• 치위생과학회지
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• 제20권4호
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• pp.261-268
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• 2020

Background: A comprehensive history taking at the first visit could be an important start of treatment. This study investigated the current status of the initial history taking for dental patients in S area, and the implementation and importance of the initial history taking process. Based on this, we intend to provide basic data for the development of organized and standardized questionnaires in dental clinics. Methods: In April 2019, 303 dental clinics in S area were targeted and special dental clinics (orthodontics, children, and disabled) were excluded. The questionnaire consisted of 29 items, including general characteristics, systemic disease history, dental history, oral health behaviors, and the data were obtained through self-administered questionnaire. Results: Initial history taking was mostly implemented using oral and questionnaire at the time of the first visit. Systemic disease history, dental history, and oral health behaviors differed in the work experience of the dental clinic staff. As a result of analyzing the importance according to implementation, there were significant differences in all questions except drug-related items. The importance of the questionnaire was highly recognized, but the reason it was not actually implemented was because of existing the questionnaire in the clinic and lack of time. Conclusion: Considering that the initial history taking implementation rate showed low, it is necessary to develop standardize a practical questionnaire and interview skills for dental clinics in the future. In addition, training programs should be provided to dental staff that can recognize the importance of initial history taking questionnaires and contribute to active implementation.

• Journal of Oral Medicine and Pain
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• 제49권3호
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• pp.57-64
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• 2024

Purpose: The aim of this study is to analyze the final diagnosis and the pain characteristics of patients with suspected nonodontogenic toothache and to contribute to the knowledge on differential diagnosis. Methods: A retrospective analysis was conducted based on medical records from 185 patients. The following data were collected: age, sex, pain characteristics, radiographic results, initial diagnosis and treatment, and final diagnosis and treatment. The final diagnosis and the pain characteristics of the 3 most common final diagnoses were analyzed. Results: Myofascial pain (MFP) was the most prevalent diagnosed condition accounting for 37.8% of cases, followed by pulpal pain (P) at 31.4%, and trigeminal neuralgia (TN) at 18.9%. There were significant differences in age, onset of the pain, and pain intensity across the 3 groups (all p<0.01). TN group exhibited a lower frequency of spontaneous and continuous pain than the MFP and P groups (all p<0.001). The proportion of patients reporting pain alleviating and aggravating factors related to dental pain was significantly higher in the P group than in the MFP and TN groups (all p<0.001). A concordance rate of 57.0% was observed between the initial and the final diagnosis. Twenty-six patients underwent tooth extractions and 24 patients had root canal treatments. Conclusions: It is important to differentiate between dental pain and nonodontogenic toothache to avoid unnecessary dental treatments. Comprehending the pain characteristics of each condition, taking a thorough history taking, and performing diagnostic tests can help differential diagnosis.

• 대한임상독성학회지
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• 제9권1호
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• pp.14-19
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• 2011

Purpose: Most paraquat poisonings are easily diagnosed by history taking on physical examination, however, some are failed to be diagnosed initially if the poisoning was veiled. The purpose of this study was to explore the clinical characteristics of veiled paraquat poisoning. Methods: We retrospectively reviewed the medical records of patients whose discharge diagnosis was paraquat poisoning in one university teaching hospital between 1 Jan, 2001 and 31 Dec, 2010. Veiled paraquat poisoning was determined when there was a positive urine paraquat kit in patients who did not mention paraquat poisoning in an initial physical examination or had unknown cause of pulmonary fibrosis, acute renal failure, or multi-organ failure. Results: Of the 117 patients with paraquat poisoning during the study period, 6 patients (5.1%) had veiled paraquat poisoning. The clinical characteristics were 1) proteinuria - 6 (100%), 2) increased creatinine - 4 (66.7%), 3) green skin stains - 2 (33.3%), 4) mucosal ulcer - 3 (50%). Blood chemistry results were variable. Conclusion: We should suspect veiled paraquat poisoning for patients who have proteinuria, increased creatinine, green skin stain, mucosal ulcer and vomiting, or if they have rapidly progressing acute renal failure or multi-organ failure with unknown cause, even if patients didn't mention about paraquat poisoning upon the initial physical examination. In cases with the above clinical conditions, a thorough repeated physical examination including history taking and use of urine paraquat kits should be performed.

• 한국임상수의학회지
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• 제18권1호
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• pp.67-69
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• 2001

A 3 years-old male Tosa dog was referred to Seoul National University Veterinary Medical Teaching Hospital with a history of difficulty in mastication. Clinical signs of dropped jaw, drooling, mild depression and dehydration were observed. According to history taking, physical examination, neurologic examination, complete blood count (CBC), serum chemical profile and radiography, the dog was diagnosed as idiopathic trigeminal nerve paralysis. Electroacupuncture treatment was applied to the dog on local and distal point at an interval of 7 days. Local points were GB-1 (Tong Zi Liao) of gall bladder meridian and ST-7 (Xia Guan) of stomach meridian. Distal points were PC-4 (Xi Men), PC-6 (Nei Guan) of pericardium meridian. Electrical stimulus was performed for 20 minutes at the frequency of 3 Hz, 3 Volts on ST-7. Ten days after the initial electroacupuncture treatment, clinical signs related to trigeminal nerve paralysis were almost disappeared.

• 한국지반공학회:학술대회논문집
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• 한국지반공학회 2009년도 세계 도시지반공학 심포지엄
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• pp.956-962
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• 2009

A high embankment is generally constructed by dividing into several sub-embankments. Unlike any soil embankment, a rock embankment is constructed by means of dynamic compaction. Such a sub-embankment and dynamic compaction may induce an increase of pressure at the lower part of embankment and cause a different behavior of ground from initial status. In this study, settlement of a high rock embankment is estimated using a hyperbolic model taking into construction history. The results from prediction are compared with those obtained from field measurements and large plate loading tests.

• 한국의료질향상학회지
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• 제2권1호
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• pp.68-84
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• 1995

Background: Guideline for practice is useful because it can be the standard for assessment and way to improve quality. We need to take account of expert opinion and consensus as well as scientific evidences to develope practice guideline because it should be practical. Delphi method has been developed to gather opinions from experts fairly. This study was designed to develop practice guideline and apply it to practices as a method to improve quality in primary medical care. Methods: Hypertension(in adults over 18 years old) was selected as a target problem. Self questionnaires about management of hypertensive patients were developed by a researcher with advice of 11 experts. The questionnaires were designed to response as a 5 pont scale. The results of previous questionary were given to respondents in second and third questionnaires. If needed, the questionnaires were changed on the previous responses. The items with medium greater than or equal to 4 point in 1st and 2nd responses were accepted in guideline. The items with medium lesser than or equal to 3 point were questioned again about whether they can be excluded or not. The criteria for assessment was made with reference to guideline and applied to 85 hypertensive patients of 9 family practitioners. At 3 months after practice guideline had been given to family practitioners, performance of same practitioners was assessed with 36 new hypertensive patients. Results: 23 professors in family medicine, 22 family practitioners and 6 cardiologists, responded among 50, 50, 15 respectively. Practice guideline with 33 items was developed as a result of 3 times questionaires. The difference of responses between professors in family medicine, family practitioners and cardiologists was not significant. Performance of practice was improved in diagnosis, history taking about 6 fields, laboratory examination and decision making about time of pharmaceutical prescription. It was not improved in physical examination, life style modification, method of pharmaceutical prescription, choice of initial antihypertensives and history taking about duration of disease and diet habit. It was decreased in history taking about psychosocial factors. The assessment scores were low in history taking, physical examination and life style modification before and after use of practice guideline. Conclusion: Practice guideline for hypertension could be developed by Delphi method. Performance of practice improved partially after use of guideline.

• 의학교육논단
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• 제14권1호
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• pp.51-56
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• 2012

Purpose: Precepted video review (PVR) has been considered one of the methods for the remediation of clinical performance examinations (CPX). This study quantified the effect of brief PVR on CPX scores. Methods: For two years, final-year students (61 students in the 1st year's cohort and 54 in the 2nd year's cohort) participated in CPXs. The scores on the initial CPX were announced to the students shortly after that CPX administration. There was no PVR after the initial CPX in the 1st year. All participants of the 2nd year were notified of the opportunity to voluntarily receive brief PVR after the initial CPX. Several months after the initial CPX, the students took the latter CPX in both years. The differences of scores between initial and latter CPX were compared in good performers and poor performers of the initial CPX. Results: Thirteen poor performers and 8 good performers received PVR in the 2nd year. In the 1st year, history taking (Hx), physical examination, and patient physician interaction (PPI) scores of the good performers of the initial CPX were significantly decreased on the latter CPX. In the 2nd year, the Hx and PPI scores of the good performers of the initial CPX, who received PVR, were significantly decreased at the latter CPX. The Hx and PPI scores of the poor performers of the initial CPX were significantly increased at the latter CPX in both years regardless of PVR. Conclusion: The changes in CPX scores according to PVR did not show any consistent trend. Brief PVR appears to be not sufficient for improving CPX scores.

• Clinics in Shoulder and Elbow
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• 제22권1호
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• pp.46-49
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• 2019

A 73-year-old woman presented with a recurrent cystic mass around her left olecranon. She had a history of 8 steroid injections due to elbow pain beginning 3 years ago and twice had undergone aspiration of olecranon bursitis that developed two months prior to presentation. She had been taking medications for hypertension and diabetes with no pertinent past history. On magnetic resonance imaging (MRI), there were multiple nodules in the olecranon bursa, which were isointense to muscle on T1-weighted images and hyperintense to muscle on T2-weighted images. Our initial diagnosis was synovial chondromatosis. On bursoscopy, masses of gray-white colored nodules were observed in the bursa. Finally, synovial chondromatosis and non-tuberculous mycobacterial infection were concurrently diagnosed. In conclusion, uncalcified synovial chondromatosis and rice bodies can have similar visual and MRI characteristics; therefore, we suggest that clinicians should be aware of the possibility of other infections in cases of this type.

• Childhood Kidney Diseases
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• 제19권1호
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• pp.1-7
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• 2015

Coexisting voiding and bowel dysfunction in children are common in the clinic. The idea that overactive bladder (OAB) and constipation arise from one single pathophysiology has been reinforced in many studies. In Korea, a nationwide multicenter study conducted in 2009 showed that overall prevalence of OAB in children, 5-13 years of age, was 16.59% and this number has increased more recently. The initial step to manage coexisting fecal retention and OAB in children is to characterize their bowel and bladder habits and to treat constipation if present. Although diagnosing constipation in children is difficult, careful history-taking using the Bristol Stool Form Scale, and a scoring system of plain abdominal radiography, can help to estimate fecal retention more easily and promptly. Non-pharmacological approaches to manage functional constipation include increasing fluids, fiber intake, and physical activity. Several osmotic laxatives are also effective in improving OAB symptoms and fecal retention. Additionally, correction and education in relation to toilet training is the most important measure in treating OAB with fecal retention.

• Investigative Magnetic Resonance Imaging
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• 제19권3호
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• pp.186-190
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• 2015

Acute disseminated encephalomyelitis (ADEM) is a demyelinating and inflammatory condition of the central nervous system, occurring predominantly in white matter. ADEM involving the rhombencephalon without affecting the white matter is very rare. Here, we present an unusual case of ADEM involving only the rhombencephalon in a 4-year-old Asian girl. The patient complained of pain in the right lower extremities, general weakness, ataxia, and dysarthria. The initial brain CT showed subtle ill-defined low-density lesions in the pons and medulla. On brain MRI, T2 high signal intensity (T2-HSI) lesions with mild swelling were present in the pons, both middle cerebellar peduncles, and the anterior medulla. The initial diagnosis was viral encephalitis involving the rhombencephalon. Curiously, a cerebrospinal fluid (CSF) study revealed no cellularity, and negative viral marker findings. Three weeks later, follow up brain MRI showed that the extent of the T2-HSI lesions in the brain stem had decreased. After reinvestigation, it was found that she had a prior history of upper respiratory infection. In this case, we report the very rare case of a patient showing isolated involvement of the rhombencephalon in ADEM, mimicking viral rhombencephalitis on CT and MR imaging. ADEM can involve unusual sites such as the rhombencephalon in isolation, without involvement of the white matter or deep gray matter and, therefore, should be considered even when it appears in unusual anatomical areas. Thorough history taking is important for making a correct diagnosis.