• 제목/요약/키워드: Cooperative medical treatment

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족관절염좌 환자 관리를 위한 한의표준임상경로 개발 연구 (A Study on the Development of a Clinical Pathway of Korean Medicine for the Management of Patients with Ankle Sprain)

  • 윤상도;송미연;정원석;김형석;신우철;김태오;조휘성;서연호;서상우;서준원;강준혁;유승호;김세윤;조재흥
    • 한방재활의학과학회지
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    • 제32권3호
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    • pp.141-151
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    • 2022
  • Objectives The purpose of this study is to improve the accessibility of Korean medicine by standardizing managements, improving quality of medical services, and reducing medical costs in ankle sprain by develop clinical pathway (CP). Methods The development of CP in this study is based on clinical practice guideline (CPG) for ankle sprain, and aims to maximize the quality of treatment, such as reducing treatment time and medical costs, and increasing patient satisfaction through standardized pathway. The CP was revised after consultation and review by the advisory committee. The advisory committee is consisted of a stakeholder group applying the CP. Results In previous research studies, there were no Korean medicine CP studies on ankle sprain. Based on CPG for ankle sprain and analysis of medical records, 6 types of time task matrix type CP (for Korean medicine doctors, medical assistant, patients) and 4 types of algorithm type CP (for Korean medicine clinics, Korean medicine hospitals, and cooperative practicing hospitals, public medical centers) were derived as a result. Conclusions Ankle sprain CP is expected to not only increase patient satisfaction and maximize the quality of treatment, but also reduce the financial burden of health insurance by reducing medical costs.

한의학에서 본 홧병의 해석 ('HWABYUNG' in the view of Oriental Medinine)

  • 김종우;황의완
    • 동의신경정신과학회지
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    • 제5권1호
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    • pp.9-15
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    • 1994
  • 홧병은 민간에서 많이 통용되는 한국의 문화관련질환으로 그간 정신과의사와 한의사 사이에서 많은 연구가 진행되어 왔다. 정신과의사는 홧병을 특유한 병리적인 경과를 밟는 '병'으로의 의미로 설명한데 반해 한의사는 화의 양상을 가진 '증'의 개념으로 이를 해석하고 있는 것을 볼 수 있다. 저자는 기존의 홧병연구를 바탕으로 한의학적으로 해석을 하여볼 때, 발병원인은 지속된 억울된 감정으로 인한 간기울결로 말미암고, 홧병의 발생이 여성에게 많은 까닭은 여성이 스트레스를 잘 풀지 못하며 생리적, 장기적 취약점이 있으며, 화의 위로 상승하는 성질과 병이 신수가 심화를 억제하지 못하는데서 비롯하므로 증상이 화의 역동성과 연관된다는 점, 그리고 발병이 만성화의 경과를 밟는 이유는 복합감정이 문제가 되고 또 감정이 오래되어 화로 바뀌며 나이가 들어 수가 화를 억제하지 못하는 시기에 발병한다는 점으로 홧병을 해석할 수 있었다. 이는 정신과의사의 임상적 경과의 관찰과 한의사의 화에 대한 연구가 상호의 협조가 병의 경과와 병리기전 예후 및 치료대책을 정립해 나가는데 있어서 더욱 필요함을 제시해 주고 있다.

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항문암 환자에서 근치적 목적의 동시 항암화학 방사선치료의 결과 (The Results of Curative Concurrent Chemoradiotherapy for Anal Carcinoma)

  • 정재욱;윤미선;송주영;안성자;정웅기;나병식;남택근
    • Radiation Oncology Journal
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    • 제28권4호
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    • pp.205-210
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    • 2010
  • 목적: 항문암으로 근치적 목적의 동시 항암화학 방사선치료를 받은 환자들을 대상으로 치료반응의 예측인자, 생존율과 관련된 예후인자를 알아보고자 하였다. 대상 및 방법: 전남대학교병원에서 1993년부터 2008년까지 병리조직학적으로 항문의 편평상피세포암으로 진단받고 근치적 목적의 동시 항암화학 방사선치료를 받은 42명의 환자를 대상으로 후향적으로 분석하였다. 환자들 나이의 중앙값은 61.5세 (39~89에)였고 방사선량의 중앙값은 50.4 Gy (30.0~64.0 Gy)였다. T병기 상 2기 이하였던 환자는 총 36명 (85.7%)이었다. 영역림프절전이는 14명(33.3%)에서 있었다. 항암화학요법으로는 5-fluorouracil, mltomycin 병행요법으로 치료받은 환자가 36명 (85.7%)이었고 나머지는 5-fluorouracil, cisplatin 병행요법을 받았다. 결과: 전체 환자의 추적관찰기간의 중앙값은 62개월 (2~202개월)이었다. 5년 전체생존율, 국소영역제어율, 무병생존율, 무장루생존율은 각각 86.0%. 71.7%. 71.7%. 78.2%였다. 전체생존율과 관련된 인자로 단변량분석에서는 Eastem Cooperative Oncology Group (ECOG) 수행능력과 완전관해여부가 유의하였고 다변량분석에서는 ECOG 수행능력만이 유의하였다. 국소영역제어율, 무병생존율과 무장루생존률에 관련된 인자는 단변량이나 다변량분석 모두 유의한 인자는 없었다. 치료 후 완전관해 여부와 관련하여 유의하게 예측할 수 있는 인자는 없었다. 국소영역재발은 7명에서, 원격전이는 1명에서 발생하였다. 전체 환자에서 평가가 가능하였던 급성 부작용으로 3도의 피부염이 4명(9.5%), 2도는 22명(52.4%)에서 발생하였다. 결론: 본 연구에서 항문의 편평상피세포암에 대한 근치적 목적의 동시 항암화학 방사선치료로 양호한 생존율을 얻을 수 있었고, 특히 ECOG 수행능력이 1 이하인 환자의 생존율이 유의하게 높았다. 그러나 치료 후 종양반응을 예측할 수 있는 유의한 인자는 없었다.

교통사고 중상자의 한방치료 경험에 대한 질적 연구 (A Qualitative Research on the Treatment Experiences of Patients with Serious Injury in Traffic Accidents Treated with Traditional Korean Medicine)

  • 김선혜;조효림;봉성민;성원석;조현석;김은정
    • 대한한의학회지
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    • 제40권2호
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    • pp.72-88
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    • 2019
  • Objectives: The purpose of this study is to understand the experience of traffic accident patients with serious injury treated with Traditional Korean Medicine (TKM). Methods: This study was conducted on the basis of grounded theory. We recruited 10 participants who had been hospitalized in Dongguk University Bundang Oriental Hospital after traffic accident. Raw data was collected by in-depth interview, and analyzed by using constant comparison. The coding(open-axial-selective) was performed in order to create paradigm and theoretical model, which can explain main theme of this study. Results: Core phenomenon of this study was 'Experiencing TKM treatment as an alternative' and core category was 'Searching for the answer to the management of traffic accident sequela through TKM treatment' Conclusions: For patients with serious injury, 'Experiencing TKM treatment as an alternative' has meaning as the following: First, The absence of accurate radiography and surgical management makes it hard for patients to choose Korean medicine hospital immediately after traffic accident. Second, Effectiveness of TKM treatment should be evaluated in the long term. Third, TKM treatment is superior to Western medicine treatment in managing long-term patients who suffered from serious injury involved in traffic accident. Finally, Cooperative service of the Western medicine and TKM will provide more satisfactory medical care for traffic accident patients.

Treatment outcomes of neoadjuvant concurrent chemoradiotherapy followed by esophagectomy for patients with esophageal cancer

  • Kim, Yong-Hyub;Song, Sang-Yun;Shim, Hyun-Jeong;Chung, Woong-Ki;Ahn, Sung-Ja;Yoon, Mee Sun;Jeong, Jae-Uk;Song, Ju-Young;Nam, Taek-Keun
    • Radiation Oncology Journal
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    • 제33권1호
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    • pp.12-20
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    • 2015
  • Purpose: To evaluate treatment outcomes and determine prognostic factors in patients with esophageal cancer treated with esophagectomy after neoadjuvant chemoradiotherapy (NCRT) Materials and Methods: We retrospectively evaluated 39 patients with esophageal cancer who underwent concurrent chemoradiotherapy followed by esophagectomy between 2002 and 2012. Initial clinical stages of patients were stage IB in 1 patient (2.6%), stage II in 5 patients (12.9%), and stage III in 33 patients (84.6%). Results: The median age of all the patients was 62 years, and the median follow-up period was 17 months. The 3-year overall survival (OS) rate was 33.6% in all the patients. The 3-year locoregional recurrence-free survival (LRFS) rate was 33.7%. In multivariate analysis with covariates of age, the Eastern Cooperative Oncology Group performance status, hypertension, diabetes mellitus, tumor length, clinical response, clinical stage, pathological response, pathological stage, lymphovascular invasion, surgical type, and radiotherapy to surgery interval, only pathological stage was an independent significant prognostic factor affecting both OS and LRFS. The complications in postoperative day 90 were pneumonia in 9 patients, anastomotic site leakage in 3 patients, and anastomotic site stricture in 2 patients. Postoperative 30-day mortality rate was 10.3% (4/39); the cause of death among these 4 patients was respiratory failure in 3 patients and myocardial infarction in one patient. Conclusion: Only pathological stage was an independent prognostic factor for both OS and LRFS in patients with esophageal cancer treated with esophagectomy after NCRT. We could confirm the significant role of NCRT in downstaging the initial tumor bulk and thus resulting in better survival of patients who gained earlier pathological stage after NCRT.

국소적으로 진행된, 절제 불가능한 췌장암에서 정위 방사선 치료 (Locally Advanced, Unresectable Pancreatic Cancer Treated by Stereotactic Radiation Therapy)

  • 최철원;김미숙;조철구;류성렬;양광모;유형준;이동한;지영훈;한철주;김진;김영한
    • Radiation Oncology Journal
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    • 제24권1호
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    • pp.11-20
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    • 2006
  • 목적: 국소적으로 진행된, 절제 불가능한 췌장암 치료에 있어 고식적 방사선 치료와 비교하여 Cyberknife(CK)를 이용한 정위 방사선 치료의 생존율 및 급성 독성에 대해 분석하고자 하였다. 대상 및 방법: 2003년 4월부터 2004년 4월까지의, Eastern Cooperative Oncology Group (ECOG) 활동도 3 이하이며 CT 및 PET/CT로 평가하여 원격 전이 없는 국소 진행된 췌장암 환자 19명을 대상으로 하였다 대상 환자는 점차 방사선량을 증가시키는 방법으로 33 Gy, 36 Gy, 39 Gy를 3분할로 각각 6명, 4명, 9명에서 CK를 이용한 정위 방사선 치료를 시행하였으며, 생존율 및 Radiation Therapeutic Oncology Group (RTOG) acute radiation morbidity criteria에 의한 위장관 독성을 분석하였다 또한 나이, 성별, ECOG 수행 점수, 항암 치료, 우회로 조성술(bypass surgery) 여부, 방사선량, CAl9-9, 계획용 표적 체적(planning target volume, PTV), CT상 주위 장기 및 혈관 침범 여부 등을 Log Rank test를 이용하여 예후 인자를 평가하였다. 결과: 본 연구에서 중앙 생존 기간은 11개월, 1년 생존율은 36.8%였다. 추적 조사 기간 중(범위 $3{\sim}20$개월, 중앙값 10개월) 유의한 위장관 급성 독성은 관찰되지 않았다 단일 인자 분석에서 계획용 표적 체적만이 유의한 예후 인자로 80cc 이하인 경우가 80cc 이상인 경우보다 생존율이 높았으며(p-value < 0.05), 나이, 성별, ECOG 수행 점수, 항암 치료, 우회로 조성술, CAl9-9 수치, 주위 장기 및 혈관 침범 여부 등에서는 통계적으로 유의한 차이를 보이지 않았다. 다인자 분석에서는 65세 이하인 경우와 PTV 80 co 이하인 경우에서 생존율이 높았다. 결론: 고식적 방사선 치료, 고선량 입체조형 방사선 치료(high dose conformal radiation therapy), 수술 중 방사선 치료(intraoperative radiation therapy) 또는 세기 조절 방사선 치료(Intensity modulated radiation therapy, IMRT)를 이용한 최근의 결과와 비교하여 CK를 이용한 정위 방사선 치료는 생존율 측면에서 비슷하거나 나은 결과를 보였다. 또한 심각한 부작용은 관찰되지 않았으며 짧은 기간의 치료로 환자에게 편의를 제공할 수 있어 결과적으로 삶의 질을 향상시킬 수 있을 것이다. 따라서, 이 새로운 치료 방법은 국소 진행된, 절제 불가능한 췌장암 환자에서 심각한 부작용 없는 효과적인 치료가 될 것으로 생각된다. 또한 계획용 표적 체적은 CK 치료의 유용한 예후 인자로 사용될 것이다.

만성 치주염을 동반한 파킨슨병 환자의 전악 보철 수복 증례 (Full mouth rehabilitation for a Parkinson's diseases patient with chronic periodontitis: a case report)

  • 고은솔;김종진;백진;차현석;이주희
    • 구강회복응용과학지
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    • 제35권4호
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    • pp.228-234
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    • 2019
  • 파킨슨병은 떨림, 느려진 움직임, 근육의 경직, 자세 불안정성, 보행장애 등의 특징을 나타내는 신경변성 질환으로 도파민과 같은 신경전달 물질이 고갈되어 생긴다. 이러한 파킨슨병의 특성으로 인해 환자들은 협조적으로 치과 치료를 받는 것이 어렵다. 본 증례에서는 만성 치주염이 있는 47세의 파킨슨병 환자에게 고정성 보철 및 임플란트 식립을 통한 전악구강수복을 시행하였고 기능적, 심미적으로 만족할만한 결과를 얻을 수 있었다. 손 조작능력의 저하와 같은 파킨슨병의 특성을 고려하여 짧은 간격의 주기적인 내원을 통한 관리가 필요할 것이다.

Survival Effect of Supportive Care Services for Turkish Patients with Metastatic Gastric Cancer

  • Namal, Esat;Ercetin, Candas;Tokocin, Merve;Akcali, Zafer;Yigitbas, Hakan;Yavuz, Erkan;Celebi, Fatih;Totoz, Tolga;Pamukcu, Ozgul;Saglam, Emel
    • Asian Pacific Journal of Cancer Prevention
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    • 제16권3호
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    • pp.1213-1217
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    • 2015
  • Background: Gastric cancer is the second most common cause of cancer- related deaths worldwide and ranks $11^{th}$ or $14^{th}$ among all deaths. Patients with advanced disease require supportive care along with the medical and/or surgical treatment. Aim: To assess the need for palliative care for patients with advanced tumours along with standard clinical therapy. Materials and Methods: Eighty-four patients with metastatic (stage 4) gastric cancer, including both patients who had received surgical treatment or not, were followed up in Bagcilar Training and Research Hospital, Division of Medical Oncology between 2011 and 2014. They were categorised as supportive care (-) (Group 1, n=37) and (+) groups (Group 2, n=47) and evaluated retrospectively. Results: Demographic characteristics of the patients were as follows: mean age, Group 1, $65.2{\pm}10.5$ years, Group $2,63.7{\pm}11.3$ years; male/female ratio, Group 1, 21/16, Group 2, 28/19; distribution of Eastern Cooperative Oncology Group (ECOG) performance scores of 0 and 1, Group 1, ECOG 0 (n=9) and 1 (n=14), Group 2, ECOG 0 (34) and 1 (n=13) (p<0.0001); patients receiving second-line, Group 1 (n=7) and Group 2 (n=22) (p<0.008) or third - line chemotherapy,Group 2 (n=6) (p<0.02); mortality rates, Group 1, (n=28; 75.6%) and Group 2 (n=30; 63.8%); progression-free survival (PFS) rates, Group 1, $17.4{\pm}6$ weeks, Group 2, $28.3{\pm}16.2$ weeks; statistically significant overall survival rates, Group 1, $20.8{\pm}8.2$ weeks and Group 2, $28.3{\pm}162$ weeks (p<0.01). Conclusions: The supportive care team (medical oncologist, general surgeon, internal medicine specialist, algologist, psychiatrist and radiologist) can play a role in the treatment of metastatic gastric tumours, with improvements shown in terms of the performance status of cases, eligibility of patients to be on chemotherapy programmes for longer duration and overall survival rates in Turkey.

최근 3년간 일개 불임전문 한방병원에 내원한 불임환자의 실태분석과 한방불임치료정책에 대한 제언 (A Study on the Status of Patients with Infertility in a Department of Oriental Gynecology for the last Three Years and on the Future Policy of Infertility Treatment in Oriental Medicine)

  • 권수경;강명자;김동일
    • 대한한의학회지
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    • 제27권2호
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    • pp.44-56
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    • 2006
  • Objectives : This study was to analyze the status of patients with infertility in the department of oriental gynecology in an oriental medical hospital and propose infertility treatment in oriental medicine. Methods : This study was presented with 2,153 cases of infertile women who had visited the department of oriental gynecology in one oriental hospital in Seoul from 2002 to 2004. Results : The total number infertile patients has decreased year by year. The age range of patients was getting higher and the age group between 30 and 35 took up about one half of the total patients. The duration of infertility for less than 3 years held about 50-60% of the total patients, and the mean duration of infertility was $39.18{\pm}29.57$ months (2004). The most common occupations of females were professionals or administrative managers. The secondary infertility was increasing and unexplained infertility increased from 38.2% (in 2002) to 54.4% (in 2004). However the duration of treatment was shorter. This shows that the age range of the patients having oriental-medicine treatment is gradually getting higher and the number of the patients having oriental-medicine treatment and compliance is decreasing. Conclusions : More studies about objectification of oriental medicine need to precede any other studies. Then, it is thought to be necessary to rebuild cooperative relationships between oriental & western medicine through systematic research and political supports and to establish firm foundations of oriental medicine.

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재발된 췌장암 환자의 한의 기반 통합 암 치료에 대한 증례보고 (A Case Report of Traditional Korean Medicine Based-Integrative Oncology of Recurrent Pancreatic Cancer)

  • 주한음;김재욱;박지혜;조영민;서현식;고은주;박소정;유화승
    • 대한암한의학회지
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    • 제27권1호
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    • pp.1-12
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    • 2022
  • Objectives: To report recurrent pancreatic cancer treated by Korean medicine based-integrated oncology treatment, who is improved quality of life without progression of cancer Method: A 63-year-old female patient diagnosed with recurrent pancreatic cancer in April, 2022 received Chemotherapy with Korean medicine based integrative oncology treatment. Radiologic outcome was assessed by Abdomen Computed Tomography (CT) based on Response Evaluation Criteria In Solid Tumors (RECIST). Clinical outcomes were assessed by National Cancer Institute Common Terminology Criteria for Adverse Event (NCI-CTCAE), Eastern Cooperative Oncology Group (ECOG), Numeric Rating Scale (NRS) Result: During 2months of treatment, Cancer size was stable in Abdominal CT. Chief complaints, Abdominal pain and dyspepsia, were improved and ECOG score was improved from grade 2 to 1. There were no toxicity on laboratory test and no side effects of grade 3 or higher on NCI-CTCAE. Conclusion: This report shows that Korean medicine based integrative oncology treatment might contribute to synergetic effect to Chemotherapy and improvement of quality of life