미국, 캐나다, 영국의 재입원율 활용 현황

이상아,주영준,신재용,박은철,이후연,Lee, Sang-Ah,Ju, Yeong-Jun,Shin, Jae-Yong,Park, Eun-Cheol,Lee, Hoo-Yeon 한국의료질향상학회 2016 한국의료질향상학회지 Vol.22 No.1

Readmission which reflects capacity to manage patients and general level of medical services has been known for one of the causes of medical expenditure due to inefficient service. Compared to disease-specific readmission, hospital wide readmission (HWR) is relatively easy to understand, and has merit to get over limitation of collateral medical services assessment; therefore, a growing interest in development and usage of readmission indicator as quality of care indicator focusing on all-disease is detected. In this study, we investigate current state of risk standardized readmission rate indicator used in the United States, the United Kingdom, and Canada, and examine the considerations when using readmission rate as quality indicator in Korea. Differences in risk-adjustment methods were showed among countries. The United States do not control race not to hide socio-demographic factors on readmission. Canada shows differentiation compared to other countries about reflecting community factors. All three-countries utilize readmission rate as monitoring quality of care rather than incentives or penalty due to the fact that readmission rate could not represent the whole quality of hospital and has a limitation at controlling socio-economic factors. Therefore, for usage readmission rate as quality indicator in Korea, preparing readmission classification standard for Korean medical environment and additional methods for acquiring information by using discharge summary is need. Moreover, continued discussion with clinical specialists is needed for obtain clinical reliability and validity.

외상성 뇌손상 후두통과 기억장애가 발생한 환자에 서각지황탕가감방(犀角地黃湯加減方)을 투여한 1례 보고

이상아,권태욱,김명호,손한범,안립,장명웅,최동준,Lee, Sang-Ah,Kwon, Tae-Wook,Kim, Myung-Ho,Son, Han-Beom,Ahn, Lib,Jang, Myung-Woong,Choi, Dong-Jun 대한한방내과학회 2013 大韓韓方內科學會誌 Vol.34 No.4

The purpose of this study is to report the clinical effects of modified Seogakjihwang-tang on a patient who had headache and memory disorder after traumatic brain injury, which were considered as the result of blood stasis. The patient had headache and memory disorder after traumatic brain injury and treated with modified Seogakjihwang-tang three times a day for 60days. As a result, the numerical rating scale and pain rating score of headache decreased and the scores of mini-mental state examination-Korea, the Korean version of Montreal cognitive assessment and the mini-memory test increased during treatment with modified Seogakjihwang-tang. Therefore, this case supports a possibility that modified Seogakjihwang-tang might be an effective treatment to patients with headache and memory disorder after traumatic brain injury.

비타민 D 고용량 주사로 인한 심한 고칼슘혈증 발생 1예

이상아,문재철,Lee, Sang Ah,Moon, Jae Cheol 제주대학교 의과학연구소 2019 The Journal of Medicine and Life Science Vol.16 No.1

Hypercalcemia is often seen in patients, but most of them showed mild to moderate hypercalcemia. The severe hypercalcemia with a blood calcium level of 14.0 mg/dL or more is known to be associated mainly with malignant tumors. Because this is emergency status, most clinicians tried to decrease serum calcium level to near normal range to improve symptoms related to hypercalcemia. A 71-year-old female patient visited the emergency room with dizziness and general weakness. Her serum calcium level was very high (15.6 mg/dL), but serum PTH, 25-OH vitamin D, and PTH related peptide were normal. We can exclude hyperparathyroidism, familial hypocalciuric hypercalcemia, other connective tissue diseases, and hypercalcemia due to malignant tumors as a cause of severe hypercalcemia. Conclusively, we diagnosed as severe hypercalcemia due to high-dose vitamin D injections treated one week ago. High dose vitamin D injections have recently been shown to increase the frequency of prescription as the various causes and the clinicians needed to carefully monitor the serum calcium levels in the patients after treating with high dose vitamin D.

나비굴경유 수술을 통해 완치된 뇌하수체 거대선종에 동반된 쿠싱병 1예

이상아,문재철,Lee, Sang Ah,Moon, Jae Cheol 제주대학교 의과학연구소 2021 The Journal of Medicine and Life Science Vol.18 No.1

Cushing's disease (CD) is a rare illness characterized by chronic hypercortisolism secondary to the overproduction of adrenocorticotropic hormone by a pituitary adenoma, which is associated with a high risk of developing serious complications, such as diabetes mellitus, cardiovascular disease, and emotional disorders. Endoscopic transsphenoidal surgery is performed for the treatment of CD, and was initially preferred over other types of treatments. However, the recurrence after pituitary surgery for CD is a common problem after an initial successful surgery. In microadenomas, the remission rates were higher than those of macroadenoma. This patient had a giant tumor that was greater than 4 cm in length on sella magnetic resonance imaging, and panhypopituitarism was detected using a combined pituitary stimulation test. After transsphenoidal surgery, the patient required temporary hormone replacement for a short period of time. After 1 year, he showed a normal cortisol response on the overnight dexamethasone suppression test and low morning cortisol levels. Therefore, we indicated that the patient was cured of giant macroadenoma with panhypopituitarism before surgery, and thus, reported this case.

인슐린 투여가 당뇨병 환자의 삶의 질, 우울 요소에 미치는 영향

이상아 ( Sang Ah Lee ),박중열 ( Joong Yeol Park ) 대한내과학회 2009 대한내과학회지 Vol.77 No.1

Insulin is the most effective drug for reducing blood glucose in patients with diabetes commonly. But it has negative aspect for diabetic patients to change from oral hypoglycemic drug to insulin injection. Insulin injection makes patients feel reducing self-esteem and QOL (quality of life). So they complain depressive moods. Multiple insulin injection has an effect on patient`s emotion more negatively than one or two injection of insulin. It is suggested that physicians much more concern about self-esteem and emotional aspect of patients when they prescript insulin. (Korean J Med 77:57-59, 2009)

특용자원 닥나무를 활용한 영월 향토음식 개발 연구

이상아(Lee, Sang-Ah) 아시아강원민속학회 2021 아시아강원민속 Vol.36 No.-

예로부터 한지의 원료로 사용되어왔던 닥나무는 경제적 가치를 높게 평가 받아 조선시대 말기 전국적으로 널리 재배를 장려했다.『세종실록』153권 지리지 강원도 원주목 영월군에 기록에 따르면 “토의(土宣)는 기장 · 피 · 조 · 콩 · 보리 · 뽕나무 · 삼 · 배 · 밤 · 칠 · 대추 · 닥나무이다”라는 기록이 있고, 영월읍 거운리의 딱밭굴이라는 지역은 거운리 남쪽 강가에 닥나무 밭이 있어서 붙여진 지명이다. 이런 역사성을 바탕으로 본 연구에서는 특용 자원으로 닥나무를 선택하여 닥나무를 활용한 다양한 지역대표 음식을 개발하여 지역문화콘텐츠로 제시하였다. 이에 본 연구에서는 경제성장으로 소득 수준이 증대된 현 시점에서 무병장수를 원하는 사람들이 많아지는데 외적인 건강과 내적인 건강 모두에 대 한 관심은 바로 웰빙으로 이어지고 있다. 예로부터 한약재로 사용할 정도로 효능이 좋았던 닥나무를 건강보조식품으로 식용화 할 수 있는 방법을 제시하였다. 닥나무는 미백, 항산화, 항암 활성 등에 효과가 있고, 닥나무 열매에 사포닌, 비타민B 및 유지가 다량 함유되어 있다. 잎에는 플라보노이드, 글리코사이드, 페놀류, 유기산, 탄닌, 아미노산의 일종인 GABA(gamma amino butyric acid)가 함유되어 있다. 이런 닥나무의 효능을 바탕으로 닥나무를 첨가한 상품화를 유도한 다양한 향토음식을 개발하였다. 닥나무 식빵, 닥나무 두부, 닥나무 혼합 밀가루를 비롯하여 닥나무 주먹밥, 닥나무 감자수제비, 닥나무 제육 쌈 김밥, 닥나무 닭백숙, 닥나무 돼지고기 수육, 닥나무 코다리찜, 닥나무 황태찹쌀구이, 닥나무 돼지고기 김치볶음 등이다. 본 연구를 통해 개발된 닥나무 상품을 영월지역 특용자원으로 생산될 닥나무와 연계하여 상용화한다면 농산물 생산농가의 부가가치 창출 및 타지 역과의 차별화된 품질의 음식문화를 개발할 수 있다. The mulberry tree, which has been used as a raw material for Korean paper since ancient times, was highly valued for its economic value and was widely promoted nationwide at the end of the Joseon Dynasty. According to the record in Yeongwol-gun, Wonju-mok, Gangwon-do, in Volume 153 of the Annals of King Sejong, “The discussion of discussion is millet, pea, millet, soybean, barley, mulberry, hemp, pear, chestnut, chil, jujube, and mulberry.” There is this area, and the area called Dakbatgul in Geoun-ri, Yeongwol-eup was given the name because there was a field of mulberry trees along the river south of Geoun-ri. Based on this historicity, in this study, mulberry was selected as a special resource, and various regional representative foods using mulberry were developed and presented as regional cultural contents. Therefore, in this study, more and more people want a disease-free long life at this point in time when income levels have increased due to economic growth, and interest in both external and internal health is directly leading to well-being. A method for making mulberry tree, which has been effective enough to be used as a herbal medicine since ancient times, into an edible health supplement was presented. The mulberry tree is effective in whitening, antioxidant, and anticancer activity, and the mulberry fruit contains a large amount of saponin, vitamin B and oil. The leaves contain flavonoids, glycosides, phenols, organic acids, tannins, and gamma amino butyric acid (GABA), an amino acid. Based on the efficacy of this mulberry tree, various local foods were developed that led to the commercialization of the mulberry tree. Paper mulberry bread, mulberry tofu, mulberry noodles, mulberry mixed flour, mulberry rice ball, mulberry potato sujebi, mulberry pork ssam gimbap, mulberry chicken stew, mulberry pork broth, mulberry braised pork belly, mulberry yellow glutinous rice roast, mulberry pork kimchi stir-fry, etc. am. If the mulberry product developed through this study is commercialized in connection with the mulberry tree to be produced as a special resource in the Yeongwol region, it is possible to create added value for agricultural producers and develop a food culture of differentiated quality from other regions.

한국형 달 복제토(KOHLS-1)의 개선방향

이상아(Lee, Sang ah),이재호(Lee, Jae ho),장병철(Chang, Byung Chul),이태식(Lee, Tai Sik) 대한토목학회 2012 대한토목학회 학술대회 Vol.2012 No.10

여성 사회복지사의 간접차별 경험에 관한 질적 사례연구

이상아(Lee, Sang A),정원미(Jung,Won Mi) 한국사회복지실천연구학회 2018 미래사회복지연구 Vol.9 No.1

본 연구의 목적은 사회복지 현장에서 나타나는 간접차별의 작동원리에 관심을 가지고 여성 사회복지사들은 어떠한 간접차별을 경험하며, 이것이 근로 환경에서 어떠한 형태로 나타나게 되는지, 그 간접차별로 나타난 결과는 무엇인지에 분석하고, 이를 바탕으로 사회복지사의 인권 연구에 기여하고자 하였다. 이를 위해 먼저 기존의 간접차별 연구와 사회복지사 차별의 경험을 주목한 연구들을 검토하였고 다음으로 질적 사례연구를 통해 사회복지 영역에서 나타나는 차별의 메커니즘을 확인하였다. 그 결과, 사례 내 분석을 통해 각 사례의 기본적인 특성, 여성 사회복지사로서의 직장 진입과정, 현재 업무, 종사하고 있는 사회복지 영역에 따른 개인의 직접적 혹은 간접적 성차별 경험들을 도출하였다. 사례 간 분석 결과는 10개의 하위 범주와 3개의 핵심 범주로 분류되었다. 3개의 핵심 범주는 ‘간접 차별’ 과정에 따라 범주화하였고 세부적으로 ‘차별 발생 배경’, ‘간접차별 상황’, ‘간접차별 인식’이었다. 이를 토대로 사회복지 기관장과 상급자의 양성평등 교육 확대 필요성과 사회복지 종사자의 간접차별 문제에 대한 인식제고와 같은 실천적 함의를 제시하였다. The purpose of this study is to examine the “working principle of indirect discrimination” in the social welfare field. Specifically, it focuses on the experience of some kind of indirect discrimination among women social workers, how they appear in the working environment, and what the result of indirect discrimination are. This study identified the mechanism of discrimination in the social welfare field through qualitative case studies. The inter-case analysis results were classified into 10 sub categories and 3 core categories. The three core categories were categorized according to the process of “gender discrimination“ and were elaborated as “discrimination background“, “direct discrimination“, and “indirect discrimination“. This study suggested a policy proposal on the necessity of expanding gender equality education for senior officials and the heads of social welfare institutions. In addition to this, the social welfare sector and worker recognized the indirect discrimination, increased the sensitivity to it, and suggested practical implications such as raising awareness on indirect discrimination problems.

건강보험 40년의 주요 지표

이상아 ( Sang Ah Lee ),박은철 ( Eun-cheol Park ) 한국보건행정학회 2017 보건행정학회지 Vol.27 No.3

This year marks the 40th anniversary of the introduction of National Health Insurance (NHI) which has contributed to improving public health and accessibility. This article aims to show the trends of main indicators during the last 40 years. NHI has achieved rapid expansion of target population (1977-1989). The percentage of population covered increased from 8.8% in 1977 to 94% in 1990. The average number of visit days per person was 0.75 in 1977 but significantly increased to 31.11 in 2015. In 2015, NHI revenues were 52.4 trillion won and expenditures were 48.2 trillion won which is 9.5 times and 9.6 times higher than in 1995. NHI achieved universal coverage in short period of time and has contributed to improving the healthcare status. However, there still remain problems including low-benefit coverage and high out of pocket money. Therefore, the effort to reform these problems is needed.

자유주제 : 三虞(삼우)와 卒哭(졸곡)의 同異(동이)에 대한 小考(소고)

이상아 ( Sang Ah Lee ) 동방한문학회 2014 東方漢文學 Vol.0 No.59

삼우와 졸곡은 喪禮의 한 의절이다. 기존의 통설은 이 두 의절을 서로 다른 날 행해지는 별개의 제사로 인식한다. 이러한 인식은 後漢의 鄭玄이 이전 학자들의 통설을 깨고 경문을 다르게 해석한 것에서 비롯된 것이다. 그러나 元나라 敖繼公이 삼우와 졸곡은 동일한 날 행해지는 동일한 제사라고 하여 정현의 해석에 대해 의문을 제기한 이후 이에 대한 논란이 이어졌으며 청나라에 와서는 그 논란이 절정에 이르렀다. 조선에서도 소수이기는 하나 삼우와 졸곡은 같은 것이라는 견해를 적극 개진한 학자들이 있었다. 이 글은 이러한 논란의 원인이 무엇인지를 살펴보고 각각의 입장에서 제시한 근거가 과연 타당한 것인지에 대해 규명할 목적으로 작성되었다. 이를 위해 먼저 虞와 卒哭의 原義를 경전의 원문에 기초하여 살펴본 뒤 삼우와 졸곡의 동이에 대한 중국과 조선의 이해 시각을 조명하고 동일설과 부동설의 문제점을 검토하였다. 그 결과 지금까지의 논의들은 모두 삼우와 졸곡의 동이를 명시적으로 제시한 경문을 근거로 한 것이 아니라 동일한 경문에 대해 구두와 해석을 달리함으로 인해 도출된 결론임을 알 수 있었다. 즉 삼우와 졸곡을 다르게 보는 통설 역시 불가변의 확론이 아니며 동일설 역시 경문 해석의 타당성을 다수에게 인정받았을 때 언제든지 통설로 바뀌어 이에 따른 行禮 역시 달라질 수 있다는 것이다. 예를 들면 초우-재우-삼우-졸곡으로 이루어진 4차례의 제사가 동일설에 따르면 초우-재우-삼우졸곡으로 이루어진 3차례의 제사로 변하며 祝辭 역시 哀薦虞事(초우)-哀薦虞事(재우)-哀薦成事(삼우)-哀薦成事(졸곡) 또는 哀薦虞事(초우)-哀薦虞事(재우)-哀薦虞事(삼우)-哀薦成事(졸곡)라고 했던 것이 동일설에 따르면 哀薦虞事(초우)-哀薦虞事(재우)-哀薦成事(삼우졸곡)으로 변하게 된다. 이에 대해 아직까지 확실한 증거가 나오지 않는 상황에서 각각의 설이 장단점은 있지만 삼우와 졸곡을 동일한 것으로 본 해석이 좀 더 자연스럽게 보인다. Samwoo(三虞) and Jolgock(卒哭) are two kinds of proprieties of mourning decorums. In conventional thinking people have viewed these proprieties as separate memorial ceremonies. This viewpoint was derived from the interpretation of Li Jing(禮經) by Jeong Hyun(鄭玄) of the Later Han Dynasty and thus overturned the existing conventional idea. However, O Gyegong(敖繼公) of Yuan Dynasty insisted that Samwoo(三虞) and Jolgock(卒哭) were the same memorial ceremonies which commemorate the same day. Raising questions of the Jeong Hyun(鄭玄)’s interpretation it continued to provoke controversy at the peak of the Ching Dynasty. There were; however, a few scholars in the Joseon Dynasty who insisted that the two ceremonies were the same. The purpose of this paper is to examine the cause of the controversy and inquire if the bases of the two sides are valid respectively. First of all, I examined the primary meaning of Samwoo(三虞) and Jolgock(卒哭) based on the original text. Then I illuminated how China and the Joseon Dynasty understood the similarities and the differences of Samwoo(三虞) and Jolgock(卒哭) and investigated the weakness of the two theories. Finally, I found that current arguments were derived not from the base of Li Jing(禮經) but instead were based on the various interpretations of the book. Therefore, I propose that the conventional idea of viewing the two ceremonies differently is not an immutable theory. Besides, the identical theory can be embraced and arrives at a common view when the majority approve that the interpretation of the original book. As a result, the ritual can also be changed following the new viewpoint. We hardly have conclusive evidence but I find that the ancient interpretation before Jeong Hyun(鄭玄) which considered the two ceremonies as the same seems to be more natural to spite the pros and cons respectively.