• 간호행정학회지
• /
• 제9권4호
• /
• pp.541-557
• /
• 2003

Purpose: This descriptive study was designed to explore the clinical nurse's ethical value regarding human life. Method: Data were collected from September to October, 2002. Study subjects were 527 clinical nurses working in General Hospital as tertiary located in Seoul. Ethical value was measured with questionnaire developed by researchers and consisted on items regarding ethical value on human life. Result: Among the items, most nurses highly agree with the item, "When a patient requests his/her health care provider to keep his/her personal secret, the health care provider is obliged to do so." and "When a patient asks for information on his/her medicinal and dietary contents, his/her wish must be granted." Most clinical nurses mainly agree with the item. "Health care providers must always be honest to the patient and/or his/her family". However, most nurses disagree with the item, "When a patient is on the verge of death after an accident, it is justifiable to soothe his/her family by saying 'he/she is OK' instead of telling them the truth, in order to avoid a sudden shock befalling on them". Most clinical nurses mainly disagree with the items, "When a patient is on the verge of death after an accident, it is justiable to soothe his/her family by saying 'he/she is OK' instead of telling them the truth, in order to avoid a sudden shock befalling on them" and "It is justiable that various new ways of treatment should be applied to patient at his/her terminal stage to prolong his/her life, even for the purpose of research". There were significant differences in some items of ethical value according by clinical nurse's age and professional experience, current position, religion, education, marital status, continued education on ethics, and the experience of holing on life saving treatment. Conclusion: It is intensifying the notion of ethical underpinning for human rights, truthfulness is essential to a trust relationship under what circumstances. Also most clinical nurses agree with that It is essential to trust in the nurse-patient relationship, patients have the right to know and it is the ethical thing to do as health care provider.

• 한국임상보건과학회지
• /
• 제3권3호
• /
• pp.399-408
• /
• 2015

Objective. There were two objectives of the study, first was to identify the barriers as perceived by the patients and providers to access the low vision services and second was to identify the challenges faced by the main providers. Study design. Structured questionnaire based interviews of patients and providers Methodology. To find out the barriers to access of low vision services, the interviews based on structured questionnaire were conducted for two patient groups. The first group consisted of 97 visually impaired individuals attending the department of low vision services at Al-Shifa Trust Eye Hospital Rawalpindi while the second group included 56 visually impaired individuals attending the four rehabilitation centers/schools for the blind in Rawalpindi/Islamabad. To identify the barriers as perceived by the main providers of low vision services and challenges faced by them the interviews based on structured questionnaire were conducted for 19 low vision service providers. Results. From patients point of view, major barrier to low vision services identified was inability to visit hospital /rehabilitation center alone - 29.8% in hospital group and 33.9% in rehabilitation centers group, while the lack of social support, lack of family support, cost of travelling, long distance, afford ability, hesitation in using devices and lack of satisfaction were other important barriers identified. From providers' point of view, major barrier to uptake of services was the need for repeated follow-ups. Optometrists were the main provider of low vision services contributing to 47.4% of the providers. The major challenge faced by the providers was motivation of patients to use low vision devices. Conclusion. The major barrier to low vision services according to the patients is inability to visit the hospital alone, while according to providers, it is the need for repeated follow up which proves major barrier towards uptake of services. The motivation is the major challenge faced by providers, majority of which are optometrists.

• Annals of Coloproctology
• /
• 제34권6호
• /
• pp.312-316
• /
• 2018

Purpose: Anemia is associated with poor treatment results for a variety of cancers. The effect of low hemoglobin levels on long-term outcomes after the treatment of patients with an anal squamous cell carcinoma (SCC) remains unclear. For that reason, this study aimed to investigate the effect of anemia on treatment outcomes following chemoradiation for an anal SCC. Methods: This was a retrospective study of all patients who underwent curative treatment for an anal SCC between 2009 and 2015 at 2 trusts in the United Kingdom. Data were collated from prospectively collected cancer databases and were cross-checked with operating-room records and records in the hospitals' patient management systems. Results: We identified 103 patients with a median age of 63 years (range, 36-84 years). The median overall survival was 39 months (range, 9-90 months), and the disease-free survival was 36 months (range, 2-90 months). During the follow-up period, 16.5% patients died and 13.6% patients developed recurrence. Twenty-two people were anemic prior to treatment, with a female preponderance (20 of 22). No differences in disease-free survival (P = 0.74) and overall survival (P = 0.12) were noted between patients with anemia and those with normal hemoglobin levels. On regression the analysis, the combination of anemia, the presence of a defunctioning colostomy, lymph-node involvement and higher tumor stage correlated with poor overall survival. Conclusion: In this study, anemia did not influence disease-free survival or overall survival. We suggest that the interaction between anemia and survival is more complex than previously demonstrated and potentially reliant on other coexisting factors.

• Journal of Preventive Medicine and Public Health
• /
• 제50권2호
• /
• pp.68-82
• /
• 2017

Objectives: We performed a systematic review to assess and aggregate the available evidence on the frequency, expected effects, obstacles, and facilitators of disclosure of patient safety incidents (DPSI). Methods: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for this systematic review and searched PubMed, Scopus, and the Cochrane Library for English articles published between 1990 and 2014. Two authors independently conducted the title screening and abstract review. Ninety-nine articles were selected for full-text reviews. One author extracted the data and another verified them. Results: There was considerable variation in the reported frequency of DPSI among medical professionals. The main expected effects of DPSI were decreased intention of the general public to file medical lawsuits and punish medical professionals, increased credibility of medical professionals, increased intention of patients to revisit and recommend physicians or hospitals, higher ratings of quality of care, and alleviation of feelings of guilt among medical professionals. The obstacles to DPSI were fear of medical lawsuits and punishment, fear of a damaged professional reputation among colleagues and patients, diminished patient trust, the complexity of the situation, and the absence of a patient safety culture. However, the factors facilitating DPSI included the creation of a safe environment for reporting patient safety incidents, as well as guidelines and education for DPSI. Conclusions: The reported frequency of the experience of the general public with DPSI was somewhat lower than the reported frequency of DPSI among medical professionals. Although we identified various expected effects of DPSI, more empirical evidence from real cases is required.

• 정보처리학회논문지C
• /
• 제17C권2호
• /
• pp.173-180
• /
• 2010

IT 기술의 발달에 힘입어 환자들의 위치에 상관없이 편리하게 진료가 가능한 유비쿼터스 헬스케어시스템이 개발되고 있다. 그러나 사용자의 수가 급증하고 다른 병원의 의사나 연구원 또는 환자의 가족들에게 의료 정보를 공개하도록 의료법이 개정되면서 사용자 관리와 프라이버시 침해라는 문제가 발생하였다. 이러한 문제를 해결하기 위하여 본 논문에서는 역할 기반 접근제어 모델에 기반한 사용자 접근 모델은 제안한다. RBAC 모델은 효율적인 사용자 관리 및 접근 제어를 제공하지만, 악의를 가진 사용자가 권한이 있는 역할을 가지고 정보를 유출하고자 할 경우 막을 방법이 없다. 이러한 RBAC의 취약점을 보완하기 위하여 "working status" 파라미터를 역할 속성과 연동하는 RBAC-WS 모델을 제안하였다. 역할에 working 속성을 연동함으로써 허가를 받은 사용자라 하더라도 업무 외 접근을 원천적으로 봉쇄함으로서 내부자에 의한 정보유출 문제를 해결하였다. 또한 RBAC을 위한 함수를 개발하여 도메인이 서로 다른 헬스케어 시스템에서도 유용하게 사용될 수 있도록 하였으며, RBAC-WS 모델의 기능 분석을 위하여 Healthcare 시스템 중 널리 사용되는 PACS에 적용하였다.

• 한국산학기술학회논문지
• /
• 제10권11호
• /
• pp.3465-3472
• /
• 2009

본 병원에 축적된 의무기록과 데이터베이스에 있는 퇴원 환자 정보를 이용하여 이탈에 영향을 미치는 특성을 파악하여 활용 가능한 예측모형을 제시하고자 한다. 외래진료 방문환자 3,503명 중 충성고객 2,118명 60.5%, 이탈 고객 1,385명 39.5%을 추출하여 분석에 사용하였다. 생존한 변수는 성별, 연령(연령대), 지역, 보험구분, 입원경로, 진료과, 퇴원과, 퇴원형태, 협진여부, 수술여부, 진료예약여부, 환자구분을 기반으로 예측모형을 만들었다. 로지스틱 회귀분석을 실시한 결과 66.0%의 정확도를 나타냈고, 신경망을 통하여 예측한 결과 분석용 결과는 정분율은 69.79%이고, 검정용 결과 정분율은 63.64%였다. CHAID를 통하여 예측한 결과 분석용 결과 정분율을 83.75% 이고, 검정용 결과 정분율은 42.74%였다. 예측 모형을 활용한 이탈고객을 위한 관리와 병원의 신뢰를 높여야 할 것이다.

• 농촌지도와개발
• /
• 제22권2호
• /
• pp.117-133
• /
• 2015

This study explored at marital conflict in multicultural families, a type of families formed through international marriages, from husbands perspectives. For the purpose of this study, in-depth interviews were used with husbands in multicultural families to ask about marital conflict, and then, conducted a qualitative case analysis. In summary, results of this study are as follows; First, among the decisive events that husbands in multicultural families often experienced in marital conflict with their wives were disrespect toward husbands and parents-in-law, husbands with a low level of trust, feelings of pressure due to financial support for wives' families and children and lack of practical sense about marriage. Second, development of marital conflict that husbands often experienced included aggravated cultural conflict between a couple and between members of the family, difficulty in managing blame and anger, signs of separation or divorce and wives leaving home and limitations in conversation and communication. Third, as to how husbands tried to deal with marital conflict, they tried to be patient and comfort wives, engage in economic activities together, find something that they could focus on, turn to religion or gatherings, use service from government organizations, have trust and develop rules and limit the range of their wives activities.

• 한국콘텐츠학회논문지
• /
• 제20권12호
• /
• pp.635-645
• /
• 2020

오픈노트는 환자-의사 간 온라인 진료기록 공유라고 정의할 수 있으며, 환자가 자신의 진료기록에 언제든 접근할 수 있도록 허용한 시도이다. 진료기록의 확장으로써 오픈노트 도입의 필요성을 확인하기 위해, 본 연구는 의료서비스의 일부를 담당하는 병원 종사자를 대상으로 진료기록과 오픈노트에 대한 인식과 태도를 조사하였다. 연구 결과 자신의 진료기록을 읽어보는 것은 건강상태를 이해하는데 도움이 되며, 병원 종사자들은 오픈노트의 유용성에 대체로 동의하였고 참여의향이 있는 것으로 나타났다. 한편 대상자들은 진료기록이 위·변조될 가능성이 있다고 인식하였다. 결론적으로 환자가 자신의 진료기록을 자유롭게 읽어보도록 허용함으로써 건강상태를 이해하고 자가건강관리를 향상시킬 수 있으며, 진료기록에 대한 불필요한 오해와 불신을 해소할 수도 있다. 오픈노트의 건강상의 효용성 뿐 만 아니라 의사에 대한 신뢰에 미치는 영향을 생각할 때, 실험적 검증을 위한 오픈노트 시범사업을 제언한다.

• Archives of Plastic Surgery
• /
• 제44권3호
• /
• pp.228-233
• /
• 2017

Background Hidradenitis suppurativa (HS) is a chronic skin condition that can affect any area with apocrine sweat glands and has the potential to involve multiple sites concurrently. Commonly affected sites include the axilla, groin, perineum and perianal areas. In this study we performed a literature review on the surgical methods for HS and describe an innovative technique for reconstructing axilla HS using an inner-arm transposition flap. Methods We reviewed all cases (5 cases from 4 patients) of transposition flap reconstruction performed by the senior author at a single London tertiary hospital from 2008-2013. Patient related outcome measures were collected using the Derriford appearance scale (DAS 24) and a study specific questionnaire. Results All patients were satisfied with their final result. One out of five cases had a complication but did not result in flap failure. There is no disease recurrence to date. DAS 24 scores collected demonstrated acceptable postoperative distress that did not deviate far from the norm tables while study specific questionnaire reveal desirable outcomes. Conclusions We have managed to achieve our aim through the use of the innovative inner-arm transposition flap. Our study hopes to provide an additional technique for axillary reconstruction. This technique offers the effective concealment of scars with the benefit of tightening of the arm tissue producing 'brachioplasty like' effects. All things considered it would be reasonable to conclude the innovative flap technique is a reliable, effective, and simple method that results in multiple benefits.

• 한국병원경영학회지
• /
• 제23권4호
• /
• pp.1-14
• /
• 2018

Purpose : Customers with loyalty are very important to hospitals for sustainable growth in their medical market. Individuals with loyalty are likely to visit same hospital repeatedly when they need medical services. This study was to identify factors associated with selection of specialty hospitals among customers with loyalty. Methods : The subjects of this study were 735 inpatients in 22 specialty hospitals in 6 designated fields(joints, spine, colorectal-anal, obstetrics and gynecology, ophthalmology, otolaryngology). Customer types classified as customers with high loyalty, neutral customers, and customers with low loyalty according to net promoter score(NPS). Factor analysis was conducted to classify 22 hospital selection factors into some similar properties. Logistic regression analysis was conducted to confirm the selection factors related to loyal customers. Findings : Most of specialty hospitals received high NPS of 8 points or higher in all the designated fields. Five factors associated with selection of specialty hospital are (1) hospital facilities and convenience, (2) trust in doctor and hospital, (3) rapidness of treatment, (4) hospital awareness, and (5) accessibility. As a result of logistic regression analysis, selection factors related to loyal customers were 'hospital facilities and convenience', 'trust in doctor and hospital' and 'rapidness of treatment'. Differences in the degree of importance of three selection factors by customer types appeared for each designated field. Practical Implications : This study confirms the high level of patient experience among inpatients of specialty hospitals. Factors associated with selection of hospital among inpatients with loyalty are 'facilities and convenience of hospitals', 'trust of doctor and hospital' and 'rapidness of treatment'. This study will be meaningful as basic data to systematically enhance the roles and functions of the health care system and to provide securing competitiveness according to designated fields in the management aspect of specialty hospitals.