• Journal of Preventive Medicine and Public Health
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• 제40권2호
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• pp.130-136
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• 2007

Objectives : Recent educational efforts have concentrated on patient's early hospital arrival after symptom onset. The purpose of this study was to evaluate the time interval between symptom onset and hospital arrival and to investigate its relation with clinical outcomes for patients with acute ischemic stroke. Methods : A prospective registry of patients with signs or symptoms of acute ischemic stroke, admitted to the OO Medical Center through emergency room, was established from September 2003 to December 2004. The interval between symptom onset and hospital arrival was recorded for each eligible patient and analyzed together with clinical characteristics, medication type, severity of neurologic deficits, and functional outcomes. Results : Based on the data of 256 patients, the median interval between symptom onset and hospital arrival was 13 hours, and 22% of patients were admitted to the hospital within 3 hours after symptom onset. Patients of not-mild initial severity and functional status showed significant differences between arrival hours of 0-3 and later than 3 in terms of their functional outcomes on discharge. Logistic regression models also showed that arrival within 3 hours was a significant factor influencing functional outcome (OR=5.6; 95% CI=2.1, 15.0), in addition to patient's initial severity, old age, cardioembolism subtype, and referral to another hospital. Conclusions : The time interval between symptom onset and hospital arrival significantly influenced treatment outcome for patients with acute ischemic stroke, even after controlling for other significant clinical characteristics. The findings provided initiatives for early hospital arrival of patients and improvement of emergency medical system.

• 대한방사선기술학회지:방사선기술과학
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• 제42권2호
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• pp.105-111
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• 2019

A medical personnel could be placed beside a patient together in CT room to do Ambu-bag for a seriously ill patients or emergency patient. At this time, the medical personnel can be exposed indirect radiation unnecessarily. In this case, it is necessary to recognize indirect radiation dose levels and methods to reduce them using actual clinical CT protocols such as Chest, Abdomen, and Brain CT. We researched surface radiation dose with or without radiation protectors such as apron and goggles according to different distances far from gantry using two different CT scanners (Fixed MDCT and mobile CT). As a result, for Chest, Abdomen, and Brain CT with Fixed MDCT, indirect radiation dose on thorax portion were 0.047, 0.089, 0.034 mSv without apron. Also, those with apron were 0.007, 0.012, 0.006 mSv. In case of mobile CT, it was 0.014 mSv without apron and 0.005 mSv with apron. By using protectors and increasing the distance, we could reduce it to 97%. Systematic management is necessary based on the measured data in order to minimize radiation damage due to indirect exposure dose.

• 대한건축학회논문집:계획계
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• 제34권11호
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• pp.3-12
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• 2018

Hospice is the wholistic caring service for terminally ill patient and his family so that he can live in dignity and maintain the quality of life until he passes away peacefully. The purpose of this study is to compare the development of hospice movement in UK, USA, Japan and Korea, to analyze space configuration characteristics of facilities built between 1980-2009 through case study. The result is as follows. First, The modern hospice started in England and it has spread around the world rapidly. In Korea, hospice service was introduced even prior to US and Japan and developed in spite of poor medical environment. The application of health insurance subsidies were late compared to other countries, but the hospice and palliative care system was quickly set on the basis of precedent cases. Second, the number of hospital beds per facility is decreasing, and it has been divided into smaller clusters for the residential atmosphere. The controversy between private rooms and multi-patient room is still ongoing, and increasing facilities without in-patient service. Rather than establishing uniform and absolute regulations, it is necessary to design a flexible space which can cope with various situations such as patients' needs, service changes, and manpower status. Third, the spaces for family members and friends to stay in both private rooms and communal spaces are increasing. Forth, Facilities for patients with different needs, such as children and adolescents and AIDS patients, have been developed in UK and USA. Further research on of patients' diverse needs and customized environmental support is necessary.

• Journal of Chest Surgery
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• 제56권1호
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• pp.42-48
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• 2023

Background: With recent advances in cardiac surgery through minimal access, mini-thoracotomy has emerged as an excellent alternative for cardiac myxoma resection. This study analyzed the surgical results of this approach, focusing on postoperative cerebral embolism and tumor recurrence. Methods: We retrospectively reviewed 64 patients (mean age, 56.0±12.1 years; 40 women) who underwent myxoma resection through mini-thoracotomy from October 2008 to July 2020. We conducted femoral cannulation and antegrade cardioplegic arrest in all patients. Patient characteristics and perioperative data, including brain diffusion-weighted magnetic resonance imaging (DWI) findings, were collected. Medium-term echocardiographic follow-up was performed. Results: Thirteen patients (20.3%) had a history of preoperative stroke, and 7 (11.7%) had dyspnea with New York Heart Association functional class III or IV. Sixty-one cases (95.3%) had myxomas in the left atrium. The mean cardiopulmonary bypass and cardiac ischemic times were 69.0±28.6 and 34.1±15.0 minutes, respectively. Sternotomy conversion was not performed in any case, and 50 patients (78.1%) were extubated in the operating room. No early mortality or postoperative clinical stroke occurred. Postoperative DWI was performed in 32 (53%) patients, and 7 (22%) showed silent cerebral embolisms. One patient underwent reoperation for tumor recurrence during the study period; in that patient, a genetic study confirmed the Carney complex. Conclusion: Mini-thoracotomy for cardiac myxoma resection showed acceptable clinical and neurological outcomes. In the medium-term echocardiographic follow-up, reliable resection was proven, with few recurrences. This approach is a promising alternative for cardiac myxoma resection.

• Annals of Occupational and Environmental Medicine
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• 제35권
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• pp.34.1-34.8
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• 2023

Background: Hydrogen sulfide is a toxic substance that humans can be exposed to occupationally, and cases of hydrogen sulfide poisoning of workers in industrial sites are commonly reported. However, there have been no cases of poisoning of the public due to an unauthorized discharge of wastewater, so it is important to describe this incident. Case presentation: In a small village in Jeollanam-do, Republic of Korea, accounts of a terrible stench had been reported. A 26-year-old man who lived and worked in a foul-smelling area was taken to the emergency room with a headache, dizziness, nausea, and repeated syncope. A subsequent police and Ministry of Environment investigation determined that the cause of the stench was the unauthorized discharge of 9 tons of wastewater containing hydrogen sulfide through a stormwater pipe while the villagers were sleeping. The patient had no previous medical history or experience of symptoms. Leukocytes and cardiac markers were elevated, an electrocardiogram indicated biatrial enlargement, left ventricular hypertrophy, and corrected QT interval prolongation. Myocardial hypertrophy was detected on a chest computed tomography scan, and hypertrophic cardiomyopathy was confirmed on echocardiography. After hospitalization, cardiac marker concentrations declined, symptoms improved, and the patient was discharged after 7 days of hospitalization. There was no recurrence of symptoms after discharge. Conclusions: We suspect that previously unrecognized heart disease manifested or was aggravated in this patient due to exposure to hydrogen sulfide. Attention should be paid to the possibility of unauthorized discharge of hydrogen sulfide, etc., in occasional local incidents and damage to public health. In the event of such an accident, it is necessary to have government guidelines in place to investigate health impact and follow-up clinical management of exposed residents.

• 한국방사선학회논문지
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• 제1권3호
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• pp.23-34
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• 2007

한 대학병원 응급실에 방문한 응급환자들이 방사선에 얼마나 피폭되는지를 알아보고자, 2006년 3월 16일 부터 31일까지 15일 동안 방문환자 200명을 임의 추출하여 방사선 피폭선량을 측정한 결과는 다음과 같다. 1. 연구대상자의 분포는 타병원전원환자 50명(25.0%), 교통사고환자 24명(8.3%), 기타사고환자 50명(25.0%), 일반환자 76명(38.0%)이었다. 2. 환자의 방사선 촬영횟수를 보면 환자 1인당 타병원, 전원환자 6.4회, 교통사고환자 14.5회, 사고환자 2.6회, 일반환자 2.4회로 교통사고환자들이 타환자군에 비해 방사선촬영 건수가 3~4배 많았다. 3. 환자의 방사선촬영종류별 피폭선량을 보면 일반촬영 28.9mGy, CT촬영 84.2 mGy, 특수촬영 1.02mGy로 CT촬영피폭이 일반촬영 비해 10배 정도 많았다. 4. 환자의 평균 방사선 피폭선량을 보면 타병원 전원환자는 24.6mGy, 교통사고환자는 55.2 mGy, 사고환자는 17.1mGy 일반환자는 17.0mGy로 타병원 전원환자와 교통사고환자가 상대적으로 피폭이 많았다. 5. 방사선촬영 부위별로 보면 일반촬영에서는 두부피폭 1.7mGy로 사고환자에서 피폭이 많았고, 흉부 2.0mGy, 복부 1.6mGy는 일반환자에게 많았으며, 척추 3.4mGy, 골반부 1.8mGy, 상지부 0.5mGy, 하지부 0.6mGy는 교통사고 환자에게 피폭이 많았으며, 통계적으로 유의한 차이를 보였다(P<0.001). 6. CT촬영에서는 타병원 및 전원환자가 두부 10.9mGy으로 많았고, 흉부와 복부는 각각 2.9mGy, 3.6mGy로 일반환자에게 많았고, 척추, 골반부 1,9mGy 2.7mGy는 교통사고환자에게 많았다. 특히 복부피폭은 통계적으로 유의한 차이를 보였다.(P<0.05) 결론적으로 한 대학병원 방문한 응급환자 특히 교통사고환자의 방사선 검사시 일반 외래 환자들의 촬영보다는 과다한 검사와 피폭이 노출선량한도가 2배 이상 증가하는 실정이다. 따라서 병원 관리자 및 방사선취급자는 환자 방사선 촬영시 노출을 최소한으로 제한하고, 방사선피폭감소를 위해 병원의 종사자인 방사선사의 기술적인 연구와 및 보조연구자 및 의료인 등 모두가 예방할 수 있는 대책이 필요할 것으로 생각한다.

• 한국방사선학회논문지
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• 제11권7호
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• pp.605-610
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• 2017

성인과 달리 소아의 경우 인지능력과 의사전달이 정확하지 않아 X선 검사에 있어 심리적 불안감으로 인한 움직임은 재검사를 증가시키는 요인 중 하나이다. X선 검사라는 거부감을 최소화하고 의료 서비스의 만족도를 향상하기 위한 방법으로 검사실의 환경을 개선하여 심리적 안정에 도움을 주어 검사과정에서 발생하는 불필요한 재검사를 비롯한 피폭선량 절감에 긍정적인 방안을 알아보고자 하였다. 실험대상으로는 2017년 5월부터 2017년 8월까지 본원 일반촬영실에서 만 6개월 이상~만 36개월 미만의 총 186명의 소아를 대상으로 청각과 시각적 환경변화를 모두 적용시키지 않는 평소 검사실을 A 군, 시각적 환경변화는 제외시키고 청각적 환경변화만 적용한 검사실을 B 군, 청각적 환경변화는 제외시키고 시각적 환경변화만 적용한 검사실을 C 군, 청각과 시각적 환경변화를 모두 적용한 검사실을 D 군으로 설정하여 연구를 진행하였다. A 군에서는 재검사 건수가 10건, B 군 7건, C 군 5건, D 군 2건의 결과를 도출할 수 있었다. 특히 A 군과 D 군에서 통계학적 유의수준 p<0.053으로 유의 하다는 결과를 얻을 수 있었다. 결론적으로 청각과 시각적 환경변화가 소아 심리적 안정에 많은 영향을 미쳤으며, 재검사 건수도 감소하여 의료서비스의 질적 향상 보였다.

• 정신신체의학
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• 제23권2호
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• pp.107-113
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• 2015

연구목적 본 연구는 자살 시도자를 대상으로 자살 생각의 심각성과 관련된 요인들을 찾아보고자 하였다. 방 법 일 대학병원 응급실에 자살 시도로 내원한 환자 중 50명을 대상으로 임상가가 면담, Columbia Suicide Severity Rating Scale(C-SSRS), Beck Depression Inventory(BDI), Korean Version of Mood Disorder Questionnaire(K-MDQ), Bipolar Spectrum Diagnostic Scale(BSDS)를 시행하였다. 결 과 자살 경향이 높은 고위험군은 C-SSRS의 자살 생각의 심각성 점수와 BDI 점수가 높았고(p<0.001), MDQ에서 양극성 장애 가능성의 양성으로 판정된 자는 자살생각의 심각성 점수가 높았다(p=0.033). 결 론 자살 시도자의 자살 생각의 심각성과 양극성 장애의 가능성은 서로 연관성이 있을 것으로 생각된다.

• Journal of Chest Surgery
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• 제47권4호
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• pp.402-405
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• 2014

Myocardial infarction (MI) secondary to coronary artery fistula and the subsequent occlusion of the distal right coronary artery (RCA) after blunt chest trauma is a rare entity. Here, we describe a case of coronary artery fistula and occlusion with an inferior MI that occurred following blunt chest trauma. At the initial visit to the emergency room after a car accident, this patient had been undiagnosed with acute myocardial infarction, readmitted five months after ischemic insult, and revealed to have experienced MI due to RCA-right atrial fistula and occlusion of the distal RCA. He underwent coronary surgery and recovered without complications.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제1권2호
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• pp.7-16
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• 1996

As surgical technologies advanced, ambulatory surgery was proposed for reduction hospital stay and patient-oriented health care delivery system. And in recent years, ambulatory surgery is also introduced in this country as medical demands expands. This study aims to represent the standards for architectural planning of the ambulatory surgery center in a general hospital according to domestic situations. For this, the present conditions and space programs of 5 general hospitals were investigated and analyzed. This study also aims to represent the unit area proposal of each departmental operation room and the methodology for deciding the number of the operation threatres in Ambulatory Surgery Center.