• 한국병원경영학회지
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• 제18권1호
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• pp.18-41
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• 2013

This study was aimed to identify the current status of medical service quality of medical institutes; propose improvements; and find out the impact of medical service quality by its attribute on overall customer satisfaction. The research was conducted on the out-patients and in-patients in a high-level general hospital located in A city. To examine the research, the IPA was utilized to identify the priority requirements for improving the medical service quality. The study also applied an extended theory to the analysis on mismatch between the level of satisfaction and importance recognized by the clients, to examine the impact of the above mentioned factors on the overall satisfaction and intention to revisit and recommend the hospital. For out-patients, the result showed that "hospital hygiene" had a positive and negative impact on the clients' intention to revisit the hospital in priority improvements. In terms of the sustainable improvements, "doctor's skill" had a negative impact on the overall service satisfaction, whereas "state-of-the-art facility" and "nurse's instruction" had a positive impact on the intention to revisit the hospital. In long-term improvements,"complaint remedy" had a positive impact on the intention to recommend the hospital but there were no relevant factors in excessive investment. On the other hand, for in-patients, the result demonstrated that there were no relevant factors in priority improvements and sustainable improvements. The factor of"service procedure speed"had a positive as well as negative impact on the intention to revisit the hospital. In excessive investment,"nurse's empathy"had a positive impact on the intention to recommend the hospital.

• Molecules and Cells
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• 제39권8호
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• pp.631-638
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• 2016

Glutathione peroxidase 3 (GPx3), an antioxidant enzyme, acts as a modulator of redox signaling, has immunomodulatory function, and catalyzes the detoxification of reactive oxygen species (ROS). GPx3 has been identified as a tumor suppressor in many cancers. Although hyper-methylation of the GPx3 promoter has been shown to down-regulate its expression, other mechanisms by which GPx3 expression is regulated have not been reported. The aim of this study was to further elucidate the mechanisms of GPx3 regulation. GPx3 gene analysis predicted the presence of ten glucocorticoid response elements (GREs) on the GPx3 gene. This result prompted us to investigate whether GPx3 expression is regulated by the glucocorticoid receptor (GR), which is implicated in tumor response to chemotherapy. The corticosteroid dexamethasone (Dex) was used to examine the possible relationship between GR and GPx3 expression. Dex significantly induced GPx3 expression in H1299, H1650, and H1975 cell lines, which exhibit low levels of GPx3 expression under normal conditions. The results of EMSA and ChIP-PCR suggest that GR binds directly to GRE 6 and 7, both of which are located near the GPx3 promoter. Assessment of GPx3 transcription efficiency using a luciferase reporter system showed that blocking formation of the GR-GRE complexes reduced luciferase activity by 7-8-fold. Suppression of GR expression by siRNA transfection also induced down-regulation of GPx3. These data indicate that GPx3 expression can be regulated independently via epigenetic or GR-mediated mechanisms in lung cancer cells, and suggest that GPx3 could potentiate glucocorticoid (GC)-mediated anti-infla-mmatory signaling in lung cancer cells.

• 한국재난정보학회 논문집
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• 제7권2호
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• pp.110-122
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• 2011

본 연구에서는 서울시 지하공간에서 화재발생시 재난관리 및 재난의료 개선방안을 지하상가를 중심으로 기술하였다. 먼저 지하공간에서의 법령 및 제도를 건축법관련, 안전관련, 소방관련, 피난관련으로 고찰해 보았다. 서울시 지하상가의 분류는 공간 및 형태적 유형에 따라 나눌 수 있으며, 유형별 형태에 따라 관리주체가 다르게 나타난다. 이러한 개별관리체계로 인하여 화재 및 재난발생 시 현장의 통합지휘체계와 현장 응급구조에 문제가 발생할 우려가 있어 향후 통합관리를 위한 대책 및 시설관리주체의 개선이 필요하다. 재해 발생 시 이송이 실제 현장에서 이루어지려면 의료진과 응급구조사가 존재하고, 현장지휘본부와의 협조가 원활해야 가능하기 때문에 평소에 재해정보와 응급의료정보가 실시간으로 파악되어야 한다. 따라서 수용의료기관 분포와 진료능력등을 고려하여 재해 발생 시 효율적인 대처방안 수립이 필요하다.

• 한국응급구조학회지
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• 제21권1호
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• pp.87-98
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• 2017

Purpose: This study investigated the use of infection management and the frequency of emergency equipment sterilization by emergency rescue crews to provide basic guidelines and suggestions for infection control. Methods: A self-reported questionnaire was completed by 160 emergency medical technician rescue crews in J area from May 7 to May 22 in 2015. The questionnaire consisted of 95 items, including the general characteristics of the subjects (8 items), the use of emergency equipment (33 items), the frequency of facility sterilization (33 items), infection control (12 items), vaccination (4 items), and the use of personal protective equipment (5 items). Results: In all, 97.3% of respondents were aware of the "Guidelines of Infection management for Rescue Operators' and 90.9% received training on infection control. A total of 72.7% and 47.3% of rescue centers were equipped with disinfection facilities and laundry rooms, respectively. The average frequency of sterilization was $3.17{\pm}0.75$, which significantly differed for teams with more clinical experience (p=.050) and teams with three members (p=.030). The average score for individual protective equipment supplies was $1.95{\pm}0.66$. Conclusion: For proper infection management of emergency equipment, our results suggest that the number of crew members should be increased for each ambulance, protective equipment and rescue products should be supplied, and the number of facilities for sterilization and laundry at rescue centers should be doubled.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제45권4호
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• pp.207-214
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• 2019

Objectives: Medically compromised patients often fear required dental surgical procedures that can increase the risk of medical emergency when combined with reduced tolerance for stress. A stress reduction protocol (SRP) helps doctors minimize treatment-related stress and improves patient management with minimum complications. Diabetes and co-morbid hypertension carry 4-fold risk of aggravation of cardiovascular emergencies and 7.2-fold risk of mortality. Diabetic neuropathy can result in difficult diagnosis of myocardial infarction and reduces chances of surviving a myocardial infarction compared with a non-diabetic person. The aim of the study was to assess the feasibility of a protocol for management of patients having both diabetes and hypertension who required minor oral surgery to minimize the rate of cardiovascular emergencies. Materials and Methods: A prospective study was conducted in 140 patients having both diabetes and hypertension who required minor oral surgical procedures. A systematic approachable protocol was designed for management of such patients. Results: Among 140 patients, 6 patients (4.3%) had cardiovascular complications, while 3 patients (1 with syncope and 2 with hypertension) did not require any intervention other than observation. Two patients were managed with aspirin and nitroglycerin, and 1 patient had possible myocardial infarction (overall incidence 0.7%) with chest pain, S-T segment elevation on electrocardiogram, and troponin level of 0.60 ng/mL. Conclusion: The proposed protocol helps to improve management of patients having both diabetes and hypertension. We recommend that patients with uncontrolled diabetes and uncontrolled hypertension and/or patients having history of cardiovascular complication should be treated in a medical facility with a readily available cardiology unit. This facilitates prompt response to emergency and instant implementation of treatment, helping to reduce morbidity and mortality.

• 지역사회간호학회지
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• 제33권4호
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• pp.357-371
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• 2022

Purpose: This study aims to investigate factors related to long-term length of stay (LOS) of patients with chronic diseases in Korean veterans hospitals. Methods: The subjects were 196 elderly patients with chronic disease staying in the hospital for more than 10 days, Data were collected by the survey of patients with structured questionnaires and medical records review by nurses from July 15 to August 10, 2019. Collected data were analyzed using t-test, ANOVA, Pearson's correlation coefficient and stepwise multiple regression. Results: The present and desired LOS were 37.78±32.66 days and 60.87±45.95 days, respectively. Factors affecting hospital LOS were found to be main disease (genitourinary) (p<.001), assistance in activities of daily living (p<.001), area of hospital (p<.001), payment of medical fees (p=.026), hospital satisfaction (p=.036) and the explanatory power of these variables was 26.4%. The most common health problems that need to be solved after discharge were symptom alleviation and health promotion. These problems can be solved using community-based facility services or visiting medical-welfare services (especially home care nursing). Conclusion: In order to reduce hospital LOS, the following measures are required: personalized self-management education, provision of transportation services for dialysis therapy of inactive patients, linking patients with visiting medical-welfare services including home care nursing and mobile healthcare services, operation of the case management system including the notice of the discharge date at admission, interim check of patient status, and connecting the patient with community resources or transferring the patient to long-term care facilities at discharge.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제30권1호
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• pp.37-44
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• 2024

Purpose: The planning of medical facilities involves formulating a comprehensive medical basic plan, translating it into spatial dimensions through a space program. Feasibility assessment often relies on empirical methods like floor area per bed. However, with the shift towards specialized medical concepts, proportional scaling to bed numbers is challenging. This study proposes scale planning improvements during the feasibility assessment stage for comprehensive hospitals, analyzing cases using area determination factors and standard areas based on medical resources. Methods: The Korean Development Institute's Public Investment Management Center (KDI) identified issues in the scale determination of medical facilities in the Preliminary Feasibility Study Guidelines and investigated alternative approaches for determining the scale of a case that passed the preliminary feasibility study in 2019. The study assessed the feasibility of applying individual factors to determine not only the number of beds but also the scale at the sector and department levels. Additionally, a statistical analysis was conducted to examine the correlation between the total number of beds and various area determination factors. Results: Results suggest a strong correlation between total beds and major equipment needs, but in hospitals with <500 beds, this correlation weakens. Ward section scale is better calculated per ward type, not just total beds. Outpatient department scale depends on specialists, influencing treatment room numbers. Medical personnel play a crucial role in determining the scale of sections like rehabilitation therapy rooms, operating rooms, dialysis rooms, and overall facility scale.

• 한국지역지리학회지
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• 제10권3호
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• pp.606-623
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• 2004

응급의료 서비스는 국가가 형평성있게 적절한 서비스를 제공하여야 하는 공공성이 놀은 영역이라고 될 수 있다. 우리나라의 응급의료기관은 매우 불균등하게 분포되어 있을 뿐만 아니라 인력, 장비, 시설 면에서도 지역간에 상당한 차이를 보이고 있다. 된 연구에서는 응급의료 서비스의 수급 현황을 공간적 관점에서 분석하기 위해 서울시를 대상으로 하여 응급의료 서비스에 대한 잠재적 수요 표면도와 공급 표면도를 구축하였다. 이렇게 구축된 응급의료 서비스 수요 표면도와 공급 표면도를 연산 기능을 이용하여 응급의료 서비스의 수급 표면도를 생성하였다. 그 결과 응급의료 서비스의 공간적 격차가 매우 두드러지게 나타났다. 수요력이 공급력보다 크게 나타난 지역은 응급의료센터의 추가 지정이 잠재적으로 요구되며, 수요력이 공급력보다 작게 나타난 지역은 응급의료 서비스의 과잉 공급으로 인해 병원운영의 어려움을 잠재적으로 안고 있다고 풀이할 수 있다. 본 연구 결과는 바람직한 응급의료 서비스의 제공과 적정 수준의 진료권의 범위를 설정하는데 필요한 정보로 활용될 수 있을 것이다.

• Journal of Acupuncture Research
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• 제31권1호
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• pp.75-93
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• 2014

Objectives : This study was designed to establish medical trust realization system by finding factors influential to it using questionnaire. Methods : 277 subjects were participated in this study. After a treatment, we conducted a survey from April 1st to October 31th about medical service perception index, medical trust index, patient satisfaction index, patient reliability index, patient flow degree index, recall intension index, and hospital image index. To evaluate the influence of medical service perception with other 6 indexes, we statistically made regression analysis of the results through the survey. Results : By the results of the analysis, evaluation of hospital image influenced all 6 indexes. The systemicity of treatment process had an effect on 5 indexes except for the flow degree of patients. The humanity of medical team brought out the estimation of 4 indexes except for the patient flow degree and hospital image. The empathic ability of doctor and appropriacy of medical costs hold the next rank influencing 3 indexes. It reached the conclusion that the systemicity of medical team tend to determine the medical trust and patient reliability. The expertise, professional skill of doctor, the fault, commercial application, fame of medical team, the speed of treatment process, the newest and clean medical facility affected each one index. Conclusions : Korean medicine should find a way to consider the mind of patients for improving the medical quality through trust realization system, keeping up with times. As a result of this research, we can find out important causes which influence the trustful medical system. From now on, we should apply this result to actual treatment of psychology customized system. Also, more simple and clear questionnaire was organized through this research, it can be used to forward research to apprehend patient mentality more conveniently.

• Journal of Yeungnam Medical Science
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• 제8권1호
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• pp.107-126
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• 1991

일부 도시 영세지역 주민의 상병양상과 의료이용형태를 파악하기 위하여 1988년 12월 한달간에 걸쳐 대구시 남구 대명 8동 영세지역 677가구 2,591명과 대조지역 688가구 2,682명의 주민을 대상으로 면접조사를 실시하였다. 두 지역의 연령별 인구 구성은 0-4세, 65세이상의 인구가 영세지역이 높았으며, 성비는 차이가 없었다. 교육정도와 경제수준은 영세지역은 낮았고, 의료보호 대상자는 영세지역이 많았다. 15일간의 급성질환 이환율은 영세지역이 1000명당 57.1로 대조지역의 24.2보다 유의하게 높았다. 두 지역에서 9세 이하 연령에서의 이환율이 높았으나 연령 증가에 따른 이환율의 뚜렷한 증감현상은 보이지 않았다. 질병분류별 급성질환 이환건수는 두 지역 모두에서 남녀 공히 호흡기계 질환이 가장 많았으며, 영세지역의 경우 감염 및 기생충 질환이 두번째로 많아 대조지역과는 다른 양상을 보였다. 급성질환 이환자의 15일간의 평균 이환기간은 영세지역 6.6일, 대조지역 5.4일로 영세지역이 약간 길었다. 급성질환 이환자의 15일간 의료기관 이용은 1차 이용에서는 영세지역의 경우 약국이 58.1% 그리고 대조지역에서는 의원이 36.9%로 가장 많았으며, 2차와 3차 이용에서 영세지역은 약국과 한의원, 대조지역은 병원과 의원이 가장 많았고, 미치료율은 영세지역이 8.8%로 대조지역의 4.6%에 비하여 훨씬 높게 나타났다. 급성질환 이환자의 지역별 의료이용행태에서 1차 이용에 있어서는 동네내 이용이 영세지역 73.6%, 대조지역 64.6%로 가장 많았다. 급성질환 이환자의 의료기관 1차 이용시 병원을 이용하는 이유로 가장 많은 것이 영세지역은 '단골'이었으며, 대조지역은 '가까운 거리'였다. 의원, 보건소 및 약국을 이용하는 이유로 가장 많은 것은 두 지역 모두 '가까운 거리'였다. 1년간 만성질환 이환율은 1000명당 영세지역 83.0, 대조지역 28.0으로 유의한 차이를 보였으며, 연령이 증가함에 따라 이환율도 증가하는 경향을 보였다. 만성질환 이환건수는 영세지역에서는 남자의 경우 신경계 질환이 19.6%, 여자의 경우는 신경계 질환 18.3%, 근골격계 질환이 18.3%로 가장 많았고, 대조지역에서는 남자의 경우 심혈관계 질환이 23.1%, 여자의 겨우 위장관계질환이 27.3%로 가장 많았다. 조사 시점전 1년간 만성질환의 평균 이환기간은 영세지역 9.8개월, 대조지역 10.4개월로 대조지역이 약간 더 길었으며, 평균 활동 제한 기간도 영세지역 1.9개월보다 대조지역 2.1개월로 다소 길었다. 만성질환 이환자의 의료기관 1차 이용에 있어서 영세지역은 약국 이용이 24.2%, 대조지역은 병원외래 이용이 34.7%로 가장 많았으며, 2차, 3차 이용에 있어 영세지역에서는 각 의료기관을 고루 이용하였고, 대조지역에서는 병원 이용이 두드러지게 많았으며, 미치료율은 영세지역과 대조지역이 각각 34.7%, 16.0%로 영세지역이 월등히 높았다. 만성질환자의 지역별 의료이용행태에서 1차 이용에 있어서는 동네내 이용이 영세지역 38.3%, 대조지역 45.3%로 두 지역 모두에서 가장 많았다. 만성질환 이환자의 지역별 의료기관 1차 이용시 병원, 의원, 보건소 및 약국을 이용하는 주된 이유는 '가까운 거리'였으며, 한의원을 이용하는 이유는 '좋은 치료결과'와 치료의 명성'이었다. 이상의 결과로 영세지역의 사회경제적수준이 상병과 의료이용행태에 영향을 미친 것으로 생각된다. 따라서 영세지역 주민을 위한 보다 적극적인 보건의료 서비스의 개발과 합리적이고 적절한 의료이용을 위한 지도 및 계몽과 아울러 사회경제적인 요소들의 개선을 위한 노력을 병행해야 만이 효과적인 보건의료 사업이 될 것으로 생각된다.