• 간호행정학회지
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• 제14권3호
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• pp.229-240
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• 2008

Purpose: To develop the patient classification system based on the resource utilization for reimbursement of long-term care hospitals in Korea. Method: Health Insurance Review & Assessment Service (HIRA) conducted a survey in July 2006 that included 2,899 patients from 35 long-term care hospitals. To calculate resource utilization, we measured care time of direct care staff (physicians, nursing personnel, physical and occupational therapists, social workers). The survey of patient characteristics included ADL, cognitive and behavioral status, diseases and treatments. Major category criteria was developed by modified delphi method from 9 experts. Each category was divided into 2-3 groups by ADL using tree regression. Relative resource use was expressed as a case mix index (CMI) calculated as a proportion of mean resource use. Result: This patient classification system composed of 6 major categories (ultra high medical care, high medical care, medium medical care, behavioral problem, impaired cognition and reduced physical function) and 11 subgroups by ADL score. The differences of CMI between groups were statistically significant (p<.0001). Homogeneity of groups was examined by total coefficient of variation (CV) of CMI. The range of CV was 29.68-40.77%. Conclusions: This patient classification system is feasible for reimbursement of long-term care hospitals.

• 한국임상약학회지
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• 제24권1호
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• pp.53-61
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• 2014

Background: The use of health functional food (HFF) is increasing and will continue to rise worldwide. Concerns about HFF-drug interactions are increasing as HFF are becoming more widely used. Therefore, awareness of consumers' perceptions and behaviors associated with HFF use may help health care providers improve their communications with patients. Purpose: The aim of this study was to assess the characteristics, perceptions, and behaviors associated with HFF use in South Korea. Method: The online survey was conducted from September 21th to October 7th, 2013. With the aid of Social Network Service (SNS) and google, the questionnaire was posted online on internet website targeting people aged 15 years or older so that self-reported data covering 4 domains were collected from 257 Koreans. Results: A total of 257 people responded the questionnaire. Among them, 81.3% reported experiences of HFF use. Female were more likely than male to use HFFs. There were no differences in demographic characteristics between HFF users and non-users in relation to age, education, and household income. Higher level of education was associated with high-level perception of HFF function (OR 3.9, 95% CI 1.48, 10.1) and a positive relationship was observed between the maximum number of HFFs used concurrently and age of the respondents. Among the HFF users, 42.6% reported concurrent HFF-medication use. However 73.3% of them did not disclose their use to physician or pharmacist and only 30.2% were informed about potential drug-HFF interactions. Pharmacy was most commonly reported as the source from which the respondents were informed about potential interactions. Conclusion: Many people had used HFF and medications concurrently while not being informed about potential HFF-drug interactions. Pharmacists and physicians should be vigilant for risk of the interactions and actively determine whether the patient is using an HFF before prescribing and administrating medications.

• 임상간호연구
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• 제26권2호
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• pp.240-253
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• 2020

Purpose: This study was conducted to provide basic data for the systematization of 13 areas related to Advanced Practice Nurses (APN). Methods: The three-phase study was conducted as follows. 1) review of APN system and curriculum, 2) Focus Group Interviews (FGI) with 9 APNs, 6 physicians, and 3 nursing professors on the APN system, 3) analysis of clinical practice of the 13 APN areas, and of the accreditation and certification system for APNs, medical board, and medical subspecialty board. Based on the above data, a systematic plan was drawn. Results: The 13 APN areas could be divided into 7 groups based on a review of the APN system and curriculum for the 13 areas. Analysis based on clinical practice showed that the 13 APN areas could be divided into 4 groups. Two themes and seven categories emerged in FGI. The two themes were 1) 13 APN areas that need to be discussed, 2) improving the curriculum for APN. Considering these themes from FGI and the system of the medical subspecialty board, results could be integrated into 2 groups - clinical area and non-clinical area. Conclusion: The 13 APN areas need to be integrated in order to activate the APN system. For that, further discussions on improvements and a standard curriculum according to legislation related to APN should be carried out.

• 대한의사협회지
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• 제61권11호
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• pp.687-698
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• 2018

Inappropriate antibiotic use significantly contributes to antibiotic resistance, resulting in reduced antibiotic efficacy and an increased burden of disease. The objective of this study was to investigate the characteristics of prescribers whose antibiotics use was high and to explore factors affecting the use of antibiotics by medical institutions. This study analyzed the National Health Insurance claims data from 2015. Antibiotic prescription data were analyzed in terms of the number of defined daily doses per 1,000 patients per day, according to the World Health Organization anatomical-therapeutic-chemical classification and methodologies for measuring the defined daily dose. We investigated the characteristics of prescribers and medical institutions with high antibiotic use. Multivariate regression analyses were performed on the basis of characteristics of the medical institution (number of patients, type of medical institution [hospital or clinic], age of the physician, etc.). The number of patients and number of beds were found to be significant factors affecting antibiotic use in hospitals, and the number of patients, region, and medical department were significant factors affecting antibiotic use at the level of medical institutions. These findings are expected to help policy-makers to better target future interventions to promote prudent antibiotic prescription.

• Journal of Preventive Medicine and Public Health
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• 제33권3호
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• pp.373-382
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• 2000

Objectives : The most frequently cited health related slogan in North Korea is that socialistic medicine is preventive medicine. It implies that North Korea puts preventive medicine at the operational center of its national health care system. This study aimed at examining and comparing preventive medicine practices in North Korea with those of South Korea. Methods : Efforts have been made to obtain a textbook for analysis its contents. Many people have iassisted in the study by joining the interview. Some of these people are as follows : a former professor of PyongYang Medical School, NK physicians living in South Korea, WHO staffs, diplomatic officials, etc. The major items of analysis consisted of industrial medicine and hygiene, nutrition, school health, epidemiology, health statistics and heath policy & management. Results : Public health philosophy is finely noted and well integrated in the operation of the North Korean national health care system, particularly in the area of industrial medicine and hygiene. Preventive medicine with a strong health surveillance system spanning a number of broad social organizations is a major tool to improve the health of the people in North Korea. The emphasis on preventive medicine has a close relationship with the 'Juche Philosophy' and the shortage of pharmaceuticals and medical equipment. To cope with the shortage problem, North Korean health workers are encouraged to grow medicinal herbs. We have found that they put little effort into teaching newly emerging diseases, such as AIDS, VDT syndrome, hazards of EMF, and agricultural chemical poisonings. Of the subjects of the preventive medicine text, 78.9% coincide with those of South Korean industrial health manuals and 34.2% with South Korean epidemiology texts. However, an absolute difference was found to exist between the health policies and management systems. Conclusion : In North Korea, the concept of preventive medicine functions as the basic philosophic strategy of the national health care system. It differs greatly from the South Korean system in both practice and educational content. Its contribution to society is simply incomparable to that of South Korea. More communication and further study is called for in order to improve the preventive medicine practices in the future.

• 의료법학
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• 제18권1호
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• pp.143-169
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• 2017

아동학대범죄의 처벌 등에 대한 특례법은 아동학대에 '범죄'라는 개념을 도입하고 신고의무자를 정함으로서, 아동학대 신고를 활성화하고자 하는 의도로 제정되었다. 동법 제10조는 의료인을 아동학대 신고의무자로 정하는데, 학대 피해 아동의 발견율이 0.5% 남짓인 현실을 고려한다면, 특정한 의학적 소견으로 비교적 명확하게 아동학대의 사실을 알 수 있는 의료인에게 신고의무를 부과한 입법적 조치는 타당하다. 향후 의료인에 의한 신고가 활성화되도록 하기 위한 제도를 마련하기 위하여 본 논문에서는 크게 세가지 제안을 한다. 첫 번째, 예비의료인과 의료인에게 아동학대 신고의무에 관한 교육을 꾸준하게 실시하는 것이다. 신고의무의 구체적인 내용 및 절차와 더불어, 의료인이 판단하기에 아동학대가 확실한 경우 뿐 아니라 "의심"되는 경우에도 신고의무가 있음을 주지시켜 아동학대를 조기에 발견하고 신고할 수 있도록 하는 것이 바람직하다. 두 번째, 신고 의료인 및 의료기관에 대한 보호 장치를 마련하여 한다. 현행법이 신고자의 보호를 위하여 필요한 조항들을 포함하고 있기는 하지만, 여기서 한발 더 나아가 의료인의 상황에 맞게 신고인을 보호할 수 있는 구체적인 지침을 마련하고, 그러한 지침에 대한 교육을 실시하여야 한다. 신고의료인에 대한 철저한 보호장치를 마련하는 것이 미신고의료인에 대한 면허 박탈 등의 처벌 조치를 강화하는 것보다 더 효과적인 신고의 유인을 제공할 것이다. 세 번째, 의료인이 모든 영유아의 건강상태를 주기적으로 모니터링할 수 있는 영유아건강검진제도를 학대아동 발견의 기회로 활용할 수 있도록 협진 체계를 마련하고, 영유아건강검진을 실시하는 의료인에 대하여 아동학대에 대한 체계적인 교육을 실시하는 것이 바람직하다.

• Journal of Korean Neurosurgical Society
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• 제63권4호
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• pp.519-531
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• 2020

Objective : The purpose of this study is identify the operation status of the neurosurgical care units (NCUs) in neurosurgical residency training hospitals nationwide and determine needed changes by comparing findings with those obtained from the Korean Neurosurgical Society (KNS) and Korean Society of Neurointensive Care Medicine (KNIC) survey of 2010. Method : This survey was conducted over 1 year in 86 neurosurgical residency training hospitals and two neurosurgery specialist hospitals and focused on the following areas : 1) the current status of the infrastructure and operating systems of NCUs in Korea, 2) barriers to installing neurointensivist team systems, 3) future roles of the KNS and KNIC, and 4) a handbook for physicians and practitioners in NCUs. We compared and analyzed the results of this survey with those from a KNIC survey of 2010. Results : Seventy seven hospitals (87.5%) participated in the survey. Nineteen hospitals (24.7%) employed a neurointensivist or faculty member; Thirty seven hospitals (48.1%) reported high demand for neurointensivists, and 62 hospitals (80.5%) stated that the mandatory deployment of a neurointensivist improved the quality of patient care. Forty four hospitals (57.1%) believed that hiring neurointensivist would increase hospital costs, and in response to a question on potential earnings declines. In terms of potential solutions to these problems, 70 respondents (90.9%) maintained that additional fees were necessary for neurointensivists' work, and 64 (83.1%) answered that direct support was needed of the personnel expenses for neurointensivists. Conclusion : We hope the results of this survey will guide successful implementation of neurointensivist systems across Korea.

• 의학교육논단
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• 제17권1호
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• pp.33-38
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• 2015

During the education reform in 2009, the Catholic University of Korea College of Medicine (CUMC) adopted body systems as the basis for structuring basic medical education. After running the new program for 5 years, we need to evaluate the program by comparing it with nationwide standards. This study was designed to evaluate the coverage of our basic medical education program by comparing it with the assessment items of the medical licensing examination for physicians in the Republic of Korea. We built a relational database populated with 3,017 learning outcomes from all the courses on basic medical education. We tagged each learning outcome according to 2 criteria: 206 physician encounters and 9 outcome domains. A majority of the learning outcomes were in the domains of 'knowledge' and 'critical thinking'. In addition, we repeated the categorization process with 584 assessment items of the medical licensing examination in the Republic of Korea and compared them with the categorization results of the learning outcomes. Among the 206 physician encounters, we found that outcomes on family violence and sexual violence were missing in the learning outcomes of CUMC. Eighty-two physician encounters were associated with more than one outcome domain, and 96 physician encounters were covered in more than one course. Twenty-one physician encounters were repeated in 5 or more courses and 34 physician encounters had outcomes categorized into 3 or more domains. Thus, we showed that the 2-way categorization could be applied to the comparison and evaluation of two different education formats.

• Tuberculosis and Respiratory Diseases
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• 제66권5호
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• pp.365-369
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• 2009

장 폐색의 증상 및 징후가 있는 폐암 환자에서는 원인에 대한 신속하고 적절한 규명이 중요한데 이는 장 폐색의 원인에 따라 치료 방침이 달라지고, 종종 더욱 심한 합병증을 예방하기 위해 응급수술이 필요한 경우도 있기 때문이다. 본 논문에서는 폐암과 동반하여 각기 다른 원인에 의한 장 폐색이 있었던 두 증례를 보고하고자 한다. 첫 번째는 폐암 치료 중 발생한 10 kg의 급격한 체중감소가 있었던 57세 남자로 반복되는 답즙성 구토를 주소로 내원하였다. 전이성 병변은 발견되지 않았으나 전산화단층촬영 및 상부위장관조영술에서 십이지장 제3부의 폐색이 보여 상장간막 동맥 증후군으로 진단되었다. 두 번째 증례는 68세 남자로 3년 전 폐암으로 수술 및 보조항암화학치료를 받았으나 재발하여 경과를 관찰 중이던 환자로 오심, 구토 및 복통으로 내원하였는데 검사 결과 소장 전이로 인한 장 폐색으로 진단되어 수술적 치료를 시행하였다. 폐암 환자에서 장 폐색이 의심될 때 그 원인이 될 수 있는 여러 가능성들을 항상 염두에 두고 진단 및 치료 방침을 세워야 할 것으로 생각된다.

• Archives of Plastic Surgery
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• 제34권3호
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• pp.395-398
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• 2007

Purpose: Elastofibroma is a rare benign tumor that is characterized histologically by the presence of abnormal elastic fibers within a stroma of fibroadipose tissue. Usually it is slow-growing, solid, ill-defined mass occurring chiefly in elderly woman and arising from the soft tissue around the inferior angle of the scapula. Methods: We experienced a representative case of elastofibroma. A 73-year-old women complained of a soft-tissue mass, which measured $6{\times}6cm$, at the inferior angle of the left scapula, which had been found incidentally 4 months before. When the arm was elevated, the mass projected out beneath the scapula. The entire mass was resected with a tumor-free margin. Results: The resected tumor appeared to be nonencapsulated, fibrous and white mass, and it contained yellow fatty streaks. We confirmed that the histopathologic diagnosis of this tumor was elastofibroma. Follow-up examination revealed no evidence of local recurrence for 10 months. Conclusion: This entity is rarely reported in Korea. However, more patients could be diagnosed if physicians pay more careful attention to clinical and radiological features of elastofibroma. Moreover, recognizing the benign nature of this lesion is important to avoid an unnecessary operation.