• Journal of Acupuncture Research
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• 제23권6호
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• pp.239-254
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• 2006

The 3rd Japan-Korea Workshop on Acupuncture and EBM was held at Kanazawa on June $16^{th}$. From Korea team, 4 papers were presented. Dr. Hahn introduced a new approach of data analysis on series of n-of-1 trials using the Bayesian statistics. It offered important information for the future n-of-1 trials. Dr. Park clearly demonstrated the significance of various sham devices proposed and stressed the importance of research questions when we choose the control intervention in RCT. Dr. Lee reported the results of survey in Korean Medical Doctors (KMD) for their point selection and techniques to the distal and local points. Dr. Kim presented the results of face to face survey on the KMD with 28 items for acupuncture treatment on the knee OA. Finally, a draft of protocol was introduced by Dr. Kim. The title was "multi-center, a randomized, single blinded, two arms, parallel-group study to compare the effectiveness and safety of 'individualized acupuncture' and 'standardized minimal acupuncture' in Korean and Japanese patients with knee osteoarthritis (Phase IV)". From Japan team, 7 speakers presented their comments and proposals on the protocol. Dr. Takahashi introduced several issues regarding n-of-1 trials and pointed out the importance of obtaining generalizability from n-of-1 trials. Dr. Shichidou pointed the importance of research design, selection of outcome measures and reduction of biases. Dr. Itoh presented the results of point selection for the knee OA based on the literature survey. Dr. Sumiya introduced several differences between KMD and Japanese acupuncturists based on the questionnaire used in KMD survey. Dr. Furuya demonstrated a result of press tack needle and its sham device on shoulder stiffness. Dr. Yamashita introduced the results of literature survey regarding adverse events occurred by acupuncture on knee OA. Dr.Tsukayama stressed the importance of responsibility of Institutional Review Board (IRB) for the conduction of clinical trials. After several issues were discussed, the need of continued meeting for final protocol development was agreed, then the workshop was closed.

• 보건행정학회지
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• 제16권4호
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• pp.48-67
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• 2006

The aim of the study was to examine levels of satisfaction with health care in North Korea and to identify factors associated with it using a convenience sample of North Korean refugees in China. Data from the 2004 Survey of Health Seeking Behavior of North Korean Households conducted by the Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health were used. The study subjects were 273 North Korean refugees whose length of stay in China was less than 3 months. Factor analysis was used to extract factor dimensions from the 12 satisfaction items. Bivariate (t test and ANOVA) and multiple regression analyses were used in examining factors associated with satisfaction with health care use in North Korea Overall, satisfaction level was low ($2.36{\pm}0.36$, score range: 1-5). Of the three-factor dimensions, physician skills scored the highest $(2.93{\pm}0.36)$, followed by drug availability $(2.51{\pm}0.07)$ and general cleanliness $(1.66{\pm}0.55)$. In the multiple regression analysis, having a usual source of care was significantly associated with patient satisfaction. Respondents who identified primary care (section) doctors as their usual source of care tended to be less satisfied than those with the city or county hospital as their usual source of care. County residents tended to report a lower degree of satisfaction with general cleanliness than city residents. Among socioeconomic characteristics, the number of household assets positively predicted satisfaction with drug availability. North Korean residents appear to be dissatisfied with their medical care. It may reflect some inadequacies in the North's universal health care system to meet the healthcare needs of its people.

• Journal of Acupuncture Research
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• 제17권1호
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• pp.27-41
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• 2000

The meridian system is the most essential and basic connecting structure that maintains the vital activities of viscera and bowels by connecting them with each part of body's surface. Doctors can understand the healthy condition, and the region and deficiency-excessiveness of disease by observing the condition of Qi flowing. Deficiency and excessiveness could be differentiated by various symptoms expressed in meridian system. Especially there could be several clues like pain, heat-cold, protuberance-depression, change of color and shine in the line of channel leads to the judgment of deficiency-excessiveness The diagnosis of deficiency and excessiveness can be generalized by quantification of elastic status in skin surface along the meridian system. By comparing data from measurement of elastic condition with those from traditional deficiency and excessiveness, it could be utilized for the development of oriental medicine. All biological activities in the human body are based on meridian system according to the oriental medicine. Also the meridian system is viewed as basic and essential structure connecting internal viscera and each part of body. The areas of expressed channel phenomena are muscle to bone, muscle to muscle and bone to bone. These areas are called depression where meridian system is present and any changing state on those points can be measured. It could be difficult in diagnosing the reaction of meridian system because doctor can depend on his own judgment. Therefore, it is necessary to quantify and indexate channel reactions. To quantify the channel reactions, specially manufactured instrument was used to quantify the protuberance and depression to differentiate the deficiency and excessiveness. The results follow as below; 1. The elastic index measurement by the equipment proved a pattern of agreement showing the values that ranged within standard deviation 0.05kgf/cm throughout the experiment except few cases' measurement in CV-17. 2. To evaluate the state of deficiency & excessiveness of elastic index measurements in frontal point, elastic index measurements in the front paint were compared to the elastic index measured surrounding the point within 2.5 cm. Such result of indexing procedure was closely matched to the concept of palpitation. 3. If the elastic index values in the surrounding front point closely located to the elastic index values in the front point, the judgement on the state of deficiency and excessiveness was delayed. Otherwise, it was judged as deficiency or excessiveness. 4. Out of total 12 cases of comparing the elastic index values to the elastic index values in the surrounding front point, Three to nine front points were judged as either in the state of deficiency or excessiveness. 5. Among the nine front points judged as either in the state of deficiency or excessiveness, Four cases were matched to the electric index measured by EAV that evaluating the internal organs by five different phases. If more clinical cases are accumulated, it is expected to systematically theorize and improve the concept of deficiency and excessiveness in the internal organs using the front point.

• 한국의료질향상학회지
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• 제7권1호
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• pp.118-131
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• 2000

Background : A continuous healthcare quality improvement is needed to provide high quality healthcare service as well as to maintain trust in terms of satisfying the needs of the patients. Recently it also became an essential issue. in hospital management, recognized for it's competitive potentiality among healthcare organization groups. This study was conducted to analyze patient complaints and issues received by the Quality Improvement Department. Its purpose is to improve healthcare qualities within the hospital, as well as establish policies and appropriate strategies in hospital management. Method : From July 1st to September 30th of the year 1999, we analyzed all complaints and issues made by various patients and their families, which were received through 24 hour phone consultation, numerous suggestion boxes, letters and E-mails, The issues were classified into 16 different categories based on a Patient Satisfaction Assessment Tool. All data were segregated according to the departmental frequencies and their contents. To come up with for environmental and patient satisfaction improvement, all complaints or issues were communicated with hospital administrators, medical and nursing staff and employees. Comprehensive customer satisfaction activities including improving phone etiquette were discussed in Customer Satisfaction Team, CQI Team and each Department. All opportunities for improvement were implemented. Feedback actions were discussed. Results : A total of 317 cases were collected. Issues regarding parking and other accommodation facilities were most common complaints that were 14.5% of total. Issues regarding admission rooms (10.7%), admission procedures (10.7%), waiting room environment (8.8%), nurses and nurse assistants (7.6%), physicians (6.6%) and others (23%) followed. Thirteen of 45 departments received more than 8 complaints. The Nursing Department had the most complaint, receiving 9.8% of total complaints. Complaints regarding the Nursing Department were predominantly related to the environment of patient rooms. The Department of Psychiatry for phone etiquette (4.7%), Department of Otolaryngology for the nursing staff's attitude and phone etiquette (4.4%), and the Admission Department followed. As a part of efforts to improve patient satisfaction, a new parking structure was built and reallocation of the parking space was done. Renovation of other accommodation facilities were carried out by hospital administration, Monthly phone call and answering attitude survey was done by QI Department. Based on this survey we made a phone etiquette manual and distributed throughout the hospital. Compare to the last year, Patient Satisfaction Index measured by Korea Productivity Center using National Customer Satisfaction Index was improved 7 points. According to our organization's own study, we confirmed the phone etiquette was improved 11% than last year. Conclusions : Issues related to parking and other accommodation facilities ranked first followed by complaints made regarding the patient care area, the admission and cashier process, and nurses' and doctors' attitude. The Nursing and Psychiatry Departments need improvement regarding phone etiquette. Results were shared and played a vital role in policymaking and strategic planning of the hospital. It is imperative that we keep our database updated by listening to and solving the needs of each patient. The CQI activities can be achieved only by full commitment of the hospital top management supported by related personal.

• Journal of Hospice and Palliative Care
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• 제17권3호
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• pp.170-178
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• 2014

목적: 섬망은 말기암환자에서 생길 수 있는 중요한 합병증으로 임상적으로나 삶의 질 적인 측면에서 매우 중요한 문제이다. 이에 호스피스 병동에 입원한 말기암 환자에서 섬망 발생과 관계된 위험 요인들을 알고자 연구를 시행하였다. 방법: 2011년 5월부터 2012년 9월까지 일개 지역 두개의 종합병원 내 호스피스 병동에 입원한 환자 중 의식이 명료하고 다른 정신과적 질환이나 약물 중독이 없는 환자를 대상으로 전향적으로 추적하여 섬망 발생 여부를 확인하였다. DSM-IV 진단기준에 맞게 2명의 의사에 의해 진단된 경우 섬망군으로 분류하였다. 입원 시 인지기능(mini-mental status examination, MMSE), 우울 점수(Beck depression inventory, BDI), 불안 점수, 불면 척도(Insomnia Severity Index, ISI), 혈액검사 결과와 섬망 발생 여부를 로지스틱 회귀분석으로 비교하고, 유의한 항목에 대해 Cox의 비례위험모형으로 교차비를 구하였다. 결과: 선정기준에 부합하는 연구 대상자 96명 중 41명(42.7%)에서 섬망이 발생하였다. 로지스틱 회귀분석 결과 일차 암 위치, 인지기능 장애(MMSE < 24), 우울($BDI{\geq}16$), 불면($ISI{\geq}15$)의 Odds ratio (OR)이 통계적으로 유의한 결과를 보였다. 이들 4가지 인자에 대해 입력 방법을 이용해 시행한 Cox 회귀분석 결과, 우울의 OR 5.130(95% CI 2.009~13.097), 인지기능저하의 OR 5.130 (95% CI 2.009~13.097)로 나타났다. 결론: 호스피스 병동에 입원한 말기암환자에서 우울하거나 인지기능 장애가 있을 경우 섬망 발생의 위험이 유의하게 높았다. 호스피스 환자에게 우울이나 인지기능에 대한 주의 깊은 관찰이 필요할 것이다.

• Journal of Preventive Medicine and Public Health
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• 제1권1호
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• pp.9-23
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• 1968

A survey was conducted by the staff of the College of Medicine and School of Public Health, Seoul National University in cooperation with Seoul Special City from 1 December 1967 through 28 February 1968, on such events as delivery, death, abortion and pregnancy. The survey directed to a total population of 47,811 residing in 9,157 households led us to the following findings: 1. Two year averages of crude birth rate, crude death rate and natural increase rate were 30.1, 5.6 and 24.5, respectively. 2. Of all deliveries, home and hospital deliveries constituted 61.1 per cent and 35.5 per cent, respectively. 3. Deliveries other than hospital deliveries were found to be attended more often by mother-in-laws (26.5 per cent) than by doctors or midwives(23.4 per cent). 4. About 51 per cent of all women having experiences in pregnancy during the last two years had an experience of consulting a doctor at least one time throughout whole period of pregnancy. 5. In most cases scissors were used to cut umbilical cords, of which 71.0 per cent were not sterilized and only 20.3 per cent sterilized. 6. In many cases placenta was incinerated(48.2 per cent) and on many other occasions it was thrown away into water(28.3 per cent). 7. Cement bags(37.4 per cent), gauze and absorbent cotton(29.8 per cent) were found to be most frequently used to receive new-born babies. 8. In 1966 8. 8 per cent of the women had at least one abortion induced and in 1967 the percentage was 9.2 per cent. 9. Nearly all(95.8 per cent) of the induced abortions reportedly were done at doctor's clinics. 10. Of all the abortions induced 65.3 per cent were done by specialists in obstetrics, 30.3 per cent by general practitioners and 2.7 per cent by midwives. 11. Those who experienced spontaneous abortions were 1.9 per cent of all women both in 1966 and 1967. 12. About 9.2 per cent of women investigated were found to be currently pregnant. 13. Age specific death rate turned out to be highest among those under 1 year of age. 14. Ten major causes of death in their order of frequency were: 15. Places of death can be classified into homes(75.3 per cent) and hospitals(13.2 per cent). 16. Method of disposing of corpses comprised burials(54.2 per cent) and cremations(44.6 per cent). 17. Infant, neonatal and hebdomadal mortality rates have been computed at 32.2, 18.9 and 13.7, respectively. 18. Infants were found to have died either at homes(81.5 per cent) or at hospitals(18.5 per cent). 19. Birth registrations had been done for about 18.5 per cent of the dead infants.

• Pediatric Infection and Vaccine
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• 제22권3호
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• pp.136-142
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• 2015

대한소아감염학회는 2015년 우리나라에서 처음으로 중동호흡기증후군(Middle East Respiratory Syndrome, MERS, 메르스) 환자가 발생하여 보건의료 응급 상황 발생의 긴박했던 시기에 이에 대한 대처에 참여하였다. 우리 학회는 메르스 발생 시 학회 홈페이지에 관련 공고문을 즉시 게시하였고 소아청소년에서의 메르스 환자의 발생시 의심 환자의 검사와 진단 및 국민안심병원 운영을 위해 소아청소년 MERS (중동호흡기) 검사 지침, 국민안심병원 소아청소년과 운영지침을 발빠르게 배포하였다. 이는 메르스 의심환자에 대한 접근에서 소아청소년에서 흔한 호흡기 질환 환자들이 메르스로 오인되어 불필요한 공포, 검사 및 격리를 당하지 않도록 하기 위함이었다. 이를 통해 소아청소년 환자를 진료하는 의사들과 이들의 보호자들을 안심시켰고 결국 많은 심리적 공포와 의료 비용을 감소시켰으며 메르스 종식 시 돌이켜보니 이는 결국 적절한 조치와 가이드라인이었음이 증명되었다. 앞으로 대한소아감염학회와 회원이 유관기관과 긴밀한 협조와 소통을 할 수 있는 체계 시스템을 구축해야 하며 상급의료기관의 소아청소년 감염전문의 필수 상주 및 이에 의한 감염관리료 제도 장착과 수가 신설 및 개선을 유도하는 등의 추진이 필요하다.

• 핵의학기술
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• 제22권1호
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• pp.98-102
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• 2018

소화기계 Leakage환자 검사 시 Planar 영상만으로 담즙누출 및 출혈여부와 위치감별이 쉽지 않다. SPECT-CT를 이용하여 담즙누출 및 위장관출혈 확인과 위치 감별을 통한 유용성을 평가하고자 한다. 본원에 내원한 환자 중 담즙누출 의심 환자 8명 및 위장관출혈이 의심되는 환자 5명, 총 13명을 대상으로 Planar영상 획득 후 판독실요청에 따라 SPECT-CT를 진행했다. 장비는 SIEMENS사의 Symbia T16과 GE사의 Discovery 670을 사용했다. Planar 및 SPECT-CT 영상은 4명의 경험 있는 핵의학 의사에 의해 1~10점의 점수로 평가했다. 민감도 및 특이도를 이용하여 ROC 곡선에 의한 검사 평가를 시행했다. 최종 진단은 재수술 결과 및 추적 관찰을 통해 확인했다. SPECT-CT의 민감도, 특이도 및 정확도는 각각 91.7%, 100% 및 94.2%였다. Planar영상은 각 각 83.3%, 68.8% 및 78.8%였다. Planar영상은 SPECT-CT와 비교하여 낮은 진단 정확도를 보였다(78.8%, 94.2%, p<0.05). 또한 ROC곡선 분석에서 SPECT-CT의 진단 신뢰도는 Planar영상보다 유용한 결과를 나타냈다(p<0.05). SPECT-CT는 담즙누출 및 위장관출혈 진단과 위치 감별에 민감도와 특이도가 높게 나타났다. Planar영상과 함께 SPECT-CT를 추가로 시행한다면 담즙누출 및 위장관출혈 환자의 진단과 위치 감별평가를 향상 시킬 것으로 사료된다. SPECT-CT는 다른 장기와의 중첩으로 진단이 어려울 경우 유용성이 있지만 추가적인 CT피폭에 대한 고려는 충분히 이루어져야 할 것이다.

• Tuberculosis and Respiratory Diseases
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• 제46권3호
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• pp.350-362
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• 1999

연구배경: 침습적 기계 호흡 이탈에 성공하여 기관내 관을 제거하였으나 48시간 이내에 급성 호흡 부전이 경우 또는 환자 스스로 기관내 관을 제거한 후 발생된 급성 호흡 부전은 이탈 실패의 중요한 원인이며, 발생시 기관내 관의 재삽관을 통한 호흡 보조가 표준적 치료이다. 비침습적 양압 환기법(noninvasive positive pressure ventilation이하 NIPPV)은 비 혹은 안면마스크를 통해 양압 환기를 시행하므로 기관내 삽관을 회피할 수 있다. 본 연구는 기계 호흡 이탈 후 기관내 관을 제거한 환자들에게 발생된 급성 호흡 부전 시 NIPPV 적용이 기관내 삽관을 통한 양압 환기 치료를 대체할 수 있는지를 알아보고자 하였다. 방 법: 대상은 아산 재단 서울 중앙병원 내과계 중환자실에 입원하여 기계적 환기 치료를 받고 이탈 과정에서 기관내 관 제거 후 48시간 이내에 급성 호흡 부전이 발생한 환자 21명 및 스스로 기관내 관을 제거한 후 급성 호흡 부전이 발생한 환자 7명과 기관내 관이 기도내 분비물로 막혀 기관내 관을 제거한 환자 2명등 총 31명에게 NIPPV를 적용하였다. NIPPV는 환자 상태에 따라 기계 환기 양식, 압력 보조 수준 및 흡입 산소의 양이 조절 되어졌으며, 압력 보조 8cm $H_2O$미만에서 임상적으로 안정된 상태를 유지하는 경우 완전히 NIPPV에서 이탈하였다. 성공군은 NIPPV 이탈후 48 시간 이상 자발 호흡을 유지한 경우로 정의하였고, 실패군은 NIPPV 시행 후 호흡 부전 소견이나 동맥혈 가스검사의 호전이 없어 다시 기관내 삽관을 시행하여 기계호흡을 시행한 환자로 정의하였다. 각 군에서 NIPPV적용 직전, 적용 후 30분, 6시간, 24시간, NIPPV 이탈 작전 또는 실패하여 기관내 재삽관으로 전환 직전의 심박동수, 분당 호흡수, 동맥혈 가스검사, 압력 보조 수준 및 호기말 양압등을 비교하였다. 결 과: 총 31명에서 NIPPV를 적용하였고, 이 중 성공군은 14명(45%)이었다. 성공군과 실패군을 비교 시 나이, 중환자실 입원 당시의 APACHE III 점수, 기관 내 삽관 기간, 기관내 관 제거 후 NIPPV적용시까지의 시간 및 NIPPV 시행 직전의 분당 호흡수, 심박동수, 동맥혈 가스검사, $PaO_2/FiO_2$ 등은 양군간에 유의한 차이가 없었다. 모든 환자에서 NIPPV적용 30분후부터 분당 호흡수 및 심박동수는 감소하였고 동맥혈 산소 포화도는 증가하였다.(p<0.05) 그러나, 실패군에서는 NIPPV 시행중에 상태가 악화되어 기관내 재삽관을 시행하였고, 재삽관 작전의 분당 호흡수 및 심박동수는 다시 증가하였으며 동맥혈 산소포화도는 감소하였다(p<0.05). 기저 질환이 COPD 이면서 기관내 관 제거 후 급성 호흡부전이 발생한 환자 8명에게 NIPPV 적용 시 COPD가 아닌 다른 환자들에 비해 NIPPV의 성공률이 의미 있게 높았다(62% 대 39%)(p=0.007). NIPPV를 이용한 이탈 시 실패의 원인으로는 기저 질환의 악화 없이 동맥혈 가스 소견이 악화되었던 예가 9예, 그 외 기저 질환 악화 5예, 마스크 부적응이 2예, 기도내 분비물 축적이 1예였다. 결 론: NIPPV는 침습적 기계 호흡이탈과정에서 특히 기저질환이 COPD인 환자들의 경우 기관내 관 제거 후 발생한 급성 호흡 부전 시 기관내 관의 재삽관을 피할 수 있는 유용한 치료적인 방법으로 사료된다.

• 한국치위생학회지
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• 제16권2호
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• pp.233-240
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• 2016

Objectives: The aim of this study was to evaluate the oral health status and behavior in Korean diabetic adults. Methods: The study subjects were 11,840 adults who participated in the fifth Korea National Health and Nutrition Examination Survey(2010-2012). Diabetic status was defined by doctors and fasting blood sugar(FBS) level. Oral health status was assessed by decayed-missing-filled teeth(DMFT), community periodontal index(CPI), periodontal disease, denture needs, limitation of oral function, and chewing difficulty. The oral health behavior was evaluated by oral examination within a year, brushing times a day, and use of auxiliary oral product. The data were analyzed by descriptive analysis, chi-square tests and multiple logistic regression analyses. Results: The prevalence rate of diabetes mellitus diagnosed by doctor and FBS was 8.3% and 10.2%, respectively. The prevalence rate of periodontitis was 25.4%. The proportions of $DMFT{\geq}20$, $CPI{\geq}3$, periodontal disease, denture needs, oral function limitation and chewing difficulty in the confirmed diabetic group by doctor were significantly higher than those of the non-diabetic group(p<0.05). In multiple logistic regression analysis, the adjusted odds ratio(aOR) for periodontal disease(aOR=1.73, 95% CI=1.41-2.12), presence of denture needs(aOR=1.40, 95% CI=1.06-1.84), limited oral function(aOR=1.43, 95% CI=1.15-1.78) and chewing difficulty(aOR=1.41 95% CI=1.13-1.77) in diabetic subjects were significantly higher than those of the non-diabetic subjects. There were similar associations between diabetes defined with FBS and oral health. In oral health behavior, diabetic subjects had significantly lower odds ratios for oral examination(aOR=0.76, 95% CI=0.60-0.98), brushing time ${\geq}2$ times(aOR=0.73, 95% CI=0.57-0.93), and auxiliary oral products(aOR=0.74, 95% CI=0.59-0.94). Conclusions: There was a significant relationship between oral health status and behavior in Korean diabetic adults. Further study is needed to evaluate the underlying mechanisms between diabetes mellitus and oral health status.