• 제목/요약/키워드: service delivery system

검색결과 803건 처리시간 0.027초

말기암환자 정보시스템을 이용한 우리나라 암환자 완화의료기관의 이용현황 (The Current Status of Utilization of Palliative Care Units in Korea: 6 Month Results of 2009 Korean Terminal Cancer Patient Information System)

  • 신동욱;최진영;남병호;서원석;김효영;황은주;강진아;김소희;김양혁;박은철
    • Journal of Hospice and Palliative Care
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    • 제13권3호
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    • pp.181-189
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    • 2010
  • 목적: 최근 보건의료 정책 결정은 근거에 기반하여 이루어지는 추세에 있으며, 말기암환자 정보시스템은 이러한 필요에 부응하기 위하여 개발되었다. 본 고에서는 말기암환자 정보시스템의 개발과정 및 6개월 데이터로부터의 통계 결과를 보고하고자 한다. 방법: 말기암환자 정보시스템의 입력항목은 실무 전문가들의 자문을 받아 개발되었으며, 이벨로스 임상연구관리시스템을 기반으로 구축하였다. 2009년 보건복지가족부에서 지정된 34개 암환자완화의료 기관에 2009년 1월 1일부터 6월 30일까지 등록된 환자들에 대한 정보가 수집되었다. 분석은 기술적 통계를 이용하였다. 결과: 총 2,940명의 전국적으로 대표성 있는 데이터로부터 아래와 같은 결과를 얻었다. 평균연령은 $64.8{\pm}12.9$ 세였고, 56.6%가 남자였다. 폐암(18.0%)이 가장 많았다. 2인 이상의 의사에 의하여 말기진단을 받은 경우는 50.3% 였으며, 입원 당시 말기라는 사실을 알고 있는 환자는 69.7%였고, 거의 절반에 가까운 환자가 특별한 의뢰 없이 입원하였다. 평균 통증 및 최고 통증은 입원 1주 후에 통계적으로 유의하게 감소하였다. 사망 퇴원한 환자가 73.4%였으며, 집으로 퇴원하는 경우는 13.3%에 불과했다. 1회당 평균 입원일수는 $20.2{\pm}21.2$일이었으며, 중위값은 13일이었다. 결론: 말기암환자 정보시스템의 운영을 통하여 완화의료 기관 이용 환자 및 가족의 특성, 서비스 제공에 관한 현황 등에 관한 전국적으로 대표성 있는 자료를 얻을 수 있었다.

농촌(農村) 주민(住民)들의 의료필요도(醫療必要度)에 관(關)한 연구(硏究) (A Study Concerning Health Needs in Rural Korea)

  • 이성관;김두희;정종학;정극수;박상빈;최정헌;홍순호;라진훈
    • Journal of Preventive Medicine and Public Health
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    • 제7권1호
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    • pp.29-94
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    • 1974
  • Today most developed countries provide modern medical care for most of the population. The rural area is the more neglected area in the medical and health field. In public health, the philosophy is that medical care for in maintenance of health is a basic right of man; it should not be discriminated against racial, environmental or financial situations. The deficiency of the medical care system, cultural bias, economic development, and ignorance of the residents about health care brought about the shortage of medical personnel and facilities on the rural areas. Moreover, medical students and physicians have been taught less about rural health care than about urban health care. Medical care, therefore, is insufficient in terms of health care personnel/and facilities in rural areas. Under such a situation, there is growing concern about the health problems among the rural population. The findings presented in this report are useful measures of the major health problems and even more important, as a guide to planning for improved medical care systems. It is hoped that findings from this study will be useful to those responsible for improving the delivery of health service for the rural population. Objectives: -to determine the health status of the residents in the rural areas. -to assess the rural population's needs in terms of health and medical care. -to make recommendations concerning improvement in the delivery of health and medical care for the rural population. Procedures: For the sampling design, the ideal would be to sample according to the proportion of the composition age-groups. As the health problems would be different by group, the sample was divided into 10 different age-groups. If the sample were allocated by proportion of composition of each age group, some age groups would be too small to estimate the health problem. The sample size of each age-group population was 100 people/age-groups. Personal interviews were conducted by specially trained medical students. The interviews dealt at length with current health status, medical care problems, utilization of medical services, medical cost paid for medical care and attitudes toward health. In addition, more information was gained from the public health field, including environmental sanitation, maternal and child health, family planning, tuberculosis control, and dental health. The sample Sample size was one fourth of total population: 1,438 The aged 10-14 years showed the largest number of 254 and the aged under one year was the smallest number of 81. Participation in examination Examination sessions usually were held in the morning every Tuesday, Wenesday, and Thursday for 3 hours at each session at the Namchun Health station. In general, the rate of participation in medical examination was low especially in ages between 10-19 years old. The highest rate of participation among are groups was the under one year age-group by 100 percent. The lowest use rate as low as 3% of those in the age-groups 10-19 years who are attending junior and senior high school in Taegu city so the time was not convenient for them to recieve examinations. Among the over 20 years old group, the rate of participation of female was higher than that of males. The results are as follows: A. Publie health problems Population: The number of pre-school age group who required child health was 724, among them infants numbered 96. Number of eligible women aged 15-44 years was 1,279, and women with husband who need maternal health numbered 700. The age-group of 65 years or older was 201 needed more health care and 65 of them had disabilities. (Table 2). Environmental sanitation: Seventy-nine percent of the residents relied upon well water as a primary source of dringking water. Ninety-three percent of the drinking water supply was rated as unfited quality for drinking. More than 90% of latrines were unhygienic, in structure design and sanitation (Table 15). Maternal and child health: Maternal health Average number of pregnancies of eligible women was 4 times. There was almost no pre- and post-natal care. Pregnancy wastage Still births was 33 per 1,000 live births. Spontaneous abortion was 156 per 1,000 live births. Induced abortion was 137 per 1,000 live births. Delivery condition More than 90 percent of deliveries were conducted at home. Attendants at last delivery were laymen by 76% and delivery without attendants was 14%. The rate of non-sterilized scissors as an instrument used to cut the umbilical cord was as high as 54% and of sickles was 14%. The rate of difficult delivery counted for 3%. Maternal death rate estimates about 35 per 10,000 live births. Child health Consultation rate for child health was almost non existant. In general, vaccination rate of children was low; vaccination rates for children aged 0-5 years with BCG and small pox were 34 and 28 percent respectively. The rate of vaccination with DPT and Polio were 23 and 25% respectively but the rate of the complete three injections were as low as 5 and 3% respectively. The number of dead children was 280 per 1,000 living children. Infants death rate was 45 per 1,000 live births (Table 16), Family planning: Approval rate of married women for family planning was as high as 86%. The rate of experiences of contraception in the past was 51%. The current rate of contraception was 37%. Willingness to use contraception in the future was as high as 86% (Table 17). Tuberculosis control: Number of registration patients at the health center currently was 25. The number indicates one eighth of estimate number of tuberculosis in the area. Number of discharged cases in the past accounted for 79 which showed 50% of active cases when discharged time. Rate of complete treatment among reasons of discharge in the past as low as 28%. There needs to be a follow up observation of the discharged cases (Table 18). Dental problems: More than 50% of the total population have at least one or more dental problems. (Table 19) B. Medical care problems Incidence rate: 1. In one month Incidence rate of medical care problems during one month was 19.6 percent. Among these health problems which required rest at home were 11.8 percent. The estimated number of patients in the total population is 1,206. The health problems reported most frequently in interviews during one month are: GI trouble, respiratory disease, neuralgia, skin disease, and communicable disease-in that order, The rate of health problems by age groups was highest in the 1-4 age group and in the 60 years or over age group, the lowest rate was the 10-14 year age group. In general, 0-29 year age group except the 1-4 year age group was low incidence rate. After 30 years old the rate of health problems increases gradually with aging. Eighty-three percent of health problems that occured during one month were solved by primary medical care procedures. Seventeen percent of health problems needed secondary care. Days rested at home because of illness during one month were 0.7 days per interviewee and 8days per patient and it accounts for 2,161 days for the total productive population in the area. (Table 20) 2. In a year The incidence rate of medical care problems during a year was 74.8%, among them health problems which required rest at home was 37 percent. Estimated number of patients in the total population during a year was 4,600. The health problems that occured most frequently among the interviewees during a year were: Cold (30%), GI trouble (18), respiratory disease (11), anemia (10), diarrhea (10), neuralgia (10), parasite disease (9), ENT (7), skin (7), headache (7), trauma (4), communicable disease (3), and circulatory disease (3) -in that order. The rate of health problems by age groups was highest in the infants group, thereafter the rate decreased gradually until the age 15-19 year age group which showed the lowest, and then the rate increased gradually with aging. Eighty-seven percent of health problems during a year were solved by primary medical care. Thirteen percent of them needed secondary medical care procedures. Days rested at home because of illness during a year were 16 days per interviewee and 44 days per patient and it accounted for 57,335 days lost among productive age group in the area (Table 21). Among those given medical examination, the conditions observed most frequently were respiratory disease, GI trouble, parasite disease, neuralgia, skin disease, trauma, tuberculosis, anemia, chronic obstructive lung disease, eye disorders-in that order (Table 22). The main health problems required secondary medical care are as fellows: (previous page). Utilization of medical care (treatment) The rate of treatment by various medical facilities for all health problems during one month was 73 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 52% while the rate of those who have health problems which did not required rest was 61 percent (Table 23). The rate of receiving of medical care for all health problems during a year was 67 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 82 percent while the rate of those who have health problems which did not required rest was as low as 53 percent (Table 24). Types of medical facilitied used were as follows: Hospital and clinics: 32-35% Herb clinics: 9-10% Drugstore: 53-58% Hospitalization Rate of hospitalization was 1.7% and the estimate number of hospitalizations among the total population during a year will be 107 persons (Table 25). Medical cost: Average medical cost per person during one month and a year were 171 and 2,800 won respectively. Average medical cost per patient during one month and a year were 1,109 and 3,740 won respectively. Average cost per household during a year was 15,800 won (Table 26, 27). Solution measures for health and medical care problems in rural area: A. Health problems which could be solved by paramedical workers such as nurses, midwives and aid nurses etc. are as follows: 1. Improvement of environmental sanitation 2. MCH except medical care problems 3. Family planning except surgical intervention 4. Tuberculosis control except diagnosis and prescription 5. Dental care except operational intervention 6. Health education for residents for improvement of utilization of medical facilities and early diagnosis etc. B. Medical care problems 1. Eighty-five percent of health problems could be solved by primary care procedures by general practitioners. 2. Fifteen percent of health problems need secondary medical procedures by a specialist. C. Medical cost Concidering the economic situation in rural area the amount of 2,062 won per residents during a year will be burdensome, so financial assistance is needed gorvernment to solve health and medical care problems for rural people.

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무인항공기의 위치 결정을 위한 사진 측량 기법과 오토 트래킹 토탈스테이션 기법의 비교 분석 (A Comparative Analysis between Photogrammetric and Auto Tracking Total Station Techniques for Determining UAV Positions)

  • 김원진;김창재;조연주;김지선;김희정;이동훈;이온유;맹주필
    • 한국측량학회지
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    • 제35권6호
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    • pp.553-562
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    • 2017
  • 무인항공기 (UAV, Unmanned Aerial Vehicle)에 탑재되는 다양한 센서들 중에서 GPS (Global Positioning System) 수신기는 GPS 신호를 기반으로 정지비행 (hovering flight), 경로비행 (waypoint flight) 등 다양한 임무의 수행을 돕는다. GPS신호가 원활하게 수신되는 환경에서는 GPS 수신기를 활용할 수 있지만, 최근에 무인항공기의 활용을 시설물 모니터링, 배송, 레저 등 다양한 분야로 용도가 확대하면서 무인항공기의 비행 장소가 다양해지고 있다. 이러한 원인으로 무인항공기가 GPS 신호의 제약을 받는 음영지역이나 고층 빌딩이 밀집한 지역 등을 비행하면서 신호가 단절되거나 멀티패스로 인해 신호 에 다양한 잡음이 포함될 수 있다. 이에 본 연구에서는 무인항공기의 3차원 위치 결정을 위하여 해석 사진 측량 기법과 오토트래킹 토탈스테이션 기법을 이용하였다. 해석 사진 측량 기법으로는 중심투영의 기하학적 원리인 공선조건식 (collinearity equation)을 이용한 광속조정법을 기반으로 하였으며, 오토 트래킹 토탈스테이션 기법은 360도 프리즘 타깃을 초단위 이하로 추적하는 원리를 기반으로 하였다. 두 가지 기법에서 무인항공기의 위치 결정을 위해 사용된 타깃은 무인항공기 상단에 각각 탑재하였으며, 타깃간에는 x, y, z방향으로 기하학적 이격이 존재한다. 무인항공기의 비행 속도에 따른 결과 확인을 위해 0.86m/s, 1.5m/s, 2.4m/s로 속도를 달리하여 데이터를 취득하였으며, 타깃의 기하학적 이격을 통해 정확도평가를 하였다. 그 결과 무인항공기의 이동 경로인 x, y 방향으로는 최소 1mm에서 최대 12.9cm까지 오차가 발생하였고 비교적 이동이 적은 z 방향으로는 비행 속도와 무관하게 동일하게 7cm 오차가 발생하였다.

의료보험(醫療保險) 실시이후(實施以後) 지역주민(地域住民)의 의료기관이용행태(醫療機關利用行態) 변화(變化) 추이(推移)와 그 요인(要因)에 관한 조사연구(調査硏究) (Analysis on the trends and causes of inhabitant's behavioral changes in medical institutions's utilization after enforcement of regional medical insurance. (pilot-project area of regional medical insurance; mainly Kun-wi and Kwang-hwa county))

  • 박정연
    • 한국보건간호학회지
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    • 제3권2호
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    • pp.47-76
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    • 1989
  • The objectives of this study was to analyze the major causes of decreasing utilization rate of health care institutios in pilot-project area of regional medical insurance, Kwang-hwa and Kun-wi country. After the implementation of medical insurance, utilization rate of health institutions turned out' to be lower than it was estimated, when the pilot-project of regional medical insurance was planned. It might be due to changes in inhabitant's behavioral attitude toward medical insurance. So this study was made to find measures for financial stability by increasing utilization rate of health care institutions and to be available for basic demand-supply program of medical care. The hypothesis of this study was as follows; First. there is difference in understanding health care institutions between Kun-wi and Kwang-hwa. Second. respondesnts of inquiry survey have exact knowledge of their past experience of treatment taken prior to enforcement of medical insurance, Questionaire survey was made as to each 700 household among total 11, 884 households in Kun-wi and 20,919 households in Kwang-hwa. In case of Kun-wi, 70% of inquired households (491) gave their answers. In Kwang-hwa, the number was 560 households (80% of inquireds). Dollected data was processed and analyzed by way of using SPSS batch system. To evaluate facto rs distribution aspects of data and to make comparison between two area, percentage and $X^2$ distribution were applied. The results were as follows; L The utilization rate of health care institutions in Kun-wi and Kwang-hwa was lower than it was estimated. when pilot-project of medical insurance was planned. 2. Prior to the implementation of medical insurance. inhabitants in two area chose the medical institutions considering such factors. First was medical care fee cheap. second in habitant's residence, Third was the institutions conveniently easy of access. 3. After the implementation of medical insurance. 26.1% of inqurieds in Kun-wi and 41.6% in Kwang-hwa, changed medical institutions. In case of Kwn-wi, from health care institution (p 0.05), and in case of Kwang-hwa, vice versa, from general medical institutions to health care institutions. 4. Evaluation by factors were made such as follows. Inquired gave high marks to following facts: In case of Kun-wi, general medical institutions were difficult of access and relation between patients: was not friendly, but burden of medical expenditure was light. Effects of treatment and facilities was good. In case of Kwang-hwa, inquired gave high evaluation marks to the follow ing facts; facilities of medical institutions was not good, but the burden of medical expenditure was light. 5. After the implementation of medical insurance, the services was evaluated as good, but inquired hopec for lessening the burden of medical expenditure. 6. In case of exact understanding of cost-sharing, the evaluation rate in Kwang-hwa was higher than that of Kun-wi (p < 0.005). And positive attitude toward necessity of medical insurance was also good in Kwang-hwa (p < 0.05). 7. In case of inquired's attitude toward medical institutions, Kwang-hwa showed positive response (p < 0.05) 8. In the case of comparison between general medical institution and health care institution, two area showed similar positive response; medical manpower, facilities of medical institutions and effest: of treatement was good. 9. In comprehensive evaluation of benefit-service; the general medical institution's positiveness was higher than that of health care institutions in Kun-wi. But in Kwang-hwa vice-versa. 10. If the medical expenditure of general medical institution and health care institutions was equal 77% of inquireds in Kun-wi and 59.1% in Kwang-hwa answered that they chose general medical insurance. Considering results above mentioned, the conclusion of this study was made as follows. 1. In Kwang-hwa county, where the understanding of health care institutions's was good, the utilization's of health care institutions was shown high. Therefore, in case of Kwang-hwa, betterment: should be made to induce increasing utilization rate for negative factors of health care institutions. 2. In case of Kun-wi, where the understanding of health care institutions was on the decrease, measures for changing such negative factors should be taken by way of strengthening public relations. And cases of Kwang-hwa should also be studied. 3. On the side of financial stabilization and establishing health care delivery system, primary health care should be available. Therefore, the major cause of inhabitant's avoiding health care institutions should be known. And measures for activating that institutions have to be taken. So, the facilities of health care institution have to be improved up to the level of clinic. And supportive measures for securing equipment and improving health care services should also be taken. It is necessary that strategy for public relations should be employed with policy considerations and supports.

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농촌 지역 중소병원의 가정간호사업소 등록환자의 방문비용분석 (Cost Analysis of Home Nursing Care Patients in Rural Hospital)

  • 김진순;금란;황보수자
    • 농촌의학ㆍ지역보건
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    • 제24권1호
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    • pp.91-101
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    • 1999
  • 장 노년층 인구증가에 따른 건강문제의 다양화, 주민의 건강 요구증가에 부응하기 위해서는 기존의 의료기관 중심의 진료서비스 만으로는 새로운 건강문제를 충분히 해결할 수 없으므로 새로운 보건의료 제공 체계가 도입 되기에 이르렀다. 이미 선진국에서는 오랜 역사를 갖고 있는 가정간호사제도가 우리 나라에서도 입법화되어 1994년부터 병원중심의 가정간호사업이 시범적으로 운영되고 있다. 본 연구는 농촌지역의 중소병원에서 실시하고있는 가정간호사업소에 등록되어 있는 환자의 방문비용을 분석하는 것을 목적으로 실시되었으며, 1996년 5월 - 1997년 4월(1년간)까지 등록된 102명의 진료기록부를 분석하였다. 자료 분석 방법은 수준을 파악하기 위하여 평균과 분포로 분석하였으며 변수간의 차이점 등은 t - test와 ANOVA로 분석하였다. 분석 결과는 다음과 같다. 첫째, 등록환자의 일반적 특성은 남자가 44.1%, 여자가 55.9%로서 여자가 높았으며 연령은 60세 이상이 73.5%로서 노인 환자가 많았다. 둘째, 골다공증이 등록환자의 35.3%로서 제일 높았으며 각종 암이 21.6%, 뇌졸중이 14.7%로 나타나 연령과 관계가 깊은 것으로 나타났다. 질환특성은 복합질환, 즉 한가지 이상의 증상, 혹은 질환을 함께 갖고있는 경우가 73.5%로서 단순질환 26.5% 보다 높았다. 셋째, 남자 환자의 방문당 평균비용이 47,764원으로서 여자 환자의 46,078원 보다 높았다. 연령별로는 연령이 높아질수록 방문당 평균비용이 높은 것으로 나타났다. 성별과 연령별 비용은 통계학적으로 유의한 차이가 있는 것으로 나타났다. 넷째, 질환 특성별 비용은 단순질환이 복합 질환보다 방문당비용이 약간 높았으나 통계학적으로 유의한 차이가 없었으며, 질환별로는 COPD, 각종 암, 당뇨, 골다공증의 순으로 방문비용이 높게 나타났다. 다섯째, 가정간호의 방문비용이 질환으로 병원에서 치료받을 경우 보다 적게 나타나 비용효율이 있는 것으로 나타났다. 본 연구 결과는 제한된 자료를 분석한 것이므로 결과를 일반화시키는데 신중을 기할 필요가 있다. 그러나 가정간호사제도가 향후 정착되기 위해서는 가정간호 대상질환의 선정, 서비스내용 및 질, 비용효율 및 효과에 대한 평가가 계속 실시될 것을 제안한다.

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지역사회간호학 관련 논문 연구동향 분석 -학회지 발표 논문을 중심으로- (A Trend of Research in Community Health Nursing)

  • 이인숙;김윤아;최경원;진영란
    • 지역사회간호학회지
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    • 제12권1호
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    • pp.288-298
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    • 2001
  • This article makes an attempt to evaluate the extent of developing community health nursing knowledge and to suggest the direction of developing a body of knowledge henceforth through the results of analysis for contents and outcomes of all literatures. which have been published in the Journal related to community health nursing. Refer to the following for the result of this article. 1. The total number of literatures analyzed amounted to 100 pieces in Journal of community health nursing society. 78 in Journal of industrial nursing society, 134 in Journal of school health society. 40 in Journal of home care nursing society. 2. Journal of community health nursing society Health needs and educational-behavioral diagnoses, which are more concrete nursing assessments and diagnoses. formed the main current(54%) of articles published in Journal of community health nursing society since 1992. There was a quantitative growth as well as a qualitative advance. Through a classification by the type of a body of knowledge. It was found that the knowledge providing nursing practice with bases, commanded an overwhelming majority(71.8%). Also, Researches on systemic supports for nursing practice are showing a tendency to increase. 3. Journal of industrial nursing society 52.6% of research papers presented in Journal of industrial nursing society dealt with health problem of workers. assessment of risk factors, diagnosis of health behaviors. Because of the beginning of an industrial nursing, the domain of nursing management to establish the role and task, work condition, training. documentary system made up 23 percent of research, subjects. A knowledge providing nursing practice with bases have a majority, 69.2%. In addition. the subject concerning a systemic support and quality assurance was scarce but continuously presented. 4. Journal of school health society The major point of this journal is the identification of health problems and risk factors which belong to assessment and diagnosis domain(56.8%) regardless of year, Because of the interdisciplinary characteristic. The knowledge on quality assurance of nursing practice is relatively rare. But, articles related to a systemic support is plentiful. 5. Journal of home care nursing society In its infancy, there was a large number of papers concerning need assessment and diagnosis, Comparing others, this journal has introduced a good many of articles related to program management. delivery system. service fee, etc that belong to domain of systemic support for nursing practice. 6. It is showing definitely that quantity and extent of research have grown for a short period. See the analysis in terms of nursing process, studies related to the domain of assessment and diagnosis command an absolute majority regardless of kinds of journal. Although articles referring to program management and implementation is increasing in number, it is scarce to evaluate a nursing program and grope for an improvement. Also, program development based on a theoretical framework is little. Therefore much more scientific effort to ensure profession should be executed. 7. In the methodological aspect, longitudinal study needs to be carried out so that we could show the evidence based nursing theory. To develop a more general theory, we have to conduct a study of various subjects and improve a validity of tools through a repeat test. In addition, the effort for interdisciplinary cooperation is needed.

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간호 관리 능력 개발을 위한 교육 연구 (Needs on Management Development Program for Head Nurse)

  • 박정선
    • 가정∙방문간호학회지
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    • 제5권
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    • pp.84-99
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    • 1998
  • The objectives of this study are to identify the actual educational contents of management for head nurse and to propose the educational subjects according to identity the needs of head, charge, and staff nurses. The subjects were investigated the actual Management Development Programs and educational needs of head nurses and prospective nurse manager(charge nurse, staff nurse with a lot of clinical experiences) in general hospitals. The tools were composed of two questionnaires: One was developed from the literature review for making items to measure actual situation. The other was revised Katz's model for measurement of educational needs. The first respondents of actual situation were 27 general hospitals with over 400 beds in Seoul and the second respondents were 89 head nurses, 67 charge nurses and 136 nurses at 3 hospitals by convenient sampling out of 27 general hospitals. Data were collected by telephone interview, mail questionnaire and visiting from 7th of October through 30th of November in 1997. In data analysis, general characteristics of the respondents and actual status of Management Development Programs were analyzed by frequency and percentage. Educational needs according to general characteristics were analyzed by ANOVA The results were as follows: 1. Actual situation of Management Development Program 1) Seven hospitals(26%) had Management Development Program for prospective managers and 14 hospitals (52%) for head nurses. 2) Education Department existed in 14 hospitals (52%). 3) One hospital(4%) had top level managers took part in the Management Development. 4) Two hospitals selected head nurse, who had finished courses of Management Development. Eight hospitals(30%) assessed educational needs. The assessment tools consisted of making a question via questionnaire(75%), determining at department meeting(12%) and interview(13%). 5) Educational programs had 3 types: 10 lecture type, 7 discussion type and 4 role play type programs. 6) One hospital evaluated the change of learner's attitude. 7) Four hospitals scored educational point, but that was measured only by attending. 8) Actual Management Development Programs were as follows. parenthesis indicates the number of hospitals. (1) Management Development Programs for Prospective manager. Role perception of Middle level Manager (1) . Role reconstruction of Nurse Manager (1). Workshop for Charge Nurse (1). Nursing Delivery System and Nursing Process (1). Communication (1). Motivation (1) (2) Management Development Programs for Head nurse.. Head nurse's Role (5). Administrative Work (7). Service Education (4). Prevention and Countermeasure of Nursing Incidence (3). Appraisal (3) 2. The results of needs on Management Development subject 1) The educational needs of all respondents on 3 skill domains showed positive agreement to strongly positive agreement. 2) High priority(more than 4.5) items were 12 of 24 Human skill items(50%), 1 of 6 Technical skill items(16%), and 2 of 13 Conceptual skill items (15%). 3) Out of high priority items, 8 items were instituted. 4) All respondents showed high needs on 3 skill domains regardless of 3 positions (head nurse, charge nurse, and nurse). Educational needs of Human skill domain, according to position were 108. S, 108.7, 106.8 (mean score = 72) , needs of Technical skill domain were 26.5, 26.6, 26.I(mean score=18), and needs of Conceptual skill domains were 56.9,56.7, 55.1(mean score=39). 5) Needs of 3 skill domains according to clinical career showed significant difference. Out of respondents, nurses with career of over 16years showed lowest degree of needs in Human skill domains(F=4.47, P=.004) and Conceptual skill domain(F=2.93, P=.034). 6) Educational needs according to educational background were not significant difference. But out of respondents, nurses educated at 3-year junior college relatively showed lowest needs in all of the 3 skill domains. With the above-mentioned findings, further study is necessary for generalization of this study at hospitals with different bed size and location. Also it is needed to study about management skill of nurse and charge nurse, and effective educational method.

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부정기선 운임율의 결정에 관한 이론적 고찰 (A Study on the Determination of Tramp Freight Rates)

  • 이종인
    • 한국항해학회지
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    • 제4권2호
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    • pp.45-79
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    • 1980
  • The aim of this paper is to analyze the mechanics of price formation in the tramp shipping. For the purpose of this study, the main characteristics of tramp freight rates and the market is examined, and a brief examination of the nature ofthe costs of operation is given which are essential for the understanding of the functioning of shipping firms as well as for the understanding of developments in the tramp freight market. The demand and supply relationships in the market is also analysed in detail. Tramp shipping is an industry that has a market which functions under conditions that are not dissimilar to the theoretical model of perfect competition. However, it does notmean that tramp shipping market is a perfectly competitive market. It is apparent that this realworld competitive system has its imperfections, which means that the market for tramp shipping is near to being a perfectly competitive market on an internaitonal scale and it is freight are therefore subjext to the laws of supply and demand. In theory, the minimum freight rate in the short term is that at which the lowest cost vessels will lay-up in preference to operating, and is equal to the variable costs minus lay-up costs; and this would imply that in all times except those of full employment for ships there is a tendency for newer low-cost, and, probably, faster vessels to be driving the older high-cost vessels in the breaker's yards. In this case, shipowners may be reluctant to lay-up their ships becasue of obligations to crews, or because they would lose credibility with shippers or financiers, or simply because of lost prestige. Mainly, however, the decision is made on strictly economic grounds. When, for example, the total operating costs minus the likely freight earnings are greater than the cost of taking the ship out of service, maintaining it, and recommissioning it, then a ship may be considered for laying-up; shipowners will, in other words, run the ships at freight earnings below operating costs by as much as the cost of laying them up. As described above, the freight rates fixed on the tramp shipping market are subject to the laws of supply and demand. In other words, the basic properties of supply and demand are of significance so far as price or rate fluctuations in the tramp freight market are concerned. In connection with the same of the demand for tramp shipping services, the following points should be brone in mind: (a) That the magnitude of demand for sea transport of dry cargoes in general and for tramp shipping services in particular is increasing in the long run. (b) That owning to external factors, the demand for tramp shipping services is capable of varying sharphy at a given going of time. (c) The demad for the industry's services tends to be price inelastic in the short run. On the other hand the demand for the services offered by the individual shipping firm tends as a rule to be infinitely price elastic. In the meantime, the properties of the supply of the tramp shipping facilities are that it cannot expand or contract in the short run. Also, that in the long run there is a time-lag between entrepreneurs' decision to expand their fleets and the actual time of delivery of the new vessels. Thus, supply is inelastic and not capable of responding to demand and price changes at a given period of time. In conclusion, it can be safely stated that short-run changes in freight rates are a direct result of variations in the magnitude of demand for tramp shipping facilities, whilest the average level of freight rates is brought down to relatively low levels over prolonged periods of time.

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분만관련 불가항력적 의료사고 보상제도에 있어 분담금부과에 관한 연구 -헌법재판소 2018. 4. 26. 선고 2015헌가13 사건을 중심으로- (A Study on Imposing Contribution in the Compensation for Uncontrollable Medical Malpractice during Delivery)

  • 범경철
    • 의료법학
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    • 제19권2호
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    • pp.139-171
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    • 2018
  • 「의료사고 피해구제 및 의료분쟁 조정 등에 관한 법률」(이하 '의료분쟁조정법'이라 한다)에서는 보건의료인이 충분한 주의의무를 다하였음에도 불구하고 분만 중 불가항력적으로 발생한 의료사고에 대하여 국가가 예산의 범위 안에서 그 피해자에게 보상하도록 하고 있다(의료분쟁조정법 제46조). 지금까지 의료사고 피해자가 소송을 통해서만 피해회복을 기대할 수 있었던 것에 비한다면 획기적인 법률이라 할 수 있다. 그런데, 이러한 의료사고보상사업에 드는 비용의 100분의 30은 보건의료기관개설자 중 분만 실적이 있는 자가 부담하고 있는 바(의료분쟁조정법 시행령 제21조), 이 분담금 부과 조항이 분만 과정에서의 산모·신생아 사망 등의 사고가 의사의 과실이 없이 불가항력적으로 발생했음에도, 의사들에게 책임을 묻는 것은 아닌지 문제가 되어 왔다. 그러나 최근 헌법재판소에서 분담금 부과와 관련한 의료분쟁조정법법 제46조 제3항 중 '보건의료기관개설자의 범위' 및 '보상재원의 분담비율' 부분에 대하여 합헌 결정을 내린 바 있다(헌법재판소 2018. 4. 26. 선고 2015헌가13 결정, 이하 '이 사건 결정'이라 한다). 이 사건 결정에서는 법률유보원칙 및 포괄위임입법금지원칙에 의하여만 판단하였으나, 본고에서는 실질적인 판단도 가미하였다. 이 사건 분담금운 과잉금지원칙에 비추어 보더라도 보건의료기관개설자들의 재산권을 침해하지 않는 점을 논증하였다. 불가항력 의료보상제도의 분담금 부과가 민사책임의 중요 원칙인 과실책임원칙에 거스르는 측면이 존재한다. 그러나 의료사고보상사업은 의료사고 피해자를 위한 국가정책으로 합리성이 있으며, 동시에 의료분쟁의 조기종결 효과로 의료계 역시 이익을 얻는 측면이 분명 존재한다. 분담금의 납부를 통한 보상재원의 확충은 이러한 의료사고보상제도를 빠르게 정착시킴으로서 분만과정에서 발생한 의료사고 피해자의 고통과 오해를 경감시키고 의료인의 안정적 진료환경 구축에 큰 도움이 될 것이다.

자율 주행을 위한 Edge to Edge 모델 및 지연 성능 평가 (Edge to Edge Model and Delay Performance Evaluation for Autonomous Driving)

  • 조문기;배경율
    • 지능정보연구
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    • 제27권1호
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    • pp.191-207
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    • 2021
  • 오늘날 이동통신은 급증하는 데이터 수요에 대응하기 위해서 주로 속도 향상에 초점을 맞추어 발전해 왔다. 그리고 5G 시대가 시작되면서 IoT, V2X, 로봇, 인공지능, 증강 가상현실, 스마트시티 등을 비롯하여 다양한 서비스를 고객들에게 제공하기위한 노력들이 진행되고 있고 이는 우리의 삶의 터전과 산업 전반에 대한 환경을 바꿀 것으로 예상되고 되고 있다. 이러한 서비스를 제공하기위해서 고속 데이터 속도 외에도, 실시간 서비스를 위한 지연 감소 그리고 신뢰도 등이 매우 중요한데 5G에서는 최대 속도 20Gbps, 지연 1ms, 연결 기기 106/㎢를 제공함으로써 서비스 제공할 수 있는 기반을 마련하였다. 하지만 5G는 고주파 대역인 3.5Ghz, 28Ghz의 높은 주파수를 사용함으로써 높은 직진성의 빠른 속도를 제공할 수 있으나, 짧은 파장을 가지고 있어 도달할 수 있는 거리가 짧고, 회절 각도가 작아서 건물 등을 투과하지 못해 실내 이용에서 제약이 따른다. 따라서 기존의 통신망으로 이러한 제약을 벗어나기가 어렵고, 기반 구조인 중앙 집중식 SDN 또한 많은 노드와의 통신으로 인해 처리 능력에 과도한 부하가 발생하기 때문에 지연에 민감한 서비스 제공에 어려움이 있다. 그래서 자율 주행 중 긴급 상황이 발생할 경우 사용 가능한 지연 관련 트리 구조의 제어 기능이 필요하다. 이러한 시나리오에서 차량 내 정보를 처리하는 네트워크 아키텍처는 지연의 주요 변수이다. 일반적인 중앙 집중 구조의 SDN에서는 원하는 지연 수준을 충족하기가 어렵기 때문에 정보 처리를 위한 SDN의 최적 크기에 대한 연구가 이루어져야 한다. 그러므로 SDN이 일정 규모로 분리하여 새로운 형태의 망을 구성 해야하며 이러한 새로운 형태의 망 구조는 동적으로 변하는 트래픽에 효율적으로 대응하고 높은 품질의 유연성 있는 서비스를 제공할 수 있다. 이러한 SDN 구조 망에서 정보의 변경 주기, RTD(Round Trip Delay), SDN의 데이터 처리 시간은 지연과 매우 밀접한 상관관계를 가진다. 이 중 RDT는 속도는 충분하고 지연은 1ms 이하이기에 유의미한 영향을 주는 요인은 아니지만 정보 변경 주기와 SDN의 데이터 처리 시간은 지연에 크게 영향을 주는 요인이다. 특히, 5G의 다양한 응용분야 중에서 지연과 신뢰도가 가장 중요한 분야인 지능형 교통 시스템과 연계된 자율주행 환경의 응급상황에서는 정보 전송은 매우 짧은 시간 안에 전송 및 처리돼야 하는 상황이기때문에 지연이라는 요인이 매우 민감하게 작용하는 조건의 대표적인 사례라고 볼 수 있다. 본 논문에서는 자율 주행 시 응급상황에서 SDN 아키텍처를 연구하고, 정보 흐름(셀 반경, 차량의 속도 및 SDN의 데이터 처리 시간의 변화)에 따라 차량이 관련정보를 요청해야 할 셀 계층과의 상관관계에 대하여 시뮬레이션을 통하여 분석을 진행하였다.