• Title/Summary/Keyword: 환자의 접근

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Psychosomatic Management of Medically Ill Elderly : Focused on Consultation Psychiatry (신체질환이 있는 노인 환자의 정신신체 의학적 치료 : 자문정신의학을 중심으로)

  • Ryu, Seong-Gon;Kwon, Hee-Jung
    • Korean Journal of Psychosomatic Medicine
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    • v.16 no.1
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    • pp.25-30
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    • 2008
  • With the rapid growth of geriatric population, geriatric psychiatric consultation has come to play a more important role in recent years. It is necessary to find out characteristics of psychiatric consultation-liaison in elderly and applicate practical guideline of consultation in medical setting. Management of medically ill elderly in psychiatric consultation requires different guideline from that of other age group patient. Because aging and each organ-specific diseases change the pharmacokinetics of psychotropic drugs variably. These pharmacokinetic changes should be considered in psychosomatic treatment in medically ill elderly. The relatively low consultation rates for psychiatric disorders in the elderly indicate that research is needed into factors that both prevent and facilitate elderly patients with psychological symptoms from consulting their general practitioners.

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Development of a Clinical Decision Support System using Formal Concept Analysis (형식개념분석 기법을 이용한 임상의사결정지원시스템의 구축)

  • Kang Yu-Kyung;Hwang Suk-Hyung;Kim Hong-Gee;Baek Seung-Hak;Kim Dong-Soon;Kim Eung-Hee;Yang Kyoung-Mo;Yang Sung-Kwon
    • Annual Conference of KIPS
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    • 2006.05a
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    • pp.407-410
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    • 2006
  • 방대한 양의 다양한 데이터들이 발생되는 의료분야에서는 임상데이터를 기반으로 보다 정확하고 효율적으로 현상을 분석/판단하여 의사가 환자진료 시 정확한 진단과 치료를 수행할 수 있도록 보조해주는 적절한 의사결정지원시스템이 요구되고 있다. 따라서, 이와 같은 요구를 충족시키기 위해서는 다종 다양한 데이터로부터 간결하면서도 효과적으로 개념들을 추출하고 구조화하여 개념계층구조로 표현할 수 있어야 하며, 실세계의 데이터에 대한 구조화와 요약을 제공하고 필요한 정보를 수월하게 접근할 수 있어야 한다. 본 연구에서는, 도메인 내의 다양한 데이터들로부터 개념들을 추출하고, 개념들 사이의 상하위 관계를 파악하여 개념계층구조를 구축하기위한 정형화된 데이터분석기법으로서 형식개념분석기법(Formal Concept Analysis)을 소개하고, 이를 치과 교정학 분야의 환자 임상데이터 분석기법(Cephalometric Analysis)에 융합한 형태의 임상의사결정지원시스템 개발 및 향후 연구과제 등에 관해 설명한다.

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The Problem-Solving Approach for Improving Walking Ability in Patient with Total Hip Replacement: Applied ICF Tool for Case Study (고관절 인공관절 치환술 환자의 보행능력 증진을 위한 문제해결 접근: ICF Tool을 적용한 단일사례연구)

  • Song, Hyun-seung;Kim, Suhn-yeop
    • The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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    • v.21 no.2
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    • pp.63-71
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    • 2015
  • Background: The purpose of the study, using the ICF Tool in the process of rehabilitation of artificial joint replacement surgery of the hip joint, goal setting and understanding of the problem, through the process of creating intervention strategies, useful clinical practical course for rehabilitation I try to present the data. Methods: Fracture was the left total hip replacement (THR) surgery due to women of 76 years old. I proceed in order screening, evaluation, diagnosis, prognosis, treatment planning and intervention, re-screening. Needs of the patient was walking short distances for using the toilet. In order to improve was carried out arbitration, after you have created a list of issues that limit the ability to walk short distances. Results: It was revealed improved results in self-paced walk test (SPWT) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to examine whether the goals. In addition, MMT VAS, DGI, and TUG is a detailed goal was improved. Conclusions: It can be shown objectively the results of interventions performed for the purpose of solving the problem which is grasped through clinical Practical course for short-range walking ability enhance patient THR. I considered practical clinical course using the ICF Tool would be useful.

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Effect of Task-Oriented Approach on Weight-Bearing Distribution and Muscular Activities of the Paretic Leg During Sit-to-Stand Movement in Chronic Stroke Patients (과제지향적 접근법이 만성 뇌졸중 환자의 일어서기 동작 시 환측다리의 체중지지비율과 근활성도에 미치는 영향)

  • Kim, Won-Ho
    • Physical Therapy Korea
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    • v.18 no.2
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    • pp.18-26
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    • 2011
  • The purpose of this study was to investigate the effects of a task-oriented approach on weight-bearing distribution and muscular activities of the paretic leg during sit-to-stand movement in 18 chronic stroke patients. Both groups were received neurodevelopmental treatment for 30 min/day and then the experimental group ($n_1$=9) followed additional a task-oriented approach (sit-to stand training with controlled environment) and the control group ($n_2$=9) followed a passive range of motion exercise for 15 min/day, five days/week, for four weeks. Weight-bearing distribution and muscular activities of the paretic leg during sit-to-stand movement were measured before and after four weeks of training. There was significantly improved weight-bearing distribution of the paretic leg during sit-to-stand movement in the experimental group compared with that of the control group after four weeks of training (p<.05). But electromyographic activities of the quadriceps and the tibialis anterior of the paretic leg were not significantly different (p>.05). Thus, it is necessary to apply a task-oriented approach to improve the weight-bearing distribution of the paretic leg during sit-to-stand movement in chronic stroke patients.

How we should approach and manage older patients with cancer (노인 암 환자의 접근과 관리 원칙)

  • Kim, Jee Hyun
    • Korean Journal of Head & Neck Oncology
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    • v.33 no.2
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    • pp.1-8
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    • 2017
  • Cancer is the disease of aging and Korea is one of the fastest aging country in the world. Older patients have decreased organ function and stress tolerance, therefore are at high risk of functional decline and developing complication from cancer and cancer treatment. Before beginning cancer treatment, it is important to assess patients' life expectancy, whether the patient is likely to die of cancer or of other comorbidity, and also the risks with cancer treatment. In order to estimate patient's physiologic age, it is recommended to perform geriatric assessment and implement appropriate geriatric intervention together with meticulous supportive care, when planning cancer treatment for older patients. In a resource limited country such as Korea, two step approach of applying screening tool followed by geriatric assessment can be more efficient. Geriatric assessment is used to predict toxicity from cancer treatment such as surgery, radiotherapy, and chemotherapy, predict survival, and also to aid treatment decision. Number of randomized trials are ongoing to compare usual care versus oncogeriatric care, and with these results we expect to improve outcome of older patients with cancer.

Pacing Wire Removal Via a Right Atriotomy: A Patient with Infected Permanent Pacemaker and Who Previously Underwent CABG - A case report - (개심술을 통한 심박동기 와이어의 제거: 관상동맥 치환술을 받은 환자에서 심박동기 삽입 후 발생한 국소 감염의 치료 - 1예 보고 -)

  • Kim, Yun-Seok;Song, Hyun;Ryu, Yang-Gi;Jung, Sung-Ho
    • Journal of Chest Surgery
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    • v.42 no.2
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    • pp.256-258
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    • 2009
  • A 63-year-old man who had a permanent pacemaker placed 17 years ago presented to us with local inflammatory signs on his chest. The skin was opened to remove the permanent pacemaker. However, the pacing wire was not easily removed. So, the permanent pacemaker was removed from the chest with leaving the remnant wire inside. However, the local infection recurred because of the remnant wire. Right thoracotomy was performed and cardiopulmonary bypass was started. After total circulatory arrest, the right atrium was opened and the wire was completely removed.

Impact of Regional Emergency Medical Access on Patients' Prognosis and Emergency Medical Expenditure (지역별 응급의료 접근성이 환자의 예후 및 응급의료비 지출에 미치는 영향)

  • Kim, Yeonjin;Lee, Tae-Jin
    • Health Policy and Management
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    • v.30 no.3
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    • pp.399-408
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    • 2020
  • Background: The purpose of this study was to examine the impact of the regional characteristics on the accessibility of emergency care and the impact of emergency medical accessibility on the patients' prognosis and the emergency medical expenditure. Methods: This study used the 13th beta version 1.6 annual data of Korea Health Panel and the statistics from the Korean Statistical Information Service. The sample included 8,119 patients who visited the emergency centers between year 2013 and 2017. The arrival time, which indicated medical access, was used as dependent variable for multi-level analysis. For ordinal logistic regression and multiple regression, the arrival time was used as independent variable while patients' prognosis and emergency medical expenditure were used as dependent variables. Results: The results for the multi-level analysis in both the individual and regional variables showed that as the number of emergency medical institutions per 100 km2 area increased, the time required to reach emergency centers significantly decreased. Ordinal logistic regression and multiple regression results showed that as the arrival time increased, the patients' prognosis significantly worsened and the emergency medical expenses significantly increased. Conclusion: In conclusion, the access to emergency care was affected by regional characteristics and affected patient outcomes and emergency medical expenditure.

One-stage Replacement of the Total Thoracic Aorta (전 흉부 대동맥 동시 치환술 -1례 보고-)

  • 김관민;김성철;박표원
    • Journal of Chest Surgery
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    • v.32 no.6
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    • pp.595-598
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    • 1999
  • Some extensive thoracic aortic aneurysms are not amenable to staged repair, such as extremely large distal aortic aneurysms that are unsuitable for an elephant trunk anastomosis, or aneurysms that are accompanied by complications such as ruptured descending thoracic aneurysm. We report here a case of successful replacement of the aorta from the ascending to the descending aorta in one operation. The patient was 65-year-old man who had an aneurysm which involved the entire thoracic aorta and ruptured in the descending aorta. The operation was performed via transverse thoracosternotomy, and under the deep hypothermic circulatory arrest with retrograde cerebral perfusion. The patient recovered uneventfully and was discharged without any neurologic complications.

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The Disease Management Experience of Patients with Asthma: Grounded Theory Approach (천식 환자의 질병관리 경험: 근거이론접근)

  • Kim, Bohye;Kim, Oksoo
    • Journal of Korean Academy of Nursing
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    • v.50 no.5
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    • pp.714-727
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    • 2020
  • Purpose: The aim of this study was to develop a situation-specific theory to explain the disease management experience of patients with asthma. Methods: Twenty participants with asthma were selected using the theoretical sampling method. The data were acquired through in-depth interviews conducted from June to October 2018 and analyzed using the grounded theory approach of Strauss and Corbin. Results: In total, 69 concepts, 30 subcategories, and 13 categories were generated to explain the disease management experience of patients with asthma. The core category of the disease management experience of patients with asthma was 'management of the disease to prevent aggravation of symptoms over the lifetime'. The disease management process of asthma patients included three steps: the 'cognition phase', the 'adjustment phase', and the 'maintenance phase'. However, some patients remained in the 'stagnation phase' of disease management, which represents the result of the continual pursuit of risky health behavior. There were three types of disease management experiences among patients with asthma: 'self-managing', 'partially self-managing', and 'avoidant'. Conclusion: This study shows that patients with asthma must lead their disease management process to prevent exacerbation of their symptoms. It is imperative to develop nursing strategies and establish policies for effective disease management of patients with asthma based on their individual disease management processes and types.

Genetic Background of Congenital Hearing Loss (선천성 난청의 유전적 배경)

  • Oh, Seung-Ha;Song, Jae-Jin
    • Journal of Genetic Medicine
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    • v.6 no.1
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    • pp.8-24
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    • 2009
  • Understanding the genetic background of hearing loss is important since almost 50% of the cases of profound hearing loss are caused by genetic factors. Until now, more than 150 causative genes have been identified. In this review, classification of genetic hearing loss (syndromic versus non-syndromic, recessive versus dominant, X-linked and mitochondrial), pitfalls in elucidating causative genes, anatomy of the inner ear, introduction of the most common syndromic hearing loss, introduction of the most common non-syndromic hearing loss-causing genes, mitochondrial and multifactorial hearing losses were discussed. Moreover, clinical approaches to the patients with hereditary hearing loss and genetic counseling were also explained briefly. Finally, future directions of the hereditary hearing loss research in Korean population were presented.

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