• 제목/요약/키워드: Patient's viewpoint

검색결과 39건 처리시간 0.021초

서울지역 의료기관의 급식서비스 및 환자식 급여화 현황 분석 (Analysis of Hospital Foodservice Management and Health Insurance Coverage of Inpatient Meals in Seoul)

  • 김혜진;김은미;이금주;이정주;임정현;이정민;전현정;이해영
    • 대한영양사협회학술지
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    • 제16권4호
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    • pp.378-396
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    • 2010
  • The objectives of this study were to explore hospital foodservice management and to investigate conditions related to health insurance coverage of inpatient meals. A questionnaire was distributed to the nutrition departments of 44 hospitals in Seoul on July 2009. The average kitchen area was 0.5 $m^2$, and centralized distribution systems were in place. Partition walls from contamination zones, separate work tables to prevent cross-contamination, exclusive areas for preparing tube feeding, and split carts with refrigerated and convection heat settings were largely used in tertiary hospitals. Most dietitians did meal rounds (93.2%) and surveyed for patient satisfaction (86.4%). The major theme of QI (Quality Improvement) was menu management (31.8%). The health insurance fees for meals were (won)4,938.9 for a general diet, (won)5,199.8 for a therapeutic diet, (won)4,067.0 for tube feeding, (won)9,950.0 for sterilized diet, and (won)18,383.4 for diets not covered by health insurance. The prices for general and therapeutic diets were significantly lower in hospitals compared to tertiary or general hospitals (P<0.001). The cost composed of 48.3% food, 44.0% labor and 7.7% overhead for general diets and 47.9%, 44.5% and 7.6% for therapeutic diets. In the case of health insurance coverage for patient meals, the number of items applied to general diets averaged 2.8 out of 4 and for therapeutic diets it averaged 1.9 out of 3. To reform the health insurance coverage system for patient meals, it is urgent that the qualified level of patient meals is presented from a national viewpoint, and monitoring should be performed consistently by developing the evaluation tools.

Subunit Principle of Vulvar Reconstruction: Algorithm and Outcomes

  • Tan, Bien-Keem;Kang, Gavin Chun-Wui;Tay, Eng Hseon;Por, Yong Chen
    • Archives of Plastic Surgery
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    • 제41권4호
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    • pp.379-386
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    • 2014
  • Background Vulvar defects result chiefly from oncologic resection of vulvar tumors. Reconstruction of vulvar defects restores form and function for the purpose of coitus, micturition, and defecation. Many surgical options exist for vulvar reconstruction. The purpose of this article is to present our experience with vulvar reconstruction. Methods From 2007 to 2013, 43 women presented to us with vulvar defects for reconstruction. Their mean age at the time of reconstruction was 61.1 years. The most common cause of vulvar defect was from resection of vulvar carcinoma and extramammary Paget's disease of the vulva. Method s of reconstruction ranged from primary closure to skin grafting to the use of pedicled flaps. Results The main complications were that of long term hypertrophic and/or unaesthetic scarring of the donor site in 4 patients. Twenty-two patients (51%) were able to resume sexual intercourse. There were no complications of flap loss, wound dehiscence, and urethral stenosis. Conclusions We present a subunit algorithmic approach to vulvar reconstruction based on defect location within the vulva, dimension of the defect, and patient age and comorbidity. The gracilis and gluteal fold flaps are particularly versatile and aesthetically suited for reconstruction of a variety of vulvar defects. From an aesthetic viewpoint the gluteal fold flap was superior because of the well-concealed donor scar. We advocate the routine use of these 2 flaps for vulvar reconstruction.

병원종사자의 직업성 스트레스에 관한 연구 - 서울시내 500병상 이상 병원종사자를 중심으로 - (Occupational Stress of Hospital Workers)

  • 이우천
    • 한국병원경영학회지
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    • 제3권1호
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    • pp.1-33
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    • 1998
  • The purpose of this thesis is to study theoretical access to the methods that have been used for the research of occupational stress, thereby providing management methods of occupational stress of hospital workers. With a stress model of hospital workers set up from the viewpoint of organization management, 929 sets of questionnaires were collected from intern doctors, resident doctors, nurses, nursing aides, pharmacists, medical technicians, workers in patient affairs(reception and medical insurance workers), administrators and clerks from the 8 hospitals in Seoul with more than 500 beds. Upon variance analysis, correlation analysis and regression analysis of the collected questionnaires, this work examined how differences in stress caused by specific occupations and formulated a method of stress management for the hospital workers. The results are as follows. 1) If some duties of the nurses suffering from role-overloaded stress are transferred to the nursing aides dissatisfied with insufficient role, the two grunting groups can be satisfied at the same time. It is also necessary to transfer some jobs of the overloaded workers in patient affairs to the administrators, or the other way around. To reduce stress of conflict and ambiguity of role caused by the obscure division of roles between the workers, the role of each occupation should be delineated and the clear division of roles should be translated into action strictly according to that delineated. 2) Stress of inefficiency of organization from which the student doctors suffer can be relieved by management of participation. If they have access to the process of decision-making in general hospital affairs and consequently their understanding and the autonomy of job performance are promoted, such stress will be reduced. 3) To cope with stress of career development from which nurses, medical technicians, administrators, workers in patient affairs suffer, it is necessary to establish whether they have a chance to revive their careers, whether there are any ways of remotivation for less contributive workers, and whether they encourage each other to develope their careers. If they are given a chance to develope their careers, such stress will be relieved. 4) Pharmacists, suffering from stresses of living and personal relations, have strong cohesive power among themselves and organize a well-integrated team; thereby reducing the stress of personal relations and increasing productivity. 5) For administrators and student doctors confined to lesser social supports and for nurses and workers in patient affairs whose recognition of stress and job satisfaction are affected by social supports, emotional and informational supports for job performance help alleviate an individual's mental, and physical stress. 6) In addition to the above-mentioned stress-management methods, if an organizational coping strategy is provided according to the types of stress from the general viewpoint of the whole group of hospital workers, it would be of great help to managing stress. For example, the redesign of jobs, the management of objective, the improvement of working environment, the formation of an autonomous working group and various working plans can be set up for those who suffer from stress related to inappropriate role, while career counseling and development of career process can be provided for those dissatisfied with career development. Participation in the process of decision-making and the restructuring of the organization are needed for those who suffer from stress of malfunctioning organization, whereas creation of a supportive organizational atmosphere is desired for those who feel stressed due to personal relations. As well, such organizational coping strategies. as the increase of welfare facilities, seminars and educational programs and provision of health-promotion facilities can be provided.

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전인간호의 임상학적 분석과 실행에 관한 연구 (A STUDY ON THE CLINICAL ANALYSIS AND PERFORMANCE IN COMPREHENSIVE NURSING CARE)

  • 전산초
    • 대한간호학회지
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    • 제4권1호
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    • pp.1-21
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    • 1974
  • A considerable change of the Korean nursing system has been made during the last decade not only in its philosophy but also in its function and structure to meet political and scientific need of the modern society. The main purpose of this study is to develope the new concept of comprehensive nursing care, both its Philosophy and ethics, as the basic of modern clinical nursing theory and practice. Comprehensive nursing care is the concept of human centered nursing care, and it helps a man to meet the basic physical, psychological, environmental, socioeconomic and teaching needs. It also helps him to help himself to meet these needs. This concept starts from the individualized nursing care and its ultimate goal is to improve a man to have a better position in his own community so that he may able to have a meaningful life. To accomplish this goal, an individualized nursing care plan as a nursing diagnosis and problem solving method should be set up for different patients with similar diagnosis to meet their needs, because each patient has a different social background. from this viewpoint, nursing is a science as well as abstruse humanity. The performance of comprehensive nursing care is a goal and issue of modern clinical nursing care. If nursing is a science and a profession for man, it should have ethics which recognize the dignity of man and offers infinite service voluntarily, and should be able to show leadership in carrying out the nursing responsibility. This leadership finds a person's potential and encourages him to utilize it. Such concepts should develop into a nursing ideology and this ideology should become a priority in comprehensive nursing care. The following statements are the conclusion of this study. 1) Modern nursing has been developed from disease centered nursing care to comprehensive nursing care based on humanity. The primary principle of nursing was to assist in the treatment of disease, but it has been changed to the professional nursing system independently. 2) The concept of nursing is one of continuous or endless scope of dispersion. It proves that nursing is grasping the professional responsibility to be able to coordinate scientific principles Patient health problems are according to scientific principles rather than adhering to nursing technical discipline as a daily work. 3) In chapter I and Ⅱ, the philosophy and ideology of nursing have been discussed and the flow of concept of clinical nursing and the rate of progress which emerges from naturalizing performance of the concept of comprehensive nursing in clinical nursing studied. The discussion developed the theory that a nurse should be to embody nursing ideas and objectives by establishing definite conviction of professions and study. 4) In chapter lil, nursing planning based on nursing diagnosis as a method to attain ideal nursing care for humanity with a definite idea of establishing philosophy of nursing was presented. 5) From the result of survey on patient needs about treatment and nursing, it was observed that all patient had emotional stress from unknown factors. Therefore it was concluded that nurses should not only educate the patient but also give them the opportunity to communicate freely their needs and anxieties. Furthermore complaints and doubts of the patient should be carefully noted and must be considered to meet these needs. 6) Patient teaching is the most important part of comprehensive nursing care. In chapter, Ⅲ, the important of patient teaching was emphasized by demonstrating the effect of patient teaching for diabetic patient. 7) In Chapter Ⅳ, from the result of the study on nurses attitudes to comprehensive nursing care, it was pointed that the evolution of nursing education and the establishment of a complete concept and value of comprehensive nursing was necessary.

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삼초(三焦)의 성쇠(盛衰)와 병위(病位)에 근거한 상한방(傷寒方) 해석방법 신고(新考) (Application Methods of Prescriptions from the Viewpoint of Exuberance-Debilitation and Disease Location of Triple Energizer)

  • 윤정훈;지규용
    • 동의생리병리학회지
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    • 제27권3호
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    • pp.273-279
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    • 2013
  • The objective of this study is to find out a reason why prescriptions have different effects on each patient who has same symptoms or same abdominal examinations and further more to classify the formulas more efficiently. In applying 's prescriptions, it is known that conventional ways such as treatment in accordance with symptoms or abdominal examinations have many advantages and problems reversely. To make up for the problems, additional references like strength of constitutional resistance and location of disease, degree of income and outgo are designed. And the notion in Oriental Medicine embracing aspects mentioned above corresponds to triple energizer. Triple energizer's exuberance-debilitation is able to draw an inference from some factors like density of skin interstices, elasticity of abdomen, appetite, digestive power. According to Exuberance-Debilitation of Triple Energizer, can be divided into five steps: weak(弱)-moderately weak(中弱)-neither weak nor strong(中)-moderately strong(中强)-strong(强). prescriptions would be dealt with those 5 steps, and it would be highly effective and consequently side effects could be reduced. On the basis of this classification method upon formula group, the prescriptions of can be applied more accurately by setting a direction through strength of constitutional resistance and location of disease and combining with existing references like symptoms, palpation and abdominal examinations.

서구(西區) 대체의학(代替醫學)의 암(癌) 치료(治療)에 관(關)한 연구(硏究) (Study on Alternative Medicine in Cancer Therapy)

  • 유화승;이용연;서상훈;최우진;조정효;이연월;손창규;조종관
    • 대한한방종양학회지
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    • 제6권1호
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    • pp.125-148
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    • 2000
  • At here, we investigated the historical background, current stage, and concrete therapies of alternatives in cancer therapy. We obtained the conclusion below. 1. Alternative medicine(AM) is a unothodoxial medical physiology, medical practice or intervension that overcome the side effects, faults, limits of coventional medicine. 2. Recentely, as emerging New-age movement, collapse of Decarte's mecanical cosmology, and emphasis on patient rights, the interest of AM is increased, and foreign & domestic use rates of AM are risen. 3. After coventional medicine in cancer therapies that depends on operations, radiations, and chemotherapy is bounded, Alternatives in cancer therapy are rapidly developed, and the majority of users are often considered satisfactory. 4. Alternatives in cancer therapy are classified six boundaries; Diet and Nutrition, Mind-body Technique, Integrated System, Pharmacologic and Biologic treatments, Immuno Enhanced Therapy, Natural and herbal medicine. 5. Looking at contents of Alternatives in cancer therapy, we get to know most of them are similar to the treatment of oriental medicine in holistic method, therapy, philosophy. If we synthesize the alternative medicine's treatment mentioned above and investigate it with oriental medical viewpoint, that may help us approach the conquest of cancer and improve the rate of cure. 6. It is certain that foreign AM will be imported reversely, and we must prepare for rebuilding of Korean traditional AM systemically, investing for activity positively, making national policy for medical system.

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『천금방』의 노인식이요법연구 (Study on the Food Therapy for the Aged as Discussed in 『천금방』)

  • 정숙이;금경수
    • 동의생리병리학회지
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    • 제18권6호
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    • pp.1580-1584
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    • 2004
  • On the basis of the widely collected fork prescriptions, long clinical practice of himself, together with integration of all the good points of earlier medical specialists, 孫思邈 wrote 『千金方』 of thirty volumes. Among them Volumes 『食治』 (Food Therapy) and 『養性』(Cultivating the Character) are especially meaningful for in gerontology. Thirty years after its completion, as a supplement, he wrote another thirty volumes of 『千金翼方』. Mr. Sun integrated his discoveries in the treatments of the aged patients, and his opinions for longevity into the Volumes 『養性』 (Cultivating the Character), 『?穀』(Fasting), 『退居』(Retirement), 『補益』(Supplementation). Thus he laid down the basic foundation for the gerontology of Chinese medicine. 『千金要方』 and 『千金翼方』 by Mr. Sun discuss mainly the prevention of illness for aged patients. As for the function of food therapy, he explains: 'Food can dispel evil elements of the body and settle down its organs. It can further bring pleasure to man's spirit and help the circulation of blood and breath.' He then propose the major method of food therapy: 'For a medical doctor, he should understand the causes of disease, then treat it with food. Only after the food treatment fails, medicine is employed.' He thinks that medicine does work in treatment, but it also creates imbalance in the body, and makes the latter vulnerable to outside harms. Therefore, a good doctor is the one who cures the disease and bring pleasure to the patient with food. He stresses that food therapy is always a priority. Mr. Sun prefers animal's organs in the food therapy for aged. For example, he uses powder of sheep's kidney to treat the lumbago. He suggests the viewpoint of 'Curing man's organs with animal's organs' and 'Strengthening man's organs with animal's organs,' and sets the theoretical foundation of 'Organic Treatment.' Mr. Sun's gerontology and food therapy received further development latter. The prescriptions contained therein had been widely used in 王懷隱's 『太平聖惠方』 and 陳直's 『養老奉親書』, both in the Song Dynasty. Eventually they had become a science of food therapy for aged patients.

티베트 의학과 한의학의 요진법에 대한 비교 고찰 (A Comparative Study on the Urinalysis of the Tibetan Medicine and the Traditional Korean Medicine)

  • 김현구;안상우;한창현
    • 한국한의학연구원논문집
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    • 제16권3호
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    • pp.53-66
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    • 2010
  • This study focuses on the contents about the Urinalysis which is the most representative one of the Tibetan medicine. Also, this study compares it with the Urinalysis of Traditional Korean medicine. This study focuses on the simple history, the theoretical system, the diagnosis and the urinalysis mainly based on the documents related to the Tibetan medicine. Also, through the comparison with the contents of textbook of Traditional Korean Medicine and the urinalysis shown in the Dongeuibogam(東醫寶鑑) which is the representative Korean medical book, the difference between Tibetan Medicine and Traditional Korean Medicine will be observed. The contents related about the urinalysis of the Tibetan medicine are more specific than those of Traditional Korean Medicine. By observing the color, scent, vapor and sediment of one's urine together with periodic changes more thoroughly, it is possible to find out the cause of a certain disease. However, Traditional Korean Medicine examines the medical conditions mainly based on the state of discharge and fever, showing a clear difference. The Tibetan medicine has an extremely specific type of urinalysis in comparison with that of Traditional Korean Medicine. It is the only characteristic of the Tibet medicine, which cannot be found in any other traditional medicine. By applying the viewpoint of the doctor who diagnoses the patient by measuring his or her pulse, it is possible to make the diagnosing process more specific and accurate. It is expected that the follow-up study will be continuously executed with the introduction of the system for the urinalysis of the Tibetan medicine to Traditional Korean medicine.

Effects of a simplified drilling protocol at 50 rpm on heat generation under water-free conditions: an in vitro study

  • Hyeon-Ji Jang;Jin-Un Yoon;Ji-Young Joo;Ju-Youn Lee;Hyun-Joo Kim
    • Journal of Periodontal and Implant Science
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    • 제53권1호
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    • pp.85-95
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    • 2023
  • Purpose: In recent years, guided implant surgery has been widely used for the convenience of patients and surgeons. Further streamlining the surgical procedure would make implant surgery more convenient. Low-speed water-free conditions are often used in guided implant surgery. Therefore, in this study, we attempted to confirm once again whether drilling was safe at a low speed without water. The main purpose of this study was to evaluate whether a simplified drilling protocol that omits some intermediate steps in the drilling process was safe from the viewpoint of heat generation. Methods: D1 density artificial bone blocks were drilled under 50 rpm, 10 N·cm water-free conditions, and the surface temperature was measured using a digital infrared camera. First, drilling was performed with the sequential drilling method, which is the most widely used technique. Second, for each drill diameter, the temperature change was measured while performing simplified drilling with omission of the previous 1, 2, or 3 steps. Results: In sequential drilling, the heat generated during drilling at all diameters was less than the critical temperature of osteonecrosis (47℃) except for the ⌀2 drill. Statistical significance was observed in all groups when comparing sequential and simplified drilling in the ⌀3.2, ⌀3.8, and ⌀4.3 drills (P<0.001). However, in the simplified drilling procedures, the temperature was below the osteonecrosis threshold temperature (47℃) except for the ⌀4.3 drill with the omission of the previous 3 steps (⌀3.0, ⌀3.2, and ⌀3.8). Conclusions: In general, drilling under low-speed, water-free conditions has shown stable results in terms of heat generation. Simplified drilling showed statistically significantly greater heat generation than sequential drilling. However, most of the diameters and omitted steps seem to be clinically acceptable, so it will be useful if an appropriate selection is made according to the patient's clinical condition.

요추간판탈출증 환자의 요천각, 요추중력중심선 및 요추전만각의 통계적 관찰 (Statistical Study of the Ferguson's Angle, Lumbar Gravity Line and Lumbar Lordotic Angle in HIVD Patients.)

  • 고동현;홍순성;이진호;정성엽;신준식
    • 척추신경추나의학회지
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    • 제2권2호
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    • pp.17-32
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    • 2007
  • Objectives : The lumbosacral joint is unstable area from an anatomical viewpoint, while it is also a very mobile area in ordinary life, so that clinically major causes of low back pain originate in this joint. The purpose of this study is to assess the difference of the Ferguson's angles, Lumbar gravity lines, Lumbar lordotic angles among Herniated of Intervertebral Disc(HIVD) patients. Methods : We analyzed the lateral view of lumbar spine checked at erect position on 88 patients who had been diagnosed as HIVD by Magnetic Resonance Imaging(MRI). We investigated the Ferguson's angle, Lumbar gravity line, Lumbar lordotic angle on X-ray film. Results and Conclusions : In the acute lumbago group the Ferguson's angle had a tendency to decrease, while in the chronic group it had a tendency to increase. In the acute lumbago group the Lumbar gravity line fell in front of the normal range(sacrum), while in the chronic group it fell behind the normal range(sacrum). In the acute lumbago group the Lumbar lordotic angle usually decreased, while in the chronic group it increased. The Ferguson's angle and the Lumbar gravity line, the Ferguson's angle and the Lumbar lordotic angle, the Lumbar gravity line and Lumbar lordotic angle each had a positive realtionship. The Ferguson's angle, the Lumbar gravity line and the Lumbar lordotic angle was less influenced by the level of HIVD and was more influenced by how long the patient had the pain. The correlationship between each factor was less in the chronic lumbago group than the acute group. In the chronic lumbago group the instability of the lumbosacral joint increased, while in the acute group the compression of the weight on the sacrum increased.

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