• 근관절건강학회지
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• 제7권1호
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• pp.102-130
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• 2000

The aims of this study were to understand and to predict the determinant factors affecting the exercise behaviors and physical fitness by testing the Ponder's health promotion model, and to help the patients with rheumatoid arthritis and osteoarthritis perform the continuous exercise program, and to help them maximize the physical effect such as muscle strength. endurance, and fuctional status and mental effects including self efficacy and quality of life, and improve the physical and mental wellbeing, and to provide a basis for the nursing intervention strategies. We analyzed the clinical records of 208 patients with rheumatoid arthritis and degenerative arthritis who visited the outpatient clinics at H university hospital in Seoul between October 5, 1999 and October 24, 1999. Data were composed of self reported questionnaire and good of fitness score which were obtained by pedalling the ergometer of bicycle for 9 minutes. SPSS Win 8.0 and Window LISREL 8.12a were used for statistical analysis. 24 Of 54 hypothetical paths were supported in modified model, which was considered as a proper model with improved fit index. The physical fitness was directly influenced by exercise participation behavior and education level, and indirectly by physical fitness, while fatigue, physical disability, pastexercise behavior, life-style, self-efficacy, which explained 20% of physical fitness. The exercise participation were directly influenced by perceived benefits and self-efficacy, and indirectly influenced by life-style, fatigue and physical disability, and directly and indirectly by past exercise behavior, which explained 53% of exercise participation. Exercise score were directly affected by perceived health status, perceived benefits, self efficacy, and past exercise behavior, and were indirectly affected by fatigue, physical disability, and life-style, which explained 50%. Perceived health status were directly influeced by level of education, depression, sleep disorder, and physical disability, which explained 34% of perceived health status. Perceived benefit was directly influenced by fatigue, sleep disorder, physical disability, and life-style, which explained 45%. Perceived barriers was directly influenced by fatigue, sleep disorder, and lifestyle, which explained 9%. Self- efficacy was directly influenced by fatigue, physical disability, past exercise behavior, and level of education, which explained 61%. In conclusion, important variables for physical fitness were exercise participation and level of education, and variables affecting exercise participation were perceived self-efficacy, benefits, and past exercise behavior. Perceived self-efficacy of exercise was a significant predictor of exercise participation. Life-style, fatigue, and physical disability showed direct effects on perceived benefit, perceived barriers, and self-efficacy, and indirect effects on exercise behavior. Therefore, disease related factor should be minimized for physical performance and well being in nursing intervention for patients with rheumatoid arthritis, and plans to promote and continue exercise should be soaked to reduce disability. In addition, Exercise program should be planned and performed by the exact evaluation of exercise according to the ability of the patients and the contents to improve the importance of exercise and self efficacy in self control program, dedicated educational program should be involved.

• 의료법학
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• 제16권1호
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• pp.221-254
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• 2015

개정된 민법은 2013년 7월 1일부터 시행되고 있다. 개정된 민법에서 가장 중요한 것은 성년후견제도 이다. 100개 이상의 조문이 개정되었으며, 개정된 민법은 후견인이 필요한 사람들의 다양하고 복잡한 요구를 충족시카는 체계와 적법한 절차를 마련하였다. 새로운 성년후견제도는 피성년후견인의 보호를 위해 그들의 자율성을 지켜주고 공적인 개입을 최소화함으로써 피성년후견인의 존엄성과 인권을 존중하려고 했다. 새로운 성년후견제도는 세 가지 종류의 법정후견제도를 가지고 있다(성년후견제도, 한정후견제도, 특정후견제도). 정신질환자는 정신보건법에 의해 입원이 이루어지고 이때 정신질환자는 동의능력이 없는 것으로 대부분 여겨지지만 원칙적으로 정신질환자는 동의능력을 가지고 있는 경우가 있다. 정신질환자와 후견인 사이에 이해상충이 발생할 경우 정신질환자의 동의가 우선된다. 정신질환자가 동의능력이 없는 경우에만 후견인의 동의에 의해 의료행위를 할 수 있는 것이 타당하다. 그러나 정신질환자가 동의능력이 없는 경우에는 후견인에 의해 문제가 발생할 경우에는 후견감독인을 두어 후견인에 대한 감독을 해야 한다. 결론적으로 정신질환자라고 하여 입원에 대한 동의능력을 상실한 것은 아니며 우리는 정신질환자의 동의범위에 대해 구체적으로 논의해야 한다. 따라서 개정 민법에 따라 정신보건법 개정이 필요하다.

• 의료법학
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• 제18권1호
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• pp.3-35
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• 2017

우리나라에서는 1979년 대법원이 처음 설명의무 위반으로 인한 손해배상을 인정하였고, 그 후 판례를 통해서 설명의무의 구체적 내용이 형성 발전되어 오고 있다. 의사의 설명의무는 헌법 제10조와 진료계약상의 의무에 근거하고 있고, 보건의료기본법 제12조 및 개별 법률에서도 설명의무에 관한 내용을 규정하고 있다. 그런데, 2016. 12. 20. 개정된 의료법 제24조의2에 설명의무에 관한 규정이 신설되었고, 개정 의료법은 2017. 6. 21.부터 시행될 예정이다. 개정 의료법에 따르면, 설명의무의 대상이 되는 의료행위는 '사람의 생명 또는 신체에 중대한 위해를 발생하게 할 우려가 있는 수술, 수혈, 전신마취'이다. 이러한 의료행위를 할 때에는 반드시 사전에 법정사항이 기재된 서면으로 설명을 하고 동의를 받아야 한다. 만약, 이를 위반하면 300만원 이하의 과태료 처분을 받게 된다. 개정 의료법의 내용과 학설 및 판례를 통해서 인정되어 온 설명의무에 관한 기존 법리를 비교 검토해 보면, 양자 간에 상당한 차이가 있음을 확인할 수 있다. 그에 따라 개정의료법의 시행 이후에도, 기존 설명의무에 관한 법리는 크게 영향을 받지 않을 것으로 보인다. 그러나, 동일한 사안에서 설명의무 위반 여부에 관한 판단이 민사상 손해배상사건과 의료법 위반으로 인한 과태료처분사건에서 서로 달라지는 것은 법적 안정성이나 법질서 전체 통일의 관점에서 바람직하지 않다. 개정 의료법상의 설명의무에 관한 내용을 기존 법리에 맞게 수정하거나 독일의 경우와 같이 진료계약의 내용에 포함시켜 민법에서 규율하는 것이 바람직하다고 생각한다.

• 대한간호학회지
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• 제29권3호
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• pp.605-613
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• 1999

The main purposes of this study were to determine the time interval between the onset of symptoms of myocardial infarction and treatment-seeking time and to identify the factors related to the interval time. This study used a retrospective design. The sample consisted of 45 patients aged over 30 who were diagnosed with an acute myocardial infarction at two large university affiliated medical center from September 1, 1997 to June 30, 1998. Data was collected by using questionnaries, which included demographic data, permonitory clinical signs and symtoms of myocardial infarction, and a measure of the severity of the signs and symptoms. Also semi-structured interviews and chart reviews were used to obtain information related to treatment-seeking time. The results of this study are summarized as follows ; 1. The most frequent premonitory clinical symptom was chest pain(92.9%), the second, was perspiration(81.0%), and the next were nausea(40.5%) and dyspnea(38.1%). Thirty two patients reported having more than four premonitory signs and symtoms. Patients described the characteristics of chest pain as “somethings very heavy pressing down”(26.2%), “felt like my chest would burst”(24.4%), or “sharp pain”(16.7%), Over 95% of the sample reported having chest pain. 2. Twenty two (52.4%) patients reported to have “very severe” premonitory pain. 3. The mean time interval between the onset of signs and symptoms and the arrival at the medical center was 6.39$\pm$10.80 hours in 42 samples, the mean time from the onset to arrival at a local hospital was 3.27$\pm$5.39 hours and for transfer from a local hospital to the medical center was 4.75$\pm$9.87 hours in patients who had arrived at medical center via local hospital. 4. The severity of premonitory signs and symptoms did not differ significantly according to existence of premonitory signs and symptoms. 5. There was no significant relationship between treatment-seeking time and age, gender, marital status, economic status, occupation, or residence. But education had significant relationship(r＝－0.51, p＝0.01). Analysis of difference of the time interval according to the premonitory signs and symptoms showed that the time was shorter in patients who experienced nausea or dyspnea(U＝115.50, p＝0.01, U＝132.00, p＝0.04), however the severity of premonitory signs and symptoms did not have statistical significance.

• 대한간호학회지
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• 제30권3호
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• pp.560-570
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• 2000

This study is aimed at developing a cardiac rehabilitation program and enlightening the effects of the program on patient's health behavior compliance, cardiovascular functional capacity, and quality of life. Using a quasi-experimental approach the nonequivalent control group pretest - posttest design was accepted for this study. The subjects of this study consisted of 55 patients with ischemic heart disease at the Cardiac Center of 'G' Hospital located in Inchon from May 1, 1998 to April 30, 1999. The patients were divided into two groups: the experimental group, which participated in the cardiac program with 30 patients and 25 patients of a control group were not involved in the program. There were two phases in the cardiac rehabilitation program: the first phase was a team approach education. It focused on reducing the risk of ischemic heart problems. The second phase was individual training by using a home based exercise program, which was comprised of 8 weeks, three sessions per week, 40-60 minutes per session, and followed by consultation. Every session involved 20-40 minutes of aerobic exercise at 40-60% of heart rate reserve, 11∼13 RPE and 10 minutes of warm-up and 10 minutes of cool-down exercises. The experimental tools for the study were the health behavior compliance scale developed by Lee, Yoon-hee (1992), and quality of life scale developed by McGirr et al.(1990). RPPsubmax were measured by the treadmill. The collected data was processed by SPSS and analyzed by χ²test and t-test. The results of this study were as follows: 1. The health behavior compliance in experimental group was significantly increased (t=5.091, p=.000) when compared to the control group. 2. RPPsubmax also decreased significantly in the experimental group when compared to the control group(t=-2.109, p=.040). 3. The quality of life significantly improved in the experimental group (t=3.853, p=.000) as compared to the control group. As the above results of this study revealed, the effectiveness of the cardiac rehabilitation program of the study was confirmed. It increased the health behavior compliance for reducing the risk of further coronary events, enhanced the cardiovascular functional capacity, and eventually improved the patient's quality of life.

• 의료법학
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• 제12권1호
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• pp.133-173
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• 2011

Since mid-1960s the reports from the Surgeon General, the World Health Organization, and other health experts state that there is no risk-free level exposure to smoking and secondhand smoke. Tobacco smoke is made up of more than 7,000 chemicals. Hundreds are toxic, and at least 70 are carcinogens. The chemicals in tobacco smoke reach smoker's lungs quickly every time smoker inhale causing damages immediately. Inhaling even the smallest amount of tobacco smoke can also damage smoker's DNA, which can lead to cancers. Smoking is responsible for more than 87% of lung cancers, but there are a host of other chronic diseases directly related to exposure to tobacco smoke. It's also a major cause of heart disease, stroke, aortic aneurysm, peripheral arterial disease and most of the other diseases. In the United States, each year with more than from 440,000 to 520,000 deaths caused by smoking and exposure to involuntary smoke. They conclude that smoking is the single most important source of preventable morbidity and mortality. The United States of America have about 60-year history of tobacco litigation. Tobacco litigation has been an important tool in tobacco control strategies aimed at limiting the activities of tobacco companies and providing redress to people who have become ill as a result of their use of tobacco products. Tobacco litigation is a kind of tort litigation. Quite often, as in the asbestos and other mass tort litigation episodes, tobacco litigation can play an educational role, warning the public about the magnitude of health risks that might otherwise be less clearly perceived. Tobacco litigation allows smokers, their families or other victims of smoking to sue tobacco companies in order to be compensated for the harm they have suffered. Potential benefits of tobacco litigation include compensation for smoking-related damages, strengthening regulatory activity, publicity, documents disclosure and changing tobacco industry behavior. And also tobacco litigation can limit the political activities of tobacco industry, protect human rights of smokers and non-smokers, increase burden to tobacco price-up and enhance the effects of law and politics in public health.

• 가정간호학회지
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• 제7권1호
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• pp.26-38
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• 2000

The purpose of this study was to estimate home care nursing cost for the patient with Cerebrovascular Disease based on a bundle of home care nursing services This study was conducted through four steps. The first step was to investigate home care nursing activities that were offered to the patient with Cerebrovascular Disease(CD) by home care nurse. The second step was to investigate the time spent on home care nursing service and to calculate labor and manufacturing cost. The third step was to calculate home care nursing cost per minute. And at the fourth step, home care nursing cost for a patient with Cerebrovascular Disease based on a bundle of home care nursing service was calculated. The results of the study were as follows: 1) The number of direct home care nursing activities for the patient with CD was 108, and the time of each activity was spent from 1 to 10 minutes. 2) Average time per visit was 51 minute, and the firs visit time were spent 1.6 times higher than 2nd visit time. 3) Nursing cost per minute(cost per visit ${\\}\;22,565\;\div\;$ average time per visit 51 minutes) was ${\\}\;442$. The cost per visit was calculated on Basic visiting cost(nurse's labor cost ${\\}\;15,760$ + management cost ${\\}\;6,805$) divided by average time per visit(51 minutes). 4) Home care nursing cost to the patient with CD based on bundle of home care nursing service was consisted of basic home care nursing cost, the cost of a bundle of service practiced on visit. and transportation fee. Basic home nursing cost(the time spent on basic home nursing service 20 minutes ${\times}$ nursing cost per minute ${\\}\;442$) was ${\\}\;8,840$. The cost of the bundle of home care nursing services to the patient with CD was calculated as self care ${\\}\;2.898$, Tracheostomy care ${\\}\;10,166$, immobility care ${\\}\;6,188$, sore care ${\\}\;6,188$. Foley care ${\\}\;6,630$, and Levin tube or Gastrostomy care ${\\}\;7.514$. Transportation fee which was composed of the labor cost for transportation(${\\}\;5,122$) and the car management cost(${\\}\;3.876$) was ${\\}\;8,998$. Home care nursing cost to the patient with CD based on bundle of home care nursing services consisted of basic home care nursing cost, the cost of a bundle of service practiced on visit, and transportation fee. It will contribute to improve quality of home care service, because of giving appreciate incentives to home care nurses. And it will be more efficient than current cost of hospital based home care. But it need to management than calculation of the current fee-for-services of home care.

• 치위생과학회지
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• 제12권3호
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• pp.245-252
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• 2012

2009년 국민건강영양조사 자료를 이용하여 한국 성인의 대사증후군과 치주질환과의 관련성에 대해 평가하고자 하였다. 만 19세 이상의 성인에서 대사증후군으로 진단된 환자 중 지역사회치주지수(Community Periodontal Index: CPI)에 대한 정보가 모두 갖춰진 1,315명을 최종분석대상자로 하여 다음과 같은 결론을 얻을 수 있었다. 1. 치주질환 유병과 관련이 있는 인구 사회학적 특성은 연령과 교육수준으로 나타났다. 연령이 증가할수록, 교육수준이 낮을수록 치주질환의 비율이 높게 나타났다(p<0.001). 2. 치주질환 유병과 관련이 있는 일반건강행위는 흡연과 음주 및 체질량 지수로 나타났다. 현재 흡연을 하는 경우(p<0.05), 일주일에 음주횟수가 많을수록(p<0.001), 체질량 지수가 높을수록(p<0.005) 치주질환의 비율이 높게 나타났다. 3. 치주질환 유병과 관련이 있는 구강건강행위는 지난 1년간 구강검진 여부, 치간칫솔 및 치실 사용 여부, 주관적 구강건강으로 나타났다. 지난 1년간 구강검진을 받지않고(p<0.001) 치간 칫솔 및 치실을 사용하지 않는 경우(p<0.05), 주관적 구강건강이 건강 하지 않다고 생각하는 경우(p<0.001) 치주질환의 비율이 높게 나타났다.

• 의료법학
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• 제21권3호
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• pp.3-33
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• 2020

'원격의료(telemedicine)'란 '의료인이 정보통신기술을 이용하여 원격으로 실시하는 의료행위'라고 정의할 수 있다. 지금까지 우리나라의 통설은 의료법 제34조를 근거로 의료인 간의 원격자문만 허용되고, 의료인과 환자 간의 원격의료는 금지되는 것으로 이해하였다. 그러나, 의료법 제34조는 의료업 수행에 대한 장소적 제한 규정일 뿐, 원격의료 자체를 금지하는 규정은 아니다. 그 외 현행 의료법에는 원격의료를 금지하는 규정이 존재하지 않는다. 건강보험 요양급여기준과 별개로 현행 의료법 해석상 원격의료가 일반적으로 금지된다고 보기는 어렵다. 다만, 의료법 제17조와 제17조의2에서의 '직접 진찰'의 의미와 관련해서 해석상 논란이 있다. 헌법재판소는 이를 '대면 진찰'로 해석한 반면, 대법원은 '스스로 진찰'로 해석하였다. '직접'의 사전적 의미와 관련 의료법 규정에 대한 해석 등에 비추어 볼 때, 대법원의 해석이 타당하다고 생각한다. '직접 진찰'이 '대면 진찰'을 의미하지는 않더라도, '진찰'의 개념 안에 '대면진찰의 원칙'이 내포되어 있고 '비대면 진찰'은 대면진찰을 보완하는 수준에서만 허용되기 때문에 비대면진찰로 인한 문제점은 충분히 극복할 수 있다고 본다. 결국은 진찰이 얼마나 충실하였느냐, 즉 '진찰의 충실성' 여부가 원격진료 허용의 한계라고 할 수 있다.

• 핵의학기술
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• 제22권1호
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• pp.67-75
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• 2018

방사선 안전에 대한 관심과 염려가 전 세계적으로 점차 증가되고 있는 가운데, 의료 실무 현장에 종사하는 방사선 작업종사자의 외부피폭 관리 또한 중요한 이슈로 부각되고 있다. 특히, $^{18}F-FDG$WholeBodyPET/CT검사의 경우 높은 에너지의 방사성동위원소를 사용하므로 검사자의 피폭선량 저감화에 더욱 관심을 기울여야 한다. 따라서, 본 연구는 $^{18}F-FDG$ Whole Body PET/CT 수검자의 거리 별 외부선량률을 측정 및 분석하고, 방사선 작업종사자의 업무 행위 별 누적선량을 확인하여 피폭선량 저감화에 도움이 되는 주요한 요소를 알아보고자 한다. $^{18}F-FDG$WholeBody PET/CT검사를 받은 106명의 환자를 대상으로 검사 종료($75.4{\pm}3.3min$) 후 가슴을 기준 0, 10, 30, 50, 100 cm 거리에서 외부선량률을 측정하였다. 환자측면에서 외부선량률에 영향을 줄 수 있는 개별적 요인을 분석하기 위해 성별, 연령, BMI, 금식시간, 당뇨병 유무, 약물 투여정보, 크레아틴 수치 정보를 수집하였다. 수집된 정보의 통계분석은 ANOVA 분석 및 T-test를 시행하였다. 방사선 작업종사자 측면에서 피폭선량에 영향을 줄 수 있는 요인을 분석하기 위해 주사 업무를 하는 3명의 직원($T_1$, $T_2$, $T_3$)과 스캔 업무를 하는 3명의 직원($T_4$, $T_5$, $T_6$)에 각각 Personal pocket dosimeter를 착용시켜 업무시간 동안 누적된 선량을 기록하였다. 또한 방사선 작업종사자 별 응대시간을 측정하여 분석하였다. 각 거리 별 외부선량은 $246.9{\pm}37.6$, $129.9{\pm}16.7$, $61.2{\pm}9.1$, $34.4{\pm}5.9$, $13.1{\pm}2.4{\mu}Sv/hr$로 산출되었다. 환자측면에서, 근거리에서 성별, BMI, 선량, 크레아틴 수치에 의해 유의미한 차이가 있었지만, 거리가 증가할수록 그 차이는 감소하였다. 그 중 크레아틴 수치의 경우 100 cm에서 집단 간 통계적으로 유의한 차이를 보이지 않는 특징이 있었다. 환자 1명으로부터 받은 선량은 주사 업무를 하는 직원($T_1$, $T_2$, $T_3$)의 경우 0.70, 1.09, $0.55{\mu}Sv/person$이었고, 스캔($T_4$, $T_5$, $T_6$)의 경우 1.25, 0.82, $1.23{\mu}Sv/person$이었다. 응대시간이 상대적으로 적은 $T_4$직원의 경우 $T_3$, $T_5$보다 34% 낮은 누적선량을 확인할 수 있었다. 이를 토대로 환자와의 적정거리 유지와 응대시간 감소가 누적선량에 크게 작용함을 알 수 있었다. 위와 같은 점을 고려했을 때, 환자의 충분한 수분 섭취 및 배뇨, 방사선 작업종사자와 환자 간 적정거리유지(최소 100 cm이상) 및 응대시간 감소를 위해 노력해야 할 것이고, 환자의 video tracking system과 장비의 원격조정 등을 통해 피폭선량 저감화를 위해 노력해야 한다.