• 디지털융복합연구
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• 제10권3호
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• pp.233-240
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• 2012

본 연구는 뇌졸중 환자의 입원 및 재원적절성에 영향을 미치는 요인을 파악함으로써 효율적인 병상이용과 질적인 의료서비스를 제공하고 불필요한 병상 이용을 줄여 급성기 치료가 꼭 필요한 대상자들이 즉시 병원을 이용할 수 있도록 도움을 주고자 하였다. 연구대상자는 일개 종합병원의 신경과에서 퇴원한 뇌졸중 환자로 의료보장별 의료 적절성을 파악하기 위해 최근 약 4년 동안인 2006년 3월 l일부터 2010년 10월 31일까지 총 154명의 대상자를 선정하였다. 연구방법은 입원 및 재원적절성을 평가하기 위해 적절성 평가지침(AEP)을 이용하여 의무기록을 분석하였고, 수집된 자료는 SPSS 12.0을 이용하여 전산처리하였다. 이상의 결과를 근거로 입원적절성을 높이고 재원기간을 단축시킨다면 재원적절성도 높아질 것이라는 결론을 얻게 된다. 또한 재원기간이 재원적절성에 영향을 미치는 것으로 조사되었기에 재원기간이 길어질수록 병상 회전율을 감소시키는 요인으로 영향을 미치게 되므로 적절한 시기에 퇴원이 이루어질 수 있도록 의료기관 내에서의 질 향상 전담팀을 구성하여 각 질환군에 따른 재원기간에 대한 적절성 평가 및 관리가 이루어져야 한다. 궁극적으로 뇌졸중 환자의 급성치료가 끝나면 즉시 재활치료 및 장기요양관리가 이루어질 수 있도록 장기요양시설 확충과 같은 정부의 뒷받침으로 불필요한 재원기간을 줄여갈 수 있는 것이다.

• Journal of Chest Surgery
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• 제49권sup1호
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• pp.37-43
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• 2016

Background: While demand for cardiovascular surgery is expected to increase gradually along with the rapid increase in cardiovascular diseases with respect to the aging population, the supply of thoracic and cardiovascular surgeons has been continuously decreasing over the past 10 years. Consequently, this study aims to achieve guidance in establishing health care policy by analyzing the supply and demand for cardiovascular surgeries in the medical service area of Korea. Methods: After investigating the actual number of cardiovascular surgeries performed using the National Health Insurance claim data of the Health Insurance Review and Assessment Service, as well as drawing from national statistics concerning the elderly population aged 65 and over, this study estimated the number of future cardiovascular surgeries by using a cell-based model. To be able to analyze the supply and demand of surgeons, the recent status of new surgeons specializing in thoracic and cardiovascular surgeries and the ratio of their subspecialties in cardiovascular surgeries were investigated. Then, while taking three different scenarios into account, the number of cardiovascular surgeons expected be working in 5-year periods was projected. Results: The number of cardiovascular surgeries, which was recorded at 10,581 cases in 2014, is predicted to increase consistently to reach a demand of 15,501 cases in 2040-an increase of 46.5%. There was a total of 245 cardiovascular surgeons at work in 2014. Looking at 5 year spans in the future, the number of surgeons expected to be supplied in 2040 is 184, to retire is 249, and expected to be working is 309-an increase of -24.9%, 1.6%, and 26.1%, respectively compared to those in 2014. This forecasts a demand-supply imbalance in every scenario. Conclusion: Cardiovascular surgeons are the most central resource in the medical service of highly specialized cardiovascular surgeries, and fostering the surgeons requires much time, effort, and resources; therefore, by analyzing the various factors affecting the supply of cardiovascular surgeons, an active intervention of policies can be prescribed for the areas that have failed to meet the appropriate market distributions.

• 동서간호학연구지
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• 제18권2호
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• pp.111-119
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• 2012

Purpose: Recently, Neurofeedback training system that based on biofeedback of brain wave was introduced. This study was performed to identify the effects of the improvement of brain function by Neurofeedback training on elders(the 2nd or 3rd grade of long-term care insurance services). Methods: A quasi-experimental design using a nonequivalent control group, pre-post test was used. Total 11 elderly were enrolled in this study (experimental group 5, control group 6). The intervention was conducted 3 times a week for 30 minutes from January to June, 2012 (total 60 times). Chi-square test and Mann-Whitney U-test were used to analyze the data. Results: After the Neurofeedback intervention, attention quotient (AQ), anti-stress quotient (ASQ), emotion quotient (EQ) and brain quotient (BQ) of the experimental group were significantly better than those of the control group. Conclusion: The findings indicate that the Neurofeedback training program was effective in reducing fatigue by AQ, increasing the physical and mental stress resistance by ASQ, emotional balance by EQ and improving of total brain function by BQ. Therefore Neurofeedback training be used as an effective training intervention for the health of elderly in geriatric facility.

• 성인간호학회지
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• 제25권2호
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• pp.219-230
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• 2013

Purpose: This study is reviewed of the available literature to identify the evidence of the value of Kegel exercise programs as an intervention to decrease urinary incontinence and the improvement of the quality of life following a radical prostatectomy in localized prostate cancer. Methods: We searched studies of randomized controlled trials that utilized the Kegel exercise programs with patient with a radical prostatectomy. The review was conducted electronic bibliographic database of Ovid-Medline, Embase, Scopus, KoreaMed and NDSL, etc. Of 630 publications identified, seven studies that met the inclusion criteria, and all studies analyzed by meta-analysis. To ensure the quality of the studies, we used Cochrane's Risk of Bias. Results: Kegel exercise helped patient to achieve continence more quickly (after 1, 3, 6, 12 months) than men not using Kegel exercises. Especially, Kegel exercise significantly reduced the development of urinary incontinence at one month after prostatectomy. The effectiveness of Kegel exercise after prostatectomy was found to improve the quality of life at a significant level. Conclusion: Based on available evidence, Kegel exercise that nurses can teach improved the return to continence more than usual care in men with prostatectomy urinary incontinence.

• 한국의료질향상학회지
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• 제20권1호
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• pp.42-57
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• 2014

Objective: The objective of this research was to develop a guideline for more effective use of physical restraint on patients in the intensive care unit and training the nurses on it and applying it on clinical practice to assess its effectiveness. Method: This research analyzed the before and after effect of the development of a guideline for physical restraint by dividing the category into nurse and patient. In the case of nurse, a comparison of knowledge and nursing service regarding the use of physical restraint from before the training on physical restraint guideline(Jan. 2011) and after the training on physical restraint guideline(Dec. 2011) was made. In the case of patient, a comparison of physical restraint usage rate and average usage time, the number of unplanned extubation cases were compared from before the use of physical restraint (Jan.~Apr. 2011) and after the use of physical restraint (Sep.~Dec. 2011) were made. Result: After the training on the physical restraint guideline, the knowledge of the nurse and the nursing practice showed notable improvement by (p<0.000) and (p<0.048) respectively and in patient, physical restraint usage rate and average time of usage decreased by (p<0.001) and (p<0.001) respectively. And despite the decrease in the number of cases in which the physical restraint was used, the number of unplanned extubation cases remained the same. Conclusion: Physical restraint guideline training and guideline usage can be stated to have brought out positive effect in both the nurse and patient. In order to maintain such positive effects, continuous training is necessary and continuous revaluation is necessary, regarding knowledge and nursing practices.

• 한국의료질향상학회지
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• 제6권1_2호
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• pp.108-119
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• 1999

Background : To study any interference of demonstrated in different patient satisfaction scores for the same questionnaires handled by hospital staff and by independent surveyors, respectively. Methods : This study included 728 subjects who were admitted to a university hospital from June 22 to July 1, 1999. The contents of the questionnaire were composed of six dimensions: hospital structure and process, staffs technical competence and humaneness, information & education and communication. Measurements were performed on a 5-score Likert scale. T-test and logistic regression analysis were also performed. Results : In an outpatient survey, satisfaction scores from a questionnaire delivered by hospital staff were significantly higher than independent surveyors for the dimension of communication, but no differences were shown among other dimensions. In an inpatient survey, satisfaction scores by hospital staff were higher for the process and communication dimensions(p<0.05). In particular, in both the inpatient and outpatient surveys, the difference of satisfaction scores for personnel items were significant between groups. After adjustment for age and sex those differences were significant between groups. Conclusion : To minimize the bias on questionnaire survey, the effects of personnel, who deliver and gather the questionnaire should be carefully considered in the evaluation of health service satisfaction.

• 한국노년학
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• 제37권3호
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• pp.747-762
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• 2017

본 연구는 서비스의 질에 중요한 영향을 미치는 치매관련(장기요양시설) 종사자들의 직무만족 및 인권옹호행동과 직무스트레스, 사회적 지지의 구조적 관계를 파악하고자 진행되었다. 이를 위해 경기도 내 노인요양시설, 주야간보호시설, 방문요양센터 등에 근무하는 치매관련 종사자 300명을 대상으로 설문지를 배부 후 210부를 회수하였고 부실응답 설문지 13개를 제외한 후 197명의 응답자료를 AMOS와 SPSS 21.0을 활용하여 분석하였다. 분석결과, 직무스트레스는 사회적 지지에 직접적인 영향(-.276)을 유의하게 미치는 것으로 나타났다. 대부분 사회적 지지도 역시 직무만족에 직접적인 영향(.315)을 유의하게 미치는 것으로 나타났다. 인권옹호에서도 직무만족에 직접적인 영향(.175)을 미치고 간접적인 영향(.102)을 미치므로 .277의 총 효과가 있는 것으로 나타났다. 이로써 사회적 지지가 인권옹호와 직무만족을 부분매개 하는 것을 알 수 있었다. 직무스트레스는 직무만족에 -.217의 직접적인 영향을 미치고 .095의 간접적인 영향을 미치므로 -.122의 총 효과가 있는 것으로 나타났으며 사회적 지지가 직무스트레스와 직무만족을 부분매개 하는 것을 알 수 있었다. 이러한 연구 결과를 놓고 볼 때 치매관련종사자들의 직무만족을 높이기 위해서는 사회적 지지를 인식할 수 있는 환경에서 인권옹호행동을 증대하고 직무스트레스를 줄여줄 수 있는 방안이 필요하다는 것을 시사한다.

• 보건의료산업학회지
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• 제9권1호
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• pp.1-16
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• 2015

This study intended to measures for high performance and for identifying competitive advantages by examining the relation between the competence and performance of the first special hospitals for which the law has now been in effect for 3 years. Furthermore, the members of special hospitals were also surveyed on measures to improve the special hospital system in order to activate it. A total of 80 special hospitals participated in this study, and 171 people responded to a survey on the special hospital system. According to the results of the multiple regression analysis the relation between the competence and performance after establishing a hypothesis that special hospital competence would have an effect on organizational performance, member competence and hospital business management competence significantly had a positive (+) effect on internal performance, and marketing management competence significantly had a positive (+) effect on external performance, which partially supported this research hypothesis. Moreover, according to the results of survey on the special hospital system, the policy thought to be the most important by special hospitals was reasonable fee system reform, followed by granting incentives.

• Journal of Chest Surgery
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• 제49권sup1호
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• pp.28-36
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• 2016

Background: This study aimed to develop the models for regional cardiac surgery centers, which take regional characteristics into consideration, as a policy measure that could alleviate the concentration of cardiac surgery in the metropolitan area and enhance the accessibility for patients who reside in the regions. Methods: To develop the models and set standards for the necessary personnel and facilities for the initial management plan, we held workshops, debates, and conference meetings with various experts. Results: After partitioning the plan into two parts (the operational autonomy and the functional comprehensiveness), three models were developed: the 'independent regional cardiac surgery center' model, the 'satellite cardiac surgery center within hospitals' model, and the 'extended cardiac surgery department within hospitals' model. Proposals on personnel and facility management for each of the models were also presented. A regional cardiac surgery center model that could be applied to each treatment area was proposed, which was developed based on the anticipated demand for cardiac surgery. The independent model or the satellite model was proposed for Chungcheong, Jeolla, North Gyeongsang, and South Gyeongsang area, where more than 500 cardiac surgeries are performed annually. The extended model was proposed as most effective for the Gangwon and Jeju area, where more than 200 cardiac surgeries are performed annually. Conclusion: The operation of regional cardiac surgery centers with high caliber professionals and quality resources such as optimal equipment and facility size, should enhance regional healthcare accessibility and the quality of cardiac surgery in South Korea.

• 한국치위생학회지
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• 제15권2호
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• pp.235-243
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• 2015

Objectives: The purpose of the study is to investigate the oral health and oral health beliefs in industrial workers and to analyze the influencing factors on dental health care utilization. Methods: The subjects were 280 adults from 16 to 64 years old in Seoul and Gyeonggi from June 20 to July 31, 2014, A self-reported questionnaire was completed after receiving informed consent. The independent variables consisted of predisposing, enabling, and need factors. The predisposing factors included gender, age, residence area, number of family. The enabling variables included monthly income, education, occupation, type of employment. The need factors included subjective oral health recognition and oral health belief model. These three variables had a direct and indirect influence on dental clinic use. The types of occupation were classified into desk duties, merchandizing and service duties technology and others by KSCO-6. Results: The relating factors to dental health care utilization were sex, oral health beliefs perceived benefits, perceived barriers, and self-efficacy. Female tended to have the higher oral health beliefs perceived benefits, perceived barriers(p<0.01), self-efficacy(p<0.05). Conclusions: Those who received frequent oral examination and health instruction tended to have a favorable impact on maintenance of oral health status and improvement in quality of life.