응급실 내원 환자의 만족도 평가 및 관련 요인에 대한 연구

서강석,감신,박정배,이정헌,김종근,윤영국,곽경숙,이원기,우석정 大韓應急醫學會 1998 대한응급의학회지 Vol.9 No.4

Background: To examine the influencing factors on patients' satisfaction in the emergency department(ED) for quality assurance. Methods: Patients who visited to the ED were prospectively investigated from November 1 to December 31, 1997. Authors developed questionnaire to investigate influencing factors on patients' satisfaction. A Chi-square test and LISREL 7.0 were applied for statistical analysis. Results: Patients' satisfaction was significantly related to physical environment variables, accessibility variables, kindness of hospital personnel variables, and patient's trust for doctors variables. In path analysis, willingness for revisit was influenced by patients' satisfation, accessibility, physical environment, patients' trust for doctors in order, and willingness for recommendation was influenced by accessibility, patients' satisfaction, and kindness of hospital personnel in order. Conclusions: The influencing factors on patients' satisfaction are physical environment, accessibility, kindness of hospital personnel, and patient's trust for doctors. Willingness for revisit and willingness for recommendation are influenced by patients' satisfation. In spite of some limitations, the results of this study can be used as a baseline information for exploring the influencing factors on patients' satisfaction. Further comprehensive research efforts should be made on the study of patients' satisfactoin in the ED.

응급환자 추이예측 분석 : AMI, Stroke, ICISS 기반 중증질환자

정재연 ( Jeong Jaeyeon ),정지윤 ( Jeong Jiyun ),이해종 ( Lee Haejong ) 경희대학교 경영연구원 2021 의료경영학연구 Vol.15 No.1

Purpose: The purpose of this study is to identify the trends and seasonality of the three major emergency diseases(Acute myocardiac infarction, Stroke, Severe trauma) and to use them to establish efficient resources and evidence-based physicians to predict the number of patients. Methodology: From 2014 to 2018, the number of patients who received emergency medical care for acute myocardial infarction, stroke, and severe trauma (based on ICISS 2008) was predicted using Emergency Medical Status Statistics provided by the National Medical Center. Based on the Autoregressive integrated moving average model, the increasing trend and seasonality of patients by disease were confirmed and the number of patients was predicted. Findings: Since 2014, the number of patients with emergency diseases has steadily increased, with the highest number of patients in the order of Severe trauma (based on ICISS 2008), Stroke, and Acute myocardiac infarction. Patients with cerebrovascular disease, such as Acute myocardiac infarction and stroke, increased rapidly in winter(Oct-Jan), and patients with severe trauma increased mainly in summer or autumn(May-Oct) and number of patients will increase with seasonality. Practical Implications: The number of major emergency patients is expected to increase steadily over time, so it is important to be prepared for this. Therefore, providing emergency care with limited resources is a very important issue, and in order to prepare for the growing elderly population, emergency medical patients, and unpredictable infectious diseases, it is necessary to keep track of the number of patients for each emergency disease.

노인의료센터를 운영하는 병원의 고령입원환자에 대한 부적절약물 사용현황 분석

정현,서예원,전수정,이은숙,이병구,김광일 한국병원약사회 2007 병원약사회지 Vol.24 No.2

Recently, the number of geriatric patients is increasing. However, absence of exact pharmacotherapy policies for geriatric patients leads to increased risk of inappropriate medication use. In Seoul National University Bundang Hospital(SNUBH), Geriatric Center where pharmacists participate was established to prevent inappropriate medication use in geriatric patients. In order to evaluate general pharmacotherapy for geriatric patients, a study of polypharmacy and inappropriate medication use in community-dwelling geriatric patients was performed in 2004. In this study, we examined the extent and trend of inappropriate medication use in hospitalized geriatric patients to assure the quality of pharmacotherapy and provide information to the medical team. Data of inappropriate medication use in the geriatric patients who admitted at between January 1st and June 30th in 2006 were obtained from Electronic Medical Record (EMR) retrospectively. We set the criteria for inappropriate medication based on Beer's criteria(2002) and Zhan's classification(2001). Various demographical and therapeutic variables (i.e., the age, gender, medical department, daily dosage of medication prescribed, duration of medication use) were compiled for analyzing the inappropriate medication use. Out of total of 20,025 admitted patients, hospitalized geriatric patients were 5,498(27.5%). Among them, the patients who received prescription of inappropriate medications were 2,350(42.7%). Also, 639 patients received more than two inappropriate medications. Based on Beer's criteria, high risk medications(92.6%) were prescribed more than low risk medications(7.4%). The most frequently prescribed medications were ketorolac(30%), pethidine(27.8%), and diazepam(16.0%). Medical departments which prescribed the most frequently were cardiovascular center(19.7%), general surgery(12.8%), internal medicine of gastroenterology(12.5%). But the relative ratio to the number of geriatric inpatients of each department was high in cardiovascular center(74.4%), joint disease and reconstruction center(69.5%), internal medicine of gastroenterology(59.0%). In Geriatric center, 28.3% of patients received inappropriate medications. Generally, the severity of disease of inpatients is so serious that inappropriate medication use in inpatients is more prevalent than in outpatients. This result may be due to medical team's overlooking, lack of available drugs to substitute and so on. In conclusion, establishment of exact pharmacotherapy policies for geriatric patients and close attention of medical team are required.

대구 경북지역에서 진단된 노령자 폐암의 임상적 특징과 예후

김현숙 ( Hyun Sook Kim ),현대성 ( Dae Sung Hyun ),김경찬 ( Kyung Chan Kim ),이상채 ( Sang Chae Lee ),정태훈 ( Tae Hoon Jung ),박재용 ( Jae Yong Park ),김창호 ( Chang Ho Kim ),차승익 ( Seung Ick Cha ),이관호 ( Kwan Ho Lee ),정진홍 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.1

연구배경: 폐암은 우리나라 암 사망원인 질환의 가장 높은 비율을 차지하는 질환으로 특히 노령 인구에서 증가하는 추세이다. 그러나 노령의 폐암 환자는 동반된 질환, 노령에 따른 장기 기능의 저하 등의 이유로 적절한 치료를 받지못하는 경우가 많다. 이에 70세 이상의 노령 폐암 환자의 임상적 특징과 치료에 따른 생존기간 등을 알아보고자 한다. 방법: 2005년 1월부터 2005년 12월까지 대구, 경북지역에 소재하고 있는 대학병원 및 종합병원(경북대학병원, 구미 순천향병원, 대구가톨릭대학병원, 대구파티마병원, 동산의료원, 영남대학병원)에서 세포학적 혹은 조직학적으로 원발성 폐암을 진단받은 706명의 환자들을 70세 이상 환자군과 70세 미만 환자군으로 나누어 후향적으로 연구하였다. 결과: 전체 환자 중 70세 이상의 환자는273명(38.7%)이었다. 70세 이상의 환자는 70세 미만보다 호흡곤란의 증상이 많았으며(p<0.001), 만성폐쇄성폐질환의 빈도가 높았고(p<0.001), 활동도가 좋은 경우가 적었다(p<0.001). 비소세포폐암 환자의 중앙생존기간은 70세 미만의 환자와 70세 이상의 환자에서 유의한 차이를 보였지만(962일 vs 298일, p=0.001), 한 가지라도 치료를 받았던 환자들을 대상으로 했을 때는 두 군간에 의미 있는 차이가 없었다(1,109일 vs 708일, p=0.14). 결론: 70세 이상의 비소세포폐암 환자에서 환자의 활동도 등을 고려하여 적극적인 치료를 시행하는 것이 바람직할 것으로 생각된다. Background: Lung cancer is the leading cause of cancer death in South Korea since the year 2000 and it is more common in elderly patients, with a peak incidence at around 70∼80 years of age. However, these elderly patients receive treatment less often than do the younger patients because of organ dysfunction related to their age and their comorbidities, and they show poor tolerance to chemotherapy. The aims of this study were to analyze the clinical characteristics and treatment-related survival of elderly patients with lung cancer. Methods: In this retrospective study, we analyzed the clinical data of 706 lung cancer patients who were diagnosed at hospitals in Daegu and Gyeongsangbukdo from January 2005 to December 2005. We compared the clinical characteristics and outcomes of the patients who were aged 70 years and older (elderly patients) with those clinical characteristics and outcomes of the younger individuals. Results: The median age of the patients was 68 years (from 29 to 93) and the elderly patients were 38.7% (n=273) of all the study``s patients. Squamous cell carcinoma was the most common type of lung cancer in both the elderly and younger patient groups. Elderly patients had more symptoms of dyspnea and chronic obstructive pulmonary disease (COPD) than the younger patients (p<0.001 and p<0.001, respectively). A good performance status (ECOG 0-1) was less common for the elderly patients (p<0.001). The median survival of the non-small cell lung cancer (NSCLC) patients was significantly higher in the younger patient group than in the elderly patient group (962 days vs 298 days, respectively, p=0.001). However, the median survival of the NSCLC patients who received any treatment showed no significant difference between the younger patient group and the elderly patient group (1,109 days vs 708 days, respectively, p=0.14). Conclusion: Our data showed that appropriate treatment for selected elderly patients improved the survival of patients with NSCLC. Therefore, elderly NSCLC patients with a good performance status should be encouraged to receive appropriate treatment.

Elderly Patients Achieving Clinical and Radiological Outcomes Comparable with Those of Younger Patients Following Minimally Invasive Transforaminal Lumbar Interbody Fusion

Joshi Nikhil N.,Joel Wei-An Lim,William Yeo,Wai-Mun Yue 대한척추외과학회 2017 Asian Spine Journal Vol.11 No.2

Study Design: Retrospective analysis of prospective database. Purpose: To compare 2-year clinical and radiological outcomes after minimally invasive transforaminal lumbar interbody fusion (MISTLIF) among “middle-age” (50–64.99 years), “young-old” (65–74.99 years), and “old-old” (>75 years) patients. Overview of Literature: Owing to higher perioperative morbidity and mortality rates, elderly patients with degenerative lumbar conditions are occasionally denied surgical care, even after conservative treatment failure. MIS-TLIF advantages include reduced blood loss, reduced analgesia requirements, early mobilization, and shorter hospital stays. Methods: Between 2007 and 2012, 22 patients (age >75 years) treated with 1-2 level MIS-TLIF were matched with “young-old” and “middle-age” patients (22 each) based on race, body mass index (BMI), diagnosis, spinal level, number of spinal levels operated upon, and bone graft type. Clinical outcomes included the Oswestry disability index (ODI), neurogenic symptom score (NSS), 36-item short form health survey (SF-36), and visual analogue scale (VAS) for back and leg pain. Radiological assessment included plain radiographs and preoperative magnetic resonance imaging (MRI) and plain radiographs at 1, 3, 6, and 24 months postoperatively. Fusion grade, loosening, cage migration, and adjacent segment degeneration were assessed. Results: The groups had similar fluoroscopy time, operation duration, and postoperative analgesia type used. “Old-old” patients took longer to ambulate (1.6 days) and had longer hospital stays (6 days). All patients showed significant improvement in clinical outcome scores at all time-points compared with the preoperative status. “Middle-age” patients showed better ODI and SF-36 physical function scores than “old-old” patients preoperatively and 2 years post surgery. NSS, VAS (back and leg), and SF-36 mental function scores were similar between groups preoperatively and at every time-point postoperatively. Minimal clinical important differences (63.6%–95.5% at 2 years) were achieved. Grade 1 fusion occurred in a minimum of 80% patients in each group 2 years post surgery. Complication rates were similar. Adjacent segment disease occurred in 2 patients from the “young-old” group, with no significant differences between groups. Conclusions: MIS-TLIF showed comparable results in selected “old-old” patients compared with “young-old” and “middle-age” patients without increased complication risks.

외국인 환자의 한국 병원 의료서비스 만족도 및 재이용의사 영향요인 분석 : 러시아권 환자를 대상으로

손진석(Son, Jinsuk),허경옥(Huh, Kyungok),최애연(Choi, Aeyeon) 충북대학교 생활과학연구소 2021 생활과학연구논총 Vol.25 No.3

The purpose of this study was to verify that the three types of medical service satisfaction, patient-oriented satisfaction, and the willingness to reuse Korean hospitals differ depending on the characteristics of foreign patients. Second, we investigate the factors affecting these four variables. The main analysis results shown in this study are as follows. First, most foreign patients were found to be highly satisfied with Korean hospital doctors and patient-oriented hospitals. In addition, more than 75 percent of foreign patients were willing to reuse Korean hospitals in the future. Second, a regression analysis of variables that affect satisfaction with Korean hospital doctors showed that the presence of long-term diseases affected. Specifically, if there is a disease in the long term, the satisfaction level of Korean hospital doctors is high. The factors that affect foreign patients satisfaction with the Korean hospital system were income and health conditions. The lower the income of foreign patients, the higher the satisfaction with the Korean hospital system in the case of positive perception of their health conditions. Meanwhile, the impact on the satisfaction of foreign patients with patient orientation in Korean hospitals was on whether they lived in Korea and recognized their health conditions. Foreign patients living abroad, not domestic residents, and foreign patients with positive perceptions of their health conditions showed high satisfaction with the patient-orientedness of Korean hospitals. Third, the regression analysis was conducted to identify the factors affecting the willingness of foreign patients to reuse Korean hospitals, and found that the medical expenses were borne by themselves, doctor satisfaction, and hospital system satisfaction. Foreign patients who do not pay for medical expenses showed high willingness to reuse Korean hospitals, while foreign patients with high satisfaction with Korean hospital doctors showed high willingness to reuse Korean hospitals.

암환자의 약물요법에 대한 전반적인 이해도와 암성통증관리의 만족도 조사

지정숙,이소현,여윤정,공경희 한국병원약사회 2005 병원약사회지 Vol.22 No.3

The purpose of this study was to evaluate patient's awareness about chemotherapy and the satisfaction about cancer pain management and to research the actual condition. This study was conducted through questionnaire of fifty outpatients and inpatients who received chemotherapy for one month from September to October 2003. As a result, only one patient was made a diagnosis as cancer by early medical examination, the rest of patients was diagnosed as cancer by subjective symptoms. 46% of the patients had positive thinking about alternative therapies and 36% of the patients answered used alternative therapies. Nobody knew drug interaction and side effects. Although patients took a pain management medicine, 20% of the patients experienced moderate pain. 78% of the patients was interfered with general activity, mood, walking, work, relationships and sleep despite use of analgesics. 20% of the patients took a pain management medicine at their discretion. The reason of it was fear about side effects and addiction. 74% of the patients answered satisfaction about pain management. The reason for satisfaction was that the pain was relieved after taking a pain management medicine. In conclusion, the research show that it is important to educate both patients and their family members about drug interaction information of alternative therapies and chemotherapy, and to correct patients false belief. To improve satisfaction of pain management and quality of life in cancer patients, we should educate patient about method of taking pain management medicine and misconceptions about opioids and analgesics.

A Comparison Between Stroke Patients Admitted to Oriental Hospital in the Years 1987 and 1994

Lee Kyung-sup,Cho, Ki-ho,Kim, Young-suk,Ko, Chang-nam,Moon Sang-kwan,Bae Hyung-sup INSTITUTE OF ORIENTAL MEDICINE KYUNG-HEE UNIVERSIT 1998 JOURNAL OF ORIENTAL MEDICINE Vol.3 No.1

The characteristics of stroke slightly vary as time changes. To compare the characteristics of stroke between the 1980s and 1990s we investigated the clinical records of stroke patients in 1987 and 1994. The subjects of this study consisted of the 1971 patients who were admitted as stroke patients to the Kyunghee University Oriental Medicine Hospital during these two years. There were 1092 stroke patients admitted from May, 1987 to April, 1988 and 879 stroke patients admitted between May, 1994 and April, 1995. The results were as follows. The frequency of cerebral infarction was 77.9% in 1987 and 79.9% in 1994. The male to female ratio of stroke patients was 1.4:1 in 1987 and 1.6:1 in 1994. The occurrence rate of stroke in both 1987 and 1994 were highest in patients in their 60s, followed by those in their 50s, 70s and older, in their 40s, and finally their 30s and below. We especially found that the rate of patients in their 70s and over increased from 17.8% in 1987 to 25.3% in 1994, which was remarkable in cerebral infarction patients. The most common disease preceding a stroke was hypertension, followed by heart disease and diabetes in 1987, and in 1994 hypertension was the most common, followed by diabetes and heart disease. The rate of recurrence among cerebral hemorrhage, that was 12% in 1987 and 24.7% in 1994. The most frequent complications of stroke in 1987 and 1994 were pneumonia and urinary tract infection, respectively. The prescriptions used most frequently during admission were Chungpaesagan-tang followed by Sunghyangjungki-san, Yangyeksanhwa-tang etc. in both 1987 and 1994. When patients were getting better, prescriptions for invigorating Qi and enriching the blood(補氣血) were used more frequently. In conclusion, the most remarkable change of stroke patients from 1987 to 1994 was an increase in occupancy rate of aged patients, especially those in their 70s and older. So we suggest that more research are needed on the stroke of aged man, along with many other subjects on stroke.

연명의료결정법에서 무연고자 규정미비 등에 관한 법적 고찰

문상혁 대한의료법학회 2023 의료법학 Vol.24 No.4

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 작성 하지 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. According to the current act of Decision-Marking in Life-Sustaining Medicine, the decision to withhold or discontinue life-sustaining treatment is primarily based on the wishes of a patient in the dying process. Decision-making regarding life- sustaining treatment for these patients is made by the patient, if he or she is conscious, directly expressing his/her intention for life-sustaining treatment in writing or verbally or by writing an advance medical directive and physician orders for life-sustaining treatment. It can be exercised. On the other hand, if the patient has not written an advance medical directive or physician orders for life- sustaining treatment, the patient's intention can be confirmed with a statement from the patient's family, or a decision to discontinue life-sustaining treatment can be made with the consent of all members of the patient's family. However, in the case of an unrelated patient who has no family or whose family is unknown, if an advance medical directive or physician orders for life- sustaining treatment are not written before hospitalization and a medical condition prevents the patient from expressing his or her opinion, the patient's will cannot be known and the patient cannot be informed. A situation arises where a decision must be made as to whether to continue or discontinue life-sustaining treatment. This study reviewed discussions and measures for unbefriended patients under the current law in order to suggest policy measures for deciding on life-sustaining treatment in the case of unbefriended patients. First, we looked at the application of the adult guardian system, but although an adult guardian can replace consent for medical treatment that infringes on the body, permission from the family court is required in cases where death may occur as a direct result of medical treatment. It cannot be said to be an appropriate solution for patients in the process of dying. Second, in accordance with Article 14 of the Life-Sustaining Treatment Decision Act, we looked at the deliberation of medical institution ethics committees on decisions to discontinue life-sustaining treatment for patients without family ties.Under the current law, the medical institution ethics committee cannot make decisions on discontinuation of life-sustaining treatment for unbefriended patients, so through revision, matters regarding decisions on discontinuation of life-sustaining treatment for unbefriended patients are reflected in Article 14 of the same Act or separate provisions for unbefriended patients are made. It is necessary to establish and amend new provisions. In addition, the medical institution ethics committee must make a decision on unbefriended patients, but if the medical institution cannot make such a decision, there is a need to revise the law so that the public ethics committee can make decisions, such as discontinuing life-sustaining treatment for unbefriended patients.

Effect of Age on Laparoscopic Surgery and Postoperative Chemotherapy in Elderly Patients With Colorectal Cancer

김현희,인명훈,이윤희,이지현,윤상철,조성우 대한대장항문학회 2020 Annals of Coloproctolgy Vol.36 No.4

Purpose: We aimed to evaluate the postoperative complications of laparoscopic colorectal cancer (CRC) surgery and the adverse events of postoperative chemotherapy in elderly patients compared to younger patients and to identify the factors influencing the termination of postoperative chemotherapy. Methods: Between June 2015 and May 2018, 188 patients with CRC underwent laparoscopic surgery with curative intent. Patients aged ≥70 were defined as elderly. Postoperative complications and adverse events of chemotherapy were assessed by using the Clavien-Dindo classification and the Common Terminology Criteria for Adverse Events, respectively. The clinicopathological factors were analyzed retrospectively. Results: Seventy-eight patients were considered elderly with a mean age of 77.5±5.5 years. Overall postoperative complications occurred in 68 patients (36.2%). Age and primary tumor location were independent predictors of overall postoperative complications. Smoking history was the only independent predictor of major postoperative complications. Of 113 patients who were recommended postoperative chemotherapy, 90 patients (79.6%) received postoperative chemotherapy. Overall adverse events occurred in 40 patients (44.4%). The American Society of Anesthesiologists physical status classification and chemotherapy regimen were significantly associated with overall adverse events. The chemotherapy regimen was the only factor significantly associated with severe adverse events. Of 90 patients, postoperative chemotherapy could not be completed in 11 (12.2%). Age was the only factor significantly associated with stopping postoperative chemotherapy (P=0.003). Conclusion: This study shows that laparoscopic CRC surgery and postoperative chemotherapy were feasible in elderly patients. Further efforts are needed to ensure that elderly patients have the opportunity to make informed decisions regarding postoperative chemotherapy.