• 보건세계
• /
• v.56 no.6
• /
• pp.19-23
• /
• 2009

외래에서 흔히 이용하는 결핵 진단법으로는 객담 도말과 배양검사, 엑스선 검사가 있다. 일단 활동성 결핵으로 진단되면 환자의 과거력 등을 참조하여 치료를 하게 되는데, 초치료인 경우 아이나, 리팜핀, 에탐부톨, 피라진아마이드를 이용한 6개월 단기 초치료 처방으로 치료를 한다. 4제 처방의 효과는 강력하여 규칙적으로 약을 복용한다면 대부분 완치되며, 완치 판정은 치료 중 추구 객담검사를 이용한다. 대부분의 환자들은 진단, 치료에 어려움이 없지만 실제 외래 치료시에는 진단, 치료에서 어려운 문제가 발생하기도 한다. 이에 외래에서 부닥칠 수 있는 상황과 적절한 대처법을 알아보기로 한다.

• The Korean Society of Law and Medicine
• /
• v.19 no.1
• /
• pp.23-80
• /
• 2018

Since the 1960s, the United States' (U.S.) deinstitutionalization policy has reinstated people with mental illness into communities. Unfortunately, when untreated, some people with psychiatric disorders become homeless, and some commit serious crimes during a psychological crisis. Assisted Outpatient Treatment (AOT), also known as Kendra's Law in New York and Laura's Law in California, provides treatment, services and support to people with mental illness in the community. AOT has repeatedly been found effective and is recognized as an evidence-based practice. The response to the mental health crisis (crisis intervention) in the U.S. has also been successful in preventing worsening mental illness and related criminality and other issues. This paper provides an opportunity to create a platform from which to learn how to successfully apply the AOT and crisis intervention of the U.S. to South Korea within the cultural and societal context when establishing social services for people with mental illness in South Korea's communities.

• Korean Journal of Psychosomatic Medicine
• /
• v.25 no.1
• /
• pp.46-55
• /
• 2017

Objectives : Outpatient treatment orders refer to a mandatory social program in which mentally ill persons are ordered by the court to participate in specified outpatient treatment programs. This study aimed to investigate the factors that affect outpatient treatment orders and adherence to outpatient treatment in mental health patients. Methods : A survey on outpatient treatment orders and adherence to outpatient treatment was conducted on 60 psychiatrists between October and November 2016. The questionnaire items were drafted based on a literature review, and they were then evaluated by 3 psychiatrists and 1 law school professor before being finalized. Answers from the respondents were analyzed using descriptive statistics, and the median, maximum, and minimum values of the effectiveness scores of outpatient treatment orders were calculated. Results : Among the 60 psychiatrists, 45(75.0%) were aware of outpatient treatment orders; however, only 2 out of the 45(4.0%) had actually used the program in the last 12 months. The subjective effectiveness was very low, with only 40 points out of 100. Furthermore, of the readmitted patients, 37.7% had received continued outpatient treatment, whereas 53.1% chose to quit the outpatient treatment programs, meaning that the number of dropouts was higher. Among the discharged patients, approximately two-thirds were receiving continued treatment. With regard to follow-up for dropouts, majority of the responses were either "Not taking any action"(n=27) or "Not following up"(n=15). Only two respondents answered "Contact the community mental health promotion center," meaning that this response was very rare. Meanwhile, when asked about efficient measures to be implemented for dropouts, a vast majority of the respondents(n=30) selected the answer "Work with the community mental health promotion center." Conclusions : The outpatient treatment orders currently being administered were found to be ineffective, and the associated adherence to outpatient treatment was also found to be extremely poor. Hence, the effectiveness of the therapeutic interventions could benefit from institutional as well as administrative improvements. Community mental health promotion centers are expected to have an important role in the future.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
• /
• v.22 no.3
• /
• pp.178-187
• /
• 2009

Background : Atopic dermatitis is chronic exzemaous dermatitis and the recurrence rate of atopic dermatitis is high. Many patients are suffering from pruritus. Objective : This study compared ambulatory care with hospitalization for atopic dermatitis treatment of one patient, and investigated the effect of Oriental medicine program for atopic dermatitis patients during short term hospitalization. Method : We treated a 5 year-old boy with uncontrollable atopic dermatitis by ambulatory care and hospitalizaion. Herbal medication and herbal dressing was done samely during ambulatory care and hospitalization. Intensive life management, education for compliance was done only during hospitalization. Results : Even though he had been treated for 5 months by ambulatory care, he still suffered from severe itching, erythema, oozing and insomnia. Admission duration was 10 days. During admission, the SCORAD scores and subjective scores were decreased rapidly. Conclusion : We concluded that effects of the treatments can be different due to compliance of the patient and in that view the short term hospitalization program could be more helpful than ambulatory care for uncontrollable atopic dermatitis patients.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.42 no.2
• /
• pp.158-163
• /
• 2015

General anesthesia (GA) for dental care in handicapped patients is necessary to facilitate the provision of safe, efficient, and effective quality treatment. The aims of this study were to determine the anesthetic characteristics of handicapped patients in need of dental treatment in these day care units, and to establish for plan to provide better services. 325 patients who had outpatient general anesthesia from January 2005 to March 2014 were assessed for this study. Patients' distribution and treatment patterns were examined. The proportion of male patients (202, 62.2%) was higher than female patients (123, 37.8%) and the largest group of patients were 5 to 10 years old (85, 26.2%). The reasons for general anesthesia included mental and physical disabilities (207, 63.7%), behavior management (84, 25.8%), parent needs (14, 4.3%), and so on. Restorative treatment was the most common procedure with the average of 4.2 teeth treated per one patient and 43 (13.2%) patients underwent general anesthesia for dental treatment more than once. To expand and improve access to the dental care of the disabled, improvement of the health care system, enhancement of their training for dental care by professionals, and enlarging caregivers'understanding of the importance of oral care in the early stages are required.

• Journal of The Korean Dental Society of Anesthesiology
• /
• v.2 no.1 s.2
• /
• pp.21-26
• /
• 2002

연구배경: 장애인의 치과치료는 일반인의 치과치료와는 달리 많은 문제점들을 가지고 있다. 이러한 장애인 환자의 치과치료를 위하여 서울대학교 치과병원에서는 치과마취과를 중심으로 임상 각과가 협진하여 외래마취 기반 하에 1999년부터 장애인 진료실을 운영하고 있다. 이번 연구에서는 서울대학교 치과병원 장애인 진료실의 치료방법을 소개하고 그 동안 치료받은 장애인 환자들의 자료를 바탕으로 마취과적인 특징을 분석하였다. 방법: 2001년 1월부터 2002년 5월까지 치료받은 총 54명의 장애인 환자들의 치료기록지와 마취, 그리고 회복실 기록지를 검토하였다. 환자의 성별, 나이, 전신질환, 수술 전 시행된 검사, 치료에 참여한 협진과, 마취 유도제와 유지제, 총 마취시간과 회복실 체류시간, 그리고 회복실에서 관찰된 합병증을 조사하였다. 결과: 총 54명의 환자들을 대상으로 58건 치과치료가 시행되었다. 한 건의 의식진정 법을 제외하고는 모두 전신마취 하에서 치과치료가 시행되었다. 마취유도제는 thiopental sodium, 근이완제는 vecuronium과 succinylcholine가 가장 많이 사용되었으며 마취 유지를 위해서는 enflurane과 isoflurane의 흡입마취제를 이용하거나 TCI를 이용한 propofol 지속정주를 이용하였다. 총 마취지속시간은 $160.2{\pm}55.5$분이었으며 회복실에서의 체류시간은 $132.8{\pm}50.1$분, 그리고 완전한 회복을 확인하기 위해 병동에 단기 입원시킨 소아환자에서는 $58.7{\pm}16.8$분이었다. 회복실에서 심각한 합병증은 발생하지 않았다. 지속적인 감시를 위하여 4명의 환자가 입원을 권유받았으나 특별한 합병증 없이 다음 날 퇴원하였다. 결론: 서울대학교 치과병원 장애인 진료실은 외래마취에 대한 기존의 연구들보다 긴 마취시간과 회복실 체류시간을 보였다. 그러나 별다른 합병증 없이 일회 방문으로 장애인 환자들에게 필요한 치과치료를 모두 제공할 수 있었다.

• Korean Journal of Psychosomatic Medicine
• /
• v.28 no.1
• /
• pp.53-62
• /
• 2020

Objectives : This study investigated lifetime experiences of trauma, treatment retention, and psychiatric symptoms among outpatients with panic disorder after initiation of pharmacotherapy. Our research hypothesis was that panic patients with childhood trauma would display more severe symptoms and less treatment retention compared to those without such history. Methods : A total of 135 first-visit outpatients with DSM-IV panic disorder were approached during the period from March 2012 to August 2016. Fifty-three patients (39%) either refused or returned incomplete questionnaires, leading to a final sample size of 82. Participants completed the Trauma History Screen, the Beck Depression Inventory, the Beck Anxiety Inventory, and the Abbreviated PTSD checklist. Results : The number of lifetime trauma was significantly correlated with treatment retention (rho=-0.269, p=0.015). Among subtypes of trauma, only childhood physical abuse was significantly correlated with treatment retention (rho=-0.298, p=0.007). Conclusions : Our results indicated that psychological trauma, particularly of an interpersonal nature from childhood, can affect pharmacotherapy treatment retention in panic disorder. This may be mediated by poor patient-doctor relationships originating from trust issues among childhood trauma survivors or lack of perceived improvement due to the more severe symptoms and unfavorable course experienced by those with childhood trauma. Further studies are needed to explore the reasons for poor treatment adherence in this population.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.30 no.1
• /
• pp.92-101
• /
• 2003

Under this thesis, 235 patients with dental problems treated under general anesthesia at the Pediatric Dentistry Clinic of Yonsei Dental College were surveyed and their age distribution, reasons for taking general anesthesia, duration of anesthesia, duration of dental procedure, dental treatment peformed and complications were analyzed. A questionnaire survey was also conducted to analyze degrees of anxiety and satisfaction among their parents according to the parents' age, educational background and experience of general anesthesia, as well as the patients' age and past dental history. Following are the results. 1. When the patients were treated under general anesthesia, the degree of anxiety of their mothers was higher than that of their fathers. It appeared that the higher the parents' educational background was, the less their anxiety. 2. The higher the parents' educational level was, the higher the degree of satisfaction after treatment under general anesthesia. 95 cases (87.2%) responded that they would accept such treatment again, if needed. From the result, dental treatment under general anesthesia causes anxiety for parent but the parent's satisfaction level was high. And that was the way gives good quality of dental service to unmanagable patients.

• Proceedings of the KOR-BRONCHOESO Conference
• /
• 1987.05a
• /
• pp.5.2-6
• /
• 1987

저자들은 1978년부터 1986년까지 서울대학병원 이비인후과에 내원했던 원인불명의 돌발성 난청환자 중 추적조사가 가능하였던 60예에 대한 임상적 분석을 시행하여 다음과 같은 결과를 얻었다. 1) 60명의 환자중 45예가 입원 치료를 받았고 15예는 외래환자로 성별은 남자 36명. 여자 24명이었고 연령분포는 10대에서 50대에 걸쳐 널리 분포되었다. 2) 발생시기는 아침 기상시가 많았고 양측성인 경우는 4 예 있었다. 3) 동반증상은 이명, 이충만감, 현기증의 순으로 많았고 상기도염은 14예에서 있었다. 4) 입원치료는 prednisolone 경구투여와 저분자 dextran을 정맥주사하였고, 이중 25예는 histamine정맥주사나 heparin 피하주사를 추가로 겸용 치료하였다. 5) 청력회복의 결과는 Siegel의 분류방법을 따랐고, 입원 치료한 경우 완전회복이 6예, 부분회복이 8예, 경도호전이 9예로 23예(51.1%)에서 청력 호전이 있었다. Histamine과 heparin의 사용은 청력회복 결과를 높이지 못하였다. 외래환자의 경우는 입원치료군과 비교하는데 어려운 점이 있었으나 전체적으로 15예중 6예(40%) 에서 청력 호전이 있어서 입원 치료군이 좋은 성적을 보였다. 6) 치료의 예후에 관련된 요인으로 발병후 1주내에 치료를 시작한 경우 결과가 좋았다. 완전회복이 된 6예중 5예가 1주 내에 치료를 시작한 것이었다. 현훈이 동반된 경우는 현훈이 없는 경우보다 예후가 나빴다. 청력상이 하강형인 경우는 상승형이나 편평형보다 결과가 좋지 않았으며 내원시 고도의 심한 난청을 보인 경우는 청력회복이 거의 없었다.

• Proceedings of the KTCVS Conference
• /
• 2004.06a
• /
• pp.70-73
• /
• 2004