• Journal of Preventive Medicine and Public Health
• /
• 제29권2호
• /
• pp.311-329
• /
• 1996

This study was designed to compare the level of medical utilization between the urban and rural areas of Korea and to explain the differences between the two regions. Data from the National Health Interview Survey performed by the Korean Institute of Health & Social Affairs in 1992 were used for this study utilizing a sample size of 21,841 people. The level of medical utilization such as the number of physician visits and the number of hospital admissions was compared between the regions with ANOVA. Various determinants for medical use were also compared by univariate analysis. Statistical models which included enabling factors, predisposing factors, need factors and region were constructed for bivariate analysis in order to further elucidate the level of medical utilization. The results were as follows: 1. There was greater medical use, both in terms of physician visits and inpatient care in the rural areas in spite of insufficient health resources. The particular reasons for higher medical utilization in rural areas were attributed to a higher number of initial physician visits as well as a longer the length of stay per hospital admission. Therefore, indicators representing the degree of met need (utilization/need) showed no significant difference between rural and urban areas in spite of the fact that the medical need is larger in rural areas. 2. Use of public health facilities received a significant portion of physician visits in the rural area. The government's effort to enhance primary health care through health centers, health subcenters and the nurse practitioner's post in rural areas has contributed to the increase of access to medical care in the rural areas. 3. There were some differences in the socio-demographic characteristics between two regions ; There were more elderly people over the age of 65: unstable marital status, less education and lower incomes also characterized the rural areas. Therefore, among rural people, there were more predisposing factors for medical use. Additionaly, need factors such as poor self-reported health status and high morbidity level were also high in the rural area. 4. In contrast it was learned that, the supply of health resources was mostly concentrated in the urban areas except for public health facilities. Therefore, geographical access to medical care was lower in the rural area both in terms travel time and travel cost. 5. The coefficient of the region variable was insignificant in the regression model which controlled the supply factor only. However, utilization was significantly higher in urban areas if the model included predisposing factors and need factors in addition to the supply factor. The results were interpreted as rural people have greater medical needs.

• 근관절건강학회지
• /
• 제22권1호
• /
• pp.40-47
• /
• 2015

Purpose: The purpose of this study was to identify factors influencing on performance of preventive actions to be exposed to infection in emergency nurses. Methods: Participants were 200 emergency nurses working in a regional emergency medical center, 4 local emergency medical centers, and 5 local emergency medical facilities in B city. The data were analyzed with descriptive statistics, independent t-test, ANOVA, Scheff$\acute{e}$'s test, Pearson's correlation coefficients, and stepwise multiple regression analysis using SPSS/WIN 21.0 programs. Results: There was no difference in performance of preventive actions to be exposed to infection by socio-demographic and job-related characteristics. The results of stepwise multiple regression analysis showed that levels of perception of preventive actions to be exposed to infection (${\beta}$=.40, p<.001) and protective environment on exposure to infection (${\beta}$=.22, p<.001) were significantly associated with performance of preventive actions, explaining 26.3% of the variance. Conclusion: In conclusion, improving performance of preventive actions to be exposed to infection is important to protect emergency nurses from exposure to infection. Thus, efforts to enhance protective environment on exposure to infection and to improve perceptions of preventive actions to be exposed to infection are necessary to improve the performance of preventive actions in emergency nurses.

• Asian Pacific Journal of Cancer Prevention
• /
• 제17권9호
• /
• pp.4395-4399
• /
• 2016

The FLT3-ITD mutation is one of the most frequent genetic abnormalities in acute myeloid leukemia (AML) where it is associated with a poor prognosis. The FLT3-ITD mutation could, therefore, be a potential molecular prognostic marker important for risk-stratified treatment options. We amplified the FLT3 gene at exon 14 and 15 in 52 AML patients (aged between 2 months and 74 years) from 4 referral centers (a university hospital and 3 regional hospitals in Northeast Thailand), using a simple PCR method. FLT3-ITD mutations were found in 10 patients (19.2%), being more common in adults than in children (21.1% vs. 14.3%) and more prevalent in patients with acute promyelocytic leukemia (AML-M3) than AML-non M3 (4 of 10 AML-M3 vs. 6 of 42 AML-non M3 patients). Duplication sequences varied in size-between 27 and 171 nucleotides (median=63.5) and in their location. FLT3-ITD mutations with common duplication sequences accounted for a significant percentage in AML patients in northeastern Thailand. This simple PCR method is feasible for routine laboratory practice and these data could help tailor use of the national protocol for AML.

• 보건교육건강증진학회지
• /
• 제22권1호
• /
• pp.147-160
• /
• 2005

The purpose of this study is to identify the nature of the patient service quality of health center, and based on that, to examine the relationship of health center visitor's perceived quality and overall satisfaction. Data were collected on the basis of 'the 3rd Regional Health Care Planning' operated by Rural Health Care Service Technology Aid Task-force Team(RHCSTAT), Ministry of Health and Welfare. Basically, the Manual of 3rd Regional Health Care Planning is composed of structure, process, and outcome measurement indicators. Of these indicators, 21 patient satisfaction questions as outcome indicators are used in this study. The samples are 3,530 patients who visited 80 health centers all of the nation. First, the reliability and validity of patient service quality items was evaluated. Second, the descriptive statistics of health service quality are calculated. Third, through the T-test and ANOVA, the differences of patient satisfaction by responder's general characteristics are compared. In final, to explore the relationship of service quality and overall satisfaction, multiple regression analysis was used. This study shows firstly, the dimension of patient service quality was categorized into 3 dimensions, that is, facilities and environment, staff kindness, and access convenience. Secondly, the reliability and validity of patient service quality items was satisfied. Thirdly, the mean score of staff kindness factors are high in contrast to the facilities and environment. And in regard to the overall satisfaction, the mean score is more higher in Daegu region, County type health center, male group, and upper 65 age group than comparison groups. Lastly, as a result of multiple regression analysis, the effect of patient's perceived service quality, especially, appropriateness of billing time(Beta=0.190) and of reservation time(Beta=0.132) are statistically significant(P<0.01). In conclusion, to satisfy the health need of community people and improve the service quality of the health center, the efforts for the access convenience might be needed. Additionally, the enlargement on health center space and supply of new medical equipment is urgent for the patient satisfaction.

• 사물인터넷융복합논문지
• /
• 제8권6호
• /
• pp.99-113
• /
• 2022

본 연구는 응급실 간호사를 대상으로 COVID-19 대유행 상황에서 COVID-19 스트레스, 대인관계(보호자-환자) 스트레스, 감정노동이 소진에 미치는 영향을 파악하기 위한 서술적 조사 연구이다. 자료수집은 H 의료원 산하기관 5개 상급종합병원과 종합병원 응급실 간호사를 대상으로 2021년 12월 9일부터 12월 23일까지 시행되었다. 대상자의 일반적 특성과 직무 관련 특성, COVID-19 스트레스, 대인관계(보호자-환자) 스트레스, 감정노동, 소진을 측정하기 위해 자기기입식 설문지로 진행하였다. 수집된 자료는 SPSS/WIN 25.0 통계 프로그램을 이용하여 빈도 분석, 기술통계분석, Independent sample t-test, One-way ANOVA, Scheffé test, Correlation analysis, 다중회귀분석을 실시하였다. 응급실 간호사의 COVID-19 스트레스의 평균은 3.64점, 대인관계(보호자-환자) 스트레스 4.35점, 감정노동 3.38점, 소진 3.44점이었다. 일반적 특성 및 직무 관련 특성에 따른 간호사의 소진은 성별, 결혼상태, 총 임상 경력, 근무 기관 형태에 따라 유의한 차이를 보였다. 소진은 COVID-19 스트레스, 대인관계 스트레스, 감정노동과 모두 유의한 정적 상관관계를 보였다. COVID-19 팬데믹 상황에서 응급실 간호사의 소진에 영향을 미치는 융합적 요인으로는 근무 기관 형태 중 권역 응급의료센터, 지역응급의료센터, 대인관계 스트레스, COVID-19 스트레스, 성별로 나타났고 설명력은 28.6%로 나타났다. 이와 같은 결과를 통해 신종감염병 대유행 시점에서 응급실 간호사의 소진을 예방하고 간호업무성과를 높이기 위한 중재프로그램 개발을 위한 기초자료를 제공하고자 한다.

• 기본간호학회지
• /
• 제21권4호
• /
• pp.380-391
• /
• 2014

Purpose: This was a descriptive research study to examine the patient safety risk factors and the level of safety management of nurses in emergency service, hospitals and to analyze the relationship between the two factors. Method: Data for analysis were collected from 232 nurses in emergency service, hospitals in Busan and Gyeongnam from July 30 to September 7, 2013. Data were analyzed using descriptive statistics, t-test, one-way ANOVA, and Pearson correlation coefficients. Results: Therapeutic agents showed the highest risk level. The prevention of transfusion errors showed the highest performance. As the nurses were working in regional emergency medical centers and received education more than 7 sessions on patient safety, they readily recognized the riskiness of the safety risk factors. In addition, as the nurses were older than 40, married, having more education about safety and understood the incident report registration system well, they performed safety management better. There were significant correlations between perception of the patient safety risk factors and performance for safety management. Conclusion: Nurses in emergency service, hospitals should try to improve safety management to reduce the risk factors shown to be higher based on the results and ensure the patient safety.

• 보건행정학회지
• /
• 제28권4호
• /
• pp.411-422
• /
• 2018

Background: Whether there is a difference in outcomes for trauma patients transferring to the helicopter emergency medical service (HEMS) according to their previous team composition is controversial. The purpose of this study is to evaluate the effectiveness of trauma team-staffed-HEMS (TTS-HEMS) when transferring to a trauma center. Methods: A retrospective comparison was conducted on patients transported to a trauma center over a 6-year period by the TTS-HEMS and paramedic-staffed-HEMS (119-HEMS). Inclusion criteria were blunt trauma with age ${\geq}15years$. Patient outcomes were compared with the Trauma and Injury Severity Score (TRISS) (30-day mortality) and the Cox proportional hazard ratio of mortality (in hospital). Results: There were 321 patients of TTS-HEMS and 92 patients of 119-HEMS. The TTS-HEMS group had a higher Injury Severity Score and longer transport time but a significantly shorter time to emergency surgery. The prehospital data showed that the trauma team performed more aggressive interventions during transport. An additional 7.6 lives were saved per 100 TTS-HEMS deployments. However, the TRISS results in the 119-HEMS group were not significant. In addition, after adjusting for confounders, the hazard ratio of mortality in the 119-HEMS group was 2.83 times higher than that in the TTS-HEMS group. Conclusion: HEMS was likely to improve the survival rate of injured patients when physicians were involved in TTS-HEMS. Survival benefits in the TTS-HEMS group appeared to be related to the fact that the trauma team performed both more aggressive prehospital resuscitation and clinical decision making during transportation.

• Journal of Trauma and Injury
• /
• 제33권1호
• /
• pp.13-17
• /
• 2020

Purpose: Accurate and appropriate prehospital field triage is essential for a trauma system. The Korean trauma system (established in 2014) uses the trauma field triage algorithm of the United States Centers for Disease Control and Prevention (CDC). This study evaluated the suitability of the CDC field triage criteria for major trauma cases (injury severity score >15) in Korea. Methods: This retrospective cohort study evaluated trauma patients who presented at the authors' regional trauma center from January 1 to May 7, 2017. The undertriage and overtriage rates of each CDC field triage step were calculated. Receiver operating characteristic curves were constructed, and the area under the curve (AUC) was evaluated for each step. Results: Among the 1,009 enrolled patients, 168 (16.7%) had major trauma. The undertriage/overtriage rates of each step (steps I, II, III, and IV) of CDC field triage were 9.2%/47.4%, 6.3%/50.8%, 4.5%/59.4%, and 5.3%/78.9%, respectively. The AUC values of each CDC triage step were 0.722, 0.783, 0.791, and 0.615, respectively. The AUC values of the separate components of each step (physiologic criteria, anatomic criteria, mechanism-of-injury criteria, and special considerations) were 0.722, 0.648, 0.647, and 0.456, respectively. Conclusions: The CDC field triage system is acceptable, but not ideal, for Korean trauma care. If we follow the protocol, it would be preferable to omit step IV. The Korean Triage and Acuity Scale may be a good indicator for in-hospital triage. However, a new triage protocol that is simple to estimate on-scene while having good performance should be developed.

• 보건교육건강증진학회지
• /
• 제33권3호
• /
• pp.61-70
• /
• 2016

Objectives: The aim of this study was to investigate the effectiveness of a hospital-based smoking cessation intervention for increasing continuous abstinence rate from smoking in patients with cerebral infarction. Methods: One-hundred and two smokers with cerebral infarction who decided to quit smoking were enrolled in the smoking cessation intervention from December 2012 to February 2015. The smokers underwent six consecutive times of individual intervention with nurse specialist on smoking cessation including education on behavioral modification, counseling for withdrawal symptoms, and anti-smoking advice over a 12-month period. Results: Among the total participants, the continuous abstinence rate from smoking changed from 79.4% at 1 month to 60.8% at 12 months after discharge. The continuous abstinence rate from smoking after 12 months was 88.5% in participants who completed the entire program (6 times), while 51.3% in participants who did not complete the entire program (${\leq}5$ times) (P=0.001). After adjustment for general and smoking-related characteristics, complete implementation of hospital-based smoking cessation intervention was significantly associated with continuous abstinence from smoking after 12 months (odds ratio: 5.93; 95% confidence interval: 1.45-24.22). Conclusions: The hospital-based smoking cessation intervention might be effective for smoking cessation in patients with cerebral infarction, especially when the intervention was implemented thoroughly.

• 대한간호학회지
• /
• 제49권1호
• /
• pp.26-35
• /
• 2019

Purpose: The aim of this study was to identify the predictive validity of the Korean Triage and Acuity Scale (KTAS). Methods: This methodological study used data from National Emergency Department Information System for 2016. The KTAS disposition and emergency treatment results for emergency patients aged 15 years and older were analyzed to evaluate its predictive validity through its sensitivity, specificity, positive predictive value, and negative predictive value. Results: In case of death in the emergency department, or where the intensive care unit admission was considered an emergency, the sensitivity, specificity, positive predictive value, and negative predictive value of the KTAS were 0.916, 0.581, 0.097, and 0.993, respectively. In case of death in the emergency department, or where the intensive or non-intensive care unit admission was considered an emergency, the sensitivity, specificity, and positive predictive value, and negative predictive value were 0.700, 0.642, 0.391, and 0.867, respectively. Conclusion: The results of this study showed that the KTAS had high sensitivity but low specificity. It is necessary to constantly review and revise the KTAS level classification because it still results in a few errors of under and over-triage. Nevertheless, this study is meaningful in that it was an evaluation of the KTAS for the total cases of adult patients who sought help at regional and local emergency medical centers in 2016.