• 한국병원경영학회지
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• 제13권2호
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• pp.20-35
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• 2008

Though the attending system was first implemented in 2003 to facilitate the efficient utilization of medical resources and specialties, only a few hospitals and physicians are participated in that system. The purpose of this study was to investigate the actual facts which related to operation of attending system and propose a basic information to revitalized of the attending system in Korea. The data were collected between August 1 and October 30, 2005 from 25 hospitals and 42 attending physicians who were in part of the attending system. Medical institutions were unwilling to participate despite the advantages of the attending system with respect to the utilization of medical resources and improvement in the quality of medical services. The primary reason for this was the lack of understanding among physicians about the attending system and the difficulty(lack of time) encountered by the attending physicians in administering care to patients hospitalized in the attending hospitals. Moreover insufficient reimbursement for rendered medical services constituted another important reason. In conclusion, we can state that the establishment of a committee is required to discuss the issues surrounding the attending system and to control the growing disparity between the viewpoints of hospitals and physicians. Regardless, there is a need to develop economical incentives for medical institutes. The attending system served as a useful policy in promoting the medical service system and bringing about an improvement in the management of medical institutes.

• Journal of Genetic Medicine
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• 제15권2호
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• pp.72-78
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• 2018

Purpose: Physicians' attitudes may have a strong influence on women's decision regarding prenatal screening options. The aim of this study is to assess the physicians' attitudes toward prenatal screening for fetal aneuploidy including non-invasive prenatal testing (NIPT) in South Korea. Materials and Methods: Questionnaires were distributed and collected at several obstetrics-gynecological conferences and meetings. The questionnaire included 31 multiple choice and 5 fill-in-the-blank questions. Seven questions requested physicians' demographic information, 17 questions requested information about the NIPT with cell-free fetal DNA, and 12 questions requested information about general prenatal screening practices. Results: Of the 203 obstetricians that completed the survey. In contrast with professional guidelines recommending the universal offering of aneuploidy screening, only 53.7% answered that prenatal aneuploidy testing (screening and/or invasive diagnostic testing) should be offered to all pregnant women. Physicians tended to have positive attitudes toward the clinical application of NIPT as both primary and secondary screening methods for patients at high-risk for fetal trisomy. However, for patients at average-risk for fetal trisomy, physicians tended to have positive attitudes only as a secondary screening method. Physicians with more knowledge about NIPT were found to tend to inform their patients that the detection rate of NIPT is higher. Conclusion: This is the first study to investigate expert opinion on prenatal screening in South Korea. Education of physicians is essential to ensure responsible patient counseling, informed consent, and appropriate management after NIPT.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제20권3호
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• pp.139-146
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• 2017

The number of papers discussing probiotics increases tremendously that limits the possibility for primary care physicians and clinicians to stay updated. Therefore, the aim of this paper will be to summarize available evidence of probiotic use in well-defined clinical indications of importance for pediatricians. Based on currently available evidence certain probiotic strains (Lactobacillus rhamnosus GG [LGG] and Saccharomyces boulardii) have proven effect in the treatment of acute gastroenteritis and prevention of antibiotic associated diarrhea. Furthermore, LGG was proven to be effective in prevention of nosocomial diarrhea and respiratory tract infection in day care centers. In conclusion, not all probiotic strains have same efficacy for all clinical indications, therefore, only strains with proven efficacy and safety should be recommended.

• Clinical and Experimental Pediatrics
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• 제61권1호
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• pp.1-5
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• 2018

We often overlook the importance of several safety issues such as identification of patients, timeout procedure, hand hygiene, handoff communication, and many others. This ignorance, along with many other issues, leads to medical error being ranked as a third leading cause of death in the U.S. Consequently, quality improvement (QI) has become one of the major subjects in healthcare despite a relatively short history. Improving quality is about making healthcare safe, effective, patient-centered, timely, efficient, and equitable. Understanding the need and methodology of QI as well as participation is now essential for physicians. Although basic QI methodology has not changed, one of the most fascinating changes in recent QI is conducting large-scale QI projects through multicenter networks. Prospective multicenter QI projects utilizing the Korean Neonatal Network are a substantial initiation of pediatric QI in Korea. The Korean Pediatric Society should set ambitious goals for QI activities for every primary care pediatrician and pediatric subspecialist.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제22권3호
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• pp.207-216
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• 2019

Functional gastrointestinal disorders (FGIDs) such as infantile colic, constipation and colic occur in almost half of the infants. The aim of this paper is to provide a critical and updated review on the management of FGIDs and their impact on the health of the infant and family to health care physicians. Guidelines and expert recommendations were reviewed. FGIDs are a frequent cause of parental concern, impairment in quality of life of infants and relatives, and impose a financial burden to families, health care, and insurance. Therefore, primary management of the FGIDs should be focused on improving the infants' symptoms and quality of life of the family. If more than parental reassurance is needed, available evidence recommends nutritional advice as it is an effective strategy and most of the time devoid of adverse effects. The role of healthcare providers in reassuring parents and proposing the correct behavior and nutritional intervention by avoiding inappropriate use of medication, is essential in the management of FGIDs.

• 정신신체의학
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• 제6권2호
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• pp.104-119
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• 1998

This study was conducted to determine the important factors in the illness behavior of panic disorder patients. And then, find the best ways to lead the patients who have recurrent panic attacks to the adequate therapeutic situations. We studied 53 patients diagnosed as panic disorder according to DSM-IV among the outpatients who had been followed up at Bong Seng Memorial Hospital for 6 Ms, from May 1997 to October 1997. To evaluate the illness behaviors, we designed a checklist including socio-demographic data, degree of subjective distress from medical and psychiatric treatment, panic symptoms, life events, places of help-seeking, Anxiety Sensitivity Index. Using the checklist, we had semistructured interviews with the panic disorder patients to elucidate their help-seeking behaviors from first panic attack to diagnosing as panic disorder. The results were as follows ; 1) After first panic attack, the patients initially sought help at 1) Emergency room 40%, 2) Rest &/or Personal emergency care 35%, 3) Pharmacy 10%, 4) Outpatient care at hospital 10%, 5) Oriental medicine 5%. 2) Considering the panic symptoms, derealization, paresthesia and the severity of panic symptoms were the most important factors affecting the patient's help-seeking behaviors who had experienced the first panic attack. 3) Most of all the patients (80%) were apt to visit the hospitals within 15 days after experiencing about 3 panic attacks. 4) Before diagnosed as panic disorder, the patients had visited 3-5 health care centers during about 1 year. 5) Primary care physicaians(for example, emergency care physicians, family doctors and internists) had the most important roles in treating or guiding the patients to the adequate therapeutic situations. From the above results, the authors propose that non-psychiatric physicians have to know the panic disorder or attacks exactly. When patients complaint sudden onset physical symptoms e.g. palpitation, dyspnea, dizziness or the cognitive symptoms like the fear of death or insanity, physicians should consider the possibility of panic attack and encourage the patients to be evaluated for psychiatric illness.

• 한국의료질향상학회지
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• 제10권1호
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• pp.58-76
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• 2003

Background : Aim of this study is focused on the analysis of the needed abilities of medical representatives resulting in building up the market and increasing sales. It is to propose methods to increase this ability ensuring continuous growth in market share and profit. Methods : A survey was conducted between January 6 and May 31, 2003. Using SPSS(Version 10.0), the collected data was analyzed by Hotelling T2, factor analysis. Some hypotheses were selected to include the conclusion. Some questionnaires for physicians working in hospitals or clinics and the medical representatives working in a pharmaceutical company were created and asked to them to either prove or reject those hypotheses. The results were analyzed to find the primary factors that effect the interactions between physician and the medical representatives. These factors were also studied along with the theoretical research based on published references. Results : The results were as follows. The main reasons for the physician to meet with a medical representatives were collection of product informations needed for patient treatment and collection of informations on current medical issue and as well as personal interests. The main parameters by which physicians evaluate the medical representatives are human relationship including sincerity and manners and supply of accurate and unbiased information on products. Overall, the medical representatives' perception on the importance of medical knowledge and ability to deliver it are lower than that expected by physicians. Conclusion : Medical and pharmaceutical companies' environment are changed rapidly. And those changes forced medical representatives to set new roles and competency. In order to drive away from the past 'rule of thumb' and 'adaptation to circumstance', optimal method and systemic development to train and support the medical representatives should be quipped. They will help medical representatives to be specialists in medical knowledge and to understand the exact need of health care professions. Product competitiveness will be increased and eventually successful business can be achieved through it.

• 한국농촌간호학회지
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• 제12권2호
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• pp.29-44
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• 2017

Purpose: The purpose of this study was to identify community health practitioners' (CHP) perception of barriers to research utilization, current status and competence in evidence-based practice (EBP). Methods: From all over the country, 126 CHP completed an e-mail survey. Results: The items with the highest barrier scores were that it is difficult to understand articles written in English and physicians will not cooperate with implementation. There were statistically significant differences in the scores for attitude toward EBP and knowledge in EBP by education level and nursing academic society membership status. When faced with a problem, the nurses usually use related regulations or asked a colleague for advice. Conclusion: Results indicate an awareness of the necessity of applying EBP, need to improve readiness to use EBP voluntarily and actively, and need to search for various factors that are barriers to research utilization. There is a need to develop and apply EBP training/education programs to find new evidence that might actually support previous practice for which nurses lack confidence. Guidelines that consider CHP task characteristics and barrier factors to research utilization should be developed.

• 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.

• 정보관리학회지
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• 제33권1호
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• pp.161-180
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• 2016

의사들은 학술연구와 환자진료에 관한 정보요구를 가지고 있고, 전자정보원을 이용하여 해결하고 있으나 정보원의 선택이나 검색에서 어려움을 겪는다. 본 연구는 의사들의 연구와 진료정보요구를 지원할 수 있는 검색시스템을 설계하고 개발하는 것이 목적이다. 이를 위해 의사들의 정보요구에 적합한 정보원 개발을 위해서 정보이용행태에 관하여 심층인터뷰를 하였고, 그 결과를 바탕으로 검색 시스템인 MediSearching을 개발하였다. 개발된 시스템은 효용성 검증과 제안을 얻기 위해 추가 인터뷰와 테스트검색을 통하여 피드백을 받았다. 의사들의 정보이용행태에 관한 인터뷰 결과 소속병원의 종류나 진료 과목에 따라서 차이를 보였다. 대학병원 의사들은 연구와 관련된 정보요구가 컸으며 학술지 논문을 주로 이용하고 있었으나, 전문병원이나 개인병원 의사들은 진료와 관련된 정보요구가 대부분으로 동료와의 대화로 해결하는 형태를 보였다. MediSearching은 연구와 진료정보요구를 동시에 지원할 수 있는 검색시스템으로 개발되었고, 인터페이스와 검색효용성이 검증되었다. 기존의 한국 의학 정보 사이트에서는 제공 정보의 종류나 검색방법에 따라 서비스 범위가 모두 달라 의사들은 동일한 검색 과정을 반복하는 불편함이 있었으나 이를 해결한 것으로 파악되었다. 또한 파일 형태나 언어와 상관없이 정보원의 추가가 가능하도록 한 점에서 유용한 것으로 평가되었다.