• 의료법학
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• 제21권3호
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• pp.117-144
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• 2020

우리나라 의료인은 의료법 제15조에 따라 정당한 사유가 없는 한 환자의 진료를 거부할 수 없으며, 정당한 사유 없이 진료를 거부한 행위는 형사처벌의 대상이 된다. 일본도 의사법에서 동일한 내용을 규정하고 있지만, 진료거부행위가 형사처벌의 대상이 되는 것은 아니다. 환자에게 손해가 발생한 경우에 한하여 의사의 손해배상책임 여부를 판단하는데 고려되는 일 요소로서 활용되고 있다는 차이가 있다. 그러나 조항 자체가 매우 추상적으로 규정되어 있어 양 국가는 의사가 환자의 진료를 거부할 수 있는 정당한 사유가 무엇인지를 구체화하기 위해 노력한다. 최근 일본은 의사의 과도한 근무환경을 개선한다는 관점에서 진료거부에 관한 논의를 현대적 관점에서 재조명하는 작업을 완료한 바 있다. 반면 우리나라는 진료거부에 관한 체계적인 논의가 부족하여 어떠한 경우에 진료를 거부할 수 있는지 명확히 알 수 없을 뿐만 아니라 오히려 불필요한 오해와 논란만 가중됨에 따라 환자와 의사간의 신뢰가 상실되는 결과를 초래하고 있다. 한편 우리나라에서는 이미 연명의료결정 중단 시행에 있어 의사가 종교적 신념 또는 양심에 따라 이를 거부할 수 있는 권리가 법적으로 보장되고 있으며, 최근 낙태의 경우에도 의사에게 이를 거부할 권리를 보장해야 한다는 논의가 진행 중에 있다. 본 연구는 일본의 논의 현황을 소개하며, 우리나라에서 확인할 수 있는 진료거부 사례를 검토하고, 이에 덧붙여 오늘날의 의료현실에서 검토가 필요한 사례를 제시하였다. 이 연구를 통해 의사의 진료거부금지 의무에 관한 발전적 논의가 촉진되기를 기대한다.

• 한국정보통신학회:학술대회논문집
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• 한국해양정보통신학회 2002년도 춘계종합학술대회
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• pp.130-133
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• 2002

사회의 발전에 따라 고령화 현상과 예전에 없던 많은 병들이 생겨나고 있다. 특히 고령환자의 경우는 건강 상태가 언제 악화될지 모르기 때문에 지속적인 관찰의 필요성에 원격 의료정보 시스템 연구가 활발히 이루어지고 있다. 생체 전위 신호의 일종인 심전도 신호는 심장 질환 보유 환자의 일상적 임상 진단 수단으로 의료 정보 시스템에 널리 사용되고 있다. 블루투스란 2.4GHz 대의 무선 주파수를 사용하는 근거리 무선 통신 기술로서 저전력 특성과 고속의 주파수 호핑 방식에 따른 높은 신뢰성 및 자체 에러 정정 기술을 지니고 있다. 이는 기존의 무선모뎀보다 데이터 전송에 있어서 높은 신뢰성을 얻을 수 있게 해준다. 또한 무선 모델은 무선 단말기 소형화에 따른 제약을 받고 있으나 블루투스를 사용함으로써 저전력 특성과 더불어 휴대용으로의 기능에 부합시킬 수 있으며, 모듈의 원칩화가 진행됨에 따라 자은 크기로의 가능성이 제시된다. 이에 따라 블루투스를 이용한 작업 중 외부로부터 입력되는 의료 정보를 블루투스 모듈이 호스트 PC에 연결된 불루투스 모듈에 무선으로 전송하고, 호스트 PC는 연결된 블루투스 모듈로부터 받은 의료 정보를 인터넷 망으로 전송하는 시스템이 구현된 바 있다. 본 연구는 기존의 시스템에서 더 나아가 호스트 PC를 임베디드화하고, Tcp/Ip 프로토콜 스택을 추가하여 의료 정보를 모두 임베디드화된 환경 하에서 웹으로 전송 할 수 있게 해준다.

• 한국콘텐츠학회논문지
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• 제20권8호
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• pp.666-673
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• 2020

의료시장 개방 등으로 의료시장이 확대되면서 일반 병원 뿐만 아니라 치과 병·의원에서도 고객 서비스 제공을 위한 다양한 시도를 하고 있다. 이 연구의 목적은 고등학생을 대상으로 치과병원 결정요인과 의료서비스 만족도에 관해 조사하고자 2019년 9월부터 10월 사이 편의표본추출 방법으로 일부지역 고등학교 재학생을 대상으로 조사하였으며, 그 결과는 다음과 같다. 일반적인 특성에 따르면, 스케일링 경험, 교정 치료, 학교 생활에 대한 만족도, 주관적인 구강 건강 상태가 치과 병원의 만족도와 관련성이 있었다. 직원 서비스 만족도가 가장 중요한 병원결정요인이었고, 병원 결정 요인 중 시설, 타인의 추천, 사용 절차, 서비스 적절성, 직원 서비스 만족도가 의료 서비스 만족도와 유의 한 양의 상관 관계가 있었다. 치과 병원 만족도에 영향을 미치는 요인으로, 주관적인 구강 건강이 음의 관련성, 이용 절차와 직원 서비스 만족도는 양의 관련성을 나타냈다. 이 연구는 일부 지역 고등학생을 대상으로 도출된 결과이기에 일반화 할 수는 없겠지만 서비스 경쟁력을 높여 환자의 만족도를 높이는 것이 병원선택에 중요한 요인이라고 할 수 있겠다.

• The Korean Journal of Pain
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• 제30권3호
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• pp.197-206
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• 2017

Background: Pain with neuropathic characteristics is generally more severe and associated with a lower quality of life compared to nociceptive pain (NcP). Short form of the Douleur Neuropathique en 4 Questions (S-DN4) is one of the most used and reliable screening questionnaires and is reported to have good diagnostic properties. This study was aimed to cross-culturally validate the Hindi version of the S-DN4 in patients with various chronic pain conditions. Methods: The S-DN4 is already translated into the Hindi language by Mapi Research Trust. This study assessed the psychometric properties of the Hindi version of the S-DN4 including internal consistency and test-retest reliability after 3 days' post-baseline assessment. Diagnostic performance was also assessed. Results: One hundred sixty patients with chronic pain, 80 each in the neuropathic pain (NeP) present and NeP absent groups, were recruited. Patients with NeP present reported significantly higher S-DN4 scores in comparison to patients in the NeP absent group (mean (SD), 4.7 (1.7) vs. 1.8 (1.6), P < 0.01). The S-DN4 was found to have an AUC of 0.88 with adequate internal consistency (Cronbach's ${\alpha}=0.80$) and a test-retest reliability (ICC = 0.92) with an optimal cut-off value of 3 (Youden's index = 0.66, sensitivity and specificity of 88.7% and 77.5%). The diagnostic concordance rate between clinician diagnosis and the S-DN4 questionnaire was 83.1% (kappa = 0.66). Conclusions: Overall, the Hindi version of the S-DN4 has good internal consistency and test-retest reliability along with good diagnostic accuracy.

• 대한간호학회지
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• 제36권5호
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• pp.782-791
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• 2006

Purpose: The purpose of this study was to conceptualize and clarify a concept of "preparatory grief" in terminal cancer patients. Method: A hybrid model of concept development was applied to develop a concept of preparatory grief, which included a field study carried out in Busan, Korea. Participants of this study were 8 cancer patients. Results: On the basis of our literature, research and clinical experience, the concept of preparatory grief emerged as a complex phenomenon playing an important role in five areas; physical, emotional, interpersonal, religious, and transcendental dimensions. Two new attributes were defined through a field phase; trust of the post-mortal world and a serene state of mind. Indicators reflected attitudes of sadness, worry, regret, capability to adapt and hope. The results of preparatory grief were loss of energy and interest, emotional chaos, contemplation, taciturnity and restoration. Conclusions : Differentiating among preparatory grief and other symptoms in cancer patients is essential because of therapeutic implications. Understanding preparatory grief is necessary in order to manage cancer patients for promoting quality of life so that its application may have a positive impact on the patient's life.

• 성인간호학회지
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• 제26권6호
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• pp.630-641
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• 2014

Purpose: The purpose of current study was to explore the positive outcomes of advanced practice nurse who have experienced the roles in their clinical settings. Methods: This study adopted a qualitative research design based on conventional content analysis. Participants were 16 nurse practitioners have been worked at hospitals or community centers. Data were collected via focus group interviews and analyzed using thematic analysis method. Results: Patients' aspect outcomes were "client-centered care in providing continuity", "providing trust based on expertise", "promoting skilled intervention in patient recovering", "blocking the negative consequences", "quality improvement: nursing becoming tighter", "providing total care for cases that require intensive care", "improving patients outcomes by total management", "increasing confidence in evidence-based professional nursing", "rising the satisfaction by cost-effective services", "providing skilled professional practice", and "providing comprehensive care related to covering various aspects". Other themes elicited also included "promoting efficacy by inter-related health professions supervising", "the expansion of specialized practice areas increase business efficiency", "formation of outside customers due to increasing the satisfaction with skilled nursing care", "filling in the emptying spaces of doctors by practicing reliable role to bridge", "attracting external customers through successful management of subjects", "increasing staff's satisfaction on the role to make a bridge between inside and outside doctors", "24 hours medical expertise of professional staff ready secured", and "low cost, same results, that is, cost-effective" in reference to health care resources aspect. Conclusion: These findings suggested that advanced practice nurses perceived various positive outcomes and provided basic data for outcome indicators of advanced practice nurses' role.

• 융합보안논문지
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• 제19권5호
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• pp.25-36
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• 2019

정보 통신 기술의 발달로 환자의 의료 정보를 전자적으로 처리하고 관리하는 병원이 증가하고 있다. 그러나 의료 정보가 전자적으로 처리되는 경우에도 환자 또는 의료진의 개인 정보를 침해 할 여지는 여전히 남아 있다. 이와 관련하여 2017년 국제 표준화기구 (ISO)는 ISO TS 25237 보건의료정보-가명을 발표한 바 있다. 본 논문에서는 ISO TS 25237에서의 보건의료정보의 가명화 절차 및 제안된 방법의 문제점에 근거한 재식별 처리 과정을 검토하고자 한다. 또한, 우리는 비식별 데이터 세트와 원본 데이터 사이의 매핑 테이블을 암호문으로 유지함으로써 기본 우리가 제안한 바 있는 안전한 차등 개인 정보 보호 방법에 재식별 절차를 추가하는 새로운 처리 방법을 제안하고자 한다. 제안하는 방법은 일부 정책적인 관리 문제를 제외하고는 ISO TS 25237 신뢰 서비스 제공 업체의 요구 사항을 충족시키는 것으로 입증되었다.

• 의료법학
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• 제14권1호
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• pp.43-83
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• 2013

Medical treatment has great potential for conflict. Even the best-trained doctors can commit medical malpractice that result in continuing physical or mental disabilities or even death. Medical conflicts have been increasing over years. The medical conflicts between patient and medical professionals that result from medical professionals' mistakes are often fueled by a violation on the pretext of the injuries form medical malpractice and can lead to litigation. The litigation usually cost a lot of money and time. The extension of the litigation period as well as expensive cost and lack of medical knowledge placing a great burden on patients. Alternative Dispute Resolution(ADR) is more efficient than litigation. In 1988, the medical dispute mediation system has been introduces as the Act on Remedy for Damage from Medical Accident and Medical Dispute Mediation by Korean Medical Association came into effect after 23 years of enactment efforts. Medical Dispute Mediation Act(hereinafter referred to as the "MDMA") has finally entered into force from 8 April 2012. The purpose of the MDMA is to promptly and fairly redress injuries caused by medical malpractice and create a stable environment for medical services of public health or medical professionals by providing for matters regarding the mediation and arbitration of medical disputes(MDMA ${\S}1$). In an effort to secure the fair, speedy and inexpensive resolution of every malpractice case, the Korea Medical Dispute Mediation and Arbitration Agency(hereinafter referred to as the "K-MEDI") was established. Following the MDMA, the K-MEDI shall endeavor to ensure the medical dispute mediation or arbitration proceedings are conducted in a prompt, fair, and efficient manner, and patients and medical professionals shall attend proceedings in good faith with mutual trust and understanding when they participate in medical dispute mediation or arbitration proceedings.

• 성인간호학회지
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• 제13권2호
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• pp.233-246
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• 2001

Spiritual health is an important indicator in the quality of life of patients with cancer. The purpose of this study was to validate a Spiritual Health Inventory (SHI) for patients with cancer developed by Highfield (1989). The SHI was translated into Korean, back-translated into English. The study sample was 96 patients with cancer. The data were collected from September, 1999 to February, 2000 for 6 months. Statistic analysis was done with the SPSS PC+ (Version 10.0) program: descriptive statistics, factor analysis, Pearson correlation coefficient, and one-way ANOVA. The results are as follows : 1. The reliability score was examined using Cronbach's ${\alpha}$ and found to be .79. 2. Construct validity was examined using factor analysis. Four factors were identified and named : (1) Peace of mind (19.1% of variance), (2) Hope (9.7%), (3) Self-esteem (6.4%), (4) Trust (6.0%). The total of 41.2 percent of the variance. 3. The Pearson correlation coefficient score of 4 factors was between r = .24~ .42. 4. SHI was identified as multidimension, that is (1) The relationship with GOD, as absolute being, (2) the relationship with others, (3) the relationship within oneself. 5. There were differences in response in items especially related to GOD. The following recommendations can be made on the above findings : 1. Replicate with a minimum sample of 150 and test for concurrent validity. 2. Since spirituality is a dynamic concept, longitudinal study is also necessary. 3. Concept analysis using a qualitative study based on religious preference is recommended. 4. The items such as 12, 13, 15, 17, 19, 22, 24, 26 indicated conceptual ambiguity for Korean populations and further study is needed on item deletion or new items.

• Archives of Plastic Surgery
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• 제43권4호
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• pp.328-338
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• 2016

Nipple-sparing mastectomy (NSM) is increasingly popular as a procedure for the treatment of breast cancer and as a prophylactic procedure for those at high risk of developing the disease. However, it remains a controversial option due to questions regarding its oncological safety and concerns regarding locoregional recurrence. This systematic review with a pooled analysis examines the current literature regarding NSM, including locoregional recurrence and complication rates. Systematic electronic searches were conducted using the PubMed database and the Ovid database for studies reporting the indications for NSM and the subsequent outcomes. Studies between January 1970 and January 2015 (inclusive) were analysed if they met the inclusion criteria. Pooled descriptive statistics were performed. Seventy-three studies that met the inclusion criteria were included in the analysis, yielding 12,358 procedures. After a mean follow up of 38 months (range, 7.4-156 months), the overall pooled locoregional recurrence rate was 2.38%, the overall complication rate was 22.3%, and the overall incidence of nipple necrosis, either partial or total, was 5.9%. Significant heterogeneity was found among the published studies and patient selection was affected by tumour characteristics. We concluded that NSM appears to be an oncologically safe option for appropriately selected patients, with low rates of locoregional recurrence. For NSM to be performed, tumours should be peripherally located, smaller than 5 cm in diameter, located more than 2 cm away from the nipple margin, and human epidermal growth factor 2-negative. A separate histopathological examination of the subareolar tissue and exclusion of malignancy at this site is essential for safe oncological practice. Long-term follow-up studies and prospective cohort studies are required in order to determine the best reconstructive methods.