• 대한두개안면성형외과학회지
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• 제21권5호
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• pp.294-300
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• 2020

Background: Mandibular fractures are one of the most common types of facial fractures, the treatment of which can be delayed due to the severity of the trauma resulting in an increase of complications; thus, early evaluation of trauma severity at the time of visit is important. In South Korea, trauma patients are triaged and intensively treated in designated regional trauma centers. This study aimed to analyze the relationship between trauma severity and mandibular fracture patterns. Methods: A medical records review was performed on patients who visited the regional trauma center at our hospital for mandibular fracture between 2009 and 2018. Epidemiologic data and mandibular fracture patterns were analyzed and compared with the conventional facial injury severity scale (FISS). Results: Among 73 patients, 51 were classified as non-severe trauma patients and 22 as severe trauma patients. A higher trauma severity was associated with older age (odds ratio [OR], 1.164; 95% confidence interval [CI], 1.057-1.404) and lower risk was associated with fractures located in the angle (OR, 0.001; 95% CI, 0-0.022), condylar process (OR, 0.001; 95% CI, 0-0.28), and coronoid process (OR, 0.004; 95% CI, 0-0.985). The risk was lower when the injury mechanism was a pedestrian traffic accident (OR, 0.004; 95% CI, 0-0.417) or fall (OR, 0.004; 95% CI, 0-0.663) compared with an in-car traffic accident. Higher FISS (OR, 1.503; 95% CI, 1.155-2.049) was associated with a higher trauma severity. The proposed model was found to predict the trauma severity better than the model using FISS (p< 0.001). Conclusion: Age, location of mandibular fractures, and injury mechanism showed significant relationships with the trauma severity. Epidemiologic data and patterns of mandibular fractures could predict the trauma severity better than FISS.

• 간호행정학회지
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• 제16권3호
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• pp.348-359
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• 2010

Purpose: This study aimed to evaluate the performance of Clinical Research Nurses (CRNs) and the importance of their roles at the Regional Clinical Trial Centers (RCTCs). Method: A questionnaire focused on the role of CRNs was crafted by a researcher and the content validity was verified by a panel of experts on clinical research. The subjects of this study were 91 CRNs and Clinical Research Coordinators (CRCs), who were Korean registered nurses working at nine RCTCs. 77 subjects yielded valid data were analyzed using descriptive analysis, the Mann-Whitney U test, Spearman's rank order correlation coefficient, and Kruskal-Wallis test. Results: The performance of CRNs and the recognition in the importance of their roles were statistically significant different in age, education, CRN careers, positions, employment status and the phase of clinical trial. The role of direct caregiver was performed most often by CRNs. The role of coordinator of care and research (pre-study) was considered the most important role but performed the least frequent. Conclusions: The role of CRNs can easily be differentiated from CRCs who are not registered nurses. The domains of CRNs should be clearly identified and established. Moreover, research should be carried out on CRN training programs to cultivate competence in CRNs.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제21권2호
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• pp.55-65
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• 2015

Purpose: Korea is increasing in the demand for medical services due to rapid economic growth and population aging in modern society. Thus, the importance has been emphasized for the health promotion in the community and the publicity and substantiality of public health centers. However, the environment is insufficient, compared to required functions and developed services as a urban public health center. The purpose of this study is to analysis the plane type and area composition of public health centers in Busan and to identify the property of their spatial configuration Methods: Eight public health centers in Busan, were classified, which had been selected as a medical tourism city. Subsequently, space requirements were analyzed, facilities were typed, vertical, horizontal spaces were reviewed, and area ratios by business function were calculated. Results: A review of the property of spatial configuration and an analysis of the area ratio revealed the three findings. 1)The horizontal analysis found various types: a single type, a multi-type, a radial type, and a circular type, 2)The vertical analysis showed that since a care function (general practice), and a task function (maternal and child health) were concentrated in lower level spaces, the lobby and core were closed located for providing quick medical services. 3)The analysis of the area ratio in public health centers in terms of their function indicated that each public health center' programs had the greatest influence on the area. Implications: This study attempted to present spatial structural problems and improvements for city public health center by identifying their state and classify their functions and types and by calculating the ratio of their area configuration according to the spatial composition. It was thus aimed to presenting implications in establish public functions and roles by activating business through in connection with the number of municipalities in many ways, such as regional health. medical welfare, etc. to improve the health of local residents, and by providing differentiated programs in accordance with local characteristics.

• Journal of Trauma and Injury
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• 제37권3호
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• pp.224-227
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• 2024

In Korea, helicopter emergency medical services (HEMS) with a physician on board were introduced in September 2011, funded by both central and regional governments. HEMS was integrated into the Korean emergency medical system to address the need for EMS in remote rural areas. The present report describes 16-month-old twins who fell from the fifth floor of an apartment building, located approximately 100 km from the nearest level I trauma center. Utilizing HEMS along with initial emergency management by an emergency physician, the patients were transported to the level I trauma center within the critical "golden hour." The children had sustained multiorgan injuries. Without intervention at the scene by an emergency physician, a fatal outcome was anticipated for both children. With the use of HEMS, one patient died, but the other survived with a good prognosis. The use of HEMS flights with an emergency physician on board may improve outcomes for pediatric patients with severe trauma in medically underserved rural areas.

• Journal of Preventive Medicine and Public Health
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• 제25권4호
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• pp.399-412
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• 1992

This study was designed to investigate factors relating to fiscal deficit for regional health insurance. The financial statements for the fiscal year 1990 of nationwide 254 regional medical insurance societies were analyzed. Important findings are summarized below: 1. There were differences in the main reason fur the financial deficit among regions when deficit and surplus societies were compared by regions. The total revenue per enrollee, especially revenue from the premium contribution of a deficit society was significantly smaller than that of a surplus society in large cities and counties. On the other hand, the total expenditure per enrollee of a deficit society was larger than that of a surplus society in small cities. 2. Both low premium rate at the beginning of health insurance program and less effort to increase the premium rate were main factors for the smaller revenue from the contribution of a deficit society in large cities and counties. 3. Larger expenditures per covered person of a deficit society in small cities were explained with larger medical expenditures especially for out-patients services rather than larger administrative expenses. 4. A regression analysis showed that utilization rates in out-patient services were significantly associated with income and numbers of total medical care institution per capita within a region where a health insurance society located. Also expenses paid by insurer per visit were associated with the proportion of utilization for tertiary care hospitals as well as the proportion of utilization of public health centers.

• 한국지역지리학회지
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• 제17권5호
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• pp.617-637
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• 2011

본 연구는 충청북도의 사례를 통해서 온라인 협진의 지리적 특성과 환자의 온라인 협진에 대한 결정 요인에 대해서 알아보는 것을 목적으로 하고 있다. 2009년 7월부터 9월까지 심층 인터뷰에 기반한 정성적 기법을 이용하였고, 충청북도에 거주하는 환자 20명을 대상으로 하였다. 이 연구에 의하면 대부분의 환자는 1차적으로 의료 문제가 해결되지 않을 경우, 온라인 협진의 본래 취지와 달리 충청북도 내에서 그것을 해결하는 것이 아니라, 경기 의료권에 위치한 의료 기관으로 방문하는 경향을 보였다. 이와 더불어, 환자의 의무 기록 또한 온라인 시스템을 통해 이들 병원에 전달되어, 온라인 협진의 공간상 네트워크는 경기 의료권으로 집중하게 된다. 이러한 주요 원인은 의료 서비스에 대한 질 혹은 수준에 대한 고려, 개인적인 이해 관계와 신뢰성, 좋은 접근성 등에 기인하는 것으로 밝혀졌다. 이에 반해, 온라인 협진 시스템의 편리성, 유효성 등과 같은 온라인 협진의 기술적 가치나 온라인 협진의 본래적인 목적인 지역의료 향상과 같은 요인은 크게 영향을 미치지 않는 것으로 밝혀졌다. 따라서 우리나라 원격진료의 결정 요인은 환자 개인에 의해서 결정이 되는 바가 크고, 아직 개개인의 인식이 지역 의료 시스템과 크게 밀착되지 않는 형태를 보이기 때문에 경기 의료권으로 원격진료의 선택이 집중된 공간 특성을 보이고 있다고 할 수 있다. 특히, 이는 기존의 의료 제도 및 환자의 행태가 온라인 상에서의 의료 활동에도 그대로 투영되기 때문인데, 가장 이상적인 원격진료의 지리적 담론인 지역화를 실현하기 위해서는 근본적인 지역의 의료 서비스 구조의 개선이 필요할 것으로 보인다.

• 한국농촌건축학회논문집
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• 제19권4호
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• pp.9-16
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• 2017

There are an increasing number of healthcare facilaties, especially branch offices, in rural areas to serve the aging population living there. However, there has been a gradual decline in the ratios of recognition, satisfaction and utilization by people who live in the regions. A significant reason of declining the ratios should be the population decline, but the most of population hierarchy shows the groups of elderly people over 60. This result appears to be limited to visit the public health centers. According to the result of population hierarchy, a branch office of public health center has been re-established as a complex welfare facility which can be fulfilled in the functions of basic medical supports and cultural supports. This research is focused on collecting the meaningful information of the status of physical facilities and utilization with 15branch offices of public health care centers in the rural regions near the city of Ik-San city. In addition, this research has a purpose of getting fundamental data for future architectural plans of the branch offices in rural regions with the results about the status of facility operation systems and users' needs.

• 한국응급구조학회지
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• 제19권2호
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• pp.51-69
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• 2015

Purpose: This study aimed to identify the effects of job insecurity and job engagement on turnover intention of paramedics who work in emergency medical institutions. Methods: From October 14 to 28, 2014, data were collected by structured questionnaires from 171 paramedics who were working in emergency medical institutions. The data were analyzed by using SPSS/WIN 21.0. Results: Of the 171 subjects, 57.3% were temporary employees, of whom 87.5% were working in regional emergency medical centers. The mean scores were 3.19 for job insecurity, 4.58 for job engagement, and 3.28 for turnover intention. The correlation between the variables showed that the higher the job insecurity of the participants, the higher their turnover intention (r = .397, p <.001). Moreover, the higher their job engagement, the lower their turnover intention (r = -.354, p <.001). The variable that most significantly affected turnover intention was job insecurity. The coefficient of determination ($R^2$) of job insecurity and job engagement was 24.3%. Conclusion: A law should be enacted to involve paramedics as required personnel for emergency medical institutions in order to enhance the quality of emergency medical services and provide prompt and professional emergency medical services to emergency patients.

• 보건교육건강증진학회지
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• 제26권4호
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• pp.117-127
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• 2009

Objectives: The primary objective of the study is to analyze the utilization patterns of provincial patients discharged from hospitals located in Seoul area. Methods: For the analysis, the study employed the nationwide data on 'Survey of Injured Patients Discharged from Hospitals' conducted by KCDC (Korea Centers for Disease Control and Prevention). The statistical methodology used in the measurement model is a logistic regression model. Results: The study has three major findings. First, compared to other disease groups, the discharged on both 'neoplasm(cancer)' and 'congenital malformation, deformity and chromosomal abnormalities' disease groups are more likely to utilize hospitals in Seoul area. Second, as for 'neoplasm(cancer)' disease group, patients with 'bones and articular cartilage' areas are more likely to utilize hospitals in Seoul area. Finally, Hospitals with more than 1,000 beds was primary factor in selecting Seoul-based hospitals by the discharged in provincial areas. Conclusion: In sum, the study showed that patients in provincial areas are more likely to utilize hospitals located in Seoul area regardless of the severity of their cases. Local authority, therefore, is required to monitor local hospitals on regular basis, as well as support them to establish specialized medical centers by providing human and physical resources.

• Journal of Trauma and Injury
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• 제34권2호
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• pp.87-97
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• 2021

Purpose: This study examined emergency medical service (EMS) transportation patterns for adult trauma patients before and after establishing a level 1 regional trauma center (RTC) and to evaluate the transportation approach after prehospital severity screening. Methods: This was a retrospective observational study of trauma patients aged ≥18 years admitted via EMS to the emergency department or a level 1 RTC, 1 year before to 3 years after RTC establishment. Patients with an Injury Severity Score (ISS) in the patient registration system were selected. Analyses were performed to determine transportation pattern changes by comparing patients pre- and post-RTC establishment and by yearly comparisons over the 4-year study period using the Mann-Whitney U test and chi-square test. Results: Overall, 3,587 patients were included. The mean ISS was higher in the post-RTC group (n=2,693; 10.63±8.90, median 9.00) than in the pre-RTC group (n=894; 9.44±8.20, median 8.00; p<0.001). The mean transportation distance (9.84±13.71, median 5.80 vs. 13.12±16.15 km, median 6.00; p<0.001) was longer in the post-RTC group than in the pre-RTC group. Furthermore, proportionally fewer patients were transported from an area in the same city as the RTC after establishment (86.1% vs. 78.3%; p<0.001). Yearly comparisons revealed a gradually increasing trend in the hospital death rate (ptrend=0.031). Conclusions: After establishing a level 1 RTC, the EMS transportation of severe trauma patients increased gradually along with the long-distance transportation of minor trauma patients. Therefore, improved prehospital EMS trauma severity assessments and level 1 RTC involvement in patient classification in the prehospital phase are necessary.