• Journal of Hospice and Palliative Care
• /
• 제22권2호
• /
• pp.67-76
• /
• 2019

포괄적이고 총체적 돌봄을 제공하는 호스피스 완화의료의 경우 평가도구를 사용하여 문제목록의 객관화하고 돌봄 계획의 구체화하는 것이 필요하다. 초기평가는 입원 당일 혹은 1일 이내에 환자의 증상과 사회적, 영적 문제, 완화의료에 대한 요구가 무엇인지 파악하며 개괄적인 돌봄의 방향을 설정하는 과정이다. 현재 병에 대한 인식과 예후를 파악하는 것부터 연명의료계획서 작성까지 함께 검토한다. 초기평가도구로는 간단하지만 포괄적으로 신체적, 정신적, 사회적, 영적 영역을 아우르는 13개의 간단한 질문으로 구성된 NEST를 추천한다. 초기평가에서 파악된 문제에 대하여 구체적인 평가도구들을 활용하여 돌봄 계획을 수립하며 입원 후 3일이내 시행하는 것이 좋다. 신체적 영역의 경우 기능상태를 포함하여 통증과 비 통증 증상, 삶의 질을 함께 파악할 수 있는 다증상 평가도구가 도움이 될 수 있다. 환자의 증상은 단독으로 의미를 가지는 것이 아니라 복합적인 상호작용으로 발생하며, 그에 따라 포괄적으로 접근해야 하기 때문이다. 정신심리적 영역은 심리적 고통과 불안, 우울을 평가한다. 사회적 영역의 평가는 의사결정, 사회경제적 환경 파악, 가족 평가 및 임종 준비의 단계로 이루어진다. 영적 평가 역시 중요한데 FACIT-Sp나 SHI를 사용할 수 있다. 평가도구를 활용하는 것은 환자의 고통을 경감시키고 삶의 질을 향상시킬 뿐 아니라 의료진이 체계적으로 훈련되는 방안이 될 수 있으며 그 과정 자체가 더 나은 돌봄 제공을 위한 발판이 될 수 있다.

• 한국환경복원기술학회지
• /
• 제26권2호
• /
• pp.1-11
• /
• 2023

By delivering effective, in-situ conservation of biodiversity, OECMs can contribute to sustaining existing biodiversity values and improving biodiversity conservation outcomes. In this study, for the reporting of OECMs required by Kunming-Montreal Global Biodiversity Framework, the site-level assessment of the Korea National Arboretum and Buffer Zones were conducted using the assessment tool of IUCN. The site-level assessment was carried out in three steps(step 1: screening, step 2 : consent for full assessment, step 3 : the full assessment). It was found that the criteria were satisfied except for the consent for full assessment, sustainability of governance and management arrangements, and the equity of governance and management. Although the governing authority, rights-holders or any other stakeholders could be identified, the step of acknowledging and agreeing to the full OECM assessment was not possible because the governance was not established. As a result of the assessment of equitable governance and management in the aspect of recognition, procedure, and distribution based on criterion(the equity of governance and management), it is judged that more specific measures are needed in the aspect of recognition. And in the aspect of procedure, there is no legal basis for participation in governance and collection of opinions, so it is judged that there is a limit to listening and reflecting the opinions of stakeholders. In the aspect of distribution, it is necessary to further confirm whether it provides direct benefits to rights-holders such as landowners in the region. And it is necessary to prepare specific criteria to assess the important biodiversity values. Therefore, in order to promote OECM reporting in the future, it is necessary to conduct detailed research on various types of governance establishment and operation plans that can establish the basis for recognizing and agreeing to OECM assessment, specific criteria and reasonable measures to judge equity, and important biodiversity value.

• 환경영향평가
• /
• 제16권6호
• /
• pp.511-524
• /
• 2007

Korea has 30 years of experiences in environmental impact assessment (EIA). Although EIA includes sanitation-public health factor, considering health impacts, among 74 unit projects of 17 sections, health impacts haven't been properly considered or have been ignored in many cases. The increasing awareness on the importance of health impacts has triggered this study to seek an optimal introduction scheme of health impact assessment (HIA). The processes of EIA already include screening, scoping, analysis, impact assessment, consultation, document review, decision making and monitoring, in which they would be the essential parts of HIA. In this context, integrating HIA into the existing EIA process could be the most effective way to use the benefits in both legal and procedural processes existed and to avoid the confusion and overlapping since the close relationships between environment and health impacts might be. Furthermore, it is desirable that the existing sanitation-public health factor should be substituted by and extended to environment-health factor with sufficient determinants to properly consider health impacts. When considering the first step of HIA, the prospective and qualitative approach is suitable more than the retrospective and quantitative one due to the lack of database accumulated. Similarly, an approach based on epidemiology and toxicology could analyze the limited evidences and impacts related to human disease, whereas one based on socio-science and psychology could provide the effective means available for predicting how the people and community will act by the change of surroundings. Checklist approach with various and comprehensive health determinants focused on prospective and qualitative methods will be very useful for more convenient and progressive dissemination of HIA. Various checklist approaches of toolkits could be found from HIA documents elsewhere, for example Westminster Toolkit, and they would be helpful to figure out how to develop common procedures and health determinants for checklist, in which the unique characteristics on korean cultural and political context compared to abroad should be carefully considered since checklist would be the most basic and essential part of HIA. After the establishment of checklist and procedural processes, the pilot projects should be conducted. Main purpose of pilot projects is to apparently prove the effectiveness and profitability of HIA. Pilot projects should be implemented to decide the effectiveness and suitability of HIA for future projects, programs and policies, and should be provided as the positive cases that can be achieved through the proper implementation and progress.

• 한국산업보건학회지
• /
• 제30권2호
• /
• pp.205-212
• /
• 2020

Objectives: The purpose of this study was to identify the needs and improvement measures of the risk assessment system through a survey of asbestos abatement companies. Methods: This study prepared a questionnaire that includes improvement measures for the risk assessment system(six questions) and the necessity of a risk assessment system for asbestos abatement(one question). The questionnaire was sent to 2,170 asbestos abatement companies and returned by 83 companies(return rate = 3.8%). We conducted frequency analysis, ANOVA, and Chi-squared testing at the 5% significance level. Results: This study analyzed the survey results and identified six main opinions on the risk assessment system and improvement measures. First, giving an advantage to companies with a high grade(S and A grades) in public bidding and/or qualification screening showed a similar preference(agree: 50.6%, disagree: 49.4%). Second, 57.6% of the respondents wanted to allow air showers along with water showers for low risk asbestos work. However, 23.2% of the respondents asserted that only a water shower should be allowed since there is no scientific evidence supporting the removal of asbestos by air shower. Third, in order to prevent missing the enrollment of workers, simply submitting a change report should be allowed when any worker is changed (40.0%). Fourth, 43% of the respondents answered that they did not know how to calculate the proper number of negative pressure units. The reasons given were a lack of guidelines or standards(38.9%), inconvenience (36.1%), and absence of education(25%). Fifth, the respondents who were favorable toward the necessity of a risk assessment system gave higher scores compared to unfavorable respondents on the necessity of the management of workers' work history(favorable respondent = 3.96 out of 5, unfavorable respondent = 2.68) and the necessity of professional training for workers(favorable respondent = 3.71, unfavorable respondent = 2.56). Finally, the respondents favorable toward a risk assessment system showed higher scores on the awareness of calculating the proper number of negative pressure units(4.79) compared to unfavorable respondents(3.3). Conclusions: The opinions of asbestos abatement companies identified through the survey in this study can be usefully utilized as fundamental information to improve the risk assessment system.

• 한국화재소방학회논문지
• /
• 제15권4호
• /
• pp.24-33
• /
• 2001

현재 전세계적으로 공장내(on-site)뿐만 아니라 공장외지역(off-site)에 대한 사고영향평가의 필요성이 대두되고 있으며, 공장외지역에 대한 영향평가 수행후 이에 대한 적절한 비상계획을 제출하도록 하고 있고, 국내에서도 종합적위험관리체계(IRMS : Integrated Risk Management System)를 PSM이나 SMS와 더불어 시행 준비중에 있다. 그러나 공장외지역에 대한 위험영향 평가시 가장 먼저 결정되어야 할 가상시나리오에 대한 기준이 체계적으로 마련되어 있지 않아 사용자나 분석자에 따라 평가결과가 다양하게 나오며, 또한 공정에서 발생할 수 있는 사고의 이상원을 정확하게 파악하지 못한다는 단점이 있다. 따라서 본 연구에서는 이러한 가상시나리오를 결정하는데 필요한 공정요소를 분석한 후, 분석결과에 따라 발생 가능하고, 먼저 고려되어야 할 시나리오를 산정할 수 있도록 전략을 제시하고자 한다. 분석된 공정요소들은 요소에 따른 가중치를 부여하여 위험등급을 결정한 후 등급에 따른 위험영향 평가를 수행하도록 한다. 분석의 결과는 가상시나리오의 신뢰성을 향상시킴으로써 위험영향평가가 과대평가되는 것을 방지하고, 공정의 설계나 비상계획의 수립시 효과적이고 적절한 대책마련을 유도할 수 있다.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
• /
• 제25권3호
• /
• pp.142-155
• /
• 2014

Objectives : The aim of this study was to develop an assessment tool for measurement of children's functioning in the mental health service. We conducted a preliminary study to develop a sensitive and inclusive scale focused on the functional changes of children rather than just focusing on their symptoms or screening. Methods : The Child and Adolescent Functional Assessment Scale and the Korean-Child Behavior Checklist (K-CBCL) were both administered to 134 parents of children with emotional or behavioral problems who participated in the Aizone program and also to 186 parents of elementary school children in the Seoul metropolitan area as a control group. SPSS version 12.0 was used for statistical analysis. Results : Most of the reliability coefficients were over 0.70 except those of the conduct behavior items, which showed relatively high internal consistency. The corrected item-total correlations ranged from .411 to 758, except those of conduct behavior items and special measure items. In a concurrent validity test with K-CBCL, the total behavior problem score of K-CBCL was highly correlated with the total score of the Child and Adolescent Functional Assesment Scale (r=.610). For the construct validity, confirmatory factor analysis was performed for each of four areas, including behavior (at home/school), achievement, peer relationship, and emotion. Conclusion : The results showed that the scale was statistically reliable and valid, except for conduct behavior items. This study was conducted only for parents with elementary children. An adolescents group should be included in future studies.

• 대한인간공학회지
• /
• 제34권4호
• /
• pp.335-351
• /
• 2015

Objective: The aim of this study was to perform a usability test for CPAD (Cognitive Perceptual Assessment for Driving) and improve it based on the test results. Background: The cognitive perceptual assessment for driving is a computer-based assessment tool to assess the driving capacity of people with brain-damages. It may be a good tool for evaluating the brain-damaged drivers' safe driving capabilities and screening cognitive and perceptual deficits related to driving. We performed a usability test to improve the CPAD based on the result. Method: Both the software consisting of 8 sub-tests (depth perception, sustained attention, divided attention, stroop test, field dependency, digit span, trail making A, trail making B) and the hardware including the input and output devices ( joystick, mouse, keyboard, touch screen) were evaluated through user interviews. Also we identified the problems and issues in using them by observing the participants performing the CPAD tasks. Results: Based on the results, the task instructions were visually and auditorily improved and more practice examples were added to help the users understand the instructions better and increase the input accuracy, a response time window was added and the joystick and touch screen were simplified, which made it easier for the user to perform the CAPD tasks. Conclusion: User discomforts were minimized by improving the task environment, unless it had affected the evaluation criteria. Application: We plan to distribute the improved version of the CPAD to the regional rehabilitation hospitals, and the driving support centers for people with disabilities throughout the country, so it could be used as an evaluation tool for disabled drivers' cognitive and perceptual functions.

• 한국병원경영학회지
• /
• 제28권3호
• /
• pp.58-67
• /
• 2023

Purpose: The purpose of this study was to analyze the factors associated with long-term hospitalized patients in long-term care hospitals using the quality assessment data for long-term care hospitals by the Health Insurance Review. Methods: Among 1,376 long-term care hospitals, frequency analysis and descriptive statistics were used to analyze the characteristics of these hospitals. Multiple linear regression was conducted to examine the associations between infrastructure characteristics, medical personnel characteristics, health outcomes and the proportion of long-term hospitalized patients. Results: The research findings indicate that the number of patients per doctor, the number of patients per nurse, and the number of patients per nursing staff were positively associated with the proportion of long-term hospitalized patients. Among health outcomes, a higher proportion of patients with more than a 5% weight loss compared to the previous month and the proportion of patients showing improvement in ADL, were more likely to have a lower proportion of long-term hospitalized patients. However the proportion of diabetic patients with HbA1c test results within the appropriate range was positively associated with the proportion of long-term hospitalized patients. Conclusion: The present study results provide fundamental data for the establishment of policies for long-term care hospitals. Based on this study, it is important to suggest screening methods for unnecessary long-term hospitalizations, such as sufficient medical personnel to improve the quality of care in long-term care hospitals. It is also necessary to clearly separate the roles of medical institutions and long-term care facilities and implement policies to support patients' social reintegration.

• Pediatric Infection and Vaccine
• /
• 제24권3호
• /
• pp.134-140
• /
• 2017

목적: 중증복합면역결핍증(severe combined immunodeficiency [SCID])은 일차면역결핍증 중 가장 심각한 형태의 질병이다. 국내에서 SCID 선별검사를 확립하기 위하여, 신생아에게 T-cell receptor excision circle (TREC)/${\kappa}$-deleting recombination excision circle (KREC) 선별검사를 시행하고, 부모에게 인식도를 조사하였다. 방법: 혈액 검체에서 TREC/KREC을 multiplex 실시간중합효소연쇄반응으로 분석하였다. 부모에게 설문조사를 실시하였다. 결과: 141명의 신생아가 선별검사에 참여하였고, 140명(99.3%)이 첫 검사에서 TREC/KREC 양성이었으며, 한 명(0.7%)은 처음에 음성이었으나, 추후 양성으로 확인되었다. 인식도 조사에는 84% (141/168)는 SCID 선별검사가 국내에서도 시행되어야 한다고 답변했다. 결론: 본 연구에서는 국내에서 처음으로 신생아 SCID 선별검사와 인식도 시행되었으며, SCID 선별검사가 국내 임상에 적용될 수 있을 것으로 보인다.

• Journal of Nutrition and Health
• /
• 제52권4호
• /
• pp.332-341
• /
• 2019

본 연구는 입원환자의 초기영양평가를 위해 개발된 영양검색도구의 타당성을 평가하고자 입원 후 24시간이내 동일한대상자에게 PG-SGA와 개별면담을 시행 후 그 결과를 비교 평가하였다. CKUNRS와 PG-SGAS 두 그룹 모두 나이는 고위험군이 평균 연령보다 높았고, BMI, 혈청 알부민과 헤모글로빈은 영양불량이 심할수록 유의적으로 낮게 나타났다. CKUNRS와 PG-SGA를 비교 분석한 영양 평가결과 전체 686명 중 영양불량 위험 환자는 각각 107명(15.6%)과 380명 (44.6%)으로 조사되었다. 민감도와 특이도는 각각 98.7% (96.8 ~ 99.5)와 33.3% (28.1 ~ 39.0)로 나타났으며, 두 도구 간 유사성 kappa 지수는 0.34로 CKUNRS는 PG-SGA를 기준으로 어느 정도 타당한 검색도구로 검증되었다. 결론적으로, CKUNRS를 PG-SGA와 같은 공인된 영양검색도구와 비교한 결과 민감도와 유사성 면에서는 어느 정도 타당한 수준의 영양검색도구인 것으로 판정되었으나, 특이도가 높지 않은 부분에 대해서는 추가적인 고려가 필요할 것으로 보인다. 초기입원 영양평가로 효과적인 영양검색도구를 위하여 재원기간, 합병증 유무, 사망률, 환자의 질병 예후와 관련된 유용성은 검증되지 않아 이에 관련하여 추가적 연구가 필요하다고 사료된다. 그리고 보다 정확한 영양불량 환자의 검색을 위해서는 간호사의 입원환자 초기 평가 및 재평가 부분에서 누락 가능성이 있는 체중변화, 소화기계장애, 식욕상태, 저작곤란, 연하곤란 등의 정확한 기록을 할 수 있도록 간호사정 기록자의 지속적인 교육이 필요할 것으로 보이며, 효과적인 초기 영양관리를 위해서는 향후 CKUNRS의 영양검색 기준에 대한 수정보완이 필요하다고 사료된다.