• Journal of Hospice and Palliative Care
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• 제25권1호
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• pp.50-54
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• 2022

Antibiotics are commonly prescribed medications in the hospice and palliative care setting, as well as in many other healthcare settings. The overuse or negligent use of antibiotics is associated with the harmful consequence of fostering the development of antibiotic-resistant pathogens. Thus, there is an urgent need to critically examine and audit antibiotic use in all aspects of healthcare. In the status quo, there is a lack of consistent standards and guidelines surrounding the use of antibiotics in hospice and palliative care settings, leading to significant variations in how antibiotics are prescribed and administered in end-of-life care. It is apparent that greater thought needs to go into antibiotic decisions for patients receiving hospice or palliative care, especially considering the harmful consequences of the overprescription of antibiotics. The literature suggests that many clinicians prescribe antibiotics inappropriately for patients who would not benefit from their use or prescribe them without adequate documentation. Clinicians should be deliberate about when they prescribe antibiotics and adhere to the appropriate documentation standards and procedures within their institution or community. Future research should seek to generate generalizable knowledge about which patients will benefit most from antibiotic therapy during end-of-life care.

• 대한약침학회지
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• 제22권4호
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• pp.260-268
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• 2019

Objectives: The Clinical Decision Support System (CDSS), which analyzes and uses electronic health records (EHR) for medical care, pursues patient-centered medical care. It is necessary to establish the CDSS in Korean medical services for objectification and standardization. For this purpose, analyses were performed on the points to be followed for CDSS implementation with a focus on herbal medicine prescription. Methods: To establish the CDSS in the prescription of Traditional Korean Medicine, the current prescription practices of Traditional Korean Medicine doctors were analyzed. We also analyzed whether the prescription support function of the electronic chart was implemented. A questionnaire survey was conducted querying Traditional Korean Medicine doctors working at Traditional Korean Medicine clinics and hospitals, to investigate their desired CDSS functions, and their perceived effects on herbal medicine prescription. The implementation of the CDSS among the audit software developers used by the Korean medical doctors was examined. Results: On average, 41.2% of Traditional Korean Medicine doctors working in Traditional Korean Medicine clinics manipulated 1 to 4 herbs, and 31.2% adjusted 4 to 7 herbs. On average, 52.5% of Traditional Korean Medicine doctors working in Traditional Korean Medicine hospitals adjusted 1 to 4 herbs, and 35.5% adjusted 4 to 7 herbs. Questioning the desired prescription support function in the electronic medical record system, the Traditional Korean Medicine doctors working at Korean medicine clinics desired information on 'medicine name, meridian entry, flavor of medicinals, nature of medicinals, efficacy,' 'herb combination information' and 'search engine by efficacy of prescription.' The doctors also desired compounding contraindications (eighteen antagonisms, nineteen incompatibilities) and other contraindicatory prescriptions, 'medicine information' and 'prescription analysis information through basic constitution analyses.' The implementation of prescription support function varied by clinics and hospitals. Conclusion: In order to implement and utilize the CDSS in a medical service, clinical information must be generated and managed in a standardized form. For this purpose, standardization of terminology, coding of prescriptions using a combination of herbal medicines, and unification such as the preparation method and the weights and measures should be integrated.

• 생물정신의학
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• 제25권3호
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• pp.72-78
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• 2018

Objectives The high suicide rate has risen as a main concern in South Korea. Given the complexity of the mechanism resulting in complete suicide, studies targeting various populations are needed for broader understanding of its risk factors. This study aims to analyze the factors affecting the suicidal tendency in the population of the elderly living alone in Seoul depending on basic elderly-care services. Methods A total number of 415 people participated in the study. Home-visit interviews were administered by trained interviewers. Suicidal tendency was measured by the Korean version of mini international neuropsychiatric interview (K-MINI). Health-related quality of life was measured by a brief version of the World Health Organization Quality-of-life Scale (WHOQOL-BREF). Alcohol problem was assessed by the Korean version of the alcohol use disorders identification test (AUDIT-K). Among total subjects of 415 interviewees, the actual responses of 408 people were used for the final analysis. Results The result showed that the suicide risk was high in persons isolated from social support [odds ratio (OR) = 4.49], having depression (OR = 14.85), and having low quality of life (OR = 4.39). Conclusions We found that social support, depression and health-related quality of life are associated with suicidal tendency in the elderly living alone on basic services. Our evidence will contribute to suicide prevention policy for the elderly living alone on care services.

• 보건행정학회지
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• 제6권1호
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• pp.191-210
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• 1996

This study purported to acquire information necessary to improve the operational efficiency of general hospitals. It tried to determine major indices which represent managerial performance of general hospitals and to identify the managerial characteristics of general hospital which affect the major financial indices. 201 hospitals which were subject to standardization audit by the Korean Hospital Association were investigated and 80 hospitals were finally chosen for this study. Their financial and managerial data during the period between January 1991 and December 1991 were collected. Considering financial indices in this study were the ration of net income to total asset, income growth rate, and quick ration. The results of study are summarized as followings. First. The ration of net income to total assets and quick ration were highly related to managerial characteristics of general hospitals. Therefore, the standardization of three financial indices should be needed to systematically check the operational efficiency of general hospitals. Second, the sample hospitals can be classified as four groups on the basis of their financial indices' level. 4 of those hospitals(5.0%) showed high level of performance in terms of three financial indices and 27 of them(33.7%) showed that they are highly related to only two financial indices. 34 hospitals(42.5%) showed they have high level of relationship with only one indices and 15 hospitals(18.8%) showed very weak performance level with three indices. In addition, there is no hospitals to show mid-range level of managerial performance in relation to all three financial indices. Third, there is no significant relationship between three financial indices and the managerial characteristics of hospitals such as the number of beds, type of operation, location of hospitals, and etc. However, in the case of hospitals which have high level of managerial performance, they have more specialists and medical support personnel in comparison to low performance hospitals. They also have high level of bed occupancy rate and average length of stay(ALOS). In conclusion, the study showed the standardization of 3 financial indices are necessary to systematically evaluate the managerial performance of general hospitals and provide more accurate operational information for each hospital. To do so, it is necessary to focus on management side of hospital such as the effective human resource management and quality enhancement of medical treatment.

• 한국의학물리학회지:의학물리
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• 제21권1호
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• pp.120-125
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• 2010

물흡수선량에 기반한 표준 측정법을 사용하여 흡수선량을 측정 시에 여러 요인들이 크건, 작건, 미미하건 간에 선량 측정의 정확성에 영향을 미칠 수 있다. 이온함의 선질 보정 인자(the beam quality correction factor) ${\kappa}_{Q,Q_0}$ 값 또한 그 중 한 요인이 될 수 있다. 본 연구에서는 특정 이온함 유형(PTW30013, PTW, Germany)을 선정하여, 국내에서 사용하고 있는 기관들로부터 9개의 이온함을 수집하였다. 동일한 전위계와 전기선으로 9개 이온함을 국내 이차표준기관으로부터 교정을 받았다. 이렇게 교정받은 이온함들을 사용하여 Siemens ONCOR 장비의 광자 빔 6 MV와 10 MV 그리고 전자 빔 12 MeV에 대해 기준 조건하에서 흡수선량을 측정하였다. 이온함 간 선량 값의 최대 차이는 광자 빔 6 MV의 경우엔 2.4%, 10MV의 경우에 0.8%, 전자 빔 12 MeV의 경우엔 0.8%이었다. 6 MV에서의 큰 차이는 측정 과정에 문제가 없었다면, 동일한 ${\kappa}_{Q,Q_0}$ 값을 모든 이온함에 적용한 게 한 요인이 될 수 있다. 이는 또한 외부 독립검사가 왜 중요한지를 보여 주는 예라 하겠다.

• Journal of Preventive Medicine and Public Health
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• 제24권4호
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• pp.531-548
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• 1991

신생아의 질적 관리를 위해 신생아실 의료인력과 의료수가의 타당성을 파악하고자 영남지역내 24개 소아과 수련병원 가운데 신설병원과 모(母)병원의 수련프로그램에 의존해 있는 병원을 제외한 20개 병원의 신생아실을 대상으로 1991년 7월 29일에서 8월 14일 사이에 각 병원을 방문하여 자료를 수집하였다. 자료는 신생아실 대장에서 1991년 6월 한달동안 입.퇴원한 정상 및 환아수를 조사하고 신생아실 수간호사와 소아과 의사를 면담하여 정상신생아 관리에 소요되는 최소한의 간호시간, 인력현황, 인력의 적정성, 그리고 인력확보의 문제점을 조사하였고 자 병원 보험심사과에서 정상 질분만시와 제왕절개분만시 산모 1인당 평균 산모 및 신생아관리분의 의료비를 조사하였다. 정상신생아 1명당 하루에 필요한 최소한의 간호시간은 평균 179.5분(${\pm}58.6$)이었고 대학병원은 202.3분(${\pm}50.7$), 종합병원은 164.2분(${\pm}60.5$)이었다. 최소한의 간호 요구시간 대 제공가능한 간호시간 비는 평균 1.42였고 환아에 대한 간호 요구량을 감안했을 때는 평균 비가 2.06으로 간호인력이 매우 부족하였다. 미국 소아과학회가 권장한 신생아실 간호인력을 기준으로 할 경우 간호사는 31%, 간호조무사는 17%가 충원된 상태였다. 신생아실 수간호사의 90%와 소아과 의사의 85%가 간호사가 부족하다고 했고 간호조무사는 각각 75%가 부족하다고 했다. 간호인력 보충이 안 되는 주된 이유는 재정사정이라고 하였다. 간호조무사의 경우는 인력구하기 힘든 것이 재정사정 다음으로 중요한 이유였다. 그러나 국립대학병원의 경우는 의사와 간호사는 T.O.의 제한이 주된 이유라고 했다. 정상 질분만으로 2박 3일만에 퇴원하는 경우 총 의료비는 평균 219,430원이었고 이 중 신생아분은 20,323원(9.3%)이었으며, 제왕절개분만으로 6박 7일만에 퇴원할 경우 평균 732,578원이었고 이 중 신생아분은 76,937원(12.0%)이었다. 원가계산방식에 의한 신생아관리에 대한 최소한의 원가는 3차진료기관의 경우 1일 16,141원, 기타 종합병원은 14,576원으로 원가가 의료보험수가의 각각 5.0배, 4.9배나 되었다. 오늘날의 의료인력의 인건비 수준과 병원시설 및 관리비를 감안할 때 현행 의료수가로 양질의 신생아관리를 기대하기 어려운 것으로 생각된다.

• Asian Pacific Journal of Cancer Prevention
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• 제16권14호
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• pp.5715-5719
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• 2015

Background: Breast cancer is the most common malignancy of women in the world. The disease is caused by infectious and non-infectious, environmental and lifestyle factors. Tobacco smoke has been one of the most widely studied environmental factors wiith possible relevance to breast cancer. The purpose of this study was to assess the impact of tobacco smoking in breast cancer patients in a hospital based cohort and to establish prognostic implications if any. Materials and Methods: A retrospective audit of 100 women with pathological diagnosis of invasive breast cancer was included in this study. The verbal questionnaire elicited information on current and previous history of exposure to smoking in addition to active smoking. All analyses were adjusted for potential confounders, including stage at presentation, alcohol intake, hormonal replacement therapy, oral contraceptive intake, obesity and menopausal status. Results: The mean age at presentation of breast cancer was $51.4{\pm}10.86$ years. Mean age of presentation was $53.1{\pm}11.5$ and $45.7{\pm}11.9$ years in never smokers and passive smokers, respectively. Age at presentation varied widely in patients exposed to tobacco smoke for >10 years in childhood from $40.3{\pm}12.0$ years to $47.7{\pm}13.9$ in patients exposed for > 20years as adults. Among passive smokers, 60.9% were premenopausal and 39.1% of patients were postmenopausal. In never smokers, 71.4% were post menopausal. Expression of receptors in non-smokers vs passive smokers was comparable with no significant differences. Metastatic potential in lung parenchyma was slightlyelevated in passive smokers as compared to never smokers although statistically non-significant. Conclusions: An inverse relationship exists between the intensity and duration of smoking and the age at presentation and poor prognostic factors. The results strongly suggest efforts should be taken to prevent smoking, encourage quitting and restrict exposure to second hand smoke in India.

• Korean Journal of Acupuncture
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• 제24권4호
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• pp.13-24
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• 2007

Objectives : This article aims to give guidance on the conduct and reporting of case series and audits of acupuncture, based on common problems that have arisen in the past. This type of project, and particularly the prospective case series or pre- post-intervention study, may give valuable evidence of the overall effectiveness of acupuncture-for example in different situations and in different conditions- and provides one step in the research pathway before generating an hypothesis. Results & Discussion : The project should be designed with the aim of reducing bias as much as possible. Careful and detailed planning is essential for the project to produce worthwhile results that readers can evaluate and replicate. Ethical issues should be considered and formal approval may be necessary. The patient group should be recruited systematically and baseline data obtained. The treatment given should be systematic and decisions to change or end treatment made explicit. The outcome should be measured in ways that are known to be reliable and valid. Musculoskeletal problems can be evaluated with scales for pain and confirmed by measuring one other symptom such as stiffness or one other aspect such as bothersomeness. Global change scores also provide supporting information, and the MYMOP (Measure Yourself Medical Outcome Profile) measure is popular when patients with different conditions are included. The design of questionnaires for beliefs and attitudes is a specialised area that should not be attempted without expert help. Adverse events should also be recorded. Analysis of the data and the best way of summarising and presenting the results are also discussed.

• 한국산학기술학회:학술대회논문집
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• 한국산학기술학회 2012년도 춘계학술논문집 1부
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• pp.25-29
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• 2012

본 연구의 목적은 농어촌지역의 음주문제 관련 상담센타, 사업장 중심의 절주 프로그램이나 치료 서비스가 취약한 형편이어서 농어촌 지역 직장인의 음주문제에 대한 대책을 마련하고자 하는데 있다. 본 연구의 대상자는 일 농어촌 지역에 거주하는 20세 이상의 남녀 직장인 530명을 대상으로 하였고, 설문에 동의하여 회수된 설문지는 512부였으며 이중 부실하게 응답한 12명의 자료를 제외한 500명의 자료를 최종 분석대상으로 하였다. 자료수집은 2007년 6월 12일부터 2007년 8월 25일까지 시행되었으며, 설문지의 내용을 이해하며 의사소통이 가능한 자에게 본 연구의 취지를 설명하고 연구에의 참여를 동의한 대상자에게 구조화된 설문지를 이용해 자료를 수집하였다. 1. 본 연구에 참여한 대상자의 음주에 대한 인식은 긍정적 인식의 평균은 2.93, 부정적 인식의 평균은 3.18로 나타났다. 2. 음주행태에서 음주경험여부는 현재 음주자가 79.7%로 가장 많았고, 비음주자 13.1%, 과거 음주자 7.2%로 나타났다. 음주빈도는 음주경험이 있는 대상자 중 '월 2-4회 마시는 경우'가 38.2%로 가장 많았고, 평소 음주량은 '소주 10잔 이상'이 34.6%로 많았으며 '소주 3잔 이상'인 경우가 전체 대상자의 92.2%를 차지하였다. 3. 대상자의 문제음주 정도 및 특성은 전체 대상자 중 CAGE를 통해 선별된 알코올 의존자(4개 문항 중 2개 이상이 그렇다고 응답하면 알코올 의존으로 규정)의 비율이 96명(25.1%)이었고, AUDIT를 통해 선별된 문제성 음주자(8점 이상)의 비율은 241명(64.8%)으로 나타났다. 4. 대상자의 음주로 인한 질병은 위장계 질환이 31.3.%로 가장 많았다. 이상의 연구결과를 종합해볼 때, 농어촌지역 직장인의 음주문제에 관한 구체적인 해결방안으로는 음주 문화에 대한 인식개선과 산업체 중심의 절주사업이 필요하며 농어촌 직장인 중 문제음주자 및 알코올 의존자의 조기발견 및 관리를 위한 알코올중독 예방 교육 및 진단 치료에 관한 교육 프로그램 개발이 필요하다.

• 보건행정학회지
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• 제5권1호
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• pp.132-160
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• 1995

This study purported to acquire information necessary to improve the management of general hospitals. It tried to determine major indices which represent managerial performance of general hospitals and to identify the managerial characteristics of general hospitals which affect the major financial indices. Eighty-eight hospitals were chosen from 188 hospitals which were subject to standardization audit by the Korean Hospital Association. The results of a discriminant analysis are summarized as followings. First, when a single index was used to measure managerial performance of the sample hospitals, the ration of net profit to total capital was the best index and its discriminant power was 58.14%. The ratio of the number of boardmen((M. D.) and average daily medical cost were highly related to this index. Second, when two indices were used, income growth rte and the ration of net profit to total capital had the highest discriminant distinction ability. Their discriminant power was 61.9%. In this case, the ratio of the number of boardmen(M. D.) was significantly and highly related to the indices. Third, when all three indices-income growth rate, the ration of net profit to total capital and quick ratio - were used together, a discriminant function was statistically insignificant. Therefore, using all three indices was not useful in measuring managerial performance of the sample hospitals. In conclusion, using two indices-income growth rate and the ration of net profit to total capital-was better in measuring manegerial performance of general hospitals than using a single index. The independent variable which affected these indices was the ration of the number of boardmen. The discriminant function was : $D_{GI}=2.77+4.832\times(the ratio of the number of boardmen)$ *G=growth index(income growth rate) *I=profit index(the ration of net profit to total capital)