• 대한임상독성학회지
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• 제9권1호
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• pp.26-29
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• 2011

Purpose: The role of a point of care test (POCT) is currently becoming important when treating patients and making decisions in the emergency department. It also plays a role for managing patients presenting with drug intoxication. But the availability of the test has not yet been studied in Korea. Therefore, we investigated the utility and the availability of POCT for drug screening used in the emergency department. Methods: This was a retrospective study for those patients with drug intoxication between January 2007 and December 2010 in an urban emergency department. Results: Between the study period, 543 patients were examined with a Triage$^{(R)}$-TOX Drug Screen. Among those, 248 (45.7%) patients showed negative results and 295 (54.3%) patients showed positive results. The sensitivity of the test for benzodiazepine, acetaminophen and tricyclic antidepressants were 85.9%, 100%, 79.2%, respectively. Conclusion: POCT of drug screening in emergency department showed good accuracy especially in patient with benzodiazepine, acetaminophen and tricyclic antidepressant intoxication. Therefore, it can be useful diagnostic tool for the management of intoxicated patients.

• Journal of Periodontal and Implant Science
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• 제48권4호
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• pp.251-260
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• 2018

Purpose: The aim of this retrospective cross-sectional study was to evaluate whether salivary findings of active matrix-metalloproteinase 8 (aMMP-8) chairside (point of care; POC) tests were associated with periodontal risk assessment parameters in patients receiving supportive periodontal therapy (SPT). Methods: A total of 125 patients receiving regular SPT were included, and their records were examined. The following inclusion criteria were used: a diagnosis of chronic periodontitis, at least 1 non-surgical periodontal treatment (scaling and root planning) with following regular SPT (minimum once a year), at least 6 remaining teeth, and clinical and aMMP-8 findings that were obtained at the same appointment. In addition to anamnestic factors (e.g., smoking and diabetes), oral hygiene indices (modified sulcus bleeding index [mSBI] and approximal plaque index), periodontal probing depth simultaneously with bleeding on probing, and dental findings (number of decayed, missing, and filled teeth) were recorded. Salivary aMMP-8 levels were tested using a commercial POC test system (Periomarker, Hager & Werken, Duisburg, Germany). Statistical analysis was performed using the t-test, Mann-Whitney U test, Fisher's exact test, and ${\chi}^2$ test, as appropriate (P<0.05). Results: Only the mSBI was significantly associated with positive salivary aMMP-8 findings (aMMP-8 positive: $27.8%{\pm}20.9%$ vs. aMMP-8 negative: $18.0%{\pm}14.5%$; P=0.017). No significant associations were found between aMMP-8 and smoking, diabetes, periodontal parameters, or parameters related to the maintenance interval (P>0.05). Conclusions: Salivary aMMP-8 chairside findings were not associated with common parameters used for periodontal risk assessment in patients receiving SPT. The diagnostic benefit of POC salivary aMMP-8 testing in risk assessment and maintenance interval adjustment during SPT remains unclear.

• The Korean Journal of Pain
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• 제31권3호
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• pp.147-154
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• 2018

Fibromyalgia (FM) is a contested illness with ill-defined boundaries. There is no clearly defined cut-point that separates FM from non-FM. Diagnosis of FM has been faced with several challenges that occur, including patients' health care-seeking behavior, symptoms recognition, and FM labeling by physicians. This review focuses on important but less visible factors that have a profound influence on under- or over-diagnosis of FM. FM shows different phenotypes and disease expression in patients and even in one patient over time. Psychosocial and cultural factors seem to be a contemporary ferment in FM which play a major role in physician diagnosis even more than having severe symptom levels in FM patients. Although the FM criteria are the only current methods which can be used for classification of FM patients in surveys, research, and clinical settings, there are several key pieces missing in the fibromyalgia diagnostic puzzle, such as invalidation, psychosocial factors, and heterogeneous disease expression. Regarding the complex nature of FM, as well as the arbitrary and illusory constructs of the existing FM criteria, FM diagnosis frequently fails to provide a clinical diagnosis fit to reality. A physicians' judgment, obtained in real communicative environments with patients, beyond the existing constructional scores, seems the only reliable way for more valid diagnoses. It plays a pivotal role in the meaning and conceptualization of symptoms and psychosocial factors, making diagnoses and labeling of FM. It is better to see FM as a whole, not as a medical specialty or constructional scores.

• 한국자기학회지
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• 제23권4호
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• pp.130-134
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• 2013

자성센싱 홀소자가 구비된 집게형 맥진기와 대중적인 생체신호를 측정하는 심전도를 이용하여 맥파전달속도(PWV)를 조사하였다. 동시 측정된 심전도파의 피크치와 요골동맥파의 시작점의 시간차 그리고 심장과 손목간의 거리차를 가지고 맥파전달속도를 계산하였다. 임상데이터로부터 분석된 PWV값은 5~7 m/s의 범위 안에 평균 6 m/s이었다. 맥파전달속도 분석을 통한 혈관탄성도를 예측함으로써, 미래의 한양방 협진용 건강관리 의료기기에서 제시하는 주요 지수로 응용할 수 있는 가능성을 확인하였다.

• 의료법학
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• 제20권1호
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• pp.163-201
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• 2019

의사에게는 환자와의 법률관계에서 비롯되는 여러 의무들이 존재한다. 그 중 하나가 의사 자신이 속해 있는 의료기관이 치료 및 진료를 위한 인프라나 의료기술이 부족한 것으로 판단하는 경우 환자를 적절한 진단 검사 및 진료가 가능한 의료기관으로 '전원(轉院)'하여야 하는 주의의무인 전원의무(轉院醫務)이다. 의료기관마다 환자의 응급성 정도에 따라 대응할 수 있는 능력이 다르므로 의사의 지시나 권고에 의하여든 환자 본인의 요청에 의하여든 이와 같은 환자의 전원은 불가피한 현상이다. 예를 들어 심각한 뇌손상을 입은 환자가 내원한 경우, 진단, 검사 장비 및 인력을 갖추지 못한 병원의 의사로서는 적절한 시기(이른바 '골든타임')에 진단, 검사 및 진료가 가능한 상급의료기관으로 전원을 고려하여야 한다. 이처럼 전원의무는 의사의 의무 중 하나인 것으로 의사뿐만 아니라 환자들에게도 널리 인식되고 있다. 그러므로 적절한 전원 시점을 놓치게 되어 의료사고가 발생한 상황에서는 전원의무위반 여부와 관련한 의사와 환자 간의 법적 분쟁이 있을 수밖에 없다. 본 연구에서는 이러한 상황과 관련하여 전원의무에 대한 구체적이고도 명확한 판단 기준 정립과 함께 현재 각 의료기관들에 마련되어 있는 가이드라인이 실제 적용에서의 여러 시행착오들을 반영하고 있는지에 대한 검토가 필요하다고 보고, 의사의 전원의무에 대한 판례의 동향 분석을 중심으로 전원의무 관련 판례에서 이미 제시되어 있는 판단 기준 요소들이 적절한지 그리고 현재 실무에서 적용되는 법령 및 가이드라인 등과 부합되는지 여부를 살펴봄으로써 앞으로 응급환자에 대한 의사의 전원의무 관련 분쟁조정 및 소송에서의 해석과 적용에 기여할 수 있도록 하였다.

• 한국간호교육학회지
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• 제6권2호
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• pp.287-302
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• 2000

The purpose of the study are to examine the perception of the importance and performance of patient education of the clinical nurse and find out the interfering factors in practicing patient education. The data were collected from convenient sample of 256 clinical nurses working in the nursing units of adult patients except the psychiatric unit, obstetric unit, dental surgical unit and intensive care unit of one University Hospital in Seoul from September 29 to October 2, 1998. Three measurement tools of self-report- questionnaires developed by researcher used. For the content validity of the questionnaires, two sessions of panel discussion and a pilot test were done and finally factor analysis was done with Varimax method. Analysis of data was done with SAS program using frequency, percentage, means, standard deviation, Pearson's Correlation Coefficients, t-test and ANOVA. The obtained results were as follows : 1. The surveyed nurses perceived the importance of patient education at higher level with mean score of 4.08 among 5 point than their perception of practice( mean score : 3.42). 2. There was positive significant correlation(r=.29, p=0.0001)between nurses' perception of the importance of patient education and it's practice 3. Among the teaching contents for patients, 'information of diagnostic procedure and operation' and 'orientation of hospitalization' were perceived most important. And 'preparation for discharge' and 'understanding of disease and health promotion' were perceived least important 4. Among the teaching contents for patients, 'orientation of hospitalization' and 'information of diagnostic procedure and operation' were perceived highly performable. And 'understanding of disease and health promotion' and 'preparation for discharge' were perceived least performable. 5. Three types of interfering factors were identified as patient-factor, situational factor, nurse-factor. The mean degree of impediment with the interfering factors was at average level(3.09 among 5). The patient and situational factors of impediments were more interfering than nurse- factor for teaching patients. 6. In older age(p<.05), married state (p<.05), higher educational status (p<.01), higher clinical experience (p<.01) and higher position(p<.01), the score of perceived importance of patients education was more high. 7. In older age(p<.01), higher clinical experience(p<.001) and surgical unit (p<.01), the score of perceived performance of patients education was more high. In conclusion, in order to activate patient education practice in the clinical setting, the continuing education for patients education should be more emphasized and the effective teaching methods and materials should be developed to help patient teaching. And an organizational support such as budgeting for patient education and reimbursement system should be administrated.

• 한국진공학회:학술대회논문집
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• 한국진공학회 2013년도 제45회 하계 정기학술대회 초록집
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• pp.273-273
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• 2013

Recently, Point-of-care (POC) testing microdevices enable to do the patient monitoring, drug screening, pathogen detection in the outside of hospital. Immunochromatographic strip (ICS) is one of the diagnostic technologies which are widely applied to POC detection. Relatively low cost, simplicity to use, easy interpretations of the diagnostic results and high stability under any circumstances are representative advantages of POC diagnosis. It would provide colorimetric results more conveniently, if the genetic analysis microsystem incorporates the ICS as a detector part. In this work, we develop a reverse transcriptase-polymerase chain reaction (RT-PCR) microfluidic device integrated with a ROSGENE strip for colorimetric influenza H1N1 virus detection. The integrated RT-PCR- ROSGENE device is consist of four functional units which are a pneumatic micropump for sample loading, 2 ${\mu}L$ volume RT-PCR chamber for target gene amplification, a resistance temperature detector (RTD) electrode for temperature control, and a ROSGENE strip for target gene detection. The device was fabricated by combining four layers: First wafer is for RTD microfabrication, the second wafer is for PCR chamber at the bottom and micropump channel on the top, the third is the monolithic PDMS, and the fourth is the manifold for micropump operation. The RT-PCR was performed with subtype specific forward and reverse primers which were labeled with Texas-red, serving as a fluorescent hapten. A biotin-dUTP was used to insert biotin moieties in the PCR amplicons, during the RT-PCR. The RT-PCR amplicons were loaded in the sample application area, and they were conjugated with Au NP-labeled hapten-antibody. The test band embedded with streptavidins captures the biotin labeled amplicons and we can see violet colorimetric signals if the target gene was amplified with the control line. The off-chip RT-PCR amplicons of the influenza H1N1 virus were analyzed with a ROSGENE strip in comparison with an agarose gel electrophoresis. The intensities of test line was proportional to the template quantity and the detection sensitivity of the strip was better than that of the agarose gel. The test band of the ROSGENE strip could be observed with only 10 copies of a RNA template by the naked eyes. For the on-chip RT-PCR-ROSGENE experiments, a RT-PCR cocktail was injected into the chamber from the inlet reservoir to the waste outlet by the micro-pump actuation. After filling without bubbles inside the chamber, a RT-PCR thermal cycling was executed for 2 hours with all the microvalves closed to isolate the PCR chamber. After thermal cycling, the RT-PCR product was delivered to the attached ROSGENE strip through the outlet reservoir. After dropping 40 ${\mu}L$ of an eluant buffer at the end of the strip, the violet test line was detected as a H1N1 virus indicator, while the negative experiment only revealed a control line and while the positive experiment a control and a test line was appeared.

• 대한한방부인과학회지
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• 제19권2호
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• pp.226-239
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• 2006

Background : Medical records are documents in files which consist of all diagnostic studies and medical treatments patients had received while they were hospitalized or treated as outpatients. A doctor or medical team can use medical records as a data for diagnosis, treatment, and education. In traditional eastern asian medicine, medical reports have different forms and contents. The most important thing in medical reports of traditional eastern asian medicine was how to express practitioner's medical ideas. So it has a weak point, for example, it has poor information about patient and clinical process, which make some trouble to understand it. Methods and Results : We studied medical records in Gyojubuin-yangbang, a commentary book of Chen-zi-ming's Obstetrics and Gynecology textbook done by Xue-ji in Ming dynasty, China. This book consists of 10 parts; treatment of menstruation disorders and leukorrhea, general gynecology, treatment of infertility, education for fetus, diagnosis of fetus and gravida, treatment of general and obstetrical disease in gravida, care for delivery, postpartum care and treatment, and treatment of mass and inflammation. It has 546 medical records about women's disease that commonly believed as Xue-ji's case reports. They are all review articles and made during about 23 years from A.D 1523 to 1546. Most patients of Xue-ji's case reports were common people, this fact is different from that of case reports in Chen-zi-ming's Obstetrics and Gynecology textbook. Conclusion : Xue-ji was a very famous Ob&Gy doctor who was from Suzhou Jingsu province in China. He was born in A.D 1468, died in A.D 1588. He emphasize emotional factors in pathology and to tonify spleen and kidney. We think Xue-ji's medical records are good references for us to treat psychosomatic Ob&Gy disease and chronic women's disease.

• 재활복지
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• 제18권4호
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• pp.257-277
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• 2014

본 연구의 목적은 국외에서 중추청각처리장애의 선별도구로 널리 사용되고 있는 Fisher's 청각행동문제 체크리스트(Fisher's auditory problems checklist, FAPC)와 청각행동특성척도(Scale of Auditory Behaviors, SAB)를 한국어로 번역하여 학령기 아동을 대상으로 실시하므로 국내의 학령기 아동의 청각행동특성을 파악하고, 두 검사 간의 특성을 비교하므로 국내에서 중추청각처리장애 선별을 위한 기초 자료를 제공하는데 있다. 한국어로 번역된 FAPC와 SAB 검사도구를 1~6학년 223명의 학생의 부모나 양육자에게 실시한 결과, FAPC와 SAB 검사 도구는 모두 학년별로 유의미한 점수 차이를 보이지 않았고, 학년 증감에 따른 수행 점수 간에 특정 유형이 관찰되지 않았으므로 본 설문지들은 학년에 상관없이 사용하여도 무방하다고 여겨진다. 그러나 두 검사의 유의미한 상관관계에도 불구하고 공통위험군 범위의 아동 수가 적어 서로 다른 특성을 포함하고 있으므로 선별검사 및 청각행동특성을 기초로 한 진단검사의 선정 및 재활 계획 수립시 서로 보완적으로 사용하는 것이 바람직하다고 여겨진다. 더하여 두 검사의 중추청각처리장애와의 관련성 검증과 표본 집단을 확대한 규준 제시를 통한 후속 표준화 연구가 요구된다.

• Radiation Oncology Journal
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• 제23권3호
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• pp.169-175
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• 2005

목적: 방사선 치료 시 3차원 영상 획득에 방사선치료 전용으로 개발된 모의 CT를 사용하고 있으나 아직까지도 많은 병원에서는 일반 진단용 CT를 이용하고 있다. 따라서 본 연구에서는 21명의 유방암 환자를 대상으로 모의치료, 진단용 CT기를 이용한 CT 스캔, 및 치료 과정 사이의 준비 오차를 분석하였다. 대상 및 방법: 준비 오차는 isocenter, SSD, CLD, 및 수술 시 삽입된 클립의 위치들의 변화를 계산하여 분석하였다. 모의조사에서 얻어진 x-ray 영상에 나타난 해부학적 구조물과 CT 스캔 시 isocenter를 표시하기 위해 환자의 몸에 부착된 marker를 기준으로 정해진 isocenter에서 얻은 DRR 영상상의 구조물을 비교하여 잘 일치하지 않을 경우 새로운 isocenter가 정해졌고 이러한 isocenter의 위치 변화를 계산하였다. 결과: 21명의 환자 중 7명의 경우 DRR상과 모의치료 필름상의 해부학적 구조물이 21명의 환자 중 7명이 일치하지 않았으므로 치료계획을 실행하기에 앞서 새로운 isocenter를 정하였다. Isocenter 이동을 근거로 계산된 진단용 CT와 모의 치료간에 발생되는 평균 준비오차의 표준편차는 횡측 방향으로 2.3 mm, longitudinal 방향으로 1.6 mm, 그리고 AP 방향으로 1.6 mm이다. 모의치료와 CT data의 AP 방향 및 tangential 방향에서 측정된 SSD 값의 평균오차 및 표준편차는 각각 $1.9{\pm}2.3\;mm$ 및 $2.8{\pm}3.7\;mm$이다. 모의치료와 DRR간의 CLD 오차의 변화범위는 0에서 6 mm 이고 모의치료와 portal 영상간의 오차범위는 0에서 5 mm이다. 클립을 기준으로 계산된 그룹의 systematic error는 횡측 방향으로 1.7 mm, AP 방향으로 2.1 mm, 그리고 SI 방향으로 1.7 mm이다. 결론: 연구 결과 SSD, CLD, 클립의 움직임 및 isocenter의 위치변화 측면에서 분석될 경우 그다지 큰 오차는 발생하지 않았음을 보여준다. 그러므로 본 연구결과 유방암 환자의 경우 진단용 CT를 사용한다 하더라도 준비오차는 모의 CT를 사용하는 경우와 비교하여 차이가 없음을 알 수 있다. 그러나 모의치료와 CT스캔 사이의 준비오차를 감소하기 위해서는 CT 영상 획득 시 환자 위치고정에 특별한 주의를 기울여야 한다.