• 대한간호학회지
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• 제5권1호
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• pp.93-111
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• 1975

As the hospitalized patients will be facing new stress situation due to change of his environment from home to hospital it will be very important to understand the psychological stress experienced by hospital patients not only for helping patients in the process of recovery from illness but also fulfil1ing the objective of comprehensive nursing care by understanding the needs of the patients. There is no doubt that it would be very helpful for treatment of patients as well as for improvement of nursing care if we know more about psychological needs of patients and give them adequate support to meet these needs. The study to find out the causes and degree of stress events experienced by hospitalized patients, with the objective of instituting improvement of nursing care program based on the needs of patients, was conducted during the month of September 1974 with 60 patients randomly selected from those admitted to medical and surgical wards at Yonsei Medical Center in that period The questionnaire form included 36 questions which are considered to be stress events for hospital patients, and was devide into five areas namely, such events related to 1) disease itself, 2) hospital environment, 3) nursing care and treatment, 4) communication and human relations, and 5) family and economic problems. The results of the study were as follows: 1. It was confirmed that hospitalization considered to be a stress producing factor and most patients perceived the admission to hospital as a stress factor. 2. According to the rating scale, it was found that degree of perceived stress shows a variation according to the source of stress producing event. 3. No significant differences in the mean values were observed statistically with the perceived stress levels according to demographic and other variables of patients related to hospitalization. 4. Among the questions related to disease itself, "Admission for surgery" was perceived most frequently as a stress event (97.14%) by patients. 5. With regard to the questions related to hospital environment, "death of the patient room-mate" was the most serious stress event perceived by patients (90%) and "living with hospital regulations"was considered to be less serious stress event (23.33%). 6. As for the questions related to nursing care and treatment, "limitation of freedom" was perceived as a stress factor most frequently (70.91%) by the patients and "worry for wrong treatment" turned out to be less frequent stress event (50.0%). 7. As for the questions related to communication and human relations, "difficulty to meet doctors when wanted"appeared to be the most frequent stress event by the respondents (75.86%) , followed by "no explanation about treatment or examination"(75.0%) and "no explanation about nursing care procedures"(71.66%). 8. With regard 111 tile questions related to family and economic problems, "inadequate finances for family living due to hospitalization"and "high cost of hospitalization" were the most frequent cause of stress mentioned by the patients. (80.0%). 9. As a result of application of the stepwise regression analysis, it was found that about 89% was explained by those events associated with disease itself, hospital environment and family and economic problems. By adding those events related to "nursing care and treatment" and "communication and human relation", 100% of stress associated with hospitalization was explained.

• 치위생과학회지
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• 제9권3호
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• pp.345-351
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• 2009

본 연구는 당뇨병 환자들의 구강건강지식 정도 및 구강관리실태와의 관련성을 파악하여 구강건강에 대한 교육의 필요성 도출과 구강건강교육 프로그램을 개발하는데 필요한 기초 자료로 활용하고자 당뇨병 환자 121명을 대상으로 설문 조사한 자료를 통하여 다음과 같은 결론을 얻었다. 1. 일반적 특성에 따른 구강건강 지식정도는 여자가 남자보다 높았고, 연령별로는 20개 이하와 50대 이상인 집단에서 구강건강 지식이 높았으며, 당뇨 유병기간이 길수록 지식정도가 높은 것으로 조사되었다. 2. 구강관리실태 중 잇솔질 방법은 전체 연구 대상자의 21.5%만이 회전법이라 답하였으며, 구강건강 지식정도가 상인 경우 당뇨 진단 후 치과치료 경험이 많았으며, 구강질병 상담자는 치과의사가 가장 많은 것으로 나타났다. 3. 연구 대상자가 치과치료를 망설이는 이유로는 모든 집단에서 '치료비용이 비싸서'라고 답하였고, '당뇨와 구강질환이 상관이 없어서'라는 항목의 경우 구강건강 지식정도가 상인 집단에서 가상 높게 나타났다. 4. 구강건강 지식정도와 구강건강교육 여부의 경우 구강건강 교육용 받았었거나, 받고 있는 당뇨병 환자일수록 구강건강 지식정도가 높게 나타났다. 5. 구강건강 지식정도가 중인 집단에서 대부분의 구강관리행위에 높은 점수를 부여하는 것으로 조사되었으나 통계적 유의성을 보이지 않았다.

• 한국병원경영학회지
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• 제6권3호
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• pp.109-129
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• 2001

The purpose of this study was the acquisition of the optimum scale of the apportionment of standard & high-class bed for the maximum profit representative of the desire of customers in a General Hospital with 1,100 beds located in Seoul. This investigation was proceeded by the analysis of the result of the simulation with the survey of both the patients' needs for bed and the degree of the medical service by the grade of the ward. And finally the consequence was obtained as follows: 1. The result of the investigation of the inpatients' preference for the grade of ward classes shows that a private ward reflected 4.3 percent, a semi-private ward 1.7 percent, a three-bed ward 0.1 percent, and a ward with six beds 93.9 percent each other. 2. A questionnaire poll was paralleled of service terms of a medical doctor and a nurse by ward class, the data were used for the standard of the allotment of labor cost by the ward class. The poll shows that the service tenn of a medical doctor and a nurse based on a ward with six beds by ward class showed 1.7 times in internal medicine and 1.9 times in surgery at a private ward; 1.4 times in internal medicine and 1.7 times in surgery at a semi-private room; and 1.2 times both in internal medicine and in surgery at a three-bed ward 3. The resultant findings revealed the most profit per bed and per patient in a private ward. However, an analysis of profit with a standard of unit area by ward class represented a higher profit in both the internal medicine and the surgery semi-private ward than other ward classes. 4. The result of the analysis through simulation based on the data of the prime cost per the ward class proved the optimum scale of the distribution of beds by class as follows: sixteen beds of the internal medicine and twenty three beds of the surgery in the private ward; two hundreds and two of the internal medicine and one hundred and ninety eight of the surgery in the semi-private room; three of both the internal medicine and the surgery each other in the three-bed ward; one hundred and ninety eight of the internal medicine and two hundred and fifty two of the surgery in the ward with six beds. The result of this research exhibits that the income and expenditure of the hospital could be improved by changing parts of wards into private ones(containing the maximum profit per a unit of width) in case the scale of the number of beds is reset with the consideration of the profit per the unit width. In the near future it's strongly expected that the research for the more scientific standard of the allotment of labour cost by ward class and for definition of the optimum scale of the number of beds that actualize the maximum profit with the change of the three elements of the prime cost: cost of materials; labor costs; management expenses.

• Archives of Plastic Surgery
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• 제36권4호
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• pp.428-431
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• 2009

Purpose: Blow out fracture resulting from facial trauma is of high frequency among facial bone fractures, and can cause severe complications. So, proper management and close observation after operation are needed. So far, Computed tomography has been the best choice in the evalution following orbit wall reconstruction. However, cost - effectiveness, accessibility to patients and hazard of radiation exposure of computed tomography require supplementary measure for the evaluation following orbit wall reconstruction. This study was performed to describe the effectiveness of ultrasonography in the evalution following orbit wall reconstruction. Methods: A retrospective study was performed on 40 patients who underwent orbit wall reconstruction from June, 2008 to July, 2008. The patients' ages ranged from 13 to 65 years (mean 27.5 years), and this group was compsoed of 27 male and 13 female patients. The follow up period ranged from 2 weeks to 28 weeks (mean 11weeks). Preoperatively, all fractures were diagnosed using computed tomography. Ultrasonography for all cases, and computed tomography for 2 cases were performed for evaluation following orbit wall reconstruction. Results: Reduction of herniated orbital soft tissue and orbit implant was identified by using ultrasonography in 38 cases out of 40 cases. In other cases which we could not identify the orbit implant, computed tomography was performed. Con clusion: Compared to computed tomography, ultrasonography is simple, inexpensive and convenient method. Ultrasonography can be used as supplementary measure to computed tomography in the evaluation following orbit wall reconstruction for elective patients.

• Archives of Plastic Surgery
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• 제41권5호
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• pp.562-570
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• 2014

Background Knee disarticulations (KD) are most commonly employed following trauma or tumor resection but represent less than 2% of all lower extremity amputations performed in the United States annually. KDs provide enhanced proprioception, a long lever arm, preservation of adductor muscle insertion, decreased metabolic cost of ambulation, and an end weight-bearing stump. The role for KDs in the setting of arterial insufficiency or overwhelming infection is less clear. The purpose of this study is to describe technique modifications and report surgical outcomes following KDs at a high-volume Limb Salvage Center. Methods A retrospective study of medical records for all patients who underwent a through-knee amputation performed by the senior author (C.E.A.) between 2004 and 2012 was completed. Medical records were reviewed to collect demographic, operative, and postoperative information for each of the patients identified. Results Between 2004 and 2012, 46 through-knee amputations for 41 patients were performed. The mean patient age was 68 and indications for surgery included infection (56%), arterial thrombosis (35%), and trauma (9%). Postoperative complications included superficial cellulitis (13%), soft tissue infection (4%), and flap ischemia (4%) necessitating one case of surgical debridement (4%) and four transfemoral amputations (9%). 9 (22%) patients went on to ambulate. Postoperative ambulation was greatest in the traumatic cohort and for patients less than 50 years of age, P<0.05. Alternatively, diabetes mellitus and infection reduced the likelihood of postoperative ambulation, P<0.01. Conclusions Knee disarticulations are a safe and effective alternative to other lower extremity amputations when clinically feasible. For patient unlikely to ambulate, a through-knee amputation maximizes ease of transfers, promotes mobility by providing a counterbalance, and eliminates the potential for knee flexion contracture with subsequent skin breakdown.

• Journal of Periodontal and Implant Science
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• 제49권4호
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• pp.248-257
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• 2019

Purpose: The purpose of this retrospective study was to investigate the relationships of types of dental insurance coverage in Korea with sociodemographic characteristics and the prevalence of systemic and oral diseases, as well as to evaluate the socioeconomic impact of Korean dental insurance policies. Methods: Sample cohort data from 2006 to 2015 were obtained from the National Health Insurance Service. Patients were divided into 2 groups. The exposed group comprised patients who received insurance benefits for complete dentures, removable partial dentures, and implant care, while the control group comprised patients who did not receive these benefits. The type of insurance coverage and the prevalence of systemic and oral diseases were compared between the 2 groups. Results: Patients who received benefits in the form of complete dentures, removable partial dentures, and implants had similar sociodemographic characteristics in terms of sex, age, income quintile, and type of insurance coverage to the control group. The prevalence of hypertension, anemia, renal disease, rheumatoid arthritis, osteoporosis, asthma, and cerebral infarction was higher in the exposed group than in the control group (P<0.05). The prevalence of periodontal diseases and dental caries was also higher in the exposed group. Conclusions: Korean dental health insurance policy has been beneficial for the medical expenses of low-income and elderly people suffering from a cost burden due to systemic diseases. However, since there is a tendency to avoid invasive interventions in older patients due to the high risk of systemic diseases, insurance coverage of dentures may be more helpful from a socioeconomic perspective than coverage of dental implant treatments.

• 한국병원경영학회지
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• 제12권3호
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• pp.47-67
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• 2007

This paper aims at suggesting several ways lo change financial vulnerability and to improve managerial capability of local public hospitals (LPHs) in Korea through the identification of factors affecting profitability. Several findings of the research are as follows: To begin with, LPHs exhibited a statistically significant difference in their profitability from one another, according to tile analyses of their profitable margins from tile general characteristics. It depends on the number of hospitals in the area, the population of the hospital-built area, the number of competing hospitals, the number of staff per 100 beds, the opening of special clinic, the educational function, and the capacity of rooms. However, there was no variable in the managerial characteristics, presenting a significant difference, in contrast with hospitals which have been managed by private companies and made a great amount of profits. Second, according to the analyses of profit differences in behavioral effort-characteristics, a statistically significant difference was revealed upon the basis of the efforts to improve the clinic service, invite special patients, and shorten the period of being hospitalized. Third, the result of analyses about the difference of profitability from medical care and finance is statistically significant in the rate of labor cost, the rate of management cost, bed-occupancy rate, and the period of being hospitalized. Fourth, according to the analyses of the factors influencing the net profit ratio of the entire capital, Adjusted explanatory power(Adjusted $R^2$) was shown up to 65.2%, which is high. To compare the adjusted explanatory power stage by stage, the first stage model applying only two variables such as structural and strategic characteristics exhibited 23.8%, and the second stage model adding financial characteristics showed 51.5%. The explanatory power was much improved up to 65.2% when the third stage model incorporated the outcome of medical care performance. When the return on investment(ROI) was examined by using the multi-variate linear regression analysis at the final model of third stage, it was found that ROI had a positive relationship with the increase rate of patients, labor costs per doctor, and medical care rate of socially protected inpatients. However, it revealed that ROI had a negative relationship with the ratio of labor costs, the number of patients per managerial staff, and occupancy rate of rooms, respectively. The research suggests that in order for LPHs to increase profitability, LPH, should make efforts not only to attract patients to the hospitals without any discrimination of the patients depending on their financial status, but also to develop efficient management methods to reduce labor costs.

• 동의신경정신과학회지
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• 제31권2호
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• pp.89-99
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• 2020

Objectives: The purpose of this study was to identify the needs of bio-signal devices for the diagnosis, assessment, and analysis of neurocognitive disorder in Korean medicine (KM) hospitals and clinics. Methods: A questionnaire was developed to survey the current status of medical device use, and diagnosis and interventions for patients with cognitive disorders in KM hospitals and clinics. November 11~December 2, 2019, 114 responses (71.9% completed) were collected by internet-based questionnaires from the members of the Korean society of Oriental Neuropsychiatry. Results: The clinical requests were in the descending order of hematology analyzer, ultrasound imaging system, and electroencephalography among the 15 most commonly used devices of which research would support for their clinical usability. The biosignal-based devices showed the highest research demands for patients with mild cognitive impairment rather than more severe stages of cognitive impairment. Prevention rather than diagnosis, or several treatment regimens was the strongest clinical area of the KM for patients with neurodegenerative cognitive impairment. Many responded that five to 10 minutes of test duration and 20,000 won to 30,000 won of cost would be appropriated for a new device to be developed. Conclusions: There were strong demands for the development of bio-signal devices for neurocognitive disorders among the KM doctors. Specifically, it showed high needs for the technology that can be used in the prevention area of cognitive disorders. Additionally, new medical devices to assess cognitive functions and to obtain KM pattern-related information were the high needs.

• 한국임상약학회지
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• 제22권3호
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• pp.239-250
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• 2012

In recent years, national health insurance(NHI) coverage had been expanded gradually for cancer as a severe disease requiring high level of medical expenditure, to reduce patient's financial burden. But, subjective burdens level for out-of-pocket(OOP) money expense are still considerable owing to high medical cost and decent numbers of services not covered by benefit plan. This study aimed to investigate OOP medical expenditures and identify factors influencing subjective financial burden in cancer patients. A 28-items questionnaire for self-reporting by responders was designed to satisfy study goal and finalized following by one pilot study and experts' verification process. Subjects were enrolled during July to October 2010 through regular meetings organized by five patient or patient-advocacy groups had acknowledged the study purpose. Subjects who aged 20 or more, have histories of cancer diagnosis and anticancer drug use, and voluntarily agreed to participate in this study were recruited. Total 107 subjects included in the analysis have cancer lesions in breast, colon, kidney, liver or stomach at the stages from I to IV. Approximately 73% of them has passed less than 5 years since cancer diagnosis. For the OOP medical expenditure regarding cancer, less 6 million won was in 31%, 6-15 million won in 35% and more than 15 million won in 28% of responders, and more than half responders(58%) felt financial burden subjectively. 63% of responders had subscribed commercial insurances, resulting in money receipts of more than 10 million won since cancer diagnoses in 76% of responders. Logistic regression results showed significant differences in subjective OOP financial burden level depending on gender, household income level, benefit type, commercial insurance money receipt degree, year cancer diagnosed, cancer lesion, therapy type, duration of anticancer drug use, drug listing in national formulary, total OOP medical expenditure and total OOP anticancer drug expense. They had mixed feelings both wishes to expand NHI coverage to reduce financial burden(70%) and no willingness to increase premium(59%). This result suggested that NHI might direct future strategies to reduce absolute total OOP medical cost and expand benefit plan coverage in higher burden groups in particular.

• 대한예방한의학회지
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• 제22권1호
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• pp.1-14
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• 2018

Objectives : This study aimed to analyze the characteristics of uninsured herbal medicine(UHM) users and the economic and social barriers of UHM utilization. Methods : We used the Korea Health Panel Data, representative national survey on medical utilization and cost, provided by National Health Insurance Service and Korea Institiute of Health and Social Affairs. The frequency analysis was used to identify the characteristics of the respondents, and the cross-analysis (${\chi}^2-test$) was used to verify the relationship between their characteristics and the usage of UHM. In order to analyze the determinants of using the UHM considering the individual's characteristics, logistic regression analysis and multiple regression analysis were conducted for those who used the Korean medicine (KM) outpatient service in 2015. Results : The usage of UHM was significantly lower for those (1) who's age of 20 to 65; (2) who have the university or higher education degree; (3) who live in Jeju province, and (4) who bought the herbal medicine for other health related purposes. On the other hand, the usage of UHM for those (1) who have the first quintile of household income; (2) who have the chronic respiratory disease; (3) who have been taking the medicine for health promotion purpose for more than 3 months and (4) who have purchased the food which has health promotion function was significantly higher than others. The patients who have chronic musculoskeletal diseases accounted the most among the UHM users. Conclusions : There was the considerable inequality in the usage of UHM among household income groups, which provides policy rationale for UHM to be covered by national health insurance. To facilitate the coverage expansion, restrictive covering model can be considered for children and adolescents, or for patients with muskuloskeletal diseases who have the high demand for UHM.