• 대한한방내과학회지
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• 제28권4호
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• pp.863-871
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• 2007

Objects : To gain better insights of East-west integrated treatment of ischemic stroke. We analyzed 89 patients with severe acute ischemic stroke who were admitted to the East-west integrated intensive care unit. Methods : Subjects enrollment was from the East-west integrated intensive care unit of Kyung Hee Medical Center from March 2006 to February 2007. Patients were admitted within 14 days after the onset of ischemic stroke. We assessed the subjects' general characteristics, risk factors, admitting routes and periods, diagnostic imaging, process of western treatment and Korean traditional treatment, complication and consequence. Results : The proportion of males was 50.6%, of females 49.4%, average age was male 66.0$\pm$10.3 and female 71.1$\pm$10.5. Average length of hospital stays was 19.5 days. Monthly admissions were highest in November and December. The admission route was through emergency room (61.8%) or ward (34.8%). Mean Glasgow coma scale score was 10.0$\pm$2.5, average time from symptom of onset to hospital admission was 2.3$\pm$2.2 days. Dominant ischemic vascular territory was middle cerebral artery (66.3%). Initial western treatment was argatroban (22.5%), urokinase (28.1%), and heparinization (38.2%). Distribution of Sasang constitution of So-yang to Tae-eum to So-eum was equal to 5.4 to 2.9 to 1.5. Major complications were observed in 40 (42.7%) patients. In hospital mortality was 12.4% (11 deaths), all of them caused by aggravation of neurological deficit and only 3 of them with major complications. There appears to be a significant positive relationship between length of hospital stay and occurrence of complications (P<0.05). After discharge from the ICU, 64 (71.9%) patients were improved, 11 (12.4%) patients had expired, and 14 (15.8%) patients were transferred. Conclusions : From this study, we suggest that patients with severe acute ischemic stroke should be treated with East-west integrated therapy for more favorable consequences and decreased mortality.

• 공학교육연구
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• 제9권2호
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• pp.5-20
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• 2006

본 연구는 주로 공과대학 대학생들을 중심으로, 대학생들의 창의성을 측정 평가하고, 이를 바탕으로 학생들의 창의성을 증진시키는 교육과정을 마련하기 위한 창의성의 공학적 응용 기반 연구의 일환으로 진행되었다. 본 연구의 목적은 창의적 문제해결 능력을 각 전공의 특성에 맞게 통합하여 교육하는 학과 통합적 프로그램(integrated program) 형식의 상상설계공학의 학습성과를 창의성과 성격유형적인 면에서 분석하는 것이다. 상상설계공학은 아이디어 창출, 특허출원, 설계, 제품 개발, 마케팅에 대한 정보를 습득하고 그 활용 방법에 대해 학습하였으며 이를 토대로 제품 개발을 위한 아이디어 창출능력을 기르고 문제해결 능력을 강화할 수 있도록 하였다. 본 연구의 학습성과는 창의성 측정도구인 TTCT 도형 검사와 성격유형검사인 MBTI를 이용하여 측정하였다. 그 결과, 첫째, 상상설계공학수업에 참여한 학생들의 TTCT 창의성 지수는 통계적으로 유의하게 상승하였고, 둘째, 상상설계공학수업에 참여한 학생들의 MBTI 성격 유형 선호지표 점수에 통계적으로 유의미한 변화가 있었으며, 그 방향은 보다 외향적(E)으로, 보다 감정적(F)으로, 보다 인식적(P)이었다. 이러한 결과를 바탕으로 분석해 볼 때, 상상설계공학 수업이 학생들의 창의성 계발에 도움이 된 것으로 판단된다.

• 대한임상독성학회지
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• 제16권2호
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• pp.75-85
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• 2018

Purpose: This study examined the Poisoning Severity Score (PSS) from acute poisoning patients, to determine the relationships among the PSS, PSSsum, the primary outcome (prolonged stay at the ER over 24 hours, general ward and ICU admission and the application of intubation and mechanical ventilator, and the administration of inotropes). Methods: A retrospective study was conducted through the EMR for 15 months. The PSS grade was classified according to the evidence of symptoms and signs. The differences in the primary outcomes between the PSS of when a single organ was damaged, and the PSS, PSSsum combined with the grade of when multiple organs were damaged, were studied. The cutoff value was calculated using the receiving operating characteristics (ROC) curve. Results: Of the 284 patients; 85 (29.9%) were men with a mean age of 48.8 years, and their average arrival time to the ER was $4.4{\pm}6.7\;hours$. The most frequently used drug was hypnotics. The number of patients with PSS grade 0, 1, 2, 3, and 4 was 17, 129, 122, 24, and one, respectively. No ICU admissions, application of intubation and mechanical ventilators, administration of inotropes were observed among the patients with PSS grades 0 and 1 but only on patients with PSS grades 2 to 4. At PSS, when separating the patients according to the number of damaged organs, 17 had no symptoms, 133 had one organ damaged, 75 had two organs damaged, 36 had three organs damaged, and 23 had four organs damaged. Significant differences were observed between increasing number of damaged organs and the primary outcome. Conclusion: Among the acute poisoning patients, the PSS was higher in severity when the grade was higher. The number of damaged organs and the primary outcome showed meaningful statistical differences. This study confirmed that when the patients' PSS>2 and PSSsum>5, the frequency of ICU admission was higher, and they were considered to be severe with an increased prescription risk of application of intubation and mechanical ventilator, and the administration of inotropes.

• Journal of Preventive Medicine and Public Health
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• 제26권3호
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• pp.400-411
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• 1993

The aim of this study is to analyze the variations among hospitals and hospital groups in resource use and procedures of diagnostic and therapeutic process, such as laboratory tests, radiologic examinations, tissue diagnosis, timing of surgery after admission, the time required for operation. The study was performed for five procedures including cesarean section (C/S), appendectomy, cholecystectomy, cataract extraction, and pediatric pneumonia. The 2,316 subjects were selected from medical insurance claims list, and from this list 413 cases were sampled for medical record review. The patterns of resource utilization and process of treatment were described according to hospitals and characteristics of hospital groups. The major results were as follows : 1. The numbers of laboratory and radiologic tests showed significant difference among hospitals and hospital groups. In case of hospital groups, we could find tendencies of more tests with increasing hospital bed size. 2. In general, the proportion of operative cases evaluated by tissue diagnosis postoperatively among all operations ranged from 28.3% to 100%. The proportion varied among hospital groups, of which general hospital A group(more than 15 specialty) showed the highest proportion. 3. Post-admission delay until operation and the time required for operative procedure were not invariable among hospitals and hospital groups. The duration of operation in tertiary hospitals was slightly shorter than general hospitals, with varying statistical significance. We could find that probably there were differences of quality among hospitals in some components of procedures, which suggested that the implementation of quality assurance activities would be mandatory. In this study, we simply described the patterns of resource utilization and some features of clinical process, with institution of the need for advanced studies with in-depth analyses for each component of diagnosis and treatment procedures.

• 대한임상독성학회지
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• 제13권1호
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• pp.25-32
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• 2015

Purpose: The aim of this study was to investigate the independent factors associated with the registration rate for the community-based post suicidal care program in the emergency department (ED). Methods: This prospective observational study was conducted between March and December 2013 at the academic ED at the tertiary urban hospital. During the study period, the pre-designed registry was recorded. The variables examined included the following: patients' demographic data (Sex, age, address, type of insurance, marital status, level of education, and history of previous psychiatric disease), suicide-related data (suicidal methods, combined drink of alcohol and number of previous attempts), and management-related data (disposition at ED, physician's training level, etc.). Univariated and multivariated logistic regression analyses were performed for identification of factors affecting the registration rate for the community-based post suicidal care program. Results: A total of 163 suicides were included during the study period. Of these, 33 (20.2%) patients were registered in the post-suicide care program. Factors including a patient's address (OR: 14.92, 95% CI: 3.606-61.711), immediate intervention by psychiatric healthcare center (OR: 5.05, CI: 1.688-15.134), admissions in hospital (OR: 3.69, CI: 1.286-10.605), and history of previous psychiatric disease (OR: 3.52, CI: 1.216-10.201) showed significant association with registration for the program. Conclusion: The community-based post-suicidal care program, which is available 24 hours a day, should be operated in each district in order to increase the registration rate. Emergency physicians should actively consider the inpatient treatment program for suicidal patients and strongly recommend registration to the program, particularly for patients without previous history of psychiatric disease.

• Journal of Preventive Medicine and Public Health
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• 제41권5호
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• pp.287-294
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• 2008

Objectives : To estimate the economic burden of osteoporotic vertebral fracture (VF) from a societal perspective. Methods : From 2002 to 2004, we identified all National Health Insurance claims records for women ${\geq}50$ years old with a diagnosis of VF. The first 6-months was defined as a "clearance period," such that patients were considered as incident cases if their first claim of fracture was recorded after June 30, 2002. We only included patients with ${\geq}$ one claim of a diagnosis of, or prescription for, osteoporosis over 3 years. For each patient, we cumulated the claims amount for the first visit and for the follow-up treatments for 1 year. The hospital charge data from 4 hospitals were investigated to measure the proportion of the non-covered services. Face-to-face interviews were conducted with 106 patients from the 4 study sites to measure the out-of-pocket spending outside of hospitals. Results : During 2.5 years, 131,453 VF patients were identified. The patients had an average of 3.38 visits, 0.40 admissions and 6.36 inpatient days. The per capita cost was 1,909,690 Won: 71.5% for direct medical costs, 20.6% for direct non-medical costs and 7.9% for indirect costs. The per capita cost increased with increasing age: 1,848,078 Won for those aged 50-64, 2,084,846 Won for 65-74, 2,129,530 Won for 75-84and 2,121,492 Won for those above 84. Conclusions : Exploring the economic burden of osteoporotic VF is expected to motivate to adopt effective treatment options for osteoporosis in order to prevent the incidence of fracture and the consequent costs.

• 대한공업교육학회지
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• 제35권2호
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• pp.182-203
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• 2010

이 연구의 목적은 일본 대학입시센터시험 정보관계기초를 분석함으로써 수능직업탐구영역의 출제에 시사점을 얻는데 있다. 이를 위해 우선 센터시험의 구성과 출제 체제를 분석하고 교육과정 내용영역, 행동영역 분류, 예상 정답률, 특이사항 등을 분석하였고 정보관계기초와 유사한 수능의 정보기술기초와 프로그래밍 문항과도 비교 분석 하였다. 이 결과로부터 얻은 결론은 첫째, 일본 대학입시센터시험 정보관계기초는 직업교육을 주로하는 전문계고의 농업, 공업, 상업 등의 계열에서 정보에 관한 과목의 공통 내용을 출제 범위로 하는 과목으로서 수능에서도 각 계열의 컴퓨터관련 과목의 공통 내용을 하나의 과목으로 출제하는 방안을 고려할 필요가 있다. 둘째, 정보관계기초는 대문항의 문제 상황과 다른 새로운 문제 상황을 하위 문항에 다양하게 제시하고 있어, 수능에서도 세트형 문항에서 문제 상황을 다양하게 제시할 필요가 있다. 셋째, 해답군에서 정답을 복수로 선택할 수 있고 해답군 없이 직접 숫자를 기입하는 서답형 문항, 선택지의 개수도 다양하게 제시되고 있어, 이를 수능 형식에 적용하여 문항 형식을 다양화할 필요가 있는 것으로 나타났다.

• 응용통계연구
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• 제24권1호
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• pp.193-206
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• 2011

자녀의 사교육비 지출은 정치, 경제, 사회 등 국민 생활 전반에 걸쳐 막대한 영향을 미치고 그 부작용이 심각하여 한국사회의 중요한 이슈가 되고 있다. 본 논문에서는 통계청에서 수집한 2008년도 사교육비 실태조사 자료 중 일반사교육비 지출과 방과후 프로그램 참가비의 두변수에 대하여 지역, 초 중 고 등 학교급 구분, 가구소득, 학생 성적, 별, 사교육 참가시간 등의 인구동태적 변수들의 영향을 알아보는 다중 선형 회귀분석을 수행 하였다. 분석결과 일반 사교육비 지출과 방과후 프로그램 참가비에 뚜렷한영향을 미치는 요소로는 지역과 학교급구분이고 나머지 변수들은 의미있는 영향력을 보여주지 못하였다. 일반 사교육비 지출에 대한 지역의 영향을 보면, 서울지역>광역시, 중소도시>읍면지역 순으로 지출에 상당한 차이가 있음을 보여주었다. 방과후 참가비에 대한 지역의 영향을 보면 서울지역, 광역시, 중소도시>읍면지역 의 순으로 지출이 많았는데 서울과 기타도시의 차이가 없다는 것이 일반 사교육비의 경우와 다른 특징이다. 학교급 구분에서는 일반사교육비의 경우 일반계 고교생에 대한 지출이 초 중생이나 전문계 고교생에 비하여 약 17% 지출이 더 많았다. 이는 대학입시 위주의 교육 풍토와 사교육 시장이 관련이 있음을 보여준다고 할 수 있다. 방과후 학교 참가비의 경우 일반계고, 초등학교> 전문계고> 중학교 의 순서이다. 초등학생은 사교육비의 부담을 덜기 위해서, 그리고 일반계 고등학생의 경우는 방과후 학교에서 내신에 도움을 주는 프로그램을 제공하기 때문으로 추측할 수 있다.

• Journal of Preventive Medicine and Public Health
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• 제29권2호
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• pp.311-329
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• 1996

This study was designed to compare the level of medical utilization between the urban and rural areas of Korea and to explain the differences between the two regions. Data from the National Health Interview Survey performed by the Korean Institute of Health & Social Affairs in 1992 were used for this study utilizing a sample size of 21,841 people. The level of medical utilization such as the number of physician visits and the number of hospital admissions was compared between the regions with ANOVA. Various determinants for medical use were also compared by univariate analysis. Statistical models which included enabling factors, predisposing factors, need factors and region were constructed for bivariate analysis in order to further elucidate the level of medical utilization. The results were as follows: 1. There was greater medical use, both in terms of physician visits and inpatient care in the rural areas in spite of insufficient health resources. The particular reasons for higher medical utilization in rural areas were attributed to a higher number of initial physician visits as well as a longer the length of stay per hospital admission. Therefore, indicators representing the degree of met need (utilization/need) showed no significant difference between rural and urban areas in spite of the fact that the medical need is larger in rural areas. 2. Use of public health facilities received a significant portion of physician visits in the rural area. The government's effort to enhance primary health care through health centers, health subcenters and the nurse practitioner's post in rural areas has contributed to the increase of access to medical care in the rural areas. 3. There were some differences in the socio-demographic characteristics between two regions ; There were more elderly people over the age of 65: unstable marital status, less education and lower incomes also characterized the rural areas. Therefore, among rural people, there were more predisposing factors for medical use. Additionaly, need factors such as poor self-reported health status and high morbidity level were also high in the rural area. 4. In contrast it was learned that, the supply of health resources was mostly concentrated in the urban areas except for public health facilities. Therefore, geographical access to medical care was lower in the rural area both in terms travel time and travel cost. 5. The coefficient of the region variable was insignificant in the regression model which controlled the supply factor only. However, utilization was significantly higher in urban areas if the model included predisposing factors and need factors in addition to the supply factor. The results were interpreted as rural people have greater medical needs.

• 한국의료질향상학회지
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• 제9권2호
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• pp.116-133
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• 2002

Background : It is very common in Korea to take care of non-acute patients in an acute setting, due to the lack of long-term facilities. Long term hospitalization increase medical expenses and decreases the bed utilization, which can affect the urgent and emergent admissions, and eventually jeopardize the hospital financially. In this study, strategies for effective transfers to the lower levels of care, and to decrease the length of stay were presented by surveying and analyzing the patient's knowledge of the transfer needs, and the willingness to transfer those whose hospital length of stay was more than 30days. Method : The survey is subject to a group of 251 patients who have been hospitalized over 30 days in a general hospital in Seoul. Excluding those that were in the Intensive Care Unit and psychiatric ward, 214 in-patients were used as participants. They were surveyed from April 9, 2002 to April 17, 2002. One hundred and thirty seven out of 214 were responded which made the response rate 64%. Data were analyzed by SAS and SPSS. Result : Multi-variable Logistic Regression Analysis showed a significant effect in medical expenses, knowledge of referral system and the information of the receiving hospital. The financial burden in medical expenses made the patient 10.7 times more willing to be transferred, knowledge of the referral system made them 5 times more willing to be transferred, and the information of receiving hospital makes 6.5 times more willing to be transferred. Reasons for willing to be transferred to a lower level of care were the phase of physical therapy, the distance from home, the attending physician's advice and being unable to be treated as an out patient. Reasons for refusing to be transferred were the following. The attending physician's competency, not being ready to be discharged, not trusting the receiving hospital's competency due to the lack of information, or never hearing about the referring system by the attending physician. Conclusion : Based on this, strategies for the effective transfer to the lower levels of care were suggested. It is desirable for the attending physician to be actively involved by making an effort to explain the transfer need, and referring to the Healthcare Coordinating Center, which can help the patient make the right decision. Nationwide networking for the referral system is the another key factor that may need to be suggested as an alternative to decrease the medical expenses. Collaborating with the Home Health Agency for the early discharge planning and the Social Service Department for financial aid are also needed. It is recommended that the hospital should expedite the transfer process by prioritizing the cost and the information as medical expenses, knowledge of referring system and the information of the receiving hospital, are the most important factors to the willingness to transfer to a lower level of care.