• 보건행정학회지
• /
• 제20권2호
• /
• pp.1-16
• /
• 2010

Background : Clinical practice guidelines are an increasingly familiar part of clinical practice. Moreover, rigorously developed evidence based guidelines has been widely used. However, in Korea, some of published documents as clinical practice guidelines have shown considerable disparity in structure, contents and quality. This is mainly because there is no consensus on the definition and quality standard of clinical practice guidelines. The purpose of this study was to draw consensus on the definition and the quality standard about clinical practice guidelines. Method : We developed a questionnaire about the definition of clinical practice guidelines with inclusion criteria(23 items) and the quality standard(30 items). We selected 9 experts who had prior experience in developing and implementing guidelines. Rating methods for appropriateness of items were adopted from the RAND method. Consensus was drawn in three rounds. Results : Of the 47 items agreed, 40 items were determined to be appropriate. Clinical practice guidelines were defined as "scientifically and systematically developed statements to assist practitioners and patients on making decisions about appropriate health care for specific clinical circumstances." Narrative reviews, systematic reviews or health technology assessment without recommendations, translation of foreign guidelines, guidelines for patients only and training manuals were not considered as clinical practice guidelines. For the quality standard of clinical practice guidelines, 27 items were deemed necessary. Conclusions : The consensus on the definition with inclusion criteria and the quality standard of clinical practice guidelines carries an important meaning as the first attempt to draw a general agreement in our society. The unique achievement of the consensus reflects the current status of clinical practice guidelines that there has been a high tendency to adapt foreign guidelines. We hope efforts of this kind will continue to bring improvement in clinical practice guidelines.

• 보건행정학회지
• /
• 제24권1호
• /
• pp.100-106
• /
• 2014

Background: There is no consensus on the definition of primary care in South Korea. This study's objective was to define the concept of primary care using a Delphi method. Methods: Three expert panels were formed, consisting of 16 primary care policy researchers, 45 stakeholders, and 16 primary care physicians. Three rounds of voting, using 9-point appropriateness scales, were conducted. The first round involved rating the appropriateness of 20 previously established attributes of primary care. In the second round, panelists received a summary of the first-round results and were asked to once again vote on the 10 undetermined attributes and the provisional definition. The final round involved voting on the appropriateness of the revised definition. The Korean Language Society reviewed the revised definition. Results: Four core (first-contact care, comprehensiveness, coordination, and longitudinality) and three ancillary (personalized care, family and community context, and community base) attributes were selected. The Korean definition of primary care was accomplished with all three panel groups arriving at a 'very good' level of consensus. Conclusion: The Korean definition of primary care will provide a framework for evaluating performance of primary care in South Korea. It will also contribute to resolving confusion about the concept of primary care.

• Journal of Dental Anesthesia and Pain Medicine
• /
• 제17권3호
• /
• pp.205-213
• /
• 2017

Background: This study retrospectively investigated outcomes following dental implantation in patients with special needs who required general anesthesia to enable treatment. Method: Patients underwent implant treatment under general anesthesia at the Clinic for the Disabled in Seoul National University Dental Hospital between January 2004 and June 2017. The study analyzed medical records and radiographs. Implant survival rates were calculated by applying criteria for success or failure. Results: Of 19 patients in the study, 8 were males and 11 were females, with a mean age of 32.9 years. The patients included 11 with mental retardation, 3 with autism, 2 with cerebral palsy, 2 with schizophrenia, and 1 with a brain disorder; 2 patients also had seizure disorders. All were incapable of oral self-care due to serious cognitive impairment and could not cooperate with normal dental treatment. A total of 27 rounds of general anesthesia and 1 round of intravenous sedation were performed for implant surgery. Implant placement was performed in 3 patients whose prosthesis records could not be found, while 3 other patients had less than 1 year of follow-up after prosthetic treatment. When the criteria for implant success or failure were applied in 13 remaining patients, 3 implant failures occurred in 59 total treatments. The cumulative survival rate of implants over an average of 43.3 months (15-116 months) was 94.9%. Conclusion: For patients with severe cognitive impairment who are incapable of oral self-care, implant treatment under general anesthesia showed a favorable prognosis.

• 의학교육논단
• /
• 제18권2호
• /
• pp.58-64
• /
• 2016

The birth of the scientific revolution, brought forth by Vesalius and Copernicus in 1543, marked the beginning of a new age. However, the changes such as treatment effectiveness, survival rate, prevalence of specific diseases, etc. had not yet become clear during the 16th century. In the early 17th century, Boerhaave emphasized bedside teaching and practice. His attitude influenced numerous students and educators, so many medical students visited hospital wards where he worked. From the late 18th to 19th centuries, Jenner's smallpox vaccination, Pasteur's anthrax and rabies vaccinations, and Koch's four postulates used to detect pathogens were developed using the scientific research method, which initiated big changes for medicine. Flexner, credited for reporting the new medical education system, adopted scientific medicine. He believed medical students must study basic medical science since it could be the foundation of clinical medicine and lead to a revolution in the field. He proposed a new medical curriculum composed of two-years of basic medicine and two-years of clinical medicine, which has been used more than 100 years. During the late 20th century, bedside teaching rounds decreased gradually as scientific medicine has become popular. Many medical educators in many articles have proposed bedside education as an effective method for medical learning. Despite the advent of the age of artificial intelligence and the changing of medical environments in the near future, bedside education will be more useful and important for medical students, educators, and patients as it is a traditional method and essential for patients who desire a more personal approach.

• 대한정형도수물리치료학회지
• /
• 제27권1호
• /
• pp.1-11
• /
• 2021

Background: The purpose of this study is to identify the elements for the construction of the Korean academy of orthopedic manipulative physical therapy's (KAOMPT's) non-face-to-face lecture system using the Delphi method. Methods: The Delphi method was applied to 50 expert panel members of the Central Committee and the Provincial Branch of the KAOMPT. The Delphi survey was conducted in two rounds, and the first Delphi survey collected opinions on 40 questions on 12 topics. The second Delphi survey was collected into 25 questions on 4 topics. As a result of the survey, the content validity ratio (CVR), consensus and convergence were measured. Referring to the number of expert panels and previous studies were determine a CVR of at least 2.29, a consensus of at least .75 and a convergence of 0 to .5. Result: In the first Delphi result, out of the total 40 items, 20 items with high content validity ratio were found, and 10 items found double agreement. In the second Delphi result, 13 out of the total 25 items had a content validity ratio higher than 2.29, and 5 items found a double agreement. Conclusion: This study derived items on the role of central and municipal councils, lecture support and lecture room construction, non-face regular course and special lecture operation and personnel for the establishment of non-face-to-face lecture system. Based on this content, it is expected that it will help establish a non-face-to-face lecture system in 2021 through a pilot non-face-to-face lecture that will be implemented in the future.

• 임상간호연구
• /
• 제27권2호
• /
• pp.149-164
• /
• 2021

Purpose: The purpose of this study was to develop a Korean Nurse Residency Program (KNRP) in order to facilitate new nurses' transition to clinical practice working at tertiary hospitals in Korea. Methods: The KNRP was developed through a literature review, investigation of NRP cases in United States, two rounds of expert consultation, and appropriateness survey. For appropriateness survey of the program, a questionnaire with 118 items and 14 subcategories including overview and operation of KNRP, education programs, staffing criteria for new nurses' education, preceptor supporting strategies, evaluation standards for new nurse's education, infrastructure, and KNRP benefits was used. Data were collected from 369 nurses including nurse educators, nurse managers, preceptors, and new nurses working at 43 tertiary hospitals in Korea from February 16, 2021 to March 22, 2021. Data were analyzed with descriptive statistics. Results: Appropriateness score of KNRP was 3.42±0.31 (out of 4) and those of 14 subcategories ranged from 3.18±0.47 to 3.58±0.46. The final version of the KNRP postulated is a one-year program, which is composed of off-job training and on-site training including preceptorship over 3 months, and competency reinforcement and adaptation supporting programs. Conclusion: The application of the one-year KNRP will facilitate new graduate nurses' transition to clinical practice. In order for effective application of the KNRP, cooperative efforts of the government, professional associations, and hospitals are needed.

• Journal of Preventive Medicine and Public Health
• /
• 제31권3호
• /
• pp.490-502
• /
• 1998

본 연구는 우리 나라 병원도산 예측모형을 도출하기 위한 연구로 1992년에서 1997년 사이 5년간의 전국 병원 경영통계 자료를 이용하여 1995년부터 1997년 사이에 도산한 병원중도산전 3년까지의 연속된 자료가 있는 31개 병원을, 비교군 병원은 도산병원과 유사한 병상규모를 가지고 당기순이익이 발생한 31개 우량병원을 선정하여 단계적 판별분석에 의한 실증연구를 시행하였다. 본 연구의 구체적 연구결과는 다음과 같다. 첫째, 도산전 각 연도별로 도산병원과 우량병원간에 연구변수의 단순 평균치분석 결과, 자본구조 지표인 자기자본비율과 수익성지표인 총자본의료이익을, 의료수익의료이익을, 총자본경상이익을, 의료수익경상이익율, 총자본순이익을 등은 도산 1, 2, 3년전 모두에서 도산병원과 우량병원간에 유의한 차이를 보였다. 자본고정성지표는 도산 1년전에 고정비율이 유의한 차이를 보였고, 유동성지표는 도산 1년전에는 유동비율과 당좌비율이 유의한 차이를 보였고 도산 2년전에는 당좌비율만이 유의한 차이를 보였다. 활동성지표로는 도산 1년전에 총자본회전율과 재고자산회전율이 유의한 차이를 보였고 도산 2년전에는 총자본회전율과 의료미수금회전율이, 도산 3년전에는 의료미수금회전율만이 유의한 차이를 보였다. 생산성지표로는 도산 2년전에 총자본투자효율이, 도산 3년전에는 조정환자1인당 부가가치가 유의한 차이를 보였다. 진료실적지표로는 도산 3년전 일평균재원환자수가 유의한 차이를 보였다. 둘째, 도산 1, 2, 3년전 판별함수는 각각 도산 1년전 Z=($0.0166\times$당좌비율)-($0.1356\times$총자본경상이익을)-($1.545\times$총자본회전을), 도산 2년전 Z=($0.0119\times$당좌비율)-($0.1433\times$총자본의료이익율)-($0.0227\times$총자본투자효율), 도산 3년전 Z=($0.3533\times$총자본순이익율)-($0.1336\times$의료미수금회전율)-($0.04301\times$조정환자1인당부가가치)+($0.000119\times$일평균재원환자수)이었다. 셋째, 도출된 도산 1, 2, 3년전 각 판별함수의 예측력은 77.42%, 79.03%, 82.25% 이었다.

• 대한간호학회지
• /
• 제26권4호
• /
• pp.946-962
• /
• 1996

The purpose of this study was to contribute to the development of clinical instruction by students' ratings of teaching effectiveness in clinical nursing education. The subjects were comprised of graduating class 618 students from 24 nursing colleges in the nation. The instruments used in this study were "general characteristics & status of clinical nursing education" developed by the researcher and "Instrument to Measure Effectiveness of Clinical Instructors" by Reeve(1994). The 50 questions used in the questionaire were categorized into 13 components subject to factor analysis. The 13 components were interpersonal relationships, communication skills, role model, resource for students, favorable to students, encouraging to think for selves, teaching methods, evaluation, finding assignments for objectives, organization of subject matter, professional competence, knowledge of subject matter & working with agency personnel. The results of this study are as follows 1. Status of clinical nursing educaion : 1) Clinical nursing education were led by nursing professors(44.9%), a team of both nuring professor & head nurse(6.8%), instructors from specific hospital(15.1%), instuctos for a specific subject(14.6%), & head nurse(6.8%). For 3-year program students, 34.6% of the clinical nursing education were led by instructors from specific hospital & 51.4% of the education by nursing professors for Bachelor's program. 2) The contents for clinical education comprised of Conference being the most frequent of 34.5% ; a combination of Nursing skills, Orientation, Conference etc.22.0% : Nursing process 21.7% : Orientation 13.5% : Inspection(making rounds ) 6.4%, & Nursing skills of 2% being the least frequent. 3) Students' preference of clinical teachers from the highest to the lowest were instructors for a specific subject being the most desired (44.9%) followed by nursing professor, head nurse, a team of both nursing professor & head nurse, & instructors from specific hospital being the least desired. 4) Students felt that the qualification for clinical teachers should be at least a master's degree holder and 5 or more years of clinical experience. The reason they felt was because knowledge & experience are imperative for professional education. 2. Clinical teaching effectiveness : The total points for teaching effectiveness was 147.97(mean of 2.95±0.98) where the total score is considered to be an average rating. 3. Teaching effectiveness as status of clinical nursing education : 1) The score ratings for the clinical instructors from the highest to the lowest were as follows : instructors for a specific subject, instructors from specific hospitals, a team of both nursing professors & head nurses, nursing professors, head nurses, which resulted in significunt difference(F=4.53, P<0.001). 2) The rating scores based on the teaching program from the highest to the lowest were as follws ; nursing skills, nursing process, a combination of nursing skills, orientation, conference etc. , conferences, orientation, inspection, which resulted in significunt difference(F=10.97, P<0.001). 4. Based on 13 categorized components from the questionaires, questions related to communication skills scored the highest points of 3.20 where inquiries regarding resource for students scored the lowest points of 2.38. 5. Among the 13 categorial components from the questionaire, Interpersonal relationship, Communication skills, Resource for students, Encouraging to think for selves, Evaluation, Teaching method, Finding assignment for objectives, Organization of subject matter, Professional competence, & Working with agency personnel, instructors for a specific subject scored the highest points and head nurse scored the lowest, which resulted in significant difference. Favorable for students, instructors for a specific subject scored highest points and nursing professor scored the lowest, which resulted in significant deference (F=5.39, P<0.001). Role model & Professional competence, instructors for a specific subject scored the highest points and head nurse scored the lowest, with minimum variation(F=1.29, P>0.05 : F=1.64, P>0.05) 6. Based on 13 categorial components as a whole, the highest points scored among the 5 groups of clinical teachers was instructors for a specific subject and the lowest, by head nurse(F=1.94, P<0. 001). A team of both nursing professor & head nurse attained higher score in clinical education than their independent education.

• 대한간호학회지
• /
• 제19권2호
• /
• pp.212-222
• /
• 1989

When the head nurse who is pivotal in the nursing service administration of the hospital performs efficiently as a first-line manager, the effectiveness of the nursing unit, which includes the quality of nursing care, the jab satisfaction of staff members, and the cohesiveness of staff members is increased. With this point of view in mind, the researcher carried out a study to determine the actual work (the content of the work, the work process, the role of the head nurse, the activity media, and the purpose of the work) of the head nurse in a university hospital in Korea. In addition, this study was also carried out for the purpose of preparing an ideal model for the work of the head nurse. The research subjects were 39 head nurses. This included all the head nurses in two university hospitals except those who were working in outpatient care, operating rooms, central supply, nursing administration, in-service education and emergency care. Data were collected from September 24th to October 21th, 1987 and April 4th to 12th, 1988. A work activity record on which the head nurse recorded directly in a chronological narrative form, was used as the research instrument. The 234 work activity records, 39 head nurse's continuous recording over 6 days(from Monday to Saturday) were collected and analysed. The results were as follows ; 1. With regard to the work content for the total daily work of the head nurse, 45.2% of the activities were managerial activities but 58.1% of the head nurse' s time was spent in direct patient care. 2. With regard to the work process of the head nurse, specifically the location, the size and membership of groups contacted, the results were as follows : 1) Of the total daily work activities 92.4% were carried out in the nursing unit and this occupied 84.5% of total daily work time. Direct patient care was generally performed on the nursing unit and managerial work was performed in other areas. 2) Of the total daily work activities, 73% was with one or more persons and 51.2% of total daily work time was spent in groups. 3) A total of 51 persons, working in different capacities were contacted. These included 21 persons giving patient care, 19 persons working in nursing unit management, and 7 persons working in human resource management. 3. With regard to the head nurse's role in work activity, 53.3% of total daily work activities involved the informational role, 26.9%, the interpersonal role and 19.9%, the decisional role. With regard to time, 57.7% was spent in the informational role, 23.9%, in the interpersonal role and 18.3%, in the decisional role. When the head nurse performed managerial work, she gave nearly equal emphasis to all three roles when she gave direct patient care the informational role was increased. 4. With regard to the activity media, the number of unscheduled activities accounted for 27.1% of the activities, scheduled activities, 24.3%, desk work activity, 22.1%, rounds, 12.5% and telephone calls, made or received, 14.0%. In daily total work time managerial work related to desk work and scheduled activities were high, ranging from 29.8% to 29.9% but for direct patient care time, scheduled activities and unscheduled activities were high, ranging from 23.6％ to 35.3%. 5. With regard to the purpose of the work performed, 54.4% of the total daily work was concerned with the team and 41.4% was concerned with the agency. The managerial work was concerned mainly with the team and the direct patient care was concerned mainly with the patient. When the frequency of an activity and time were compared no significant difference was found between the days for which the work was recorded for any of the variables : the work content, the work process, the work role, the activity media and purpose of the work. On the basis of this study the following are proposed as an ideal model for head nurse work in Korea : The managerial work should be increased to 70%. The decisional role activities should be increased to 40%. Twenty percent of the work activity should be allocated to agency, community and profession. It is believed that this model for the head nurse's work can contribute to guidelines for job description development. Finally, educational programs, organizational and structural devices, and administrative support are needed for the proper function of the head nurse in this proposed model.

• 헤리티지:역사와 과학
• /
• 제42권1호
• /
• pp.88-99
• /
• 2009

본 연구는 우리나라 노거수의 생육환경의 악화 및 훼손에 따른 관리방안을 제시하기 위하여 천연기념물 노거수의 생육환경을 분석함으로서 과학적인 보호관리대책을 수립하기 위한 목적으로 실시하였다. 연구대상지는 서울, 인천, 경기 지역의 천연기념물 노거수 20주를 대상으로 개체별 특성을 파악하였다. 생물학적 특성은 수종명, 수령, 수고, 근원둘레 4개항목을 조사하고, 입지현황은 입지유형, 입지환경의 2개 항목, 근원부 성상은 나지화, 복토깊이의 2개 항목, 건강도는 고사지율, 공동크기, 수피이탈율, 병충해, 신초생장의 5개 항목, 토양환경은 토양 pH, 유기물함량, 유효인산, 치환성양이온(K, Ca), 토양경도의 6개 항목으로 설정되었다. 이와 같은 조사항목별 현황조사 결과를 토대로 노거수의 입지현황과 생육환경 및 토양환경과의 상호관련성을 파악하기 위하여 상관관계 분석을 실시하여 노거수의 건강에 가장 영향을 끼치는 인자를 구명하고, 이에 따른 과학적인 관리방안을 제시하고자 하였다. 조사항목별 현장조사 결과 생물학적 특성에 있어서는 천연기념물 노거수는 백송(4주), 은행나무(3주), 향나무(3주), 다래, 등나무, 측백나무, 굴참나무, 탱자나무(2주), 회화나무, 느티나무, 물푸레나무, 소나무로 12종로 분포하였으며, 수고는 4.2~39.2m, 근원둘레 1.01~15.2m이었다. 입지현황은 건물내부형(4주), 유적지형(5주), 주택지형, 들판형, 동산형이 각 3주, 하천 및 해변형이 각 1주로 구분되었으며, 생육환경의 나지화 정도에 있어서는 조사지역 중 75%가 나지화가 진행된 상태이며, 복토깊이는 복토되지 않은 지역 4주(25%)를 제외하고 10cm 이상 복토가 이루어졌다. 건강도에 있어서 첫째, 고사지율은 용문사 은행나무 20%, 강화군 사기리 탱자나무 5%였으며, 그 외 지역은 관리가 이루어져 고사지가 발생되지 않은 상태이었다. 둘째, 공동크기에 있어서는 전 조사지역에서 $5{\sim}100cm^3$로 공동이 발생하였으며, 셋째, 수피이탈율에 있어서는 5~50%로서 공동발생이 높은 서울지역의 수송동 백송 및 문묘의 백송, 삼청동 등나무, 강화군 사기리 탱자나무가 45%로 높은 수피이탈율을 나타내었다. 넷째, 병해충의 피해는 인위적인 관리가 이루어지고 있어 경미한 상태이었으며, 다섯째, 신초생장에 있어서 창덕궁, 선농당 향나무의 신초생장이 1/2로서 주변 대기오염의 영향을 받고 있는 것으로 사료되었으며, 파주 적성면의 물푸레나무, 이천 백사 도립리의 소나무는 신초의 생장상태가 양호하여 근원부 복토가 되지 않아 신초생장에 영향을 미치는 것으로 사료되었다. 토양환경에 있어서 토양 pH 5.2~8.3, 유기물함량 및 유효인산이 각각 12~56%, 104~618ppm으로서 토양의 시비 관리가 이루어지고 있는 것으로 파악할 수 있었다. 토양경도에 있어서는 7~28mm이었으며, 조사대상 중 수송동의 백송, 삼청동의 측백나무, 문묘 은행나무, 용문사 은행나무 지역은 토양경도 21~28mm로 나지화 현상이 심하게 나타나고 있었다. 이러한 조사결과를 토대로 상관관계분석을 실시하였는데, 복토깊이가 수목의 생육에 커다란 영향을 미치는 것으로 분석되었으며, 향후 세부적인 자료구축을 통한 상관관계성 규명이 필요할 것으로 사료되었다. 본 연구를 통하여 노거수의 주변환경으로 건물, 시설지의 제한적인 관리 및 규제 등을 통한 인위적인 영향을 최소화하고 노거수의 양호한 생육을 위한 복토제거 등 근권확보가 필요할 것으로 사료되었다. 이와 같은 노거수 환경에 따른 문제점을 극복하고, 지속적인 관리시스템 구축을 위하여 동일 수종별 객관적인 비교, 분석을 통한 적정한 생육환경 조성 방안의 구축이 필요하며, 지속적인 모니터링을 생육의 피해현상 및 토양환경과의 지속적인 데이터축적을 통하여 관리 시스템의 정립이 이루어져야 할 것이다.