• 한국응급구조학회지
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• 제25권3호
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• pp.189-200
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• 2021

Purpose: We aimed to provide effective emergency medical services (EMS) response strategies for coping with high acuity patients during the pandemic by analyzing the influence of the COVID-19 and social distancing on EMS. Methods: In this retrospective observational study, we analyzed the distribution of high acuity patients transported by Daejeon 1-1-9 EMS during the COVID-19 pandemic period, between February 1, 2020 and October 31, 2020 and the same period in 2019, as well as the level 3 social distancing enforced period, between July 27, 2020 and October 31, 2020. Results: The EMS dispatches decreased by 17% during the observed COVID-19 pandemic period compared to the same period in 2019. The number of cases with cardiac arrest and positive prehospital stroke scale rose by (p<.001). Patients with cardiac arrest, trauma, and positive prehospital stroke scale increased by during the level 3 social distancing period. Conclusion: Unlike the decreased EMS call volume and patient transports during the COVID-19 pandemic, cardiac arrest cases and the severity of high acuity patients tended to increase. We suggest that EMS systems should contrive a response strategy considering the collateral effect of major epidemics on the incidence rate of high acuity patients.

• Physical Therapy Rehabilitation Science
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• 제7권2호
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• pp.54-60
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• 2018

Objective: Persons with chronic stroke fall more often than healthy elderly individuals. The Timed Up and Go test (TUG) is used as a fall prediction tool, but only provides a result for the total measurement time. This study aimed to determine the optimal cut-off values for each of the 6 components of the TUG. Design: Retrospective study. Methods: Thirty persons with chronic stroke participated in the study. TUG evaluation was performed using a wearable miniaturized inertial sensor. Sensitivity, specificity, and predictive values were calculated using the Receiver Operating Characteristic (ROC) curve analysis for the measured values in each section. Optimal values for fall risk classification were determined. Logistic regression analysis was used to investigate the risk of future falls based on TUG. Results: The cut-off values of the 6 sections of the TUG were determined, as follows: sit-to-stand >2.00 seconds (p<0.05), forward gait >4.68 seconds (p<0.05), mid-turn >3.82 seconds (p<0.05), return gait >4.81 seconds (p<0.05), end-turn >2.95 seconds (p<0.05), and stand-to-sit >2.13 seconds (p<0.05). The risk of falling increased by 2.278 times when the mid-turn value was >3.82 seconds (p<0.05). Conclusions: The risk of falls increased by 2.28 times when the value of the mid-turn interval exceeded 3.82 seconds. Therefore, when interpreting TUG results, the predictive accuracy for falls will be higher when the measurement time for each section is analyzed, together with the total time for TUG.

• 한국산학기술학회논문지
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• 제21권8호
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• pp.429-439
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• 2020

본 연구의 목적은 메타분석을 통해 가상현실 프로그램이 뇌졸중 환자의 상지기능에 미치는 효과크기를 알아보고자 한다. 데이터베이스는 한국교육학술정보원(RISS), 한국학술정보(KISS), 국립중앙도서관, 한국학술지인용색인(KCI), 국가과학기술정보센터(NDSL)를 활용하였다. 2010년 1월부터 2019년 6월까지 가상현실 프로그램을 실시한 선행연구들을 조사하였다. 본 연구는 PICO(Patient, Intervention, Comparison, Outcome, PICO)기준에 의거하여 최종 14편을 선정하여 메타분석을 실시하였다. 질 평가도구로 RCT(Randomized Control Trials) 연구는 RoB(Risk of Bias) 도구, NRCT(Non-Randomized Control Trials) 연구는 RoBANS(Risk of Bias Assessment tool for Non-randomised Study) 도구를 사용하였다. 선정된 각 연구들의 효과크기를 산출하기 위해 CMA 3.0프로그램을 사용하였다. 추가적으로 하위집단분석과 메타회귀분석 및 출판편의 분석을 실시하였다. 가상현실 프로그램이 상지기능에 대한 전체 효과크기는 Hedges's=0.390 (95 % CI: 0.192~0.587)으로 확인되었다(p<.05). 가상현실 프로그램은 뇌졸중 환자의 상지기능에 긍정적인 영향을 미친다. 따라서, 4차 산업에 발맞추어 뇌졸중 환자를 위한 다양한 가상현실 프로그램과 산학 협력 기술 개발이 요구된다. 향후 가상현실 프로그램에 대한 RCT연구들과 세부적인 상지기능에 대한 연구가 질적 및 양적으로 확보되어야 할 것이다.

• 대한한의학회지
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• 제17권1호
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• pp.48-83
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• 1996

Our conclusions for function evaluation tools of Stroke patients are as follows. 1. Evaluating tools of Activities of Daily Living, Katz Index, Barthel Index, Modified Barthel Index have high validity and reliability because of ease of measuring, high accuracy, consistency, sensitivity and sufficient stastistics, but they mainly measure motor function except sense, mentation, language, and social conception. Therefore cerebrovascular disease and brain injury in trauma patients with lacked acknowledgement and sensation, we are not able to apply these tools. 2. PULSES Profile is a useful scale for measuring the patient's over-all status, upper and lower limb functions, sensory components, excretary functions, and intellectual and emotional adaptabilities. It is recognized as a good, useful tool to evaluate patient's whole function. 3. Motor Assessment Scale was designed to measure the progress of stroke patients. The scale was supplemented with upper arm function items. We believe that the Motor Assessment Scale could be a useful evaluation tool with inter-rater reliability ,test-retest reliability. 4. The existing evaluation tools, Katz Index, Barthel Index, Modified Barthel Index, PULSES Profile, Motor Assessment Scale, mainly measured the rehabilitational motor function of sequela of cerebrovascular patients. On the other hand CNS & INH stroke scale can measure cerebrovascular disease patient's neurologic deficits and over-all stautus, which are recognition ability, speech status, motor function, sensory function, activities of daily living. Those scales have been recognized as useful tools to measure function of cerebrovascular disease patients and have increased in use. 5. Every function evaluation tool was recognized to have some validity and inter-rater, test-retest reliability in items of each evaluation tool and total scores of each evaluation tools, but it is thought that none of these scales have been fully validated and proved reliable. Therefore afterward, the development of a highly reliable rating system may best be accomplished by a careful comparison of several tools, using the same patients and the same observers in order to choose the most reliable items from each. 6. Ideal evaluation tools must have the following conditions; (1) It should show the objective functional statues at the same time. (2) It should be repeated consecutively to know changed function status. (3) It should be easy to observe the treatment program. (4) It should have the same result with another rater to help rater exchange information with treatment team members. (5) It should be practical and simple. (6) The patient should not suffer from the observer.

• 대한물리의학회지
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• 제17권4호
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• pp.103-111
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• 2022

PURPOSE: This study was performed to investigate the effects of the whole-body vibration exercise combined with ankle joint mobilization on the gait and balancing ability in patients with hemiplegic stroke. METHODS: A total of 19 patients at a rehabilitation hospital who had suffered a hemiplegic stroke were randomly assigned to the experimental group (whole-body vibration exercise combined with ankle joint mobilization, n=10) or control group (whole-body vibration exercise, n=9). All participants underwent 30 min of comprehensive rehabilitation therapy (5 × /week for 6 weeks). Additionally, the experimental group performed the whole body vibration exercise and ankle joint mobilization (15 minutes each, 30 minutes total, 3 × / week for 6 weeks). In the control group, only the whole- body vibration exercise was performed in the same manner and not the ankle joint mobilization. The gait and balancing abilities were measured before and after the 6-week training. RESULTS: Significant improvements were observed in the 10-m walk test, timed up-and-go (TUG) test, center of pressure (COP) path length, and COP path velocity in the experimental group (p < .05). The experimental group showed a larger decrease in the COP path length and velocity than the control group (COP path length, -10.27 mm vs. -3.67 mm, p < .05; COP path velocity, -.33 cm/sec vs. -.13 cm/sec, p < .05, respectively). CONCLUSION: The whole-body vibration exercise combined with ankle joint mobilization could be effective in improving the gait and balancing ability of stroke patients and could also be more effective for improving the static balance ability than the general whole-body vibration exercise alone.

• Korean Journal of Radiology
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• 제23권8호
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• pp.811-820
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• 2022

Objective: To develop a model incorporating radiomic features and clinical factors to accurately predict acute ischemic stroke (AIS) outcomes. Materials and Methods: Data from 522 AIS patients (382 male [73.2%]; mean age ± standard deviation, 58.9 ± 11.5 years) were randomly divided into the training (n = 311) and validation cohorts (n = 211). According to the modified Rankin Scale (mRS) at 6 months after hospital discharge, prognosis was dichotomized into good (mRS ≤ 2) and poor (mRS > 2); 1310 radiomics features were extracted from diffusion-weighted imaging and apparent diffusion coefficient maps. The minimum redundancy maximum relevance algorithm and the least absolute shrinkage and selection operator logistic regression method were implemented to select the features and establish a radiomics model. Univariable and multivariable logistic regression analyses were performed to identify the clinical factors and construct a clinical model. Ultimately, a multivariable logistic regression analysis incorporating independent clinical factors and radiomics score was implemented to establish the final combined prediction model using a backward step-down selection procedure, and a clinical-radiomics nomogram was developed. The models were evaluated using calibration, receiver operating characteristic (ROC), and decision curve analyses. Results: Age, sex, stroke history, diabetes, baseline mRS, baseline National Institutes of Health Stroke Scale score, and radiomics score were independent predictors of AIS outcomes. The area under the ROC curve of the clinical-radiomics model was 0.868 (95% confidence interval, 0.825-0.910) in the training cohort and 0.890 (0.844-0.936) in the validation cohort, which was significantly larger than that of the clinical or radiomics models. The clinical radiomics nomogram was well calibrated (p > 0.05). The decision curve analysis indicated its clinical usefulness. Conclusion: The clinical-radiomics model outperformed individual clinical or radiomics models and achieved satisfactory performance in predicting AIS outcomes.

• 한국정밀공학회지
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• 제32권11호
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• pp.945-952
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• 2015

In drawing sheet metal, the blank holding force is applied to prevent wrinkling of the product and to add a tensile stress to the material for the plastic deformation. Applying an inappropriate blank holding force can cause wrinkling or fracture. Therefore, it is important to determine the appropriate blank holding force. Recent developments of the servo cushion open up the possibility to reduce the possibility of fracture and wrinkling by controlling the blank holding force along the stroke. In this study, a method is presented to find the optimal variable blank holding force curve, which uses statistical analysis with consideration of the nonlinear deformation path. The optimal blank holding force curve was numerically and experimentally applied to door inner parts. Consequently, it was shown that the application of the variable blank holding force curve to door inner parts could effectively reduce the possibility of fracture and wrinkling.

• 디지털융복합연구
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• 제10권3호
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• pp.233-240
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• 2012

본 연구는 뇌졸중 환자의 입원 및 재원적절성에 영향을 미치는 요인을 파악함으로써 효율적인 병상이용과 질적인 의료서비스를 제공하고 불필요한 병상 이용을 줄여 급성기 치료가 꼭 필요한 대상자들이 즉시 병원을 이용할 수 있도록 도움을 주고자 하였다. 연구대상자는 일개 종합병원의 신경과에서 퇴원한 뇌졸중 환자로 의료보장별 의료 적절성을 파악하기 위해 최근 약 4년 동안인 2006년 3월 l일부터 2010년 10월 31일까지 총 154명의 대상자를 선정하였다. 연구방법은 입원 및 재원적절성을 평가하기 위해 적절성 평가지침(AEP)을 이용하여 의무기록을 분석하였고, 수집된 자료는 SPSS 12.0을 이용하여 전산처리하였다. 이상의 결과를 근거로 입원적절성을 높이고 재원기간을 단축시킨다면 재원적절성도 높아질 것이라는 결론을 얻게 된다. 또한 재원기간이 재원적절성에 영향을 미치는 것으로 조사되었기에 재원기간이 길어질수록 병상 회전율을 감소시키는 요인으로 영향을 미치게 되므로 적절한 시기에 퇴원이 이루어질 수 있도록 의료기관 내에서의 질 향상 전담팀을 구성하여 각 질환군에 따른 재원기간에 대한 적절성 평가 및 관리가 이루어져야 한다. 궁극적으로 뇌졸중 환자의 급성치료가 끝나면 즉시 재활치료 및 장기요양관리가 이루어질 수 있도록 장기요양시설 확충과 같은 정부의 뒷받침으로 불필요한 재원기간을 줄여갈 수 있는 것이다.

• 한국산업융합학회 논문집
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• 제22권3호
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• pp.259-264
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• 2019

In this study, we experiment by making and designing of compression ignition diesel engine witch has air cooling, 2-cylinder and 2-strokes. Also, we make controller witch can control injection timing and period by arbitrary manual operation for change of injection timing. We also study experimentally in change about pressure and power of combustion chamber by increasing density of air which comes into cylinder because of increasing scavenging pressure. Through this, we confirmed that output change and scavenging pressure can develop performance of the engine by scavenging efficiency of a chamber and development of volume efficiency.

• 한국병원경영학회지
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• 제8권4호
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• pp.149-181
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• 2003

It has been asserted that per diem payment system should be introduced, in place of the current fee-for-service system, for payment of the inpatient services of the geriatric hospitals, Based on the assentation, this study aims at calculating costs and profits per inpatient-day of the geriatric hospitals, and thereby at contributing to the managerial improvement from the both sides of the Government and the hospitals. Relevant data of the three months, May to August, 2002 were collected from the five geriatric hospitals, and per inpatient-day costs and profits were calculated for the three disease groups. Major results and conclusions are as follow : Firstly, total costs per insured inpatient-day of the geriatric hospitals are 65, 389 won for dementia (including optimal profit of 3,858 won), 69,730 won for stroke (including optimal profit of 4,117 won), and 70,085 won for other diseases (including optimal profit of 4,134 won). Secondly, the amount of the non-insured costs per inpatient-day occupies 34.5% of the total costs for dementia, 30.3% for stroke, and 30.1% for other diseases. Thirdly, the total amount of the per inpatient-day costs calculated including the optimal profits is, on the average, higher by 12% than the present price level calculated for the current fee-far-service system. This implies that the present price level should rise by 12% when the current fee-far-service payment system be maintained, and Finally, introduction of a sliding-scale payment system should be considered for the inpatient medical management fees for the length of stay over six months or more that are being cut in the claim examination process by the insurance corporation.