• Clinical and Experimental Pediatrics
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• 제48권4호
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• pp.355-362
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• 2005

Constipation is very common phenomenon during childhood that accounts approximately 3% of general pediatric outpatient visits and up to 25% of visit to the pediatric gastroenterologist. The diagnosis of functional constipation is based on the historical features and absence of physical abnormalities. Most infants and children with chronic constipation require no diagnostic tests. Constipation and subsequent fecal retention behavior often begins soon after experience of painful defecation. The effective management of childhood chronic constipation consist of education, prolonged support by physicians and parents, medications, and long term follow up.

• 한국임상약학회지
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• 제19권2호
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• pp.120-130
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• 2009

The objective of this study was to analyze and to improve therapeutic drug monitoring(TDM) service of vancomycin in a local hospital. Patients with TDM service between September 2005 and December 2008 were included and the data were collected for vancomycin use and components of TDM. During that period, 421 cases of TDM service of vancomycin in 236 patients were retrospectively reviewed. The first dosages of vancomycin were appropriate in 135(57.2%) patients and administration of vancomycin was discontinued in 126(53.4%) patients due to therapeutic failure or adverse drug reaction. MRSA was identified in 191(80.9%) patients and 135(70.7%) samples for the identification were sputum. According to the TDM reports, 232(55.1%) serum samples were obtained at the steady-state conditions and 55.5% of the samples that were drawn before the steady-state was due to the physician's inappropriate knowledge about the steady-state. Based on the time of vancomycin administration, 35.8% of the samples were not obtained at the recommended sampling time. For the patients in general wards, the most common reason for the incorrect samples was routine serum sampling by the laboratory medicine phlebotomists between 6 and 8 a.m. except sunday. In contrast, samples drawn by nurses or physicians at inappropriate time were the most common reason for the incorrect samples with patients in the intensive care units. Physicians accepted 68.5% of the recommendations for vancomycin dosage and administration. In conclusion, TDM service of vancomycin needs to be improved in inappropriate sampling time and vancomycin dosage. For solving these problems, current team made of TDM pharmacists and physicians of laboratory medicine can be expanded to include a physician of infectious diseases, nurses and laboratory medicine phlebotomists as new members. Through the TDM service of vancomycin by the new team, we can settle the problems and make the guideline for the scientific controversies associated with therapeutic monitoring of vancomycin.

• 보건행정학회지
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• 제8권2호
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• pp.166-190
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• 1998

This study presents the status on drug prescription for clinic outpatients' bronchitis, gastritis, and gastric ulcer, and also the physician factors that affects their prescriptions. In this research project the physician factors are as follows: their demographic features, their work related features, education related features, drug information related features and drug promotion related features. The variables in drug prescriptions are drug expenses, daily drug expenses, days of medication, the highest price of the drugs used and the number of the different drugs used. Analysis of the use of prescription drugs was performed on NFMI(National Federation of Medical Insurance) 1994 medical expense claim data. Data on physicians' characteristics were collected by mailing surveys. Patients with secondary diseases were excluded. In this study, 388 adults with bronchitis, 1,038 children with bronchitis, 1,158 patients with gastritis, 369 patients with gastric ulcer were included. The older physicians tend to allow the lower drug costs: this explains that the older doctors who are more experienced less depend on the medicines. It can be also explained that doctors are likely to use the medicines that had been used for their intern and resident practice/training period. General practitioners give more intensive prescription compared to specialists. And specialists prescribed medicines to patients for longer period. The doctors' prescriptions for patients are largely affected by commercial sources. So objective and reliable sources for drug information is needed for patients' benefits. Physician factors explain better at the daily drug expenses, the drug price and the number of different drugs than days of medication. Gastric ulcer are better explained by the prescription model adopted in this study than other diseases.

• Journal of Korean Medical Science
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• 제33권52호
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• pp.339.1-339.11
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• 2018

Background: Hip pain is a common musculoskeletal complaint in general practice. Although comprehensive diagnostic approach on hip pain is mandatory for adequate treatment, un- or mis-diagnosis is not rare in primary care. The aim of this study was to analyze descriptively un- or mis-diagnosed hip pain cases referred from primary care to a tertiary hospital, especially in young adults ${\leq}50years\;old$. Methods: We retrospectively analyzed a consecutive cohort of 150 patients (${\leq}50years\;old$) with chronic hip pain (${\geq}6weeks$), which was not diagnosed or misdiagnosed based on the information provided on the referral form. Results: Overall an average 32 cases/month were referred due to hip pain without a diagnosis or with an incorrect diagnosis. Among them, 150 patients were enrolled in this study and 146 (97.3%) could be allocated to a specific disease by using data from routine clinical practice. Four common final diagnoses were femoroacetabular impingement (FAI) syndrome (55.3%), hip dysplasia (HD, 13.3%), referred pain from the lumbar spine (9.3%), and spondyloarthritis (SpA, 7.3%). In patients with FAI syndrome, 37 (44.0%) had pincer-type FAI and 33 (39.8%) had combined-type. Although the pain site or gender was not tightly clustered, the distribution of final diagnosis was significantly different according to hip pain location or gender. Especially, SpA or HD was not observed in younger women subgroup or elder men subgroup, respectively, when stratified by the mean age of participants. Conclusion: Most (> 80%) young patients with hip pain, a difficult issue to diagnosis for many primary physicians, had FAI syndrome, HD, spine lesions, and SpA. This study could give a chance to feedback information about cases with un- or mis-diagnosed hip pain, and it suggests that primary physicians need to be familiar with the diagnostic approach for these 4 diseases.

• Safety and Health at Work
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• 제12권4호
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• pp.490-495
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• 2021

Introduction: The risk of experiencing psychiatric symptoms related to the COVID-19 pandemic is high among healthcare workers whose occupations are in public health, emergency medicine, and intensive or critical care. Materials and methods: A cross-sectional study aimed to assess the prevalence of fear of COVID-19 among 411 frontline Egyptian physicians during the COVID-19 pandemic; identify determinants and predictors for fear of COVID-19; determine the impact of fear of COVID-19 on job satisfaction; and detect the impact of fear of COVID-19 on turnover intention. Three standardized scales (fear of COVID-19, job satisfaction, and turnover intention scores) were used for data collection via online Google Form. Results: Regarding fear relating to the COVID-19 pandemic, 16.5% of the study subjects were classified as experiencing a severe fear level, while 78.1% experienced a moderate degree. A significant association between the level of fear relating to COVID-19 and the work department. The highest degree of fear is in a general-educational-university facility. Regarding job satisfaction, 42% of those having a severe level of fear are dissatisfied. Fear of COVID-19 is negatively associated with job satisfaction while positively significant correlated with turnover scores, a positive significant predictor of turnover intention. Job satisfaction is negatively associated with turnover intention; a negative significant predictor of turnover intention. Conclusions: Frontline Egyptian physicians reported higher levels of fear relating to the COVID-19 pandemic (moderate to severe). Increased fear levels relating to COVID-19 have a relationship with lower levels of job satisfaction and higher levels of job turnover.

• 한국간호교육학회지
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• 제29권3호
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• pp.319-334
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• 2023

Purpose: This study investigated the prevalence and perceptions of workplace violence against registered nurses (RNs) in hospitals. Methods: One thousand RNs replied to a nationwide survey from November 14 to December 22, 2022. They reported their general characteristics, prevalence of and their responses to different types of workplace violence from patients, family caregivers, physicians, and nurse peers, as well as their perceptions of workplace violence management systems. Results: A total of 71.1% of the RNs reported that they had experienced workplace violence in the last six months. The violence and sexual harassment experienced from patients and family caregivers were 57.3% and 19.1%, respectively. Furthermore, violence, sexual harassment, and workplace harassment from physicians were experienced by 24.6%, 4.0%, and 7.4%, respectively, of the RNs, and those from nurse peers by 21.4%, 3.1%, and 11.3%, respectively. The RNs stated that they often responded to workplace violence with passive and inactive behaviors, which were more serious toward physicians' workplace violence or sexual harassment from different perpetrators. Only 69.5% were aware of their hospital's workplace violence management systems, while only 14.7%~27.4%, according to the type of hospital (p=.471), perceived the systems as effective. Multiple important strategies were identified to prevent workplace violence. Conclusion: Critical suggestions are discussed for the prevention of workplace violence, including protecting the human rights of healthcare professionals, inter-organizational collaboration, and a culture of person-centered healthcare, and training nurse managers' competency in managing workplace violence.

• Asian Pacific Journal of Cancer Prevention
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• 제15권22호
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• pp.9817-9822
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• 2014

Background: Breast cancer is a serious health problem. Early detection is crucial for optimal treatment and reducing mortality. Objective: The aim of this study was to evaluate health beliefs concerning performance of breast self- examination (BSE) and mammography in a sample of Iranian female health workers. Materials and Methods: This cross-sectional study was performed among 441 female health care workers (physicians=88, nurses=163, midwives=38, officers=68, and others=84) in 3 different health centers in Yazd, Iran. Data were collected using a self administered questionnaire which included demographic characteristics and thenPersian version of the Champion's Health Belief Model Scale (CHBMS). Results: The mean age of the participants was $34.7{\pm}13.7$. It was found that 41.9% of the workers performed BSE in the past and 14.9% of them regularly, but only 10.6% of them had undergone a mammogram. Perceived barriers to BSE (F=6.351, P=0.021) and mammography (F=5.214, p=0.022) were significantly higher in officers than physicians, nurses or midwives. Perceived barriers were lower among those who had performed BSE and mammography, but not significant (p=0.34 and p=0.56, respectively). Furthermore, perceived susceptibility and perceived benefits of the workers who had BSE and mammography were significantly higher than who did not (p<0.05). Perceived seriousness was not a significant variable in BSE and mammography (p=0.71 and p=0.43, respectively). Conclusions: The health beliefs of health workers concerning the perceived susceptibility of breast cancer and the perceived benefits BSE and mammography significantly impact their screening practices.

• Journal of Preventive Medicine and Public Health
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• 제25권4호
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• pp.357-373
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• 1992

After medical insurance came into effect in Korea, health care system has undergone tremendous changes. Changing patterns of newly established clinics is one of them. To investigate changes and trends, a total of 10,184 clinics which were newly established from 1981 to 1990 were analysed. Data were obtained from the file of contracting medical facilities of the Federation of Medical Insurance Societies. The proportion of newly establishied clinics has increased gradually, so that they amount to 13% of the total medical facilities in Korea. Meanwhile, the number of newly established medium-size hospitals and general hospitals have decreased. The number of newly established clinics per 100,000 populations has increased in the all areas, but the rate of increase has decreased in the cities except in 6 major cities in 1990. The rate of increase in newly established clinics surpasses that of population increase. This study has identified the trend of young physicians' early driving into their solo medical practice than before. This indicates chance of the medical specialty training nowadays toughen due to the limited openings in residency programs. However, the sex ratio of physicians at newly established clinics has not changed. The decreasing tendency to open medical practice without beds and the increasing size of clinics are found in this study(The size has been measured in terms of medical manpower, of beds, and of medical equipment in this study). Two thirds of general practitioners have opened their clinics without beds, although such trend has been less in the case of specialists. All three indicators show increasing size, especially in the case of rural clinics. However, among them, the number of medical equipments has increased most significantly from 8.9 items in 1981 to 12.9 in 1990.

• 농촌의학ㆍ지역보건
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• 제36권1호
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• pp.36-46
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• 2011

본 연구는 도서지역에 있는 47개 보건지소에 근무하는 의과 공중보건의사 79명을 대상으로 응급의료 수행 현황 및 지식수준 등을 파악하고자 하였다. 전체 79명의 대상자 중 35명이 설문에 응답하여 44.30%의 응답률을 보였다. 지난 6개월간 도서지역 보건지소에 근무하는 공중보건의사 중 58.68%가 응급의료 질환을 경험하였고, 평균 1.92건의 응급처치를 수행한 것으로 나타났다. 하지만, 실제 응급처치 능력에 대해서는 일부 생명과 직접 연관된 응급처치 능력에 자신이 없음을 호소하였다. 보건지소 근무 의사 중 20.25%만이 전문의 자격을 갖춘 의사였는데, 응급의료 관련 질환을 처치하는 데 있어 전문의가 일반의와 비교하면 지식수준이 유의하게 높은 것을 확인할 수 있었다. 또한, 지식수준이 높다 하더라도 장비 및 의료지원 등 부족으로 실제 처치 능력으로 이어지지 못하는 것을 알 수 있었다. 일부 섬의 경우 1명의 공중보건의사만 배치된 일도 있었으나 일반의 1인, 전문의 1인을 배치하는 것이 타당하다는 의견이 많았고, 공중보건의사 배치 이후 부족한 지식 및 기술을 습득하기 위한 교육 및 지원체계가 필요하다는 의견이 다수 있었다. 도서지역은 지리적으로 고립되어 있고, 이용할 수 있는 보건의료기관에 대한 선택권이 적다는 점에서 보건지소의 역할이 무엇보다 중요하다. 특히 응급질환 발생시 보건지소를 이용하는 주민이 많다는 측면에서도 보건지소 응급의료 기능을 강화하는 방안을 마련하는 것이 필요하겠다. 응급의료 기능을 효율적으로 수행하고 질 높은 서비스 제공을 위하여 적절한 인력, 의료장비를 갖추도록 하고, 응급의료에 대한 매뉴얼 개발 및 현장교육 체계를 정비하여 최신의 지식과 기술을 보급하는 방안을 강구하여야 한다.

• 보건교육건강증진학회지
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• 제2권1호
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• pp.56-80
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• 1984

The main objectives of the present study is to evaluate Physician's Health Education Activities by means of physician's direct response to the prepared questionnaire and patient's perception to the physician in the course of medical care. For the data collection, the present study was conducted from Aug. 16 to Oct. 7, 1983 for 739 patients and 91 physicians who were attended outpatient clinics of 5 general hospitals in Seoul. The major findings are summarized as follows: 1. Self-evaluation on Physician's Health Education Activities (1) In consideration of health education services for the patient, the data revealed that 9.9% of the sampled physician wanted to strength public health and preventive medicine lecture in the curricula at medical education. On the other hand, only 1.1% expressed that they wanted to make it short. (2) In consideration of the necessity of health education service, it was shown that 95.6% of physicians agreed to take it into consideration. Self expression for the practice of health education was placed on the 3.15 score when 5 point scale used. (3) To evaluate the degree of an explanation about medical care for the patient, Index score with 4 point scale was employed. The Index score for the first time was shown that scale was placed on 3.23 for 'diagnosis', 3.12 for 'progress of the disease', 3.11 for 'discription of procedure' and 3.02 for 'cause of the disease' respectively. In comparison of the physician's explanation about the status of disease for the first and the second visitors to clinic, they evaluated themselves as giving more detailed explanation for the second visitors rather than the first visitors. 2. Physician's Health Education Services evaluated by patients (1) To evaluate physician-patient communication at beginning time for taking history about disease, the Index score with 5 point scale was employed. The data on taking history have shown that the score placed on 3.07 for those patients who visited the first time and 2.53 for second visitors. And the score about listening from the patients was placed on 3.52 and 3.42 respectively. (2) The Index score with 5 point scale, as used before, was also employed to evaluate medical care services for the patient. The data evaluated by the patients was shown that the score placed on 4.21 for patient treatment in general, 4.58 for physician's credibility, and 3.6 for physician's kindness. However, approximately 80% of those who failed to understand physician's explanation was caused by highly sophisticated medical terminology. (3) According to the Index score with 4 point scale, to evaluate physician's explanation, the data was shown that the patient who visited the first time gave 2.51 for 'diagnosis', 2.35 for 'progress', 2.11 for 'cause of the disease' and so on. It is acknowledged on the whole that the patients who visited the second time have more satisfaction in physician's explanation about their disease, than those who visited the first time. 3. Comparison of self-evaluation of Physician's Health Education Activities and patient's perception. (1) There was communication barriers between physicians and patients in expressing some medical terminology. For example physician understood that they explained more than 50% of medical terminology into common words for the patient, but 30% of patient complained medical terminology used by physician. (2) Comparing the index score of health education practice recognized by patients and physicians for both first visit and revisit groups, it was shown that the Index score of health education activities evaluated by physicians themselves were slightly higher than the score evaluated by patients.