신체부위별로 다르게 나타났다. 요인분석의 결과는 목의 경우 초졸의 학력이 영향을 끼쳤고, 어깨의 경우 여자, 나이 50~59세, 학력 중졸, 간병기간 1년 이내와 1년 7개월 이상 2년 이내가 영향을 끼쳤다. 팔/팔꿈치의 경우 나이 40~49세, 학력 대졸, 간병기간 1년 이내와 1년 7개월 이상 2년 이내 변인이 유의한 영향을 끼쳤다. 손/손목/손가락의 경우 나이 50~59세, 간병기간 1년 이내와 1년 7개월 이상 2년 이내 변인이 통증에 유의한 영향을 끼쳤다. 다리/발의 경우 나이 50~59세, 간병기간 6개월 이내 변인이 통증에 유의한 영향을 미치는 것으로 나타났다. 허리의 경우 학력 초졸 중졸 고졸, 간병기간 1년 이내와 1년 7개월 이상 2년 이내, 독립보행 불가능 변인이 통증에 유의한 영향을 미치는 것으로 나타났다. 진단명 별 간병활동 특성에서 근골격계 자각증상 호소율은 통계적으로 유의하지 않았다. 근골격계 자각증상 호소에 가장 영향을 미치는 간병활동 동작으로는 이동하기와 보행이었다. 근골격계 자각증상에 영향을 미치는 전체 요인에 대해서는 간병 기간 1년 이내가 전체 통증에 유의한(p<.05) 영향을 미치는 것으로 나타났다. 본 연구의 결론으로는 뇌손상 환자의 가족 간병인은 환자를 간병하는 간병활동 특성에서 근골격계 질환의 위험에 노출되어 생활하는 것을 알 수 있었다. 또한 뇌손상 환자를 돌보는 가족 간병인의 신체부위별 근골격계 증상에 영향을 미치는 요인이 다르므로 이러한 요인에 대한 체계적이며 종합적인 예방 교육과 연구가 마련되어야 할 것이다.

마리화나 남용환자의 역동적인 발달요인과 문제해결 (Dynamic Developmental Factors and their Problem Solving of Patients that Abuse Marihuana)

  • 원정숙
    • 대한간호학회지
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    • 제4권3호
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    • pp.105-116
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    • 1974
  • This study was made on patients who were Hospitalized due to sickness caused by the abuse of marihuana at the Psychiatric Section of a hospital during the period from Feb. to Oct., 1974. The following conclusion was obtained by reviewing the literature with respect to the nursing, and problem solving of those patients. 1. It appears that marihuana is a comparatively mild intoxicant in ordinary preparation without causing physical dependence or tolerance. 2. According to the status of men who are marihuana smokers, approximately 20% of them were college students, those preparing to retake college entrance examinations, non-employed and pharmacists. The men belong mostly to the middle foreigner′s mistress of higher, income bracket, and in the case of women, most of the smokers were US. servicemen entertainers. 3. Dynamic developmental factors: Case 1. : The patient had a characteristic, hysterical and emotionally unitable character, and was of low intelligence, In addition, to this already existing problem, the added uses of marihuana caused a mental illness to develope. Case 2 : The character, was reserved and introspective, her creative power and sentiment was fading and his ability of self-control was weakened. She used the smoking of marihuana to get rid of her own feeling of inferiority complex and tensions coming from interpersonal relationships. Case 3 : The patient was unconditionally resistive to the authoritativeness of superiors and irresponsible in his relationship with women, in his attitude concerning sex in general. He smoked marihuana because he felt become peace-loving and get enchanted experience through smoking it. 4. The points of issue appearing from the above case; (1) Movement of anti-social feelings against the "established system" by the youngsters. (2) Family problem. (3) Shamelessness, loss of motivation, disorderly attitude toward the sex, (4) Worries concerning the future. (5) Lack of knowledge concerning smoking of cigarette and marihuana. Chronic use of marihuana made, those youngman who had originally been ambitions to achieve something in life, lazy, inefficient, unable to make long-term plans, are such weak mined persons that they did not try to overcome problems when encountered. This will pose a great and important question in the mental health of the society, 5. Treatment and Problem sieving According to the literature, we will have to place importance upon hospitalized treatment The phases of treatment were divided into five parts. (1) Prehospital phase (2) Withdrawal Phase (3) Rehabilitation phase (4) Transitional phase (5) After-care phase The experiments have proved that there was much progress in the recovery of patients through environment therapy, supportive therapy and group psychotherapy. This was the above mentioned 5 phases of treating process in accordance with the weekly schedule of the hospital. It was thought that the patients would require prolonged after care management even after they were released from the hospital and that they will also require periodic visit, to the hospital and doctor′s interview with their family. In conclusion, the question of the young generation and marihuana smoking is becoming a great social problem in which their resistances to the "established system" and society is growing in the from of antiestablishment movements. In our country, the smoking of marihuana is gradually developing, therefore, I think, that it would be a very fortunate thing for us, if this report could be helpful for the motivation of further study on the questions of the young generation and its problems.

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유기농식품의 건강증진가치 평가를 위한 Human Biomonitoring 실증모형 개발 (Development of a Human Biomonitoring Empirical Model for Health Promotion Value Evaluation of Organic Foods)

  • 최덕천
    • 한국유기농업학회지
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    • 제21권4호
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    • pp.569-588
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    • 2013
  • The organic foods is the terminology calling the organic products, the organic livestock and the organic processing food. The value of organic food may be evaluated as the index of the nutrient content, the safety and the health promotion. The reason why consumers prefer the organic food in the market is because the value of health promotion to be obtained through its consumption is expected to be bigger than the expense according to the purchase of organic food. This study has the significance in developing the direct evaluation model like the human biomonitoring method. The hypothesis for this study is summarized, "If the metabolome of metabolic syndrome of decreases, the exposure of substance of health harm decreases, the number of hospital care decreases and the quality of life shall be improved if the organic food is incepted in the long term and the health care is managed well". The consumer's cooperative and the health consumer's cooperative select the experimental group of 100 persons and the comparative group of 100 persons in 5 areas in the whole country at the same time to verify this hypothesis. Its rate of change is compared and analyzed by measuring the blood and urine of each biomarkers such as the exposed agriculture pesticides, the nitrate in the body at intervals of 2 months for 1 year. Also, by letting participants in the experiment record the major activity such as the dietary intake and the exercise, etc., in the questionnaire and the performance evaluation form, the statistical analysis for the correlation of this with the metabolome, etc., is conducted. The time that is called minimum 1 year and a lot of expense are required to implement this model. Accordingly, the cooperative study by composing the consortium of the interdisciplinary and the interagency is desirable.

정맥주입 전문간호사가 삽입한 말초삽입형 중심정맥관(PICC) 사용 결과에 대한 후향적 분석 (Analysis of PICC Inserted Patient Data in a Hospital by IV CNS-Driven Intervention)

  • 박정윤;박광옥;백미경;김세라;권혜리;양수진
    • Journal of Korean Biological Nursing Science
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    • 제6권1호
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    • pp.33-42
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    • 2004
  • Background : Intravenous(IV) access is becoming an increasingly important part of health care today. The current drive for clinical effectiveness and cost-effective health care serves to increase the need for reliable vascular access. Venous access devices were developed to overcome problems associated with limited peripheral access and frequent venipuncture in patients with long-term therapy. Although the peripherally inserted central catheter(PICC) have become popular during recent years in USA, its procedure is rare in Korea. Purpose : The goal of this study was to analyze the PICC inserted patient data by IV CNS intervention. Method : A Total of 62 PICCs were inserted into 51 patients by the IV CNS during a 10-month period form November, 14, 2002, to October 2, 2002. Data was obtained retrospectively through chart review. Result : The patient population included 34(54.8%) men and 28(45.2%) women, with a mean age 50.6 years. The main indication for PICC placement was to access vein in poor peripheral venous status(40.3%). The mean served interval for PICC insertions was 16.7 days(range, $2{\sim}61$ days). The reasons for removal were completed therapy in 18 cases(29.0%), patient death in 13 cases(21.0%), and mechanical or functional PICC problem in 10cases(16.1%). The three PICCs removed for presumed infection, and one had only positive tip cultures(0.2%). Conclusion : PICCs are rapidly growing popularity and required an extended course of IV therapy.

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내과계 중환자실 재원 성인 환자의 Clostridium difficile associated Diarrhea에 대한 Metronidazole과 Vancomycin의 치료효과 비교 (A Comparison of Vancomycin and Metronidazole for the Treatment of Clostridium difficile-associated Diarrhea (CDAD) in Medical Intensive Care Unit (MICU))

  • 조은애;이경아;김재송;김수현;손은선
    • 한국임상약학회지
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    • 제27권2호
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    • pp.77-82
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    • 2017
  • Background: Clostridium difficile associated diarrhea (CDAD) is a leading cause of hospital-associated gastrointestinal illness. Risk factors for CDAD include advanced age, long-term admission, antibiotics, proton-pump inhibitor or $H_2$ blocker use and immunosuppression. The practice guideline of American Journal of Gastroenterology (2013) suggests metronidazole for the first-line therapy of mild-moderate CDAD as well as vancomycin for severe CDAD. MICU inpatients receiving stress ulcer prophylaxis and antibiotics are susceptible to nosocomial CDAD. Therefore, this study aimed to evaluate occurrence and treatment of CDAD in MICU. Methods: Patients who were admitted to the MICU and had CDAD from August 2012 to August 2015 were analyzed retrospectively. Results: Of the 90 patients with CDAD, 20 patients (2.22%) had mild-moderate CDAD (16 received metronidazole and 4 received vancomycin therapy) and 70 patients (77.8%) had severe CDAD(54 received metronidazole and 16 received vancomycin therapy). Among the patients with mild- moderate CDAD, treatment with metronidazole or vancomycin resulted in same clinical cure in 50% of the patients (p=1.00). Among the patients with severe CDAD, treatment with metronidazole or vancomycin resulted in clinical cure in 40.7% and 50.0% of the patients, respectively (p=0.511). Clinical symptoms recurred in 7.4% of the severe CDAD patients treated with metronidazole and 6.3% of those treated with vancomycin(p=0.875). Conclusion: Our findings suggest that metronidazole and vancomycin are equally effective for the treatment of mild-moderate CDAD; however, vancomycin demonstrated higher clinical cure rate and lower recurrence rate for severe CDAD, although the difference was not statistically significant. For better clinical outcomes, appropriate medication use by disease severity is needed.