• 대한간호학회지
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• 제26권4호
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• pp.868-877
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• 1996

This study was done to analyze research trends and to suggest future perspectives for nursing research on fatigue. The author reviewed 31 Korean and foreign research papers which have been published in the literature since 1970. An analysis of the study focused on the type of research subjects, type of study design. measurement instrument, and its correlated parameters. The results of the study are summarized as follows : First, within all of the studies analayzed, 14 studies were publised in Korea and 17 were published abroad. The number of studies done abroad have been increasing rapidly since 1991. Second, an analysis of the research design of the studies showed, eight studies each, Korean and foreign used survey design. Two Korean studies and seven foreign studies used a correlational design. Four comparative studies were done in Korea, but only two experimetal studies were performed abroad. Therefore, it was found that the trend of the study design used is survey design and there are more correlational studies done abroad than in Korea. Third, the type of the study subjects ; 11 Korean and three foreign studies dealt with healthy people. In addition, three Korean and 14 foreign studies investigated patients with various illnesses. It was found that patients with various illnesses were studied more frequently in foreign studies than in Korean studies. Fourth, the measurement tool used in the Korean studies ; 13 studies used a testible tool to assess patients' subjective symtoms or complaints of fatigue. The most commonly used tool used in 10 studies, was the Fatigue Self-Perception Scale, which was designed by the Labor and Health Institute of Japan. The Visual Analogue Scale was used in two studies, and Piper Fatigue Scale, addtional with physiologic parameters, was used in one study. In the foreign studies, subjective measurement tools were used in 16 studies. A combination of a subjective measurement tool with objective parameters was used in ten studies. For the subjective measurement tool used in the foreign studies, a specific measurement tool developed by the researcher which was used in seven studies. Either Rhoten Fatigue Scale or the Visual Analog Scale were used in three studies. Additionally, in order to identify the relationship between fatigue and psychological factors, The Profile of Mood State was used in three studies. Beck Depression Inventory was used in two studies. The Self Rated Depression Scale, developed by Zung, was used in one study and other measurement tools were used to measure various psychological parameters. Rhoten fatigue Checklist was also used to observe behavior patterns. Lastly, nine studies identified correlations between fatigue and other parameters. A significant correlation was found between fatigue and psychological factors such as depression, and pain. As a result of the above findings, it can be said that research trends on fatigue are increasing internationally. The selected study designs are survey studies both in Korea and abroad. There are more correlational studies abroad than in Korea. In addition, subjective measurement tools and objective parameters are used variously and combined with each other. had, there is a significant correlation between fatigue and psychological factors such as depression, and pain. More survey and correlational studies need to be done to identify the relationship of fatigue in patients with various condition or diagnoses and to suggest a scientific basis for nursing interventions with fatigue. Also, a tool to assess patient's subjective, objective, and behavioral aspects on fatigue needs to be developed.

• 대한소아치과학회지
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• 제37권2호
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• pp.260-266
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• 2010

유치에 가해진 외력은 하방으로 전달되어, 계승 영구치의 손상이라는 합병증이 야기시킬 수 있기 때문에 유치에 손상이 가해진 경우의 치료계획은 영구치의 안전성에 초점을 두어야만 한다. 유치의 외상에 의한 계승 영구치 발육 장애의 정도는, 외상 당시 소아의 연령 및 치아의 발육 상태, 손상의 종류와 정도 및 외상 후부터 치료 전까지의 경과 시간 등에 따라서 달라지며, 그 정도는 미약한 석회화 부전에서 성장 정지에 이르기까지 다양하게 나타난다. 본 증례는 33개월, 만 5세, 26개월의 소아에서 각각 유치의 함입, 완전탈구, 아탈구 등의 외상성 손상이 발생한 후, 후속영구치의 발육 장애가 관찰된 경우로 비슷한 연령대임에도 불구하고, 아탈구와 같은 경미한 외상이 발생한 경우에는 법랑질저형성증과 같은 경미한 수준의 발육 장애가 나타났지만, 합입이 일어난 경우는 치근의 만곡이 관찰되었다. 또한 영구치의 교환 시기에 가까운 나이인 5세경이라 하더라도 완전탈구가 일어난 경우에는 치근의 형성부전 등 보다 심각한 합병증이 관찰되어, 유치의 손상양상과 외상을 당한 시기의 환아의 나이에 따라 계승 영구치에 미치는 영향이 달라진다는 사실을 확인 할 수있었다. 따라서 유치의 변위를 초래하는 모든 종류의 외상이 발생한 경우, 술자는 외상의 유형 및 영구치의 발육상태를 고려하여 적절한 치료 계획을 세워나가는 것이 중요하리라 사료된다.

• Journal of Chest Surgery
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• 제34권11호
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• pp.843-847
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• 2001

배경: 식도질환의 수술 후 식도재건술은 아직도 식도수술에 관여하는 외과의사에게 해결해야 될 부분이 많이 있다. 1996년 1월부터 1999년 12월가지 흉부식도암환자 27명에서 흉부식도절제술 후 15예의 식도-위 문합술과 12예의 유리총장 이식술을 시행하였다. 저자들은 식도암 수술 후 문합부 누출, 문합부위의 협착, 역류성식도염, 수술시간, 호흡기 합병증 등을 양 군을 나누어 비교하였다. 대상 및 방법: 고식적 우회술 또는 식도인공삽입술, 인두식도와 식도 위 결합부위의 암은 본 연구에서 제외하였다. 우측 개흉술로 식도를 절제하였고, 자동봉합기를 사용하여 식도-위 문합을 시행하였다. 유리공장이식술의 경우 근위부의 식도는 6예에서 자동봉합기를 사용하였으며, 6예의 근위부와 12예의 원위부는 수기통합하였다. 모든 식도 재건술은 후종격동을 경유하였다. 결과: 3예의 수술사망을 포함하여 3예의 문합부 누출, 2예의 이식공장괴사 등 중한 합병증과 11예의 역류성 식도염, 5예의 문합부 협착이 발생되었다. 식도-위 문합술의 평균 수술시간은 300$\pm$160분, 유리공장이식술은 550$\pm$280분이었다. 결론: 역류성 식도염은 식도-위 문합군에서 더 많았고, 수술시간은 유리공장이식군에서 더 길었다(p<0.05). 적절한 환자의 선택과 장시간의 수술에 따르는 술 후 합병증을 줄일 수 있다면, 식도재건수술후의 역류식도염을 감소시키는 수술로 유리공장이식술이 우수하다고 판단된다.

• Journal of Chest Surgery
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• 제20권1호
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• pp.112-127
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• 1987

Myasthenia gravis is a neuromuscular transmission function disorder characterized by fatigue and weakness of voluntary muscles. This muscular weakness is intensified by activity and stress, and improved by the use of anticholinesterase compounds. It was initially described by Erb in 1879 and later named myasthenia gravis by Jolly in 1895. Although the pathogenesis is Known to be an autoimmune related reduction in the number of available acetylcholine receptors at neuromuscular junctions, the role of thymus in myasthenia gravis is still unclear and under investigation. Thymectomy in the management of myasthenia gravis has become increasingly important since Dr. Blalock observed in 1939 that some patients with thymic tumors and myasthenia gravis improved following thymectomy. A clinical study of 102 cases of myasthenia gravis was performed at Yonsei University College of Medicine. Seoul, Korea from Jan. 1976 to Jun. 1986. In order to determine which factors are of prognostic significance, attention is focused upon pre-operative patient evaluation, problems in operative and post-operative care, and long-term follow-up observations. The results were as follows: 1. The sex distribution was 67 females and 35 males, the mean age of onset was 28.95*1.69 years, and the maximal incidence occurred between 21 and 40 years of age [56 cases: 54.9%]. 2. Clinical manifestations of ocular symptoms were seen to 70 patients [68.6%] extremities weakness in 33 [32.3%], bulbar weakness in 29 [28.4%], and dyspnea in 13 [12.7%]. 3. Study cases more than two thirds were classified as mild types [MG 1 and MG 11A] and 6 cases as grave [MG 1V] based on the modified Osserman`s classification system, 4. Thymectomy was performed in 19 cases which presented in severe myasthenia symptoms and showed no improvement with cholinergic drugs. Histologic examination of the excised thymus glands revealed no abnormalities in 4 cases, thymic hyperplasia in 5, benign thymoma in 5, and malignant thymoma in 5. 5. Immediate post-operative complications included 2 cases of pneumothorax which were treated by tube thoracostomies, there was no operative mortality. 6. The response to cholinergic drugs in 36 cases younger than 20 years old and in 27 cases older than 40 years was relatively poor, while that in 35 cases between the ages of 21 and 40 years old was good. 7. Thirty of 39 cases in groups IIB, III & IV improved markedly with medical or surgical management while only 16 of 59 cases in the mild groups [I and IIA] improved, almost all surgical cases improved in all categories. 8. There were 5 deaths. occurring between 7 months and 3 years 3 months of treatment of myasthenia gravis. The causes of death were myasthenic crisis in 2 cases, respiratory failure due to candidiasis & radiation pneumonitis in one case, cerebral hemorrhage due to high blood pressure in two case.

• 대한예방한의학회지
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• 제6권1호
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• pp.1-14
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• 2002

The proportion and role of public sector in health care industry is very small in Korea. Asymmetric distribution of health care resources is one of the major health care concerns. This issue is so important that it raises a question of accessibility, availability, continuity of care and equity of rural area people's health care utilization. To solve these problems and to satisfy the basic demand of oriental medical service in rural areas, the oriental public health doctors were placed in rural health centers since 1998. The main objectives of this study are twofold: to measure the cognition and attitude of health center directors on the strategies for utilizing oriental public health doctors and to provide basic data for improving the health manpower management program. Data have been collected by way of the self-administrative questionnaires. Developing the questionnaire, the literature review on the previous studies and delphi method were carried out. The response rate was 38.7%. The results of this study are summarized as follows; 1. community people respond positively on the oriental medical service activity in health center. 2. In regard to workloads of oriental public health doctor, 'appropriate' was 81.1% and 'burdensome' was 18.2%, respectively. 3. The 94.0% of respondents thought that the oriental medical service will be continued. 4. To activate oriental medical service in health center, the sufficient budget and provision of aid workers is a necessity. 5. The 75.5% of health center directors respond positively on the allocation of oriental public health doctor to health sub-centers. 6. Health center directors agreed that oriental public health doctor should perform the clinical service as well as prevention and health promotion activity. These results recommend that oriental medical service in health center should be continued gradually, and oriental public health doctors working at health center perform their work efficiently. Undoubtedly, their activity should be more focused on health promotion and disease prevention than daily patient care. For achieving this objective, more support of governmental policy is essential for utilizing oriental public health doctor and better health of the rural area community people.

• 한국응급구조학회지
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• 제10권1호
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• pp.71-77
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• 2006

This study is focused on middle school students who are composed of a factor in medical emergency system. In the case of cardiac failure, it is to make its basic data and develop its education program of CPR(cardiopulmonary resuscitation) which can increase the patient's survival rate before his hospitalization. The findings of this study is as follows. The subject of study is composed of 117 persons who are 54 boy-students(46.2%) and 63 girl-students(53.8%) in sex and 72 first-grade students(61.5%) and 45 second-grade students (38.5%) in a school year. In the accuracy degree, the practice of artificial respiration is $42.28{\pm}34.42%$ in case of basic CPR(cardiopulmonary resuscitation). The accuracy degree of the thorax pressure is $82.17{\pm}15.40%.$ In the accuracy degree, the practice of artificial respiration is $92.16{\pm}25.68%$ in boy-students and $20.38{\pm}24.16%$ in girl-students, the second-grade students is $58.40{\pm}33.29%$, which is higher than the first-grade students' $32.21{\pm}31.14%$. In the accuracy degree, the thorax pressure is $92.16{\pm}3.91%$ in boy-studetns and $73.61{\pm}16.41%$ in girl-students. In the accuracy degree of the thorax pressure, the second-grade students are $82.60{\pm}16.54%$ and the first-grade students $81.91{\pm}3.91$, which doesn't show any significant difference in school year. The satisfaction degree after theory & practice education is $2.12{\pm}.85$. In the satisfaction degree of its basic CPR, girl-students are $2.14{\pm}.83$ and boy-students are 2.11. In the satisfaction degree of its basic CPR, the second-grade students are $2.40{\pm}.61$ and the first-grade students are $1.95{\pm}.94$. This study is to lead to some suggestions. First, it is necessary to develop the education program and educate its knowledge & technology in proportion to student's characteristics of sex and school year. Second, education authorities should develop a subject of the accident prevention and first-aid treatment in its curriculum and provide the practical education of CPR for adults, adolescents and children. Third, it is necessary to study the education program as well as the education evaluation of CPR further on.

• 한국응급구조학회지
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• 제14권3호
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• pp.13-28
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• 2010

Purpose: In this study, we investigated the better application of the law which is about the AED installation and more effective ways of emergency medical care system, to understand the law and to research the current condition of public facilities which belong to local governments, and to seize the aspect of safety guards who currently work in order to provide the installation of AED in the public facilities and to provide more efficient emergency medical service with the effectuation of the immunity law of the good intention of first-aid treatment. Methods: In Gwang-ju, 234 public facilities have been identified by 31 December, 2008. With the exception of the duplication, we researched 158 facilities and received the answers from 95 of them. Results: In the research, 53% of them have had internal emergency first-aid education, and 55% of them didn't have this education and a CPR education manual, and 30% of the facilities even didn't know how to connect with the manager of the company for the first-aid department. On the other hand, most of them were highly interested in CPR and AED education on the ratio of 91% and 93%. 88% of them have been trained about first-aid, 51% of them haven't been retrained, 17% have never been trained. so, the reality of emergency system at public facilities is serious. 78% of them knew they are working at public facilities, though 49% of them didn't know about AED installation. 57% of them didn't know the fact there is the immunity law related with good intentions for first-aid treatment. 63% of the facilities have security guards, and 30% of them didn't answer the questions. Also, many of them agreed to the opinion that all employees should have first-aid training. At representative survey report of participator of public-facility, emergency treatment is 61%, 16% of patients calling. Accordingly they importantly think better doing an on-site first-aid than evacuating the patient. And the rates show that 57% of them answerers tend to call Fire-Office(119) for evacuating the patients, and 28% of them EMIC(1339) for the first-aid. Conclusions: In this study, we are suggest to improve the details of the efficient operations and management after the grasp of the uninstallation, indifference, and unreliable conditions of AED. 1) Need a publicity of AED install cognition which is an emergency medical instrument at public facilities. 2) Arrangement of safety agents at facilities and concerns about them for good management from the parties concerned. 3) Need a designation of legal details according to the decision of the AED installation and the standard of the AED installation. 4) Training about first-aid of safety guards and the persons concerned in the facilities should be practiced participation with the positive and through this, first-aid treatment could be done by anyone who knows the immunity law related to medical emergency. 5) The brochures for the potential users and the results form practicing the instructions need to be improved in many ways through recording the emergency cases that have happened.

• 한국콘텐츠학회논문지
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• 제13권12호
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• pp.900-909
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• 2013

본 연구의 목적은 요양병원에 입원한 알츠하이머 치매환자의 재원기간에 영향을 미치는 요인을 분석하는 것이다. 분석 자료는 건강보험심사평가원의 2009년 환자표본데이터를 사용하여 추출하였고, 요양병원에 입원한 65세 이상의 노인이면서 알츠하이머 치매로 입원한 178개 병원의 총 538명을 분석에 이용되었다. 요인은 환자 측 변수와 요양병원의 구조특성변수이며, 환자특성변수는 성별, 연령, 중증도를 사용하였고, 중증도는 요양병원 수가처치 코드를 이용하여 5개의 그룹(의료고도, 의료중도, 문제행동군, 인지장애군, 의료경도)으로 분류하였다. 구조특성변수는 병상수, 의사수, 간호사수, 그리고 CT 보유수를 연구모형에 포함하여 분석하였다. 다중회귀분석결과에서 병원의 구조변수는 환자의 재원기간에 통계학적으로 유의한 영향은 없었다. 환자변수 중에서 중증도의 경우 의료고도와 문제행동군에서 통계학적으로 유의한 영향을 미치는 것으로 나타났으나 모두 음의 관계를 갖는 것으로 나타났다. 이는 중증도가 높은 의료고도에서 레퍼런스 그룹인 의료중도에 대해 양의 관계를 가질 것이라는 예상과는 상반된 결과였다. 이러한 결과는 알츠하이머 치매환자의 특성과 병원의 구조적특성이 환자의 재원일수 변이에 큰 영향을 미치지 않는다는 가능성을 시사하고 있다. 요양병원은 일반 급성기 병원과는 다른 환자의 질병 특성을 지니고 있고, 수가 지불체계에 대해서도 다른 특성을 가진다. 특히 최근 대두되는 '사회적 입원' 문제와 같이 환자의 사회경제적인 요인에 의한 변이가 대두되는 시점에서, 재원기간에 영향을 미칠 수 있는 사회경제적인 요인에 대한 연구가 지속적으로 필요할 것으로 보인다.

• 기술혁신학회지
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• 제17권2호
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• pp.421-447
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• 2014

전통의학이 국가 의료체계에 편입되어 있는 국가는 한국 중국 대만 등이나 한국과 중국이 대표적이다. 본 연구는 두 나라의 전통의학 정책을 비교한 것이다. 이를 위해 전통의학 정책의 분석 틀을 최초로 제시했다. 한의학과 중의학의 공통점은 발전과정이 국가정책에 의해 규정되었고, 동일한 패턴을 보인다는 점이다. 차이점은 국가의료체계의 차이 혹은 발전정도에 따른 것이다. 중의학은 의료체계상 보다 활성화되어 있고, 중의, 중서결합의 및 민족의학까지를 다루어 범주가 크다. 한국은 저출산, 고령사회에서의 역할을, 중국은 응급 및 중대질병의 예방치료체계 구축에 관심이 크다. 한국은 해외환자 유치를 추진하고, 중국은 해외진출을 도모한다. 한국은 한약재 유통과 안전성을 강조하고, 중국은 생산기술을 강조한다. 한국은 의료기기 육성정책이 시도되고 있으나 중국은 연구개발 단계이다. 양국 공통으로 천연물 신약개발을 강조하나, 한국은 응용산업에서 한방화장품을 강조하고, 중국은 응용산업정책이 약하다. 중국은 전통의학의 문화와 이론을 강화하고 있으나 한국은 이러한 정책은 없다. 한국은 국제기구와 의료봉사에 초점을 맞추고, 중국은 국가 간 실질협력에 관심을 두고 있다.

• Clinics in Shoulder and Elbow
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• 제13권1호
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• pp.111-116
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• 2010

서론: 견갑상 신경 마비를 유발하는 극관절와 결절성 낭포에 대하여 여러 가지 치료 방법이 알려져 있으나, 술 후 잔존하는 낭포의 경과에 대한 보고는 미미한 실정이다 대상 및 방법: 견갑상 신경 마비를 동반한 극관절와 결절성 낭포에 대해 관절경적 감압술 및 상부 관절와순 봉합술 시행 후, 평균 15 (12~23)개월 추시 가능하였던 6예를 대상으로 하였다. 술후, 초음파 및 자기공명 영상으로 극관절와 결정성 낭포의 잔존 여부를 확인하였다. 결과: 수술 직후 시행한 초음파 검사상 5예에서 결절성 낭포가 잔존하고 있었으며, 1예의 경우완전 소실되었다. 술 후 3개월에 시행한 초음파 검사상 모든 예에서 잔여 낭포가 소실 되었고, 술후 1년에 시행한 자기공명영상에서도 재발된 경우는 없었다. 결론: 극관절와 결절성 낭포의 관절경적 감압술 및 상부관절와순 봉합술 후 잔존하는 낭포는 3개월 이내 자연 흡수되는 경향이 있는 것으로 판단한다.