• 제목/요약/키워드: 서울대학교병원

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전자간호기록에 사용된 간호과정 완성도 분석 - 위절제술 환자를 중심으로 - (Evaluation on the Record Completeness of the Nursing Process in Electronic Nursing Record for Patients Undertaken Gastrectomy)

  • 박인숙;유정숙;이순형;우경선;주영희;최완희;강현숙;정미라;김희진;박미옥;이수희;안선영
    • 임상간호연구
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    • 제15권3호
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    • pp.107-116
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    • 2009
  • Purpose: This study was conducted to evaluate the record completeness of the nursing process in the Electronic Nursing Record(ENR) in a university hospital. Methods: We compared nursing statements documented in 2004 with those from the year 2007, given the fact that the ENR system had been utilized since 2004. The ENRs of 35 gastrectomy patients in each year were selected for evaluation. The selected data were 11,822 nursing statements in 2004 and 27,870 in 2007. Results: The number of nursing records which documented the whole nursing process completely was 4,010 (48.3%) in 2007, whereas 513 (5.9%) in 2004 (p<.001). The number of incomplete records in 2004 was 8,142 (94.1%), while 4,300 (51.7%) in 2007 (p<.001). The number of nursing diagnoses was 846 in 2004 and 4,313 in 2007, which increased in number more than 5 times. The most frequently used diagnoses were 'pain', 'risk for infection' and 'risk for ileus' in both years. Conclusion: There was a significant increase in the record completeness on nursing process in 2007 compared to the records in 2004. The reasons for this increase are attributed to nurse training for encouraging to complete recording and nursing record auditing.

혈액종양 환자의 골수검사 후 침상안정 시간에 따른 불편감 및 출혈 (Discomfort and Bleeding in Relation to Bedrest Time after Bone Marrow Examination among Hemato-oncology Patients)

  • 이혜연;정진영;박세연;조은미;장창섭;김향선;박미정;황유민;서은영
    • 임상간호연구
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    • 제25권1호
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    • pp.91-97
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    • 2019
  • Purpose: The purpose of this study was to investigate hemato-oncology patients' discomfort and bleeding in relation to the bedrest time after bone marrow examination. Methods: A descriptive correlational study was conducted. The data were collected using self- report questionnaire from total of 131 patients who underwent bone marrow examination from January 2017 to September 2017. Data were analyzed with descriptive statistics, Wilcoxon Signed-rank test, McNemar's test and logistic regression. Results: The level of discomfort after 4 hours of bedrest was significantly higher when compared to 2 hours of bedrest(p<.001). The occurrence of bleeding after 2 hours of bedrest was significantly higher than 4 hours of bedrest(p<.001), however the degree of bleeding was slight. No bleeding occurred in 84% of the patients after 2 hours of bedrest. Conclusion: The results of this study demonstrated that shortening the bed rest time after bone marrow examination was helpful in improving the patient's well-being. Bedrest time could be shortened according to the site of bone marrow examination and patient's condition.

한국형 소아 환자 분류도구의 신뢰도와 타당도 검증 및 간호시간 환산지수 산출 연구 (Verification of the Reliability and Validity of the Korean Pediatric Patient Classification System and Estimation of Nursing Time Conversion Index)

  • 심미영;박지선;권미경;송숙희;김예슬;강민서;이신애;최은석;하은주
    • 임상간호연구
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    • 제28권2호
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    • pp.185-197
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    • 2022
  • Purpose: This study was performed to verify reliability and validity of the Korean Pediatric Patient Classification System (KPPCS) and estimate nursing time conversion index. Methods: The study was conducted in 9 children's hospital which included various areas and size of bed settings. To verify intraclass correlation reliability and construct validity, staff nurses and nurse managers of 21 wards classified 575 patients according to KPPCS comparing differences by age, days of stay, type of stay and medical department. Direct and indirect nursing time of 575 patients were measured by 284 nursing staffs by stopwatch observation and self reports for 24 hours. Results: KPPCS has 12 categories, 55 nursing activities and 80 criterions. High agreement among nurses (r=.91, p<.001) suggested substantial reliability. Construct validity was verified by comparing differences in age, days of stay, type of stay and medical department (p<.05). The correlation of nursing time and classification score was also statistically significant (r=.59, p<.001). The nursing time conversion index was 10.78 minutes per 1 classification score. The entire patient group were classified to four groups using KPPCS. Conclusion: The findings suggest that KPPCS would be a useful tool for estimating nursing demands related to the complexity of pediatric patients.

니볼루맙 치료 도중 발생한 폐포자충 폐렴 1예 (Pneumocystis Pneumonia Developing during Treatment of Recurrent Renal Cell Cancer with Nivolumab)

  • 김학로;김범석;박영식;김미소;김태민;김동완;허대석
    • The Korean Journal of Medicine
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    • 제93권6호
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    • pp.571-574
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    • 2018
  • 니볼루맙을 사용하는 도중 폐렴이 발생할 수 있고, 폐렴이 의심되면 치료하기 이전에 바이러스를 포함한 감염 여부와 림프관성 암의 진행 상태 및 울혈성 심장 기능 상실 여부 등의 감별이 필요하며 폐렴의 등급과 중증도를 평가하여 스테로이드를 경험적으로 쓰는 것이 중요하다. 본 증례에서는 감염을 배제하기 위하여 기관지 폐포세척을 시행한 후 폐포자충 폐렴이 진단된 사례로 드물기는 하지만 페포자충 폐렴의 감별이 필요함을 보여주어 증례로 보고하는 바이다.

합성곱 신경망을 이용한 동결절편의 암세포 전이 여부 자동진단에 관한 예비연구 (A Pilot Study on Automatic Diagnosis of Cancer Cells Metastasis in Frozen Section Using Convolutional Neural Network)

  • 정대일;강재구;전혜린;오세종;김성철;김영곤;공경엽;송인혜;박소연;안수민;이현나;양동현;유원상
    • 한국정보처리학회:학술대회논문집
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    • 한국정보처리학회 2020년도 춘계학술발표대회
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    • pp.480-482
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    • 2020
  • 동결절편검사는 수술과 연계하여 암 전이 여부를 판단하기 위한 응급한 병리검사가 필요할 때 이용된다. 합성곱 신경망은 이미지 분류에 뛰어난 성능을 보이는 딥러닝 기법으로 본 논문에서는 이를 이용하여 유방암 전이 여부를 자동적으로 진단하는 방법을 제안한다. 실험과정은 전처리, 학습, 후처리의 과정으로 구성되어 있으며, 합성곱 신경망으로는 Resnet-18 모델을 사용하였다. 실험결과 예측 정확도 및 종양의 최대 길이 정합 여부를 점수로 환산하여 약 0.514 의 결과를 보였다.

Immune Checkpoint Inhibitor에 의한 다발신경병의 Rituximab 치료 (Rituximab Treatment for Polyneuropathy Induced by an Immune Checkpoint Inhibitor)

  • 신혜림;강동완;김은영;김태민;이순태
    • 대한신경과학회지
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    • 제36권4호
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    • pp.329-332
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    • 2018
  • Immune checkpoint inhibitor is associated with variety of immune-related adverse events. We present a case of polyneuropathy induced by immune checkpoint inhibitor, which was refractory to steroid and immunoglobulin. While high-dose steroid and immunoglobulin were not effective, we tried rituximab which is effective in other immune-mediated polyneuropathy. After rituximab treatment, patient's clinical symptom and nerve conduction study finding was markedly improved. We suggest rituximab might be effective in polyneuropathy induced by immune checkpoint inhibitor.

위축성 위염과 장상피화생의 호전에 영향을 미치는 인자에 대한 전향적 연구 (Predictive Factors for Improvement of Atrophic Gastritis and Intestinal Metaplasia: A Long-term Prospective Clinical Study)

  • 황영재;김나영;윤창용;권민구;백성민;권영재;이혜승;이제봉;최윤진;윤혁;신철민;박영수;이동호
    • 대한상부위장관⦁헬리코박터학회지
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    • 제18권3호
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    • pp.186-197
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    • 2018
  • Background/Aims: To investigate the predictive factors for improvement of atrophic gastritis (AG) and intestinal metaplasia (IM). Materials and Methods: A total of 778 subjects were prospectively enrolled and followed up for 10 years. Histological analysis of AG and IM was performed by using the updated Sydney system. To find the predictive factors for reversibility of AG and IM, 24 factors including genetic polymorphisms and bacterial and environmental factors were analyzed. Results: In all subjects, the predictive factor by multivariate analysis for improvement of both antral and corpus AG was successful eradication. The predictive factors for improvement of antral IM were age and successful eradication. The predictive factor for improvement of corpus IM was successful eradication. In patients with Helicobacter pylori infection, age and cagA were predictive factors for improvement of AG and IM. In patients with H. pylori eradication, monthly income and cagA were predictive factors for improvement of AG and IM. Conclusions: H. pylori eradication is an important predictive factor of regression of AG and IM and would be beneficial for the prevention of intestinal-type gastric cancer. Young age, high income, and cagA are additional predictive factors for improving AG and IM status. Thus, various factors affect the improvement of AG and IM.

횡격막 아래 장기에서 발생한 악성 종양의 경부림프절 전이 사례 분석 (Cervical lymph node metastasis form non-head & neck sites: below diaphragm)

  • 김진일;송슬기;석준걸;이민형;한성준;정영호;안순현;정우진
    • 대한두경부종양학회지
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    • 제34권2호
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    • pp.17-21
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    • 2018
  • Background/Objectives: Cancers of the abdominal or pelvic organ rarely metastasize to the cervical lymph nodes. Although it indicates distant metastasis, perceivable prolongation of survival or cure may be possible in selected cases. We sought to identify patients with cervical metastasis from cancers below the diaphragm and identify patients who may benefit from aggressive treatment. Materials & Methods: From 2009 to 2017, patients with pathologically confirmed metastatic cervical lymph nodes originating from below the diaphragm were included for analysis. Patient demographics, cancer characteristics, treatment course, and clinical outcomes were analyzed. Results: 208 patients were identified. Left supraclavicular node (Virchow's node) was the most frequently involved. Irrespective of treatment, survival for uterine cervical and ovarian cancers was significantly longer than that of other primaries. Patients with isolated cervical metastasis (oligometastasis) had significantly longer median survival compared to patients with concomitant bone, lung, brain, and mediastinal metastases. Conclusion: Although cervical metastasis from cancers of the abdominal and pelvic organ represent distant metastasis, patients with uterine cervix and ovary primary and oligometastatic lesions may benefit from aggressive treatment. Prudent patient selection and further investigation is warranted.

만성 뇌혈관 협착폐색증에서 아세타졸아미드 부하 다상 동맥스핀표지 자기공명관류영상으로 평가한 뇌혈류 예비능과 동맥 통과 시간의 변화 (Cerebrovascular Reservoir and Arterial Transit Time Changes Assessed by Acetazolamide-Challenged Multi-Phase Arterial Spin Labeling Perfusion MRI in Chronic Cerebrovascular Steno-Occlusive Disease)

  • 황인평;손철호;정근화;연응구;이지예;유노을;강경미;윤태진;최승홍;김지훈
    • 대한영상의학회지
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    • 제82권3호
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    • pp.626-637
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    • 2021
  • 목적 만성 뇌동맥 협착-폐색증에서 아세타졸아미드 부하 다상 동맥 스핀 표지(multi-phase arterial spin labeling; 이하 MP-ASL) 자기공명관류영상을 이용하여 뇌혈류 예비능(cerebrovascular reservoir; 이하 CVR)과 동맥 통과 시간(arterial transit time; 이하 ATT)의 변화를 탐색하였다. 대상과 방법 2019년 6월부터 2020년 10월까지 새롭게 만성 협착-폐색증으로 진단되어 아세타졸아미드 부하 MP-ASL을 시행한 환자를 후향적으로 모집하였다. 부하 전후의 뇌혈류(cerebral blood flow), CVR, 부하전 ATT 및 부하 전후의 ATT 변화량을 중증 협착과 완전 폐색간, 만성 뇌경색 병변의 유무에 따라 비교하였다. 결과 5명의 양측성 협착-폐색을 포함하여 총 32명의 환자가 본 연구에 포함되었다. CVR은 완전 폐색에서 중증 협착보다 유의하게 낮았다(26.2% ± 28.8% vs. 41.4% ± 34.1%, p = 0.004). ATT의 변화는 두 군간 유의한 차이는 없었다(p = 0.717). 만성 뇌경색 병변의 유무에 따른 CVR의 통계적 차이는 미미하였다(29.6% ± 39.1% vs. 38.9% ± 28.7%, p = 0.076). 하지만, 만성 뇌경색 병변이 있는 환자에서 ATT의 단축 정도는 유의하게 작았다(-54 ± 135 vs. -117 ± 128 ms, p = 0.013). 결론 만성 협착-폐색증에서 아세타졸아미드 부하 MP-ASL 검사는 MRI 기반의 CVR 평가 도구로 사용될 수 있다.