• 제목/요약/키워드: Patient family

검색결과 1,285건 처리시간 0.036초

인플루엔자 바이러스 감염에서 소아 열성 경련과 열성 경련의 재발에 관한 위험인자 (Risk factor of influenza virus infection to febrile convulsions and recurrent febrile convulsions in children)

  • 문재원;강장희;김현지;변순옥
    • Clinical and Experimental Pediatrics
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    • 제52권7호
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    • pp.785-790
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    • 2009
  • 목 적 : 열성 경련은 소아에서 흔한 신경계 질환이며 재발의 가능성이 있어 위험인자를 조절하여 예방하는 것이 중요하다. 최근 인플루엔자 바이러스 감염이 열성 경련과 관련성이 높고 열성 경련의 재발과 연관되어 있다는 보고가 있어, 인플루엔자 바이러스 감염과 관련하여 발생한 열성 경련 환아의 임상적 특징과 재발에 관계된 위험 요소를 알아보고자 하였다. 방 법 : 2005년 11월부터 2008년 2월까지 침례 병원에 입원하여 인플루엔자 바이러스 감염으로 증명된 환아 57명 중 열성 경련을 일으켰던 11명을 환자군으로 하였다. 비교를 위하여 대조군은 인플루엔자 바이러스 감염이 있으면서 열성 경련을 일으키지 않은 환아 46명을 대조군 1로, 열성 경련으로 입원하였으나 인플루엔자 바이러스 감염이 없었던 환아 53명을 대조군 2로 하였다. 결 과 : 환자군에서는 대조군 1보다 최고체온이 $39.3{\pm}0.5^{\circ}C$로 높았고, 총 발열 기간이 $2.9{\pm}1.2$일로 짧았으며, 열성 경련의 과거력이 8명(72.7%)으로 더 많았다. 또한 환자군과 대조군 1의 비교에서 다변량 분석 결과 인플루엔자 바이러스 감염이 있을 때 이전 열성 경련의 병력이 있는 경우 열성 경련의 재발 가능성이 통계적으로 유의하게 높은 것으로 조사되었다(OR=225.9, 95% CI : 1.7-4,780.0, P<0.05). 그 외에 성별, 나이, 열성 경련의 가족력은 두 군 간에 유의한 차이는 보이지 않았다. 열성 경련 환아에서 인플루엔자 바이러스 감염 유무에 따라 비교하였을 때, 환자군에서 대조군 2에 비해 경련이 있기 전까지 발열 기간이 $0.9{\pm}0.7$일로 짧았고, 열성 경련의 과거력이 8명(72.7%)으로 대조군2에서 18명(34%)보다 더 많았다. 환자군과 대조군 2의 비교에서 다변량 분석결과 이전 열성 경련의 병력이 있는 경우 인플루엔자 바이러스 감염 시 재발할 가능성이 통계적으로 유의하게(OR=5.5, 95% CI : 1.2-25.1, P=0.03) 높았고, 인플루엔자 바이러스 감염 시 열성 경련 전의 발열 기간이 1일 증가할 때마다 열성 경련할 가능성은 0.3배(95% CI : 0.1-0.9) 감소하였다. 복합 열성 경련은 환자군에서 36%였고, 대조군 2에서 22%로 통계적으로 의미 있게 차이를 보이지는 않았다(P=0.46). 그 외에 성별, 나이, 최고 체온, 총 발열기간, 열성 경련의 가족력의 경우는 통계적으로 의미 있는 차이를 보이지 않았다. 결 론 : 환자군과 대조군1,2사이에 다변량 분석결과를 비교해 볼 때 인플루엔자 바이러스 감염 환아에서 열성 경련의 위험인자로서 열성 경련의 과거력이 유일하였다. 그러므로 열성 경련의 과거력이 있는 환아에서, 특히 인플루엔자 유행 시기에는 인플루엔자 바이러스 예방접종이 인플루엔자 바이러스 감염에 의한 열성 경련의 재발을 막는데 도움을 줄 수 있을 것으로 사료된다.

병원 호스피스센터-보건소 연계를 통한 지역사회 재가암환자 관리 프로그램 평가 (Evaluation of a Community-Based Cancer Patient Management Program: Collaboration between a Hospice Center and Public Health Centers)

  • 이해숙;박선희;정영순;이부경;권소희
    • Journal of Hospice and Palliative Care
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    • 제13권4호
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    • pp.216-224
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    • 2010
  • 목적: 본 연구는 말기 재가암환자 관리를 위한 병원호스피스센터와 보건소 간의 연계 프로그램을 평가함으로써 보다 효율적이고 효과적인 재가암환자 관리체계를 구축하고자 시도되었다. 방법: 호스피스센터-보건소 재가암관리 연계 사업은 1) 협약체결, 2) 재가 말기암환자 발굴 및 등록, 3) 가정호스피스 방문 서비스 제공, 4) 만족도 조사의 단계로 전개되었다. 일 호스피스센터와 지역의 3개 보건소가 협약을 체결하였고, 2009년 2월 1일에서 12월 31일까지 11개월 동안 43명의 환자에게 605건의 가정호스피스 방문을 실시하였다. 방문기록지 분석을 통해 서비스 대상자의 특성과 제공된 서비스의 종류와 내용을 분석하였고, 이 중 20명에게 서비스 만족도 조사를 실시하였다. 결과: 대상자의 76.7%가 60세 이상이었고, ECOG 전신 수행상태 점수는 0점과 1점이 각각 37.2%, 39.5%이었다. 환자가 병식이 있는 경우는 90.7%, 호스피스 동의서에 서명한 경우는 62.8%였다. 초기방문 시 환자의 주 호소는 전신쇠약감(86.0%)과 식욕부진(72.1%)이 가장 많았다. 평균 총 서비스 기간은 144.42일이었고, 총 605건의 방문 중 간호사 방문이 371회로 가장 많았다. 각 방문중 정서적 지지와 건강상담이 가장 빈번하게 제공되었고, 서비스 전반에 대한 만족도는 5점 척도로 측정하였을 때 평균 4.45점이었다. 결론: 본 연구는 지역사회 내에서 실제적이고 체계적인 재가 말기암환자 관리 프로그램 구축을 위한 중간평가로서의 의미가 있다. 본 연구에서 의뢰된 대상자는 입원형 호스피스보다 기능 상태가 양호하고 서비스 제공기간이 길었으며, 서비스에 대한 만족도, 특히 정서적지지와 환자상태 설명에 대한 만족도가 높았다. 그러나 방문횟수와 빈도, 임종기 관리, 병원입원 재입원하는 환자관리에 대한 기준과 서비스 표준마련은 앞으로의 과제로 제시되었다.

저소득층 방문간호 관리를 위한 제안 - 강북구 방문간호 대상자를 중심으로- (A Proposal on a Management Model Applicable to Visiting Nursing Program for a Low-income Group)

  • 고미자
    • 한국보건간호학회지
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    • 제10권1호
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    • pp.118-138
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    • 1996
  • Because of accelerated urbanization public body visiting nursing project that started according as matter of health on urban class in the lower brackets of income was concentrated on Social interests has a unsatisfied points to propel project efficiently from the lack of rating materials. Therefore centering around written contents in documentary literature of citizen health by household in five years from starting year of project to now. visiting frequency by medical manpower was evaluated quantitatively and qualitatively in aspect of management hereupon. for the sake of giving a basic materials for public health project of this field. This research presents documentary literature of citizen health which become materials is that as one person's charged region of nurse in duty scale. district is Kang-Buck Gu. the object is resident in the lower brackets of income grounded livelihood protection law and who is admitted by the head of organ~chief of health care). and the number of material centering around the head of a household is 415 copy. The result of research is summarized. as follow. 1. Average visiting frequency examinated by medical manpower show difference according to valuables of supervision characteristics namely average visiting. Frequency of nurse has long term residence in case registration season is early and supervision season is the first year and is high incase a kind of house is unlicdnsed mountain town. Average visiting frequency with doctor is high incase supervision season is the first year and the medical insurance system is admitted by chief of health care. That shows that a man of discomfort behavior left alone are yet many in local society. The meaning of this result shows that the continuity of official relation about class in the lowest brackets of income of long term residence goes well between househole who is a user of visiting nursing service of the object according to midway income under management influences a given duty of nurse s and so causes quantitative decrease. 2. In case behavier and condition of health that nurse diagnoses are bad. as the type matter is a lack of health and the number of patient is large. the average visiting frequency of nurse is high. because average visiting frequency with doctor is high as the condition of health is bad and the number of patient is large. That is similar with that of nurse. CD Average visiting frequency of nurse s seen by matter of disease is very high only in apoplexy by 39.50 and is confined within limits from 7.63 to 11.36 in other disease. But average visiting frequency with doctor is double as many as that of nurse but defined in apoplexy hypertension and articulate. (1) Average visiting frequency of nurse by existence in inoculation of hepatitis is low by 6.73 in unidentified group and very high by 26.89 in group of non-inoculation and the case of the antigenic positive man of B type hepatitis or epileptic who can't be inoculated shows 13.00 and that even family nursing service is needed to them. That result shows that though one person nurse of local charge has a large scale of duty. as visting nursing service is given a class who has a large demand preferentially by respectively accurate nursing diagnosis. the number of diagnosis service is similar with it. 3. During five years. average visiting frequency of nurse is 10.84 and average visiting frequency with doctor is 76.50 seeing from the official scale of nurse. visiting by household is performed two more per year to the average. Seeing this by type of service. average visiting frequency of nurse is higher in indirectly nursing than in directly nursing and that suggests that at the time of visiting household nurse performs education of protection lively save patient but at the time of contrastedly visiting with doctor. directly nursing is more contents of service show no difference by man power and medication dressing by demand is 14.3 and 18.6 the aid of hardship term of doctor and nurse is high by 18.7 and 17.00 in the request of hospitalization when seeing by demands. 4. Action by turns exemplified 1994 is well in sequence of 2/4 turn. 3/4 turn. 1/4 turn. 4/4 turn. When seen by average visiting frequency of nurse but gradually is even. Without difference by turns. average visiting frequency of doctor is much higher in 1/4 turn than other turns. Type of service by turns is all even but directly nursing is inactive in 4/4 and indirectly nursing. Very increases in 4/4 and so. Nurse's quantity of duty is plentiful that shows that by evaluation of last turn and plan of project. Contents of service follows that medication and dressing is the highest by' 5.57 in 1/4turn. goes down gradually by turn. becomes 3.57 in 3/4 turn. and increases again by 4.83 in 4/4 turn. the rest service is higher in 2/4 turn than other turns. 5. Total visiting frequency of nurse is explained to total $37.5\%$ by six valuables of visiting frequency of doctor. nursing demand. demand of diagnosis. condition of behavior. year. Special terms and magnitude of influential power is the same as sequence of enumerated valuables. Namely. the higher the visiting frequency of doctor. the bigger nursing and demand of diagnosis is. the worse the condition of behavior is. the older the object is and the more the household of special terms is. the high total visiting frequency of nurse is.

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병동형 호스피스 대상자를 위한 전인적 호스피스 간호중재 프로그램의 개발 (Development of Wholistic Hospice Nursing Intervention Program for In-patient of Hospice Palliative Care Unit)

  • 강은실;최성은;강성년
    • 호스피스학술지
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    • 제7권1호
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    • pp.29-45
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    • 2007
  • People in the end of life and their families suffer in their physical disease and other aspects as a whole person. They need hospice care to palliate their total suffering in physical, emotional, social and also spiritual aspect through professional hospice team. To care their whole personal needs, hospice team must be a multi-discipline team which consists of medical doctors, nurses, social workers, pastors and volunteers. Recently those who die in hospice palliative care unit have trend to increase more than in home year by year. So it is necessary to develop the nursing intervention program to be performed by multi-discipline team approach for in-patient of hospice palliative care unit. The purposes of this study were to develop of wholistic hospice nursing intervention program for inpatient of hospice palliative care unit. The subjects of study were collected from 30 patients those who were over 18 years old and admitted in hospice palliative care unit of S hospital in P city with agreement in hospice palliative care in their terminal disease. The period of data collection was from December 15, 2003 to March 15, 2004. The result were as follows : 1. The result of Wholistic Hospice Nursing Program's development was as follow : A Wholistic Hospice Nursing Program was developed by me in this study is one of the service program for hospice palliative care unit. It was named as ‘Rainbow Program’ to be approached easily by hospice patients. The purposes of it are to improve the quality of life of the terminal patients with their dignity, to help them live in abundant and meaningful in their lives, to care them in peaceful in dying process with understanding them in whole personal, and also to palliate the grief and suffering of the bereaved. It was provided by hospice professionals(nurses, medical doctors, social worker, pastors, art therapists) and volunteers those who were educated in hospice for multi-diciplinary team approach to collaborate with each role play I 20-30 minuters of each through visiting their rooms individually and a place of hospice palliative care unit of S hospital in P city. The subjects of it were the terminal patients those who admitted hospice palliative care unit and their familes. with agreement in hospice palliative care in their terminal disease. The characteristics of it were multi-disciplinary team approach, whole personal care, individual care and total care according to their needs in their condition. The contents of it were pain control, symptom control, counseling patient, counseling family, hair cutting, hair shampooing, bed bath, recreation, taking a walk, event of culture(screen, recital, festival of praises, exhibition and so on), pastoral counseling, ritual service in bed, praying, service in bed, sing a worship praise, listening to the music, sharing remembrance of life, individual visiting music service(sing and praying), meditation Bible, art therapies(dance and drawing), social worker's counselling, confessing and sharing love and thanksgiving. The experimental group subjects participated in Wholistic Hospice Nursing Program which takes 120 minutes per session, total 10 sessions(total 1,200 minutes) altogether. In conclusion, this Wholistic Hospice Nursing Intervention can be used actively for whole personal well-being of the patients in hospice palliative in hospice palliative care unit and also applied in hospice practice as an useful model of multi-disciplinary team approach by hospice professionals.

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청소년기 교정환자의 치료 협조도와 연관된 요소에 관한 연구 (A study on the factors associated with treatment compliance in adolescent orthodontic patients)

  • 김진이;차봉근;이남기
    • 대한치과교정학회지
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    • 제34권2호
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    • pp.177-188
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    • 2004
  • 교정치료 시기의 적기이며 내원 환자의 많은 부분을 차지하고 있는 청소년기 교정환자의 치료 협조도에 영향을 미치는 요소들에 대해 파악하고자 강릉대학교 치과병원 교정과에서 10개월 이상 동적 치료를 받은 중학교 1학년 이상, 고등학교 3학년 이하 남녀 청소년 60명 (남자 23명, 여자 37명)을 대상으로 인구학적 변인에 따른 치료 협조도를 비교하고 성별, 학령, 치료 협조도에 따른 교정적 태도 척도, 교정용 내외통제소재 척도를 측정, 비교 분석하여 다음과 같은 결과를 얻었다. 1. 교정용 내외통제소재 척도를 조사 분석한 결과 외적통제-부모의 항목에서 성별에 따라 유의한 차이가 인정되었으며(p<0.05) 남학생이 여학생보다 높은 외적통제-부모의 양상을 나타내었다. 2. 교정용 내외통제소재 척도를 조사 분석한 결과 협조적인 환자 군과 비협조적인 환자 군간에 외적통제-부모 항목에서 유의성 있는 차이가 인정되었으며(p<0.05) 교정치료에 대해 협조적인 군에서 외적통제-부모에 대한 인식이 보다 높았다. 3. 교정 치료를 권유하거나 치료받기를 결정한 사람과 치료시의 협조도 사이에는 통계적으로 유의한 차이가 인정되었으며(p<0.05) 환자 자신의 결정에 의한 경우 가장 높은 협조도를 나타내었다. 4. 치료기간과 협조도 사이에 유의한 차이가 인정되었으며 (p<0.05) 치료기간이 길어질수록 협조도는 지속적으로 감소하였다. 5. 교정적 태도 척도를 조사 분석한 결과 성별, 중학생과 고등학생간, 협조적인 환자군과 비협조적인 환자군 사이 에 통계적으로 유의한 차이가 없었다. 6. 교정치료 시 협조정도와 한자의 성별, 연령, 가족관계, 부모의 직업 및 학력, 학업성적, 양치횟수 등의 변인과는 통계적으로 유의한 차이가 인정되지 않았다.

ARC(Arthrogryposis, Renal Tubular Dysfunction, Cholestasis) 증후군의 발병양상에 관한 연구 (Clinical Characteristics of Arthrogryposis, Renal Tubular Dysfunction, Cholestasis(ARC) Syndrome in Korea)

  • 이순민;김지홍;이재승;한석주
    • Childhood Kidney Diseases
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    • 제9권2호
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    • pp.222-230
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    • 2005
  • 목 적 : ARC 증후군은 관절구축, 신세뇨관 장애 및 담즙 정체의 동반으로 진단되며, 윈인 유전자(VPS33B)가 확인 된 선천성 질환으로, 전세계적으로 41례 정도가 보고되었고, 국내 보고는 거의 없는 매우 드문 질환이다. 저자들은 신세뇨관 기능부전을 중심으로 7례의 ARC 증후군의 임상 경과를 고찰하여 본질환의 진단에 도움이 되고자 하였다. 방 법 : 1995년 3월부터 2005년 8월까지 세브란스병원에 내원한 임상적 진단기준을 만족하는 7례의 ARC 증후군을 대상으로 후향적 조사를 시행하였다. 결 과 : 대상 환아 남, 녀 비는 4:3이었으며, 출생당시 정상체중아가 6례(85$\%$), 미숙아는 1례(14$\%$)였다. 7례 모두 심한 황달을 동반하는 담즙 정체를 보였으며, Brown 등에 의한 관절구축의 분류 기준상 type III 2례, type IV 2례 type VI 1례, type VII 2례, 미분류 1례(14$\%$)였다. 기타 임상양상은 성장장애 6례(85$\%$), 늘어지고 거친 피부 5례(71$\%$), 거대혈소판 4례(57$\%$), 청력장애 2례(29$\%$)였다. 소변 검사상 단백뇨 6례(85$\%$), 혈뇨 3례(43$\%$), 당뇨 5례(71$\%$), 인산뇨 2례(29$\%$), 칼슘뇨 2례(29$\%$)였다. 전해질 검사상 저나트륨혈증 4례(57$\%$), 저칼륨혈증 3례(43$\%$)였고, 혈중 크레아틴치 상승은 1례(14$\%$)에서 관찰되었다. 신세뇨관 기능부전은 신세뇨관 산증 6례(85$\%$), 신성 요붕증 2례(29$\%$), 판코니 증후군 2례(29$\%$)로 나타났다. 치료는 단순관찰 2례(29$\%$), 지속적 전해질 보충 및 산증 교정 5례(85$\%$), 신대체요법 1례(14$\%$)였다. 가계도 분석에서 가계내 발병은 1례에서만 확인되었다. 추적관찰 결과 사망 4례(57$\%$), 생존 2례(29$\%$), 추적관찰 중단 1례(14$\%$)로 사망 환아는 평균 8.1개월에 사망하였으며, 생존 환아의 평균연령은 11.8개월이었다. 결 론 : 전세계적으로 드물게 보고되고 있는 ARC 증후군은 다양한 양상의 신세뇨관 기능 부전을 동반하고 있으나, 본 연구에서는 신세뇨관 기능 손상 정도가 상대적으로 미약하며, 생존 기간도 높은 경향을 나타내었다. 또한 국외 보고와는 달리 대상 환아의 가계 내 동일질환의 발생례가 적어 산발적인 유전자 돌연변이에 의한 발병 가능성도 있으나, 예후가 극히 불량한 본 질환의 철저한 차단을 위하여 무엇보다도 환자 발생 가계 내에서의 정확한 산전 유전자 진단이 요구되는 바이다.

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가정간호 사업에 대한 의사, 간호사, 진료관련부서 직원 및 환자의 인식 비교 (A Study on Differences of Opinions on Home Health Care Program among Physicians, Nurses, Non-medical personnel, and Patients.)

  • 김용순;임영신;전춘영;이정자;박지원
    • 대한간호
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    • 제29권2호
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    • pp.48-65
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    • 1990
  • The government has adopted a policy to introduce Home Health Care Program, and has established a three stage plan to implement it. The three stage plan is : First, to amend Article 54 (Nurses for Different Types of Services) of the Regulations for Implementing the Law of Medical Services; Second, to tryout the new system through pilot projects established in public hospitals and clinics; and third, to implement at all hospitals and equivalent medical institutions. In accordance with the plan, the Regulation has been amend and it was promulgated on January 9,1990, thus establishing a legal ground for implementing the policy. Subsequently, however, the Medical Association raised its objection to the policy, causing a delay in moving into the second stage of the plan. Under these circumstances, a study was conducted by collecting and evaluating the opinions of physicians, nurses, non-medical personnel and patients on the need and expected result from the home health care for the purpose of help facilitating the implementation of the new system. As a result of this study, it was revealed that: 1. Except the physicians, absolute majority of all other three groups - nurses, non-medical personnel and patients -gave positive answers to all 11 items related to the need for establishing a program for Home Health Care. Among the physicians, the opinions on the need for the new services were different depending on their field of specialty, and those who have been treating long term patients were more positive in supporting the new system. 2. The respondents in all four groups held very positive view for the effectiveness and the expected result of the program. The composite total of scores for all of 17 items, however, re-veals that the physicians were least positive for the- effectiveness of the new system. The people in all four groups held high expectation on the system on the ground that: it will help continued medical care after the discharge from hospitals; that it will alleviate physical and economic burden of patient's family; that it will offer nursing services at home for the patients who are suffering from chronic disease, for those early discharge from hospital, or those who are without family members to look after the patients at home. 3. Opinions were different between patients( who will receive services) and nurses (who will provide services) on the types of services home visiting nurses should offer. The patients wanted "education on how to take care patients at home", "making arrangement to be admitted into hospital when need arises", "IV injection", "checking blood pressure", and "administering medications." On the other hand, nurses believed that they can offer all 16 types of services except "Controlling pain of patients", 4. For the question of "what types of patients are suitable for Home Health Care Program; " the physicians, the nurses and non-medical personnel all gave high score on the cases of "patients of chronic disease", "patients of old age", "terminal cases", and the "patients who require long-term stay in hospital". 5. On the question of who should control Home Health Care Program, only physicians proposed that it should be done through hospitals, while remaining three groups recommended that it should be done through public institutions such as public health center. 6. On the question of home health care fee, the respondents in all four groups believed that the most desireable way is to charge a fixed amount of visiting fee plus treatment service fee and cost of material. 7. In the case when the Home Health Care Program is to be operated through hospitals, it is recommended that a new section be created in the out-patient department for an exclusive handling of the services, instead of assigning it to an existing section. 8. For the qualification of the nurses for-home visiting, the majority of respondents recommended that they should be "registered nurses who have had clinical experiences and who have attended training courses for home health care". 9. On the question of if the program should be implemented; 74.0% of physicians, 87.5% of non-medical personnel, and 93.0% of nurses surveyed expressed positive support. 10. Among the respondents, 74.5% of -physicians, 81.3% of non-medical personnel and 90.9% of nurses said that they would refer patients' to home health care. 11. To the question addressed to patients if they would take advantage of home health care; 82.7% said they would if the fee is applicable to the Health Insurance, and 86.9% said they would follow advises of physicians in case they were decided for early discharge from hospitals. 12. While 93.5% of nurses surveyed had heard about the Home Health Care Program, only 38.6% of physicians surveyed, 50.9% of non-medical personnel, and 35.7% of patients surveyed had heard about the program. In view of above findings, the following measures are deemed prerequisite for an effective implementation of Home Health Care Program. 1. The fee for home health care to be included in the public health insurance. 2. Clearly define the types and scope of services to be offered in the Home Health Care Program. 3. Develop special programs for training nurses who will be assigned to the Home Health Care Program. 4. Train those nurses by consigning them at hospitals and educational institutions. 5. Government conducts publicity campaign toward the public and the hospitals so that the hospitals support the program and patients take advantage of them. 6. Systematic and effective publicity and educational programs for home heath care must be developed and exercises for the people of medical professions in hospitals as well as patients and their families. 7. Establish and operate pilot projects for home health care, to evaluate and refine their programs.

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개인정보 보호를 위한 의료영상 발급 표준 업무절차 개발연구 (Development of Standard Process for Private Information Protection of Medical Imaging Issuance)

  • 박범진;유병규;이종석;정재호;손기경;강희두
    • 대한방사선기술학회지:방사선기술과학
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    • 제32권3호
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    • pp.335-341
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    • 2009
  • 목 적 : 기존 필름으로 발급되었던 의료영상은 IT기술의 발달로 디지털화 되어 CD로 발급되고 있다. 그러나 발급 시 신분확인을 하고 있는 의무기록과는 달리 필름을 사용하던 시절부터 의료영상은 별다른 신분확인을 하지 않는 의료기관이 많다. 이에 신청자의 개인의료정보 보호에 대한 인식 실태를 조사하고 여러 의료기관의 CD 또는 DVD 등의 매체를 통한 의료영상 복사 현황을 조사, 정보보안에 관련된 국, 내외 법률 및 권고안을 분석하여 국내 환경에 부합하는 의료영상 복사 발급과 절차를 마련하는 기준을 제시하고자 한다. 대상 및 방법 : 첫째, 2008년 5월 1일부터 7월 31일까지 수도권에 있는 33개 종합병원을 대상으로 의료영상복사 신청 시 구비서류, 발급절차 등을 전화를 통한 유선 조사를 시행하였다. 신청자에 따른 구비서류를 의료법 제 21조 2항에 의거 (1) 본인일 경우 신분증 확인, (2) 가족일 경우 신청자 신분증, 가족관계 서류(건강보험증, 가족관계증명서, 등본 등), (3) 제 3자 대리인일 경우 신분증, 위임장, 인감증명서로 기준을 마련하여 조사하였다. 둘째, 연구기간 동안 위의 기준에 따라 의료영상을 발급해 주고 있는 K 의료원에 복사를 신청하는 신청자들이 준비해온 구비서류 여부를 파악하였다. 셋째, 구비서류의 확인 및 미비 시 조치 등에 대한 발급절차의 기준을 정립하여 프로세스를 개발하였다. 결 과 : 수도권 33개 의료영상 발급현황을 조사한 결과 모든 조건을 충족한 병원은 16곳(49%), 신분증만 있으면 가능한 병원은 4곳(12%), 누구나 신청 가능한 병원 4곳(12%)이었으며 의료영상을 발급하는 부서가 아닌 진료과에서 신청하는 곳이 9곳(27%)으로 구비서류 조건여부는 알 수 없었다. 또한 신청자들이 복사 신청시 준비해온 구비서류가 조건에 충족한지 3개월간의 조사 결과 모두 준비한 경우(완비)는 629건(49%), 일부만 준비한 경우(일부 미비) 416건(33%), 모두 준비하지 않은 경우(미비) 226건(18%)이였다. 위의 연구결과를 근거로 의료영상 복사 신청 절차에 대한 프로세스를 정립하여 객관적인 응대를 할 수 있도록 하고, 환자와의 마찰을 줄이고 불편을 최소화 하면서 환자의 편의를 도모하고자 세분화된 발급절차 모형도를 작성하였다. 결 론 : 다른 전산 시스템과 달리 의료영상 시스템인 PACS가 의료기기로 분류되어 있는 것은 그만큼 의료정보의 중요성이 크다는 의미이다. 또한 의료영상의 학문적 성격으로 의학교육 및 연구에 많이 쓰이는데 이러한 이유로 쉽게 인용되고 남용 될 수 있다. 따라서 의료영상은 전문적인 교육을 받은 의료영상 관리자에 의해 적절한 발급 기준으로 발급, 관리되어야 할 것이며 이에 관한 개인정보보호와 의료영상에 대한 적극적인 홍보가 필요할 것이다.

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당뇨병 환자의 민간요법 시행에 대한 실태조사 (A Study of the Application of Folk Medicine in Patients with Diabetes Mellitus)

  • 엄동춘;이영신
    • 동서간호학연구지
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    • 제1권1호
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    • pp.72-81
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    • 1997
  • Korean society is a mix of western and traditional cultures. Even though the patients try to recover through both aspects, hospital only utilizes a western approachs. When they have suffered from a chronic disease, especially diabeties meliitus(DM), application of folk medicine is more varied but the nurses are unaware of the practices. This study was done to describe the current use of the folk medicine with which the patients with DM have had an experience and to identify the relationships between the westernized medical care and folk medicine application. The 244 patients with non-insulin dependent diabetes millitus who participated were interviewed at a DM education clinic in a 1500-bed hospital. The results of the study are as follows: 1. 54.1%(N=133) of the participated patients in this study have had a folk medicine. 2. 44 kinds of folk medicine were used for the treatment of DM. Among them 14 items were used by more than two people and the rest were used by one person. Among the used items, 70.4% consisted of various types of plants, 11.4% was animal material and 18. 2% was the mixed group. As a single item, Commelina Communis(Dalgaebi) was the most frequently used(62.8%), followed by the root of Rosa rugosa(Haedangwha) 14.3%, and Youngi mushroom 13.6%. 3. In the analysis of the relationships between the general characters of the patients with regular fol1ow-up(F-U), self blood sugar test(BST) and folk medicine usage: 1) The higher the educational back ground patient had, the lower the folk medicine usage was ($X^2$=14.265, P=.003). 2) The more complex their treatment was($X^2$=24. 016. P=.000). and the longer they had suffered from DM($X^2$=75.739, P=.000), the fewer they visited regular F-U. On the other hand, they did self-BST well($X^2$=7.722, P=.021 : $X^2$=14. 775, P=.002) and had more folk medicine($X^2$=33.382, P=.000 ; $X^2$=43.410, P=.000). 3) If they had suffered many symptoms, they had fewer regular F-U ($X^2$=13.192. P=.001). On the other hand, they had more folk medicine($X^2$=6.070, P=.048). 4) The group of family history($X^2$=6.801. P=.009) and the group of DM education experience($X^2$=15.678, P=.000) carried out self BST well. DM education group used more folk medicine($X^2$=8.680, P=.003). In conclusion, DM education should be grouped according to the treatment type and suffering period. Then the management of DM would be effective and the vague application of folk medicine would be decreased.

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시간제 간호사 및 인턴간호사의 직무만족도에 관한 비교연구 (Comparative Study on the Job Satisfaction of Part-time Nurses and Internship Nurses)

  • 최숙자
    • 지역사회간호학회지
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    • 제10권1호
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    • pp.93-105
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    • 1999
  • Recently, Korean health care industry managers are paying more attention to customer oriented service, the rationalization of business administration, and quality control of service to adjust their business to outer environment since IMF bailout program. They are focusing on the cost reduction through remodeling the size and structure of man power, viz. labor flexibility. Nurses are not free from this juncture and contingent nurses are increasing fast. This article intends to verify the actual condition of two types of contingent nurses -part-time nurses and internship nurses-and to compare their job satisfaction to provide basic resource for efficient management of nurse man power. The concrete goals of this article are; Firstly, to verify the actual condition of their employment. Secondly, to compare their job satisfaction. And Thirdly, to the relation between employment condition and job satisfaction. To accomplish these research goals, a statistical survey was executed, in which 384 questionnaires - 66 for manager nurses, 318 for contingent nurses-were given to nurses working at 66 general hospitals-which have at least 100 beds-in Seoul. Among them, 121 questionnaires-of 28 general hospitals-were returned. Then, the data coded and submitted to mean, standard deviation, T-test, variance analysis (ANOVA), correlation analysis, multiple regression analysis with SAS program. The research results of the contingent nurses are followings: 1. Two types of contingent nurses shows similar age spans: they are mostly 21 - 30 years old and unmarried. But internship nurses have high level of educational career. Part - time nurses spread at general beds, out -patient part, intensive care part, operation part, etc, but internship nurses work mostly at general beds. 2. Two groups shows difference in actual employment condition: average employment career of part -time nurses is 7.0 months but internship nurses' is 2.0 months: average duty-on days per month of part - time nurses are 23.7 days but internship nurses' are 24.8 days. But there are little difference in average working time per day: 7.7 hours for part -time nurses and 0 hours for internship nurses. 3. The average wage per month for part -time nurses is 836,026 won but for internship nurses is 557,428 won-66.7% of part-time nurses'. Both groups are enjoying little additional pay. 4. Both groups are getting job not so much through advertisement of newspaper or hospitals as through acquainted person or college. 5. Both groups show very high level of job satisfaction: 3.2195 for part -time nurses and 3.2881 for internship nurses. But they show very low satisfaction on payment level compared with other categories and two groups show meaningful difference(P<.0001). 6. The multiple regression test reveals the factors related with job satisfaction: wage level, working part(OR or ICU), age, job career, and motive of contingent job-taking('because I can take care of family duties at the same time') influence positively: motive of contingent job-taking('because I can work regularly without alternation') influences negatively.

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