• 제목/요약/키워드: Value-based health care

검색결과 199건 처리시간 0.024초

유방암 환자의 통증 관련 약물 현황과 통증에 미치는 요인 (Pain-related Prescribing Patterns and Associated Factor in Breast Cancer Patients)

  • 이진;박이병;서화정
    • 한국임상약학회지
    • /
    • 제31권2호
    • /
    • pp.115-124
    • /
    • 2021
  • Background: With an increase in the number of breast cancer survivors, greater importance is attached to health-related quality of life, particularly pain and symptom control. This study aimed to identify the factors that are associated with pain in cancer patients based on the patterns of prescribing opioid, non-opioid, and adjuvant analgesics. Methods: This analysis included new patients who had developed breast cancer between 2003 and 2012. The degree of pain was analyzed based on the socio-demographic (age, income quintile, number of hospitalizations, and duration of disease), indicator (Body Mass Index; BMI, Charlson Comorbidity Index; CCI, Cumulative Analgesic Consumption Score; CACS), operation (mastectomy, lymph node dissection), and therapy (chemotherapy, radiation therapy), as well as complication-related variable (lymphedema). Results: As for the patterns of prescribing analgesics by stages, non-opioid and opioid analgesics constituted 30.7 and 69.3%, respectively. The mean value and variance of CACS were 5.596 and 12.567, respectively. The factors that significantly affected the degree of pain were age (≥50; IRR: 1.848, 95% CI 1.564-2.184, p=0.000), income quintile (IRR: 0.964, 95% CI 0.938-0.991, p=0.008), BMI (≥ 25; IRR: 1.479, 95% CI 1.222-1.795, p=0.000), CCI (≥ 4; IRR: 1.649, 95% CI 1.344-2.036, p=0.000), and lymphedema (yes; IRR: 1.267, 95% CI 1.006-1.610, p=0.047). Conclusions: It is necessary to develop systematic and comprehensive pain control measures to improve the quality of life for breast cancer survivors, especially for those who are 50 years or older, lie in the lower-income quintile, have BMI of ≥25 and CCI score ≥ 4, or have lymphedema.

한국 중년 여성의 건강증진 행위 예측 모형 구축 (Determinants of Health Promoting Behavior of Middle Aged Women in Korea)

  • 이숙자;박은숙;박영주
    • 대한간호학회지
    • /
    • 제26권2호
    • /
    • pp.320-336
    • /
    • 1996
  • Health promoting behaviors of an individual are affected by various variables. Recently, there has been a growing concern over important health problems of the middle aged women. Physiological changes in the middle aged women and their responsibility for family care can result in physical and psychological burden experienced by middle aged women. This study was designed to test Pender's model and thus purpose a model that explains health promoting behaviors among middle-aged women in Korea. The hypothetical model was developed based on the Pender's health promoting model and the findings from past studies on women's health. Data were collected by self-reported questionnaires from 863 women living in Seoul, between 20th, April and 15th, July 1995. Data were analyzed using descriptive statistics and correlation analysis. The Linear Structural Relationship(LISREL) modeling process was used to find the best fit model which assumes causal relationships among variables. The results are as follows : 1. The Overall fit of the hypothetical model to the data was good expect chi-square value(GFI=.96, AGFI=.91, RMR=.04). 2. Paths of the model were modified by considering both its theoretical implication and statistical significance of the parameter estimates. Compared to the hypothetical model, the revised model has become parsimonious and had a better fit to the data expect chi-square value(GFI=.95, AFGI= .92. RMR=.04). 3. Some of modifying factors, especially age, occupation, educational levels and body mass index (BMI) are revealed significant effects on health promoting behaviors. 4. Some of cognitive-perceptual factors, especially internal health locus of control, self-efficacy and perceptive health status are revealed significant effects on health promoting behaviors. 5. All predictive variables of health promoting behaviors, especially age, occupation, educational levels, body mass index(BMI), internal health locus of control, self-efficacy & perceptive health status are explained 20.0% of the total variance in the model.

  • PDF

물성 분석을 통한 Valine 의 여드름균 바이오필름 내부 세균막 형성 억제 연구 (A Study on Inhibition of Bacterial Membrane Formation in Biofilm formed by Acne Bacteria in Valine through Property Analysis)

  • 송상훈;황병우;손성길;강내규
    • 대한화장품학회지
    • /
    • 제47권2호
    • /
    • pp.163-170
    • /
    • 2021
  • 본 연구는 인체 친화적인 소재로 여드름균을 제거하는 기술을 만들기 위해서 진행하였다. 먼저 여드름균을 운모 디스크에 흡착시켜 생장시킨 후 원자현미경을 통해 바이오필름이 제대로 성장하였는지를 확인하였다. 이미지 상으로 형태가 둥글게 변하였고 사이즈도 평균 17% 정도 길어졌으며 물질을 구분하는 공명주파수의 위상 값이 단일값으로 관찰된 것을 볼 때 세균막이 운모디스크 전체를 덮어서 자란 바이오필름을 확인할 수 있었다. 이렇게 바이오필름을 생성시킨 여드름균에 여러 가지 아미노산 50 mM을 각각 처리하여 관찰한 결과 valine, serine, argine, leucine을 처리하였을 때 여드름균의 농도가 감소한 것을 발견하였다. 나노인덴터와 AFM 컨택모드로 스캔을 한 결과 valine (Val)을 처리한 여드름균 바이오필름의 강도가 증가해 있는 것을 확인하였다. 이것은 균을 보호하는 외곽의 세균막이 형성 억제됨으로써 세균막보다 더 높은 강도일 수 있는 균을 측정했기 때문일 수 있다. 여드름균과 Val을 처리한 여드름균에 균과 바이오필름 내부의 세균막을 볼 수 있는 형광물질을 각각 태깅하고 형광 이미지를 관찰한 결과 저농도 Val을 처리한 여드름균에서는 세균막이 관찰되었으나 10 mM 이상의 Val을 처리할 때부터 여드름균의 세균막이 형성 억제됨을 알 수 있었다. 뿐만 아니라 Val 10 mM 이상의 농도에서는 여드름균 전체의 농도도 감소하는 것을 알 수 있었다. 즉, 세균막이 형성 억제됨으로써 약화된 여드름균의 결합력에 의해서 여드름 균의 농도가 감소한 것으로 볼 수 있다. 마침내 Val의 투입은 세균막 생성을 억제함으로써 여드름균을 제거하는 효능이 있음을 확인하였다.

응급실 중증도 분류 간호사의 의사결정과정에 나타난 사고전략: 소리내어 생각하기 (Thinking Strategies of Triage Nurses' Decision Making in the Emergency Department: Think Aloud Study)

  • 문선희;박연환
    • 중환자간호학회지
    • /
    • 제9권1호
    • /
    • pp.15-26
    • /
    • 2016
  • Purpose: The aim of this study was to identify thinking strategies in the complicated decision-making process based on real patient-based data of triage nurses in the emergency department (ED). Methods: This study used the 'think aloud' method to collect data from 8 triage nurses from one general hospital ED in South Korea. The data were analyzed with protocol analysis using thinking strategies. Results: The triage process was divided into three stages. The first stage consisted of 8 thinking strategies, including searching for information. They used intuition based on directly observed concepts for identifying a crisis. The second stage consisted of 17 thinking strategies related to the decision-making process. They assessed patients and generated a hypothesis to try to understand their health problems through analytic thinking. The third stage consisted of 10 thinking strategies, including qualifying. They considered the situation of the ED and properly triaged the patients. During the triage process, they frequently used judging the value and searching for information on 17 thinking strategies. Conclusions: Triage nurses demonstrated various connected thinking strategies for each stage. Based on our results, further studies should be done to develop a triage education program.

  • PDF

운동에 영향을 끼치는 피트니스 앱 요인 연구 (What Makes People Walk Using a Fitness App?)

  • 김진솔;손새아;김희웅
    • 한국정보시스템학회지:정보시스템연구
    • /
    • 제29권4호
    • /
    • pp.1-24
    • /
    • 2020
  • Purpose An increase in the number of fitness apps across the world is a testament to the growing interest in health. As focus on medical services shifted from treatment to prevention, this type of app plays an essential role in promoting one's health and exercise management. Yet little has been known about practical effects of fitness apps in existing literature thus this study searches for factors that affect daily use of fitness apps and examine the relationship between app usage and exercise patterns. Design/methodology/approach This study surveyed people who used Cashwalk, the pedometer app for a minimum of a week to analyze reasons why they used the app. Particpants' exercise patterns were also recorded. By examining survey results of fitness app users and developing a research model based on the Customer Value Theory, this study provides real-life factors to the fitness and smart health care industry that will adopt a proactive lifestyle pattern. Findings Empirical analysis proved properties such as the complexity of fitness apps, monetary rewards, exercise monitoring and the enjoyment of using fitness apps contribute to using fitness apps on a daily basis. Furthermore, more daily use of fitness apps was shown to have a greater impact on exercise. This study also confirmed that social comparison does not affect the daily use of fitness apps and the amount of exercise, and the habitual walking was proved to directly affect the amount of exercise.

수면무호흡 환자의 양압기 제품서비스디자인 개발에 대한 서비스 제공자와 수혜자가 느끼는 디자인 컨셉 가치 비교연구 (Design Concept Value Competitive Research Between Service Provider and Service Receiver)

  • 이성필;정주영;이상기;홍정표
    • 서비스연구
    • /
    • 제7권4호
    • /
    • pp.39-50
    • /
    • 2017
  • 본 연구의 목적은 서비스 제공자(개발자)와 서비스 수혜자(고객)집단 간에 느끼는 디자인 컨셉 가치에 대한 비교연구로서 양압기(CPAP)를 중심으로 진행된 IoT기반 U-헬스케어 및 사용자 환경기반 서비스모델을 제시하여 사례연구로 진행하였다. 더블다이아몬드(Double Diamond)연구방법을 활용하여 울산에 소재한 U병원 이비인후과와 공동으로 사례 연구를 진행하였으며, 수면 무호흡 수면 환자들을 대상으로 진단부터 구매 후 사용까지 다양한 의미 있는 경험을 발췌하고 고객 유형별 차이점을 분류 하였다. 최종적으로 제시한 13개의 서비스 시나리오 모델을 대상으로 고객은 카노(Kano)만족도와 잠재적 고객만족 개선 지수(PCSI)평가를 진행하였고 개발에 참여한 서비스제공자 집단을 대상으로 스코어모델(+-)평가와 컨셉포지션(Concept Position)평가를 진행하였다. 본 연구를 통하여 도출한 결과는 총 12가지 문항에서 7가지 문항은 수혜자와 공급자 사이에서의 가치적 견해의 일치가 나타났으며 이는 사용자 환경기반 서비스모델 속성 이었으며, 반대로 가치적 견해가 상의한 결과인 5가지 문항은 IoT기반 U-헬스케어 서비스 모델 속성에 포함 되어 있었다는 것을 알 수 있었다.

동기면담을 적용한 구강 관리 프로그램의 효과 (The Effect of Oral Health Care Program Based on Motivational Interviewing)

  • 한예슬;배현숙;조영식
    • 치위생과학회지
    • /
    • 제14권3호
    • /
    • pp.287-294
    • /
    • 2014
  • 본 연구는 구강 건강 개선을 위해 효과적인 구강 보건 교육방법을 모색하고자 동기면담이라는 새로운 상담기법을 적용한 구강 관리 프로그램을 진행하였다. 동기면담의 효과를 검증하고, 구강 관리 프로그램 개발의 기초자료로 제시하고자 대학생 98명을 대상으로 구강 관리 프로그램을 시행하였다. 첫 방문 날짜를 기준으로 실험군 32명과 대조군 66명으로 배정하였으며, 실험군에게는 총 3회의 동기면담을 시행한 결과 다음과 같은 결과를 얻었다. 1. 중재 유무에 따라 프로그램 참여 전후의 구강 상태를 비교한 결과 실험군에서 유의한 차이를 나타냈다. 치주상태를 평가하는 PSR, 치은 지수, 치석 지수, 치면세균막 지수, QLF-D 측정값인 SPS 모두 중재 전보다 중재 후에 측정값이 유의하게 감소하였다(p<0.05). 2. 구강 관리 프로그램 시행 기간 총 3회 동안 치면세균막지수값을 측정한 결과 두 집단 간의 차이는 통계적으로 유의하지 않았으나(p>0.05), 3회의 치면세균막 측정 시점 간의 차이는 통계적으로 유의하였으며 집단과 측정 시점간의 교호작용도 유의한 차이를 나타냈다(p<0.05). 3. 구강 관리 프로그램 참여 기간 동안 재방문 준수도는 실험군의 방문 준수도가 높게 나타났다. 또한 프로그램 재방문에 영향을 미치는 요인을 분석한 결과 동기면담을 시행한 집단이 시행하지 않은 집단보다 재방문할 가능성이 23.89배 높았으며, 구강 양치액을 사용하는 사람이 사용하지 않는 사람보다 21.73배, 치주상태 측정값 PSR이 큰사람이 12.19배 재방문할 가능성이 높은 것으로 나타났다(p<0.05). 이상의 결과를 종합해 보면, 동기면담의 시행은 구강 상태를 개선하며 그 가운데 치면세균막 감소에 높은 영향력이 있음을 확인할 수 있다. 또한 동기면담을 적용한 집단은 치면세균막 지수가 점차 감소하는 반면 중재를 시행하지 않는 집단은 다시 증가하는 양상을 나타내어 동기면담의 시행이 행동 유지에 관련이 있음을 알 수 있다. 동기면담 시행 집단이 재방문율이 높고, 재방문 준수에 동기면담의 영향력이 있는 것을 확인하였으므로 동기면담은 구강 관리 프로그램에 적용 가능하며 구강건강개선에 영향력 있는 중재로 이용될 것으로 생각된다.

간호사의 행복: 통합적 문헌고찰 및 메타분석 (Nurses' Happiness: Integrative Literature Review and Meta-analysis)

  • 김은주;김성광
    • 가정∙방문간호학회지
    • /
    • 제28권3호
    • /
    • pp.243-255
    • /
    • 2021
  • Purpose: This study was conducted to explore research trends on hospital nurses' happiness. Methods: Studies published from January 1, 2000 to December 31, 2020 were searched. At the first search, 1,898 articles were extracted from academic databases. Twenty-eight articles were used in the systematic review, and 20 included meta-analysis. Results: There were 38 variables explored in relation to nurses' happiness. The variables with the highest meta-analysis value were resilience, positive psychological capabilities, quality of nursing work life, and perceived stress on nursing performance measurement. Among the areas classified based on the nurses' happiness theoretical framework, personal factors (r=.60) and work environment factors (r=.51) showed high meta-correlation values. Conclusion: The relationship between the hospital nurses' happiness and work-related factor in various dimensions has been confirmed. Considering variables related to hospital nurses' happiness in the future, various programs at the individual level and organizational level should be developed.

우리나라 병동 간호사의 병원 특성이 재직률, 근무기간 및 퇴직에 미치는 영향: 건강보험심사평가원(HIRAS)자료를 이용한 후향적 코호트 연구 (Effects of Hospital Characteristics on Employment Rate, Working Period and Retirement of Ward Nurses in Korea: A Retrospective Cohort Study Based on HIRAS Data)

  • 서희정;김기연;장세진
    • 대한간호학회지
    • /
    • 제50권6호
    • /
    • pp.837-847
    • /
    • 2020
  • Purpose: The purpose of this study was to investigate the effects of hospital characteristics on employment rate, working period, and retirement of ward nurses in Korea through a retrospective cohort study based on HIRAS data. Methods: Data were obtained from a report on medical care institutions of Health Insurance Review & Assessment Service (HIRAS). Data from 259,941 nurses who were working for a day or more from January 1, 2012, to December 31, 2016, at 2,942 medical care institutions were analyzed. Life table method analysis, Kaplan-Meier analysis, and Cox proportional hazard regression analysis were conducted. Results: The employment rates of 5 yeas and 10 years for the total sample were 38% and 28%, respectively. The estimated mean value of the working period was 3,642.7 days (SE: 17.4 days). Cox proportional hazard regression analyses revealed that nurses who were working at the general hospital/hospital, clinic, and nursing hospital were more likely to leave the hospital compared to those who were working at the 3rd general hospital. Nurses who were working at the medical institutions which were located in cities and countries, established by the private foundation, rated lower levels of nursing, and owned an insufficient number of beds, nurses and doctors were more likely to leave their workplace compared to those of the counterparts. Conclusion: This study indicates that hospital characteristics may play a significant role in retirement and working period of ward nurses in Korea. The improvement of hospital conditions to reduce ward nurses' retirement are needed.

2015 재난적 의료비 경험률과 추이 (Catastrophic Health Expenditure Status and Trend of Korea in 2015)

  • 김우림;박은철
    • 보건행정학회지
    • /
    • 제27권1호
    • /
    • pp.84-87
    • /
    • 2017
  • Catastrophic healthcare expenditure refers to out-of-pocket spending for healthcare exceeding a certain proportion of a household's income and can lead to subsequent impoverishment. The aim of this study was to investigate the proportion of South Korean households that experienced catastrophic healthcare expenditure between 2006 and 2015 using available data from the Korea Health Panel, National Survey of Tax and Benefit, and Household Income and Expenditure Survey. Frequencies and trend tests were conducted to analyze the proportion of households with catastrophic healthcare expenditure. Subgroup analysis was performed based on income level. The results of the Household Income and Expenditure Survey revealed that around 2.88% of households experienced catastrophic healthcare expenditure in 2015 and that this proportion was highest in the low income group. Results also showed a statistically significant increasing trend in the number of households with catastrophic healthcare expenditure (annual percentage change= 0.92%, p-value < 0.0001). Therefore, the findings infer a need to strengthen public health care financing and to particularly monitor catastrophic healthcare expenditure in the low income group.