• Archives of Plastic Surgery
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• 제34권3호
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• pp.336-341
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• 2007

Purpose: The most accepted method for the reanimation of a paralyzed face is the two-stage method that combines cross-face nerve grafting with free-muscle transfer. Although the results of reconstruction with this method are satisfactory, there is an excessive delay between the stages, which prolongs the period of rehabilitation. In order to overcome this drawback, a one- stage, neurovascular free-flap reconstruction method using free neurovascular muscle flaps is introduced. Methods: From 1994 to 2004, 35 patients with longstanding facial palsy were treated. Fifteen patients underwent the single-stage reconstruction with the latissimus dorsi muscle, and 20 patients underwent the two-stage reconstruction method with the gracilis muscle. We compared the long-term results of the two methods of reconstruction. The mean follow-up period was 28.7 months for one-stage reconstruction, and 35.2 months for the two-stage, respectively. Results: In the patient group of the single stage reconstruction, both mouth corner excursion and animation grade were markedly improved at the final postoperative visit. Moreover, the first muscle contraction occurred earlier in this group, than in the two-stage reconstruction group. However, four patients in the single stage group never achieved a first muscle contraction or mouth corner excursion. Conclusion: Facial palsy is a very challenging condition for cosmetic surgeons to deal with. Traditional methods for treatment of chronic facial palsy use a two-stage muscle flap which is time-consuming and burdensome to patients, many of whom are averse to waiting 8 to 12 months to complete the two stages. The one-stage reconstruction method described herein uses a latissimus dorsi free-flap and has demonstrated consistent positive outcomes in clinical assessments.

• 대한간호학회지
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• 제28권1호
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• pp.26-36
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• 1998

This primary study was done to develop an ethical guideline for organ transplantation, a life-saving treatment which helps improve the quality of life. This study tried to identify the current situation in Korea, in terms of ethical considerations in organ transplantations. This study collected basic data in organ transplantations, in the hope that procedure of organ transplantations could be developed that would be fair to both organ donors and recipients. The immediate goals of this study were : 1)to identify staff in charge of organ transplantations and their jobs in the hospital, 2)to survey whether there exists a Hospital Ethics Committee(HEC), 3)to research what consideration are formally taken in selecting recipients, and 4)to accumulate data on how consent from donors are currently obtained. The study used a survey questionnaire and received responses from 31 hospitals out of 45 hospitals where organ transplantation are being done. Organ transplantation coordinators were found in 16 hospitals, but the job description varied among hospitals. The survey showed that all 16 hospitals with an HEC that health care personnel unnecessarily dominate the committee. The study notes that HECs should be vitalized by recruiting, as members, ethicists, theologians, patients, guardians, as well as the general public outside of the hospital. The study revealed that in selecting recipients the hospital take into account ABO blood type, histocompatibility, age, waiting time. and level of patient compliance. Finally, it was shown that in the cases of living donors the transplanting hospitals seek a formal consent, whereas there are no common consenting practice established for cadaveric donors. The study concludes with three proposals. First, a nationwide institution responsible exclusively for procurement and distribution of cadaveric organs for transplantation should be established. Second. we should rebuild the national health insurance system so that have costly organ transplantation expenses are substantially covered. Last, but certainly not least. there is a need to emphasize the HEC's committment to prepare a proper ethical guideline for organ transplantation in general.

• 대한예방한의학회지
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• 제18권3호
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• pp.57-67
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• 2014

Objective : This study aimed to compare the patients' satisfactions with local Korean Medicine(KM) clinics and networked KM clinics, and to find out which factors had an effect on it. Method : Six local KM clinics and six networked KM clinics were selected, and patients' questionnaires on the satisfaction with KM clinic use were administered using exit poll method. The questionnaires were developed to measure satisfactions with facility, doctor and staffs, and services. 240 patients completed the questionnaires, and the data were statistically analyzed. Results : There was more diversity in patients' diseases among networked KM clinics users, however, treatments provided were not differentiated clinically between two types of KM clinics. Patients' satisfaction scores for local KM clinics were significantly higher than those for networked KM clinics in the aspects of doctors/staffs (9.35 vs 8.92, p<.01) and services (8.76 vs 8.42, p<.05). 90.0% of local KM clinic users expressed their willingness to recommend the clinics they used to others, while 75.0% of networked KM clinics users did. For both the local and networked clinics, 'KM doctors' kindness', and 'process and waiting time' were statistical factors affecting patients' satisfaction. Conclusion : The patients' satisfactions with general KM clinics were higher than those with networked KM clinics. Networked KM clinics need to develop services to meet the diverse medical demands which were created by them selves.

• 융합정보논문지
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• 제12권4호
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• pp.212-218
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• 2022

본 연구는 의료소비자의 만성질환 유무에 따른 정보탐색행태를 파악하고자 수행되었다. 이를 위해 2016년 2월 9일에서 2월 11일까지 서울 소재 대학병원에 방문한 환자들을 대상으로 설문조사를 실시하였으며, SPSS 26.0 통계 패키지를 활용하여, 총 240명의 자료를 분석하였다. 주요 분석 결과는 다음과 같다. 첫째, 만성질환자들은 만성질환이 없는 사람들보다, 전문가 정보원과 경험적 정보원을 많이 이용한 것으로 나타났다. 둘째, 질환과 관련해서는 영양관리, 운동 관리 및 동일 질환자들의 사례를 많이 탐색하는 것으로 나타났다. 마지막으로 병원과 관련해서 만성질환자들은 대기시간과 진료비를 많이 알아본 것으로 나타났다. 본 연구는 만성질환자들의 수요를 반영한 효율적인 정보제공과 마케팅전략 수립의 기초자료를 제공한 의의가 있다.

• 핵의학기술
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• 제18권1호
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• pp.149-152
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• 2014

핵의학과 영상검사 후에 검체검사를 시행할 경우 결과값에 미치는 영향을 알아보기 위해 PET-CT, Gated Myocardial SPECT, DTPA GFR Scan을 시행하기 전 후에 채혈하여 Tumor marker (AFP,CEA,CA19-9), Hormone (TSH,T3,TG,TG Ab)검사를 시행하여 Difference를 구하였다. 대부분의 결과가 10% 이내의 차이를 나타냈지만 Table 7의 sample 2와 Table 8의 sample 1, sample 6, sample 8의 저 농도 값에서 20%를 넘는 차이를 나타내는 경우가 있었다. 그렇지만 cpm값은 Table 7의 sample 2는 984(전), 1057(후) Table 8의 sample 1은 243(전), 301(후) sample 6은 58(전), 64(후) sample 8은 258(전), 203(후)으로 매우 흡사한 값을 나타냈다. 이 같은 값을 바탕으로 볼 때 영상검사를 시행한 후에 검체검사를 시행하더라도 결과값에 미치는 영향은 없는 것으로 판단된다.

• 대한간호학회지
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• 제31권1호
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• pp.68-80
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• 2001

The purpose of this study is to analyze ER patient's Triage and other statistical data. The subjects were 12,618 patients who visited the ER during the year 1998. The study showed the following results; 1. The male vs female ratio was 1.3 : 1.0, the male were in the majority (56.6%), and the age range of 20-29 old was the majority (15.3). The patients who visited ER at 8-10 pm were the majority (11.5%). On Sunday the number of patients who visited the ER were 2,189, and the majority were 17.4%. On Saturday the number of patients was visited the ER were 1,944 patients the second majority (15.4%). Their traffic means : the general passenger cars (75.5%), 119 or hospital ambulance (11.3%). 2.The reasons of visiting ER were : diseases (59.2%), injuries (23.7%). The disease vs injury ratio was 100 : 69. 3. Triage : urgent 40.7%, non-urgent 38.2%, acute 17.8%, and critical 3.2%. 4. The time of waiting and staying in the ER by the Triaget: the average time was 572 minutes (9.53 hrs.). The majority of critical patients (20.5%), acute patients (24.7%) and urgent patients (21.2%) stayed 12-24 hrs., but the majority of non-emergent (27.8%) stayed not longer than one hour. 5. Treatments by the Triage : the 42.9% of critical patients, and 61.3% of acute patients, 57.5% of urgent patients were admitted. But 91.8% of the non-emergents were discharged and 4.7% was admitted. Mortality of total ER visiter were 1.7%. DAA portion was 0.86%. 26.6% of the critical patients were DAA. DAA vs DOA ratio was 1.3 : 1.0. 6. Visiting time, monthly and seasonal distribution by the Triage : the majority of critical patients (12.2%), visited 10-12 am. The majority of acute (12.9%) and urgent (11.7%) visited 4-6 pm, but the majority of non-emergents (15.1%) visited during 8-10 pm. Autumn visiter were the majority (27.6%). The percentage of non-emergent visited in Spring was 41.4% and Autumn was 41.3%. The percentage of urgents who visited in the Summer was 45.3% and the Winter was 40.4%. By clinical departments: the 48.0% of critical patients was NS. The 45.5% of acute and the 33.6% of urgent patients were IM. But the majority of non-emergent patients was PS (21.2%), and the second majority of non-emergent patients was oral Surgery (12.8%).

• 근관절건강학회지
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• 제3권2호
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• pp.166-176
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• 1996

This is a study through survey with the purpose of analysing of treatment cost for arthritis. Treatment cost can be devided Into two characteristics, one is the direct cost and the other is the indirect cost. Direct cost contains fees of medical treatment Including cost of self treatment & purchsing price of herb durg. On the other hand indirect cost means the using money of tansportation, lodging charge & labor-losing-time cost. For the succession of medical treatment of chronic diseases patients have to control themselves to go shopping around for the cure remeadies. And also it is important that the cost for unefficient or probably hamful folk remeadies should be reduced in order to distribute appropriatively the limited financial resources. As the result of this study, the fees for self treatment & herb drug are two times as much as those of regural medical treatment. Within the direct cost, there are the mean cost of regural medical treatment 59,630 won/mon., self-treatment 42,790 won/mon., and herb drug 78,380won/mon. therefore total mean direct cost is 180,800won per month. Moreover patients intermittently pay the cost of prostheses If folk remedies, these are added to the direct cost as above mentioned. Attributes of folk remedies are various from cure & analgesics to nutrients and their virtues as medicine are not clear in view of scientific knowledge. But 56% of arthritis patients have ever been experienced folk remedies. the cost for these remedies has wide ranges from 40,000 won to 1,000,000won. Total mean indirect cost including the transfortation fee, lodging charge & labor-losing-time cost has the range from 82,825won/month to 106,150won/month. Among these cost, labor-losing-time cost has a mojority because the waiting times are too long for seeing a doctor. In conclusion those patients having arthritis have a large burden against the treatment cost for continuous care. Therefore health professional should make effort to guide the patient to determine themselves informed choice about the treatment process.

• 보건행정학회지
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• 제10권2호
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• pp.22-40
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• 2000

The purpose of the study was to discuss amrketing strategy for oriental hospital, by making a comparative analysis of how hospital user satifaction was affected by hospi시 choice motivation between oriental hospital users and western hospital. The data usel in this study was the Korea Isititute of oriental medicine(1999)'s study on utilization of oriental medical care. And and interview was hold with outpatients who visited around march to April, 1999, at each an oriental hospital and a westen hospital in Seoul and in Wonju city, Kongwon province. The collected data were analyzed by SPSS program. The factor analysis of hospital choice motivation was made by figuring out facor's mean value, and T-test and ANOVA were employed to find out what difference was made by sociodmographic charcteristics to the factors. Also, the multiple regression analysis was carried out to examine what gave an impact on hospital user satisfaction. The findings of this study were as follows; First as a result of making a factor analysis against hospital choice motivation to find out what kind of differenc there was between oriental hospital user motivation and western hospital and person factors. Among them, the hospital charcteristics, preception, personal and person factors. Among them, the hospital charcteristics appered to have the biggest effect of hospital choice motivation. Second, as a result of making comparison between oriental oriental hospital user satisfaction and werterm hospital user satisfaction, there was a singificant between their satisfaction at treatment time, kindness and relative kiness aginst the pther hospital. The oriental level combining 6 items. The geneal satisfaction level combining 6itmes tured out to have reliability of chronbach $\alpha$=0.7126. As a result of examining how mech the general satifaction level depended on sociodemographic characteristics, ther was found be significantly affected by age, marital status, educational background or hospital type. Those who a spouse or a lower educational background or the oriental hospital users got better score. Third, the multiple regression analysis was made to find out what factors affected western and oriental hospital user satisfaction, As a result, the waiting time, experience of other medical facilities and hospital characteristic variable were identified as a key factor on which westerm hospital user satisfaction depended. In conclusion, the oriental hhspital user expressed more staisfaction than the weshren hospital users. Then the characteristic factor played a singificant role in user satisfaction, which included hospital facilities, kindness of herb doctor and employees, or hospital reputation of credibility. in order to raise hospital user datisfaction, it seemed necessary to pay more attention to hospital characteristic factor rather than to perception factor.

• 한국산학기술학회논문지
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• 제14권6호
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• pp.2819-2827
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• 2013

본 연구는 신경계 재활전문병원의 이탈환자에 대한 환경적 요인과 의료적 요인에 관해서 조사하는 것이다. 대상자는 107명의 입원환자를 대상으로 조사하였다. 수집된 자료는 SPSS Win 19.0을 이용하여 분석하였다. 그 결과 첫째, 일반적 병원선택에서는 추천이 35.5%, 환경적 불만족 요인에는 병원시설이 37.4%, 병원 선택인에는 지인이 23.4%로 장 높게 나타났다. 둘째, 전문성, 친절성 및 설명성에 대한 만족도 조사에서 만족도가 가장 낮은 그룹은 간병사 그룹이고 만족도가 가장 높은 그룹은 물리치료사와 작업치료사 그룹으로 나타났다. 셋째, 원무(행정)절차, 진료절차, 대기시간 및 의료비용에 관한 만족도는 모두 '보통'의 선택 안이 가장 높은 분포를 보였다. 결론적으로 환경적 불만족 요인에서 높은 비율을 차지한 병원시설은 신경계전문병원의 수가 적어서 환자의 밀집현상으로 인해 발생한 것으로 보여 환자이탈의 요소로 간주될 수 있고, 의료적 불만족 요인에서는 환자와 많은 시간을 할애하는 간병사(care worker)에 대한 만족도(전문성, 친절성, 설명성)가 가장 낮아서 환자 이탈의 중요한 요인이 됨을 알 수 있었다. 따라서 간병사에 대한 서비스 만족도와 불만족도에 미치는 요인을 조사하고 문제점을 해결하여 간병사의 서비스 질을 향상시킬 수 있는 방안을 모색해야 할 것으로 사료된다.

• 핵의학기술
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• 제14권2호
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• pp.33-37
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• 2010

관상동맥질환의 진단 및 평가에 있어서 myocardial perfusion SPECT검사와 FDG를 이용한 myocardial PET검사 그리고 PET/CT에 장착된 64-slice CT를 이용한 coronary CT angiography를 동시에 실행함으로 검사의 신뢰도와 편의성을 한층 더 높이고자 한다. 먼저 약물부하 myocardial perfusion SPECT검사를 먼저 시행한다. 환자의 피폭경감을 위해서 $^{99m}Tc$-MIBI 10 mCi 로 주사하며 myocardial PET검사를 위해서 지방식을 먹지 않고 ursodeoxcholic acid 100 mg을 생수와 함께 복용하게 하여 1시간 후에 SPECT 영상을 얻는다. 이어서 myocardial FDG PET검사를 시행한다. 혈중의 지방산 농도를 낮추고 심장의 FDG섭취율을 증가시키기 위해 혈중 포도당 농도치에 따라 insulin과 Acipimox를 함께 사용하는 독창적인 경구 당 부하법을 사용하였으며, 환자의 피폭 경감을 위해서 $^{18}F$-FDG 5 mCi를 주사하고 1시간 후에 10분간 gated 영상을 얻으며 필요시 delay 영상을 얻는다. PET검사가 끝남과 동시에 환자는 동일한 position을 하고 연속해서 coronary CTA를 시행한다. 이 검사에서 가장 중요한 것은 심박동수 조절과 환자의 호흡협조이다. 심박동수를 65회 이하로 낮추기 위해 beta blocker 50 mg~200 mg을 의사와 상의하여 복용케 하고 호흡법을 충분히 연습을 시키다. 검사 직전에 isosorbide dinitrate를 3~5회 분무하여 혈관벽의 긴장을 낮추고 혈관을 확장시켜서 coronary artery의 해부학적 형태를 더욱 잘 나타낼 수 있게 한다. 촬영 시 CT 조영제를 4.0~5.0 mL/sec의 압력으로 주입하며 촬영을 한다. Coronary CTA를 이용하면 coronary artery stenosis가 잘 보이며, 약물부하 myocardial perfusion SPECT로 coronary CTA에서 보인 stenosis와 perfusion저하의 상관관계를 검토(culprit vessel 확인)할 수 있으며, FDG PET으로 hibernating myocardium 또는 infarction site의 viability를 확인할 수 있다. 한 가지 검사로 lesion site와 severity 및 치료에 대한 반응 예측이 가능함으로 약물치료, PCI, CABG 등 치료방향을 설정할 수 있다. 또한 모든 검사 과정들이 연속적으로 동시에 이루어지기 때문에 짧은 시간(3시간) 내에 one-stop으로 검사를 종료할 수 있는 큰 장점을 가지게 된다. 그러므로 이 검사법은 ischemic heart disease의 one-stop evaluation에 있어서 유용한 protocol로 보여진다.