• 의료법학
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• 제21권2호
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• pp.3-33
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• 2020

원격의료가 이미 허용되어 상당히 진행된 국가도 있는 반면, 원격의료가 법률해석상 금지되는 국가들도 있다. 최근까지 한국과 독일은 모두 후자에 속하였다. 독일에서 원격의료가 금지되는 가장 주요한 근거는 독일연방의사협회가 마련한 표준의사직업규정 제7조 제4항이 "상담을 전적으로 인쇄 및 통신매체를 통해 수행해서는 안 된다. 원격의료절차에서도, 의사가 환자를 직접 진료하는 것이 보장되어야 한다."고 규정하고 있었고 각 주(州)의 의사직업규정이 이를 그대로 수용하였기 때문이다. 그렇지만 독일 내에서도 전적인 원격의료가 허용되어야 한다는 논의 및 전자의료(E-Health) 활성화를 위한 인프라와 그를 규제하는 법을 마련해야 한다는 논의가 상당히 오래 전부터 있어 왔다. 2018년 표준의사직업규정이 변경되었고 대부분의 주(州)의사협회가 의사직업규정을 개정하였으므로 이제 독일에서는 원격의료가 대부분 허용된다고 할 수 있다. 아직 우리나라는 원격의료를 허용하지는 않으나, 우리와 같은 입장이었던 독일이 어떤 준비 하에 원격의료 허용 쪽으로 선회하였는지 살펴보는 것은 우리법이 개정될 경우를 대비하여 여전히 중요한 작업이라 할 것이다.

• 디지털융복합연구
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• 제17권9호
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• pp.185-192
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• 2019

스마트 기술의 도입은 의사와 환자 모두에게 정확성, 안전성, 효율성을 제공한다. 투명 교정장치에 대한 관심은 국내외에서 점점 높아지고 있지만, 현재 투명교정 장치로 치열교정을 할 경우, 환자는 1, 2주에 한 번씩 병원을 방문하여 교체하여야 하며, 약 40~80개 정도의 장치가 제작되고 교정장치의 착용 순서 및 기간 등을 고려해서 교정이 이루어지기 때문에 치과 의사와 환자는 매우 번거롭고 혼란스럽다. 또한 이 과정에서 치과 의사와 환자 간 정확한 의사소통이 필요하다. 따라서 본 연구는 투명 교정장치에 QR 코드를 삽입하여 환자와 의료진 간의 커뮤니케이션이 보다 원활하게 이루어질 수 있도록 투명 교정장치 관리 시스템을 설계 및 개발하였다. 개발 결과 QR 코드의 크기는 구강 내에서 사용 가능한 $6{\ast}6mm^2$ 이상이면 100% 인식하였고, 인식 거리는 12cm 이내에서 100% 인식률을 보였다. 제안한 시스템으로 치과의사는 환자를 원격으로 관리하며 교정효과를 높여 주기 때문에 국내의 환자는 물론 해외의 환자 관리가 가능하다.

• 보건행정학회지
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• 제28권4호
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• pp.411-422
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• 2018

Background: Whether there is a difference in outcomes for trauma patients transferring to the helicopter emergency medical service (HEMS) according to their previous team composition is controversial. The purpose of this study is to evaluate the effectiveness of trauma team-staffed-HEMS (TTS-HEMS) when transferring to a trauma center. Methods: A retrospective comparison was conducted on patients transported to a trauma center over a 6-year period by the TTS-HEMS and paramedic-staffed-HEMS (119-HEMS). Inclusion criteria were blunt trauma with age ${\geq}15years$. Patient outcomes were compared with the Trauma and Injury Severity Score (TRISS) (30-day mortality) and the Cox proportional hazard ratio of mortality (in hospital). Results: There were 321 patients of TTS-HEMS and 92 patients of 119-HEMS. The TTS-HEMS group had a higher Injury Severity Score and longer transport time but a significantly shorter time to emergency surgery. The prehospital data showed that the trauma team performed more aggressive interventions during transport. An additional 7.6 lives were saved per 100 TTS-HEMS deployments. However, the TRISS results in the 119-HEMS group were not significant. In addition, after adjusting for confounders, the hazard ratio of mortality in the 119-HEMS group was 2.83 times higher than that in the TTS-HEMS group. Conclusion: HEMS was likely to improve the survival rate of injured patients when physicians were involved in TTS-HEMS. Survival benefits in the TTS-HEMS group appeared to be related to the fact that the trauma team performed both more aggressive prehospital resuscitation and clinical decision making during transportation.

• 문화기술의 융합
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• 제5권2호
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• pp.23-30
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• 2019

본 연구는 상급종합병원의 간호 간병통합서비스 병동에서 근무하는 간호사의 직무스트레스, 직무만족도, 이직의도를 파악하기 위한 서술적조사연구로서 상급종합병원 두 곳을 편의추출하여 이 두 의료기관의 간호 간병통합서비스 병동에 근무하고 있는 간호사를 대상으로 설문조사를 실시하였다. 자료 분석은 대상자의 일반적 특성, 직무스트레스, 직무만족, 이직의도는 서술통계로, 대상자의 일반적 특성에 따른 직무스트레스, 직무만족, 이직의도의 비교는 Mann-Whitney U test를 이용하였다. 본 조사연구가 실시된 상급종합병원 두 곳의 간호 간병통합서비스 병동에서 근무하는 간호사는 모두 여성으로 30세 미만이며 미혼이 대부분이었다. 학력은 학사가 대부분이었다. 간호사 월수입은 93.8%가 150이상 300만원 미만으로 응답하였다. 직무스트레스가 높게 나타난 하위영역은 '의사와갈등', '보호자와 환자', '대인관계갈등'이었고, 직무만족이 가장 낮은 영역은 '보수및승진' '필수적직무'였다. 높은 이직의도를 보인 경우는 '본인이 원하지 않는 부서이동이 되었을때 이직하고 싶다', '부서이동을 인해 업무수행에 어려움이 심할 때 이직하고 싶다', '업무에 비해 월급이 적다고 느낄 때 이직하고 싶다' 등이었다. 간호 간병통합서비스 본래의 취지에 부합하도록 이 서비스를 정착하고 확대하기 위해서는 이 서비스를 제공하는 주요 의료인력인 간호사의 근무환경에 대한 체계적인 평가가 필요하다. 간호 간병통합서비스를 제공하는 간호사의 직무스트레스를 낮추고, 직무만족을 높이기 위해서는 적절한 보상, 명확한 업무에 대한 규정, 일반병동과 간호 간병통합서비스 병동 중에 선호하는 곳에서 근무할 수 있는 여건 등이 고려되어야 하며 이를 위해 정책적인 지원이 필요하다.

• Tuberculosis and Respiratory Diseases
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• 제82권2호
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• pp.102-117
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• 2019

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrosing interstitial pneumonia, which presents with a progressive worsening dyspnea, and thus a poor outcome. The members of the Korean Academy of Tuberculosis and Respiratory Diseases as well as the participating members of the Korea Interstitial Lung Disease Study Group drafted this clinical practice guideline for IPF management. This guideline includes a wide range of topics, including the epidemiology, pathogenesis, risk factors, clinical features, diagnosis, treatment, prognosis, and acute exacerbation of IPF in Korea. Additionally, we suggested the PICO for the use of pirfenidone and nintendanib and for lung transplantation for the treatment of patients with IPF through a systemic literature review using experts' help in conducting a meta-analysis. We recommend this guideline to physicians, other health care professionals, and government personnel in Korea, to facilitate the treatment of patients with IPF.

• 대한임상독성학회지
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• 제16권2호
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• pp.61-67
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• 2018

Purpose: To evaluate the association between neutrophil-to-lymphocyte ratio (NLR) and occurrence of aspiration pneumonia in drug intoxication (DI) patients in the emergency department (ED) and to evaluate the relationship between NLR and length of hospital admission/intensive care unit (ICU) admission Methods: A total of 466 patients diagnosed with DI in the ED from January 2016 to December 2017 were included in the analysis. The clinical and laboratory results, including NLR, were evaluated as variables. NLR was calculated as the absolute neutrophil count/absolute lymphocyte count. To evaluate the prognosis of DI, data on the development of aspiration pneumonia were obtained. Also, we evaluated the relationship between NLR and length of hospital admission and between NLR and length of ICU admission. Statistically, multivariate logistic regression analyses, receiver-operating characteristic (ROC) curve analysis, and Pearson's correlation (${\rho}$) were performed. Results: Among the 466 DI patients, 86 (18.5%) developed aspiration pneumonia. Multivariate logistic regression analysis revealed NLR as an independent factor in predicting aspiration pneumonia (odds ratio, 1.7; p=0.001). NLR showed excellent predictive performance for aspiration pneumonia (areas under the ROC curves, 0.815; cut-off value, 3.47; p<0.001) with a sensitivity of 86.0% and a specificity of 72.6%. No correlations between NLR and length of hospital admission (${\rho}=0.195$) and between NLR and length of ICU admission (${\rho}=0.092$) were observed. Conclusion: The NLR is a simple and effective marker for predicting the occurrence of aspiration pneumonia in DI patients. Emergency physicians should be alert for aspiration pneumonia in DI patients with high NLR value (>3.47).

• Journal of Rheumatic Diseases
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• 제24권4호
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• pp.227-235
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• 2017

Objective. Failure of first-line anti-tumor necrosis factor (TNF) agents in in rheumatoid arthritis patients leads to decisions among second-line biologic agents. To better inform these decisions, the therapeutic effectiveness of rituximab is compared with other second-line biologic agents in this observational study. Methods. Between November 2011 and December 2014, study subjects were observed for 12 month periods. Patients with an inadequate response to initial anti-TNF agent received either rituximab or alternative anti-TNF agents (adalimumab/etanercept/infliximab) based on the preference of patients and physicians. The efficacy end point of this study was the change in 28-joint count Disease Activity Score (DAS28) at six and 12 months from baseline. Safety data were also collected. Results. Ninety patients were enrolled in the study. DAS28 at six months did not change significantly whether the patients were treated with rituximab or alternative anti-TNF agents in intention-to-treat analysis (n=34, $-1.63{\pm}0.30$ vs. n=31, $-2.05{\pm}0.34$) and standard population set analysis (n=31, $-1.51{\pm}0.29$ vs. n=24, $-2.21{\pm}0.34$). Similarly, the change in DAS28 at 12 months did not reach statistical significance ($-1.82{\pm}0.35$ in the rituximab vs. $-2.34{\pm}0.44$ in the alternative anti-TNF agents, p=0.2390). Furthermore, the incidences of adverse events were similar between two groups (23.5% for rituximab group vs. 25.8% for alternative anti-TNF agents group, p=0.7851). Conclusion. Despite the limitations of our study, switching to rituximab or alternative anti-TNF agents after failure of the initial TNF antagonist showed no significant therapeutic difference in DAS28 reduction.

• 대한영상의학회지
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• 제79권5호
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• pp.259-263
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• 2018

52세 남자 환자가 우측 유방의 바깥부위에서 무통의 단단한 종괴를 호소하였다. 흉부 CT에서 3.3 cm 크기의 원형의 미세소엽상 경계의 조영증강되는 종괴가 확인되었고, 초음파에서는 미세소엽상 경계를 보이는 저에코성 종괴로, 종괴의 내부에는 석회화와 혈류가 보였다. 중심부바늘생검에서 종괴는 양성 과립세포종양(granular cell tumor; 이하 GCT)으로 확진되었다. 환자는 타병원으로 전원되어 병변의 수술적 제거를 시행하였다. 과립세포종양은 슈반세포(schwann cell)에 유래하는 종양으로, 유방에서는 드물고 대부분은 양성이다. 과립세포종양의 임상적 및 방사선학적 특징은 악성 종양과 유사한 소견을 보여 감별이 어려운 경우가 있으며, CT 영상은 거의 보고된 바가 없다. 본 증례를 통해 임상의와 방사선 전문의가 드물지만 양성종양인 GCT의 영상의학적 특징을 알고, 이를 악성종양과 감별하여 과도한 치료를 피해야 할것이다.

• 대한방사선기술학회지:방사선기술과학
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• 제44권5호
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• pp.503-512
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• 2021

The purpose of this study is to check the extent to which "instruction of physician or dentist" defined in the Medical Service Technologists, etc. Act is applied in relation to radiography examination procedures for radiological technologists. In addition, it is intended to present basic data on the requirement to revise the Medical Service Technologists, etc. Act in the radiological technologist's duty area and scope of work, The subjects of this study were radiological technologists with license, and the response data were collected after sending the questionnaire link written on the online questionnaire form. The final number of respondents were 1,018, and the response rate was 6.8%. Most of the negative responses were "I have never received 'instruction' for radiologic examination by a physician or dentist, including a radiologist in a medical environment." There were a high perception that "the professionalism in radiation examination on radiological technologists are higher than that of a physician or dentist." They answered that the current continuing education has a great impact on maintaining and continuing professionalism and learning new knowledge in the radiology field. In addition, the radiological technologists provide a very high level of education in areas related to radiography procedure ethics such as patient care, patient safety, and patient privacy protection, as well as specialized fields such as radiation-related examination methods, radiography examination dose, and patient exposure dose. Radiological technologists replied that they were receiving it consistently. In conclusion, in the current medical environment, the 'instruction' of a physician or dentist cannot be seen as being realistically performed. The phrase 'instruction' of a physician or dentist as defined in the Medical Service Technologists, etc. Act is considered inappropriate in respect of the fact that the state recognizes the qualifications of the medical service technologist through a license. It is thought that revision to a new term suitable for the current medical environment is necessary.

• Journal of Neurogastroenterology and Motility
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• 제25권3호
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• pp.343-362
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• 2019

Background/Aims There has been major progress in our understanding of the irritable bowel syndrome (IBS), and novel treatment classes have emerged. The Rome IV guidelines were published in 2016 and together with the growing body of Asian data on IBS, we felt it is timely to update the Asian IBS Consensus. Methods Key opinion leaders from Asian countries were organized into 4 teams to review 4 themes: symptoms and epidemiology, pathophysiology, diagnosis and investigations, and lifestyle modifications and treatments. The consensus development process was carried out by using a modified Delphi method. Results Thirty-seven statements were developed. Asian data substantiate the current global viewpoint that IBS is a disorder of gut-brain interaction. Socio-cultural and environmental factors in Asia appear to influence the greater overlap between IBS and upper gastrointestinal symptoms. New classes of treatments comprising low fermentable oligo-, di-, monosacharides, and polyols diet, probiotics, non-absorbable antibiotics, and secretagogues have good evidence base for their efficacy. Conclusions Our consensus is that all patients with functional gastrointestinal disorders should be evaluated comprehensively with a view to holistic management. Physicians should be encouraged to take a positive attitude to the treatment outcomes for IBS patients.