• Title/Summary/Keyword: 치료거부

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INTRAVENOUS SEDATION WITH MIDAZOLAM (Midazolam을 이용한 정주진정요법)

  • Lee, Jun-Seok;Kim, Jong-Soo;Kim, Seung-Oh
    • The Journal of Korea Assosiation for Disability and Oral Health
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    • v.2 no.2
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    • pp.142-146
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    • 2006
  • Oral administration of chloral hydrate with hydroxyzine, nitrous oxide inhalation and intramuscular or intranasal administration of midazolam is the most commonly used pharmacological behavior management methods for the children in pre-cooperative stage or show negative behavior in pediatric dentistry. For oral administration of chloral hydrate with hydroxyzine, it is hard to apply to the patient refused to intake and with overweighted or elderly children and the effect of the drug decrease. Nitrous oxide and midazolam is anxiolytic agents and have limitation for properly managing the behavior of the children refuse to dental treatment. These occasions, deep sedation or general anesthesia can be considered. Although intravenous sedation with midazolam has many advantages such as, rapid onset and recovery, possible to titration and few side effect, no rebound effect by metabolites, the reports for, intravenous sedation with midazolam is insufficient in pediatric dentistry. We report the case in pre-cooperative stage. He is treated successfully under intravenous sedation with midazolam.

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Concept Analysis of Psychological Resistance to Antihypertensive Medication (고혈압환자의 약물치료에 대한 심리적 저항의 개념분석)

  • Jang, Hee Soon;Kong, Kyoung Ran;Lee, Eun Nam;Kang, Jiyeon;Jang, Moon Jung
    • Journal of Korean Critical Care Nursing
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    • v.9 no.2
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    • pp.48-60
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    • 2016
  • Purpose: The purpose of this study was to identify the attributes of the concept, of psychological resistance to antihypertensive medication. Methods: The study was conducted in accordance with Walker and Avant's conceptual analysis process. We reviewed 47 related studies selected from 4 international and Korean databases including Medline, CINAHL, NDSL, and RISS to perform the analytical processes from January 1980 to September 2015. Results: The attributes of psychological resistance to antihypertensive medication include 1) reservation, 2) opposition, 3) denial, 4) refusal, and 5) seeking alternative therapy. The antecedents of the concept can be classified into patient factors such as reactance trait and knowledge deficit, provider factors, interpersonal factors, and environmental factors. The consequences of psychological resistance to antihypertensive medication are non-compliance, deterioration of the disease, developing complications, increased anxiety, and changes in life. Conclusions: The concept of psycho logical resistance to antihypertensive medication can provide guidance for the development of an intervention program that promotes the compliance to medication regimen of hypertensive patients. Further research needs to be done to develop a measurement tool for psychological resistance to antihypertensive medication.

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Pulmonary Aspergillosis in Cardiac Transplant Patients -The Report of Two Cases (심장이식후 발생한 아스페르길루스증-2례 보고-)

  • 박국양;김희정
    • Journal of Chest Surgery
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    • v.30 no.3
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    • pp.330-335
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    • 1997
  • Aspergillus Infection is a major.cause of mortality in individuals with depressed cell-mediated immunity. Despite therapy with intravenous amphotericin B and oral antifungal agents, high mortality has been reported among heart transplant recipients. We experienced two cases of pulmonary aspergillosis among 15 heart transplantation cases. Both cases were similiar in terms of age, time of diagnosis, and medication. Percutaneous needle aspiration biopsy revealed Aspergillus fumigatus in both cases. The thirst case showed multiple aspergilloma on both lung fields and were treated by IV Amphotericin B and oral itraconazole. After completion of treatment, the lesion completely disappeared and he has been followed up for more than one year in his good condition. The second case showed a single nodule on his right lower lung field and were treated by both medication and surgery. The patient recovered well and had been doing well until 4th postoperative month when he developed humoral rejection and expired.

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Effective Behavioral Strategies for Pediatric Feeding Problems (섭식 문제 행동에 대한 효과적인 행동전략)

  • Chung, Kyong-Mee
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.11 no.sup1
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    • pp.143-148
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    • 2008
  • It is relatively common to have various feeding problem during infancy and childhood, even for typically developing children. Treatment outcome studies for pediatric feeding disorder consistently reported that applied behavior analaysis (ABA), a type of behavior intervention, is very effective and efficacious. Interdisciplinary team approach is necessary for severe feeding problems, but similar methods could be used through parent training for moderate and mild feeding problems. This article introduced assessment procedure to identify feeding problems as well as specific methods to deal with diver feeding issues. Each strategy can be used effectively only when it is combined with several other strategies including environmental rearrangement and should be developed individually upon each child's feeding issues. In addition, systematic and continuous parent trainings are mandatory. At the end, several treatments related issues were addressed.

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CLINICAL SUBTYPING AND TREATMENT STRATEGY OF COLLEGE ENTERANCE EXAMINATION STRESS SYNDROME (입시병의 아형과 대처방안)

  • Lee, Young-Sik;Ku, Young-Jin;Lee, Kil-Hong
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.2 no.1
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    • pp.43-48
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    • 1991
  • The College entrance examination stress syndrome is a kind of anxiety disorder. The underlying cause of this disorder is not a test anxiety itself. One's hidden inner and familial conflicts are more likely attributed to this disorder. Patient's the most common complaints are various psychosomatic symptoms but in severe cases underlying psychopathology may be activated and progress to major psychosis. In a broad sense adolescent's delinguent behavior, drug abuse, school drop-out and sucide are closely related to this syndrome. In clinical management of these patients, considering the special situation of impending examination, the therapist must access to central conflict theme in a short time without severe resistance. The authors classified this syndrome into 5 clinical subtypes ; 'the anxious group', 'the exhaustion group', 'the despair group', 'the emptyness group' and 'the boredome group'. Typical case of each subtype and it's management methods were presented briefly.

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Radiotherapy in Medically Inoperable Early Stage Non-small Cell Lung Cancer (내과적 문제로 수술이 불가능한 조기 비소세포성 폐암에서의 방사선치료)

  • Kim, Bo-Kyoung;Park, Charn-Il
    • Radiation Oncology Journal
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    • v.18 no.4
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    • pp.257-264
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    • 2000
  • Purpose: For early stage non-small-cell lung cancer, surgical resection is the treatment of choice. But when the patients are not able to tolerate it because of medical problem and when refuse surgery, radiation therapy is considered an acceptable alternative. We report on the treatment results and the effect of achieving local control of primary tumors on survival end points, and analyze factors that may influence survival and local control. Materials and Method : We reviewed the medical records of 32 patients with medically inoperable non-small cell lung cancer treated at our institution from June, 1987 through June, 1997. All patients had a pathologic diagnosis of non-small cell lung cancer and were not candidate for surgical resection because of either patients refusal (4), old age (2), lung problem (21), chest wail invasion (3) and heart problems (3). In 8 patients, there were more than 2 problems. The median age of the patients was 68 years (ranging from 60 to 86 years). Histologic cell type included souamous (24), adenocarcinoma (6) and unclassiried squamous cell (2). The clinical stages of the patients were 71 in 5, 72 in 25, 73 in 2 patients. Initial tumor size was 3.0 cm in 11, between 3.0 cm and 5.0 cm in 13 and more than 5.0 cm in 8 patients. Ail patients had taken chest x-rays, chest CT, abdomen USG and bone scan. Radiotherapy was delivered using 6 MV or 10 MV linear accelerators. The doses of primary tumor were the ranging from 54.0 Gy to 68.8 Gy (median; 61.2 Gy). The duration of treatment was from 37 days through 64 days (median; 0.5 days) and there was no treatment interruption except 1 patient due to poor general status. In 12 patients, concomitant boost technique was used. There were no neoadjuvant or adjuvant treatments such as surgery or chemotherapy. The period of follow-up was ranging from 2 months through 93 months (median; 23 months). Survival was measured from the date radiation therapy was initiated. Results : The overall survival rate was 44.6$\%$ at 2 years and 24.5$\%$ at 5 years, with the median survival time of 23 months. of the 25 deaths, 7 patients died of intercurrent illness, and cause-specific survival rate was 61.0$\%$ at 2 years and 33.5$\%$ at 5 years. The disease-free survival rate was 38.9$\%$ at 2 years and 28.3$\%$ at 5 years. The local-relapse-free survival rate was 35.1$\%$, 28.1$\%$, respectively. On univariate analysis, tumor size was significant variable of overall survival (p=0.0015, 95$\%$ C.1.; 1.4814-5.2815), disease-free survival (P=0.0022, 95$\%$ C.1., 1.4707-5.7780) and local-relapse-free survival (p=0.0015, 95$\%$ C.1., 1.2910- 4.1197). 7 stage was significant variable of overall survival (p=0.0395, 95$\%$ C.1.; 1.1084-55.9112) and had borderline significance on disease-free survival (p=0.0649, 95$\%$ C.1.; 0.8888-50.7123) and local-relapse-free survival (p=0.0582, 95$\%$ C,1.; 0.9342-52.7755). On multivariate analysis, tumor size had borderline significance on overall survival (p=0.6919, 955 C.1., 0.9610-5.1277) and local-relapse-free survival ( p=0.0585, 95$\%$ C.1.; 0.9720-4.9657). Tumor size was also significant variable of disease-free survival (p=0.0317, 95% C.1.; 1.1028-8.4968). Conclusion : Radical radiotherapy is an effective treatment for small (71 or f3 cm) tumors and can be offered as alternative to surgery in elderly or infirmed patients. But when the size of tumor is larger than 5 cm, there were few long-term survivors treated with radiotherapy alone. The use of hypefractionated radiotherapy, endobronchial boost, radisensitizer and conformal or IMRT should be consider to improve the local control rate and disease-specific survival rate.

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A Study on the Self-diagnosis System Using Mental Health Simple Screening Tool (정신건강 간이선별도구를 활용한 자가진단 시스템 구축에 관한 연구)

  • Lee, Young-Won;Song, Won-Gil;Park, Ki-Tae;Kang, Yang-Koo;Kang, Min-Koo
    • Proceedings of the Korea Multimedia Society Conference
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    • 2012.05a
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    • pp.302-303
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    • 2012
  • 최근 급증하고 있는 자살률과 청소년들의 학교폭력, 강력범죄 등은 심각한 사회적 문제가 되고 있다. 또한 컴퓨터의 보급으로 인한 인터넷 중독, 중년의 치매 등도 우리의 정신건강을 해치는 중요한 요인이다. 본 논문은 정신건강 간이선별도구를 활용하여 생활 스트레스로부터 발생되는 우울증과 인터넷 중독 등 정신건강을 헤치는 다양한 요인에 대한 대상자의 위험도를 파악하여 고(高)위험군에 해당되는 대상자의 1차 선별을 가능하게 하며, 정신건강진단에 대한 거부감을 줄이기 위한 놀이형태의 진단방법을 통하여 전문적인 치료로 유도하는 시스템을 구축하는 연구이다.

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Exploring the Applicability of SMART Recovery for the Recovery of Addiction (중독 회복을 위한 SMART Recovery의 적용 가능성에 관한 연구)

  • Huh, Eun Jung;Kim, Nami;Kim, Bee
    • Proceedings of the Korea Contents Association Conference
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    • 2019.05a
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    • pp.467-468
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    • 2019
  • Alcoholics Anonymous(AA)/Narcotic Anonymous(NA)의 12 단계 중독 회복 프로그램과 선배 회복자의 지지는 중독 치료 모델에서 성공적인 회복에 기여하는 주요한 역할을 한다. 12단계 중독회복 프로그램의 특징은 특정 종교를 기반으로 하지 않지만 자신의 무력감과 영적 존재에 대한 인정을 바탕으로 한다. 어떤 이들에게는 성공의 요인으로 작용하는 이 특징이 일부 참여자에게 거부하게 하는 요인으로 작용한다. 또한 AA/NA의 오프라인 모임에서 발생하는 다양한 부작용으로 인해 사회적 지지가 필요하지만 사회적 지지를 포기하는 이탈이 발생하여 참석자의 회복에 지장을 주기도 한다. 이에 서구 여러 나라에서 AA/NA와 유사하지만 오프라인뿐만 아니라 온라인 모임이 가능하고, 외부의 존재에 대한 의존이 아닌 중독자 스스로가 중독을 극복하게 도와주며 다양한 형태의 중독의 문제를 다루도록 돕는 SMART(Self Management and Recovery Training) Recovery가 대안으로 부상하였다. 따라서 본 연구에서는 중독회복에 상호자조집단의 도움이 필요하지만 12단계 프로그램이나 오프라인 모임 외에 다른 대안이 없는 국내 상황에 대한 새로운 대안으로 SMART Recovery에 대한 정보와 접근방법들을 심도 있게 탐색하고자 한다.

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Experimental Model of Cardiac Xenograft, Mouse Heart to Rat. (이종이형의 심장이식의 실험적 모델)

  • Kim, Byung-Il;Sohn, Sang-Tae;Shin, Sung-Ho;Chung, Won-Sang;Kim, Hyuk;Kim, Young-Hak;Kang, Jung-Ho;Jee, Heng-Ok;Lee, Chul-Burm;Seo, Jung-Kuk
    • Journal of Chest Surgery
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    • v.32 no.1
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    • pp.1-4
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    • 1999
  • Background: The transplantation of organs between phylogenetically disparate or harmonious species has invariably failed due to the occurrence of hyperacute rejection or accerelated acute rejection. But, concordant cardiac xenograft offer us an opportunity to study xenotransplantation in the absence of hyperacute rejection. Current therapeutics for the prolongation of survival of rodent concordant xenotransplantation are not ideal with many regimens having a high mortality rate. Cyclosporine A & Mycophenolate Mofetil are new immunosuppresive agent which has been shown to be effective at prolonging survival of allograft, as purine synthesis inhibitor. Material and Method: We used white mongrel rats as recipient and mice as donor, divided 4 groups(n=6), control group(Group 1) has no medication or pretreatment, Group 2 has splenectomy as pretreatment 7∼10 days before transplantation, Group 3 has Cyclosporine A treatment group, Group 4 has combined treatment of Cyclosporine A & Mycophenolate Mofetil(RS 61443). We compared survival time. Reuslt: We can't find significant difference of survival time between each groups. Conclusion: We concluded that rejection of cardiac xenograft was different from rejection of allograft, and new immunossuppresive Agent(Mycophenolate Mofetil, Cyclosporine A) was not effective for prolongation of survival time after cardiac xenograft.

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Results of Preoperative Chemoradiotherapy in Low Rectal Cancer (하부 직장암의 수술 전 화학방사선요법 결과)

  • Yun Hyong-Geun
    • Radiation Oncology Journal
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    • v.24 no.1
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    • pp.21-29
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    • 2006
  • Purpose: This study explored the anal sphincter-saving rate and down-staging rate after preoperative chemoradiotherapy for treating lower rectal cancer. We also explored the prognosis of the patients who refused surgery after preoperative chemoradiotherapy. Materials and Methods: Thirty seven patients with histologically proven lower rectal cancer who underwent preoperative chemoradiotherapy were retrospectively analyzed. In each case, the tumor location was 0 to 5 em from the anal verge, and curative resection of the cancer with performing a sphincter-saving procedure was not feasible before chemoradiotherapy. In each case, the staging examinations, including biopsy, were done before starting radiotherapy and this was repeated at 1 month after radiation therapy. Results: After chemoradiotherapy, among the 37 included patients, 56.8% and 32.4% were downstaged to the T stage and N stage, respectively, when comparing the postradiotherapy stage with pre-radiotherapy stage. Twenty five patients underwent complete resection of cancer at 6 weeks after radiotherapy: eleven, eight and six patients underwent abdominoperineal resection, low anterior resection and local excision, respectively. The sphincter-saving rate among the 24 completely resected cases was 54.2%. Twelve patients refused surgery after radiotherapy. Among 6 patients who refused surgery with biopsy-proven complete remission after chemoradiotherapy, 5 patients were alive without disease at a median follow up period of 31 months, and only 1 patient had local failure. Conclusion: For lower rectal cancer, a high sphincter-saving rate was accomplished with preoperative chemoradiotherapy. The prognosis of the patients who refused surgery with biopsy proven complete remission after chemoradiotherapy was good and these patients need to be kept under close surveillance.