• 한국보건간호학회지
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• 제9권1호
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• pp.83-102
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• 1995

As the society is being industrialized, the fast-paced economic development that has caused substantial increase in cerebrovascular and coronary artery diseases and the industrial development and increased use of means of transportation have resulted in the rapid rise of incidents in external injuries as well. So the pubic has become acutely aware of the need for fast and effective emergency care delivery system. The goal of emergency care delivery system is to meet the emergency care needs of patients. The emergency care delivery system is seeking to efficiently satisfy the care needs of people. Therefore the purpose of this study is designed to develop an effective programs for emergency care delivery system in Korea. The following specific objectives were investigated. This emergency care delivery system must have the necessary man power, for transfering the patients, communication net work, and emergency care facilities. 1) Man power Emergency care requires n0t only specialized traning in the emergency treatment but also knowledge and experience i11 other related area, so emergency care personnel traning program should be designed in order to adapt to the specific need of emergency patients. It will be necessary to ensure professional personnel who aquires the sufficient traning and experience for emergency care and to look for legal basis. We have to develop re-educational programs for emergency nurse specialist. They should be received speciality of emergency nursing care so that they will work actively and positively in emergency part. Emergency medical doctor and nurse specialist should be given an education which is related in emergency and critical care. Emergency care personnel will continue to provide both acute and continuing care as partner with other medical team. 2) Transfering the patients. Successful management of pre-hospital care requires adequate traning for the emergency medical technician. Traning program should be required to participate in a actual first aids activites in order to have apportunities to acquire practical skills as well as theoretical knowledge. The system of emergency medical technician should be remarkablly successful with first responder firefighters. Establishing this system must add necessary ambulances operating at any given time. It will be necessary to standardize the ambulance size and equipment. Ambulance should be arranged with each and every fire station. 3) Communication net work. The head office of emergency commumication network should be arranged with the head office of fire station in community. It is proposed that Hot-line system for emergency care should be introduce. High controlled ambulance and thirtial emergency center should simultaneously equip critical-line in order to communication with each other. Ordinary ambulance and secondary emergency facility should also simultaneously equip emergency-line in order to communication with each other. 4) Emergency care facilities. Primary emergency care facilities should be covered with the ambulatory emergency patients-minor illness and injuires. Secondary emergency care facilities should be covered with the emergency admission patients. Third emergency care center should be covered with the critical patients who need special treatments and operation. Secondary and third emergency care facilities should employ emergency medical doctor and emergency nurse specialist to treat in-patients with severe and acute illness and multiple injuires. It should be fashioned for a system of emergency facilities that meets emergency patients needs. Provide incentives for increased number of emergency care facilities with traning in personal/clinical emergency care. 5) Finance It is recommended to put the finance of a emergency care on a firm basis. The emergency care delivery system should be managed by the government or accreditted organizations. In order to facilitate this relevant program the fund is needed for more efficient and effective emergency researchs, service, programs, and policy. 6) Gaining understanding and co-operation of pubic It is also important to undertake pubic education to improve understanding of first aids and C. P. R of individuals, communities and business. It is proposed that teachers and health officers be certified in C. P. R. The C. P. R education can be powerful influence save lives. Lastly appropriate emergency care information must be provided to the pubic for assisting them in choosing emergency care.

• 농촌의학ㆍ지역보건
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• 제26권2호
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• pp.15-41
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• 2001

연구는 전라북도지역의 보건기관 공무원을 대상으로 지역담당제 실시에 관한 인식과 태도에 대한 기초자료를 얻기 위한 목적으로 시도하였다. 보건기관 근무 공무원들은 지역담당제에 대한 이해도가 매우 높았으며, 지역담당제 실시에 있어 그 실시의 필요성을 높게 인식하고 있으나, 그 실시시기는 단계적 실시의 주장이 높았으며, 제공서비스로는 방문간호와 만성질환관리에 높은 의견을 보였다. 건강증진사업에 국한할 시 건강교실이, 노인보건사업에 국한할 시 방문간호와 거동불편자, 독거노인 등이 높게 나타났으며, 지역담당제 구축을 위한 선결과제로는 재원확보, 인력 및 조직이 재정비가 가장 시급한 것으로 인식하고 있다. 제도개선사항으로는 근무여건 개선이 우선이었고, 지역담당제 구축을 위한 정보체계 확립이 부족하다고 인식하고 있으며, 팀별 지역담당제를 통한 보건사업 전달체계 확립을 위해 적정 전문인력의 배치를 가장 높게 들었다. 지역담당제 실시에 관한 이점으로 대상자에 대한 관리가 잘될 수 있고, 전문성 향상으로 환자에 대한 간호의 질이 향상될 것으로 인식하고 있다. 지역보건사업에서의 지역사회 주민의 요구증대 및 다양화에 따른 대응이 부족하며, 보건소의 사업의 내용개발에 있어서 충분히 개발되고 있지 못하다고 인식하고 있다. 그리고 새로운 보건사업의 확장에 있어서 가장 큰 문제로서 획일적(형식적)사업을 들고 있다. 이러한 연구결과 등을 토대로 하여 지역담당제 정착을 위한 검토방안과 추진전략에 대하여 아래와 같이 제언하고자 한다. 첫째, 지역담당제 실시는 단계적으로 담당지역을 선정하여 실시하고, 지역적 특성을 고려한 사업의 추진이 있어야하며, 현행의 보건사업 업무중에서 이들 사업이 지역담당중심으로 수행하는 것이 좋을 것인지 사업중심으로 수행하는 것이 효율적인 것인지를 사업대상 및 범위, 지리적 여건, 현재의 보건소 업무 수행체계를 근거로 검토되는 등 다양한 측면이 재고려되어야 한다. 둘째, 지역사회의 현실적인 요구의 수준과 보건소의 현재 위상을 중심으로 자원과 예산 소요를 추정하고 타당성과 현실성을 검토할 필요가 있으며, 이와 더불어 지역주민의 요구와 수요에 부응할 수 있도록 단계적으로 보건소 방문간호사 인력의 확충방안을 강구하고, 방문간호사 교육 훈련비 및 방문차량 구입비 등을 재원확보 및 지원을 하여야 하며, 보건소 사업에서 지역담당제에 관한 연구개발 및 시범운영이 있어야 할 것으로 판단된다. 셋째, 대상자 관리의 내실화와 지역사회 주민의 서비스 욕구에 대한 만족도를 제고시키기 위하여 사업내용을 충분히 개발해야 하며, 지역담당자의 근무여건을 개선하는 등 전문인력의 배치가 요구된다. 마지막으로 과거와는 달리 환경과 보건에 대한 일반인의 관심이 급격하게 확산되고 있는 상황 속에서 소수 전문가들의 실험적 시범사업으로는 대중적인 지지기반을 확대할 수 없기 때문에 지역담당제가 일반주민의 생활속에서 대중화된 사업으로 정착시킬 수 있어야 하며, 그동안 지역담당제에 대한 논의나 연구가 소수의 연구자 및 한정된 시범지역에 의해서만 연구된 점을 지양하고 폭 넓은 연구가 지속되어야 함을 제언한다.

• Asian Journal for Public Opinion Research
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• 제4권1호
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• pp.38-50
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• 2016

Introduction: Geriatric depression is one of the significant mental health issues for older people. This descriptive study aimed to investigate the correlation between selected factors and depression among older people, living in homes for the aged in the western part of Thailand. Methods: 107 older people, living in two homes for the aged of the western part of Thailand were recruited to the study, using cluster sampling. Three questionnaires, including the Barthel Index Activity of Daily living (BADL), the Thai Geriatric Depression Scale (TGDS), and personal characteristics, perceived health status, chronic diseases, family relationship, and recent grief and loss experience were used. The quality of all questionnaires, especially the reliability of BADL, TGDS, and selected factors (e.g., health factors) were 0.95, 0.93, and 0.72 respectively. After finishing data collection, percentages, medians, and Spearman's rank correlation and Mann-Whitney U were used to analyze the data. Results and discussion: The results revealed that nearly half (41.1%) of older people suffered from depression. Furthermore, income, perceived health status, and Barthel ADL index were significantly negatively associated with depression at p<0.01; whereas, the number of chronic diseases was significantly positively associated with depression at p<0.05. Conclusion: results on the correlation may guide the practice in the future. For example, the officers or health care providers in homes for the aged should encourage older people to be independent, improve their perceived health status, increase health promoting behaviors to prevent or delay chronic illnesses, or increase older people incomes by promoting the appropriate occupation.

• 한국의료질향상학회지
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• 제12권1호
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• pp.78-90
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• 2006

Background : The concept of 'service' in a hospital is based on the quality of medical staffs who serve as customer-satisfying media, and this is what distinguishes general hospitals from other business corporations in which customer satisfaction is achieved through commercial products. Thus, the internal employee satisfaction is essential in the improvement of the 'service' and subsequent 'competitiveness' of a hospital. The purpose of this study is to establish internal marketing strategies for a general hospital through regular surveys on employee satisfaction. Method : Surveys on employee satisfaction in radiology department were conducted regularly twice a year in a university hospital with 800 beds 2001 in 2004. The subjects of this study were 35 employees who work in radiology department. The authors developed the questionnaires and the surveys were conducted initially during the first 6 months of the year. After necessary improvements were made by applying 6 Sigma techniques, subsequent surveys were conducted during the latter 6 months of the year and the degree of employee satisfaction was compared. Results : Overall satisfaction increased with a constant rate and the authors were able to assess that the hospital is being gradually stabilized. The degree of satisfaction assessed by multiple choices showed only minor changes. However, as a result of focusing on the demands put forth by the employees through the open questions, the degree of satisfaction increased gradually year after year. Conclusions : It is important to heighten the internal employee satisfaction systematically and harmoniously through the assessment on the demands of the internal customers and feedback-based communications between the management officers and the staffs. Continuous surveys on the internal employee satisfaction will serve to be valuable materials in the establishment of internal marketing strategies for a general hospital.

• Healthcare Informatics Research
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• 제24권4호
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• pp.327-334
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• 2018

Objectives: The objective of this study was to investigate the relationship between the level of Electronic Medical Record (EMR) system adoption and healthcare information technology (IT) infrastructure. Methods: Both survey and various healthcare administrative datasets in Korea were used. The survey was conducted during the period from June 13 to September 25, 2017. The chief information officers of hospitals were respondents. Among them, 257 general hospitals and 273 small hospitals were analyzed. A logistic regression analysis was conducted using the SAS program. Results: The odds of having full EMR systems in general hospitals statistically significantly increased as the number of IT department staff members increased (odds ratio [OR] = 1.058, confidence interval [CI], 1.003-1.115; p = 0.038). The odds of having full EMR systems was significantly higher for small hospitals that had an IT department than those of small hospitals with no IT department (OR = 1.325; CI, 1.150-1.525; p < 0.001). Full EMR system adoption had a positive relationship with IT infrastructure in both general hospitals and small hospitals, which was statistically significant in small hospitals. The odds of having full EMR systems for small hospitals increased as IT infrastructure increased after controlling the covariates (OR = 1.527; CI, 1.317-4.135; p = 0.004). Conclusions: This study verified that full EMR adoption was closely associated with IT infrastructure, such as organizational structure, human resources, and various IT subsystems. This finding suggests that political support related to these areas is indeed necessary for the fast dispersion of EMR systems into the healthcare industry.

• 한국산학기술학회논문지
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• 제15권9호
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• pp.5610-5620
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• 2014

본 연구는 일부 사무직 행정공무원들의 직무스트레스 수준을 파악하고 사회심리적 요인(A형 행동유형, 통제신념, 자기존중감)과 직무스트레스와의 관련성을 규명하고자 시도하였다. 연구대상은 C도청에 근무하고 있는 공무원 634명(남자 505명, 여자 129명)이었으며, 자료 수집은 2013년 2월 18일부터 3월 10일까지의 기간 동안에 구조화된 무기명 자기기입식 설문지를 이용한 설문조사에 의하였다. 연구결과, 조사대상자의 직무스트레스 수준은 성별, 연령, 학력, 결혼상태, 직급, 근무경력, 공무원생활에 대한 만족도, 흡연상태, 음주상태, 수면시간, A형행동유형, 통제신념 및 자기존중감에 따라서 유의한 차이를 보였다. 사회심리적 요인과 직무스트레스 수준과의 상관관계를 보면, 업무요구도는 내적 통제신념과 유의한 음의 상관관계를 보였으며, 업무의 자율성은 A형행동유형, 내적 통제신념 및 자기존중감과 유의한 음의 상관관계를 보였다. 상사의 지지도는 외적 통제신념과 유의한 음의 상관관계를 보였다. 위계적다중회귀분석 결과 직무스트레스 수준에 영향을 미치는 요인으로는 연령, 주관적인 건강상태, 직위, 잔업시간, 질병으로 인한 결근, 업무에 대한 만족도, 수면시간, 여가시간, 외래진료경험유무, A형행동유형, 통제신념 및 자기존중감이 선정되었으며 이들의 설명력은 32.1%이었다. 위의 모델에서 보면 A형행동유형, 통제신념 및 자기존중감 등의 사회심리적 요인이 추가됨으로 해서 15.0%의 설명력을 증가시켜 직무스트레스에 사회심리적 요인이 큰 영향을 미치고 있음을 알 수 있었다.

• 한국정보통신학회논문지
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• 제19권3호
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• pp.537-542
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• 2015

종합적 표준 임상 의학용어 체계인 SNOMED CT는 용어의 방대함 및 구조의 복잡성 때문에 환자 상태를 표현하는 가장 적합한 용어를 짧은 진료 시간 내에 선택하기가 어려운 용어 선택의 모호성 문제를 내포하고 있다. 본 논문에서는 용어 검색 과정에서 발생하는 동일하거나 유사한 용어를 분석하고 이를 효과적으로 구분하기 위한 용어 비교 검색 기법을 제시한다. 제안하는 기법은 용어의 계층 구조 분석을 통해 용어 간 "is-not-a" 관계를 새로 정의함으로써 두 비교 대상 용어의 차이점을 명확하게 하는 특징이 있다. 이를 통해 진료 과정에서 유사한 이름을 가진 용어들 중 환자의 상태를 가장 적합하게 표현하는 용어를 빠르게 선택함으로써 SNOMED CT의 활용성을 개선한다.

• Perspectives in Nursing Science
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• 제6권1호
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• pp.67-76
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• 2009

Recently, small and medium-sized hospitals which are located in rural areas have many difficulties in securing high quality nurses. That is because working environments for nurses in small and medium-sized hospitals in rural areas are poor compared with those of big hospitals in urban. As a result, the migration of nurses from small and medium-sized hospitals in rural areas to big hospitals in urban is continuously happening. In general, big hospitals provide nurses with high level of salary and fringe benefits. To prevent the migration of nurses, chief executive officers of small & medium hospitals in rural areas have been interested in improving nurses' working conditions including wages. Also, they have raised nurses' salary and improved working conditions. But, basically these individualized efforts have some limit. In connection with this, medical interest groups have produced various voices in terms of interpretation and solutions for these issues. However, from the future perspectives, it seems evident that two approaches for both manpower supply and demand plans of nurses are necessary. They should contain not only accurate estimation of the supply-demand of nursing manpower but also the improvement of working conditions and wages of nurses. Estimation of nursing manpower supply-demand depends on the standards and criteria being used. Supply and demand may be met or not in accordance with the points emphasized on the decision. In the articles, issues regarding nursing manpower, levels of salary, other working conditions and social support system for child care are discussed. According to Joe's report (2005), most health institutions did not meet the guidelines of nurse staffing in Medical Law. The wages of nurse vary on every hospital and there is a big difference in wages' range. The average starting salary for a nurse is 22 million won a year. In case of tertiary hospitals, it reaches up to 30 million won a year. Nurse as a profession should have a strong responsibility and should take care of the patients for 24 hours with three working shifts. Also, most of them are female who have the burden of child rearing. Therefore, it is suggested to increase the salary, to provide comfortable working conditions, and to have social support system for nurses with household affairs.

• 의료법학
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• 제25권1호
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• pp.87-115
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• 2024

우리나라는 급격한 발전과 더불어 많은 성장을 이루는 과정에서 스트레스에 노출이 정신적 고통을 수반하게 되었고 다양한 사회문제로 나타나며, 응급입원의 빈도가 높아지고 있다. 정신질환자의 경우 '비자의 입원'이 문제가 되며, 경찰, 119구급대원이 정신질환자의 신체억제를 시도하며, 많은 문제점이 노출되고 있다. 이는 정신건강복지법 상 응급입원의 조항의 구성요건이 현실을 반영하지 못해 하나의 정신질환자를 두고 각 기관이 다른 입장을 내며, 응급입원이 원활하게 진행되지 않거나, 관계기관의 마찰로 이어지며 정신질환자의 안전이나, 타인의 안전이 확보되지 못하는 경우가 발생하고 있다. 응급입원은 주체가 '정신질환자로 추정되는 사람으로 자신의 건강 또는 안전이나 다른 사람에게 해를 끼칠 위험이 큰 사람을 발견한 사람'으로 정하고 있으며, 그 상황이 매우 급박하여 스스로 입원을 결정하는 입원절차를 거칠 시간적 여유가 없는 경우 의사와 경찰관의 동의를 얻어 응급입원을 의뢰할 수 있다고 규정하고, 이 경우 119구급대원이 정신의료기관까지의 호송하도록 하고 있다. 이러한 응급입원의 조항은 정신의료기관까지 이송하는 과정에 많은 문제를 내포하고 있다. 실무를 담당하는 경찰관이나 119구급대원이 응급입원과정 중 '물리력'을 사용하게 되면, 필연적으로 부작용이 발생하게 되는데, 업무상과실이 문제가 될 수 있으며, 구체적으로는 물리력을 행사할 때 법령에 근거하고 비례원칙에 따른 필요최소한도의 신체억제가 필요하게 되는데, 법령상 119구급대원이나 경찰관의 주의의무의 부재가 결국 다른 법령을 적용하여 해결하게 된다는 것이다. 이에 정신건강복지법 상 응급입원 조항의 주체를 경찰, 소방기관의 장점을 살려 주체를 변경하고, 정신보건법의 시행규칙으로 신체보호대 사용을 정의하고, 규정함으로써 119구급대원과 경찰관의 주의의무를 설정하고 정신질환자가 안전하게 치료받을 수 있도록 이송에 대한 환경을 조성함으로써 자기 또는 타인의 위험을 내포하고 있는 정신질환자 또한 안전한 환경에서 정신의료기관으로 이송될 수 있는 계기가 될 것이다.

• Asian Pacific Journal of Cancer Prevention
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• 제17권8호
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• pp.3809-3816
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• 2016

Background: Increasing knowledge and awareness of cancer screening significantly influence health promotion behavior which could markedly reduce incidence rates. In many countries, health care providers are the principal source of information concerning cancer screening. This study was carried out to assess the level of knowledge concerning cancer screening among medical students, house officers and residents and to explore their attitude towards cancer screening practices. Materials and Methods: This cross-sectional study was conducted in Kasr Al Ainy Medical School at Cairo University in Egypt, with 300 undergraduate medical students and 150 postgraduates (interns and residents) enrolled. A pre-tested self-administered questionnaire was used to collect data from the study participants regarding personal and education-related information, knowledge about cancer screening and its sources, and attitude towards cancer screening. Results: More than 64% of participants had knowledge scores of ${\leq}10$ points (out of 24). The total knowledge score (out of 6 points) for breast cancer screening increased from $1.9{\pm}1.0$ to $2.3{\pm}1.2$ and $2.4{\pm}1.1$ for $4^{th}$, $5^{th}$ and $6^{th}$ year respectively, interns showed the highest score of $2.6{\pm}1.1$, P= 0.001. Year of enrollment at medical school was a significant positive predictor of acquiring knowledge about cancer screening (post graduate vs. undergraduate students) (OR= 1.30, C.I =1.01-1.63), lack of or none receiving of orientation/training about cancer screening was the sole negative significant predictor for proper knowledge about cancer screening (OR=0.50, C.I=0.31-0.82). Over 92% of students agreed that they had insufficient knowledge about cancer screening, 88.2% appraised the need to have enough knowledge in order to direct/advice patients, relatives and friends, and 93.7% required that the faculty should emphasize the importance of cancer screening in the delivered curricula at medical school. Conclusions: A relatively low to moderate level of knowledge about cancer screening was detected among the selected medical students regardless of their year of enrollment at medical school or their graduation status, which may implicate a negative impact on early cancer detection especially in a low resource country like Egypt.