• 대한방사선기술학회지:방사선기술과학
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• 제32권2호
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• pp.161-168
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• 2009

초음파에 의한 경동맥 내막-중막 두께의 측정은 동맥경화의 조기발견, 뇌혈관질환, 죽상동맥경화증의 지표로서 사용되지만, 죽상경화증이 내막에 국한되어 발생하는 현상임에도 불구하고 경동맥 내막-중막 두께의 측정은 혈관 벽의 전반적인 두께를 측정하며 일차적으로 중막의 변화를 측정한다는 문제점을 가지고 있다. 이에 반해 죽상경화반의 경우는 혈관벽을 따라 넓게 분포한 것이 아니라 일부분의 위치에 국한되어 나타나는 현상으로 죽상경화증을 더 반영한다고 볼 수 있다. 따라서 본 연구는 뇌경색환자에 대해 경동맥 초음파 검사를 실시하여 경동맥 내막-중막 두께와 죽상경화반의 관계를 파악하고 뇌경색 예측인자인 죽상경화반의 선별검사로 경동맥 초음파 검사가 유용한지 알아보고자 하였다. 2008년 1월에서 3월까지 뇌졸중 전문병원 신경과에 입원한 환자를 대상으로 B-mode 초음파를 이용한 경동맥 내막-중막 두께와 죽상경화반을 검사하였다. 뇌경색환자는 자기공명촬영을 통해 확인하고 나이, 성별과 두개강외 혈관 협착의 위험 인자들을 분석하였다. 대상자의 연령이 높은 군에서 경동맥 내막-중막 두께가 이상이 있는 사람의 분포가 높은 것으로 나타났고(p = 0.004), 경동맥 분지에서의 죽상경화반은 연령이 높은 군에서 그 분포가 높은 것으로 나타났다(p = 0.006). 경동맥 내막-중막 두께가 정상인 사람 총 131명 중 죽상경화반이 발견된 경우는 90명(69%)이었고, 경동맥 내막-중막 두께가 이상인 사람 총 91명 중 죽상경화반이 발견된 경우는 84명(92%)이어서 경동맥 내막-중막 두께가 이상적으로 두꺼운 사람에서 죽상경화반이 발견된 경우가 유의하게 높게 나타났다(p < 0.05). 따라서, 경동맥 내막-중막 두께와 죽상경화반은 밀접한 관련성이 있고, 뇌혈관 질환발생 여부 미치는 영향을 보기 위해 정상인을 대상으로 한 전향적 연구가 필요한 것으로 사료된다.

• 한국병원경영학회지
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• 제6권3호
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• pp.148-166
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• 2001

The purpose of this study is to classify elderly patient in long-term care facilities using RUG(Resource Utilization Group)-III. It is designed by measuring patient medical characteristics and medical staff time. Elderly patients are classified into 7 categories by clinical(medical and behavioral) hierarchical typology of patients. Through the tertiary split, all 44 groups are formulated. This classification is explained by each patient resource(staff time) utilization level which is called CMI(Case-Mix Index). Major findings are as follows; 1. The objects in this study were classified into 35 groups out of 44 groups. The most frequent category is clinical complex category(CCC; 38.9%). And extensive service category(ESC; 18.8%), reduced physical function category(RPC; 13.1%), special rehabilitation category(SRC; 12.8%), and impaired cognitive category(ICC; 0.00%) are followed. 2. The mean of total CMI was $1.02{\pm}0.36$, ranging from 0.68 to 1.44(1 vs 2.12). The mean of CMI of SRC is only 1.17 which should be the highest. The means of ESC and see are equally 1.20. The means of CMI of CCI, ICC, BPC, and RPC were 0.90, 0.75, 0.83 and 0.96, respectively. 3. The validity of this classification was tested. Trend-test using Regression Analysis was done in the secondary split level. SCC, CCC, ICC, and RPC which covered 68.4% of this research objects showed linear trend of CMI in interim classification. This results were statistically significant. 4. In clinical hierarchy, the trend were showed linearity. But the multiple comparison of categories using Scheffe-test showed that SRC, ESC and see had same level of CMI means and CCC and ICC, too. This results were statistically significant. Classifying elderly patients with RUG-III, the results showed partly linear trend in clinical hierarchy and in interim classification in conclusion. But, in clinical hierarchy, it was failed to show the consistent order of CMI. It can be explained by two reasons. One is that this research subjects were overlapped in each clinical hierarchy group. And the other is that the some of the characteristics for clinical hierarchy is not appropriate for them. For the further study, it needs to have proper sample size and to modify RUG-III to K-RUG to consider our.. medical environment.

• 대한소아치과학회지
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• 제45권2호
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• pp.170-178
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• 2018

의학적 관리가 필요하거나 공포로 인해 치과치료를 기피하는 경우 등 다양한 경우에서 소아환자의 치과치료는 일반적인 행동조절만으로는 불가능한 경우가 많다. 이에 최근 전신마취를 이용한 치과치료에 대한 관심이 증가하는 추세이다. 본 연구는 서울대학교치과병원 소아치과에서 시행된 전신마취 하 치과치료에 대한 분석을 위하여 시행되었다. 2011년 10월부터 2015년 12월까지 서울대학교치과병원 소아치과에서 만 18세 미만의 환자를 대상으로 시행한 전신마취 1378례(1322명)에 대한 자료를 조사하였다. 성별은 남자가 805명(60.9%)로 여성보다 더 많았으며, 연령은 5 - 9세(56.0%)가 가장 많았다. 치료 전 전신상태는 ASA 1등급 67.8%, 2등급 이상이 32.2%이었다. 주된 치료는 치아우식증 치료(51.1%)가 가장 많았으며, 다음으로 외과적 치료(42.2%)가 많았다. 전신마취는 행동조절법 중 하나로 다양한 장점이 있으며, 협조가 부족한 환자에서 유용한 방법이 될 수 있다.

• 한국임상약학회지
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• 제22권4호
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• pp.330-339
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• 2012

Background : Hypertension is treated with both lifestyle modification and pharmacotherapy. The Seventh Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7), published in 2003, provides a streamlined management approach to hypertension for the primary care physician. The JNC-7 is the gold standard also in Korea. According to the JNC-7, special therapeutic considerations are recommended for high-risk individuals with compelling indications. The presence of compelling indications in any given patient should be considered when selecting specific pharmacotherapy to treat hypertension. However, in patients with compelling indications, it is unknown that hepatotoxicity is caused by Calcium Channel Blocker (CCB), one of 1st anti-hypertensive drugs. Now, the CCB is the most used 1st anti-hypertensive drug in Korea Therefore, we evaluated the changes in blood liver function parameters (ALT, AST, Total bilirubin, serum albumin) for the study group. Methods : We randomly collected and retrospectively analyzed Electronic Medical Record data (n=28,788) of patients, and who took calcium channel blockers(non-dihydropyridines; diltiazem, verapamil, dihydropyridines; amlodipine, barnidipine, benidipine, clinidipine, efonidipine, felodipine, isradipine, lacidipine, lercanidipine, nicardipine, nifedipine, nimodipine), with having liver function tests (LFTs) from July 1st 2009 to June 30th 2010 at the Seoul National University Hospital in Korea. Control groups are two antihypertensive agents: RAS blockade (ARB; candesartan, irbesartan, losartan, olmesartan, telmisartan, valsartan, ACE-I; cilazapril, enalapril, fosinopril, imidapril, perindopril, ramipril) and, Diuretics (loop; furosemide, torsemide, thiazide; hydrochlorothiazide[HCTZ], indapamide). Patients not having LFT results at these three standard points of time(baseline, during, medication, and after finishing medication) were excluded. The collected data were analyzed by using the SPSS (Version12.0) and Microsoft Excel (Version2007). Results : 711 patients who were treated CCB (297), RAS blockade (232) or Diuretics (182) monotherapy were selected for the study. In selected patients, liver damage degree(changes of each LFTs value) was higher in diuretics group than other groups, followed by RAS blockade and CCB. In diuretics group's was loop-diuretics group was higher than thiazide-diuretics group. In CCB group, Nondihydropyridine-CCB's damage degree was higher than Dihydropyrine-CCB's that. Conclusions : Despite the limitations due to the retrospective study, among patients with abnormal LFTs, the use of CCBs led to a less liver damage than other 1st anti-hypertensive agents. It can be recommended CCBs as one of the initial treatments of hypertension in patients with liver disease.

• Asian Pacific Journal of Cancer Prevention
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• 제15권8호
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• pp.3721-3729
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• 2014

Background: Cancer is becoming the most important public health burden around the globe. As per the GLOBOCAN 2008 estimates, about 12.7 million cancer cases and 7.6 million cancer deaths were estimated to have occurred in 2008. The burden of cancer cases for India in the year 2020 is calculated to be 1,148,757 (male 534,353; female 614,404) compared to 979,786 in 2010. The pattern of cancer incidence is varying among geographical regions, esophageal cancer for example being high in China, lung cancer in USA, and gallbladder cancer in Chile. The question remains why? Is it due to the diversity in genome pool, food habits, risk factor association and role of genetic susceptibility or some other factors associated with it? In India, the North East (NE)-India region is seeing a marked increase in cancer incidence and deaths, with a very different cancer incidence pattern compared to mainland India. The genome pool of the region is also quite distinct from the rest of India. Northeastern tribes are quite distinct from other groups; they are more closely related to East Asians than to other Indians. In this paper an attempt was made to see whether there is any similarity among the pattern of cancer incidence cases for different sites of NE-India region to South or East-Asia. Materials and Methods: Principal Component Analysis (PCA), Hierarchical Cluster Analysis (HCA), Pearson Correlation coefficient test was assessed to evaluate the linkage of North-East India region to other regions. A p value <0.05 was considered as statistically significant. Results: The results clearly shows that there are similarities in occurrence of cancer incidence patterns for various cancer sites of NE-India with South and East-Asian regions, which may lead to the conclusion that there might be a genetic linkage between these regions.

• Journal of Chest Surgery
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• 제22권6호
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• pp.980-989
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• 1989

The Hancock porcine xenograft valves had been used in Seoul National University Hospital, mainly because of their antithrombogenicity despite of the predicted failure, from March 1976 to April 1984, and a total and consecutive 163 patients were retrospectively studied for late results with the special stress on the structural failure. The hospital mortality rate [within 30 days] was 6.1 %, and the 153 early survivors were followed up for a total of 822.9 patient-years [p-y][Mean * SD 5.38 * 3.02 years]. The linealized late mortality was 1.823%/p-y. Four major complications related to the Hancock valve were: 1.822% thromboembolism/p-y; 0.729 % bleeding/p-y; 0.972% endocarditis/p-y; 3.646% overall valve failure/p-y and 2.187 % primary tissue failure [PTF]/p-y. The actuarial survival rates at 5 and 10 years were 94.90 * 1.89% and 80.58 * 5.21 %; and the probabilities of freedom from thromboembolism at 5 and 10 years were 90.93 * 2.63% and 83.35 * 7.64 9o respectively. The probabilities from PTF at 5, 10 and 12 years were 98.02 * 1.39%, 60.62 * 8.89% and 49.60 * 12.34 %. One hundred-eighteen patients [72.4%] had single MVR [age, 34.0 * 10.9 years] with the operative mortality rate of 4.2%; and 113 early survivors were followed up for a total 616.4 patient-years[5.46 * 2.96 years]. The late mortality rate was 1.460 %/p-y. The major complications were: 1.622 % thromboembolism /p-y; 0.487% bleeding/p-y; 0.649 % endocarditis/p-y; 2.920% primary valve failure/p y and 1.785% PTF/p-y. The actuarial survival rates were 97.08 * 1.67%[at 5 years] and 81.27 * 6.64%[at 10 years], and the probabilities of freedom from thromboembolism 92.44 * 2.76 %[at 5 years] and 80.89 * 11.08%[at 10 years]. The probabilities of freedom from PTF at 5 and 10 years were 98 70 * 1.29% and 65.59 * 9.78% respectively. The mean age of 11 patients of PTF was 25.7 * 8.8 years and the valve extraction period 7.16 * 1.45 years. Failure of bioprosthetic xenograft valves are reportedly known to occur earlier in young patients in an accelerated fashion. The study with two groups divided into the cumulative younger and the cumulative older patients according to the age limits of 5-year interval strongly suggested these tendency. Although PTF began to occur past postoperative 5 years and the probabilities of freedom from PTF increased as the age limits raised and the number of patients increased in the cumulative younger patients while they decreased as the age limits lowered and the number of patients increased in the cumulative older patients, the definite age limits from which the Hancock valve can be safely recommended could not be obtained. From the results, the Hancock valves are contraindicated in patients younger than 20 to 25 years and may be safely recommended in patients older than 45 years as a tentative conclusion. Further longitudinal study may define these age factors.

• 보건행정학회지
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• 제15권4호
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• pp.136-160
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• 2005

Before introducing the national long-term care insurance in 2008, the want for long term care service has to be estimated and analysed. This study estimates the demand and analyses what determines the want of long term care service. This study investigated data of 3f6 elderlies, that was collected by age stratified random sampling. The elderies resided in Onyang 4 - dong (urban area) and Dogo-myun (rural area) In the city of Asan. The researchers visited the elderlies and their care giver, and assessed their demand for the long term care service and examined physical, mental, socio-economic status by the assessment tools for Korean Long-Term Care System. $64\%$ of the those who are entitled to be served refuse the long term care service. $26.7\%$ of them wants for home care service and $7.9\%$ want facility care service. It is estimated that the want of home care service are three or four times as much as that of facility care service. The demand for long term care service is 5.155 times higher for those who live in rural area (p=0.000), 3.040 times higher for those who do not have spouse(p=0.057), and 3.356 times higher for the people who is in medicaid than medical insurance(p=0.029). However, income(p=0.782), means(p=0.614), living alone(p=0.223), number of family to live with (p=0.341) and age of the elderly(p=0.420) are not related with the demand of long term care service. The assessment tools for Korean Long-Term Care System for need evaluation of the long term care service can reflect the demand well.(p=0.024) If medical care will cover $80\%$ of total cost, the willingness to pay of the out of pocket money of the people with medical insurance is 67,400 Korean Won(66.77 US$) for the home care service and 182,500 Korean Won(180.78 US$) for the facility care service. There is possibility that long term care demand is still small after Introducing the long term care Insurance due to the care given by family members. When developing service delivery system of long term care insurance, rural area has to be given more consideration than urban area because of the higher demand. The people who do not have spouse or are in medicaid have to be given special consideration as well.

• 대한한의학회지
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• 제33권3호
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• pp.147-159
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• 2012

Objectives: Systems related to the production, authorization, and listing for insurance of herbal medicine products were compared between South Korea and Taiwan to illuminate herbal medicine products system issues in South Korea. Methods: Papers, and laws and policies related to the production, authorization, and listing for insurance of herbal medicine products in South Korea and Taiwan are analyzed to create the primary documents. The documents from South Korea were screened with the advice of a specialist, while those from Taiwan have been verified through local investigation and with the help of a related specialist. The screened documents were then compared and analyzed in the order of the systems related to the production, authorization, and listing for insurance of herbal medicine products. Results: The systems related to the production of herbal medicine products satisfy GMP requirements in both countries, while Taiwan has more specialized systems related to the production of herbal medicine products and a more strict authorization program as compared to South Korea. While South Korea has most of the herbal medicine products classified as non-prescription drugs, Taiwan has them as prescription drugs. And while South Korea does not allow new herbal medicine products to be listed for insurance, Taiwan allows for once-a-year application toward listing for insurance. Conclusions: In order to ensure the safe and effective use of herbal medicine products, systems related to the production, authorization, and listing for insurance of herbal medicine products are to be established, while the categorization of medicine products principally used by Korean medicine doctors should be prepared. Furthermore, prescription by a Korean medicine doctor for new drugs made with natural products and their listing for insurance need to be encouraged.

• 가정∙방문간호학회지
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• 제13권1호
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• pp.24-32
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• 2006

The purpose of this study is to predict the degree of taking the complementary & alternative therapy in the home care nursing service and provide basic data for the application of it. To accomplish this, degree of general recognition of the complementary & alternative therapy, experiences, degree of concern, applicability of the therapy, and educational need should be studied. This study is a descriptive research survey on the home care nurses working at 73 medical centers out of 125 nationwide who provide hospital based home nursing care. The data was collected from Sep. 20, to Oct. 20, 2004 by ChoiHeyran's questionaries (2002). The data was analyzed by the frequency and the percentage. The results of this study are as follows ; 1. The degree of pre-cognition on the complementary & alternative therapy is very high. Information about the therapy was mostly obtained through medias. Home care nurses understand that he desirable treatment is to practice medical treatment and complementary & alternative therapy simultaneously. While 50% of them have already practiced complementary & alternative therapy among their patients. The most commonly used therapy is Acupressure. And Home care nurses have open and positive attitudes about the complementary & alternative therapy as to answer they aye ready to recommend it to their patients. 2. Over half of the Home care nurses met patients taking complementary & alternative therapy. 94.5% of them think scientific diagnosis on the effect of the therapy. advice from the doctor. and the special working staff is required to apply it on to the home care nursing. 3. 68.5% of the Home care nurses have taken education on the therapy through general comprehensive instructions and supplementary. Most of them want to have a opportunity education on the therapy because they want to provide comprehensive nursing and diversified nursing service. The preferred educations are Hand acupuncture, Acupressure & Massage and Aromatherapy, in that order. Based on the above results, the followings are recommended. 1. A study that stipulates the types, applications, and efficiency assessment of the complementary & alternative therapy practiced by Home care nurses in the home care nursing care procedure. And systematic and scientific nursing intervention be developed.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제29권1호
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• pp.5-13
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• 2003

본 연구의 목적은 두경부 감염 환자에서 적혈구침강속도(ESR), 백혈구와 비교해 혈장 내 C-Reactive Protein(CRP)이 가지는 진단과 경과관찰에서의 기여도를 아는 데 있다. 본 연구를 위해 31명의 감염환자를 실험군으로, 32명의 악교정 수술 환자를 대조군으로 설정하여 다음과 같은 결과를 얻었다. 1. 실험군에서의 C-Reactive Protein(CRP)은 대조군의 CRP에 비해 더 높은 수치를 나타내며 감염이 지속되었던 증례를 제외하고는 지속적으로 감소하는 경향을 나타내었다(P<0.001). 2. ESR은 실험군과 대조군에서 모두 일정한 경향이 없었다. 3. 각 변수간의 상관관계는 CRP와 백혈구가 상관계수 0.664로 가장 높은 양의 상관관계를 나타내었다(r=0.664, P<0.01). 4. 설정된 ROC curve에서 분류기준값(cut-off value)의 변화에 따라 CRP 곡선의 증가가 빠르게 나타나고 측정된 곡선의 아래 면적(AUC: Area Under the Curve)이 0.744로 높은 값을 나타내어 예측의 정확도가 높다고 판단된다. 5. 실험군에서 회복일(recovery day)에 각 변수의 민감도는 CRP가 83%, ESR이 17%, 백혈구가 71%로 나타났다. 이상의 연구로 미루어 볼 때, 두경부 영역에서 CRP는 감염을 진단하고 경과관찰을 하는데 있어 ESR이나 Leukocyte에 비해 더 민감하게 환자를 감시(monitoring)할 수 있는 유용한 검사라고 사료된다.