• Journal of Chest Surgery
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• 제39권8호
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• pp.633-636
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• 2006

부분 심내막상 결손증은 일차공 결손과 승모판 전엽에 열공을 동반하는 질환으로 완전형 심내막상 결손증에 비해 임상 증상이 심하지 않으나, 승모판 부전이 진행할수록 심비대, 심부전, 폐동맥 고혈압 등이 더욱 쉽게 발현되어 그 예후가 좋지 않고, 따라서 고령에서는 보기 힘든 질환이다. 본원으로 30년 전부터 증상이 있던 67세 부분 심내막상 결손증 환자가 내원하였다. 심도자 검사상 폐동맥압이 45/22 mmHg, 평균 압력은 32 mmHg로 약간의 폐동맥 고혈압이 있었고, 수술 소견상 $3.5{\times}2.5\;cm$ 크기의 일차공 결손과 심한 석회화를 동반한 승모판 전엽의 열공이 보여 일차공 결손 첨포 봉합과 승모판막 치환술을 시행하였다. 수술 후 11일째부터 심한 방설 차단이 발생하여, 영구 심박동기를 삽입하였고, 수술 27일 후 퇴원하였다. 저자들은 임상적으로 보기 드문 고령에서의 부분 심내막상 결손증을 수술적으로 교정하였기에 문헌 고찰과 함께 보고하는 바이다.

• 한방재활의학과학회지
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• 제27권4호
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• pp.97-109
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• 2017

Objectives The aim of this study is to analyze the patients who have low back pain through registry. Methods We registered patients with low back pain who visited department of korean rehabilitation medicine in university hospitals on study. We collected data from 116 subjects consisted of 51 inpatients and 65 outpatients and ruled out 8 who didn't have pattern identification data at the point of inpatient or outpatient visit so we analyzed 108 in total. We used Pearson's product moment correlation to find correlationship among variables, and analyzed statistical data using Phyton scipy library stats package. Results We set general features, region of the pain, physical examination, ROM, questionnaire results, pattern identification as variables and draw a conclusion by analyzing these variables. Conclusions Registry aimed at low back pain patients was established in department of korean rehabilitation medicine of university hospitals and exploratory analysis based on data were made. Through the registry, we expect that more advanced studies will be performed; for example, executing research which verifies effectiveness and stability of korean medical treatment or developing tools to fill the gap between pattern identification and disease identification.

• 간호행정학회지
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• 제5권1호
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• pp.113-136
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• 1999

There are some new trends in judgments concerning medical malpractice. which include emphasis on medical professionals' explanation duty in order to materialize patient's rights of self-determination. Now, patient is not a mere subject of medical and nursing care any more, but a subject, participating in medical practice on equal terms with medical professionals. Legal accountability is no limited to nurses in advanced practice: it is a recognized fact of life for every practicing nurse. whether she is an RN employed as a staff nurse in a hospital, a Certified Nurse-Midwife in independent practice or a patient's home. Therefore, it is essential for nurses to be as familiar as possible with the legal guidelines that govern their patient care responsibilities. However there are only a few studies focused on nursing negligence. To define nurse's civil liability in medical malpractice, it is necessary to indentify both legal nursing behaviors and nurse's due care in those nursing behaviors. So this paper focused on nurse's due care, especially in nursing malpractice. To clarify nurses' due care. chapter II has focused on nursing behavior and the scope of nursing practice based on the medical law and health care related study results. Chapter III deals with the content and scope of nurse's due care. Generally. negligence is defined as not doing something which a resonable person. guided by those ordinary considerations which or dinarily regulate human affairs. would do. or doing something which a resonable and prudent man would not do. Next. it describes how we can set the standard of due care in nursing practice. There is objective factors and subjective factors. And we also discuss about the limitation of due care in nursing practice. Finally. chapter IV deals with the case studies related to nursing negligence in the situation of determination. Now', patient is not a mere subject of medical and nursing care any more, but a subject participating in medical practice on equal terms with medical professionals. Legal accountability is not limited to nurses in advanced practice; it is a recognized fact of life for every practicing nurse. whether she is an RN employed as a staff nurse in a hospital. a Certified Nurse-Midwife in independent practice or a patient's home. Therefore, it is essential for nurses to be as familiar as possible with the legal guidelines that govern their patient care responsibilities. However. there are only a few studies focused on nursing negligence. To define nurse's civil liability in medical malpractice, it is necessary to identify both legal nursing behaviors and nurse's due care in those nursing behaviors. So this paper focused on nurse's intravenous injection. post operation nursing care. blood transfusion. and patient nursing care. The result of this paper is as follows. First. there are several cases dealing with nurse's negligence in nursing practice. however, those cases didn't judge nurse's due care based on individual -specific standard but general-objective standard. Second, there is a tendency to put an emphasis on the principal of belief to distinguish who has the liability in the case of medical malpractice among medical care team. So nurses shoud practice nursing care more actively to protect themselves and patients because there is an effort to form professional nurse system and the scope of nursing practice will be deeper and broader. Third, standard of care is a necessary element in establishing negligence. If a nurse is able to meet the standard of care, no breach will be found.

• Journal of Yeungnam Medical Science
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• 제16권2호
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• pp.208-218
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• 1999

영남대학교 의과대학 부속병원 내과에서 최근 6년간 조직학적으로 원발성 폐암이 진단되고, 알부민으로 교정한 혈청 칼슘농도가 10.5mg/dl 이상으로, 고칼슘혈증을 시사하는 임상증상이 있었던 29례를 대상으로 조직학적 소견 및 병기, 종괴의 크기, 골전이 유 무, 그리고 수행능력에 따른 혈청 칼슘농도의 차이와 혈청 칼슘농도에 따른 임상양상의 차이, 그리고 치료에 대한 반응 정도를 조사하였다. 폐암의 진단과 고칼슘혈증 발현과의 시간간격 및 고칼슘혈증이 진단된 후 생존기간 등에 대해서도 함께 고찰하여 다음과 같은 결과를 얻었다. 1) 대상환자 중 고칼슘혈증은 50대와 60대가 가장 많았으며 편평상피세포암이 대부분을 차지하였다(89.7%). 2) 고칼슘혈증은 병기가 진행될수록, 분화가 나쁠수록 유의하게 빈발하였으며, 수행등급이 나쁘거나 종괴의 크기가 클수록, 그리고 골전이가 있는 환자에서 혈청칼슘농도가 높았으나 통계학적으로 유의하지는 않았다. 3) 고칼슘혈증은 폐암진단 당시보다 진단 후 경과관찰 중 발현한 경우가 많았고, 대부분 폐암진단 후 1년 이내에 발현하였다. 4) 고칼슘혈증의 치료에 대한 반응은 치료방법에 따른 차이는 없었으나 치료에 반응한 환자군의 평균 생존기간이 유의하게 길었다. 5) 고칼슘혈증으로 진단된 폐암 환자 29례 중 27례는 고칼슘혈증 진단 후 6개월 이내 사망하였으며, 특히 진단 후 1개월 이내 사망한 경우가 68.9%로 대부분을 차지하였다. 결론적으로 고칼슘혈증은 폐암환자의 중요한 사망 원인 중 하나로 환자의 예후를 추측할 수 있는 예측인자이며, 적절한 치료로 호전될 경우 급격한 증상의 악화와 사망을 피할 수 있어 고칼슘혈증에 대한 적극적인 조사 및 치료가 필요할 것으로 생각한다.

• Asian Pacific Journal of Cancer Prevention
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• 제13권9호
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• pp.4373-4378
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• 2012

Introduction: Hypercalcemia is mainly caused by bone resorption due to either secretion of cytokines including parathyroid hormone-related protein (PTHrP) or bone metastases. However, hypercalcemia may occur in patients with or without bone metastases. The present study aimed to describe the effect of chemotherapy treatment, regimens and doses on calcium levels among breast and lung cancer patients with hypercalcemia. Methods: We carried a review of medical records of breast and lung cancer patients hospitalized in years 2003 and 2009 at Penang General Hospital, a public tertiary care center in Penang Island, north of Malaysia. Patients with hypercalcemia (defined as a calcium level above 10.5 mg/dl) at the time of cancer diagnosis or during cancer treatment had their medical history abstracted, including presence of metastasis, chemotherapy types and doses, calcium levels throughout cancer treatment, and other co-morbidity. The mean calcium levels at first hospitalization before chemotherapy were compared with calcium levels at the end of or at the latest chemotherapy treatment. Statistical analysis was conducted using the Chi-square test for categorical data, logistic regression test for categorical variables, and Spearman correlation test, linear regression and the paired sample t tests for continuous data. Results: Of a total 1,023 of breast cancer and 814 lung cancer patients identified, 292 had hypercalcemia at first hospitalization or during cancer treatment (174 breast and 118 lung cancer patients). About a quarter of these patients had advanced stage cancers: 26.4% had mild hypercalcemia (10.5-11.9 mg/dl), 55.5% had moderate (12-12.9 mg/dl), and 18.2% severe hypercalcemia (13-13.9; 14-16 mg/dl). Chemotherapy lowered calcium levels significantly both in breast and lung cancer patients with hypercalcemia; in particular with chemotherapy type 5-flurouracil+epirubicin+cyclophosphamide (FEC) for breast cancer, and gemcitabine+cisplatin in lung cancer. Conclusion: Chemotherapy decreases calcium levels in breast and lung cancer cases with hypercalcemia at cancer diagnosis, probably by reducing PTHrP levels.

• Asian Pacific Journal of Cancer Prevention
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• 제15권19호
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• pp.8221-8224
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• 2014

Gastric cancer continues to be a leading cause of cancer death. The majority of patients with gastric adenocarcinoma in China present with advanced disease. Ruling out unresectable cancers from an unnecessary "open" exploration is very important. The aim of this study was to assess the value of five-port anatomical laparoscopic exploration in T4 gastric cancer in comparison with three-port laparoscopic exploration and laparotomy exploration. We conducted a retrospective study on 126 patients with T4 stage scheduled for D2 curative gastrectomy based on computed tomography (CT) staging at Department of Gastric Cancer and Soft Tissue Sarcoma, Fudan University Shanghai Cancer Center, from Apr. 2011 to Apr. 2013. Laparotomy exploration (Group I), three-port laparoscopic exploration (Group II) or five-port anatomical laparoscopic exploration (Group III) were performed prior to radical gastrectomy. Accuracy rate for feasibility of D2 curative gastrectomy in laparotomy exploration and five-port anatomical laparoscopic exploration groups was higher than that in the three-port laparoscopic exploration group. Five-port anatomical laparoscopic exploration group had the highest accuracy resection rate (Group I vs Group II vs Group III,92.6% vs78.6% vs 97.7%; p<0.05) and shorter length of hospitalization (Group I vs Group II vs Group III, $9.58{\pm}4.17$ vs $6.13{\pm}2.85$ vs $5.00{\pm}1.81$; p<0.001). Three-port laparoscopic exploration has low accuracy rate for assessing feasibility of D2 curative gastrectomy and five-port anatomical laparoscopic exploration should be performed on patients with T4 gastric cancer.

• The Journal of Advanced Prosthodontics
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• 제5권4호
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• pp.471-478
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• 2013

PURPOSE. The aim of the study was to evaluate the effect of annealing on the nanostructure and hardness of Co-Cr metal ceramic samples that were fabricated with a direct metal laser sintering (DMLS) technique. MATERIALS AND METHODS. Five groups of Co-Cr dental alloy samples were manufactured in a rectangular form measuring $4{\times}2{\times}2$ mm. Samples fabricated by a conventional casting technique (Group I) and prefabricated milling blanks (Group II) were examined as conventional technique groups. The DMLS samples were randomly divided into three groups as not annealed (Group III), annealed in argon atmosphere (Group IV), or annealed in oxygen atmosphere (Group V). The nanostructure was examined with the small-angle X-ray scattering method. The Rockwell hardness test was used to measure the hardness changes in each group, and the means and standard deviations were statistically analyzed by one-way ANOVA for comparison of continuous variables and Tukey's HSD test was used for post hoc analysis. P values of <.05 were accepted as statistically significant. RESULTS. The general nanostructures of the samples were composed of small spherical entities stacked atop one another in dendritic form. All groups also displayed different hardness values depending on the manufacturing technique. The annealing procedure and environment directly affected both the nanostructure and hardness of the Co-Cr alloy. Group III exhibited a non-homogeneous structure and increased hardness ($48.16{\pm}3.02$ HRC) because the annealing process was incomplete and the inner stress was not relieved. Annealing in argon atmosphere of Group IV not only relieved the inner stresses but also decreased the hardness ($27.40{\pm}3.98$ HRC). The results of fitting function presented that Group IV was the most homogeneous product as the minimum bilayer thickness was measured (7.11 ${\AA}$). CONCLUSION. After the manufacturing with DMLS technique, annealing in argon atmosphere is an essential process for Co-Cr metal ceramic substructures. The dentists should be familiar with the materials that are used in clinic for prosthodontics treatments.

• 한국멀티미디어학회논문지
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• 제1권1호
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• pp.45-55
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• 1998

원격의료정보 시스템에서는 멀티미디어 정보의 전송을 위한 광대역 통신망과 멀티미디어 원격 의료 정보를 쉽게 사용할 수 있게 하는 단말장치가 기본적으로 구성되어야 한다. 특히 멀티미디어 원격 의료정보 시스템의 단말기에는 의료진이 쉽게 사용할 수 있도록 병원의 기존 진료 절차와 거의 동일한 형태의 진료업무가 실행될 수 있는 멀티미디어 GUI 환경이 제공되어야 한다. 본 논문에서는 ATM/B-ISDN을 기반으로 한 멀티미디어 원격의료정보 시스템에서의 PC용 멀티미디어 원격진료 GUI(TeleMe야_GUI)를 구현하였다. ATM/B-ISDN 통신망 환경에서 워크스테이션을 멀티미디어 데이터베이스 서버로 두고, 각 의료진이 사용하는 PC의 TeleMe야_GUI에서 멀티미디어 진료 자료들을 원격 검색 할 수 있도록 하기 위한 클라이언트/서버간의 통신 프로토콜을 제안하였다. 이러한 ATM 통신망과 통신 프로토콜을 기반으로 하여 PC용 GUI를 구현하였다. 본 논문에서 제시하는 TeleMedi_GUI를 이용하면 의사는 X-ray/CT와 같은 영상정보나 X-ray 판독소견과 같은 음성정보를 이용하여 환자를 효율적으로 진료할 수 있다. 이 연구결과는 1차 진료기관과 2차 종합 진료기관간의 의료정보 서비스망으로 활용될 수 있으며, 병원 내부에서도 멀티미디어 진료시스템 개발에 활용될 수있다.

• 한국식품영양과학회지
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• 제35권3호
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• pp.383-387
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• 2006

호남지역 병원 6곳의 급식시설 및 부식류 등에 대한 미생물학적 안정성이 평가되어졌다. 조사된 병원급식시설의 공중낙하균 평가에서는 식탁, 조리장 및 냉동고에서 미생물균수가 비교적 높게 측정되어 이러한 시설에 대한 미생물학적 오염에 대한 철저한 관리가 요구됨을 보여 주었다. 또한 조리기구 및 용기 표면의 미생물학적 안정성 측정에서는 도마, 칼, 식판 등의 일반세균수는 비교적 높았으나 유의적인 수준은 아니었으며 대장균군, 황색포도상구균, 대장균 등의 수준도 일반적인 미생물 오염기준 미만으로 나타나 미생물학적 안정성은 양호하였다. 하지만 이들 급식시설에서 제공되는 부식류에 대한 미생물학적 안정성 평가에서는 대체적으로 가열조리식품의 미생물학적 오염은 기준 미만으로 나타났으나 기준을 초과한 부식에 대해서는 철저한 미생물학적 안전 관리가 이루어져야 할 것으로 판단되었다.

• 한국산학기술학회논문지
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• 제18권8호
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• pp.162-170
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• 2017

본 연구는 중소병원 간호인력 현황과 관련 정책을 분석하고 인력 확보에 영향을 주는 요인을 파악하여 중소병원 간호인력 확보를 위한 정책을 입안하고 결정하는 데에 근거를 제시하고자 실시되었다. 보건복지부와 건강보험심사평가원 등에서 제시한 통계자료를 2차 분석한 후 그 결과를 다양한 내 외적 보건의료환경에 대한 이해를 기반으로 조명하였다. 연구결과 우리나라의 활동 간호사 수는 면허간호사 수의 50% 미만으로 그 수는 해마다 감소하고 있었으며, 이는 간호대학 정원증가의 비용 대비 성과의 효율성을 재고할 필요가 있음을 의미한다. 또한 간호관리료 차등제 실시로 인해 신규간호사는 물론 간호사 인력부족이 심각한 중소병원의 경력간호사들이 상급종합병원으로 이동하게 되는 결과를 야기하였으며, 결국 중소병원 간호인력 부족 현상을 더욱 악화시키는 원인이 되었다. 따라서 입원환자 간호관리료 차등제가 중소병원 간호인력 확보 정책으로 실효성이 있는지에 대한 재검토가 필요하며, 면허간호사에 대한 추적 관리 시스템을 통해 간호인력 수급의 불균형을 해소할 수 있어야 한다.