4 research outputs found
Changes in Do-not-resuscitate consent and medical costs before and after Severance-hospital-case: a single center study
No full text학위논문 (석사)-- 서울대학교 대학원 : 보건대학원 보건학과, 2018. 2. 이태진.목적: 2009년 소위 을 통해 환자의 의지에 따른 연명 치료의 중단이 법적으로 허용될 수 있는 토대가 마련되었고, 환자 및 보호자, 의료진의 존엄사에 대한 인식의 변화가 발생했을 것으로 예상할 수 있다. 본 연구에서는 연명의료결정법 시행 전, 해당 법이 도입된 결정적인 계기였던 전후 의향서 작성 건수, 시점을 비교하여 해당 사건이 환자, 보호자 및 의료진의 존엄사에 대한 인식에 미친 영향을 가늠하고자 한다. 또한 의향서 작성과 관련된 요인을 밝히며, 의향서 작성 시점에 따른 의료비의 차이를 분석한다. 이를 통해 이 의향서 작성에 미친 영향 및 보건경제학적 효과를 평가할 수 있으며, 나아가 올바른 연명의료결정법 시행을 위해 제언하고자 한다.
방법: 후향적 의무기록 연구를 통하여, 전후 3년 동안(2006년 5월 21일~2012년 5월 21일) 서울대학교병원 내과 병동에서 사망한 입원 환자를 대상으로, 전후 의향서 작성 건수, 시점, 의료비의 변화를 분석하였다.
결과: 연구 대상자는 4191명이었으며, 그 중 의향서를 작성한 환자는 총 2946명이었다. 전에 비해서 사건 후 집단에서 통계적으로 유의하게 의향서 작성 건수가 증가하였고(교차비 3.34, 95% 신뢰구간 2.90-3.84, 유의확률 <0.001), 의향서 작성 시점과 총 평균 의료비 및 사망 전 2주간 평균 의료비는 유의한 변화가 없었다.
결론: 본 연구에서는 전후 의향서 건수는 증가했지만, 작성 시점의 변화가 없었고, 의료비가 감소하지 않았다는 것을 밝혔다. 연명의료법 시행 이후 의향서 작성 건수의 증가가 예상되나, 불필요한 연명치료와 이로 인한 의료비 증가를 막기 위해서 의료공급자 및 일반 국민을 대상으로 법의 내용을 적극적으로 홍보하고, 의료공급자, 환자 및 보호자의 의식 개선이 반드시 필요하다.제1장. 서론 1
제2장. 연구 방법 6
제3장. 결과 11
제4장. 고찰 30
제5장. 결론 38
참고문헌 39
영문 초록 45Maste
Cardiovascular Effects of Long‐Term Exposure to Air Pollution: A Population‐Based Study With 900 845 Person‐Years of Follow‐up
No full text
Background
Studies have shown that long‐term exposure to air pollution such as fine particulate matter (≤2.5 μm in aerodynamic diameter [
PM
2.5
]) increases the risk of all‐cause and cardiovascular mortality. To date, however, there are limited data on the impact of air pollution on specific cardiovascular diseases. This study aimed to evaluate cardiovascular effects of long‐term exposure to air pollution among residents of Seoul, Korea.
Methods and Results
Healthy participants with no previous history of cardiovascular disease were evaluated between 2007 and 2013. Exposure to air pollutants was estimated by linking the location of outdoor monitors to the
ZIP
code of each participant's residence. Crude and adjusted analyses were performed using Cox regression models to evaluate the risk for composite cardiovascular events including cardiovascular mortality, acute myocardial infarction, congestive heart failure, and stroke. A total of 136 094 participants were followed for a median of 7.0 years (900 845 person‐years). The risk of major cardiovascular events increased with higher mean concentrations of
PM
2.5
in a linear relationship, with a hazard ratio of 1.36 (95% confidence interval, 1.29–1.43) per 1 μg/m
3
PM
2.5
. Other pollutants including
PM
2.5–10
of
CO
,
SO
2
, and
NO
2
, but not O
3
, were significantly associated with increased risk of cardiovascular events. The burden from air pollution was comparable to that from hypertension and diabetes mellitus.
Conclusions
This large‐scale population‐based study demonstrated that long‐term exposure to air pollution including
PM
2.5
increases the risk of major cardiovascular disease and mortality. Air pollution should be considered an important modifiable environmental cardiovascular risk factor.
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A focus group interview with health professionals: establishing efficient transition care plan for older adult patients in Korea
No full textBackground
Although transition care planning can affect the functional status and quality of life after acute hospitalization in older adults, little is known on problems associated with discharge planning in acute care hospitals in Korea. We aimed to investigate barriers and possible solutions on transfer planning of complex older patients in this study.
Methods
We used focus group interviews with the application of framework analysis. Twelve physicians providing inpatient care from 6 different institutions in Korea participated in the interview. Facilitating questions were extracted from 2 roundtable meetings prior to the primary interview. From transcribed verbatim, themes were constructed from corresponding remarks by participants.
Results
We revealed two main domains of the barrier, which included multiple subdomains for each of them. The first domain was a patient factor barrier, a composite of misperception of medical providers’ intentions, incomprehension of the healthcare system, and communication failure between the caregivers or decision-makers. The second domain, institutional factors included different fee structures across the different levels of care, high barrier to accessing health service in tertiary hospitals or to be referred to, the hardship of communication between institutions, and insufficient subacute rehabilitation service across the country.
Conclusions
Through the interview, physicians in the field recognized barriers to a smooth transition care process from tertiary level hospitals to community care, especially for older adults. Participants emphasized both the patients and hospital sides of adjustment on behaviors, communication, and greater attention for the individuals during the transition period
