• 대한예방한의학회지
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• 제17권1호
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• pp.181-197
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• 2013

Objectives : This study aimed to assess the differences in treatment behavior by reviewing data of a medical institution that studies treatment behavior in URI and assessing the treatment efficacy in Korea. Methods : We analyzed the behavior of medical customers and providers of upper respiratory infection medications using the NPS published by the Health Insurance Review Assessment Service. We created an operational definition for complications, and confirmed the difference in complication distribution between medical specialties. We also performed a multivariate analysis using a mixed model to elucidate the factors influencing the occurrence of complications. Results : The outcomes of analyzing factors to influence the difference in practice patterns of the diagnosing URI between the physicians are as follows; (1) Analysis of antibiotics prescriptions rate showed significant difference from medical departments (pediatrics; 49.7%, internal medicine; 54.2%, otorhinolaryngology; 69.6%, family medicine; 61.6%, general surgery; 57.5%, p<0.001). Analysis of steroid prescriptions rate showed significant difference from medical departments (pediatrics; 3.8%, internal medicine; 4.5%, otorhinolaryngology; 5.4%, family medicine; 3.0%, general surgery; 11.2%, p<0.001). (2) In patients who visited medical institutes with the common cold, the complication distribution differed according to the medical specialty, which suggests that specific complications arise depending on the particular medical specialty (p<0.001). (3) Moreover, through multivariate analysis, we found that the complication rate is higher in clinics than in hospitals, depending on the institute's size. (p<0.001; odds ratio of 4.67 in clinics than in hospitals, 95% CI 2.66-8.21) Conclusions : We observe a deviation between the behavior of patients diagnosed with URI and medication providers. This may arise from the interaction between providers and consumers, wherein the complications are associated with the choice of outpatient department and the prevention of cutting incentives. These findings suggest that the health policies should be improved to prevent inappropriate medical practice in the treatment of pediatric URI.

• Journal of Preventive Medicine and Public Health
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• 제34권4호
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• pp.379-388
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• 2001

Background : Cervix cancer is the most common form of cancer among Korea women. in spite of proof that cervical cancer screening could reduce death rates substantially, the screening rates reported by previous Korean studies remain stubbornly very low. Behavioral studies to increase the cervix cancer screening rate are essential in order to develop the cancer screening program. Objective : To evaluate the factors which are related to the intention and behavior for cervix cancer screening using the Theory of Planned Behavior (TPB) and the Theory of Reasoned Action (TRA). Methods : The survey was conducted from July 21 st to 26th in 1998. Of 3,218 women, 303(12.2%) between 30 and 55 years old, voluntarily participated in the survey in the 3 Myeons in Choongju city. Charge-free cervix cancer screening was provided for the subjects 3 months later. Results : The R-square of both TPB and TRA to the intention (30% and 42%, respectively) was greater than the actual behavior (21% and 13%, respectively. TPB and TRA were found to provide an appropriate framework for the study of cervix cancer screening behavior. However, TRA was more powerful in explaining the intention, not only because the perceived behavioral control component exhibited lower reliability and validity than other components(altitude and subjective norm), but also because there may have been a few limitations in this study design. Consequently, the use of TRA is preferred in attempting to explain intention and actual behavior in this study. Conclusions : This study suggests that a successful intervention program should focus on changing attitudes and reducing psychologic barriers, rather than on just providing information. Physician recommendations, and the support of family members and friends are also very important factors in cervix cancer program participation. Physicians, friends, family members, and opinion leaders in rural areas, all of whom could affect the individual subjective norm, may all have the potential to play great roles as facilitators.

• Journal of Gastric Cancer
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• 제16권3호
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• pp.182-190
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• 2016

Purpose: This study aimed to establish a large-scale database of patients with gastric cancer to facilitate the development of a nationalcancer management system and a comprehensive cancer control policy. Materials and Methods: An observational prospective cohort study on gastric cancer was initiated in 2010. A total of 14 cancer centers throughout the country and 152 researchers were involved in this study. Patient enrollment began in January 2011, and data regarding clinicopathological characteristics, life style-related factors, quality of life, as well as diet diaries were collected. Results: In total, 4,963 patients were enrolled until December 2014, and approximately 5% of all Korean patients with gastric cancer annually were included. The mean age was $58.2{\pm}11.5$ years, and 68.2% were men. The number of patients in each stage was as follows: 3,394 patients (68.4%) were in stage IA/B; 514 patients (10.4%), in stage IIA/B; 469 patients (9.5%), in stage IIIA/B/C; and 127 patients (2.6%), in stage IV. Surgical treatment was performed in 3,958 patients (79.8%), endoscopic resection was performed in 700 patients (14.1%), and 167 patients (3.4%) received palliative chemotherapy. The response rate for the questionnaire on the quality of life was 95%; however, diet diaries were only collected for 27% of patients. Conclusions: To provide comprehensive information on gastric cancer for patients, physicians, and government officials, a large-scale database of Korean patients with gastric cancer was established. Based on the findings of this cohort study, an effective cancer management system and national cancer control policy could be developed.

• Advances in pediatric surgery
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• 제3권1호
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• pp.61-67
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• 1997

To understand the current status of pediatric surgical practice of the members of the Korean Association of Pediatric Surgeons, a survey of the practice of the 31 members in both 1994 and 1995. Twenty five members(80%) representing 20 hospitals responded. An average of four hundred and seventy four cases pediatric surgical operations were performed at individual institution in 1995 with 40 newborn cases. Eighteen members(72%) are currently working at university hospital. Fourteen institutions(70%) are currently classified as tertiary by the health insurance agency. The majority(15 to 60%) of members are working in the metropolitan Seoul area, while five in Taegu area. Sixteen members reported having the title of department head/director. Four members reported occasional non-pediatric surgical practice. Nine members out of 20 reported having independent pediatric surgical out-patient clinic before the establishment of the association(1985). Eight out of 15 members reported being appointed chief of pediatric surgery before 1985. In 20 institutions, 34 full time physicians(27 members, reportedly) are working in pediatric surgery. In regarding to pediatric surgical training, 16 members(64%) received an average of 16 months of training abroad, 5 members trained at home and abroad, and 4 from only at home. There are no differences in length of training periods in these groups. Twenty one members received their basic pediatric surgical training before 1985, the year of inauguration of the association. Twelve members received post-pediatric surgery refresher courses averaging 11 months' duration, after 2-11 years. Thirteen participants of this study belongs to the founding members of the association.

• 정신신체의학
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• 제17권2호
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• pp.62-67
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• 2009

연구목적 : 집단 치료 방법 중의 하나인 소시오드라마가 종합병원의료종사자의 직무 만족도와 소진정도를 개선할 수 있는지와 직종 및 직종 내의 갈등, 직무만족도, 그리고 소진정도의 관계를 알아보고자 본 연구를 수행하였다. 방법 : 종합병원에 근무하는 간호사 20명에게 정신과 전문의가 소시오드라마에 참여를 권유하여 동의한 15명을 대상으로 하였다. 소시오드라마 시행 1주후 병동조직특성척도(ward organizational feature scale)과 소진척도(Maslach burnout inventory)를 작성하게 하였다. 대조군으로는 소시오드라마 시행군과 동일병동에 근무하는 간호사들 중 소시오드라마에 참여하지 않았던 20명에게 동일한 척도를 시행하기를 권유하였으며 17명이 척도를 완성하였다. 결과 : 소시오드라마 시행군(N=15)은 대조군(N=17)에 비해 소진정도가 유의하게 낮았다. 간호사/의사관계와 직무만족도 및 소진정도와 유의한 상관관계를 보였으나 회귀분석을 통해 변인간 상호작용을 통제하였을 때에는 직무만족도만이 소진에 대한 유의한 예측변인이였다. 결론 : 본 연구의 결과는 종합병원 간호사의 소진정도를 개선하는데 있어 소시오드라마의 시행이 긍정적인 효과를 가질 수 있을 가능성을 제시한다. 향후 본 연구의 제한점을 개선한 추가연구가 필요하다.

• 호스피스학술지
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• 제3권1호
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• pp.31-41
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• 2003

Background: The purpose of this study is to assess the effectiveness of family support on the quality of life in patients admitted to the hospice facility at Saemmul Hospice. Method: The subjects of this study were 152 terminal cancer patients that were admitted to the hospice facility at Saemmul hospice between January 2002 and February 2003. Their each quality of life were assessed at admission, one, three, five and seven weeks at Saemmul Hospice using a questionnaire prepared by the Saemmul hospice and were anlalyzed by means of T-test. Result: There was no difference in the quality of life score between patients with family support and patients without family support in terms of physical, psychosocial, and spiritual aspects in the admission. There was no difference in the quality of life score between the patients with frequent family member's visit(>=8) and less frequent family visit(<=7), and between the patients whose family members stayed at the facility for 24hrs and the patients without staying family members. There was no difference in the quality of life score between the patients in low-middle and low-high class among 9 classes of familial economic status(high-high, high-middle, high-low, middle-high, middle-middle, middle-low, low-high, low-middle, low-low). There was no difference in the quality of life score between the patients whose familial religion were Christianity and the patients with other religions. After 1, 3, 5, 7 weeks assessment, the scores in the physical, psychosocial, spiritual aspect of quality of life were increased. Conclusion: The results suggest that family support is important to improve the quality of life in hospice patients and hospice care team is needed to replace 24 hours of family care. There is a urgent need of trained hospice care teams, so training programs for physicians, nurses, clergies, social workers, and volunteers are necessary.

• Tuberculosis and Respiratory Diseases
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• 제80권4호
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• pp.377-384
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• 2017

Background: Proper education regarding inhaler usage and optimal management of chronic obstructive pulmonary disease (COPD) is essential for effectively treating patients with COPD. This study was conducted to evaluate the effects of a comprehensive education program including inhaler training and COPD management. Methods: We enlisted 127 patients with COPD on an outpatient basis at 43 private clinics in Korea. The patients were educated on inhaler usage and disease management for three visits across 2 weeks. Physicians and patients were administered a COPD assessment test (CAT) and questionnaires about the correct usage of inhalers and management of COPD before commencement of this program and after their third visit. Results: The outcomes of 127 COPD patients were analyzed. CAT scores ($19.6{\pm}12.5$ vs. $15.1{\pm}12.3$) improved significantly after this program (p<0.05). Patients with improved CAT scores of 4 points or more had a better understanding of COPD management and the correct technique for using inhalers than those who did not have improved CAT scores (p<0.05). Conclusion: A comprehensive education program including inhaler training and COPD management at a primary care setting improved CAT scores and led to patients' better understanding of COPD management.

• 대한예방한의학회지
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• 제16권3호
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• pp.37-51
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• 2012

Objectives : The objective of this study is to determine the present state of patients with breast cancer use of Korean medicine(KM) and predictive factors for the use. Through this, the present study is intended to present reasonable treatment approaches for patients with breast cancer as well as communicating correct information on KM to healthcare providers and presenting objective alternatives for patients with breast cancer management based on the subjects' experience in health benefits obtained from their use of KM. Methods : To collect data for the present study, questionnaire surveys were conducted on outpatients who visited four hospitals located in Seoul, Korea during around three weeks from May 31, 2012. Although the total number of the questionnaire sheet distributed in the form of directly asking questionnaire questions was 300, 12 incomplete questionnaire sheets were excluded. Therefore, the number of questionnaire sheets actually used in analyses was 288 and thus the collect rate was 96%. Results : Major results of this study are as follows. First, the number of subjects who responded to the questionnaire was 288 in total. Forty-six percent of the patients reported KM usage and the most commonly used ginseng and qigong/exercise. KM use was found to be associated with age, experiencing side effects of cancer treamnent. Factors that affect the use of KM were analyzed by Linear Logistic Regression and the results showed that age, experiencing side effects of cancer treatment, effectiveness of cancer treatment, and satisfaction of the treatment were factors that were related with relatively more frequent use of KM. Conclusions : Comparing the previous studies, it could be seen that patients with breast cancer were highly interested in and used KM in which conventional medicine and KM are used simultaneously. Knowledge on the integrative use of KM and conventional therapies is necessary for cancer physicians and traditional Korean medical doctors to help patients make informed choices. KM use may play a role in the positive benefits associated with process of breast center treatment. Healthcare providers should communicate correct information on the KM use that has been scientifically verified and talk with each other openly. The fact that the significant correlation between predictive factors for the use of KM was identified trough the present study is quite meaningful.

• 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.

• 한국임상약학회지
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• 제30권1호
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• pp.19-30
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• 2020

Objective: To describe patterns of spontaneous reporting on adverse events following immunization (AEFIs) using the human papilloma virus (HPV) vaccine according to the Brighton Collaboration (BC) criteria. Methods: We used the Korea Adverse Event Reporting System (KAERS) database including vaccinations between 2008 and 2017. To apply BC criteria, we classified 58 BC AEFIs into World Health Organization Adverse Reaction Terminology (WHO-ART) codes. We applied MedDRA standard medical queries that were pre-defined as five BC AEFIs. Terminology mapping between MedDRA and WHO-ART terms was performed by three researchers. Descriptive statistics of individual case safety reports were analyzed according to BC applicability. Disproportionality analyses were performed on each BC AEFI and each preferred AEFI term according to the case-noncase approach; reporting odds ratio (ROR) and 95% confidence intervals (CI) were calculated. Results: Among the 30,266 reports of vaccinations between 2008 and 2017, 2,845 reports included the HPV vaccine. Of these reports, 1,511 (53.1%) included at least one BC AEFI. Reports from physicians or manufacturers included more BC AEFIs than from other reporters. Injection site reactions and fever were frequently reported in BC AEFIs; spontaneous abortion and ectopic pregnancy (ROR, 14.29 [95% CI, 4.30-47.49]) and vasculitic peripheral neuropathy (ROR, 8.57 [95% CI, 2.61-28.10]) showed the highest ROR. Among non-BC AEFIs, dizziness or myalgia were frequently reported; exposure during pregnancy (ROR, 23.95 [95% CI, 16.27-35.25]) and inappropriate schedule of administration (ROR, 22.89 [95% CI, 16.74-31.31]) showed the highest ROR. Conclusion: BC criteria would be applicable for labeled AEFIs, whereas analyzing non-BC AEFIs would be useful for detecting unlabeled AEFIs.