• Proceedings of the Korean Institute of Information and Commucation Sciences Conference
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• 2021.10a
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• pp.100-101
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• 2021

In Korea, which has entered an aging society, 87% of the elderly population suffers from chronic diseases such as dementia and stroke, of which Alzheimer's dementia accounts for 71.3% of all dementia. In this paper, labeling verification was performed to review the error problem of deep learning results divided by Alzheimer's dementia MRI image into three stages.

• Journal of Korean Clinical Nursing Research
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• v.14 no.1
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• pp.161-172
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• 2008

Purpose: This study was to classify patient severity score for hemodialysis patients. Method: The subject of this study was 1,575 patients. To study the severity of the patients, we used t-test and ANOVA. The congruity was measured by Kappa coefficient and the severity in each medical facility was analyzed by ANOVA. Result: The results showed that there was a significant difference according to the levels of medical center (F=171.187, p<.0001). Categorizing the severity of the patients in each medical facility, group II and III of the secondary medical institution had higher ratio than the primary medical institution. There was not a single patient coming under group IV in both of the primary or secondary medical institutions. However, the tertiary medical institutions had more subjects in group II and III than the primary and secondary medical institutions. The group IV with the highest severity had 11 patients(1.5%), demonstrating that the tertiary medical institution had higher severity patients than the primary or secondary medical institutions. Conclusion: The results of this study appropriately reflects the repayment system of medical expenses by the government. Also, it provides the fundamental information to develop nursing fee system taken into account of the systemic differences among the primary, secondary and tertiary medical institutions.

• Sleep Medicine and Psychophysiology
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• v.19 no.2
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• pp.68-76
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• 2012

Objectives: Sleep disorders cause changes of autonomic nervous system (ANS) which affect cardiovascular system. Primary insomnia (PI) makes acceleration of sympathetic nervous system (SNS) tone by sleep deficiency and arousal. Obstructive sleep apnea syndrome (OSAS) sets off SNS by frequent arousals and hypoxemias during sleep. We aimed to compare the changes of heart rate variability (HRV) indices induced by insomnia or sleep apnea to analyze for ANS how much to be affected by PI or OSAS. Methods: Total 315 subjects carried out nocturnal polysomnography (NPSG) were categorized into 4 groups - PI, mild, moderate and severe OSAS. Severity of OSAS was determined by apnea-hypopnea index (AHI). Then we selected 110 subjects considering age, sex and valance of each group's size [Group 1 : PI (mean age=$41.50{\pm}13.16$ yrs, AHI <5, n=20), Group 2 : mild OSAS (mean age=$43.67{\pm}12.11$ yrs, AHI 5-15, n=30), Group 3 : moderate OSAS (mean age $44.93{\pm}12.38$ yrs, AHI 16-30, n=30), Group 4 : severe OSAS (mean age=$45.87{\pm}12.44$ yrs, AHI >30, n=30)]. Comparison of HRV indices among the four groups was performed with ANCOVA (adjusted for age and body mass index) and Sidak post-hoc test. Results: We found statistically significant differences in HRV indices between severe OSAS group and the other groups (PI, mild OSAS and moderate OSAS). And there were no significant differences in HRV indices among PI, mild and moderate OSAS group. In HRV indices of PI and severe OSAS group showing the most prominent difference in the group comparisons, average RR interval were $991.1{\pm}27.1$ and $875.8{\pm}22.0$ ms (p=0.016), standard deviation of NN interval (SDNN) was $85.4{\pm}6.6$ and $112.8{\pm}5.4$ ms (p=0.022), SDNN index was $57.5{\pm}5.2$ and $87.6{\pm}4.2$ (p<0.001), total power was $11,893.5{\pm}1,359.9$ and $18,097.0{\pm}1,107.2ms^2$(p=0.008), very low frequency (VLF) was $7,534.8{\pm}1,120.1$ and $11,883.8{\pm}912.0ms^2$ (p=0.035), low frequency (LF) was $2,724.2{\pm}327.8$ and $4,351.6{\pm}266.9ms^2$(p=0.003). Conclusions: VLF and LF which were correlated with SNS tone showed more increased differences between severe OSAS group and PI group than other group comparisons. We could suggest that severe OSAS group was more influential to increased SNS activity than PI group.

• Tuberculosis and Respiratory Diseases
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• v.44 no.6
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• pp.1256-1262
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• 1997

Background : Leukocyte-endothelial adhesion molecules have been implicated in the pathogenesis of inflammatory disease. ICAM-1, VCAM-1 and E-selectin are cell surface adhesion molecule on vascular endothelial cells. They are up-regulated by inflammatory cytokines and regulate the adhesion and migration of leukocytes across the endothelium. Tuberculosis, a granulomatous disorder is an infection caused by Mycobacterium tuberculosis. The clinical manifestations of tuberculosis are dependent on the cellular immune response to tubercule bacilli. Circulating adhesion molecules are probably formed by cleavage and release into the circulation of the extracellular domain of the membrane bound form. The elevated levels of circulating adhesion molecules have been reported in numerous disease state. To evaluate their role as markers of disease activity in tuberculosis, we measured a sE-selectin, sVCAM-1 and sICAM-1 levels in the serum with severities of mild, moderate and far advanced pulmonary tuberculosis. Methods : The control and test groups were divided as follows. Group I : control(n=5), Group II : patients with mild pulmonary tuberculosis(n=12), Group III : pateints with moderate pulmonary tuberculosis(n=20), Group IV : patients with far advanced pulmonary tuberculosis(n=19). Serum sICAM-1, sVCAM-1 and sE-selectin were measured by ELISA kit Results : Serum soluble adhesion molecules are elevated in patients with pulmonary tuberculosis, Circulating ICAM-1 levels were significantly elevated in patients with moderate and far advanced pulmonary tuberculosis when compared with control group. When compared with control group, serum sVCAM-1 levels showed significant elevation in patients with mild, moderate and far advanced pulmonary tuberculosis. Serum sE-selectin levels were significantly elevated in patients with far advanced pulmonary tuberculosis when compared with control group. Conclusion : These results suggest that sICAM-1, sVCAM-1, and sE-selectin may be invloved in the pathogenesis of tuberculosis. And, particularly, sICAM-1 and sVCAM-1 may be useful markers of the disease activity.

• Journal of Korean Clinical Nursing Research
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• v.28 no.2
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• pp.198-209
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• 2022

Purpose: The purpose of the study was to shorten the KPCS-1 (Korean Patient Classification System-1) for predicting nursing care need level and to explore whether the patients can be clustered by their acuity and dependency. Methods: The participants were inpatients in two surgical wards and two internal medicine wards at a teritory hospital during 14 days investigations. The KPCS-1 was evaluated once a day for all inpatients and 2,082 cases of data from a total of 411 patients were analyzed. Results: The items were reducted from 50 items to 26 items by partial least squares analysis and expert review. Through factor analysis, it was confirmed that hygiene, diet, elimination, and exercise were categorized as dependence factors. Patients were clustered with low acuity/low dependency (average score: 7.68±2.81/1.05±1.33), high acuity/low dependency (average score: 17.20±4.15/1.94±2.40), medium acuity/high dependency (average score: 13.56±5.30/9.66±2.64) through cluster analysis. The total score of the three groups for their nursing care needs was 8.73±3.36, 19.14±5.74, and 23.24±6.31 in order, and the results showed a statistically significant difference (F=1712.12, p<.001). Conclusion: The shortening of the KPCS-1 and the new criteria for categorizing patients according to acuity and dependence will increase clinical utility and be useful for manpower assignment criteria in detail.

• Research in Community and Public Health Nursing
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• v.11 no.1
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• pp.289-316
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• 2000

우리나라의 경우 지역사회 재난 관리계획과 훈련이 보건의료적 모형이라기 보다는 민방위 모형에 입각하기 때문에 사고 현장에서의 환자 중증도 분류, 합리적 환자배분 및 이송, 병원 응급실에서의 대처 등이 체계적으로 이루어지지 못하고 있으며, 지역사회가 이에 즉각적으로 반응할 수 없다. 본 연구는 삼풍 붕괴사고 시에 대응방식과 그 후의 우리나라 응급의료 체계를 분석함으로써 대형사고 예방과 재난관리를 위한 우리나라 응급의료체계의 개선방안과 간호교육에서의 준비부분을 제시하고자 한다. 1 삼풍 사고 발생시에는 이를 관장할 만한 법적 근거인 인위적 재해에 관한 재난관리법이 없었다. 따라서 현장에서는 의학적 명령체계를 확보하지 못했기 때문에 현장에서의 응급 처치는 전혀 이루어지지 못하였다. 현장에서의 중증도 분류. 응급조치와 의뢰, 병원과 현장본부 그리고 구급차간의 통신 체계 두절, 환자 운송 중 의료지시를 받을 수 있도록 인력, 장비, 통신 체계가 준비되지 못하였던 점이 주요한 문제였다. 또한 병원 응급실에서는 재난 계획이 없거나 있었더라도 이를 활성화하여 병원의 운영 체계를 변환해가지 못하였다. 2. 삼풍백화점 붕괴사고 한달 후에는 인위적 재해에 대한 재난관리법이 제정되고, 행정부 수준별로 매년 지역요구에 합당한 재난관리 계획을 세우도록 법으로 규정하였다. 재난 관리법에는 보건의료 측면에서의 현장대응, 주민 참여, 응급 의료적 대처, 정보의 배된. 교육/훈련 등이 포함되어 있어야 한다. 그러나 법적 기반이 마련된 이후에도 한국 재난 계획 내에는 응급의료 측면의 대응 영역은 부처간 역할의 명시가 미흡하며, 현장에서의 응급 대응과정을 수행할 수 있는 운영 지침이 없이 명목상 언급으로 그치고 있기 때문에 계획을 활성화시켜 지역사회에서 운영하기는 어렵다. 즉 이 내용 속에는 사고의 확인 /공고, 응급 사고 지령, 요구 평가, 사상자의 중증도 분류와 안정화, 사상자 수집, 현장 처치 생명보존과 내과 외과적 응급처치가 수반된 이송, 사고 후 정신적 스트레스 관리, 사고의 총괄적 평가 부분에 대한 인력간 부처간 역할과 업무가 분명히 제시되어 있지 못하여, 사고 발생시 가장 중요한 연계적 업무 처리나 부문간 협조를 하기 어렵다. 의료 기관과 응급실/중환자실, 시민 안전을 책임지고 있는 기관들과의 상호 협력의 연계는 부족하다. 즉 현재의 재난 대비 계획 속에는 부처별 분명한 업무 분장, 재난 상황에 따른 시나리오적 대비 계획과 이를 훈련할 틀을 확보하고 있지 못하다. 3. 지방 정부 수준의 재난 계획서에는 재난 발생시 보건의료에 관한 사항 전반을 공공 보건소가 핵심적 역할을 하며 재난 관리에 대처해야 된다고 규정하고 있다. 그러므로 보건소는 지역사회 중심의 재난 관리 계획을 구성하고 이를 운영하며, 재난 현장에서의 응급 치료 대응 과정은 구조/ 구명을 책임지고 있는 공공기관인 소방서와 지역의 응급의료병원에게 위임한다. 즉 지역사회 재난 관리 계획이 보건소 주도하에 관내 병원과 관련기관(소방서. 경찰서)이 협동하여 만들고 업무를 명확히 분담하여 연계방안을 만든다. 이는 재난관리 대처에 성공여부를 결정하는 주요 요인이다. 4 대한 적십자사의 지역사회 주민에 대한 교육 프로그램은 연중 열리고 있다. 그러나 대부분의 교육주제는 건강증진 영역이며. 응급의료 관리는 전체 교육시간의 8%를 차지하며 이중 재난 준비를 위한 주민 교육 프로그램은 없다. 또한 특정 연령층이 모여있는 학교의 경우도 정규 보건교육 시간이 없기 때문에 생명구조나 응급처치를 체계적으로 배우고 연습할 기회가 없으면서 국민의 재난 준비의 기반확대가 되고 있지 못하다. 5. 병원은 재난 관리 위원회를 군성하여 병원의 진료권역 내에 있는 여러 자원을 감안한 포괄적인 재난관리계획을 세우고, 지역사회를 포함한 훈련을 해야 한다. 그러나 현재 병원은 명목상의 재난 관리 계획을 갖고 있을 뿐이다. 6. 재난관리 준비도를 평가할 때 병원응급실 치료 팀의 인력과 장비 등은 비교적 기준을 충족시키고 있었으나 병원의 재난 관리 계획은 전혀 훈련되고 있지 못하였다 그러므로 우리나라 재난 관리의 준비를 위해서는 현장의 응급의료체계, 재난 대응 계획, 이의 훈련을 통한 주민교육이 선행되어야만 개선될 수 있다. 즉 민방위 훈련 모델이 아닌 응급의료 서비스 모델에 입각한 장기적 노력과 재원의 투입이 필요하며, 지역사회를 중심으로 대응 준비와 이의 활성화 전략 개발, 훈련과 연습. 교육에 노력을 부여해야 한다. 7. 현장의 1차 응급처치자에 대해서는 법적으로 명시하고 있는 역할이 없다. 한국에서는 응급구조사 1급과 2급에 대한 교육과 규정을 1995년 이후 응급의료에 관한 법률에서 정하고 있다. 이 교육과정은 미국이 정하고 있는 응급구조사 과정 기준과 유사하지만 실습실이나 현장에서의 실습시간이 절대적으로 부족하다. 덧붙여 승인된 응급구조사 교육 기관의 강사는 강사로서의 자격기준을 충족할 뿐 아니라 실습강사는 대체적으로 1주일의 1/2은 응급 구조차를 탑승하여 현장 활동을 끊임없이 하고 있으며, 실습은 시나리오 유형으로 진행된다. 그러므로 우리나라의 경우 응급 구조사가 현장 기술 인력으로 역할 할 수 있도록 교과과정 내에서 실습을 강화 시켜야하며, 졸업생은 인턴쉽을 통한 현장 능력을 배양시키는 것이 필요하다. 8. 간호사의 경우 응급전문간호사의 자격을 부여받게 됨에 따라, 이를 위한 표준 교육 지침을 개발함으로써 병원 전 처치와 재난시 대응할 수 있는 역량을 보완해야 한다. 또한 현 자격 부여 프로그램 내용을 고려하여 정규자격 간호사가 현장 1차 치료자(first responder)로 역할 할 수 있도록 간호학 교과과정을 부분 보완해야한다.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.20 no.11
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• pp.157-163
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• 2019

This study determines the difference in prevalence of anemia and hemoglobin concentration between chronic obstructive pulmonary disease (COPD) and control groups in the elderly. Moreover, this study also examines the prevalence of anemia and hemoglobin concentration according to the severity of COPD in the elderly. Medical records of 8150 participants who answered the 7th National Health and Nutritional Survey conducted in 2016 were reviewed, and a total of 694 participants was included in the analysis. Participants were classified into two groups: COPD and control groups. Laboratory studies on hemoglobin, hematocrit, red blood cell concentration and prevalence of anemia were collected. Subgroup analysis was also conducted according to the severity of COPD. No significant differences were determined for the prevalence of anemia and hemoglobin concentration between both groups. Hemoglobin concentration was significantly higher in the COPD group. Although not statistically significant, there was a tendency for decrease in the prevalence of anemia and increase in the hemoglobin concentration as the severity of COPD increased. Our findings present specific data about the prevalence of anemia and hemoglobin concentration in elderly patients with COPD. Hence, we propose that occurrence of anemia in elderly patients with COPD requires further evaluation of the causes.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.19 no.10
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• pp.222-230
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• 2018

This was a retrospective study that compared the characteristics of patients with decreased mental status (DMS) during their stays in an emergency department (ED) with that of patients with alert mental status (AMS). The participants in this study consisted of 90 patients with DMS who were staying in an ED along with 100 randomly selected patients with AMS. The DMS group contained more instances of cerebrovascular disease, liver disease, diabetes, and hypertension compared to the AMS group (p=0.001, p=0.003, p<0.001, and p=0.002, respectively). With regard to triage, the DMS group had higher severity than the AMS group (p<.001). The final diagnosis for the DMS group was as follows: 64.9% neurological and 63.3% related to the digestive system, which differed from that of the AMS group (p<.001). Fifty-six (62.2%) patients with DMS had their statuses discovered by nurses, while nine patients in the DMS group had received cardiopulmonary resuscitation. These results suggest that ED nurses frequently assess the consciousness of patients who they suspect may have neurologic or digestive diseases and are classified as high severity, even when the patients are alert.

• Korean Journal of Psychosomatic Medicine
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• v.26 no.2
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• pp.119-126
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• 2018

Objectives : The aim of this study is to investigate correlation between degree of white matter hyperintensities (WMH) and neurocognitive function along with behavioral and psychological symptoms of dementia (BPSD) in Korean patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI). Methods : Participants were 115 elderly subjects diagnosed with Alzheimer's disease or mild cognitive impairment in this retrospective study. WMH in brain MRI were rated with standardized visual rating scales (Fazekas scales) and the subjects were divided into two groups according to Fazekas scale. Cognitive function was evaluated with Korean version of the consortium to establish a registry for Alzheimer's Disease (CERAD-K), and BPSD was evaluated with Korean neuropsychiatric inventory (K-NPI). Independent t-test was performed to analyze the relationship between the degree of WMH and neurocognitive functions & BPSD. Results : Especially, the group with high severity of WMH showed significantly lower language fluency (p<0.05). In addition, the group with high severity of WMH showed significantly higher score in K-NPI. Conclusions : There was a significant association between WMH and neurocognitive test related with executive function. Moreover, WMH seems to affect BPSD severity. Evaluation of WMH would provide useful information in clinical settings.

• Journal of the Korean Society of Radiology
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• v.17 no.3
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• pp.423-431
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• 2023

The purpose of this study is to analyze the factors affecting the classification of the severity of contrast media side effects based on the patient's body information using artificial intelligence techniques to be used as basic data to reduce the degree of contrast medium side effects. The data used in this study were 606 examiners who had no contrast medium side effects in the past history survey among 1,235 cases of contrast medium side effects among 58,000 CT scans performed at a general hospital in Seoul. The total data is 606, of which 70% was used as a training set and the remaining 30% was used as a test set for validation. Age, BMI(Body Mass Index), GFR(Glomerular Filtration Rate), BUN(Blood Urea Nitrogen), GGT(Gamma Glutamyl Transgerase), AST(Aspartate Amino Transferase,), and ALT(Alanine Amiono Transferase) features were used as independent variables, and contrast media severity was used as a target variable. AUC(Area under curve), CA(Classification Accuracy), F1, Precision, and Recall were identified through AdaBoost, Tree, Neural network, SVM, and Random foest algorithm. AdaBoost and Random Forest show the highest evaluation index in the classification prediction algorithm. The largest factors in the predictions of all models were GFR, BMI, and GGT. It was found that the difference in the amount of contrast media injected according to renal filtration function and obesity, and the presence or absence of metabolic syndrome affected the severity of contrast medium side effects.