• 제목/요약/키워드: Medical care services

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제2형 당뇨병환자에서 임상영앙치료의 임상적 효과와 비용효과 연구 (The Clinical and Cost Effectiveness of Medical Nutrition Therapy for Patients with Type 2 Diabetes Mellitus)

  • 조영연;이문규;장학철;라미용;김지영;박영미;손정민
    • Journal of Nutrition and Health
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    • 제41권2호
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    • pp.147-155
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    • 2008
  • 우리나라의 경제적 발달과 문화 수준의 향상으로 질병 양상과 사망 원인에 많은 변화가 있는데, 그 중에서도 최근 당뇨병의 유병률의 상승 현상이 두드러지게 나타나고 있으며, 사망 원인의 수위를 차지하고 있다. 그러므로 이를 예방하고 당뇨병 합병증을 예방하기 위한 구체적이고 근거중심인 영양치료 방법의 제시가 절실한 실정이다. 미국영양사협회에서는 지속적으로 증가하는 당뇨병 유병율을 낮추기 위하여 생활습관의 개선을 목표로 임상영양치료의 표준화 지침을 제시하고 이에 따른 치료 효과 연구가 활발히 진행되고 있으나, 아직 국내에서는 많은 연구가 진행되고 있지 않은 현실이다. 따라서 본 연구에서는 이미 국외에서 사용되고 있는 지침에 근거하여 심층영양교육 방법을 실시하여 그 효과를 1회 교육만으로 시행되는 기본교육 방법과 비교하여 다음과 같으나 결과를 얻었다. 심층 및 기본영양교육 즉, 두 가지 교육 방법을 비교하였을 때 심층영양치료 방법을 실시한 경우 기본영양교육을 실시한 경우보다 혈당, 혈압 및 체중 강하 효과 면에서 유의적으로 개선효과가 있는 것으로 나타났다. 비용효과 면에서 장기간의 혈당변화 상태를 알 수 있는 당화혈색소의 경우 1%를 낮추기 위하여 소요되는 비용은 심층영양교육군에서 더 적었으며, 교육의 잠재 효과를 고려하였을 경우, 모든 혈당 검사 지표의 영양치료 비용 대비 효과 면에서 심층영양교육 방법이 기본영양교육 방법보다 앞서는 것으로 나타났다. 저비용 고치료 효과를 보여주고 있는 임상영양치료는 당노병과 같은 만성질환의 중요한 기본치료로 주목되고 있는 현 시점에서 영양치료행위의 의료 보험 급여화는 국민의 건강을 증진시키고, 국가적으로는 의료비 지출을 감소시키며 국민의 건강을 증진시키는데 큰 기여를 하는 합리적인 방안이라 생각된다. 따라서 현 비급여 수가로 되어 있는 교육수가를 급여화하여 많은 환자들에게 의료 혜택을 주는 일이 필요하리라 사료된다.

DACUM 기법에 의한 1급 응급구조사의 직무분석 (Task Analysis of Paramedics of Korea Based on DACUM Method)

  • 배기숙;고봉연;이정은;이인모;최근명;김수태
    • 한국응급구조학회지
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    • 제15권1호
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    • pp.5-23
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    • 2011
  • Objective : This study grasps specific task on paramedics who plays a great role in the emergency scene, thereby eliciting definition of job called paramedics and analyzing occupation by DACUM method. Thus, the aim is to suggest working-level guidelines on the task of paramedics. Methods : It targeted paramedics who are working at hospitals, fire stations, and industries in Seoul and Gyeonggi area from Oct. 11, 2010 to Nov. 30. A total of 608 copies of questionnaire were analyzed by DACUM method. A research tool on occupational analysis consisted of 8 pieces for duty, 43 pieces for task, and 149 pieces for task elements. In order to survey performance frequency, importance, and difficulty by element, each task was developed by this research team, and each task was analyzed and finally elicited through workshop of DACUM method. Results : The occupational definition of paramedics, which was defined through this DACUM, was elicited as 'professional job of performing emergency medical care on the scene, during transferring, or within medical institution in order to maintain life and prevent wound deterioration, targeting a person who is put in emergency situation.' Task element, whose performance frequency was indicated to be the highest, was in order of checking mental status($2.76{\pm}0.497$), checking vital signs($2.70{\pm}0.578$), and airway/c-spine immobilization($2.69{\pm}.546$). Especially, defibrillation stood at $2.23{\pm}.655$ points. Task element, whose performance frequency was low, was in order of caring sexual abuse victims($1.32{\pm}0.563$), performing cricothyrotomy($1.36{\pm}0.618$), and caring cardiac arrest victims($1.40{\pm}0.636$). Importance of task was in order of airway/c-spine immobilization ($2.88{\pm}0.338$), maintenance of respiration($2.88{\pm}0.351$), caring cardiac arrest victims($2.87{\pm}0.349$), and performing CPR($2.87{\pm}0.361$). Task element, whose importance is low, was indicated to be in order of enema($2.29{\pm}0.736$), urinary catheterization($2.35{\pm}0.664$), and nasogastric intubation($2.35{\pm}0.667$). Task element, whose difficulty was shown to be the highest, was indicated to be in order of caring cardiac arrest victims during pregnancy ($2.60{\pm}0.559$), caring cardiovascular injury($2.59{\pm}0.546$), and labor management($2.53{\pm}0.533$). Conclusion : Based on the results of this study, the job performance work table(Dacom chart) of paramedics is suggested to be used, thereby being applied to development in education and curriculum of paramedics. It is necessary to evaluate usefulness of the job performance work table by estimating effect of education for paramedics based on the job performance work table of paramedics.

TMA 분석을 위한 지능적 의학 전문가 시스템의 설계 및 구현 (Design and Implementation of an Intelligent Medical Expert System for TMA(Tissue Mineral Analysis))

  • 조영임;한근식
    • 한국정보과학회논문지:소프트웨어및응용
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    • 제31권2호
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    • pp.137-152
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    • 2004
  • 모발분석(TMA: Tissue Mineral Analysis)은 머리카락 속에 있는 30여 가지의 미네랄과 8가지의 중금속의 양과 중요 미네랄 비율을 분석하여 체내에 과잉, 결핍 및 불균형 상태를 평가하고, 그 결과가 현재 인체에 미치는 영향을 예측하여, 건강을 유지하는 방향을 제시하는 임상 영양학 및 독성학 모발조직 검사방법을 말한다. 그러나 국내 TMA 분석방법은 몇 가지 문제점이 있다. 첫째, TMA 분석기기는 있으나 분석결과를 해석할 수 있는 한국형 의학 정보 데이타베이스가 없다. 둘째, 미국에서 보내오는 TMA 검사결과 자료가 영문이며 철저한 보안에 바탕을 둔 그래픽 파일 형태이므로 활용성이 적다. 셋째, TMA 관련 데이터베이스가 있어도 의료기관에서 사용하기 어려운 매우 낮은 수준이므로 TMA 분석 및 의료서비스를 위해 매번 미국에 의뢰해야 하므로 심각한 외화낭비를 초래한다. 넷째, TMA 결과가 서구식 생활패턴에서 비롯된 데이터 베이스로부터 구축된 것이므로 검사결과의 신뢰성 문제가 발생한다. 따라서 본 논문에서는 이러한 문제점을 해결하기 위해 국내 전문 기관으로부터 자료를 제공받아 TMA 관련 국내 최초 지능적 의학 전문가 시스템(IMES: Intelligent Medical Expert System)을 개발하였다. IMES는 TMA 자료를 다단계 통계분석 방법에 의한 결정 트리 분류기를 이용하여 분류하고 다중 퍼지 규칙베이스를 구축하여, 지능적 퍼지추론 방법에 의해 한글화된 데이터베이스로부터 복잡한 자료를 추론하도록 구축하였다. 본 IMES 시스템을 실제 적용한 결과 업무능률과 만족도가 각각 86%, 92% 증가함을 알 수 있었다.

한국인 성인 비만의 사회경제적 비용 (Socioeconomic Costs of obesity for Korean Adults)

  • 문옥륜;김남순;강재헌;윤태호;이상이;이신재;정백근
    • Journal of Preventive Medicine and Public Health
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    • 제35권1호
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    • pp.1-12
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    • 2002
  • Objective : To estimate the socioeconomic costs of obesity in Korea,1998. Methods : The 1998 National Health and Nutrition Examination Survey(1998 NHNES) data was used and 10,880 persons who had taken health examinations were selected for study. Essential hypertension, NIDDM(non insulin-dependent diabetes mellitus), dyslipidemia, osteoarthritis, coronary heart disease, stroke were included as obesity related disease. The data of direct costs of obesity was obtained from the National Federation of Medical Insurance. The category of indirect costs was the loss of productivity caused by premature death and admission, time costs, traffic costs, nursing fees due to obesity. Multiple logistic regression model was developed to estimate prevalence odds ratio by obesity class adjusted demographic and socio-ecnomic factors and calculate PAF(Population Attributable Fraction) of obesity on obesity related disease. And we finally calculated the socioeconomic costs of obesity in relation to BMI with PAF. Results : The direct costs of obesity were 2,126 billion${\sim}965$ billion Won in considering out of pocket payment to uninsured services, and the indirect costs of obesity were 2,099 billion${\sim}1,086$ billion Won. Consequently, in considering out of pocket payment to uninsured services, the socioeconomic costs of obesity were 4.225 billion${\sim}2,050$ billion Won, which corresponded to about $0.094%{\sim}0.046%$ of GDP and $1.88%{\sim}0.91$ of total health care costs in Korea. Conclusions : Obesity represents a major health problem with significant economic implications for the society. This results are conservative estimates as far as all obesity related disease and all health care and indirect costs were not included due to missing information. further studies are needed to caculate socioeconomic costs of obesity more exactly.

도시와 농촌노인의 건강생활습관과 만성질환관리 실태비교 (Comparison of Healthy Life Style and Chronic Disease Management between Urban and Rural Older Adults)

  • 이지아;이예나
    • 재활간호학회지
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    • 제15권2호
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    • pp.100-108
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    • 2012
  • Purpose: The purpose of this study was to compare healthy life style and chronic disease management between urban and rural older adults. Methods: The study employed a comparative and descriptive survey design. Data were collected from 154 older adults living independently in communities (79 from urban and 75 from rural areas) using structured questionaries from 24 July, 2010 to 14 August, 2011. Results: Perceived health status was significantly lower in urban older adults than those in rural areas ($x^2$=13.27, p = .001). Frequency of regular health examination was better in the urban group than the rural group ($x^2$=4.71, p = .030). Among older adults with hypertension, medication noncompliance was higher, and participation rate in disease management education was lower in the rural group than the urban group ($x^2$=6.43, p = .040; $x^2$=23.51, p<.001, respectively) and the same as arthritis. Conclusion: Rural older adults had more problems with health and disease management in this study, might be, due to difficulties in access to health care services than urban residents. More tailored programs of disease management as well as health service programs and staffing should be developed in rural areas. For urban older adults, meal preparation program and more opportunities producing income may be needed.

메디컬 그리드 장치를 위한 안전한 모바일 헬스케어 시스템에 관한 연구 (A Study of The Secure Mobile Healthcare System for Medical Grid Devices)

  • 최규석
    • 한국인터넷방송통신학회논문지
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    • 제8권6호
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    • pp.89-95
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    • 2008
  • 분산 컴퓨팅 환경에서 모바일 서로게이트 시스템은 보안상의 문제로 인하여 널리 사용되고 있지 못하고 있다. 현재 가장 널리 사용되고 있는 그리드 미들웨어인 글로버스에서도 모바일 단말기를 인증하는 방법이 제공되고 있지 않아 그리드의 강력한 컴퓨팅 능력을 모바일 클라이언트까지 확장하는 것을 어렵게 하는 중요한 요인이 되고 있다. 본 논문에서는 PDA와 같이 컴퓨팅 파워가 미약한 모바일 단말기기와 그리드 호스트 간의 인터페이스 역할을 하는 게이트웨이를 두고 모바일 클라이언트가 이동 중 그리드 서비스를 이용할 수 있도록 하는 안전한 모바일 그리드서비스 프레임워크를 설계 구현하였다. 아울러, 이를 구현하여 ECG 신호처리를 위한 헬스케어 시스템에 적용하였다. 이 시스템은 이동 환경에서 환자의 생체 신호를 그리드 컴퓨팅으로 분석하여 원격에 있는 의료진이 진단할 수 있는 모바일 헬스케어에 활용가능하다.

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스마트 기기를 활용한 응급 지원 시스템 (Emergency Support System using Smart Device)

  • 정필성;조양현
    • 한국정보통신학회논문지
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    • 제20권9호
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    • pp.1791-1798
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    • 2016
  • 최근 스마트폰과 웨어러블 디바이스를 이용한 스마트 헬스케어에 대한 연구가 활발히 진행되고 있다. 스마트 헬스케어란 다양한 종류의 생체신호 측정 센서와 스마트 디바이스를 이용하여 개인화된 건강관리서비스를 제공받는 서비스를 말한다. 스마트 디바이스를 이용한 스마트 헬스케어를 위해서는 스마트 웨어러블 디바이스를 이용한 개인 건강관리 모니터링 서비스 중심의 연구뿐만 아니라 응급 상황 이후의 응급조치 방안을 위한 서비스에 대한 연구 또한 필요하다. 본 논문에서는 스마트 디바이스를 이용하여 그룹관리 기법을 이용하여 응급 상황을 모니터링 하고 상황을 전파하는 응급환자 지원 시스템을 제안하였다. 제안하는 시스템은 응급 상황을 판단했을 때 위치 정보를 기반으로 응급처치 지원자에게 연락을 취한다. 또한 스마트 디바이스를 이용하여 환자의 사진을 서버로 전송하면 환자의 정보를 화면에 제공하는 응급 지원 시스템을 설계 및 구현하였다.

Thoracic and Cardiovascular Surgeons' Perception of the Concentration of Cardiovascular Operations in Seoul Metropolitan Area's Hospitals

  • Jeong, Hyo Seon;Lee, Kun Sei;Chee, Hyun Keun;Ahn, Hye Mi;Sim, Sung Bo
    • Journal of Chest Surgery
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    • 제49권sup1호
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    • pp.53-59
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    • 2016
  • Background: The purpose of this study is to evaluate the concentration of cardiovascular surgical procedures in a metropolitan area and investigate the perception of specialists regarding governmental policies to resolve this imbalance. Methods: From March to May 2015, surveys were distributed to members of the Thoracic and Cardiovascular Surgery Association. The final pool of research subjects consisted of 75 respondents. Subjects were queried regarding the concentration of cardiovascular operations in metropolitan areas, alternatives to the imbalance, and governmental policies to resolve the inequalities. Results: Survey participants responded that South Korea needs governmental policies to alleviate the concentration of cardiovascular surgery patients in large metropolitan hospitals. Participants agreed that the freedom to choose medical institutions and improved accessibility to metropolitan hospitals due to advanced transportation systems were some of the causes for the concentration. A majority (98.7%) of respondents thought establishing thoracic and cardiovascular surgery centers in provinces was an appropriate solution to alleviate the concentration. Thoracic and cardiovascular surgery specialists were ranked as the number one group on which to focus development. Conclusion: Developing and carrying out policies to establish thoracic and cardiovascular surgery centers in provinces will alleviate the regional imbalance in available heart surgery services and an overall improvement in cardiovascular disease treatment in South Korea.

Epidemiology of Hydatidiform Moles in a Tertiary Hospital in Thailand over Two Decades: Impact of the National Health Policy

  • Wairachpanich, Varangkana;Limpongsanurak, Sompop;Lertkhachonsuk, Ruangsak
    • Asian Pacific Journal of Cancer Prevention
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    • 제16권18호
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    • pp.8321-8325
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    • 2016
  • Background: The incidence of hydatidiform mole (HM) differs among regions but has declined significantly over time. In Thailand, the initiation of universal health coverage in 2002 has resulted in a change of medical services countrywide. However, impacts of these policies on gestational trophoblastic disease (GTD) cases in Thailand have not been reported. This study aimed to find the incidence of hydatidiform mole (HM) in King Chulalongkorn Memorial Hospital (KCMH) from 1994-2013, comparing before and after the implementation of the universal coverage health policy. Materials and Methods: All cases of GTD in KCMH from 1994-2013 were reviewed from medical records. The incidence of HM, patient characteristics, treatment and remission rates were compared over two study decades between 1994-2003 and 2004-2013. Results: Hydatidiform mole cases decreased from 204 cases in the first decade to 111 cases in the seond decade. Overall incidence of HM was 1.70 per 1,000 deliveries. The incidence of HM in the first and second decades were 1.70 and 1.71 per 1,000 deliveries, respectively (p=0.65, 95%CI 1.54-1.88). Referred cases of nonmolar gestational trophoblastic neoplasia (GTN) increased from 12 (4.4%) to 23 (14.4%, p<0.01). Vaginal bleeding was the most common presenting symptom which decreased from 89.4% to 79.6% (p=0.02). Asymptomatic HM patients increased from 4.8% to 10.2% (p=0.07). Rate of postmolar GTN was 26%. Conclusions: The number of HM cases in this study decreased over 2 decades but incidence was unchanged. Referral rates of malignant cases were more common after universal health coverage policy initiation. Classic clinical presentation was decreased significantly in the last decade.

외래간호사의 직무에 대한 중요도, 난이도, 빈도 분석 (Analysis of Importance, Difficulty, and Frequency of Nurses' Job in Outpatient Departments)

  • 이여진;조경숙;박영숙;임난영;김동옥;권성복;이은희
    • 기본간호학회지
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    • 제16권2호
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    • pp.232-241
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    • 2009
  • Purpose: The purpose of this study was to analyze the importance, difficulty, and frequency of work (duties and tasks) done by nurses' in Outpatient Departments (OPD). Method: Data were collected using structured questionnaires, which included 11 duties and 92 tasks making up the OPD nurse's job. Questionnaires were completed by 286 nurses. Each duty and task was analyzed for importance, difficulty, and frequency (range 1-3). Results: The mean score for importance was $2.58{\pm}0.29$, for difficulty, $2.11{\pm}0.31$, and for frequency, $2.18{\pm}0.31$. OPD nurses recognized 'patient education and consultation' as important and difficult. However, in practice OPD nurses reported the most frequent task as 'support for medical services'. There was a significant difference in importance and difficulty of duties according to OPD nurses' university degree (F=3.693, p=.026; F=4.089, p=.018) and hospital size (F=4.274, p=.006; F=3.154, p=.025). However there were no differences in importance, difficulty, or frequency according to clinical experience in OPD. Conclusion: The findings indicate that OPD nurses must be able to do important and difficult duties and tasks, especially patient education and consultation. To have time for these uniquely nursing tasks, OPD nurses need to delegate 'preparation for medical service', and 'management of facility and environment' to nonmedical health-care workers.

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