• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제13권1호
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• pp.23-29
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• 2010

목 적: 본 연구에서는 소아의 내시경 시술 전 출혈의 위험성을 예측하는 검사로 혈소판과 혈액 응고 검사의 임상적 의의를 평가하고자 하였다. 방 법: 2004년 3월부터 2009년 12월까지 분당서울대학교병원 소아청소년과 외래 및 입원 환자 중에서 위장관 내시경 검사를 시행 받은 소아청소년 환자의 의무기록과 혈소판 수치 및 혈액 응고 검사 결과들을 후향적으로 분석하였다. 결 과: 총 1,476건의 검사 결과, 혈소판 수치가 정상보다 낮은 경우는 1명이었고, PT INR만이 비정상으로 연장된 경우가 25건(1.7%)이었고, aPTT만 연장된 경우가 132건(9%)이었고, 둘 다 연장된 경우가 5건(0.3%)이었다. aPTT 결과가 비정상이었던 경우에 혈액 응고 인자 검사를 시행한 경우가 14건이었고, 이 중 혈액 응고인자 XII 결핍증으로 진단된 경우가 7명, 폰 빌레블란드 병으로 진단된 경우가 1명, 폰 빌레블란드 병과 혈액 응고 인자 XII 결핍증이 동시에 나타난 경우가 1명, 경증의 A형 혈우병이 의심된 경우가 1명이었으며, 나머지 4명은 정상이었다. 혈액 응고 질환으로 진단된 환자를 포함하여 내시경 시술을 받은 모든 소아 환자에서 의미 있는 출혈 합병증이 나타난 경우는 없었다. 결 론: 소아 내시경 사전 검사로 시행하는 혈액 응고검사에서 일부 이상 소견이 확인되더라도 실제 혈액 응고 질환으로 진단되는 경우는 드물고, 혈액 응고 질환으로 진단된 환자에서조차 내시경 시술에 의한 출혈 합병증이 나타나지 않았다. 따라서 내시경 시술 전에 모든 환자를 대상으로 혈액 응고 검사 및 혈소판 검사를 반드시 시행할 필요는 없을 것으로 여겨지며, 출혈 경향을 나타내는 과거력과 가족력이 있는 소아와 이전에 혈액 응고 검사를 한 번도 시행 받지 않았던 영유아 환자에서 내시경 시술 전에 혈액 응고 검사를 시행하는 것이 바람직할 것이다.

• Journal of Radiation Protection and Research
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• 제39권3호
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• pp.142-149
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• 2014

한국은 국가건강검진을 시행하여 국민건강증진에 크게 기여하고 있으며 그 수검률 또한 증가하고 있다. 본 연구는 수검률 증가에 따른 방사선검사의 증가가 예상되어 그 이용 빈도(이용량)와 피폭선량을 파악하고자 한다. 본 연구는 2011년 국민건강보험공단 건강검진 분석 자료에서 방사선검사를 분리하여 이용량을 파악하고, UNSCEAR 2008년 보고서의 수록되어 있는 검사별 선량을 적용하여 국가건강검진에서 방사선검사로 인한 피폭선량을 추정한다. 주요 분석결과 2011년 국가건강검진 수검자 1인당 평균 피폭선량은 0.57 mSv로 추정되었고, 최대 11.081 mSv, 최소 0.02 mSv로 추정되었다. 방사선검사의 이용 빈도와 피폭선량은 각각 총 16,005,914건, 6,311.76 person-Sv로, 이중 이용량은 흉부 X선검사가 1,070,569 (69.17%)건으로 가장 높았고, 피폭선량은 위장조영검사가 5,217.94 (82.67%) person-Sv로 가장 높았다. 성 연령별 결과 39세 이하를 제외한 전 연령대에서 여성의 수검비율과 피폭선량이 높았고, 특히 50-54세 여성이 1,674,787 (10.5%)건, 701.59 (11.1%) person-Sv로 가장 높았다. 검사별 선량에서 위장조영검사가 전체 82.67%를 차지하는 만큼 의료상(목적) 반드시 시행하는 경우를 제외하고는 위장내시경검사를 선택하여 수검 받도록 정책적으로 장려하고 외국의 사례와 같이 경제성과 실효성 평가에 따라 폐지된다면 국가건강검진에의 방사선피폭은 현저히 줄어들 것으로 예상한다.

• 한국안전학회지
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• 제35권1호
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• pp.87-96
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• 2020

The purpose of this paper is to develop a fire HRA (Human Reliability Analysis) procedure for full power operation of domestic NPPs (Nuclear Power Plants). For the development of fire HRA procedure, the recent research results of NUREG-1921 in an effort to meet the requirements of the ASME/ANS PRA Standard were reviewed. The K-HRA method, a standard method for HRA of a domestic level 1 PSA (Probabilistic Safety Assessment) and fire related procedures in domestic NPPs were reviewed. Based on the review, a procedure for the fire HRA required for a domestic fire PSA based on the K-HRA method was developed. To this end, HRA issues such as new operator actions required in the event of a fire and complexity of fire situations were considered. Based on the four kinds of HFE (Human Failure Event) developed for a fire HRA in this research, a qualitative analysis such as feasibility evaluation was suggested. And also a quantitative analysis process which consists of screening analysis and detailed analysis was proposed. For the qualitative analysis, a screening analysis by NUREG-1921 was used. In this research, the screening criteria for the screening analysis was modified to reduce vague description and to reflect recent experimental results. For a detailed analysis, the K-HRA method and scoping analysis by NUREG-1921 were adopted. To apply K-HRA to fire HRA for quantification, efforts to modify PSFs (Performance Shaping Factors) of K-HRA to reflect fire situation and effects were made. For example, an absence of STA (Shift Technical Advisor) to command a fire brigade at a fire area is considered and the absence time should be reflected for a HEP (Human Error Probability) quantification. Based on the fire HRA procedure developed in this paper, a case study for HEP quantification such as a screening analysis and detailed analysis with the modified K-HRA was performed. It is expected that the HRA procedure suggested in this paper will be utilized for fire PSA for domestic NPPs as it is the first attempt to establish an HRA process considering fire effects.

• Asian Pacific Journal of Cancer Prevention
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• 제14권12호
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• pp.7607-7611
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• 2013

Background: Cervical cancer continues to be a major problem in Bangladesh with approximately 18,000 new cases annually of which over 10,000 women die from it. Visual inspection of the cervix after 3-5% acetic acid (VIA) application is a simple and easy to learn method for cervical cancer screening, although cytology-based screening is more often applied in developed countries where it has successfully reduced the prevalence of cervical cancer. Objective: To compare the efficacy of VIA and cytology-based primary methods for cervical cancer screening in Bangladesh. Materials and Methods: This hospital based comparative study was conducted at the VIA centre and Colposcopy Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU) from October 2008 to October 2010. Results: Among 650 women, 74 (11.4%) were VIA+ve and 8 (1.2%) had abnormalities in their Pap smear reports. During colposcopy, 38 (7.7%) women had different grades of CIN and 4 (0.6%) had cervical cancer. The gold standard histology findings proved 20 women had CIN I, 14 had CIN II/II and 4 had cervical cancer. Among the 38 histology diagnosed abnormalities, VIA test could identify 30 abnormalities including two cervical cancers. However, Pap smear could detect only 8 cases of histological abnormalities (2 low grade and 6 had high grade lesion) and it missed all the cervical cancer cases. The sensitivity and specificity of VIA were 88.9% and 52.1%. The positive predictive value (PPV) and negative predictive value (NPV) were 41.0%, and 92.6% respectively. Moreover, the sensitivity, specificity, PPV and NPV of Pap smear were 33.3%, 95.8%, 75.0% and 79.3%, respectively. Conclusions: VIA test should be used as the primary screening tool even with its low sensitivity and specificity in low resource countries like Bangladesh. False positive results may be greater, but overtreatment can be minimized by colposcopy evaluation of the VIA positive women.

• Imaging Science in Dentistry
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• 제43권3호
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• pp.179-184
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• 2013

Purpose: X-ray exposure should be clinically justified and each exposure should be expected to give patients benefits. Since dental radiographic examination is one of the most frequent radiological procedures, radiation hazard becomes an important public health concern. The purpose of this study was to investigate the attitude of Korean dentists about radiation safety and use of criteria for selecting the frequency and type of radiographic examinations. Materials and Methods: The study included 267 Korean dentists. Five questions related to radiation safety were asked of each of them. These questions were about factors associated with radiation protection of patients and operators including the use of radiographic selection criteria for intraoral radiographic procedures. Results: The frequency of prescription of routine radiographic examination (an example is a panoramic radiograph for screening process for occult disease) was 34.1%, while that of selective radiography was 64.0%. Dentists' discussion of radiation risk and benefit with patients was infrequent. More than half of the operators held the image receptor by themselves during intraoral radiographic examinations. Lead apron/thyroid collars for patient protection were used by fewer than 22% of dental offices. Rectangular collimation was utilized by fewer than 15% of dental offices. Conclusion: The majority of Korean dentists in the study did not practice radiation protection procedures which would be required to minimize exposure to unnecessary radiation for patients and dental professionals. Mandatory continuing professional education in radiation safety and development of Korean radiographic selection criteria is recommended.

• 대한예방의학회:학술대회논문집
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• 대한예방의학회 1994년도 교수 연수회(환경)
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• pp.440-449
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• 1994

Current risk assessment practices largely reflect the need for a consistent set of relatively rapid, first-cut procedures to assess 'plausible upper limits' of various risks. These practices have important roles to play in 1) screening candidate hazards for initial attention and 2) directing attention to cases where moderate-cost measures to control exposures are likely to be warranted, in the absence of further extensive (and expensive) data gathering and analysis. A problem with the current practices, however, is that they have led assessors to do a generally poor job of analyzing and expressing uncertainties, fostering 'One-Number Disease' (in which everything from one's social policy position on risk acceptance to one's technical judgment on the likelihood of different cancer dose-response relationships is rolled into a single quantity). At least for analyses that involve relatively important decisions for society (both relatively large potential health risks and relatively large potential economic costs or other disruptions), we can and should at least go one further step - and that is to assess and convey both a central tendency estimate of exposure and risk as well as our more conventional 'conservative' upper-confidence-limit values. To accomplish this, more sophisticated efforts are needed to appropriately represent the likely effects of various sources of uncertainty along the casual chain from the release of toxicants to the production of adverse effects. When the effects of individual sources of uncertainty are assessed (and any important interactions included), Monte Carlo simulation procedures can be used to produce an overall analysis of uncertainties and to highlight areas where uncertainties might be appreciably reduced by further study. Beyond the information yielded by such analyses for decision-making in a few important cases, the value of doing several exemplary risk assessments in. this way is that a set of benchmarks can be defined that will help calibrate the assumptions used in the larger number of risk assessments that must be done by 'default' procedures.

• 환경영향평가
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• 제13권2호
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• pp.57-71
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• 2004

This study aims to review the environmental impact assessment systems of Japanese local governments, to compare its outcome with the systems of Korean local governments, and to suggest the development direction for the environmental impact assessment systems of Korean local governments based on the result. The study results showed that, first, due to distinction in the political systems of Japan and Korea, while Japan has bottom-up environmental impact assessment systems, Korea has topdown environment impact assessment systems. Second, although introduction of national systems on planning was put on hold as a future initiative, local governments including Tokyo and Saitama are experimenting evaluation procedures tailored to local features by legislating them as regulations. On the other hand, while 'prior environmental review system' was in effect as a national system, nothing was practiced at all by local governments. Third, in a total of 47 Japanese local governments, about 45 projects and 44 assessment items were added to local government environmental impact assessment only and designated as target projects and assessment items. Fourth, in both national and local environment impact assessment systems in Japan, screening procedures to determine assessment by separating into Type 1 projects and Type 2 projects and scoping procedures to discuss assessment items in advance were introduced and in effect. This Japanese EIA system may serve as a good reference to the Korean national and local government EIA systems.

• 한국임상약학회지
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• 제31권2호
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• pp.153-159
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• 2021

Background: With increasing economic evaluation studies on the treatment of or screening tools for liver diseases that cause hepatocellular carcinoma (HCC), interest in the analysis of the medical utilization and costs of HCC treatment is increasing. Therefore, we aimed to estimate the medical utilization and costs of HCC patients, and calculate the cost of main procedures for HCC treatment, including liver transplant (LT), hepatic resection (HR), radiofrequency ablation (RFA), and transarterial chemoembolization (TACE). Methods: We analyzed claim data from January to December 2018 from the Health Insurance and Review and Assessment Service-National Patient Sample (HIRA-NPS-2018) dataset, including data of patients diagnosed with HCC (Korean Standard Classification of Diseases code C22.0) who had at least one inpatient claim for HCC. Results: A total of 715 HCC patients were identified. In 2018, the yearly average medical cost per HCC patient was ₩18,460K (thousand), of which ₩14,870K was attributed to HCC. Among the total medical costs of HCC patients, the inpatient cost accounted for the largest portion of both the total medical and HCC-related costs. The major procedures of HCC treatment occurred most frequently in the order of TACE, RFA, HR, and LT. The average medical cost per treatment episode was the highest for LT (₩87,280K), followed by HR (₩10,026K), TACE (₩4,047K), and RFA (₩2,927K). Conclusion: By identifying the medical costs of HCC patients and the costs of the main procedures of HCC treatment, our results provide basic information that could be utilized for cost estimation in liver disease-related economic evaluation studies.

• 환경영향평가
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• 제4권1호
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• pp.59-64
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• 1995

Environmental Impact Assesment(EIA) is composed of various procedures, such as screening, scoping, inventory survey, prediction, assessment, mitigation measure, alternative assessment, and post management. Remote sensing introduced lately begins to be applied ecosystem and land use in inventory survey and assessment of EIA. This study explains on land use classification, buffering analysis of residential area, and overlaying analysis of odor predictive data with residential area for application to EIA with remote sensing data. Residential area extracted from land use classification of remote sensing provides effectively buffering analysis of residential area in selection of landfill site with GIS. It could assess also residential effect to an offensive odor by overlaying analysis. Application methods in EIA should be enlarged to assess effectively.

• 환경영향평가
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• 제4권3호
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• pp.31-39
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• 1995

Environmental Impact Assessment (EIA) is composed of various procedures, such as screening, scoping, inventory survey, prediction, assessment, alternative assessment, mitigation measures, and post management. Environmental monitoring data for air quality or water quality, etc. is applied in the EIA process, especially in prediction and post management. As an effective tool of environmental monitoring, the remote sensing method, introduced recently, was used in collecting nationwide data concerning ecosystem and land use. This article explains the current monitoring status in Korea. Monitoring factors include air quality, water quality, soil, ocean, odor, noise, and ecosystems. This report explains the organization of the environmental monitoring system managed by the Ministry of Environment in Korea. Furthermore, it shows the environmental criteria and environmental policies applied to EIA in Korea.