Applying the RE-AIM Framework to Evaluate the Dissemination and Implementation of Clinical Practice Guidelines for Sexually Transmitted Infections

정헌재,조희숙,오무경,오형원 대한의학회 2015 Journal of Korean medical science Vol.30 No.7

Clinical practice guidelines (CPG) are one of the most effective ways to translate evidence of medical improvement into everyday practice. This study evaluated the dissemination and implementation of the Sexually Transmitted Infections-Korean Guidelines (STIKG) by applying the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework. A survey questionnaire was administered to clinicians via the internet. Among the 332 respondents, 190 (57.2%) stated that they were aware of STIKG and 107 (33.2%) implemented STIKG in their practice. The odds that a physician was exposed to STIKG (dissemination) were 2.61 times greater among physicians with previous training or education for any CPG than those who did not. Clinicians who indicated that STIKG were easy to understand were 4.88 times more likely to implement STIKG in their practice than those who found them not so easy. When a clinician’s workplace had a supporting system for CPG use, the odds of implementation was 3.76 times higher. Perceived level of effectiveness of STIKG did not significantly influence their implementation. The findings of this study suggest that, ultimately, knowing how to engage clinicians in CPG implementation is as important as how to disseminate such guidelines; moreover, easy-touse guidelines and institutional support are key factors.

다양한 환경요인과 난분해성 유기물에 따른 고온산화 및 UV산화방식 총 유기탄소 산화율 변화

정헌재,이보미,이근헌,신현상,허진 한국물환경학회 2016 한국물환경학회지 Vol.33 No.2

This study examined the effects of environmental conditions and the presence of refractory organic matter on oxidation rates of total organic carbon (TOC) measurements based on high temperature combustion and ultraviolet-sulfate methods. Spectroscopic indices for prediction of oxidation rates were also explored using the UV spectra and fluorescence excitation-emission matrix (EEM) of humic acids. Furthermore, optimum TOC instrument conditions were suggested by comparing oxidation rates of a standard TOC material under various conditions. Environmental conditions included salts, reduced ions, and suspended solids. Salts had the greatest influence on oxidation rates in the UV-sulfate method. However, no effect was detected in the high temperature combustion method. The UV-sulfate method showed lower humic substance oxidation rates, refractory natural organic matter, compared to the other methods. TOC oxidation rates for the UV-sulfate method were negatively correlated with higher specific-UV absorbance, humification index, and humic-like EEM peak intensities, suggesting that these spectroscopic indices could be used to predict TOC oxidation rates. TOC signals from instruments using the UV-sulfate method increased with increasing chamber temperature and increasing UV exposure durations. Signals were more sensitive to the former condition, suggesting that chamber temperature is important for improving the TOC oxidation rates of refractory organic matter.

다양한 환경요인에 따른 고온산화방식과 UV산화방식 총유기탄소 산화율 비교

정헌재,신현상,이근헌,허진 대한환경공학회 2015 대한환경공학회 학술발표논문집 Vol.2015 No.10

Lifting Shadows off the End-of-Life Care: Hopes and Beliefs on Video Decision Support Tools for Advance Care Planning

정헌재,Hyeyeon Yoon 한국호스피스완화의료학회 2016 한국호스피스.완화의료학회지 Vol.19 No.1

As advance care planning is taking center stage in the field of end-of-life care, various tools have been developed to aid in the often emotional and difficult decision-making process. Video decision support tools are one of the most promising means of assistance, of which the modus operandi is to provide more comprehensive and precise information of medical procedures to patients and their families, allowing them to make better informed decisions. Despite such value, some are concerned about its potential negative impact. For example, video footages of some procedures may be shocking and unpalatable to non-medical professionals, and patients and families may refuse the procedures. One approach to soften the sometimes unpleasant visual of medical procedures is to show less aggressive or more relaxing scenes. Yet another potential issue is that the objectivity of video decision support tools might be vulnerable to the very stakeholders who were involved in the development. Some might argue that having multiple stakeholders may function as checks and balances and provide collective wisdom, but we should provide more systematic guarantee on the objectivity of the visual decision aids. Because the decision of the modality of an individual’s death is the last and most significant choice in one’s life, no party should exert their influence on such a delicate decision. With carefully designed video decision support tools, our patients will live the last moments of their lives with dignity, as they deserve.

보건사업전담 공중보건의사 직무만족도 및 제도 개선방안

정헌재 ( Heon Jae Jeong ),조희숙 ( Heui Sug Jo ),배상수 ( Sang Soo Bae ) 한국보건행정학회 2004 보건행정학회지 Vol.14 No.1

본 연구는 보건사업전담 공중보건의사의 직무 실태를 조사하고 직무에 대한 만족도를 파악하여 이에 대한 개선방안을 강구하기 위하여 수행되었다. 설문조사 대상은 각 시·군 보건소에 근무하는 보건사업전담 공중보건의사로서 지역보건사업 중앙지원단에 등록되어 있던 138명의 보건사업전담 의사들이었고, 2003년 3월부터 4월까지 2개월간 e-mail을 통하여 조사가 이루어졌다. 조사 결과 총 96명이 응답하여 70%의 응답률을 나타내었다. 본 연구에서 얻어진 연구 결과는 다음과 같다. 보건사업전담 공중보건의사들의 근무 경력은 1년차인 경우가 61.6%로 가장 많았고, 전문의 자격을 가진 경우가 63.0%였다. 배치 과정에서 50.0%가 전혀 본인의사가 반영되지 않은 것으로 나타났다. 본인이 평가하는 보건사업 참여 정도는 응답자의 60.0%가 거의 없거나 낮다고 응답하였다. 제도의 필요성에 대하여는 66.7%에서 필요하지만 개선이 요구된다고 응답하였다. 본인의 직무에 대하여 70%에서 불만족하고 있었고 사업에 대한 계획수립과 활동에 참여가 용이할 수록, 배치 과정에서 본인의 의사가 잘 반영될수록 만족도가 유의하게 높았다(p<0.05). 전문의 경력을 가진 경우에서 직무 수행도가 높게 나타났고 제도 수행을 위한 지원에 있어서는 배치과정에서의 의사반영, 제도의 교육과 홍보, 행정적 권한 강화, 예산지원 등이 공히 직무 만족도와 직무 수행점수에 유의한 차이를 나타내었다. 업무 수행 동기 향상을 위한 대안에 관하여는 사업에 대한 행정적·재정적 권한의 강화, 사업 항목의 구체적 명시, 진료의 완전 배제 등이 높게 나타났다. 보건사업전담의사가 수행하기 적당한 보건사업으로는 방문보건사업의 시행, 지역사회진단, 건강증진 교육 프로그램의 개발 순으로 나타났다. 이상의 결과에서 보면 보건사업전담의사 제도에 대한 당위성과 필요성은 높게 제시되고 있으나 제도 운영에 대한 개선이 필요하며 실질적인 사업 참여를 가능하게 하기 위한 역량 강화와 동기부여 방안, 구체적인 사업 제시 등이 필요함을 알 수 있다. This study was carried out to investigate the activities and job satisfaction of public health doctors in charge of community health programmes. Subjects were 138 public health doctors charged with community health project, registered in the roll of public health doctors, made out by Central Supporting Team for the District Health Work in 2002. Data was obtained from Ninety-six public health doctors. The response rate was 70%. The survey was conducted from March to April in 2003 by e-mail. The items of the questionnaire consisted of general characteristics of participants, understanding of their activities, support system, job satisfaction, and suggestions to improve the system. Collected data was analyzed using PC-SPSS 10.1. Descriptive analysis, t-test, and ANOVA test were used. The results are as follows: Most of the respondents showed a low participation rate in community health services, but they agreed to the importance of their activities and the necessity to modify and improve the system. 70% of the respondents were dissatisfied with their jobs. The participation in health planning and programmes of health center, and the degree of acceptance of their opinion from health center workers were significantly related to their job satisfaction. The participation rate of the public health doctors having specialty, in community health services is higher than that of the others. In terms of the supports for system operation, the reflection of one`s intention in job arrangement process, education and public relation of this system, and the administrative and financial supports made significant differences in the job satisfaction and the accomplishment of their duty. The respondents hoped that the administrative and financial supports for public health doctors in charge of community health programmes should be reinforced to motivate them. They also wanted that they could keep from being overloaded with clinical services. They favored to conduct home visit, community diagnosis, health planning, and health promotion programs as their appropriate activities. From these results, we suggest some strategies to motivate and empower the public health doctors in charge of community health programmes.

총 유기탄소 분석 방법에 따른 측정 장비별 특성 비교

정헌재(Heon-Jae Jung),이한샘(Han-Saem Lee),박준호(Jun Ho Park),이상철(Sang-Chul Lee),허준(Jun Heo),정찬우(Chan-Woo Jeong),황용(Yong Hwang),정용채(Yong Chae Jeong),허진(Jin Hur) 대한환경공학회 2020 대한환경공학회 학술발표논문집 Vol.2020 No.11

다양한 환경요인과 난분해성 유기물에 따른 고온산화 및 UV산화방식 총 유기탄소 산화율 변화

정헌재 ( Heon Jae Jung ),이보미 ( Bo Mi Lee ),이근헌 ( Keun Heon Lee ),신현상 ( Hyun Sang Shin ),허진 ( Jin Hur ) 한국물환경학회 2016 한국물환경학회지 Vol.32 No.1

This study examined the effects of environmental conditions and the presence of refractory organic matter on oxidation rates of total organic carbon (TOC) measurements based on high temperature combustion and ultraviolet-sulfate methods. Spectroscopic indices for prediction of oxidation rates were also explored using the UV spectra and fluorescence excitationemission matrix (EEM) of humic acids. Furthermore, optimum TOC instrument conditions were suggested by comparing oxidation rates of a standard TOC material under various conditions. Environmental conditions included salts, reduced ions, and suspended solids. Salts had the greatest influence on oxidation rates in the UV-sulfate method. However, no effect was detected in the high temperature combustion method. The UV-sulfate method showed lower humic substance oxidation rates, refractory natural organic matter, compared to the other methods. TOC oxidation rates for the UV-sulfate method were negatively correlated with higher specific-UV absorbance, humification index, and humic-like EEM peak intensities, suggesting that these spectroscopic indices could be used to predict TOC oxidation rates. TOC signals from instruments using the UV-sulfate method increased with increasing chamber temperature and increasing UV exposure durations. Signals were more sensitive to the former condition, suggesting that chamber temperature is important for improving the TOC oxidation rates of refractory organic matter.

EEM-PARAFAC을 이용한 하천 퇴적 유기물 공극수 성상 비교

한소정,정헌재,현정호,최정현,이효진,허인애,허진 대한환경공학회 2016 대한환경공학회 학술발표논문집 Vol.2016 No.11

자루재배용 배지의 종류와 양액의 $\textrm{NO}_3^\;-$:$\textrm{NH}_4^\;+$-N의 비율이 단고추의 생육 및 수량에 미치는 영향

김덕호,김영호,정헌재 한국생물환경조절학회 2000 시설원예‧식물공장 Vol.9 No.2

단고추의 자루재배에 의한 양액재배시 NO3--N과 NH4--N의 비유 (8:2와 10:0), 배지 종류에 따른 생육, 수량 및 무기성분 흡수에 미치는 영향을 조사하였다. 배지의 무기성분 중 P, K, Ca 및 Mg는 배지간에 차이가 나타났는데, P 및 Mg는 버미큘라이트+왕겨에서, K는 펄라이트+버미큘라이트에서, 그리고 Ca은 펄라이트+피트모스에서 각각 그 농도가 높았으며, 펄라이트 단용배지에서 가장 낮았다. 다른 성분에 비하여 Ca의 농도가 가장 높았으며, 10:0 양액에 비하여 8:2 양액에서 배지내 무기성분의 농도가 낮았다. 양액의 pH는 NO3-:NH4+ 비율에 따라 배지간에 다소 차이가 있었으나, 10:0에서 안정적이었으며, 8:2에 비하여 약간 높게 유지되었다. 배지별 EC는 펄라이트+버미큘라이트와 버미큘라이트+왕겨에서 높았다. 8:2에서는 1.83∼2.10ds·m-1 범위였고, 10:0에서는 1.78∼1.97 ds·ms-1 범위로 나타나 모든 배지에서 단고추 생육에 적합한 범위를 유지하였다. 초장고 경경은 8:2와 10:0의 경우 배지에 따른 생육차는 없었으며, 엽면적은 버미큘라이트+왕겨에서, 생체중, 건물중 등은 피트모스+훈탄에서 무거웠고, 펄라이트 단용 배지에서 가장 불량하였다. 생육 등은 배지 종류에 따른 영향도 있었으나, 초장, 경경, 엽면적, 생체중 및 건물중 등은 NH4+를 첨가한 8:2 양액에서 배지종류에 관계없이 10:0에 비하여 높게 나타났다. 주당과수 및 주당수량은 8:2에서 버미큘라이트+왕겨에서 17.53개와 1,588g으로 많거나 무거웠으며, 펄라이트 단용배지에서 가장 적었다. 10:0에서의 주당과수는 버미큘라이트+왕겨에서 16.44개로, 수량은 펄라이트+피트모스에서 1,394g 으로 가장 높게 나타났다. 수량성은 배지 종류에 따른 차이도 일부 인정되었으나, 8:2의 모든 배지에서 과수, 주당수량, 평균과정, 과경, 과장 및 상품과율 등이 모두 10:0 양액보다 높게 나타났다. 식물체내의 무기성분은 8:2의 경우 K+ 및 Mg2+는 잎에서 Ca2+은 뿌리에서 많았으며 PO4-은 과실과 줄기에서 많았다. 10:0에서의 무기성분도 8:2에서와 같은 경향을 나타내었으며, 배지간에 무기성분의 차이는 인정되지 않았다. 양액조성에 따른 무기성분 함량의 차이는 K+, Ca2+ 및 Mg2+는 10:0에서, PO4-은 8:2에서 각각 많았다. This study was carried out to investigate the effects of several substrates and ratio of NO3--N to NH4--N in nutrient solution on growth, yield and mineral uptake of sweet pepper(Capsicum annuum L.) in bag culture. The content of minerals such as P, K, Ca and Mg showed difference in concentration among media: P and Mg were the highest in vermiculite in vermiculti+rice hull, K in perlite+vermiculite and Ca in perlite+peatmoss; with the lowest in the single perlite medium respectively, Ca of mineral made fairly higest level in concentration compared with the others in all of the media. The concentration of mineral content was lower in the ratio of 8:2 than that of 10:0. Admitting that the pH made difference depending on the kind of substrates and ratios of NO3--N to NH4--N. The pH of 10:0 ratio in all the substrates was higher and more stable than that of 8:2. The range of EC in all the substrates showed from 1.78ds·m-1 to 2.10 ds·m-1, which was optimum range for growth of sweet pepper, and range of EC is larger in 8:2 ratio than that in 10:0 ratio. Plant height and stem diameter were nothing to do with the kind of substrates, but leaf area was the largest at vermiculite+rice hull of the 8:2 ratio, fresh and dry weights were heavier at peatmoss+carbonized rice hull, but were the lightest at perlite. All indexes related to the growth which had something to do with the kind of substrates higher in 8:2 ratio than those in 10:0 ratio. The number of fruit and fresh weight related to the ratio of the 8:2 were the highest as 17.5 at vermiculite+rice hull with 1,588g of fresh weight, while the yield from perlite was the lowest. The number of fruit was the highest as 16.4 at virmiculite+rice hull, yield was the higest as 1,394a at perlite+ peatmoss. The yield of 8:2 ratio at all substrates was higher than that of 10:0 ratio. Of the mineral content related to the plant part, K+ and Mg2+ were higher in concentration at leaf; Ca2+ were higher at root; PO4- was higher at stem and fruit; The content of mineral showed no difference between the ratio of the 8:2 and the ratio of the 10:0 with no regrading to the difference of mineral content among substrates; and K+, Ca2+, and Mg2+ uptake of sweet pepper were higher at 10:0 ratio than that of 8:2; 2while PO4- uptake of sweet pepper was lower at 10:0 ratio than that of 8:2 ratio.

환자안전문화 측정을 위한 설문조사 수행 및 결과 활용 기법

이경실,박미진,나해란,정헌재,Lee, Gyeong-sil,Park, Mi-jin,Na, Hae-ran,Jeong, Heon-jae 한국의료질향상학회 2015 한국의료질향상학회지 Vol.21 No.1

Objectives : A safety culture is the bedrock for all patient safety improvement initiatives; thus, many resources have been invested in measuring hospital culture. However, many of these endeavors have failed to yield meaningful results. This article proposes a practical checklist to ensure successful administration of a safety culture survey and describes current methodologies for analyzing survey results to develop safety improvement programs. Methods : We reviewed currently used safety culture surveys and summarized their strengths and weaknesses. We also reviewed studies using safety culture surveys and found several pitfalls leading to failure in survey administration. With this information, we developed a checklist that covers critical items in the survey process. We also reviewed newly developed methodologies for survey results analysis and application and described them using the Korean version of the Safety Attitudes Questionnaire as an example. Results : The checklist consists of three steps: survey preparation, administration, and analysis and application. Each step contains clear action items. The content even describes how to get buy-in from hospital executives and manage communication channels with them. Also, common misunderstandings regarding survey scores are described and possible solutions are suggested. In the analysis section, we demonstrate new methods for obtaining more accurate survey results and how to utilize these methods to develop and implement hospital-wide safety improvement programs. Conclusion : A successful safety culture survey is the foundation of all future safety improvement projects. This review is intended to guide hospitals in enhancing safety.