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임플란트 보철물과 인접치 사이의 식편압입에 관한 임상적 연구
신동욱,이진한,김세연,동진근,Shin, Dong-Wook,Lee, Jin-Han,Kim, Se-Yeon,Dong, Jin-Keun 대한치과보철학회 2014 대한치과보철학회지 Vol.52 No.1
연구 목적: 본 연구는 임플란트 보철물과 인접치 사이의 식편압입을 호소하는 환자를 대상으로 각종 임상 자료를 분석하여 식편압입의 임상적 발현 양상을 알아보고자 하였다. 연구 재료 및 방법: 식편압입을 주소로 내원한 보철물 장착이 완료된 임플란트 환자 51명을 대상으로 설문조사와 구강검사를 시행하고 방사선 사진과 모형을 채득하여 식편압입과 관련이 있는 요소를 분석한 결과 다음과 같은 결과를 얻었다. 결과: 1. 식편압입은 하악(39.2%)보다 상악(60.7%)에서 많이 나타났다. 2. 식편압입은 자연치아가 임플란트 보철물의 원심 부위(13.7%)에 있는 경우보다 근심 부위(86.2%)에 있는 경우에 많이 나타났다. 3. 식편압입이 나타난 임플란트 보철물과 그 인접치 사이의 접촉점은 긴밀하지 않은 경우(94.2%)가 대부분이었다. 결론: 임플란트 보철물과 인접치 사이에 식편압입이 일어나지 않기 위해서는 임플란트 보철물과 인접치아가 적절한 긴밀도를 가지고 있어야 하겠다. Purpose: The purpose of this study was to investigate the food impaction between implant prostheses and adjacent natural teeth. Materials and methods: For this study, 51 patients with food impaction were selected and investigated mobility, tightness of contact area, gingival index, plaque index, attachment loss, alveolar bone level, proximal caries, marginal ridge distance and occlusal relationships. Results: Food impaction was found in the upper teeth (60.7%) more than the lower teeth (39.2%). Food impaction was occurred on mesial side of implant prostheses (86.2%) more than distal side (13.7%). Food impaction was mostly found in loose or open contact area (94.2%). Food impaction was frequent on stepped relationship between implant and adjacent teeth. Conclusion: Treatment plan should include proper adjacent and antagonistic occlusal plane and occlusal surface, to prevent food impaction, and the plan should include less adjacent tooth mobility with proper tightness between implant prostheses and adjacent teeth.
말기암환자 정보시스템을 이용한 우리나라 암환자 완화의료기관의 이용현황
신동욱,최진영,남병호,서원석,김효영,황은주,강진아,김소희,김양혁,박은철,Shin, Dong-Wook,Choi, Jin-Young,Nam, Byung-Ho,Seo, Won-Seok,Kim, Hyo-Young,Hwang, Eun-Joo,Kang, Jina,Kim, So-Hee,Kim, Yang-Hyuck,Park, Eun-Cheol 한국호스피스완화의료학회 2010 한국호스피스.완화의료학회지 Vol.13 No.3
목적: 최근 보건의료 정책 결정은 근거에 기반하여 이루어지는 추세에 있으며, 말기암환자 정보시스템은 이러한 필요에 부응하기 위하여 개발되었다. 본 고에서는 말기암환자 정보시스템의 개발과정 및 6개월 데이터로부터의 통계 결과를 보고하고자 한다. 방법: 말기암환자 정보시스템의 입력항목은 실무 전문가들의 자문을 받아 개발되었으며, 이벨로스 임상연구관리시스템을 기반으로 구축하였다. 2009년 보건복지가족부에서 지정된 34개 암환자완화의료 기관에 2009년 1월 1일부터 6월 30일까지 등록된 환자들에 대한 정보가 수집되었다. 분석은 기술적 통계를 이용하였다. 결과: 총 2,940명의 전국적으로 대표성 있는 데이터로부터 아래와 같은 결과를 얻었다. 평균연령은 $64.8{\pm}12.9$ 세였고, 56.6%가 남자였다. 폐암(18.0%)이 가장 많았다. 2인 이상의 의사에 의하여 말기진단을 받은 경우는 50.3% 였으며, 입원 당시 말기라는 사실을 알고 있는 환자는 69.7%였고, 거의 절반에 가까운 환자가 특별한 의뢰 없이 입원하였다. 평균 통증 및 최고 통증은 입원 1주 후에 통계적으로 유의하게 감소하였다. 사망 퇴원한 환자가 73.4%였으며, 집으로 퇴원하는 경우는 13.3%에 불과했다. 1회당 평균 입원일수는 $20.2{\pm}21.2$일이었으며, 중위값은 13일이었다. 결론: 말기암환자 정보시스템의 운영을 통하여 완화의료 기관 이용 환자 및 가족의 특성, 서비스 제공에 관한 현황 등에 관한 전국적으로 대표성 있는 자료를 얻을 수 있었다. Purpose: Recently, health policy making is increasingly based on evidence. Therefore, Korean Terminal Cancer Patient Information System (KTCPIS) was developed to meet such need. We aimed to report its developmental process and statistics from 6 months data. Methods: Items for KTCPIS were developed through the consultation with practitioners. E-Velos web-based clinical trial management system was used as a technical platform. Data were collected for patients who were registered to 34 inpatient palliative care services, designated by Ministry of Health, Welfare, and Family Affairs, from $1^{st}$ of January to $30^{th}$ of June in 2009. Descriptive statistics were used for the analysis. Results: From the nationally representative set of 2,940 patients, we obtained the following results. Mean age was $64.8{\pm}12.9$ years, and 56.6% were male. Lung cancer (18.0%) was most common diagnosis. Only 50.3% of patients received the confirmation of terminal diagnosis by two or more physicians, and 69.7% had an insight of terminal diagnosis at the time of admission. About half of patients were admitted to the units on their own without any formal referral. Average and worst pain scores were significantly reduced after 1 week when compared to those at the time of admission. 73.4% faced death in the units, and home-discharge comprised only 13.3%. Mean length of stay per admission was $20.2{\pm}21.2$ days, with median value of 13. Conclusion: Nationally representative data on the characteristics of patients and their caregiver, and current practice of service delivery in palliative care units were obtained through the operation of KTCPIS.
DEA에 의한 병원 효율성 평가에서 질적 측면 통합 모형에 관한 연구 -국립대학교병원에 대한 분석을 중심으로-
신동욱 ( Dong Wook Shin ),신종각 ( Chong Gak Shin ),정기택 ( Kee Taig Jung ) 한국병원경영학회 2008 병원경영학회지 Vol.13 No.3
Rising healthcare cost is a global phenomenon that justifies governments` introduction of `incentive regulation` plan for the improvement of hospital efficiency. A number of previous studies tried to evaluate the efficiency of healthcare organization by using Data Envelopment Analysis(DEA), a common efficiency benchmarking method. However, there is a concern that this kind of efficiency evaluation could induce “quantity-quality trade-off”. Moreover, as quality aspect is especially important in terms of `effectiveness` of health care, it should be considered in efficiency evaluation of healthcare organization. A number of different models were tried so far to incorporate quality aspect into DEA, however, none is universally recognized as a standard. Thus, in this study, previous quality-incorporating DEA models were categorized into 6 types according to the way of incorporating quality aspect, and strengths and limitations of each type were reviewed with a set of artificial data as an example. Based on this review, a new quality- incorporating efficiency evaluation model, named Quality-adjusted output DEA(QAO- DEA), was suggested. As an exploratory empirical analysis, technical efficiency of human resource were measured with different quality-incorporating DEA models, using 2004 data from National University Hospitals. In conclusion, Quality-adjusted output DEA(QAO-DEA) model seems to be one of the most desirable alternatives to incorporate quality aspect in efficiency evaluation of hospital, and deserves the consideration as a policy tool to induce simultaneous improvement of both efficiency and quality.
신동욱(Dong Wook Shin) 한국보건의료연구원 2016 근거와 가치 Vol.2 No.3
Second opinion seeking and doctor shopping are common, but understudied medical phenomena. The prevalence of second opinion seeking and doctor shopping varied widely according to medical conditions, and are reported to be around 6.5%~36% and 6.3%~56%, respectively. Dissatisfaction with or distrust of first opinion doctor is the most important reasons for such phenomena, but other factors related to patients’ own condition or characteristics also contribute. Second opinions frequently discord with first opinions, and often change the diagnosis or treatment recommendation, although the degrees of the discrepancy widely vary with specialty. Most patients reported high satisfaction with the second opinion process, and became more confident with their diagnosis or treatment options. Second opinion can sometimes induce duplicate tests, but also have potential to reduce unnecessary procedures. There is no good evidence on whether second opinion actually improves the quality of care or patient outcomes. With increasing demand for second opinion as well as the trend for patient autonomy and consumerism, there is a need to establish a well-designed second opinion program. However, there are many practical, legal, and ethical issues which need to be discussed. In addition, it should be emphasized that a health care system which can ensure first opinion based on evidence-based clinical guideline and also enhance enough communication between the physician and the patients in order to prevent patients’ dissatisfaction and subsequent unnecessary second opinion seeking or doctor shopping.