• Journal of Preventive Medicine and Public Health
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• 제17권1호
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• pp.37-45
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• 1984

의료보호사업의 의료이용 현황을 파악하고 그동안 시행과정에서 나타난 문제점을 발견하여 이에 대한 합리적인 개선책을 마련하는데 도움을 주고자 경산군의 전 의료보호대상자 17,527명이 1981년 10월 1일부터 1982년 9월말까지 1년동안에 진료증을 사용하여 진료를 받은 의료이용과 상병상태를 일차진료기관의 진료기록부와 매달 각 의료기관에서 군에 제출한 진료비청구서 및 내역서 기타 군과 읍, 면의 각종 행정통제자료에서 조사분석하였다. 경산군의 의료보호대상자는 전인구의 12.7%로서 전국의 9.5%보다 높았다. 대상자들의 의료이용율은 1차진료의 경우 대상자 100명당 월간 환자수는 9.3명, 방문회수는 14.0회, 투약일수는 42.9일이었다. 2,3차 진료의 경우는 연간 대상자 100명 당 입원이 1.7건, 외래이용이 9.3건이었다. 1종대상자가 2종대상자에 비해 1차진료 및 2,3차 진료 모두에서 의료이용이 월등히 높았다. 성별이용율은 1차진료는 여자가, 2,3차 진료는 남자가 많았다. 월별이용율은 7월이 가장 높고 1월이 가장 낮았다. 1월이 가장 낮은 것은 진료증의 갱신때문인 것으로 생각된다. 2,3차 진료기관의 연간 이용자수는 1,931명이고 이중 84.4%가 외래진료이었고 15.6%가 입원이었다. 전문과목별로는 정신과 환자가 66명중 55명이 입원으로 가장 높은 입원율을 나타내었으며, 이비인후과, 안과, 피부과, 비뇨기과 등은 연 입원환자가 $1{\sim}4$명으로 아주 낮은 입원율을 나타내었다. 2,3차 진료기관의 평균입원일수는 21.2일, 외래평균치료기관은 4.7일, 입원과 외래전체의 평균치료기간은 8.6일이었다. 정신과 환자의 평균 입원일수가 74.4일이나 되어 정신과를 제외할 경우 평균 입원일수는 9.3일이었다. 질환군으로 분류한 환자분포는 1차진료는 호흡기질환(35.4%)이 가장 많고, 2,3차 진료는 신경감각기질환(20.1%)이 가장 많았다. 연간 의료보호대상자 1인당 평균 진료비는 9,821원(1종: 24,240원, 2종: 7,464원)이고, 가구당 평균진료비는 40,531원(1종: 66,605원, 2종: 33,559원)이었다. 일차진료기관의 건당진료비는 3,901원, 일당진료비는 840원이고, 2,3차 진료기관의 건당진료비는 49,875원, 일당진료비는 5,822원이었다. 본 조사결과 다음과 같은 의료보호제도의 개선책을 제시하고자 한다. 첫째, 의료보호증의 연초에 일제갱신시 재발급절차를 신속히 할 수 있는 방안이 마련되었으면 한다. 둘째, 전문과목별로 1차지정의료기관을 지정함으로(관내에 전문의료기관이 없을 경우 인근 진료권에 지정) 2,3차 진료기관으로 이송되는 환자를 줄여서 예산의 절감과 이용자의 불편을 덜어주어야 한다고 생각된다. 셋째, 1차지정의료기관과 2,3차 지정의료기관의 진료비 산출방법이 좀더 합리적으로 개선되어야 한다고 생각된다.

• 대한디지털의료영상학회논문지
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• 제10권2호
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• pp.11-16
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• 2008

Images of medical treatment on PACS environment are digitized and they make saving and transmission of patient's information easy with CD format causing increase of patients transfer rate between hospital and data transmission as well. Figuring out the configuration of confining status of copied images of medical treatment with CD format and present the appropriate way of identification for personal information. 20 general hospital over 500 beds which are utilizing PACS currently. Questionnaire investigation focusing on PACS operation center and it's management people. In accordance with the law of securing personal information of public organizations, it says "Anyone who wants to see his or her information via representative he or she needs to make a letter of attorney and turn in this to the president of it's possessing facility" in the article 16. Based on the investigation of general hospital for CD copy issue status near metropolitan area, 8 out of 20, were issuing CD copy through personal identification process(the person oneself and representative) and 10 general hospital were doing by getting signature of receiptor only without identification of the person oneself and 2 general hospital confirmation process is not at all. By the law of securing personal information of public organization, article 16, confirmation process is supposed to mandate lawfully with a letter of attorney when there is any request of reading and/or copies of one's information. But in reality, there were no consistent rules on reading, the process and coverage of copy issue, rejection coverage of copy issue of CD copy in each general hospital PACS operation center. Therefore there is a big need for consolidated format which is applicable by law when the representative requests to issue of CD copy that is storing medical treatment images. By issue through this consolidated format, securing medical information of individual and systemic operation and management will be valid and effective.

• Journal of Trauma and Injury
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• 제27권4호
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• pp.229-232
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• 2014

A 55 year-old man hit a vehicle while riding a bicycle. He was diagnosed as left hemopneumothorax, multiple rib fracture, cerebral hemorrhage, and skull fracture. Initially he suffered from hypoxia requiring 100% oxygen with a mechanical ventilator. Finally he became hypotensive. Venovenous extracorporeal membrane oxygenation (ECMO) was initiated to support patient's gas exchange. Because hypotension and left ventricular dysfuction persisted, we converted the mode of support to veno-arterio-venous ECMO. Over four days of intensive care, we could wean off ECMO. The patient went to rehabilitation facility after 45 days of hospitalization. Although trauma and bleeding are considered as relative contraindication of ECMO, careful decision making and management may enable us to use ECMO for trauma-related refractory heart and/or lung failure.

• 한국병원경영학회지
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• 제23권4호
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• pp.40-52
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• 2018

The purpose of this study is to identify medical consumers' hospital selection factors in response to the rapidly changing environment of medical industry. For that purpose this study classified consumers' hospital selection factors into three categories such that human factors including expertise, reliability, empathy; system factor including, convenience, differentiation, efficiency; and facility factor including tangibility, accessibility, and location, based on the previous studies and the results of a preliminary survey of the patients of a small private hospital. The nine factors were further divided into 23 more specific attributes. Then, an online survey was conducted to measure the perceptions of the 23 attributes by the medical consumers over the age of 20. The analysis of the survey data using Kano model and Timko model indicated that 14 of the 23 attributes were classified as attractive factors, eight attributes were or classified as, one-dimensional factors, and one attribute, doctors' educational background, was classified as indifference factor. Of the 14 attractive factors, "unique and differentiated services related to medical treatment" and "distance from home to hospital" had the highest customer satisfaction coefficients. Of the eight one-dimensional factors, "kind treatment," "providing adequate explanations," "accuracy of diagnosis," and "cleanness of facilities" had the highest customer satisfaction coefficients as well as the highest dissatisfaction coefficients. The findings indicate that these six attributes are the most basic and most impactful attributes that hospitals must manage strategically to improve their service quality and attract more medical consumers to their hospitals.

• 한국융합학회논문지
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• 제10권10호
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• pp.259-266
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• 2019

본 연구는 의료 환경의 변화로 병원의 경쟁력을 갖추기 위하여 병원의 행정전략에 대한 변화의 필요성이 있으며, 의료서비스 향상을 위해서 어떤 전략이 가장 중요한지 제시하여, 의료서비스 향상을 위한 병원 행정전략에 기초자료를 제공하고자 한다. 이를 위해서 병원행정 분야와 관련된 행정학 및 경영학 박사급 전문가 20명을 선정하였고, 자료분석방법은 AHP 방법으로 상대적 중요도를 측정하였다. 이에 대한 연구결과는 다음과 같다. 첫째, 측정영역에서 의료서비스 향상을 위한 병원 행정전략에 대한 상대적 중요도는 의료진 요인(1순위), 제반시설 요인(2순위), 직원서비스 요인(3순위), 접근편의 요인(4순위) 순으로 결과가 나타났다. 둘째, 복합가중치 분석 결과, 의료진 전문성(1순위), 의료진 다양성(2순위), 의료장비수준(3순위) 순으로 상대적 중요도가 측정되어 의료서비스 향상을 위한 병원 행정전략은 의료진의 전문성 확보, 의료진의 다양성, 그리고 의료장비 수준을 높이는 것이 가장 중요함을 알 수 있다. 이러한 결과가 의료서비스를 향상시키기 위한 병원의 행정전략 마련 시에 유용한 기초자료로 활용될 수 있을 것이며, 또한 향후 병원 행정전략 마련 시에 다각적인 요소들을 파악해야 할 것이다.

• 지역사회간호학회지
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• 제19권2호
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• pp.260-269
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• 2008

Purpose: The purpose of this study was to identify differences in health status and the utilization of long-term care service between urban and rural aged residents in Korea. Methods: Through convenience sampling, 1,405 elders (829 from urban areas and 576 from rural areas) were selected during March 1 to May 31 in 2004. All the subjects agreed to participate and filled out the survey questionnaire after signing the consent form. The instruments utilized in this study were the impairment of physio-sensory function, ADL IADL, cognitive function, and psycho-social function scale. This instrument was developed by modifying the scab developed by Gurland & Wilder (1984). Data was analyzed using the SPSS Win program. Results: There were significant differences in economic status, duration of living and type of medical insurance between rural and urban elderly(p<.05). Physio-sensory functions (t=4.53. p<.001), ADL (t=3.61. p<.001), IADL (t=2.45, p=.014), cognitive functions (t=-2.63. p=.024) and psycho-social functions (t=3.69. p<.001) were significantly different between the two groups. The utilization of long-term care facility in the urban elderly was significantly higher than that in the rural elderly ($x^2=10.14$, p<.001). Conclusion: Considering these findings. the need for long-term care should be assessed by residence characteristics. Because of different utilization of long term care facility according to the elderly's needs, long-term care services should be considered the residence characteristics.

• 가정과삶의질연구
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• 제22권4호
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• pp.1-14
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• 2004

Although the proportion of frail elderly among the elderly population has been rapidly increasing, there is little preparation to provide housing alternatives for them in Korean society. Long-term care facility a housing alternative for frail elderly that enables them to receive social and medical care services that enhance the quality of their life. This research was conducted to study the opinions of middle-aged Koreans about long-term care facilities for the frail elderly. This study provides useful suggestions for the development of user-paid long-term care facilities in the near future. A survey questionnaire was administered to 600 adults in their 50s to collect data. The sample was stratified according to region, gender, and housing structure type. The results showed that most of the respondents were aware of long-term care facilities for the frail elderly; but they were relatively unwilling to live in these facilities, as compared to other housing alternatives. However, a larger number of respondents said that as they became very frail, they would be willing to live in these facilities. The respondents expressed a high level of need for user-paid long-term care facilities as an alternative to hospitalization. Also, they wanted to have a variety of long-term care facilities that are designed for different levels of disability. The education level of respondents and their spouses, average monthly income, subjective economic level, and religion were major variables that differentiated significantly the opinions about long-term care facilities for the frail elderly.

• 한국디지털건축인테리어학회논문집
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• 제11권4호
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• pp.5-11
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• 2011

The present study investigated the actual conditions of physical therapy rooms at long-term hospitals in Korea and conducted a comparative analysis to develop an efficient floor plan and facility improvement measures. 1. At hospitals surveyed, physical therapy services were used at a high frequency but they did not have enough space for rehab treatment and long paths of patient flow were found to make patient management inconvenient. Therefore, physical therapy units should be conveniently located both in terms of distance and direction so as to be accessible from patient rooms or wards. The space should be organized in a concentrated layout for efficiency of physical therapy, and floor planning for therapy units should ensure the best possible viewing angle to therapists. 2. With regard to the disease characteristics of patients, many physical therapy rooms were in difficult circumstances because of poor facilities, so they need to secure skilled personnel, supplement apparatuses and equipment and have rooms for functional recovery, hydrotherapy and operation treatment. In addition, each of the curtained or partitioned areas for treatment should be set up with consideration for the amount of space taken up by medical equipment. The area under each bed should be designed for patient convenience so that it can be used as storage space for patient's belongings and shoes. 3. Patients complained about the lack of physical therapy space, resting places or exercise areas and demanded the expansion of rehab programs and facilities. Physical therapy facilities need to be improved for patient privacy and effective natural ventilation. 4. At most of the long-term hospitals surveyed, physical therapy units were found to have small areas and treatment equipment and devices were insufficient compared to the number of patients. Therefore, it is required to secure more space (at least 138.24 sq. meters per 100 beds) and improve facilities for better physical therapy services.

• Nuclear Engineering and Technology
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• 제48권3호
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• pp.785-794
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• 2016

The Argonne National Laboratory of the United States and the Kharkov Institute of Physics and Technology of the Ukraine have been collaborating on the design, development and construction of a neutron source facility at Kharkov Institute of Physics and Technology utilizing an electron-accelerator-driven subcritical assembly. The electron beam power is 100 kW using 100-MeV electrons. The facility was designed to perform basic and applied nuclear research, produce medical isotopes, and train nuclear specialists. The biological shield of the accelerator building was designed to reduce the biological dose to less than 5.0e-03 mSv/h during operation. The main source of the biological dose for the accelerator building is the photons and neutrons generated from different interactions of leaked electrons from the electron gun and the accelerator sections with the surrounding components and materials. The Monte Carlo N-particle extended code (MCNPX) was used for the shielding calculations because of its capability to perform electron-, photon-, and neutron-coupled transport simulations. The photon dose was tallied using the MCNPX calculation, starting with the leaked electrons. However, it is difficult to accurately tally the neutron dose directly from the leaked electrons. The neutron yield per electron from the interactions with the surrounding components is very small, ~0.01 neutron for 100-MeV electron and even smaller for lower-energy electrons. This causes difficulties for the Monte Carlo analyses and consumes tremendous computation resources for tallying the neutron dose outside the shield boundary with an acceptable accuracy. To avoid these difficulties, the SOURCE and TALLYX user subroutines of MCNPX were utilized for this study. The generated neutrons were banked, together with all related parameters, for a subsequent MCNPX calculation to obtain the neutron dose. The weight windows variance reduction technique was also utilized for both neutron and photon dose calculations. Two shielding materials, heavy concrete and ordinary concrete, were considered for the shield design. The main goal is to maintain the total dose outside the shield boundary less than 5.0e-03 mSv/h during operation. The shield configuration and parameters of the accelerator building were determined and are presented in this paper.

• 한국화재소방학회논문지
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• 제30권5호
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• pp.108-115
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• 2016

화재감지기는 화재를 조기에 감지하여 관계인에 통보함으로써 자산보호 및 인명안전에 중요한 역할을 한다. 따라서 화재를 조기에 탐지할 수 있는 성능과 비화재보를 발생하지 않는 신뢰성이 중요하다. 최근 공동주택 오피스텔 숙박시설 노유자시설 의료시설 등과 같이 취침, 숙박, 입원 등 이와 유사한 용도로 사용되는 거실에는 조기화재 감지를 위한 연기감지기를 설치하도록 국가 화재안전기준이 개정되어 연기감지기의 적용이 증가되고 있다. 반면 현재 비화재보를 예방하기 위한 연구가 부족하다. 본 연구는 아날로그 광전식 연기감지기의 순간적으로 발생되는 먼지 등으로 인해 발생되는 비화재보를 예방하기 위한 알고리즘 개선과 감지기의 자기보상기능을 통해 감지기의 오염과 화재신호를 구분할 수 있도록 개선하였다. 본 연구를 통해 최근 수요가 증가하는 아날로그 광전식 연기감지기의 비화재보 개선으로 제품의 신뢰성을 확보하여 비화재보로 인한 경제적 손실을 예방할 것으로 기대된다.