• 한국산학기술학회논문지
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• 제17권4호
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• pp.512-520
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• 2016

유방암은 여성에서 가장 흔한 악성종양이며, 림프부종은 가장 흔한 유방암수술 후 합병증 가운데 하나이다. 따라서 림프부종과 같은 치료 후유증의 위험도 감소와 적절한 관리는 유방암 생존 환자와 의사에게 있어서 그 중요성이 점차 커지고 있다. 이러한 림프부종의 발생을 예방하기 위하여 흔히 운동이 처방된다. 그러나 그러한 운동의 시기와 효과에 대해서는 각각 상반된 결과들이 보고되어 왔다. 저자들은 림프부종에 대한 운동 효과를 점검하여 환자 치료에 최선의 근거를 도입하기 위해 최신문헌과 상호 심사된 출판물, 전문 기구의 웹사이트를 체계적으로 고찰하여 림프부종의 예방이나 치료를 위해 시행되는 운동의 효과를 검토하였고, 그 결과 이미 림프부종이 발생해 있는 환자들에서는 임상적인 부종진행의 차이점에 유의성이 없었지만, 발생 전 환자들에서는 운동 혹은 훈련이 이차성 림프부종의 발생을 감소시키고 진행을 변경시키는 양상을 볼 수 있었다. 암치료의 발전, 암과 운동 연구, 림프부종의 관리를 위해서는 현재까지 도출된 근거들에 대한 고찰과 이해가 있어야 임상의사들이 적절한 환자 교육과 전문가의뢰를 시행할 수 있을 것이다.

• 한국융합학회논문지
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• 제10권4호
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• pp.277-284
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• 2019

본 연구의 목적은 종합 병원 신규 간호사의 직무 스트레스, 회복력과 이직의도와의 관계를 파악하고 이직의도에 영향을 미치는 요인을 파악하기 위함이다. S시에 있는 종합 병원의 신규 간호사 90명을 대상으로 하였으며, 자료 분석은 t-test, ANOVA, pearson's correlation 및 다중 회귀 분석으로 하였다. 이직 의도는 의사와의 갈등(r=.17, p=.049), 상사와의 문제(r=.18, p=.040), 차별(r=.18, p=.041)과 양의 상관 관계가 있는 것으로 나타났으며 회복력(r=-.21, p=.023)과 음의 상관 관계가 있는 것으로 나타났다. 본 연구에서 이직 의도에 영향을 미치는 요인은 연령, 직무 스트레스, 직무 만족도, 회복력이었으며 설명력은 24.5%이었다. 본 연구 결과를 통하여 신규 간호사의 이직 의도를 감소시키기 위해서 종합 병원 간호사의 직무 스트레스를 줄이기 위한 방안이 제시되어야 한다. 또한 직무 만족도 및 회복력을 증진시키기 위한 방안을 마련하고 신규 간호사 이직을 줄이기 위한 전략이 고려되어야 한다.

• Safety and Health at Work
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• 제5권4호
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• pp.191-197
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• 2014

Background: Disabling fatigue is common in the working age population. It is essential that occupational health (OH) professionals are up-to-date with the management of fatigue in order to reduce the impact of fatigue on workplace productivity. Our aim was to evaluate the impact of one-day workshops on OH professionals' knowledge of fatigue and chronic fatigue syndrome (CFS), and their confidence in diagnosing and managing these in a working population. Methods: Five interactive problem-based workshops were held in the United Kingdom. These workshops were developed and delivered by experts in the field. Questionnaires were self-administered immediately prior to, immediately after, and 4 months following each workshop. Questionnaires included measures of satisfaction, knowledge of fatigue and CFS, and confidence in diagnosing and managing fatigue. Open-ended questions were used to elicit feedback about the workshops. Results: General knowledge of fatigue increased significantly after training (with a 25% increase in the median score). Participants showed significantly higher levels of confidence in diagnosing and managing CFS (with a 62.5% increase in the median score), and high scores were maintained 4 months after the workshops. OH physicians scored higher on knowledge and confidence than nurses. Similarly, thematic analysis revealed that participants had increased knowledge and confidence after attending the workshops. Conclusion: Fatigue can lead to severe functional impairment with adverse workplace outcomes. One-day workshops can be effective in training OH professionals in how to diagnose and manage fatigue and CFS. Training may increase general knowledge of fatigue and confidence in fatigue management in an OH setting.

• Tuberculosis and Respiratory Diseases
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• 제64권2호
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• pp.109-124
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• 2008

연구배경: COPD는 전세계적으로 유병률, 이환율 및 사망률이 급격히 증가하는 질환으로 환자의 삶의 질을 호전 시키고 사회, 경제적인 질병부담을 줄이기 위해 경증 COPD 환자를 조기에 진단하여 적절히 치료하는데 일차진료의사의 역할이 중요하다. 근거중심을 바탕으로 개발된 GOLD와 같은 COPD 진료지침은 이 목적을 위해 유용하나 우리나라의 진료실태가 반영되지 않은 문제점이 있다. 근거중심을 바탕으로 우리나라 진료실정이 반영된 진료지침을 개발하기 위해 우리나라 일차진료의사들의 진료 실태를 조사하여 보고한다. 방법: 진료실태는 웹을 기반으로 COPD의 진단, 치료, 위험인자, 교육, 진료지침에 대한 25개의 설문을 포함 제작하였고 총 217명의 일차진료의사가 설문조사에 동의하고 참여하였다. 참여자의 의사경력은 평균 17.7년이며 76.5%가 내과를 전공하였고 지역적으로는 63.6%가 서울, 경기지역에서 진료를 하고 있었다. 결과: 비교적 높은 비율(61.8%)로 폐기능검사기를 보유하고 있지만 실제 진료 시 활용도는 낮은(35.8%) 편임을 알 수 있었다. 안정 시, 급성악화 시 COPD의 치료에서 경구제제의 처방빈도가 흡입제제에 비해서 모두 높았다. COPD의 주요 위험인자인 흡연에 대해서는 흡연여부 확인율, 금연권유율 등이 90% 이상으로 높았으나 금연을 위한 처방에서 금연 성공률이 높은 니코친대체제와 부프로피온의 병용 처방률이 4.3%로 낮았다. COPD 진료지침에 대한 인지도는 56.7%였고 그대로 따르는 경우는 7.3%로 국내 진료실태를 반영한 진료지침의 개발이 요구되며 진료지침의 보급과 확산을 위해서는 진료지침책자를 포함한 인쇄자료의 보급이 효과적임을 알 수 있었다. 결론: 우리나라 일차진료의사들의 COPD 진료실태는 진단에서 폐기능검사의 보유율에 비해 사용률이 낮고 치료에서 흡입제에 비해 경구제제의 처방을 선호하는 경향을 보였다. GOLD 진료지침에 대한 인지도는 높으나 그대로 따르는 일차진료의사는 적으므로 이번 진료실태조사 결과를 바탕으로 근거중심이지만 국내실정을 반영한 COPD 진료지침의 개발 및 보급이 필요하리라 생각된다.

• 대한암한의학회지
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• 제22권1호
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• pp.23-35
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• 2017

Backgrounds: The demand of complementary and alternative medicine (CAM) including Korean Medicine (KM) is increasing worldwide. But cancer patients (CP) still have a difficulty in gathering CAM information or communicating with their doctors, and clinical status in cancer care is unclear in the field of KM in Korea especially. The aim of this study is to examine clinical status of KM for cancer symptom care by KM doctors in medical service institutions. Methods: Total forty nine KM doctors completed the site survey questionnaire. The questionnaire items were to list chief symptom complaints of CP treated with KM and effective KM therapies. Results: The majority of the respondents were general physicians without KM specialist board (67.4%) who have 10-20 years clinical experience with CP (55.1%). Primary cancer lesion, diagnostic status, and treatment period were not different in KM clinical service institutions. In chief symptom complaints of CP treated with KM, gastrointestinal (32.9%), musculoskeletal (19.9%), circulatory & respiratory (16.2%), psychiatric (14.1%), urinary (5.8%) symptoms were in turn. In effective KM therapies assessed by KM doctors, xerostomia (45.7%) and cancer-related fatigue (44.8%) were more effective with herbal treatments. Peripheral neuropathy (43.4%), depression, insomnia (38.2%), and cancer pain (31.9%) were preferred to treat using acupuncture. Conclusion: The CP treated with KM used evenly KM medical service institutions regardless of hospital size, and there will be further survey for CP treated KM in the future.

• 한국병원경영학회지
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• 제22권3호
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• pp.74-87
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• 2017

Purposes: The purpose is to establish the direction of healthcare R&D through private nonprofit organization. Methodology: The data is divided into two groups: 12 physicians and pharmacists, and 16 persons including professors related to university donation, non-profit foundation executives. Each group was subjected to two Delphi surveys. To analyze the validity of the opinion, the content validity ratio and the consensus of experts were verified. Findings: Funding should be invested in 'development research' and 'application research'. The factors that hinder the donation culture are 'donation prevention system such as tax imposition system and rebate double penalty system', 'insufficient motivation of fund raising person', and 'lack of fund specializing specialist'. The fund raising strategy should be centered on a small number of large donors or a balance between large and small donors. The fund raising target should be effective to raise funds for corporate and individual donors. It is necessary to clarify the purpose of the social problem to be solved by the campaign strategy for promoting donation, to announce the validity of the trust and transparency of the institution, and to emphasize the social investment by the private sector. Practical Implications: It is necessary to present directions through private nonprofit organizations for the future development of healthcare R&D. The legal and institutional deficiencies of the domestic nonprofit organization fundraising infrastructure should be improved. In order to create a social investment climate, it is necessary to improve the awareness of donations and develop various donation programs for the private sector.

• 의학교육논단
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• 제25권3호
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• pp.198-211
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• 2023

Health systems science (HSS) is recognized as the third pillar of medical education. alongside basic and clinical sciences. Today's physicians must also be systems thinkers who are able to discern how social, economic, environmental, and technological forces influence clinical decision-making. This study aimed to propose strategies for structuring an HSS curriculum that is tailored to the Korean healthcare and medical education context. First, the authors of this study conducted a survey to identify the present curricular contents of HSS related education at Korean medical schools. Second, a needs assessment was performed to determine the necessity of HSS competencies, as well as the prerequisites for the seamless integration of HSS into the existing curriculum. Third, literature reviews on HSS education at 14 US medical schools and expert consultations was conducted. We would like to propose a set of strategic approaches, classified into two levels: comprehensive and partial restructuring of the current medical curriculum to incorporate HSS. The partial restructuring approach entails a gradual, incremental incorporation of HSS content, while maintaining the current curricular structure. In contrast, a complete overhaul of the curriculum may be ideal to build HSS as the third pillar of medical education, but its feasibility remains relatively limited. The partial reorganization approach, however, has the advantage of being highly feasible. Collaborative efforts between professors and students are imperative to collectively devise effective methods for the seamless integration of HSS into the existing curriculum.

• 대한간호학회지
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• 제38권2호
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• pp.298-309
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• 2008

Purpose: The purpose of the study was to describe the experiences of do-not-resuscitate (DNR) among nurses. Methods: Data were collected by in-depth interviews with 8 nurses in 8 different hospitals. Conventional qualitative content analysis was used to analyze the data. Results: Eight major themes emerged from the analysis: DNR decision-making bypassing the patient, inefficiency in the decision-making process of DNR, negative connotation of DNR, predominance of verbal DNR over written DNR, doubts and confusion about DNR, least amount of intervention in the decision for DNR change of focus in the care of the patient after a DNR order, and care burden of patients with DNR. Decision-making of DNR occurred between physicians and family members, not the patients themselves. Often high medical expenses were involved in choosing DNR, thus if choosing DNR it was implied the family members and health professionals as well did not try their best to help the patient. Verbal DNR permission was more popular in clinical settings. Most nurses felt guilty and depressed about the dying/death of patients with DNR. Conclusion: Clearer guidelines on DNR, which reflect a family-oriented culture, need to be established to reduce confusion and to promote involvement in the decision-making process of DNR among nurses.

• 대한간호학회지
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• 제17권2호
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• pp.145-152
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• 1987

The problem addressed by this study was to reveal what people of Korean rural villages think about the cause, treatment and prevention of illness. The purpose was to contribute to the building of a concept of health toward the development of Korean Nursing Theory. Subjects were residents of five districts among four counties in a farming area of Chonbuk province recommended by health workers as appropriate informants. They were interviewed in their homes, using ethnoscientific methods developed in anthropology. The research tool consisted of open questions developed through the literature and preliminary exploratory interviews. Data were analyzed by classifying each concepts of cause, treatment and prevention of illness or illness symptoms collated by frequency and percentage. The causes of illness are conceived as primarily concrete physical and natural, for examples, overeating, lack of energy, changes in the season and extreme temperatures. Compared to others studies, few supernatural causes related to traditional view of illness were identified. Concepts of the treatment of illness included formal treatments used by modern western or oriental physicians and traditional therapists. But folk medicine used by traditional healers or by the family in the home was most prevalent. The concept of illness prevention originated in the concept of the cause of illness, thus primarily physical and natural, for examples, nutritious food, limiting the amount of food, avoiding becoming cold. When the concept of illness of rural Korean is researched from a sociocultural aspect, the traditional views of an evil cause of ill health and treatment by supernatural methods is not found to be prevalent but folk medicine still occupies a large place in treatment which si often a complex mixture from many mysterious sources. The significance of this study lies in the fact that ethnonursing research can contribute basic data toward the development of Korean nursing theories. Modern western medical concepts have not been accepted unconditionally: traditional concepts are alive and dynamic in Korea and must be recognized in Korean nursing.

• Journal of Hospice and Palliative Care
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• 제26권1호
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• pp.7-17
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• 2023

Purpose: The purpose of this study was to analyze end-of-life care practices in lung disease patients with physician orders for life-sustaining treatment (POLSTs). Methods: We retrospectively analyzed data from medical records regarding the end-of-life care practices of POLST decisions for patients with lung disease hospitalized at a tertiary hospital in Seoul, South Korea. Data were collected from January 1 to June 30, 2021. Results: Of 300 total patients, 198 had lung cancer (66.0%) and 102 had non-malignant lung diseases (34.0%). A POLST was written for 187 patients (62.3%), and an advance directive was written for 20 patients (6.7%). Subsequent treatments were hemodialysis in 13 patients (4.3%), surgery in 3 patients (1.0%), and cardiopulmonary cerebral resuscitation in 1 patient (0.3%). Among cancer patients, chemotherapy was performed in 11 patients (3.7%), targeted therapy in 11 patients (3.7%), immunotherapy in 6 patients (2.0%), and radiation therapy in 13 patients (4.3%). Depending on the type of lung disease, types of treatment differed, including hemodialysis, ventilators, bilevel positive airway pressure, high-flow nasal cannulas, nebulizers, enteral nutrition, central line, inotropic agents, and opioids. Conclusion: Although the goals of hospice care are the same whether a patient has lung cancer or a non-malignant lung disease, because the characteristics of the respective diseases differ, end-of-life care practices and hospice approaches must be considered differently.