• 대한임상검사과학회지
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• 제48권4호
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• pp.348-354
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• 2016

병원정보시스템에 저장되어 있는 자료들은 적절성 평가 및 질관리를 향상시키는 데 있어 많은 잠재력을 가지고 있으며 이를 기반으로 하는 데이터웨어하우스의 구축은 질 관리의 향상과 임상진료에 많은 도움을 줄 수 있는 것으로 알려져 있다. 본 연구는 감염관리 정보의 체계적이고 효과적인 자료 분석을 위한 일환으로 항생제 사용량 분석이 가능한 데이터마트를 구축하였다. 감염관리의 구성요소 및 평가 척도를 선정 후 XML DTD 방법으로 메타데이터를 설계하였고 모델링을 통해 데이터마트를 구축하여 항생제 사용량 분석을 위한 다차원 분석 도구인 OLAP를 시현하였다. 실험 자료는 1997년 7월 한 달 동안의 천안 지역의 일개 대학병원의 항생제 사용량 자료를 이용하였다. 감염관리 메타데이터의 상위요소는 항생제 내성 정보, 항생제 사용량 정보, 감염 정보, 검사 정보, 환자 정보 및 감염 관련 비용으로서 구성하였다. 이 중 항생제 사용량 정보를 스타 스키마에 적용하기 위한 데이터베이스의 설계를 하여 데이터마트를 구축하였다. 그리고 일 개월 간 사용된 항생제 사용량에 대해 OLAP을 시현하였다. 본 연구는 XML과 OLAP 기술의 구현을 통해 항생제 사용량에 대한 감염관리 데이터마트를 수립하였다. 개념적이고 구조화된 데이터마트의 구축은 감염관리 정보에 대해 신속하고 다양한 분석을 제공할 것으로 사료되었다.

• 한국콘텐츠학회논문지
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• 제16권11호
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• pp.499-509
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• 2016

본 연구는 유방암 환자의 외상 후 성장에 영향을 미치는 요인을 조사하고자 진행되었으며 자료수집은 인천광역시 내 대학병원 외래를 내원하여 유방암 진단을 받고 치료과정 중에 있는 유방암 환자 100명을 대상으로 하였다. 연구도구는 한국어판 외상 후 성장 척도(K-PTGI), 사회적지지(mMOS-SS), 유방암 자가관리에 대한 자기효능감 척도(SESSM-B)와 대처행동(CCQ) 도구를 사용하였다. 자료의 분석은 t-검정, ANOVA, Pearson 상관분석, 단계적 다중회귀분석을 하였다. 연구결과 외상 후 성장 정도는 5점만점에 평균 3.4(${\pm}0.9$)점이었다. 외상 후 성장은 사회적 지지, 유방암 자가관리에 대한 자기효능감, 대처행동과 통계적으로 유의한 양의 상관관계를 보였다. 단계적 다중회귀분석에서, 치료이행 자기효능감과 긍정적 재구조화 대처행동이 유방암환자의 외상 후 성장 영향 요인으로 나타났고, 이들 변수들의 설명력은 29%였다. 본 연구 결과를 바탕으로 유방암환자의 외상 후 성장을 향상시킬 수 있는 간호 중재 개발을 고려할 필요가 있겠다.

• Tuberculosis and Respiratory Diseases
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• 제52권3호
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• pp.271-277
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• 2002

저자들은 기침 및 흉통을 주소로 내원한 53세의 알코올중독 남자 환자에서 발견된 종격동 췌장 가성낭종을 내시경적 역행성췌담도배액술과 somatostatin 유사체인 octreotide acetate를 투여하여 치료한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Gastric Cancer
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• 제16권3호
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• pp.182-190
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• 2016

Purpose: This study aimed to establish a large-scale database of patients with gastric cancer to facilitate the development of a nationalcancer management system and a comprehensive cancer control policy. Materials and Methods: An observational prospective cohort study on gastric cancer was initiated in 2010. A total of 14 cancer centers throughout the country and 152 researchers were involved in this study. Patient enrollment began in January 2011, and data regarding clinicopathological characteristics, life style-related factors, quality of life, as well as diet diaries were collected. Results: In total, 4,963 patients were enrolled until December 2014, and approximately 5% of all Korean patients with gastric cancer annually were included. The mean age was $58.2{\pm}11.5$ years, and 68.2% were men. The number of patients in each stage was as follows: 3,394 patients (68.4%) were in stage IA/B; 514 patients (10.4%), in stage IIA/B; 469 patients (9.5%), in stage IIIA/B/C; and 127 patients (2.6%), in stage IV. Surgical treatment was performed in 3,958 patients (79.8%), endoscopic resection was performed in 700 patients (14.1%), and 167 patients (3.4%) received palliative chemotherapy. The response rate for the questionnaire on the quality of life was 95%; however, diet diaries were only collected for 27% of patients. Conclusions: To provide comprehensive information on gastric cancer for patients, physicians, and government officials, a large-scale database of Korean patients with gastric cancer was established. Based on the findings of this cohort study, an effective cancer management system and national cancer control policy could be developed.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제39권3호
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• pp.127-133
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• 2013

Objectives: Infererior alveolar nerve (IAN) damage may be one of the distressing complications occurring during implant placement. Because of nature of closed injury, a large proportion is approached non-invasively. The purpose of this study was to analyze the outcomes of conservative management of the injured nerve during dental implant procedure. Materials and Methods: Sixty-four patients of implant related IAN injury, who were managed by medication or observation from January 1997 to March 2007 at the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, were retrospectively investigated. The objective tests and subjective evaluations were performed to evaluate the degree of damage and duration of sensory disturbance recovery. Tests were performed on the day of the first visit and every two months afterward. Patient's initial symptoms, proximity of the implant to the IAN, time interval between implant surgery and the first visit to our clinic, and treatment after implant surgery were analyzed to determine whether these factors affected the final outcomes. Results: Among the 64 patients, 23 had a chief complaint of sensory disturbance and others with dysesthesia. The mean time until first visit to our hospital after the injury was 10.9 months.One year after nerve injury, the sensation was improved in 9 patients, whereas not improved in 38 patients, even 4 patients experienced deterioration. Better prognosis was observed in the group of patients with early visits and with implants placed or managed not too close to the IAN. Conclusion: Nearly 70% of patients with IAN injury during implant placement showed no improvement in sensation or dysesthesia with the conservative management. Earlier decision for active treatment needs to be considered because of possibility of deterioration of symptoms and unsatisfactory recovery.

• 한국산학기술학회논문지
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• 제21권4호
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• pp.463-470
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• 2020

본 연구는 중소병원 간호사를 대상으로 다제내성균 감염관리 지식과 교육요구도를 파악하여 중소병원 간호사 맞춤형 감염관리 교육프로그램을 개발하고자 시도되었다. 자료수집은 중소병원에 근무하는 간호사 115명을 대상으로 하였다. 자료수집기간은 2019년 11월 15일~11월 30일까지 구조화된 설문지를 이용하여 시행되었다. 수집된 자료는 IBM SPSS 21.0 프로그램을 이용하여 분석하였으며, 기술통계, t-test, ANOVA를 이용하였다. 연구결과 중소병원 간호사의 86.1%가 다제내성균 환자를 간호한 경험이 있었으며 다제내성균 감염관리 교육을 받은 경우가 67.8%로 나타났다. 다제내성균 감염관리지식은 27점 만점에 25.51점이었으며, 다제내성균 환자가 사용한 의료기기에 대한 소독수준, 선제 격리환자의 격리 해제기준, 코호트 격리에서 환자관리, 개인보호구 탈의시점에서 정답률이 낮았다. 교육요구도는 격리병실배정, 선별검사 대상기준, 유행발생관리가 가장 높았다. 또한 일반적 특성에 따른 교육요구도 차이에서 최종학력과 직급에서 차이가 있었다. 따라서 다제내성균의 원내전파 차단 및 유행발생을 예방하기 위해서 다제내성균 감염관리 교육이 중요하므로 다제내성균 감염관리 교육프로그램 개발시 경력별로 교육 구성의 차별화가 필요하다. 신규간호사와 경력간호사 감염관리교육시 필수적으로 다제내성균 감염관리 교육을 수행하는 것이 필요하다.

• 의료법학
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• 제15권2호
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• pp.31-60
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• 2014

In this paper the good Samaritan civil liability is argued. In many cases some damage could be caused by an emergency medical service. In such situations the degree of duty of care taken by the service provider would be alleviated depending upon the degree of emergency. Then the service provided by anyone not carrying any duty to do so could be generally ruled by the 'Korean Civil Act' Article 735. This article is related to the management of affairs in urgency. The application of this article means the mitigation of civil liability of the service provider. If the service provider not carrying any duty to provide it "has managed the affairs" of the service "in order to protect the" victim "against an imminent danger to the latter's life", the provider "shall not be liable for any damages caused thereby, unless he acted intentionally or with gross negligence". Korea has another rule applied in such a situation, that is the Korean 'Emergency Medical Service Act' Article 5-2. This article is established for the exemption from responsibility for well-intentioned emergency medical service. It could be referred to as the Good Samaritan law. It provides: "In cases where no intention or gross negligence is committed on the property damage and death or injury caused by giving any emergency medical service or first-aid treatment falling under any of the following subparagraphs to an emergency patient whose life is in jeopardy, the relevant actor shall not take the civil liability ${\cdots}$" In this paper the two articles is compared in the viewpoints of the requirements for and effects of the application of them respectively. The 'Korean Civil Act' Article 735 is relatively general rule against the the Korean 'Emergency Medical Service Act' Article 5-2 in the same circumstance. Therefore the former could be resorted to only if any situation could not satisfy the requisites for the application of the latter. In this paper it has suggested that the former article be more specific for the accuracy of making decision to apply it; and that the latter be revise in some requirements including the victim, the service provider, and the service.

• 보건행정학회지
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• 제20권4호
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• pp.58-73
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• 2010

Background : Cancer is a disease that not only places a significant burden on patients clinically but also requires significant expense for diagnosis and treatment. Although the cancer coverage of health insurance has recently been expended, the need for financial assistance among cancer patients and their families is still expected to be significant. In this study, cancer patients' need for financial assistance in Korea was examined and its influence factors were analyzed. Methods : Target study subjects were those who are over 18 years of age and were diagnosed with cancer more than four months prior at the National Cancer Center and 9 Regional Cancer Centers in Korea during the period from July to August of 2008. Quarter sampling was conducted according to the ratio of the type of each cancer. A face to face interview survey was conducted. A total of 2,661 cancer patients finished the survey. Medical charts were reviewed in order to obtain the cancer type and SEER stage of cancer patients. An ordered logistic regression model was used to examine the level of need for financial assistance according to the demographical, clinical, and socio-economic variables of cancer patients. Result : The percentage of cancer patients who needed financial assistance was 69.0%, and 36.9% needed significant financial assistance. The need for financial assistance was perceived to be greater in males, younger age group, low income group, low education group, medical aid recipients, those who were diagnosed recently, those with a low level of quality of life measured through EQ5D, and those with decreased income after cancer diagnosis. Conclusion : In spite of the current policy to increase health insurance coverage, the majority of cancer patients and their families in Korea still need financial assistance due to cancer. In particular, there were more vulnerable groups, such as the low income, or low education group. In the future, policies that focus on the disadvantaged, which strengthen social security, should be considered for achievement of a substantially better quality of life for cancer patients and their families.

• 보건행정학회지
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• 제28권4호
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• pp.411-422
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• 2018

Background: Whether there is a difference in outcomes for trauma patients transferring to the helicopter emergency medical service (HEMS) according to their previous team composition is controversial. The purpose of this study is to evaluate the effectiveness of trauma team-staffed-HEMS (TTS-HEMS) when transferring to a trauma center. Methods: A retrospective comparison was conducted on patients transported to a trauma center over a 6-year period by the TTS-HEMS and paramedic-staffed-HEMS (119-HEMS). Inclusion criteria were blunt trauma with age ${\geq}15years$. Patient outcomes were compared with the Trauma and Injury Severity Score (TRISS) (30-day mortality) and the Cox proportional hazard ratio of mortality (in hospital). Results: There were 321 patients of TTS-HEMS and 92 patients of 119-HEMS. The TTS-HEMS group had a higher Injury Severity Score and longer transport time but a significantly shorter time to emergency surgery. The prehospital data showed that the trauma team performed more aggressive interventions during transport. An additional 7.6 lives were saved per 100 TTS-HEMS deployments. However, the TRISS results in the 119-HEMS group were not significant. In addition, after adjusting for confounders, the hazard ratio of mortality in the 119-HEMS group was 2.83 times higher than that in the TTS-HEMS group. Conclusion: HEMS was likely to improve the survival rate of injured patients when physicians were involved in TTS-HEMS. Survival benefits in the TTS-HEMS group appeared to be related to the fact that the trauma team performed both more aggressive prehospital resuscitation and clinical decision making during transportation.

• 대한족부족관절학회지
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• 제25권4호
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• pp.149-156
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• 2021

Purpose: Given the lack of definite evidence-based guidelines in clinical practice, there may be a wide variation in treatment protocols for osteochondral lesions of the talus (OLT). Based on the Korean Foot and Ankle Society (KFAS) member survey, this study aimed to report the current trends in the management of OLT. Materials and Methods: A web-based questionnaire containing 30 questions was sent to all KFAS members in September 2021. The questions were mainly related to clinical experience and preferences in diagnosis, conservative, and surgical treatments for patients with OLT. Answers with a prevalence of ≥50% of respondents were considered a tendency. Results: Sixty-two (11.3%) of the 550 surgeons queried responded to the survey. The responses to 9 (30.0%) of the total of 30 questions established a tendency. Answers exhibiting a tendency were as follows; additional diagnostic tools except for plain radiograph (magnetic resonance imaging), most common conservative treatment method (oral medication, rest), most important radiological factor in decision making for surgical treatment and method (size of the lesion, ankle instability, loose bodies), most important patient factors in decision making for surgical treatment and method (age, activity or occupation), infrequently requiring posterior arthroscopy (less than 3%), most common revision surgery for failed bone marrow stimulation procedure (osteochondral autograft transplantation [OAT]), not requiring additional procedure for donor site in OAT, the main reason for unsatisfactory result after OAT (persistent pain without radiological abnormality), no generalization of autologous chondrocyte implantation or chondrogenesis using stem cells. Conclusion: This study presents updated information on current trends in the management of OLT in Korea. Both consensus and variations in the approach to patients with OLT were revealed through this survey. Since recent biologic efforts to regenerate cartilage have been unsuccessful, further studies to identify clinical evidence would be needed.