• 융합정보논문지
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• 제10권5호
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• pp.177-187
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• 2020

본 연구는 65세 이상 노인의 돌봄요구군을 분류하고, 군간 특성을 확인하기 위하여 수행되었다. 한국보건사 회연구원이 진행한 '2017년도 노인실태조사'의 자료를 이용한 이차자료 분석연구로, 분석대상은 2017년 노인실태 조사 참여자 중 서울시 노인 999명, 가중치 부여 1,295,491명이다. 돌봄요구군의 분류를 위하여, 의료요구, 일상생활수행 지원요구, 사회적 활동 지원요구의 특성을 파악하였다. 지원요구가 하나도 없는 일반군이 50.4%, 의료요구군이 17.9%, 일상생활수행 지원요구 또는 사회적 활동 지원요구가 있는 복지요구군이 14.2%, 의료요구와 복지요구가 모두 있는 복합요구군이 17.5%이었다. 성별, 흡연, 치매검진, 지난 1년간 외래이용, 일상생활수행 도움 여부, 비동거 자녀 또는 손녀 여부를 제외한 일반적 특성, 장기요양등급 및 장애등급 현황, 경제적 부담 및 일상생활 도움 정도, 건강행태와 건강상태, 삶의 만족도에서 돌봄요구군간 유의미한 차이를 보였다(p<.001). 복합요구군에게 의료와 복지의 통합돌봄 서비스를 우선 제공해야 한다. 특히 복합요구군은 의료, 복지, 운동, 영양, 정신건강, 간호의 요구를 모두 가지고 있는 대상자로 다학제적 팀 접근이 필요하다.

• 종양간호연구
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• 제4권2호
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• pp.110-123
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• 2004

The purpose of this study was to develop a clinical pathway for the allogeneic bone marrow transplantation donor. For this study, a conceptual framework was developed through a review of the literature including six steps which are using in Jones Hopkins Hospital. USA. The researcher reviewed 129 medical re-cords of donor who had bone marrow donation between January 2002 to January 2004, to identify the overall service contents required by these patients and to make a preliminary clinical pathway. A content validity test was done for the preliminary clinical pathway, a professional group screened 51 medical re-cords and adopted with 3 hospitalization days as the clinical pathway framework. In the fifth step, clinical pathway test was also done to 7 donors from April 28th to July, 2004. After these processes the final clinical pathway was developed. The results of this study are as follows: 1. The vertical axis of the clinical pathway Includes the following 9 items: vital signs, nursing assessment, activity, diet, intervention, medication, test, consultation and patient teaching. The duration of the horizontal axis was 3days from admission to discharge 2. Analysis of the 129 medical records indicated that the average length of stay was 3 4 days. The medical performance according to the vertical axis in the preliminary clinical pathway consisted of 51 items After clinical validity test, it steel consisted of 51 items in the final form. 3. Clinical Validity test was done to 7 bone marrow donors. During these process, The first patient was deleted because he was out of the criteria the investigate set and 6 patients were used, finally The result of this study indicated all of 7 donors were discharged on expected day. 4. Clinical pathway enables to improve the quality of care, multidisciplinary team work It also helps nursing bone marrow donor, effective education to donor or medical member. The results of this study suggest that clinical pathway may be able to improve the quality of nursing care for bone marrow transplantation donors.

• Archives of Plastic Surgery
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• 제47권3호
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• pp.223-227
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• 2020

Background After the laws regulating emergency medicine were amended in 2012, regional trauma centers were established in South Korea. Plastic surgeons specialize in the simultaneous surgical care of patients with facial trauma, burns, and complicated wounds. The objective of this study was to evaluate the role of the plastic surgery department in treating severe trauma patients. Methods From January 2012 to December 2018, we enrolled 366 severe trauma patients with an Injury Severity Score (ISS) over 15 who received treatment by specialists in the plastic surgery department. Of these patients, 298 (81.4%) were male, and their mean age was 51.35 years (range, 6-91 years). The average ISS was 22.01 points (range, 16-75 points). Results The most common diagnosis was facial trauma (95.1%), and facial bone fracture (65.9%) was most common injury within this subgroup. Patients were referred to 1.8 departments on average, with the neurosurgery department accounting for a high proportion of collaborations (37.0%). The most common cause of trauma was traffic accidents (62.3%), and the average length of stay in the general ward and intensive care unit was 36.90 and 8.01 days, respectively. Most patients were discharged home (62.0%) without additional transfer or readmission. Conclusions Through this study, we scoped out the role of the specialty of plastic surgery in the multidisciplinary team at regional trauma centers. These results may have implications for trauma system planning.

• Journal of Hospice and Palliative Care
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• 제20권3호
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• pp.159-166
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• 2017

항레트로바이러스제 치료의 확립, 조기치료로 HIV 감염인들의 바이러스의 조절과 면역저하의 개선이 이루어지고 있다. 다수의 환자들이 더 이상 에이즈 관련 합병증으로 사망하지 않고, 심혈관질환, 대사성질환, 간질환, 신장질환, 신경계질환과 같은 만성합병질환을 갖고 고령화되고 있다. 그러나 지금도 여전히 사회적 차별과 낙인이 존재하는 가운데 후기 발현자로 후천면역결핍증 상태로 방문하여 사망하거나 중증의 신경계합병증으로 장애를 갖는 환자들이 있다. 환자의 다양한 증상들에 대해 이른 시기부터의 완화의료적 접근이 필요하다. 원위 대칭성 감각 다발신경병증 등의 환자의 만성 통증은 저평가되어 왔고 이에 대한 적극적인 통증 중재가 필요하다. 이전 호스피스 기준은 현재 시점에서 새롭게 제시한다. 감염인의 약제 지속 등의 의학적 필요, 심리적 상태, 사회적 여건에 대한 이해가 필요하다. 표준주의 감염관리 원칙을 준수한다면 만성질환으로서의 보편적 호스피스 진료의 제공이 가능하겠다. 생의 말기 빠르고 적극적인 호스피스팀의 개입을 통해 환자들이 존엄하게 삶을 마무리하실 수 있도록 임상경험이 늘어나고, 제도가 마련되길 바란다.

• 한국의료질향상학회지
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• 제4권1호
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• pp.82-103
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• 1997

Background : With increased concerns about variation among physician's practice pattern and their impact on the quality of care, clinical practice guidelines have been developed by many different organizations, with differing aims and incentives. From the same point of view, there is growing interest in the development of clinical practice guidelines in Korea, but with only a few examples. As a result, there is not much exploration on the incentive and barrier to develop guidelines as well as description on the development process. The purposes of this study are to describe the process of the four different clinical practice guidelines in a hospital setting, and to identify incentives and barriers in the development of guidelines. Methods : For this research, a clinical practice guideline development committee and four clinical practice guideline development teams were organized in a university hospital which has more than 1,200 bead. Twenty eight doctors, three nurses, and one technician participated as members of development teams for eight months. Four to six meetings were held, and three to seven departments in the hospital were involved. Results : The topics which developed into clinical practice guidelines were cardiopulmonary resuscitation(CPR), blood transfusion, anticoagulation, and angiography. The main goals set by teams were education(CPR, angiography), risk management(blood transfusion), and to enhance quality of care(anticoagulation). Among four teams, only in the team for anticoagulation guideline medical record review and pilot-testing were performed. Also literature review was not carried out systematically. However, all the guidelines were developed by multidisciplinary be used as standard protocols in the practice. Conclusion : Experience and skill in developing process has to be improved to have a more valid and useful practice guideline. In particular, literature review and problem identification by examining medical record should be emphasized. Also further studies on the clinical outcomes of the guidelines application and changes in physicians' behaviors would be required.

• Archives of Plastic Surgery
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• 제36권3호
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• pp.277-282
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• 2009

Purpose: The vegetative state is a clinical condition with complete unawareness of self and environment, but with preservation of brain - stem functions. Vegetative patients may have nosocomial infections in their wounds, like pressure sores and infected craniums after cranioplasties. Usually flap surgery is necessary for those wounds, but decision of undergoing surgery is difficult because of various adverse conditions of vegetative patients. We share our experience of several successful flap surgeries in vegetative patients, and evaluate obstacles and requirements to get satisfactory results. Methods: From December 2005 to September 2008, a total of 4 vegetative patients underwent surgeries. In 2 patients with infected artificial craniums, scalp reconstructions with free flaps were performed. In other 2 patients with huge pressure sores with sepsis, island flap coverage of wounds was done. Retrospective study was done on hospital day, vegetative period, number of surgeries done, underlying diseases, causative bacteria, and contents of informed consent. Results: Mean hospital day was 14 months and mean vegetative period was 17.5 months. Patients underwent average of 4.5 surgeries under general anesthesia. There were several underlying diseases like hypertension, DM, CHF and chronic anemia. MRSA(Methicilin - resistant Staphylococcus Aureus) was cultured from every patient's wounds. Informed consent included a warning for high mortality and a need of attentive familial cooperation. Conclusion: There are three requirements for doing flap surgeries in vegetative patients. First, to prevent aggravation of brain damage and underlying diseases by general anesthesia, multidisciplinary team approach is needed. Second, operation should be beneficial for prolonging patient's lifespan. Third, because postoperative care is very difficult and long hospitalization is needed, detailed informed consent and highly cooperative attitude of family should be confirmed before operation.

• Safety and Health at Work
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• 제3권2호
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• pp.140-145
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• 2012

Objectives: To understand the personal experiences of mine workers that have experienced job relocation due to silicosis at the Andina Division of Corporaci$\acute{o}$n Nacional del Cobre (CODELCO), Chile. The purpose of the study was to provide useful information for the development of new local, business and public policies for the care of workers with silicosis. Methods: A qualitative study based on a practical case study of 5 workers. The information was collected by means of structured individual interviews. The method of analysis was phenomenology. Results: The corporal axis was the most commented upon. It included awareness of the illness, body pains, fatigue, and antagonistic mood disorders (sadness, or the difficulty in finding meaning in life). As far as personal relationships, there was evidence of strong relationships with family, coworkers and friends, as well as extended family. Over all, the experience of relocation was positive with periods of impatience and uncertainty. The job reassignment provided a new and pleasant context for the relocated workers and in the process improved their perception of their quality of life. Conclusions: A multidisciplinary team should attend mine workers relocated because of silicosis by addressing the mental and physical aspects of their disease, along with the integral participation of close family members. It is suggested that this investigation be maintain over time to record the personal experiences in the medium-term, adding new cases with the intention of shedding more light on the phenomenon being studied. As a preventive measure, continual workshops are needed on the proper use of respiratory protection in addition, a group of monitors is required.

• 근관절건강학회지
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• 제18권2호
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• pp.169-181
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• 2011

Purpose: This paper presents the development process and the final contents of the sellf- management education program integrated with exercise training (Healthy Aging Happy Aging, HAHA program) for community residing older adults with chronic diseases. Methods: The program evaluation methodology was applied which is an interactive program development process based on needs assessment, formative evaluation, process evaluation and outcome evaluation. The program was developed and revised while the program was implementing to 22 hypertension (HT) and 32 diabetic (DM) participants. Results: The final program has two sub-programs for HT and DM participants utilizing self-efficacy resources. They share four common components; 1) health screening of exercise risks, 2) weekly 1-hour group self-management education classes, 3) biweekly 1-hour group exercise training and 4) a mid-term individual counseling. Both sub-programs were 12-weeks long but have different education and exercise contents. Participants-rated mean satisfaction scores were 3.47/4 and 3.61/4 for HT and DM program respectively. Attendance rate were 83.1% ~ 92.3% for the classes. Conclusion: The HAHA program developed by multidisciplinary team which reflected participants needs was accepted well by participants evidenced by high attendance rate and perceived satisfaction level.

• 대한영상의학회지
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• 제82권2호
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• pp.347-358
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• 2021

외상은 40세 이하에서 가장 흔한 사망의 원인 중에 하나이다. 과거에는 외상 환자의 치료로 대부분 수술적 치료가 우선 되었다. 하지만 점차 외상 환자의 치료에서 장기 보존이 중요하게 되었으며, 외상 후 환자의 치료는 수술적 치료에서 비수술적 치료로 바뀌고 있다. 외상 환자의 적절한 치료를 위해서는 다양한 분야의 협력이 필요하다. 그중 인터벤션 영상 의학은 외상 환자를 평가하고 치료하는데 중요한 역할을 담당하고 있다. 이에 본 논문은 인터벤션 치료가 급성 외상 환자에서 중요한 역할을 했던 다양한 증례들에 대해 소개해 보고자 한다.

• 농촌의학ㆍ지역보건
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• 제49권2호
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• pp.132-145
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• 2024

본 연구는 국내 의료기관 중심 보건의료·복지통합 서비스 활성 방안을 모색하기위하여 대구의료원 달구벌건강주치의사업, 삼척의료원 301 네트워크 사업, 부산의료원 3 for 1 사업 을 프로그램 논리모형을 적용하여 사례 비교하였다. 상황적 측면에서 세 사업 모두 보건의료·복지 서비스의 분절과 의료사각지대 문제를 해결하기 위해 고안되었으며, 투입 요소 중 인력은 모두 다학제 팀 구성 현황은 유사하였으나 구체적인 구성 분야, 채용 규모, 고용 형태, 에서는 기관별 차이가 있었다. 예산을 지원받는 재원 출처의 차이로 각 사업은 지역사회와 협력하고 지원하는 방식과 향후 방향성에서의 차별성도 확인할 수 있었다. 산출은 수혜대상자 수와 진료 건수에 차이가 있었으며, 투입인력 또는 운영비 대비실인원 수, 수혜대상 1인당 사업비 비교시 다른 결과를 확인하였다. 의료기관 중심의 보건의료·복지 통합제공체계의 설계 시 우선적으로 권고하는 상황은 안정적인 기금마련 기전을 확보하고 이에 합당한 대상자와 서비스 전달체계를 구축하라는 것이다. 또한, 의료기관 내 사례관리 전담기구로서 각 부문의 활동을 연계할 수 있도록 위탁이 아닌 전담부서 설치, 적정 규모의 채용, 안정적 고용 체계가 필요하며, 민·관 협력 및 경증부터 중증까지 제공할 수 있는 포괄적 제공체계 구축을 제안한다. 이를 통해 의료기관 중심보건의료복지 통합 서비스 제공 사업은 지역사회에서 풀리지 않는 난제였던 보건의료 서비스 강화와 촘촘한 연계를 가능하게 함으로 궁극적인 지역사회 건강안전망 역할 강화를 기대한다.