• Journal of Periodontal and Implant Science
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• 제46권3호
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• pp.166-175
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• 2016

Purpose: Decision-making by dental and medical experts can be influenced by their biases, interests, and experiences, and academic arguments about controversial issues may additionally be considered indirect experiences capable of affecting decision-making. This study reports on the use of interactive communication devices to evaluate preferences and flexibility in decision-making among dental care providers who attended two distinct academic conferences. Methods: Two debates were presented by a team of two lecturers at two academic conferences (focusing on periodontology and implant dentistry, respectively) and the audience members of each session were surveyed. Before each lecture, two case modules about the diagnosis and treatment of multirooted molar lesions were provided, and interactive communication devices were used to collect responses about decision-making preferences in treatment planning immediately before and after a debate about treatment strategies. Results: In total, 81 and 84 completed answers from both conferences were obtained for the first and second case modules, respectively. The preferred treatment plan differed significantly according to the focus of the conference, and a tendency emerged for the clinicians participating in each conference to express uniform preferences. However, attending the debates resulted in significant changes in decision-making preferences regardless of the conference focus or the characteristics of the participants. Conclusions: Our findings suggest that providing continuing education via debates on controversial issues may be effective in widening conceptual knowledge and reducing biases among experts in the dental and medical fields.

• 상하수도학회지
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• 제29권1호
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• pp.1-9
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• 2015

A combined treatment system using multiple source water is becoming important as an alternative to conventional water supply for small-scale water systems. In this research, combined water treatment systems were investigated for simultaneous use of multi-source water including rainwater, ground water, river water, and reclaimed wastewater. A laboratory-scale system was developed to systematically compare various combinations of water treatment processes, including sand filtration, microfiltration (MF), granular activated carbon (GAC), and nanofiltration (NF). Results showed that the efficiency of combined water treatment systems was affected by the quality of feed waters. In addition, a simply approach based on the concept of linear combination was suggested to support a decision-making for the optimum water treatment systems with the consideration of final water quality.

• 의료법학
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• 제24권4호
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• pp.103-128
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• 2023

현행 연명의료결정법에 따르면 연명의료를 시행하지 않거나 중단하는 결정은 임종과정에 있는 환자의 의사가 우선적으로 적용된다. 이러한 환자를 대상으로 하는 연명의료의 의사결정은 환자가 의식이 있는 경우에는 환자 본인이 연명의료에 대한 의사를 직접 서면이나 구두로 표시하거나 사전연명의료의향서와 연명의료계획서를 작성하는 것으로 자기결정을 행사할 수 있다. 반면에, 환자가 사전연명의료의향서나 연명의료계획서를 작성하지 않은 경우에는 환자 가족의 진술로 환자의 의사를 확인하거나 환자가족 전원의 동의로 연명의료중단등결정을 할 수 있다. 그러나 가족이 없거나 가족을 알 수 없는 무연고 환자인 경우에는 입원하기 전에 사전연명의료의향서와 연명의료계획서를 작성하지 않은 상태에서 의사표현을 할 수 없는 의학적 상태로 되면 환자의 의사를 알 수가 없어 환자에 대한 연명의료를 지속해야 할지 중단해야 할지에 대한 결정을 해야 하는 상황이 발생한다. 본 연구는 무연고환자의 경우에 연명의료결정을 위한 정책적 방안을 제시하고자 현행법상 무연고 환자에 대한 논의와 방안 검토했다. 첫째로, 성년후견인제도의 적용을 살펴보았지만, 성년후견인은 신체를 침해하는 의료행위에 대한 동의를 대신할 수 있지만 의료행위의 직접적인 결과로 사망할 수 있는 경우에는 가정법원의 허가를 필요로 하기 때문에 임종과정에 있는 급박한 환자에게는 적절한 방안이라고 할 수 없다. 둘째로, 연명의료결정법 제14조에 따라 의료기관윤리위원회에서 무연고 환자에 대한 연명의료중단등결정에 관한 심의에 대해 살펴보았다. 현행법상에서는 의료기관윤리위원회에서 무연고 환자에 대한 연명의료중단등결정을 할 수 없기 때문에, 개정을 통하여 무연고 환자에 대한 연명의료중단등결정에 대한 사항을 동법 제14조에 반영하거나 무연고 환자에 대한 규정을 따로 신설하여 개정하는 것이 필요하다. 또한 의료기관윤리위원회에서 무연고 환자에 대한 결정해야 하지만, 그런 결정을 하는 것에 대해서 해당 의료기관에서 할 수 없다면, 공용윤리위원회에서 무연고환자의 연명의료중단등결정을 할 수 있도록 법률을 개정할 필요가 있다.

• Clinics in Shoulder and Elbow
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• 제25권1호
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• pp.49-56
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• 2022

Background: The treatment approach for proximal humeral fractures is determined by various factors, including patient age, sex, dominant arm, fracture pattern, presence of osteoporosis, preexisting arthritis, rotator cuff status, and medical comorbidities. However, there is a lack of consensus in the literature regarding the optimal treatment for displaced proximal humeral fractures. This study aimed to assess and quantify the decision-making process for either conservative or surgical treatment and the choice of surgical method among shoulder surgeons when treating proximal humeral fractures. Methods: Forty sets of true anteroposterior view, scapular Y projection view, and three-dimensional computed tomography of proximal humeral fractures were provided to 12 shoulder surgeons along with clinical information. Surveys regarding Neer classification, decisions between conservative and surgical treatments, and chosen methods were conducted twice with an interval of 2 months. The factors affecting the treatment plans were also assessed. Results: The inter-rater agreement was fair for Neer classification (kappa=0.395), moderate for the decision between conservative and surgical treatments (kappa=0.528), and substantial for the chosen method of surgical treatment (kappa=0.740). The percentage of agreement was 71.1% for Neer classification, 84.6% for the decision between conservative and surgical treatment, and 96.4% for the chosen method of surgical treatment. The fracture pattern was the most crucial factor in deciding between conservative and surgical treatments, followed by age and physical activity. Conclusions: The decision between conservative and surgical treatment for proximal humeral fractures showed good agreement, while the chosen method between osteosynthesis and arthroplasty showed substantial agreement among shoulder surgeons.

• 보건행정학회지
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• 제33권1호
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• pp.19-28
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• 2023

Background: With the enactment of the Hospice, Palliative, Care, and Life-sustaining Treatment Decision-Making Act in February 2018, legal guidelines for physician orders for life-sustaining treatment (POLST) were presented. This study was conducted to analyze the association of writing POLST on the use of health care before death. Methods: The study analyzed the electronic medical records and POLSTs of 1,003 adult patients who died at a tertiary hospital located in Seoul from February 4, 2018 to February 4, 2019. Results: Of the deaths, 80% (n=804) completed POLST. Among patients who completed POLST before death, 51% (n=412) were written 1-7 days before death, and only 31% (n=246) were completed by patients themselves. 99% (n=799) decided to withdraw or withhold cardiopulmonary resuscitation. As a result of analyzing the effect of POLST on medical use before death, it was found that POLST and inpatient cost had a significant negative correlation, and POLST completion significantly reduced death in the intensive care unit (ICU). However, both inpatient costs and death at ICU increased when the POLST was completed by surrogate decision-makers rather than patients themselves. Conclusion: The enactment of the Hospice, Palliative, Care, and Life-sustaining Treatment Decision-Making Act provided a legal basis for withdrawing and withholding meaningless life-sustaining treatment. By specifying the treatment to be received at the end of one's life through the POLST, inpatient treatment costs and death at the ICU were decreased. However, the frequent decision-making by the surrogates and completion of POLST close to death may hinder the original purpose of the law.

• 조명전기설비학회논문지
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• 제15권6호
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• pp.89-96
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• 2001

본 논문에서는 생물학적 반응을 이용한 하수처리에서 미생물의 유기물 분해 반응에 필요한 적정 폭기량을 판단하는 기법을 제안한다. 적정 폭기량의 판단 시스템은 크게 세가지 부분으로 구성된다. 첫 번째는 주어진 운전데이터로부터 적정 폭기량을 판단하는 기능이며, 두 번째는 투입 폭기량을 판단된 적정 폭기량으로 변경했을 때의 처리 성능을 하수 처리 과정의 모델을 이용하여 계산하는 부분이고, 세 번째는 판단 결과를 보여주는 부분이다. 40일 동안의 하수처리장 운전데이터를 이용하여 제안된 판단 시스템의 성능을 확인하여 본 결과, 하수처리의 목적을 달성하면서도 폭기량을 10%이상 절감할 수 있음을 보였다

• 대한간호학회지
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• 제49권3호
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• pp.329-339
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• 2019

Purpose: The purpose of this study was to investigate the frequency, patterns, and factors of reversals in decisions about life-sustaining treatment (LST) among older patients with terminal-stage chronic cardiopulmonary disease. Methods: This was a retrospective correlational descriptive study based on medical chart review. De-identified patient electronic medical record data were collected from 124 deceased older patients with terminal-stage cardiopulmonary disease who had made reversals of LST decisions in an academic tertiary hospital in 2015. Data were extracted about the reversed LST decisions, LST treatments applied before death, and patients' demographic and clinical factors. Multivariate logistic regression analysis was used to identify the factors associated with the reversal to higher intensity of LST treatment. Results: The use of inotropic agents was the most frequently reversed LST treatment, followed by cardiopulmonary resuscitation, intubation, ventilator therapy, and hemodialysis. Inconsistency between the last LST decisions and actual treatments occurred most often in hemodialysis. One-third of the reversals in LST decisions were made toward higher intensity of LST treatment. Patients who had lung diseases (vs. heart diseases); were single, divorced, or bereaved (vs. married); and had an acquaintance as a primary decision maker (vs. the patients themselves) were significantly more likely to reverse the LST decisions to higher intensity of LST treatment. Conclusion: This study demonstrated the complex and turmoil situation of the LST decision-making process among older patients with terminal-stage cardiopulmonary disease and suggests the importance of support for patients and families in their LST decision-making process.

• 한국산학기술학회논문지
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• 제19권12호
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• pp.636-644
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• 2018

본 연구는 응급처치 교육프로그램이 간호대학생의 셀프리더십, 진로결정자기효능감 및 수행능력에 미치는 효과를 파악하고자 시도하였다. 연구방법은 비동등성 대조군 전후설계의 유사실험연구이며, 자료수집 기간은 2017년 6월 1일부터 8월 31일까지였다. 연구대상자는 D시 D대학 간호학과 학생 중 연구참여를 희망하고 동의한 실험군 27명과 대조군 25명으로 총 52명이었다. 대조군은 2017년 6월 1일 사전 설문조사 후 어떠한 처치도 없이 2주 후 사후 설문조사를 시행하였다. 실험군은 7월 25일 실험처치인 응급처치 교육 프로그램 시행 전에 사전 설문조사를 시행하였으며, 중재 후 8월 31일까지 사후 설문조사를 시행하였다. 실험군에게 제공된 응급처치 교육프로그램은 성인심폐소생술과 기도폐쇄, 화상, 출혈 및 골절에 대한 응급처치 교육내용 2시간 수강, 자율적인 동영상 시청, 강사로서 4시간 동안 초등학생 응급처치 교육수행 등으로 진행되었다. 자료분석방법은 SPSS/WIN 20.0 프로그램을 이용하여 기술통계, independent t-test, $x^2$ test 및 paired t-test로 분석하였다. 응급처치 교육프로그램 적용 전후 두 집단 간 차이를 분석한 결과 셀프리더십(t=2.08, p<.05), 진로결정자기효능감((t=4.22, p<.05), 및 수행능력(t=5.02, p<.05)은 통계적으로 유의한 차이가 나타났다. 즉, 본 연구에서 적용한 응급처치 교육프로그램은 간호대학생의 셀프리더십, 진로결정자기효능감 및 수행능력을 증가시키는데 효과적임을 알 수 있다.

• 보건행정학회지
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• 제16권3호
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• pp.70-85
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• 2006

The purposes of this study were (1) to describe patients' behaviors to protect themselves from medical errors and their involvement in decision making on the diagnostic and treatment procedures (2) to examine whether patients' characteristics, such as age, sex, education, experience of hospitalization and/or surgery influence their self protect behaviors and involvement in decision making on the diagnostic and treatment procedures. A survey was conducted with 99 patients visited one university hospital in Seoul, Korea. A 20-item questionnaire, a 4-point Likert scale, was used to measure the degree of patients' active involvement in decision making; patients' self protect behaviors regarding medication, hospitalization, and surgery; and communication (Cronbach's alpha=0.801). SPSS 12.0 was used for the descriptive and correlation analysis. Only 6.1% of the participants were involved in the decision making process for the diagnostic tests and treatment. More patients did self-protect behaviors associated with the medication than other areas but widely varied from 18.2 to 94.3 % among various items. More people with age of 60 or older compared to people in younger age groups reported more protect behaviors particularly associated with medication. Patient education is needed to improve their active role in preventing medical errors and to promote patients' safety.

• 디지털융복합연구
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• 제16권10호
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• pp.485-496
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• 2018

본 연구는 대학 신입생이 느끼는 심리적 진로장벽 해소를 위한 집단프로그램을 구성하여 적용하고, 심리적 진로장벽, 진로결정 자기효능감과 자기결정성에 미치는 효과를 검증하고자 하였다. 이를 위해 처치집단에 8명, 비교집단에 9명을 할당하여 처치집단에는 7회기에 해당하는 심리적 진로장벽 해소 집단프로그램을 실시하고 비교집단에는 아무런 처치를 하지 않았다. 프로그램의 효과를 알아보기 위해 처치집단과 비교집단 각각 사전검사와 사후검사로 심리적 진로장벽, 진로결정 자기효능감, 자기결정성검사를 실시한 후 사전 사후 차이 검증을 실시하였다. 그 결과, 첫째, 심리적 진로장벽점수는 비교집단에 비해 처치집단의 점수가 유의하게 낮아진 것으로 나타났다. 둘째, 진로결정 자기효능감점수는 비교집단에 비해 처치집단의 점수가 유의하게 향상된 것으로 나타났다. 셋째, 자기결정성점수는 비교집단에 비해 처치집단의 점수가 유의하게 향상된 것으로 나타났다. 즉, 본 집단프로그램은 대학 신입생의 심리적 진로장벽 인식을 낮추고 진로결정 자기효능감과 자기결정성을 향상시키는 데 효과가 있었다. 본 연구결과의 활용과 향후 연구에 대해 논의하였다.