• 한국임상약학회지
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• 제21권1호
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• pp.14-21
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• 2011

Drug Utilization Review (DUR) is known to play an important role to improve appropriateness of drug prescriptions. This retrospective, observational study was conducted to compare prescription patterns after installation of Computerized DUR Program (Drug Information Framework-$Korea^{TM}$) (Jan-Mar 2008; After) to before DUR program (Jan-Mar 2007: Before). 8 physicians affiliated in the S University Hospital were enrolled in the study and their 3 months' prescription data were analysed for drug prescription trends and DUR conflict events per 7 DUR screening modules (drugdrug interaction, therapeutic duplication, allergy, dosing, disease contra-indication, geriatric contra-indication, pediatric contra-indication). Average rate of DUR modules usage in 2008 (After) were 0.72. Average number of prescription drug per patient were reduced from 5.6 (Before) to 3.8 (After), and DUR program seemed to effect positively on physician's prescription related decision process. Overall DUR conflict events occurred by 8 physicians for 3 months were 17,923 Before and 20,057 After DUR program, and DUR conflict events per prescription were 2.8 Before and 2.9 After, respectively. Therapeutic duplication (37%), geriatric contra-indication (34%) and dosing (18%) were high ranked DUR conflicts. As the study was not sufficient to show a consistent trend to reduce DUR conflicts After, another study to confirm it's effectiveness would be recommended. This study would be of help to develop awareness of DUR program to healthcare providers.

• 정보관리학회지
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• 제33권3호
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• pp.177-193
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• 2016

본 논문은 임상의사가 환자치료 시 발생하는 문제를 해결하기 위해 온라인상에서 정보검색하는 과정을 연구하였다. 이를 위해 국내 대학병원 내과 전문의 10명을 대상으로 관찰조사와 심층면담을 수행하였다. Wilson의 문제 해결 모형을 기반으로 임상의사가 임상질문 해결을 위해 온라인상에서 검색하는 단계별 특성과 정보검색의 효용성에 대해 분석하였다. 그 결과, 임상의사는 사전 배경지식을 바탕으로 즉각적인 임상질문을 구성하지만, 실제 검색에서는 대부분 기본 검색전략만 사용하였으며, 본인에게 익숙한 특정 정보원만을 선호하였다. 하지만, 온라인 정보검색 평균 만족도는 7점 리커트 스케일 기준 5.7로 높게 나타났으며, 정보검색 후에 문제해결지수가 상승하였다. 임상의사는 잘 정리된 근거 중심의 신뢰성 높은 정보를 빠르고 쉽게 이용하기를 원하기 때문에 환자 진료시스템에서 바로 치료에 필요한 정보를 보여줄 수 있는 검색시스템의 연계가 필요함을 알 수 있다. 또한, 구글이나 PubMed 외에 다른 온라인 정보원에 대한 인지도는 현격히 낮게 나타나 다른 정보원에 대한 적극적인 홍보와 정보활용교육의 활성화도 필요함을 알 수 있다.

• 성인간호학회지
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• 제19권4호
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• pp.556-566
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• 2007

Purpose: This study attempted to analyze problems of informed consent in the clinical setting and appraise ethical aspects inherent in such issues in order to boost awareness of informed consent and its implementation among healthcare professionals. Methods: Study methods included identifying ethical meanings of informed consent in the clinical setting based on the principal ethics, and exploring the process of informed consent utilizing communicative ethics and feminine care ethics Results: The ethical basis of informed consent encompasses not only respect for autonomy but also prohibiting malice, practicing beneficience, and establishing justice. These principles, however, are limited in illustrating the ethical aspects of communicative ethics and care ethics that are entailed in informed consent within clinical settings. The ethical meaning of informed consent involves a communicative and caring process between healthcare professionals, patients, and family built on mutual respect. Conclusion: Healthcare professionals must fully understand the ethical meanings of informed consent and in turn respect and protect the clients' right to know and making decisions. Nurses especially, must take on the role of mediator and advocate throughout the process of obtaining informed consent, and practice ethical caring by facilitating communication grounded in mutual understanding among the physician, patient, and family members.

• 한국임상약학회지
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• 제24권1호
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• pp.53-61
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• 2014

Background: The use of health functional food (HFF) is increasing and will continue to rise worldwide. Concerns about HFF-drug interactions are increasing as HFF are becoming more widely used. Therefore, awareness of consumers' perceptions and behaviors associated with HFF use may help health care providers improve their communications with patients. Purpose: The aim of this study was to assess the characteristics, perceptions, and behaviors associated with HFF use in South Korea. Method: The online survey was conducted from September 21th to October 7th, 2013. With the aid of Social Network Service (SNS) and google, the questionnaire was posted online on internet website targeting people aged 15 years or older so that self-reported data covering 4 domains were collected from 257 Koreans. Results: A total of 257 people responded the questionnaire. Among them, 81.3% reported experiences of HFF use. Female were more likely than male to use HFFs. There were no differences in demographic characteristics between HFF users and non-users in relation to age, education, and household income. Higher level of education was associated with high-level perception of HFF function (OR 3.9, 95% CI 1.48, 10.1) and a positive relationship was observed between the maximum number of HFFs used concurrently and age of the respondents. Among the HFF users, 42.6% reported concurrent HFF-medication use. However 73.3% of them did not disclose their use to physician or pharmacist and only 30.2% were informed about potential drug-HFF interactions. Pharmacy was most commonly reported as the source from which the respondents were informed about potential interactions. Conclusion: Many people had used HFF and medications concurrently while not being informed about potential HFF-drug interactions. Pharmacists and physicians should be vigilant for risk of the interactions and actively determine whether the patient is using an HFF before prescribing and administrating medications.

• Asian Pacific Journal of Cancer Prevention
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• 제16권12호
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• pp.5119-5124
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• 2015

Background: HPV vaccination in Singapore is voluntary and physician prescription-based. This study investigated the current status and intention for HPV vaccination among Singapore nurses. Materials and Methods: All female nurses in a general hospital were given an anonymous questionnaire on HPV vaccination experience and intention of vaccinating their daughters. The influence of age, knowledge and perceived-risk of cervical cancer, and cultural background on mother's intention of vaccinating their daughters was analyzed. Results: Of 2,000 nurses, 1,622 (81.1%) responded and analysis was performed on 1,611 with valid data. They showed good awareness on association of cervical cancer with multiple sexual partners (81.9%), history of sexually transmissible diseases (78.2%), and history of genital warts/HPV infection (73.5%), and on cervical cancer preventive effects of HPV vaccination (54.6%). The prevailing misconceptions of the vaccines were: investigational nature (38.9%), side effects (27.9%) and indicated for women at high risk for cervical cancer (20.5%). Conclusions: Misconceptions on the nature, role and safety of HPV vaccines low vaccine up-take rates and daughters. Dissemination of adequate and accurate HPV vaccine information and a review for school-based vaccination are needed for optimal delivery of HPV vaccines in Singapore.

• 대한예방한의학회지
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• 제17권1호
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• pp.107-116
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• 2013

Objectives : This study was aimed to facilitate mutual comprehension between Western and Traditional Korean Medicine (TKM) by analyzing recognition of medical school students on traditional medical prescription and treatment such as herbal medicines and acupuncture. Methods : We conducted a survey targeting medical school students of four medical schools from April through May 2009, and analyzed 208 cases responded. Results : Survey results revealed that medical school students took knowledge of traditional medicine from TV programs and on the Web in general. They thought they had considerable traditional medical knowledge but did not almost understand for professional contents. Regardless of some positive recognition for traditional herbal medicine, negative perspectives were more common and its safety and efficacy on the drug reference were considered as a major reason. On the other hand, recognition on acupuncture was comparatively positive. Scientific data for both herbal medicine and acupuncture are lacking in reality but the attitude only for acupuncture was different. Of the survey respondents, 57.8% had negative attitude against diagnostic methods of TKM and 59.1% opposed to the usage of modern medical equipments by TKM doctors. With regard to the future position of TKM, they tacitly approved that TKM would be absorbed into the complementary and alternative medicine (CAM) and importance of TKM objectification, followed by Government's support. Conclusions : Medical school students neither affirm nor deny TKM as a whole but the state of awareness for each item was similar to the physician. In terms of TKM its internal and external innovation would be required to continuously establish objectification of TKM prescription and scientific research on treatment technology.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제20권4호
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• pp.222-226
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• 2017

Purpose: Celiac disease, an autoimmune enteropathy triggered by exposure to gluten, is not uncommon in South Jordan. However, its prevalence is underestimated due to lack of physician awareness of the diversity of disease presentation. The clinical spectrum includes classic gastrointestinal manifestations, as well as rickets, iron-deficiency anemia, short stature, elevated liver enzymes, and edema. Our goal was to evaluate celiac disease presentation in clinically diagnosed children. Methods: Retrospective study included all children diagnosed with celiac disease between September 2009 and September 2015. Hospital charts were reviewed. Demographic data, clinical characteristics, and follow-up were recorded. Results: Thirty-five children were diagnosed with celiac disease during the study period. Mean age${\pm}$standard deviation was $6.7{\pm}3.8$ years (range, 2.0-14 years). There were 17 (48.6%) female patients. The average duration between onset of symptoms and diagnosis was $16.3{\pm}18.7$ months. Fifteen (42.9%) patients presented with classic malabsorption symptoms, whereas 7 (20.0%) patients presented with short stature. Positive tissue transglutaminase antibodies (tTg)-immunoglobulin A (IgA) was seen in 34 (97.1%) patients. The one patient with negative tTg-IgA had IgA deficiency. Although tTG-IgA values were not available for objective documentation of compliance, clinical data (resolution of presenting abnormalities and growth improvement) assured acceptable compliance in 22 (62.9%) patients. Conclusion: CD in children may present with diverse picture. Although of the small number, the non-classical presentations are not uncommon in our rural community. Gluten-free diet is the main strategy for treatment and associated with usually correction of laboratory abnormalities and improvement of growth.

• 의학교육논단
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• 제24권2호
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• pp.79-92
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• 2022

With increasing demands for medical care by society, the medical system, and general citizens and rapid changes in doctor's awareness, the competencies required of doctors are also changing. The goal of this study was to develop a doctor's competency framework from the patient's perspective, and to make it the basis for the development of milestones and entrustable professional activities for each period of medical student education and resident training. To this end, a big data analysis using topic modeling was performed on domestic and international research papers (2011-2020), domestic newspaper articles (2016-2020), and domestic social networking service data (2016-2020) related to doctor's competencies. Delphi surveys were conducted twice with 28 medical education experts. In addition, a survey was conducted on doctor's competencies among 1,000 citizens, 407 nurses, 237 medical students, 361 majors, and 200 specialists. Through the above process, six core competencies, 16 sub-competencies, and 47 competencies were derived as subject-oriented doctor's competencies. The core competencies were: (1) competency related to disease and health as an expert; (2) competency related to patients as a communicator; (3) competency related to colleagues as a collaborator; (4) competency related to society as a health care leader (5) competency related to oneself as a professional, and (6) competency related to academics as a scholar who contributes to the development of medicine.

• Journal of Nutrition and Health
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• 제50권5호
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• pp.519-529
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• 2017

임상영양서비스에 대한 의사의 인식과 임상영양사 요구도에 대한 의사의 인식에 대한 인과관계를 명확하게 파악하기 위해 매개효과를 분석하고 부트스트래핑으로 매개효과를 검증한 이 연구의 결과물을 요약하면 다음과 같다. 연구목적을 달성하기 위해 5가지 가설을 다음과 같이 세웠다. 가설 1. '의사가 인식하는 임상영양서비스의 실행에 대한 의사의 인식'은 '임상영양서비스의 중요도에 대한 의사의 인식'에 정(+)의 영향을 줄 것이다. 가설 2. 의사가 인식하는 '임상영양서비스의 질병 치료 효과에 대한 의사의 인식'은 '임상영양서비스 중요도에 대한 의사의 인식'에 정(+)의 영향을 줄 것이다. 가설 3. '임상영양서비스의 중요도에 대한 의사의 인식'은 '임상영양사 요구도에 대한 의사의 인식'에 정(+)의 영향을 줄 것이다. 가설 4. '임상영양서비스 중요도에 대한 의사의 인식'은 '임상영양서비스 실행에 대한 의사의 인식'과 '임상영양사 요구도에 대한 의사의 인식' 사이에서 매개역할을 할 것이다. 가설 5. '임상영양서비스 중요도에 대한 의사의 인식'은 '임상영양서비스의 질병 치료 효과에 대한 의사의 인식'과 '임상영양사 요구도에 대한 의사의 인식' 사이에서 매개역할을 할 것 이다. 가설검증 결과와 매개효과 분석 결과 가설 1~5까지의 가설이 모두 지지되었다. 결론적으로 1) '임상영양서비스의 중요도에 대한 의사의 인식'이 완전 매개로 작용한 경우는 임상영양서비스 실행 횟수에 상관없이 의사가 임상영양서비스의 중요도를 인식해야만 임상영양사 요구도를 인식한다는 것이며, 2) 임상영양서비스의 중요도에 대한 의사의 인식이 불완전 매개로 작용한 경우는 임상영양서비스의 질병 치료 효과에 대한 의사의 인식과 임상영양서비스 요구도에 대한 의사의 인식 사이에서 프로세스 역할을 수행하지만, 임상영양서비스의 질병 치료 효과에 대한 의사의 인식이 임상영양서비스 요구도에 대한 의사의 인식에 더 큰 영향을 준다는 것이다. 따라서 임상영양서비스에 대한 의사들의 긍정적인 인식은 임상영양사 요구도에 대한 의사의 인식을 높이지만, 단순히 임상영양서비스의 양적 횟수 즉 임상영양서비스의 실행에 대한 의사의 인식이 아니라 환자 치료에 있어서 도움이 되는 질적 효과 즉 임상영양서비스의 질병 치료효과에 대한 의사의 인식과 임상영양서비스의 중요도에 대한 의사의 인식이 의사들에게서 임상영양서비스에 대한 긍정적인 인식을 이끌어 낼 수 있다. 이러한 의료진의 긍정적인 인식을 높이기 위해서는 추가적으로 임상영양서비스를 수행하는 임상영양사의 전문성이 요구된다. 이상의 결과를 근거로 임상영양서비스에 대한 의사의 인식이 임상영양사 요구도에 영향을 준다고 여겨진다. 더불어 영양학 분야의 유사연구에서 사회과학 분야 통계기법을 활용하여 명확한 인과관계를 규명하는데 본 연구가 발판이 되어 질 것으로 기대하는 바이다.

• 한국산학기술학회논문지
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• 제16권4호
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• pp.2691-2703
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• 2015

본 연구는 중환자실 간호사들의 DNR에 대한 윤리적 문제의 인식과 태도를 파악하여 DNR 환자간호에 도움이 되는 기초자료로 활용하고자 시도하였다. G광역시 상급종합병원 1개소, 전라 남 북도 700병상이상 종합병원 각각 1개소 중환자실에 근무하는 간호사를 대상으로 2014년 8월 1일 부터 9월 5일까지 설문조사하여 154부를 최종분석 하였다. 첫째, DNR 결정 태도는 치료를 거부하는 환자의견에 반대, 예후가 좋지 않은 환자라도 생명의 연장에 찬성, 환자가 원했을 경우 어떠한 상태라도 DNR 미실시, 보호자의 요구에 의한 치료와 가망 없는 환자의 CPR실시에 반대하였다. 둘째, 환자가족에 의한 인공호흡기 및 다른 치료의 적극적 실시에 반대, 보호자의 중환자실 입실에 대립적인 입장을 보였다. DNR 환자에 대해 의사의 인공호흡기의 소극적 사용에 찬성, 환자의 신체적 심리적 안정을 위해 기본적인 간호도 줄여야 하고, 무균술을 지키지 않은 처치에 묵인하는 입장이며, 가족에 의한 환자의 상태변화를 주치의에게 여러 차례 보고하는 것에 반대하였다. 셋째, 의사의 관심감소를 인정하고, 이에 보호자의 항의가 있을 때 의료팀을 옹호하며, DNR 결정을 주치의가 내린 것에 대립적인 입장이며, DNR 지침에 따른 결정에 반대하였다. 예후가 좋지 않은 환자에게 그대로 설명하는 것에 반대 또는 중립적이며, 환자나 보호자에게 환자상태를 있는 그대로 설명하는 것과 사망에 가까운 경우 환자나 보호자에게 상태를 그대로 설명하는 것에 반대하였다. 결론적으로 DNR 주체는 환자이며, 환자의견이 충분히 반영 되어야 하며, 의료행위의 범위와 결정과정에서의 갈등을 최소화하고 환자중심의 윤리적 의사결정이 되도록 DNR 결정에 대한 표준과 지침이 필요하며, 충분한 설명을 근거로 한 동의가 이루어 져야하겠다.