• Asian Pacific Journal of Cancer Prevention
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• 제16권16호
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• pp.6857-6862
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• 2015

Background: To identify the optimal cost effective strategy for the management of women having ASC-US who attended at King Chulalongkorn Memorial Hospital (KMCH). Design: An Economical Analysis based on a retrospective study. Subject: The women who were referred to the gynecological department due to screening result of ASC-US at King Chulalongkorn Memorial Hospital, a general and tertiary referral center in Bangkok Thailand, from Jan 2008 - Dec 2012. Materials and Methods: A decision tree-based was constructed to evaluate the cost effectiveness of three follow up strategies in the management of ASC-US results: repeat cytology, triage with HPV testing and immediate colposcopy. Each ASC-US woman made the decision of each strategy after receiving all details about this algorithm, advantages and disadvantages of each strategy from a doctor. The model compared the incremental costs per case of high-grade cervical intraepithelial neoplasia (CIN2+) detected as measured by incremental cost-effectiveness ratio (ICER). Results: From the provider's perspective, immediate colposcopy is the least costly strategy and also the most effective option among the three follow up strategies. Compared with HPV triage, repeat cytology triage is less costly than HPV triage, whereas the latter provides a more effective option at an incremental cost-effectiveness ratio (ICER) of 56,048 Baht per additional case of CIN 2+ detected. From the patient's perspective, the least costly and least effective is repeat cytology triage. Repeat colposcopy has an incremental cost-effectiveness (ICER) of 2,500 Baht per additional case of CIN2+ detected when compared to colposcopy. From the sensitivity analysis, immediate colposcopy triage is no longer cost effective when the cost exceeds 2,250 Baht or the cost of cytology is less than 50 Baht (1USD = 31.58 THB). Conclusions: In women with ASC-US cytology, colposcopy is more cost-effective than repeat cytology or triage with HPV testing for both provider and patient perspectives.

• Journal of Preventive Medicine and Public Health
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• 제28권3호
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• pp.623-639
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• 1995

We have never seen any method to cope basically with complicated situation and problems around medical reimbursement rates here in Korea since 1977 witnessed by the beginning of medical insurance. By the way researchers concerned are beginning to propose some kinds of innovative and detailed ideas to government these days. They are Diagnosis-related group(DRG) and Resource-based .elative value scale(RBRVS). In the light of this situation it is so encouraging that our government can come up with that and move. In case of RBRVS research we have already been reaching even to the level of reviewing and revising methodology for its further development after naive pilot study on internal medicine and general surgery last year. However there might be something different conditions between USA and Korea to apply the same Dr. Hsiao's method and it must be vital to check so called' total work approach' compared with 'intra-service work approach' before expanding to the whole medical fields. According to the' Intra-service approach', the physician's work is supposed to be divided into three sub-works by the name of intraservice work, pre, and post service work. These sub-works, again should be merged together to be the pre-postwork subset through some statistical methods of the estimation process applied by Dr. Hsiao's methodology in RBRVS development later on. But in this paper that estimation process was not taken because we could have real values for all of those surveyed items related to just one specialty, OB & GY. Instead, We used some statistical comparison procedures relevant to demographic characteristics, reliability & validity and correlation analysis with American RVU(Relative value unit) between the total work and merged total work from intraservice work approach. The unit of analysis was individual physicians of OB & GY and 300 physicians were selected for each approach through statistical sampling method based on national population of OB & GY physicians in Korea. And also with the thankful help of Advisory Committee under Korean Association of OB & GY, questionnaires were made and mailed to the subjects, two times. As a result there were not any statistically significant differences in demographic characteristics between the two approaches except for the variable 'Response time for the questionnaires', but in other sections of comparisons, response rate, representative values, reliability & validity test, correlation analysis with American RVU, all showed 'Total approach' was not only more rational and statistically meaningful than 'Intra-service approach' but also had considerable merits. But we are not absolutely sure about this paper's robustness. Because of some limitations, we'd rather like to suggest further researches should be followed. In that sense the first thing would be a research for the influence of doctor's characteristics, especially 'frequency' on the rating of work and the way to define total work more clearly.

• 대한치과의사협회지
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• 제50권12호
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• pp.763-770
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• 2012

The purposes of this work were to assess the cognition of the registered nurse(RN) on oral and maxillofacial emergency treatment and to compare cognition of the RN with that of the 119 emergency medical technician(EMT). 450 RNs who were working at each of secondary hospitals in Jeju province had responded to the questionnaire. Independent sample t-test and chi-square test were used to assess the state of RN on dental emergency treatment and to compare RN with EMT. The question 'education time on dentistry in formal education' that marked '0 hour' and '1-3 hours' were 73.3% and 20.0%, respectively. The question 'refresher training class on dentistry' that marked '0 hour' and '1-3 hours' were 92.9% and 6.7%, aggregately 99.6%. The results showed low score in the question 'reduction of temporo-mandibular joint(TMJ)'($1.67{\pm}0.857$), 'fixation of dislocated TMJ'($1.70{\pm}0.853$) and 'post-avulsed tooth treatment'($1.78{\pm}0.774$) by 5-point Likert scale. Likewise, the scores were $2.02{\pm}0.806$ in the question 'treatment of maxillofacial trauma', $2.76{\pm}1.061$ in the question 'emergent care of avulsed tooth', $2.70{\pm}1.095$ in the question 'treatment time of avulsed tooth' and $2.79{\pm}1.056$ in the question 'mouth guard', respectively. Compared to EMT, results of RN showed a statistically lower figure(p<0.05) in all items compared except the question 'medicine control', and the question 'doctor care in emergency room' was borderline(p=0.069). From this study, it is necessary for RN and student of nursing science to be educated on the oral and maxillofacial emergency treatment for the initial management of injuries. Authors suggest further co-study and nation-wide research with nursing care.

• 대한방사선기술학회지:방사선기술과학
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• 제19권1호
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• pp.55-74
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• 1996

This study was carried out to improve service efficiency and to cope with a emergency situation in emergency radiography, through analysis of the radiographic distribution and literature cited about emergency care. Data collection of radiographic distribution was surveyed for 761 emergency outpatients who visit during JAN, 1994 at ER of the general hospital in Pusan city. The results is as follows: Emergency radiography rate of simple radiography was 61.1 %, special radiography 2.5 %, CT 12.6 %, and ultrasonography 6.7 %. In simple radiography rate, a high rate was distributed on male(63.6 %), thoracicsurgery part(90.0%), admission patient(74.9 %), and long stayed patient at ER. In special raiography rate, a high rate was observed in urologic part(28.6%), and in CT rate, observed neurosurgery part(49.2 %) and neurologic part(36.7%). Ultrasonography rate was high for female(8.8 %) and internal medicine part(15.9 %). There are distributed regional radiography rate in radiographic type that chest(55.3 %) is high in the simple radiography, urinary system(1.2%) in the special study, and brain(40.0 %) in the CT. Regional radiography rate according to diagnostic department also was showed highly for head(64.6%) in neurosurgery, chest(90.0%) in thoracic-surgery, abdomen(58.0%) in general-surgery, spine (40.0% ) in neuro-surgery, and pelvis(15.9%), upper extrimity(20.5%), and lower extrimity(31.8%) in orthopedic-surgery each. Mean radiographic case number per patient of simple radiography was sinificant on sex, age, transfer relation in both total and radiographic patients(p<0.05). Mean radiographic case number was highly distributed on male(2.2 case number) in sex, on thirties(2.7) in age, transfered patient(2.7) in patient type, and on neurosurgery(3.4) in diagnostic charged part. Total radiographic case number in regional part was highly distributed on chest(499 case number). Considering the above results, emergency radiographer should take care of the elder patient in emergency radiography and get hold of injury mechanism to decrease possible secondary injury during radiography. Because of high radiography rate of urinary system in special study, radiographer should know well about dealing with contrastmedia administration and related instrument. All radiographer who take charge emergency patient should cope with a emergency situation during radiography, Because head trauma patients is very important in patient care, especilly in CT at night, charged doctor should be always silted with CT room and monitoring-patient. Radiography was reqested by many diagnostic department in ER. Considering that rate of simple radiography is high, special room for emergency radiography should be established in ER area, and the radiographer of this room should be stationed radiologic technician who is career and can implement emergency patient care.

• 디지털융복합연구
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• 제20권4호
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• pp.725-735
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• 2022

본 연구는 간호사를 형상화한 문학 작품들을 대상으로 이들 작품이 간호사에 대한 다양한 담론들을 어떻게 수용하여 문학적으로 재현하고 있는지를 분석했다. 분석대상은 간호사가 등장하는 한국 현대소설로 1927년에서 2016년까지 29개의 작품을 선정했다. 분석 방법은 질적 연구방법 중 소설에 대한 내용분석이다. 분석단위는 소설 속의 간호사 이미지를 다루고 있는 서술이나 대화가 나오는 문장을 하나의 분석단위로 채택하고, 선행연구의 이미지 결정 요소를 통합하여 4가지 유형으로 범주화하여 고찰했다. 소설 속 간호사 이미지를 분석한 결과 첫째, 전통적 이미지 유형으로는 이광수 『사랑』, 김의정 「닥터 한」, 정도상 『푸른방』, 조정래 『한강』, 공지영 「별들의 들판」, 서성란 「겨울 손」, 백민석 「불쌍한 꼬마 한스」 둘째, 사회적 이미지 유형으로는 강경애 「어둠」, 김경욱 「천국의 문」, 최정희 「천맥」, 이제하 「나그네는 길에서도 쉬지 않는다」, 원재길 「꽃바람」 셋째, 전문적 이미지 유형으로는 이청준 「조만득 씨」, 「퇴원」, 최인훈 「광장」, 김연수 「주쌩뚜디피니를 듣던 터널의 밤」, 정세랑 『보건교사 안은영』 그리고 넷째, 개인적 이미지 유형으로는 최인호 「견습환자」, 김정한 「제 3병동」, 은희경 『마이너리그』, 김훈 「화장」, 하성란 『식사의 즐거움』, 김지연 「히포크라테스의 연가」, 김진명의 「하늘이여 땅이여」, 박경리 「불신시대」, 유순하 「금빛 햇살」, 정미경 「비소여인」으로 유형화하였다. 이러한 소설 속 간호사의 이미지를 통해 소설은 인간 돌봄에 시사하는 함의를 논의하였다.

• 가정간호학회지
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• 제1권
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• pp.57-70
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• 1993

본 연구는 입원환자들의 가정간호사제도에 대한 찬반여부 및 가정간호 서비스 내용과 그 요구도를 파악하기 위하여 대구시내 3개 종합병원에서 1993년 9월 6일부터 10월 9일까지 뇌질환, 척추질환 및 근골격계질환으로 입원한 환자중 퇴원예정에 있는 환자 242명을 대상으로 설문지에 응답하도록 하여 자료를 수집하였다. 가정간호제도를 찬성한 환자는 66.1%(161명)이었으며 반대는 33.5%(81명)이었다. 환자의 일반적 특성별로는 30세에서 49세 사이가 75.5%, 중소도시에 거주하는 75.9%로 높은 찬성율을 보였다. 특히 의료보호 환자군에서는 40.0% 낮은 찬성율을 보였다. 척추손상 환자의 75.6%가 찬성한 반면 복합질 환자는 54.5%의 찬성율을 보였다. 그리고 거동 가능한 환자의 69.4%, 임종을 기다리는 환자의 80.0% 및 조기퇴원을 희망하는 환자의 73.9%가 가정 간호사제도를 찬성하였다. 가정간호사제도를 찬성하는 환자(161명)의 찬성 이유는 주치의와 계속적인 연결을 갖고 싶어서가 37.3%로 가장 높았고, 그 다음 병원에 오기가 블편해서였고 기능적 상태에 따라 찬성 이유간에는 유의한 차이가 있었다(p<0.05). 가정간호사제도를 반대하는 환자(81명)의 이유를 보면 병원보다 질이 낮을 것같다가 가장 많았고, 방문이 번거롭다 및 가정에서 가족이 돌볼 수 있어서의 순이였다. 조기퇴원을 원하는 환자는 74.8%였으며 조기퇴원 이유는 병원생활이 지루하기 때문에가 57.5%로 가장 많았고, 조기퇴원을 원하지 않는 환자는 질병상태에 대한 불안감 때문에가 54.0%로 가장 높았다. 가정간호사제도를 찬성한 환자들에게 가정간호서비스 내용을 23개 항목으로 나눈 요구 빈도에서 앞으로 수혜받기를 원하는 가정간호활동 내용은 회복촉진, 합병증예방, 상담 및 건강관리지도로 76.4%로 가장 많았으며, 그 다음의 투약관리 및 지도 (62.1%), 활력증상의 정기적인 측정(555.9%)의 순이었고 임종간호(3.7%) 및 호흡유지를 위한 간호(9.9%) 등은 요구빈도가 가장 낮았다. 가정간호서비스 항목에 있어서 진단내용, 환자의 기능적 상태, 합병증 유무 등에 따라서는 큰 차이 없이 회복촉진, 합병증예방상담 및 건강관리지도 항목에서 가장 높은 요구도를 나타냈고 나머지 간호요구는 큰 차이가 없었다.

• 대한간호학회지
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• 제10권1호
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• pp.41-55
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• 1980

The medical care insurance system, being put into practice nearly for three years, seem to have brought about some considerable problems as serious for the government as to consider a revision of that system. As one of the most serious problems of present system, the treatment cost of insurance patients is so remarkably low in comparison with than of non-insurance cases that normal operation of hospitals is threatened and care services of low quality are induced. The researcher carried out this survey to analyze and bring to light several aspects of treatment cost of non-insurance patients as a material for a re-assessment of the cost of insurance cases which shows a a considerable difference in amount at the standpoint of hospitals with than of non-insurance cases and further, hoping the significant blind spot of present insurance system(that is, the absence of regulations' for cost assessment by patterns or types of health care treatment) will be mended in near future. The survey was carried out with the treatment invoice sheets of total 902 in-hospital Patients of a general hospital in Seoul during the period of the 2 nd quarter of the year(1979). Among total 902 patients, 694 cases were used for analysis, because those disease or syndromes shared by less than 10% of the patients were put aside before procession. The data were analyzed by kinds or types of diseases, demographic characteristics of patients, hospitalization patterns, types of nursing treatment, etc. The result of analysis was as follows 1. Among all the non-insurance cases, those who received one or more kinds of nursing treatment mounted up to 96. 7 ％. The invoice issue frequency per person was 7.2 times, while that frequency per day for a person was 0.8, : the treatment cosr per person was ￦22,650 while its daily average was ￦2,430, due to the average 9.3 in-hospital days per person. 2. As to the nursing treatment types by the demographic characteristics of patients and hospitalization patterns. a. The unit cost female patients was generally more expensive them that of males, and independent nursing service was more given than other types of treatment. As to age, higher age groups received independent nursing service most, while the youngest group received instrumental and integrated nursing services. b. As to room grade, the unit cost of I.C.U. cases was the highest : and the cast of private room patients was higher than that of public room patients. By in-hospital days, the curve of function showed L. type : that is, the longer stay, the lower function. 3. State of treatment types by kinds of disease were ; a. Dependent nursing service showed comparatively high availability in surgical and neurologic disease and independent nursing service was most received by medical, obstetrical and urological patients, while instrumental and integrated services were most available for respiratory disease and obstetrical and neurologic diseases next. b. The invoice issue frequency per day for a patient was highest in obstetrical disease 3.8 times, and the unit cost(per one invoice sheet) was also highest in obstertrical disease(￦10,880) and next in neurologic cases(￦ 4,690 ). 4. As to the pertained departments. a. Cost amount per person was highest in department of Psychiatries daily cost was highest in obstetrical cases : while the invoice issue frequency was highest in obstetrics and next in pediatrics. b. In departments in need of surgical operation, dependent nursing care was highly availabl : while in internal medicine and obstetrics, independent service was higher. Psychiatrics showed the highest the of integrate nursing while pediatrics and obstetrics higher of instrumental services. The variation co-efficien of treatment cost came out to be relatively in high in special surgery, opthalmology and internal medicine. 5. State of treatment cost by types of nursing behavior was. a. The average frequency of invoice issue was 3.5 (times). Among the type four types of treatment, instrumetal service (4.3) and independent nursing behavior(3.9) showed higher frequency than average respectively. But as to unit cost (per invoice). dependent (￦5,200) and integrated (￦5,340) nursing care services were higher than average and considerably higher than the other two types. b. In repect patient distribution. independent nursing behavior(80.3% ) was the highest and depend ent nursing (31.7% ) the lowest. The variation co-efficient of treatment cost appeared highest in dependent nursing be havior as a whole, and among that, doctor's diagnosis showed the highest coefficient value (100.7). In conclusion, the variaty of treatment cost(treatment itself ) by various characteristics and treatment types pro- that treatment various sort of patients and treatment cost of various types of nursing behavior cannot be uniform. Therefore, to attain the equalization of health care service and its cost both for insurant and non-insurant patients, a more specific provision for assessment of cost should be added to the present medical care insurance system and, in addition, the cost of nursing treatment is desired to be inserted into the treatment invoice.

• 대한간호학회지
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• 제27권4호
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• pp.975-987
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• 1997

The purpose of this study was to investigate the current status of curriculum operation of the basic medical sciences in nursing education at college of nursing, department of nursing and junior college of nursing, ultimately to provide the basic data to improve a curriculum of basic medical science in nursing education. 78 professors who were in charge of basic medical science at 22 colleges of nursing and department of nursing, and 20 junior colleges of nursing responded the questionnaire consisted of 22 question items about the status of objectives, lectures, laboratory practice and characteristics of professors, and mailed to the author. The findings of this study were as follows : 1. The subjects of basic medical science were identified as physiology, anatomy, biochemistry, pathology, microbiology, pharmacology in the most colleges of nursing and junior colleges of nursing. 2 colleges of nursing and department of nursing(9.1%) and 19 junior colleges of nursing(95%) did not open biochemistry, 1 college of nursing and department of nursing(5%) did not open pathology and pharmacology. 2 Junior colleges of nursing(10%) did not open pharmacology, 1 junior college of nursing(5%) did not open pathology, the other 1 junior college of nursing did not open microbiology. 2. Credits of the subjects were ranged from 1 to 4. Lecture hours of one semester of physiology at school of nursing and junior college of nursing was average 103.6 and average 102.67, that of anatomy was average 127.1 and average 98, that of microbiology was average 109.7 and average 86.33, that of biochemistry was average 105, that of pathology was average 91 and average 94, that of pharmacology was average 86 and average 85.75. 3. Most of schools used 1 textbook for lectures, 3 school of nursing and department of nursing recommended references without using textbook, while all 36 junior colleges of nursing used textbooks. 4. 5 among 10 schools of nursing and department of nursing had a laboratory practice in physiology, 4 among 7 schools in anatomy, 4 among 6 schools in biochemistry, 2 among 6 schools in pathology 5 among 6 schools in microbiology. Not all the schools had a laboratory practice in pharmacology. 4 among 9 junior colleges of nursing had a laboratory practice in physiology. 1 among 4 schools in anatomy, 2 among 7 schools in microbiology. Not all the junior colleges of nursing had a laboratory practice in pathology and pharmacology. 11 among 20 colleges of nursing and department of nursing, 4 among 7 junior schools of nursing used a textbook of laboratory practice. 5. All the subjects at school of nursing and department of nursing responded that content of lectures and laboratory practices of basic medical science should be different from that of medical education, 34 junior schools of nursing responded that content of lecture of basic medical science in nursing education should be different from that of medical education. 33 junior schools of nursing responded that content of practice of basic medical science in nursing education should be different from that of medical education. 6. The final degree of 25 professors who were in charge of basic medical science were doctors of. medicine, that of 5 professors were masters of medicine, that of 5 were doctor of pharmacology, that of 2 were a master of pharmacology, that of 1 was physical science. The final degree of 8 professors who were in charge of basic medical science were masters of medicine, 7 doctors of medicine, 4 masters of nursing science, 4 masters of pharmacology, 2 doctors of nursing, 2 doctors of physical science, 2 doctors of pharmacology and 1 master of public health. 9 full professors, 13 associate professors, 11 assist ant professors, 3 full time instructors, and 6 part time instructors were in charge of basic medical science at college of nursing and department of nursing, 20 part time instructors, 8 associate professors, 6 assistant professors, and 2 full professors were in charge of has basic medical science at junior college of nursing. Based on these results, curriculum of basic medical science in nursing education should be reviewed deeply based on nursing model.

• 수면정신생리
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• 제18권2호
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• pp.87-94
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• 2011

목 적 : 폐쇄성 수면무호흡증은 흔하고 심각한 질환이므로 적극적인 진단과 치료가 필요하다. 본 연구에서는 이미 증상이 있어 코골이 클리닉을 방문한 환자들의 코골이와 수면무호흡증에 대한 인식 정도를 조사하고자 하였다. 방 법 : 서울대학교병원 이비인후과 코골이 클리닉을 방문한 179명(남자 135명, 여자 44명)의 환자를 대상으로 설문 조사를 시행하였다. 설문지를 통해 클리닉을 방문한 이유, 수면무호흡증과 코골이 치료법, 검사 방법, 관련 증상 및 합병증에 대한 지식을 파악하였다. 결 과 : 환자들의 평균 연령은 $45.2{\pm}14.5$세였고 체질량지수의 평균값은 $24.8{\pm}3.4$였다. 환자들의 89.4%이 폐쇄성 수면무호흡증에 대해 들어보았다고 대답했으며, 주로 텔레비전과 라디오와 같은 대중매체(58.1%)를 통해 정보를 접했다고 했다. 코골이와 폐쇄성 수면무호흡증이 밀접한 관련이 있다는 것은 60.3%가 알고 있었고, 59.8%는 치료방침을 정하기 위해 야간 수면다원검사가 필요함을 알고 있었다. 코골이 치료 방법으로는 수술(67%)을 가장 많이 알고 있었다. 코골이 치료를 선택할 때 의사의 권고에 따르겠다는 사람들이 55.9%로 가장 많았으나 양압술을 선택한 사람은 아무도 없었다. 양압술 치료에 대해 들어본 사람들은 전체의 12.3%였고, 폐쇄성 수면무호흡증의 치료로 양압술을 선택한 사람은 아무도 없었다. 환자들 중에서 폐쇄성 수면무호흡증이 고혈압과 관련되어 있다는 것을 아는 사람들은 34.6%, 당뇨와 관련이 있다는 것을 아는 사람들은 12.8%였다. 결 론 : 이미 증상이 있어 코골이 클리닉을 방문한 사람들조차 폐쇄성 수면무호흡증의 위험성과 적절한 치료 방법에 대해 잘 알고 있지 못했다. 환자와 일반인들을 대상으로 폐쇄성 수면무호흡증에 대해 교육하고 홍보하는 것이 향후 질환의 진단율을 높이고 적절한 치료로 연결하며 연관 질환을 예방하는 것에 중요할 것이다.

• 대한치과교정학회지
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• 제39권3호
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• pp.168-176
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• 2009

본 연구의 목적은 아동에서 사춘기 성장 동안 기도의 변화가 안면 성장에 미치는 영향을 평가하는 것이었다. 9 - 11세(평균 10.7세)의 교정환자 36명을 대상으로 하여 초진 시(T1)와 치료 종료 시(T2)에 각각 측모두부방사선사진과 수완부 방사선 사진을 촬영하였다. 측모두부방사선사진상의 기도 폭경을 기준으로 하여 대상을 세 그룹으로 나누었다; 폭경이 좁은 그룹(AW-Narrow: 5.2 - 8.6 mm), 중간 그룹(AW-Medium: 8.9 - 11.5 mm), 넓은 그룹(AW-Wide: 11.7 - 16.0 mm). T1과 T2시기에 각 그룹 간의 안면 계측치의 차이를 비교하였으며 T1 - T2 사이의 계측치의 변화량을 각 그룹별로 비교하여 성장을 평가하였다. 각 그룹의 기도 폭경 증가량은 AW-Narrow, AW-Medium, AW-Wide group에서 각각 4.55 mm, 3.84 mm, 1.94 mm였으며 통계적으로 유의한 차이를 보였다. T1시기의 각 그룹 간의 비교에서 AW-Narrow group에서 다른 그룹에 비해 PFH가 유의하게 작은 값을 나타냈다. T1 - T2 사이의 성장 평가에서는 AW-Narrow group에서 다른 그룹에 비해 PFH/AFH, facial axis, ANS (T1 - T2), and Gn (T1 - T2)의 변화가 유의하게 큰 값을 보였다. 이 시기의 안면 성장 기간 동안 기도 폭경이 좁은 그룹에서 기도 폭경 및 안면 성장의 보상성 변화가 일어난 것으로 생각된다. 바람직하지 않은 안면 성장을 예방하기 위한 외과적 기도 처치를 고려할 때 자발적인 개선 가능성을 고려하여 좀 더 신중한 평가가 필요할 것으로 생각된다.