• Title/Summary/Keyword: 의료비 통계

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Effect of Multidisciplinary Emergency Consultation System for Drug Intoxicated Patients (응급실을 내원한 약물중독 환자에 대한 다학제 응급협진체계의 효과 검증)

  • Kang, Jino;Kim, Hye Ri;Min, Kyungjoon;Kim, Na Ryoung;Heo, Yoon Kyung;Kim, Sun Mi
    • Korean Journal of Psychosomatic Medicine
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    • v.27 no.2
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    • pp.130-137
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    • 2019
  • Objectives : When a patient who attempts suicide visits the emergency room, it is important that the departments of emergency medicine, internal medicine, and psychiatry communicate with each other and prioritize treatment. This study was conducted to verify the effectiveness of the multidisciplinary emergency consultation system (ECS) for drug intoxicated patients. Methods : We retrospectively analyzed the data from medical records prior to the ECS, from July 2017 to May 2018, and after the ECS, from July 2018 to May 2019, to verify the effectiveness of the system. Results : After the ECS, admission to open wards was significantly higher than to the intensive care units (χ2=8.567, p=0.014). In addition, the proportion of consultations to the department of psychiatry among patients admitted to other departments tended to increase (χ2=4.202, p=0.053), and the time required for consultation response decreased (Z=-2.031, p=0.042). As a result of the consultation, the proportion of the patients who had been transferred to the department of psychiatry was increased (χ2=4.692, p=0.043), and the time spent to transfer tended to decrease (Z=-1.941, p=0.052). Conclusions : After implementing the ECS for drug intoxicated patients, unnecessary intensive care unit admissions, consultation response time, and the time spent to transfer were reduced, and the rate of consultation referrals and transfer rates increased. This means that the multidisciplinary consultation system rapidly provided essential medical services to patients at lower medical costs.

Factors Influencing Problem Solving Ability among Dental Hygiene Students (일부 치위생과 학생의 문제해결능력에 영향을 미치는 요인)

  • Yu, Ji-Su;Hwang, Su-Hyun;Choi, Yu-Jin
    • Journal of dental hygiene science
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    • v.13 no.4
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    • pp.510-517
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    • 2013
  • This study was carried out in order to be utilized as basic data necessary for developing dental hygiene curriculum by confirming the difference in propensity level and the variables of having influence upon problem-solving ability of dental hygiene students and by grasping influence of relevant variables at the point of time that requires arrangement of a learning system for promoting problem solving ability aiming to train talents who have ability available for performing successful practical affairs. The influence of factors upon the problem solving ability had statistically significant relationship with academic year, interpersonal relations, school record, and major satisfaction. According to academic year, the problem solving ability of sophomore (B=-0.182, p=0.010) was shown the lower tendency than junior. The problem solving ability was lower in when being bad (B=-0.349, p=0.020) compared to when being good as for interpersonal relations, in when the mark is under 3.0 (B=-0.328, p=0.004) than over 4.0 as for academic achievement, and in when being dissatisfied (B=-0.483, p=0.005) than when being satisfied as for the major satisfaction. Hence, to train competent people who have ability available for performing successful practical affairs, the education is considered to be likely needed that has substantial problem solving ability for reinforcing problem solving ability by grasping a learning problem oneself without the differentiated curriculum, by establishing an alternative plan for solving problem, and by searching for and acquiring necessary data according to factors of having influence upon problem solving ability of dental hygiene students.

A Study of on the Method to Select Manufacturing Activities Sensitive to Regional Characteristics by Analyzing the Locational Hierarchy (입지계층분석을 활용한 산업단지 유치 업종 결정에 관한 연구)

  • So, Jin-Kwang;Lee, Hyeon-Joo;Kim, Sun-Woo
    • Land and Housing Review
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    • v.2 no.4
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    • pp.559-568
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    • 2011
  • This study aims at listing up those manufacturing activities sensitive to regional characteristics by analyzing locational hierarchy designed on the urban rank-size rule. This locational hierarchy by manufacturing activities is expected to provide a ground for the proper supply of an industrial complex. The analysis of the locational hierarchy by manufacturing activities can work as a method of observing the characteristics of the distribution of location for each economic activity by analyzing the trend in the change of manufacturing location. Consequently, it can be used to determine the appropriate manufacturing activities for the industrial complex of a particular region. Here, the locational hierarchy is analyzed depending on the base of the basic local government such as Gun(district level) and Si(city level), and manufacturing activities are categorized by Korea Standard Industry Code. Those activities demonstrating growth pattern are Manufacture of Electronic Equipment(KSIC 26), Manufacture of Medical Precision Optical Instruments Watch(KSIC 27), Manufacture of Motor Vehicles (KSIC 30, 31), etc. With proper infrastructures, these activities can be located everywhere. Those sectors on the decline pattern in the locational hierarchy can be summarized as Manufacture of Tobacco Products(KSIC 12), Manufacture of wearing apparel Fur Articles(KSIC 14), etc. Those sectors scattered widely in the locational hierarchy are Manufacture of Food Products(KSIC 10), Manufacture of Coke Petroleum Products(KSIC 19), Manufacture of Chemical Products(KSIC 20), Manufacture of Electronic Equipment(KSIC 26). These particular manufacturing activities can be operated in those regions in a sufficient supply of unskilled workers regardless of proper infrastructures. Those activities that have a tendency to reconcentrate on larger cities are Manufacture of Textiles(KSIC 13), Manufacture of Wearing Apparel Clothing Fur Articles(KSIC 14), Manufacture of Other Transport Equiptmen(KSIC 31). In most cases, these sectors tend to favor their existing agglomerated areas and concentrate around large cities. Therefore, it is inefficient to promote these sectors in small or medium-sized cities or underdeveloped regions. The establishment of developmental strategies of an industrial complex can gain greater competitiveness by observing such characteristics of the locational hierarchy.

A Study on the Mitigation of Nitrous Oxide emission with the Horticultural Fertilizer of Containing Urease Inhibitor in Hot Pepper and Chinese Cabbage Field (고추와 배추 재배지에서 요소분해효소 억제제 함유 원예용 비료 시용에 따른 아산화질소 배출 저감 효과)

  • Ju, Ok Jung;Lim, Gap June;Lee, Sang Duk;Won, Tae Jin;Park, Jung Soo;Kang, Chang Sung;Hong, Soon Sung;Kang, Nam Goo
    • Korean Journal of Environmental Agriculture
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    • v.37 no.4
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    • pp.235-242
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    • 2018
  • BACKGROUND: About 81% of nitrous oxide ($N_2O$) emissions from agricultural land to the atmosphere is due to nitrogen (N) fertilizer application. Mitigation of $N_2O$ emissions can be more effective in controlling biochemical processes such as nitrification and denitrification in the soil rather than decreasing fertilizer application. The use of urease inhibitors is an effective way to improve N fertilizer efficiency and reduce $N_2O$ emissions. Several compounds act as urease inhibitors, but N-(n-butyl) thiophosphoric triamide (NBPT) has been used worldwide. METHODS AND RESULTS: Hot pepper and chinese cabbage were cultivated in five treatments: standard fertilizer of nitrogen-phosphorus-potassium(N-P-K, $N-P_2O_5-K_2O$: 22.5-11.2-14.9 kg/ha for hot pepper and $N-P_2O_5-K_2O$: 32.0-7.8-19.8 kg/ha for chinese cabbage), no fertilizer, and NBPT-treated fertilizer of 0.5, 1.0, and 2.0 times of nitrogen basal application rate of the standard fertilizer, respectively in Gyeonggi-do Hwaseong-si for 2 years(2015-2016). According to application of NBPT-treated fertilizer in hot pepper and chinese cabbage, $N_2O$ emission decreased by 19-20% compared to that of the standard fertilizer plot. CONCLUSION: NBPT-treated fertilizer proved that $N_2O$ emissions decreased statistically significant in the same growth conditions as the standard fertilization in the hot pepper and chinese cabbage cultivated fields. It means that NBPT-treated fertilizer can be applied for N fertilizer efficiency and $N_2O$ emissions reduction.

Hospice Volunteer's Perception of Death (호스피스 자원 봉사자들의 죽음 인식에 관한 연구)

  • Lee, Won-Hee;Lee, Young-Ja
    • Journal of Hospice and Palliative Care
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    • v.2 no.2
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    • pp.101-108
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    • 1999
  • Purpose : The purpose of this study was to identify hospice volunteers' perception of the death. Methods : This study was conducted with 327 adults who registered for the hospice volunteer education program in Severance Hospice Center from 1996 through 1999. The 4-years data was collected through a self-reporting questionnaire constructed and revised by the authors. The questionnaire was classified into 5 categories. The data collected were analyzed using SPSS/W. Results : 1) Hospice volunteers were mostly female(93.9%) with an average age of 48 years. The majority(82.6%) of the participants were Protestant. 2) From the 4-years data over 90 percent of participants thought of death as a process of life and responded positively to these three items : 'Death is a temporary separation from family', 'I will die in peace', 'Faith in God results in a freedom from fear of death'. 3) Age were statistically relevant to the following items: 'I often read the obituaries in the newspaper', 'Dying is a tragedy', and 6 items were significantly related to religion: 'I rarely think of dying unexpectedly', 'Death is a temporary separation from family'. 'Dying is a tragedy', 'We have to do our best to prolong life by use of modem medical technology', 'I feel comfortable thinking of death and dying, 'Faith in God results in a freedom from fear of death'. The finding that religiosity was related to perception of death is consistent with other reports. And $40{\sim}50$ year old Protestant women had more positive perception of death than $20{\sim}30$ year old women. Conclusion : The findings indicated an importance of considering the age and religiosity when we educate the hospice volunteers. And that will be a important basic-data to develope program for hospice volunteers.

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Risk Factors for Lymphedema Patients (림프부종 환자에서의 위험 인자)

  • Jung, Gyou-Chul;Kim, Sun-Hyun;Yeom, Chang-Hwan
    • Journal of Hospice and Palliative Care
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    • v.8 no.2
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    • pp.156-162
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    • 2005
  • Purpose: Lymphedema is edema developing mainly in the arms and legs due to an abnormal lymphatic system, over one hundred millions of patient worldwide suffer from it. At present, prevention is the best treatment. Thus, It is important to know which patient are more pone to develop it in order to prevent it. By evaluating the risk factor for lymphedema, we intended to find the effective prevention. Methods: We have investigated that outpatients who chiefly complained of lymphedema visited the lymphedema clinic at one university hospital from September 1 in 2003 to August 31 in 2005. We evaluated the risk factor for lymphedema by questionnaires. Questionnaire consists of demographic data, disease factor, treatment factor, posttreatment factor. We evaluated the correlation between lymphedema with each factor. Results: The total number of patients was 50, 19 patients with breast cancer and 31 patients with cervical cancer. In terms of stages of edema, 12 patients were below stage 1 and 38 patients were above stage 2. The incidence of lymphangitis was more frequent, more obese and the impairment of the site of edema site more severe, the stage of cancer was higher in the patients higher than stage 2 than in the patients below stage 1 (P>0.05). Conclusion: Lymphedema is more severe when the cancer stage in higher, accompanying more frequent infections, more obesity and more impairment at the site of edema site. Above all, cancer stage and the impairment of edema site are impossible to correct but obesity and infection may be corrected. Therefore we speculate that we are able to protect the aggravation of edema by weight reduction and infection control.

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Nursing Need and Satisfaction of Patients in Hospice Ward (호스피스병동 입원 환자의 간호요구도와 간호만족도)

  • Kim, Jung Ah;Kim, Kyunghee;Kang, Hee Sun;Kim, Ji-Su
    • Journal of Hospice and Palliative Care
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    • v.17 no.4
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    • pp.248-258
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    • 2014
  • Purpose: This study was conducted to explore the nursing needs and satisfaction of patients who are hospitalized at hospice palliative care institutions. Methods: This study included 80 hospice patients who were in-patients of the hospice department of two general hospitals in S city. The collected data were analyzed by descriptive statistics, t-test, one-way ANOVA, and Pearson's correlation coefficients using the IBM SPSS 20.0 program. Results: The mean score of nursing needs and satisfaction were 3.58 (${\pm}0.31$) and 3.25 (${\pm}0.20$) respectively. Significant differences in hospice nursing needs and satisfaction were observed in terms of general characteristics including gender, education level, occupation, religion, support for medical expense and functional status. Significant positive correlation was found between the overall nursing needs and nursing satisfaction. Conclusion: Based on the results of this study, in order to improve the quality of hospice service, further study is necessary in a comprehensive manner to develop nursing intervention to meet physical, psychological/social, spiritual, and educational/referral nursing needs of hospice in-patients.

NEED FOR DEVELOPMENT OF HOME HEALTH NURSING PROGRAM IN KOREA (가정 간호 사업에 관한 연구)

  • Ruth M. Virginia;Moon Jung Soon
    • Journal of Korean Public Health Nursing
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    • v.5 no.1
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    • pp.53-69
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    • 1991
  • 가정간호사업 도입에 대한 대상자의 필요성에 대한 인식을 알아보고자, 1988년 7월 1일부터 동년 8월말까지 서울시내 5개 대학병원에서 퇴원하는 환자 390명과 환자 보호자 380명, 주민 780명, 총 1550명을 대상으로 조사한 결과 다음과 같은 결론을 얻었다. 1. $81\%$의 대상자가 가정간호 사업 도입이 필요하다고 한 반면 $7.5\%$는 필요 없다고 하였으며, $11.5\%$는 잘 모르겠다고 하였다. 필요성 인식 율은 주민이 $83\%$, 환자보호자가 $79\%$, 환자가 $78\%$로서 세 집단 간에 유의한 차이 가 있었다. (P<.01). 인구학적 변수별로 보았을 때, 교육수준과 가정수입에 따라 인식 율에는 유의한 차이가 있어서 (P<.001, P<.01), 교육수준이 높을수록, 수입이 많을수록 높았다. 2. 필요성 인식 율은 가정간호사업 이용의사에 따라서도 유의한 차이가 있어서 (P<.001), 이용의사가 많은 군이 인식 율도 높았다. 3. 환자들의 필요성 인식 율은 퇴원시기에 대한 의견과 병원비 지출액에 따라 유의한 차이가 있어서 (P<.05, P<.02), 퇴원시기가 적절하다는 군이 부적절, 하다는 군보다, 또한 병원비 지출액이 적을수록 인식 율이 높았다. 진단명에 따라서는 피부 및 피하조직 진환$(100\%)$, 임신 및 출산에 관련된 합병증$(90\%)$, 신경 및 감각기계 질환$(85\%)$, 부상 및 중독$(83\%)$, 신생물$(79\%)$, 등에서 필요성 인식 율이 높았다. 4. 가정간호사업 이용에 대한 대상자의 의견을 $47.8\%$가 이용할 의사가 있었고, $49.9\%$는 상황에 따라 결정하겠다고 하였으며, $3.2\%$는 이용하지 않겠다고 응답하였다. 인구학적 변수별로 보았을 때, 연령별로는 노년층, 성별로는 남성이, 교육수준은 낮은 군이, 의료보험을 가진 군이 이용할 의사가 많았으며, 통계적으로 유의한 차이가 있었다. (P<.01, p<.001, p<01, p<.01). 5. 환자들의 가정간호사업 이용 의사는 퇴원시의 상태에 따라서 유의한 차이가 있어서 (P<.02), 상태 가 입원 시와 변화가 없거나 악화된 군이 이용할 의사가 많았다. 진단별로는 내분비계 질환$(63\%)$, 신생물$(57\%)$, 혈액 및 조혈기능 장애$(55\%)$, 부상 및 중독$(55\%)$, 등이 이용할 의사가 많았다. 6. 대상자들이 가정간호사업의 장점으로 생각하는 것은 환자의 심리적 안정$(66\%)$, 시간 절약$(57\%)$, 가족의 편이$(57\%)$, 환자 간호에 대해 배운다$(53\%)$, 질병 과정을 배운다$(51\%)$ 등이었다. 7. 대상자들이 가정간호사업의 단점으로 생각하는 것은 응급시에 대처하기가 어렵다$(49\%)$, 환자가 불안해 할 것이다$(41\%)$ 가정환경이 환장에게 부적합하다$(43\%)$ 등이었다. 8. 가정간호사업에서 수용할 수 있는 간호 업무로$50\%$ 이상의 대상자가 지정한 것은 활력징후측정, 경구 및 비경구 투약, 운동과 휴식지도, 개인 위생관리, 보건교육, 정신 심리 간호 등이었다. 9. 가정간호사업에 대한 지불방법은 $32.9\%$가 제공된 업무에 따라 지불해야 한다는 의견으로 가장 많았다.

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A Pilot Study on Korean Version Development of the Rearing Knowledge and Practice for Infant Parents (부모의 양육지식과 실천 도구 개발 예비연구)

  • Kim, Kyeong Uoon
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.18 no.12
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    • pp.485-493
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    • 2017
  • Rearing knowledge is a significant factor of relevance for rearing practice, and assessment of rearing knowledge and practice is important for infant parents. The author adopted the Child Rearing Knowledge Scale (CRKS) and Child Rearing Practice Scale (CRPS) that were developed and validated by Saramma & Thomas. According to the international linguistic validation process, pilot testing was done based on 20 infant's mothers in one Oketani massage center and one public health center. Descriptive statistic methods and Wilcoxon Rank Sum Test were employed to evaluate the level and compare the mean score according to general characteristics of subjects of the tools. Reliability and validity were tested by Cronbach's alpha and Spearman Correlations. The mean age of the subjects was 33.94 (${\pm}2.99$) years and the mean age of babies was 3.35 (${\pm}0.58$) months. The understanding level of the Korean version of the CRKS and CRPS was 1.80 (${\pm}0.65$) and 1.33 (${\pm}0.54$), respectively. In addition, the CRKS and CRPS were relatively easy to use. The mean score of the CRKS was 22.50 (${\pm}4.89$), which was a moderate score, while the mean score of the CRPS was 30.75 (${\pm}2.04$), which was high. The Cronbach's alpha values of the CRPS were as follows: feeding, 0.71; growth and development, 0.64; cleaning and protection 0.68; infant stimulation, 0.77. There was a significant correlation between infant stimulation of the CRPS and growth and development of the CRKS (r=0.530, p=0.016). The CRKS score of medical staff was significantly higher than that of non-medical staff (p=0.04). The CRKS and CRPS are expected to be used in clinical or community care practice as easy-to-use tools that are easy to respond to.

Strategic Orientation of Rural Hospitals in the U.S.A. -Implications for Korean Rural Hospitals-

  • Seo, Young-Joon;Robert L. Ludke;Ko, Jong-Wook
    • Health Policy and Management
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    • v.6 no.1
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    • pp.163-190
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    • 1996
  • 본 논문은 미국 농촌병원의 경영전략과 관련하여 몇가지 가설을 검증한 연구결과이다. 구체적으로 1987년부터 1991년 사이의 미국 농촌병원들의 기본적 경영전략 지향 형태와 변화 추세, 경영전략과 환경 및 병원특성과의 관계, 그리고 경영전략과 재정적 성과의 관계 등이 연구되었다. 본 연구의 자료수집은 미국 농촌지역의 모든 종교병원과 영리병원, 그리고 무작위 표본추출로 뽑힌 50%의 공공병원 및 기타 비영리 병원의 최고경영자를 대상으로 1989년에 우편설문조사를 통해 이루어졌으며 회수된 설문지 중 사용가능한 640개 병원 (응답율 43%)의 자료가 분석 이용되었다. 조사대상병원의 환경적 특성자료는 지역자원 파일(Area Resource File)에서 수집하였고, 병원특성 및 재정적 성과자료는 미국병원협회 연감(Annual Survey of Hospitals)에서 구하였다. 응답병원과 비응답병원간에 환경 및 병원특성에 유의한 차이는 없는 것으로 나타났다. 본 연구에서는 Miles와 Snow가 개발한 방어형(defender), 분석형(analyzer), 진보형(prospector), 반응형(reactor)의 네가지 경영전략지향 형태를 사용하여 분석하였다. 본 연구의 결과를 요약하면 다음과 같다. 1) 미국 농촌 병원들은 과거에는 방어형 및 분석형의 경영전략 지향을 보이다가 점차 반응형과 진보형으로 변화해 가고 있다. 2) 가장 뚜렷한 경영전략 지향의 변화추세는 방어형이 급격히 줄고 반응형이 크게 늘어나고 있다는 점이다. 이는 많은 병원들이 급격한 환경변화에 적응하기 위해 일관된 전략 지향보다 융통성 있고 탈력적인 경영전략을 선호하고 있음을 나타낸다. 3) 농촌병원들은 경영전략의 급격한 변화를 추구하지는 않을 것이라는 가설을 뒷받침할 근거는 없는 것으로 나타났다. 이는 급격한 의료환경의 변화로 인해 병원들이 다양한 경영전략의 변화를 모새하고 있는 것으로 볼 수 있다. 4) 대부분의 외부환경 및 병원특성은 병원의 전략지향의 선택에 큰 영향을 미치지 않는 것으로 나타났으나 인구 10,000명당 의사수, 병상규모, 위탁경영 여부, 병상점유율, 소유형태 등의 변수들이 경영전략 지향 형태에 따라 유의한 차이가 있는 것으로 나타났다. 5) 경영전략 지향이 상이한 병원들은 세부 실천전략에 있어서도 치이가 있을 것이라는 가설을 일부 전략에 있어서 사실인 것으로 나타났다. 즉 방어형 병원들은 진보형이나 반응형 병원들보다 내부관리전략, 다양화 전략, 의사유치전략, 직원복지전략 등에 있어서 소극적인 것으로 나타났다. 6) 비록 방어형 병원들이 다른 형태의 병원보다 낮은 재정적 성과를 보이고 있었지만 본 연구의 자료로는 경영전략지향과 재정적 성과간의 인과관계를 구명할 수 없었다. 또한 재정적성과에 따른 전략지향의 변화여부도 통계적으로 유의한 관계가 있지는 않은 것으로 나타났다. 이는 각각의 전략지향들이 환경에 따라 나름대로 장점을 가질 수 있으며 반드시 어느 한가지의 전략지향만이 최선은 아님을 시사해주고 있다. 7) 병원의 경영전략 변화는 환경의 변화와 더블어 그러한 변화에 적응할 수 있는 내부의 능력과도 관계가 있는 것으로 보인다. 이상의 연구결과에 따르면 미국의 농촌병원들은 급격한 환경변화에 적응하기 위하여 다수의 병원들이 환경 및 벼원특성에 관계없이 생존을 위한 전략적 노력을 기울이고 있음을 알 수 있다. 끝으로 이러한 연구결과는 최근 어려운 경영환경에 처한 한국의 농촌병원들도 합리적인 경영을 위해서는 병원이 처한 외부환경분석과 함께 내부의 능력에 적합한 경영전략의 방향을 설정하고 그에 따른 실천적 세부 경영전략을 수립해야만 한다는 것을 시사해 주고 있다.

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