• Title/Summary/Keyword: Medical consultation

검색결과 412건 처리시간 0.028초

자살시도자의 정신건강의학과 치료 연계 형태에 따른 동반질병 심각도의 차이 (Severity of Comorbidities among Suicidal Attempters Classified by the Forms of Psychiatric Follow-up)

  • 이혁;오승택;김민경;이선구;석정호;최원정;이병욱
    • 정신신체의학
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    • 제24권1호
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    • pp.74-82
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    • 2016
  • 연구목적 자살시도자는 일반적인 경우에 비해 의사결정 능력이 떨어지며, 다시 자살을 시도할 위험성이 높기 때문에 재시도 전에 정신건강의학과 치료로 연계하는 것이 중요하다. 특히 신체적 질병이 있는 사람은 자살시도를 할 확률이 높고, 사망률 역시 높아진다. 이 연구는 자살시도자의 특성을 조사하고, 자살시도 후 응급실에 방문하여 정신건강의학과 치료를 받기로 결정하는 데 신체적 질병이 어떤 영향을 주는지 분석하였다. 방 법 2012년 1월부터 12월까지 경기도의 일 종합병원 응급실에 내원한 132명의 자살시도자를 대상으로 하였다. 환자의 의무 기록을 후향적으로 검토해 인구통계학적, 임상적 요인을 조사하였고 정신건강의학과 치료 연계여부에 따라 분석하였다. 결 과 입원과 외래 상관 없이 정신건강의학과 치료를 받는 것에 영향을 주는 요인은 정신건강의학과 진단 유무, 직업 유무, 정신건강의학과 치료 과거력, 자살시도 과거력이었다. 정신건강의학과 치료 형태를 입원과 외래로 나누어 동반된 의학적 질병의 심각도(Charlson comorbidity index)를 비교했을 때, 입원을 통해 정신건강의학과 치료를 받은 자살시도자와 치료 자체를 거부한 자살시도자는 외래에서 치료를 받은 자살시도자보다 동반된 의학적 질병의 심각도가 높게 나타났다. 결 론 이 연구 결과 응급실에 내원한 자살시도자에게 동반된 의학적 질병의 심각도(Charlson comorbidity index)가 정신건강의학과 치료 형태에 영향을 미친다는 점을 알 수 있었다. 따라서 정신건강의학과 의사는 응급실에 내원한 자살시도자에 대해 의학적 동반질병의 여부 및 심각도를 평가하여 동반된 의학적 질병이 상대적으로 심각함에도 불구하고 자의퇴원을 진행하려고 하는 자살시도자에게 좀 더 합리적인 의사결정을 할 수 있도록 도움을 줄 수 있어야 한다.

한국농촌보건(韓國農村保健)의 문제점(問題點)과 개선방안(改善方案) (Innovative approaches to the health problems of rural Korea)

  • 노인규
    • 농촌의학ㆍ지역보건
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    • 제1권1호
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    • pp.5-9
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    • 1976
  • The categories of national health problems may be mainly divided into health promotion, problems of diseases, and population-economic problems which are indirectly related to health. Of them, the problems of diseases will be exclusively dealt with this speech. Rurality and Disease Problems There are many differences between rural and urban areas. In general, indicators of rurality are small size of towns, dispersion of the population, remoteness from urban centers, inadequacy of public transportation, poor communication, inadequate sanitation, poor housing, poverty, little education lack of health personnels and facilities, and in-accessibility to health services. The influence of such conditions creates, directly or indirectly, many problems of diseases in the rural areas. Those art the occurrence of preventable diseases, deterioration and prolongation of illness due to loss of chance to get early treatment, decreased or prolonged labour force loss, unnecessary death, doubling of medical cost, and economic loss. Some Considerations of Innovative Approach The followings art some considerations of innovative approaches to the problems of diseases in the rural Korea. 1. It would be essential goal of the innovative approaches that the damage and economic loss due to diseases will be maintained to minimum level by minimizing the absolute amount of the diseases, and by moderating the fee for medical cares. The goal of the minimization of the disease amount may be achieved by preventive services and early treatment, and the goal of moderating the medical fee may be achieved by lowering the prime cost and by adjusting the medical fees to reasonable level. 2. Community health service or community medicine will be adopted as a innovative means to disease problems. In this case, a community is defined as an unit area where supply and utilization of primary service activities can be accomplished within a day. The essential nature o the community health service should be such activities as health promotion, preventive measures, medical care, and rehabilitation performing efficiently through the organized efforts of the residents in a community. Each service activity should cover all members of the residents in a community in its plan and performance. The cooperation of the community peoples in one of the essential elements for success of the service program, The motivations of their cooperative mood may be activated through several ways: when the participation of the residents in service program of especially the direct participation of organized cooperation of the area leaders art achieved through a means of health education: when the residents get actual experience of having received the benefit of good quality services; and when the health personnels being armed with an idealism that they art working in the areas to help health problems of the residents, maintain good human relationships with them. For the success of a community health service program, a personnel who is in charge of leadership and has an able, a sincere and a steady characters seems to be required in a community. The government should lead and support the community health service programs of the nation under the basis of results appeared in the demonstrative programs so as to be carried out the programs efficiently. Moss of the health problems may be treated properly in the community levels through suitable community health service programs but there might be some problems which art beyond their abilities to be dealt with. To solve such problems each community health service program should be under the referral systems which are connected with health centers, hospitals, and so forth. 3. An approach should be intensively groped to have a physician in each community. The shortage of physicians in rural areas is world-wide problem and so is the Korean situation. In the past the government has initiated a system of area-limited physician, coercion, and a small scale of scholarship program with unsatisfactory results. But there might be ways of achieving the goal by intervice, broadened, and continuous approaches. There will be several ways of approach to motivate the physicians to be settled in a rural community. They are, for examples, to expos the students to the community health service programs during training, to be run community health service programs by every health or medical schools and other main medical facilities, communication activities and advertisement, desire of community peoples to invite a physician, scholarship program, payment of satisfactory level, fulfilment of military obligation in case of a future draft, economic growth and development of rural communities, sufficiency of health and medical facilities, provision of proper medical care system, coercion, and so forth. And, hopefully, more useful reference data on the motivations may be available when a survey be conducted to the physicians who are presently engaging in the rural community levels. 4. In communities where the availability of a physician is difficult, a trial to use physician extenders, under certain conditions, may be considered. The reason is that it would be beneficial for the health of the residents to give them the remedies of primary medical care through the extenders rather than to leave their medical problems out of management. The followings are the conditions to be considered when the physician extenders are used: their positions will be prescribed as a temporary one instead of permanent one so as to allow easy replacement of the position with a physician applicant; the extender will be under periodic direction and supervision of a physician, and also referral channel will be provided: legal constraints will be placed upon the extenders primary care practice, and the physician extenders will used only under the public medical care system. 5. For the balanced health care delivery, a greater investment to the rural areas is needed to compensate weak points of a rurality. The characteristics of a rurality has been already mentioned. The objective of balanced service for rural communities to level up that of urban areas will be hard to achieve without greater efforts and supports. For example, rural communities need mobile powers more than urban areas, communication network is extremely necessary at health delivery facilities in rural areas as well as the need of urban areas, health and medical facilities in rural areas should be provided more substantially than those of urban areas to minimize, in a sense, the amount of patient consultation and request of laboratory specimens through referral system of which procedures are more troublesome in rural areas, and more intensive control measures against communicable diseases are needed in rural areas where greater numbers of cases are occurred under the poor sanitary conditions.

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DACUM 기법에 의한 병원 임상영양사의 직무기술서 개발 (Development of Job Description of Clinical Dietitians in Hospitals by the DACUM Method)

  • 차진아;김강은;김은미;박미선;박유경;백희준;이송미;최수경;서정숙
    • 대한영양사협회학술지
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    • 제19권3호
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    • pp.265-286
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    • 2013
  • The present study was conducted to develop a standardized job description for clinical dietitians working in hospitals. A developing curriculum (DACUM) method was used for the job analysis of clinical dietitians. Based on DACUM analysis with 14 members, including clinical dietitians and professors majoring in clinical nutrition and job analysis, information on the duties, tasks, and task elements of clinical dietitians was determined. To verify the job descriptions derived from DACUM analysis, a total of 46 tertiary and general hospitals with over 500 beds were recruited for the survey. The final developed job description for clinical dietitians included 7 duties, 27 tasks, and 93 task elements. The duties consisted of nutritional assessment, nutrition diagnosis, nutrition intervention, nutrition monitoring evaluation, consultation cooperation, nutrition research, and self-development. The mean scores of perceived importance, performance, and difficulty on the clinical dietitian's task elements (out of a maximum score of 5.0) were 4.5, 3.7, and 3.5, respectively, with significant differences between the items (P<0.001). The perceived importance and performance grid of clinical dietitian's tasks showed that "construction and maintenance of collaboration" (E2) and "activity of quality improvement" (F1) received relatively low scores for performance despite their high importance scores; thus the performance of these tasks requires significant improvement. In conclusion, the job descriptions of clinical dietitians developed from this study are useful for the qualitative improvement of clinical nutrition services in hospitals.

지리정보시스템을 활용한 재난피해자 관리시스템 (A Disaster Victim Management System Using Geographic Information System)

  • 황현숙;최은혜;김창수
    • 한국지리정보학회지
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    • 제14권1호
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    • pp.59-72
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    • 2011
  • 갑작스런 재난에 의해 물적 신체적 손상뿐 만 아니라 심리적 손상을 입은 피해자들이 원활하게 사회생활에 다시 적응할 수 있게 하기 위한 안전복지차원의 재난 피해자 심리지원시스템에 대한 연구가 진행되고 있다. 국내에서는 소방방재청 주관으로"재난 피해자 심리지원 센터"를 운영함으로써 재난 피해자들의 심리 치유를 도우고 재난 심리 관리를 체계적으로 지원하기 위해 심리관리 서비스 전달 체계, 재난심리지원 피해자 분류, 위기 상담 방법 등에 관한 체계를 연구하고 있다. 하지만, 기존 재난 피해자 심리지원 센터에서는 지원센터 및 복지기관 현황에 대한 기본 정보만을 제공하고 있고 이러한 체계 구축에 필요한 정보를 획득하기 위한 정보기술을 기반으로 하는 관리시스템 개발은 미비한 실정이다. 따라서, 본 논문에서는 재난 피해자 및 관리자들에게 정보기술을 기반으로 원활한 교류를 지원하고 정상적인 사회생활로 복귀할 수 있도록 지도 기반의 통합 관리 시스템을 제안하고 간단한 프로토타입 시스템을 구축한다. 본 시스템은 재난 피해자, 손상발생, 관련 의료, 복지, 정신센터에 대한 데이터를 위치 기반으로 구축하고 있어, 키워드에 의한 기본 정보 검색 뿐 만 아니라 지도 기반의 공간 검색 및 통계 분석을 지원함으로써 재난 관리자들의 효율적인 정책 체계에 도움을 제공하여 심리적인 피해로 인한 피해 빈도를 줄일 수 있게 될 것이다.

환아 어머니 교육이 육아지식 정도 및 외래간호 만족도에 미치는 영향 (A Study on the Educational Effects on Child-Raising Knowledge and Satisfaction with Out-Patient Care of Mothers with Ill-Child)

  • 이소연;최미혜;권혜진
    • Child Health Nursing Research
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    • 제3권1호
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    • pp.83-98
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    • 1997
  • The purpose of this study were to find out the practical way to enlarged child-raising knowledge and to enhance their satisfaction with out-patient care by evaluating how effectively the education is done by nurses for mothers with ill-child and how their satisfaction with out-patient care changed. This study was designed as a Nonequivalent Control Group study. The subjects studied were consisted of the experimental and control group. Each consisted of 50 mothers with ill-child in pediatric department at one university hospital in Seoul. The period of this study is from May 20, 1996 to J one 28, 1996. The first data were collected from both of experimental and control groups in which mothers with ill-child come to the hospital for the first time. After this being done, the experimental group had been educated by the planned program and then the second data were collected from them. On the contrary, as for the control group, there had been no education and the second data were col looted on the same method. The data analysis was done by SPSS program. The results of this study are as follow, 1 The child-raising knowledge level of mothers with education was higher than that of with no education. (t=18.84, df=49, p=0.000) 2. The satisfaction with out-patient care level of mothers with education was higher than that of no education. (t=10.51, df=49, p=0.000) Based on these results, I suggest as follow, 1. The research on the patients and their family should be made not only in pediatric department, but in every out-patient department. 2. For more effective education, it is required for all out-patient nurses to research the education demand of patients and their family. 3. To increase the effect of education, there must be the consultation room in out-patient department. 4. The meetings with the mothers with ill-child of the same illness have to be established and periodical education must be executed. 5. Audio-visual education programs like video tapes are needed to make use of waiting time for the medical treatment. 6. On-line consulting programs are needed.

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재가 복지 봉사 사업의 가정 간호 사업연계 필요 조사 (Study on Effective Utilization Strategies of the Home Health Care Program in the Community Care Service of Welfare Policy)

  • 김성실
    • 지역사회간호학회지
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    • 제7권2호
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    • pp.183-202
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    • 1996
  • This study was designed out to develop a home health care service for nurses working in community care services. This study investigates actual conditions at welfare institutions related to health needs the demands of clients, and the state of home health care services we hope that this study will improve upon the current service system. In Korea home health care services are still developing and only new becoming a part of the health care supply system. The data was collected by recording the client home nursing assessments modified to the situation of UTMB home health agency. In this study 107 clients were selected for home care who needed care for physical and mental deficits. The study lasted from March to November of 1995 at one of the welfare service institutions in Chunchon city. The results show that those who most frequently needed care services were over 50 years old with a health deficit of 80.3%, followed by sex as women who needed care at 59.8%. 50.5% of the clients had very little education. 99.1% of the clients live with their family, and a medical diagnostic analysis reveals that 73.9% of the 5 year period of illnesses were the following : 38.8% - muscular -skeleton system disorder, 24.4% - hypertension and stroke, 25.7% sole disease of arthritis. For behavioral conditions 43.3% of the patients were without care services, 56.6% of the patients were taking treatment that 73.5% of those were taking medication. The most main complaint of patients were 22.4% of pain in the extremities, next were 16.8% of a limitation of body activities, 15.0% was lumbo-sacralgia. According to the investigator who was a senior student nurse, the following suggestions were made: 32.7% for curative medical services, 29.9% for physical exercise, 19.6% for emotional support. Consultation nursing services consisted of 67.2% for physical therapy, 11.2% for the maintaining healing, 9.4% for counseling. The patients at home, required assistance most frequently for muscular-skeleton problems under the category of physical systems (33.3%). But, on the other hand, 49.5% of the patients required care givers at home, 28.2% had a knowledge deficit, 21.0% had malnutrition, 18.4% had bad impaired communication. The character of health problems were devided into chronic disease(67.0%), accidents(I3.1%), and general disease(15.9%). 86% of the disabled client had an impairment of the physical system. Eating (86.9%) , Toileting(77.6%), and personal care showed much the same of ADL condition, the level and range of achievement of mobility, the most frequently self performed was 81.3% only in a room size area, and 40.2% were completely dependent when going out. Although there were a large number of home care services in th community at these welfare institutions, many clients needed a variety of curative services. As policy changes have gathered momentum, responsibility for the development of a more suitable program was demanded by the clients from the community.

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음허증 측정도구의 개발 및 신뢰도 타당도 검정 (Development of Yin-Deficiency Questionnaire and Examine the Reliability and Validity)

  • 이상재;박종배;이송실;김광호
    • 동의생리병리학회지
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    • 제18권2호
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    • pp.376-380
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    • 2004
  • The purpose of this study is the develop a questionnaire for measuring Yin-Deficiency and examine the reliability and validity for its' value as a barometer for evaluating Yin-Deficiency. Questionnaire was developed according to the symptoms of Yin-Deficiency suggested in the 'Standardization of diagnostic terms and requirements of Korean Medicine', With and as a reference, each symptom has been worked on to be put on the questionnaire. Visual analogue scales(VAS) was used as a barometer for measuring frequency of manifestation of symptoms. A study was performed to measure validity and reliability of the final questionnaire for analysis. reliability of YinDQ was measured by Cronbach's alpha coefficient and test-retest method. This study utilized factor analysis and clinical validity for evaluation of validity. For the purpose of decreasing the amount of data-the number of factors, and at the same time minimize the loss of information factor analysis was performed Component factors were extracted using Principal Component Analysis. This study evaluated the clinical validity for examination of difference between the normal group and the patient group. Evaluation on the's internal consistency showed strong internal consistency with value of 0.8615. reliability from test-rest with three-week interval, followed by comparisons of the correlation coefficient and mean values of each item between the two. The Spearman correlation coefficient was 0.54-0.79. By factor analyse two factors with Eigen value of greater than 2.2 were selected. Factor 1 consists of items of 'irritable fever on the five Hearts', 'flushing of the zygomatic region in the afternoon', 'tidal fever', 'night sweats', and 'dryness on the mouth or the throat'. Factor two consists of items of 'emaciation', 'dizziness', 'insomnia', 'decreased amount of urine with yellowish color', and 'constipation'. The comparison between the patient group and the normal group showed significant differences for every ten questions. The results implies that YinDQ is a barometer with sufficient reliability and validity. The questionnaire for Yin-Deficiency may not be enough to replace the specific differential diagnosis by a doctor of Oriental medicine. Nevertheless, it can be effectively utilized as an assisting method in consultation or a method of measuring the degree of Yin-Deficiency in a group.

지역사회 치매관리 모형 개발 : 광명시의 경우 (Development of Dementia Care Model in a Community)

  • 배상수;김동현;우영국;오진주;민경복;이수현;이미라;이상숙;표옥정
    • 보건행정학회지
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    • 제9권1호
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    • pp.30-71
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    • 1999
  • There has been a dramatic increase in public awareness regarding dementia during recent years. However, dementia remains a family affair and patients do not receive adequate care in Korea. This study aims to assist patients and their caregivers by establishing Home and Community based Long-Term Care in a city. The data collected for analysis include five main categories: dementia prevalence, limitations of daily activities of patients, burden of caregivers, the services that patient's family want to utilize, the resources that handle dementia in the community. Major findings can be summarized as follows: 1)The prevalence rate of dementia for elderly people is 13.1 per 100 persons. Alzheimer's disease amount to 38.9% of dementia patients and vascular dementia account for 36.7% of them 2)Eight out of ten patients have mild dementia. Almost all patients have normal ADL. IADL, however, shows different picture. In every items of IADL, about 60% of patients reveals some limitations. 3)The proportion of patients who had medical diagnosis is as low as 20%. Families of patients think dementia as normal aging process and medical doctors in the community do not give special concern to dementia patients. 4)Caregivers does not have proper social support. They suffer from long care time, experience large obstacles in respect of health, daily living, and social activity. 5)Health center and Community welfare center have launched some programs-consultation, home-visiting nursing, day care center, voluntary force mobilization and so on-for dementia patients. But they do not perform expected roles and functions because of lack of skilled personnels and inadequate coordination of relevant organizations for dementia care. 6)Families of dementia patients prefer home helper and home-visiting nurse to hospitalization. For the future, however, demand for institution-based long-term services will increase. We develope community dementia care model based on above findings as follows: 1)Health center execute community cardiovascular control program for the prevention of vascular dementia. 2)Refer to epidemiologic characteristics of patients and preference of family, the most urgent task for dementia care in this city is to expand and organize Home and Community based Long-Term Care. 3)For the continuous and comprehensive care, care plan for a patient must be prepared. Case management team should be builded to prepare this plan and coordinate relevant resources. 4)Special long-term care unit for dementia will be needed in a near future. This unit should have multiple functions, such as day-care center, short stay facility, training center for relevant personnels, besides long-term nursing home considering effective care of dementia and efficient operation of the facility. 5)Voluntary workers deserve their due efforts. Incentive mechanisms must be developed to activate voluntary activities.

주요 출혈성 질환자에서 치성감염 관리에 관한 임상적 연구 (A CLINICAL STUDY ON THE CARE OF ODONTOGENIC INFECTIONS IN THE PATIENTS WITH MAJOR BLEEDING DISORDERS)

  • 김종배;정원균;노희진;장선옥;유재하;한상권;정재형;김병욱
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • 제29권5호
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    • pp.330-337
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    • 2003
  • This is a retrospective study on the care of odontogenic infections in admission patients with major bleeding disorders. The study was based on a series of 514 patients treated at Dong San Medical Center, Wonju Christian Hospital and Il San Health Insurance Hospital, from Jan. 1, 2000, to Dec. 31, 2002. The obtained results were as follows : 1. The cardiovascular disease was the most frequent cause of the systemic diseases with major bleeding disorders, and liver disease, cerebrovascular disease and renal failure were next in order of frequency. But, there was the most frequent dental consultation in the liver disease, owing to the many odontogenic infectious diseases. 2. Male prediction (66.3%) was almost existed in the odontogenic infectious patients with major bleeding disorders. But, there was slight female prediction (53.4%) in the cardiovascular disease. 3. The most common age group of the odontogenic infectious patients with major bleeding disorders was the fifty decade(27.2%), followed by the forty, sixty & thirty decade in order. 4. In the contents of chief complaints on the odontogenic infectious patients with major bleeding disorder, peak incidence was occurred as toothache (42.2%), followed by intraoral bleeding, ulcer pain, dental extraction in order. 5. In the diagnosis group of odontogenic infectious diseases, periodontitis, pulpitis and periapical abscess were more common. 6. In the treatment group of odontogenic infectious diseases, the most frequent incidence(44.2%) was showed in primary endodontic drainage(pulp extirpation, occlusal reduction & canal opening drainage) and followed by the incision & drainage, the medications & oral hygiene instruction, scaling, indirect pulp capping in order.

선천적 심질환아의 수술동의서 작성과 관련된 부모의 요구 (Needs of Parents Who have the Child with Congenital Heart Disease Related to the Informed Consent)

  • 최미영
    • 부모자녀건강학회지
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    • 제6권1호
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    • pp.18-30
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    • 2003
  • Congenital heart disease is the most frequently shown congenital disease among children, most of them can be corrected with operation. However, Patients and their parents need nursing intervention when they face this risky incident of operation. Therefore, parents' experiences are absolutely needed to plan nursing intervention to give practical help to the patients and their parents. The purpose of this study is to provide basic resources to develop a feasible intervention program for the parents by understanding the experiences related to the informed consent of cardiac surgery of their child. From January to June 2003, 10 parents of children patients with congenital heart disease were interviewed who filled out Operation Agreement before the primary operation after they are diagnosed as congenital heart disease in pediatric chest surgery of A hospital in Seoul. They were asked to give opinion regarding pre-operation needs and the interviewed information was analyzed. The results of this study are as follows : Firstly, they were asked what they felt before they were told about the operation of their children from the doctor before filling out the informed consent of operation. They felt 1) vague, 2) confusion of choose, 3) risky, 4) resented, 5) uneasy, 6) guilty, and 7) the burden of operation. Secondly, they were asked what they felt after they filled out the informed consent of operation and the doctor gave them detailed information on the operation of their children. They felt 1) confused, 2) responsible, 3) rejected, 4) angry, 5) plain, 6) to have hope, 7) trying to trust medical people, 8) that consolation is needed, and 9) conditional reduction of the burden of operation. Thirdly, followings are the categories of congenital parents' demand before operation based on the analysis of experiences related to the preparation of the informed consent of operation. 1) Information Demand (1) Anticipatory information (2) Concrete and precise information (3) Individual information 2) Support (1) Empathy (2) Parental supporting (3) Support of parents in the same situation 3) Education and consulting (1) Children-oriented Education (2) Consultation Considering the results of this study, parents of the child with congenital heart disease seem to have various emotional experiences related to filling out the informed consent and they need concrete and practical helps before cardiac surgery. This study proposes that systematic nursing intervention is needed according to the needs of the parents who have the child with congenital heart disease before operation in the field of child health nursing.

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