• Tuberculosis and Respiratory Diseases
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• 제80권4호
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• pp.377-384
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• 2017

Background: Proper education regarding inhaler usage and optimal management of chronic obstructive pulmonary disease (COPD) is essential for effectively treating patients with COPD. This study was conducted to evaluate the effects of a comprehensive education program including inhaler training and COPD management. Methods: We enlisted 127 patients with COPD on an outpatient basis at 43 private clinics in Korea. The patients were educated on inhaler usage and disease management for three visits across 2 weeks. Physicians and patients were administered a COPD assessment test (CAT) and questionnaires about the correct usage of inhalers and management of COPD before commencement of this program and after their third visit. Results: The outcomes of 127 COPD patients were analyzed. CAT scores ($19.6{\pm}12.5$ vs. $15.1{\pm}12.3$) improved significantly after this program (p<0.05). Patients with improved CAT scores of 4 points or more had a better understanding of COPD management and the correct technique for using inhalers than those who did not have improved CAT scores (p<0.05). Conclusion: A comprehensive education program including inhaler training and COPD management at a primary care setting improved CAT scores and led to patients' better understanding of COPD management.

• 종양간호연구
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• 제6권2호
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• pp.93-103
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• 2006

Purpose: With accumulated necessity to develop Advanced Practice Nursing (APN) in Korea, various types of Nurse Practitioner (NP) programs have been recently developed. Unlike the origin of the NP programs in the U.S., in which the lack of primary health care provider preceded the creation of NP education, NP programs in Korea are currently in an early stage in which the scope of practice and educational boundaries are still evolving. Just imitating American models may result in culturally inappropriate and practically non-feasible APN programs in Korea. This article was aimed to evaluate the top-ranked Oncology NP (ONP) programs in U.S. with those in Korea. Method: Using the Donabedian paradigm, the educational structure, process, and outcome were compared and contrasted between two countries. Results: The findings of this paper demonstrated that many aspects of structure of the Korean program are similar to those of the Americans with minor differences. Three strategies for future development of ONP program in Korea are suggested. Conclusion: Practical and feasible scope of practice for ONP in Korea should be determined. It needs to embrace every aspects of cancer experience. Also, nursing-oriented and culturally competent practice needs to be identified and incorporated into the ONP practice.

• 한국병원경영학회지
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• 제8권2호
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• pp.49-69
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• 2003

This study purported to evaluate the performance of the appointment system for outpatients in primary care dental clinic. The data of patients' time flow for 1,245 patients in Y Dental Clinic were collected for one month in 2002 and then analyzed. Specifically, the time periods of treatment and patients' waiting as well as rates of appointment and it's failure are estimated. The accuracy of expected treatment time period was also evaluated. The results showed that 72% of patients visited the clinic with appointments, and only 56% kept their appointments. The patient's waiting time period turned out to be 11 minutes in Y clinic. The expected treatment time period is turned out to be very important because they influence significantly on patient's waiting time period. Practically, the expected treatment time period should be overestimated about 9 minutes in general, and the characteristics of dentist, each patient's diagnosis and age need to be especially considered. Hospitals and clinics also need to make the systematic and detailed critical pathways for a variety of patient cases by analyzing the patients' treatment pattern. With the improved appointment systems, healthcare institutions will approach the goal of effective and efficient management of the institution and also satisfy their customers.

• 대한소아치과학회지
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• 제32권1호
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• pp.126-131
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• 2005

본 연구는 항생제를 복합 투여하여 유치의 근관 및 치근단 주위 감염에 대한 효과를 임상적으로 관찰하고자 하였다. 근관 및 치근단 주위 병소의 멸균을 목적으로 metronidazole, ciprofloxacin 및 minocyclin을 증류수 및 근관시멘트와 혼합하여 적용하였다. 유치의 근관 입구로부터 하방에 $Fissurotomy^{(R)}$ bur(SS White, USA)를 이용하여 약제 공간을 형성하였고 약제는 치수실 바닥까지 채웠다. 본 증례들에서 단회 적용으로 임상 증상이 개선되었다. 치은종창, 동통, 누공 등 모든 증상이 술 후 1주일 내에 소실되었다. 임상적으로 활용하기 위해서는 보다 많은 수의 증례와 장기간의 임상적 평가가 필요하며 아직까지 근관내 항생제 사용에 따른 부작용에 대한 보고가 없지만 항생제에 민감한 환아에 대해서는 사용에 주의가 필요할 것으로 사료된다. 저자는 행동조절이 곤란한 소아에서 생리적 치근흡수가 진행 중인 감염된 유치를 가진 환아들을 대상으로 항생제를 복합 사용한 바 증상의 개선을 관찰하였기에 보고하는 바이다.

• Asian Pacific Journal of Cancer Prevention
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• 제17권12호
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• pp.5159-5164
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• 2016

Objective: The dynamics of morbidity, disability and death rates due to malignant neoplasms in the population in Uralsk city of the Republic of Kazakhstan were studied for 2011-2015, with a focus on age and sex, as well as tumor location. Methods: Statistics for total morbidity, primary disability and mortality from cancer in the adult population of the city of Uralsk for 2011-2015 were calculated per 100 thousand. Estimation of morbidity was based on data from form - $N{\underline{o}}12$ ${\ll}$Report on the number of diseases registered in patients living in the area of health care organizations and patient population under medical observation". Evaluation of primary disability was based on form $N{\underline{o}}7$ ${\ll}$The distribution of newly recognized disabled by disease class, age, sex and disability groups" for 2011-2015 in Ural city and analysis of cancer was carried out using annual form 7 "Report on the sick, and diseases of malignant neoplasms". Result: The most common localizations of cancer were the trachea, bronchi, lungs, stomach and mammary glands. High death rates were noted for patients with cancer of the trachea, bronchi, lung, as compared to stomach and esophagus. Conclusion: The results of our investigation and data in the literature indicate that regional characteristics influence the impact of risk factors associated with cancer. An unfavorable environmental background contributes to ill health of urban populations, contributing to development of cancer. Moreover behavioral risk factors are very important, such as smoking, alcohol drinking, and an unhealthy diet. All these factors require urgent adoption of a package of measures for prevention, early detection and timely treatment. Detailed study of cancer is necessary to develop national programs and activities for prevention and control.

• 한국의료질향상학회지
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• 제8권2호
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• pp.146-159
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• 2001

Background : To propose effective strategies for successful implementation of QI in health care institutions, by identifying facilitating factors and barriers to conducting QI programs. Methods : In order to examine empirical evidence on the success factors or barriers to QI implementation in hospitals, a literature study was performed on the basis of MEDLINE search. Among the identified literature. 13 provided reliable findings and basis comprehensive discussion on this issue and thus were selected for in-depth analysis. A mailed questionnaire survey was conducted for hospital CEOs and QI directors of hospitals with 400 beds or greater to investigate what attributes of their organizations they perceived as success factors or obstacles to QI implementation. Result : The analysis of selected literature and survey results presented that the primary factors considered to be most important as successful implementation of QI were: strong support from hospital CEOs, setting higher priority for QI activities, continuous and persistent efforts in QI activities, and active participation of clinical staffs. The barriers identified in this study were : the lack of orientation and understanding of QI concepts, low level of interest and participation of physician in QI programs, the lack of evaluation and rewarding system for QI activities. Conclusion : By identifying factors that affect facilitation of QI, the study results will be of great use for either institutions being in the early stage of evolving QI or those looking for better strategies to achieve more active and persistent QI implementation in their institutions.

• 농촌의학ㆍ지역보건
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• 제28권2호
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• pp.1-14
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• 2003

이 연구는 농촌지역 정신보건의료서비스의 필요도와 공급수준을 파악하고 일차정신보건시설로서 보건소가 운영하는 정신보건사업을 평가하고자 하였다. 필요도는 유병률과 정신보건서비스 이용률로 한정하여 2001년도에 보건복지부가 주관하여 실시한 정신질환 실태 역학조사 결과를 이용하여 도농간 차이를 비교하였다. 공급수준은 입원 및 요양 병상수와 일차정신보건의료시설의 기초자치 단체별 설치율로 한정하여 전자는 2002년도에 보건복지부 산하 지역사회 기술지원단이 작성한 보고서 결과내용 중 일부를 발췌하였고 후자는 보건복지부의 2003년도 정신보건사업 안내서와 정신보건의료기관 총람의 내용을 토대로 재구성하였다. 농촌지역의 보건소 정신보건사업을 평가하기 위하여 2002년도에 각 기초자치단체가 중앙에 제출한 제3기 지역보건 의료계획서들 중 농촌형지역과 도농복합형지역으로 구분하여 각각 중앙 및 광역자치단체 정부의 지원 여부에 따라 지원한 경우 1-2개, 지원하지 않는 경우 광역자치단체별로 각각 2개소를 무작위 추출하여 정신보건사업내용부문을 사업대상 및 등록, 구조, 과정으로 나누어 정신보건사업안내서에 제시한 기준을 가지고 평가하였고 담당자들이 작성한 정신보건사업의 문제점들을 분석하였다. 이 연구는 2003년 4월 1일부터 5월 10일까지 이루어졌고 그 결과는 다음과 같다. 첫째, 니코틴 장애를 제외한 평생유병률과 일년유병률은 도시지역이 24.9%, 13.2%, 농촌지역이 28.2%, 17.7%이었으며 정신분열증, 주요우울증, 불안장애, 알코올 사용장애 등 주요 정신질환 역시 도시보다 농촌지역이 더 높은 것으로 나타났다. 또한 지난 일년간 정신보건의료서비스 이용률은 전체적으로 8.9%에 불과하였다. 둘째, 입원 및 요양 병상수는 2001년 현재 인구 천명당 0.97병상이며 요양시설을 포함할 경우 1.27병상으로 세계 보건기구가 권장하는 인구 천명당 1.0병상, 그리고 병상 감소정책을 추진하고 있는 유럽이 0.93병상임을 고려할 때 양적으로 부족하지는 않다. 그러나 광역자치단체간 편차가 큰 것으로 나타났는데 서울, 인천, 울산 등 대도시지역이 충북, 충남, 경남, 전남지역의 1/6내외수준이었다. 셋째, 일차정신보건의료시설의 기초자치단체 충원율을 살펴보면, 정신과 의원은 광역시 및 특별시형은 100%인 반면 농촌형지역 89곳 중 15곳(16.9%)만이 설치되어 있었으며 사회복귀시설은 전반적으로 낮았으며 농촌지역의 충원율이 7.9%로 가장 낮은 것으로 나타났다. 보건소 정신보건사업에 대한 중앙 및 광역자치단체의 지원율이 광역시 및 특별시형이 42%인 반면 농촌형지역은 22.5%인 것으로 나타났다. 다섯째, 농촌형지역과 도농복합형지역 모두에서 지원을 받지 않은곳이 자체예산을 추가로 확충하지 않아 사업인력 및 예산이 매우 취약하고 중앙정부가 제시하는 기본사업에 대한 충실도가 매우 낮은 것으로 나타났다. 이상의 결과를 종합해볼 때 농촌지역이 도시지역에 못지 않게 정신보건의료서비스에 대한 필요도가 높으나 서비스 이용률은 매우 낮았으며 도시지역에 비해 농촌지역의 일차정신보건의료시설들이 매우 부족한 것으로 나타났다. 또한 일차정신보건의료시설로서 보건소가 도시지역 보다 농촌지역에서 더 중요한 역할을 수행해야 하나 중앙의 지원율은 오히려 농촌지역 보다 도시지역이 더 높았고 지원을 받지 않는 보건소의 정신보건사업프로그램은 매우 형식적으로 진행되고 있었다. 앞으로 중앙정부는 일반의료서비스에 있어서 농어촌의료서비스 개선정책을 추진하듯이 정신보건정책에 있어서도 이러한 고려가 필요하다.

• 대한예방한의학회지
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• 제6권2호
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• pp.1-18
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• 2002

The subjects were 420 workers who received oriental and western health examination both in the workplaces for 1 month. This study was planned for the reflection of western health examination results through evaluation of Sasang constitution with use of data from western health examination, and for the presentation of basic data applicable to constitutional medicine with preventive medicine. Data that were collected in field research were analyzed into frequencies, One-Way ANOVA, Chi-square testing by the study purposes, and the research results were as follows: 1. The distribution of Sasang constitution in 420 subjects was Taeumin > Soumin > Soyangin, and the general characteristics of subject by Sasang constitution were no significant difference. 2. For the measured values for body by the subject of Sasang constitution, Taeumin had higher value for height, body weight, systolic and diastolic blood pressure than other 2 constitutions. Soumin had the lowest values in average for all items, and on the other hand, Soyangin had high pulse pressure compared to other constitutions. It was significant difference between constitutions. 3. For the hematological average, Taeumin had high average for FBS, Total-C, GPT, and Taeumin ,and Soyangin had high in Hb compared to Soumin. Soyangin had the highest average for ${\gamma}-GPT$, and there were significant differences between FBS, Total-C, Hb, GPT, ${\gamma}-GTP$, excepting for GOT. 4. For the result of health examination by the Sasang constitution of subject, Taeumin showed the highest percentage in the items of obesity, primary care, secondary suspicion, and showed significant difference by the constitution. For the distribution of the past disease history by the health examination result of Sasang constitution, Taeumin and Soumin had high prevalence rate for hypertension, liver disease, and Soyangin had high prevalence rate for liver disease, hypertension. For the requirement of lifestyle improvement to the subject, the highest requirements by the Sasang constitution were physical exercise for Soumin, regulation of body weight for Taeumin, and it showed significant difference. For the requirement of primary care by the constitution, the highest requiremetns were obesity control for Taeumin, blood pressure control for Soumin, Soyangin, and liver suspicion was the highest distribution for each constitution in the case of having decision for secondary suspicion.

• Tuberculosis and Respiratory Diseases
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• 제62권5호
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• pp.427-431
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• 2007

기관지 연관 림프조직 림프종은 비특이적인 호흡기 증상만을 나타내며, 전산화단층촬영에서 세기관지 폐포암, 림프구성 간질성 폐렴등과 뚜렷이 구분이 되지 않는 결절 외 림프종의 일종이다. 저자들은 비특이적인 호흡기 증상만을 나타내는 병변에 대해 침습적인 방법인 경피 미세흡입생검을 시행하여, 원발성 기관지 연관 림프조직 림프종으로 진단하였으며, 병리적 진단이 내려진 상태에서 치료를 목적으로 좌상엽 절제술을 시행하였다. 기관지 연관 림프조직 림프종은 서서히 진행되는 질환으로, 대부분 최종 진단이 늦어지는 경향을 보인다. 국소적 병변일 경우 외과적 수술로 완치가 가능한 질환이므로, 질환이 의심되는 경우 적극적 검사와 치료를 시도하는 것이 중요할 것으로 생각된다.

• 농촌의학ㆍ지역보건
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• 제12권1호
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• pp.54-62
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• 1987

This study was performed as a part of survey for the operation and interim evaluation of the on-going pilot project of community health in Jeomdong-Myon, Yeoju-Gun, Kyunggi-Province since 1982. Seven Villages (Ri) were selected purposively for the survey from a total of 26 villages in Jeomdong-Myon, target area, under the consideration of the socio-economic background and the distribution of health resources. The target population was the women in age group of 15-44 years in that area and a total of 156 women were interviewed. This study was done by the interview survey using questionnaire which was composed with questions about MCH and FP. The results were as follows; 1) ln the status of maternal health, (1) the proportion of receiving antenatal care was relatively high (67.1%) in this area, but the starting time of antenatal care was delayed to 7 months or more of gestational period in 22 percent. Therefore some intervention would be necessary for advancing the time of antenatal care. (2) The proportion of home delivery was decreased according to the rank of birth-order. And more than 50 percent of delivery attendants were mothers-in-law or neighbors. The fact indicates that the health education for non-professional delivery attendents would be necessary for improving home delivery and the content of education would be preferable to focussing to the method of hygienic delivery attending. (3) The comprehensive health service and education would be recommended for the postnatal care, because of the extremely low rate of postnatal care in this area. 2) In the status of child health, (1) the pro-portion of breast feeding was 90.2 percent, and the weaning started after 12 months of birth in 12.7 percent. This indicates the necessity of education about the weaning program. (2) The proportion of completed basic vaccination was 39.6% and the main reason of missing vaccination was poor accessibility in terms of time. For that, the supply of vaccine to primary health care units (health subcenters) should be continuous, not infrequent nor occassional. 3) The proportion of respondants who were using contraceptive methods currently was 79.8 percent and in 44.7 percent they accepted the permanent contraceptive methods. Those results are distinct in this area. But it seems a serious health problem that 53.2 percent of respondants were experienced the induced abortion for birth control.