• 한국방사선학회논문지
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• 제14권6호
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• pp.801-810
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• 2020

본 연구에서는 PET 검사의 건강보험 적용 및 급여기준 변경 현황을 살펴보고, 지난 10년간 건강보험 이용량을 분석하였다. PET 검사가 건강보험으로 적용된 것은 2006년으로 ¹⁸F-FDG가 최초로 건강보험으로 적용된 이후 여러 가지 방사성동위원소를 이용한 PET 검사가 건강보험으로 적용되고 있다. 2019년 기준 PET 검사 수는 198,651건, 진료금액은 약 883억원이며, 일반적 특성에 따른 검사 수는 남성이 여성보다 많았고, 연령별로는 60대에서 검사수가 가장 많았다. 외래 검사수가 입원 검사수 보다 많았고, 상급종합병원 검사수가 68.2%로 종합병원, 병원보다 월등히 많았다. 검사부위는 토르소 검사가 86.6%로 가장 많았으며, 방사성동위원소는 ¹⁸F-FDG를 이용한 검사수가 93.6%로 가장 많았다. 10년간 건강보험 이용량 변화로는 2010년 부터 2014년까지 꾸준히 증가하였으나 2014년 정부의 건강보험 적용기준 변경에 따라 무증상 장기추적 검사의 인정이 삭제되면서 이용량이 이후 급격히 감소하였다. 정부의 건강보험 적용기준 변경이 건강보험 이용량 변화에 큰 영향을 주는 만큼 향후 지속적인 모니터링이 필요할 것이다.

• 한국간호교육학회지
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• 제4권1호
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• pp.66-80
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• 1998

With the opening of healthcare market, the health care environment in Korea is anticipating a drastic change. In this Internationally open market environment, it is necessary to introduce a systematic health care plan and DRG system which offer qualitative medical services as well as reduced cost. Purpose of this study is to develop and test the critical pathway for Cesarean section patient in the way to be possible the integrated inpatient management. It was adopted the process of six phases to develop the critical pathway as the theoretical framework implemented by Johns Hopkins Hospital, Maryland, U.S.A. In the first phase, make a selection of diagnosis/procedures to develop. In the second phase, organize a development team consisted of eight expertises working in maternity nursing area. In the third phase, analyze the overall medical service offered to patient through review medical records and decided the service content and the implementation period for the Cesarean section patient. In the forth phase, make out a preliminary critical pathway after verification of expert group on content validity. In the fifth phase, validity operate to ten Cesarean section patients to test implementation in practice by using the preliminary critical pathway, In the sixth phase, defined the final critical pathway. The result of this study was as follows. 1. There were classified 8 categories as monitoring/assesment, treatment, medication, activity, diet, test, consult, education/discharge plan for vertical axis and showed hospital stayed from admission to discharge for horizontal axis of critical pathway through analysis 68 Cesarean section patients medical records. 2. After critical review 68 medical records to make out a preliminary critical pathway, hospital stays for horizontal axis were showed 6 days, mean hospital stays were 7.5 days, 2.1 days were to be taken operation after admission and 4.2 days were stayed until discharge after operation. 3. After making out a questionare in 90 items of a medical service content of eight categories and verifying the content validity of expertises, the 85 items of the preliminary critical pathway were selected by expertises agreement over 88% and modified or deleted 5 items showing agreement below 75%. 4. After verifying a validity to 10 patients for 4 weeks, hospital stays were 5.9 days. There were deleted 1 item and modified or supplemented the 9 items of the 10 items.

• 한국콘텐츠학회논문지
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• 제12권1호
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• pp.416-429
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• 2012

본 연구는 회복지향의 통합재활프로그램이 만성정신분열병 환자의 증상, 인지 사회적 기능, 재활동기, 정신건강회복수준에 미치는 효과를 검증하고자 시도되었다. 이 프로그램은 인지분화, 정서관리, 직업재활, 가족교육으로 구성된 4개의 소프로그램과 함께 동기강화프로그램이 포함되어 있다. 연구대상은 지방소재의 일개 국립병원에 입원한 정신신분열증 환자로, 실험군 18명과 대조군 16명으로 구성된 비동등성 대조군 전후시차 설계를 사용하였다. 수집된 자료는 SPSS 12.0을 이용하여 통계 분석하였다. 프로그램의 효과를 검증한 결과, 인지 사회적 기능에 별다른 효과를 나타내지 못했으나, 재활동기수준(유지단계에서 p=.027)과 정신건강회복수준(p=.039)에서만 실험군과 대조군에서 유의한 차이를 나타내어 제한적인 효과를 나타내었다. 입원세팅에서 단기간의 회복지향의 통합재활프로그램은 증상감소나 기능향상보다는 재활 동기나 정신건강회복수준을 향상시키는데 보다 효과적으로 활용될 수 있는 가능성이 있는 것으로 보인다. 임상세팅에서 보다 회복지향적인 서비스를 제공하기 위한 노력이 필요하다.

• 대한간호
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• 제36권2호
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• pp.73-83
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• 1997

Bed rest is recommended to prevent postlumbar puncture headaches(PLPHA), but the period of bed rest varies in the literature from 6 hours to 24 hours. In clinical practice the period of bed rest varies but nursing methods for adults and children have little difference. In Seoul National University Hospital, children have been given at least 6 hours bed rest after a lumbar puncture. Pediatric oncology patients require a lumbar puncture for an initial diagnosis, follow up treatment or administration of chemotherapeutic agent. But it is difficult for young children to lie supine or to refrain from their usual activities in any way, and unpleasant problems related to a shortage of beds often occurs during discharge or in an outpatient setting. The purpose of this study is to substantiate the preventive effect of PLPHA by the period of bed rest, to identify the other factors that influence PLPHA, and to use the nursing methods proper to children. The subjects were 65 children, ages 1-17, undergoing treatment in the children's cancer center at SNUCH during the period June 1, 1995, to Aug. 31, 1995. The team nurses asked questions about PLPHA of the parents and children in order to fill out a questionnaire. The data were evaluated by percent, t-test, Chi-square test and Mann-Whitney U test. Result; 1. There was no significant difference relating the bed rest time spent to the occurrence of postspinal headaches (t-test). 2. There was a significant risk of PLPHA in the children who were irritable before procedure and/or had experienced previous PLPHA(p<0.05, ${x^2}-test$). 3. The following factors were not found to be associated with increased risk of PLPHA: previous puncture experience, giving analgesics, the choice of puncturist, inpatient/outpatient status, gauge of needle, purpose, the amount of CSF removed, gender, diagnosis, the number of peripheral WBCs, previous lumbago experience after LP, position after bed rest, age, the number of aural puncture at the time. A longer period of bed rest is unlikely to be more effective to prevent PLPHA and seems impractical. A shorter period will save time and effort. Perhaps it will also allay some of the fears which surround LP. So 1 hour bed rest after LP is suggested and nursing methods for emotional support should be investigated to reduce PLPH.

• 한국콘텐츠학회논문지
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• 제10권4호
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• pp.247-256
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• 2010

이 연구는 현역병사를 대상으로 설문지를 이용하여 조사하였다. 조사기간은 2009년 10월 5일부터 24일까지 20일이었으며, 600부를 배부하여 565부를 회수하였다. 연구의 목적은 현역병들의 의료 이용실태를 조사하고 의료기관이용경험에 따른 향후 민간병원의 선택의사 및 군병원의 진료서비스 수준에 대한 인식을 파악하는데 있다. 연구의 결과는 다음과 같다. 외래이용경험률은 군병원이 60.7%, 민간병원이 18.9%이었으며 급이 높을수록 이용경험이 높았다(p<.000). 민간병원을 이용하게 된 동기는 우수한 의료진이 58.9%로 가장 높았으며 의료장비 및 시설만족 49.6% 순이었다. 군복무중 진료의료기관의 선택의향에서는 '입원 외래 모두 민간병원 선택'이 가장 높았으며 계급이 높을수록 민간병원을 선호하는 경향이 통계적으로 유의하게 나타났다(p<.005). 결론적으로 현역병의 군병원에 대한 선호도를 높이기 위해서는 군의료수준을 민간의료수준으로 발전시켜야 하며, 의료인력의 확충과 첨단의료장비의 도입 등 적극적인 재원투자가 필요하다. 또한 군병원도 일반병원과 경쟁하도록 외부의 의료서비스 평가를 의뢰하고 그 결과를 적극 수용하도록 하여 의료 서비스의 질적 개선 향상을 위한 노력을 하여야 한다.

• 보건행정학회지
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• 제5권1호
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• pp.31-58
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• 1995

The Korean government achieved the universal coverage of health insurance in July 1989, and concomitantly introduced a new measure of regulated health care delivery system in using medical care. There are three reasons why the government took the new health care delivery system. Firstly, there was ample room for improving the allocative efficiency in the use of medical facilities. And the second one was to constrain the dramatic increase of medical demand under health insurance. Thirdly, and the most important reason was to alleviate the patient crowdedness in big general hospitals, particularly tertiary hospitals. There are essentially two different ways to control the use of health care : one is to cut the demand for health care, and the other to regulate behaviors of providers through the use of incentives/disincentives, demand-side approach or supply-side approach. The objective of this study is to examine whether or not medical care utilization behaviors under health insurance scheme have been changed among medical facilities such as clinic, hospital, general hospital and tertiary hospital in comparison with those before and after the introduction, particularly whether the patient crowdedness in tertiary hospitals has been alleviated or not. In order to conduct this study, the insurance claim data during the period of January 1989 and July 1992 were analyzed by focusing on diagnosis of both inpatients and outpatients, and especially the fifteen most frequent diseases in ambulatory care and the seven most frequent diseases in hospitalizatio. In addition, the same analyses were made on the changes in medical care utilization by specialty department. This was because the five departments, such as family medicine, ENT, eye, dermatology and rehabilitation, were exempted from applying the regulated health care delivery system in tertiary hospitals. The study revealed that a remarkable alleviation effect in the crowdness was noted for tertiary hospitals. This effect was most conspicuous for the most frequent mild diseases of both inpatient and outpatient care. For example, the fifteen most frequent OPD care at tertiary facilities have decreased as much as by 40%, of which 34% belonged to the cut in initial visits. Meanwhile, the proportion of those who used general hospitals and private practitioner's clinics have increased due to the shift of patients. The cases from the five special departments were also decreased, but not so much as other departments. A problem was noted that, as time passed by, the decreasing tendencies of crowdness at tertiary hospitals due to the regulated system became slightly smaller. Therefore, through complementary remedies are needed for the future implementation.

• Journal of Hospice and Palliative Care
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• 제21권3호
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• pp.75-83
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• 2018

목적: 호스피스 완화의료에서 환자의 기대 여명 예측뿐 아니라 퇴원형태를 예측하여 적절한 치료를 제공할 필요가 있다. 이번 연구에서는 입원 초기 환자의 퇴원 형태 예측에 유의한 요소들을 알아보고 효율적인 완화의료의 방향에 대해 제시하고자 한다. 방법: 2016년 4월 1일부터 2017년 12월 31일까지 P병원 호스피스 병동에 입원한 말기암환자 568명 중 377명을 대상으로 하였으며 입원 시 사정한 환자의 수행 지수, 증상 및 징후, 사회 경제적 상태와 혈액검사 자료를 바탕으로 연구를 진행하였다. 결과: 입원 당시 높은 수행지수, 양호한 증상 및 징후, 정상에 가까운 혈액검사 수치를 보일 때 생존 퇴원할 가능성이 높았다. 결론: 환자의 퇴원형태 예측에 ECOG, KPS, Global health, Mental status와 같은 수행지수, dyspnea, anorexia, dysphagia, fatigue와 같은 증상 및 징후, CBC, LFT, BUN, CRP 혈액검사 수치가 유의한 지표임을 확인하였다.

• Journal of Preventive Medicine and Public Health
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• 제6권1호
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• pp.43-49
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• 1973

서울시내 4개 종합병원에 대한 병실내 소음원을 조사 측정하고 상호영향관계를 검토하였다. 입원환자 171명을 무작위 추출하여 소음에 대한 반응도를 조사하여 측정된 소음과 비교 검토하였다. 결과적으로 거주지역에 위치한 2개의 병원은 유선방송의 스피커소리와 방문객에 의한 소음이 크고 상업지역에 위치한 2개의 병원은 교통소음이 크게 환자의 불평대상이 되고 있다는 결과를 얻었다. 그러나 61%의 환자들은 가정과 분리된 병원생황의 영향으로 약 60dB (A)의 음악 또는 기타소리를 원하고 있었다. 이런점을 고려하여 다음과 같은 방법으로 소음을 감소시킬 수 있을 것이다. 1. 보호자이외의 방문객수 및 체류시간을 단축시킨다 2. 병원내의 유선방송을 폐지시키고 무선통신방법을 활용한다. 부득이한 경우 사무실 위주로 방송한다. 3. 차량의 정지, 출발 그리고 가속시에 발생하는 소음의 영향을 감안하여 서울시당국에서 병원주위도로를 통행하는 차량에게 적당한 행정조치를 하고 고가도로 건설을 피하게 한다. 4. 병실내 환자의 기호에. 따라 들을 수 있는 청취장치를 (이어폰을 사용)하여 Masking Effect로 소음을 음폐토록 한다. 5. 도로변에 인접할 병실은 가능한한 사무실로 사용하고 병실로 사용시는 이중창을 장치하도록 한다.

• 동의생리병리학회지
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• 제28권6호
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• pp.689-694
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• 2014

We report a female small cell lung cancer patient in the extensive stage(T3N3Mx). After 6 cycles of chemotherapy combined radiation therapy, she received inpatient Korean medical care including herbal medicine, acupuncture therapy and concurrent western oral medications of opioid analgesics and anti-anxiety agent. The chief complaint was right side thoracic wall pain which had started after chemotherapy and was not effectively controlled by analgesics. For this condition, we treated her with 2Hz of constant electrical stimulation on Jiaji (Ex-B2) points T5-T7 laterally (right) using three needles for 20 minutes once a day for 9 days. With every session of electrical acupuncture treatment, thoracic pain decreased acutely. Korean medicine treatments including Jiaji (Ex-B2) point stimulation might be tried for lung cancer patients with uncontrolled thoracic pain at least for the acute analgesic effect.

• 한국치위생학회지
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• 제10권6호
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• pp.1001-1014
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• 2010

Objectives : The purpose of this study is about discovering the basic references to find the ways to vitalize handicapped dental clinics. Methods : The study was analyzed by the satisfactions of those patients who took the advantages of using the dental care at B-welfare center and also their transformed perceptions after the services are influenced. The analysis was the questionnaire consisting of 100 items and survey data. Results : 1. The satisfaction of the dental service for the disabled was respectively high which was the average of 4.49. 2. Their satisfactions of receiving kindness services by volunteers and employees were the highest in the entire research of successful handicapped dental services and it was 4.78 overall. 3. The satisfaction of using handicapped dental clinic has the higher range of female users than male's. In the mean time treatment details of the dental care and the satisfaction towards to the volunteers and faculty at the center show the statistical significance gap. 4. The oral care service after experiencing the dental clinic for handicapped relived their discomforts of using the regular dental clinic which shows their highest satisfaction as it is the point of 4.75. 5. the change perception after dental treatment for handicapped has the higher range of females than men's and solving the problems of mouth reference and discomfort of using regular clinics show the statistical significance gap. 6. In the change perception after having dental treatment for handicapped the thought of the possibility of periodical dental care shows the highest perception when the number of visiting is usually shorter and it shows the statistical significance. Conclusions : According to the satisfaction of those inpatients who use free dental care services that belong to dental clinics for handicapped in a part of Seoul welfare centers human services were appeared as the most important factor due to their advantages of taking services from volunteers and staff members. On the other hand to enhance the medical treatment information and environment which showed the weakest factors each inpatient should be specifically specialized for their needs and also further study on plans which enhance their perceptions toward to a better quality of oral-related life is required after using dental treatment service.