• 제목/요약/키워드: Body part discomfort

검색결과 39건 처리시간 0.026초

안와 및 안부속기 종양의 방사선치료에서 백내장의 예방을 위한 렌즈보호 장치의 효용성 (Efficacy of Lens Shielding Device to Prevent Cataract with Radiotherapy for Orbit or Ocular Adnexal Tumor)

  • 조정근;조현상;한태종
    • 한국콘텐츠학회논문지
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    • 제7권12호
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    • pp.139-144
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    • 2007
  • 안와 림프종의 치료에 가장 효과적인 치료법인 방사선 치료는 안구 질환의 증가로 인해 계속 늘어나는 추세이다. 항암화학요법과 치료 기술의 비약적인 발전으로 치료 및 예후가 좋아지고는 있지만 백내장, 안구건조, 망막병증 등의 부작용이 발생되고 있다. 이에 본 연구에서는 안와 림프종의 방사선치료 시 백내장 발생의 방어수단으로써 Lens Shielding Device(이하 LSD)를 고안 제작하였고 이의 제작방법과 방사선 차폐 정도에 대해 알아보았다. 안구 표면에 해당하는 깊이에서 TLD의 측정결과는 3개의 평균값이 5.7%로 나타났고 관심부위인 수정체의 위치에서는 TLD 4.2%, markus chamber 5.1%의 선량값을 나타내었다. 본 연구에서 안와에 발생한 림프종의 방사선 치료로 인한 부작용을 예방하기 위해 제작한 LSD는 치료 중 조사받게 되는 총 30Gy의 선량 중에서 5%에 해당하는 약 1.5Gy의 방사선량만이 수정체와 각막에 영향을 미치는 것으로 확인되어 백내장의 역치선량인 2Gy와 임상적으로 백내장이 발생된다고 보고된 5Gy보다 적은 선량이 조사됨을 알 수 있었다. 방사선 치료 시 발생할 수 있는 여러 부작용의 예방에 유용한 기구임을 확인하였고 환자의 안구와 일치되도록 개인별로 제작하여 착용 시 이물감에 의한 불편을 줄일 수 있을 뿐만 아니라 치료 시 고정 또한 매우 용이함을 검증하였다.

피로를 호소하는 외래환자에 대한 임상적 관찰 (Clinical Investigation of Fatigue Among Outpatients)

  • 박신명;승현석;김영철;이장훈;우홍정;이지현
    • 대한한방내과학회지
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    • 제22권3호
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    • pp.299-307
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    • 2001
  • Objectives: Fatigue is a common symptom experienced by many people who visit Oriental medical clinics or hospital. However, there has been little study about the fatigue in the Oriental medical academic world. For this reason, we attempted to investigate the present status of fatigue of outpatients, and its relation with Health Practice Index(HPI). Methods: The subjects were 63 outpatients who visited the Tonification Clinic in Kyunghee Oriental Medical Center between January 1, 2001 and July 31, 2001. Their chief complaint was fatigue and they did not have any physical or mental problem. They were given a questionnaire which included questions reflecting general characteristics, fatigue degree and health habits. We measured degree of fatigue by Chalder scale et al. Health habits were investigated about 5 articles out of 'Breslow 7 Health habits'. Results: Among the subjects, 48 people(76.2%) were considered as 'fatigue patients' by the Chalder scale. Of this 48 fatigue patients, 27 people(56.3%) had manifested fatigue for more than 6 months. The average of scale II for all the patients was 14.05, which indicates moderate degree of fatigue. They complained fatigue, drowsiness and general weakness, dryness and discomfort of the eyes, headache, shoulder pain and neck stiffness, dizziness, heat in the upper part of the body, and poor concentration. There were no differences in degree of fatigue according to Health habits including exercise or not, smoking or not, the frequency of drinking, hours of sleeping, and body mass index. Conclusions: Many people complain fatigue symptom. Therefore doctors should have more interest in fatigue and care. This study can provide standards of prognosis of fatigue patients. Also prospective studies are needed to find relationship between health habits and fatigue degree.

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설문지를 이용한 암환자의 동반 자각 증상에 관한 연구 - 홍삼투여 인체적용시험에 참여한 48명 환자를 중심으로 - (Research on Subjective Symptoms of Cancer Patients Using Questionnaire - Based on the 48 Patients Who Have Participated in Clinical Trial about Korean Red Ginseng -)

  • 김은정;정찬영;김갑성;이승덕
    • 대한한의학회지
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    • 제33권3호
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    • pp.1-9
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    • 2012
  • Objectives: This research was aimed 1) to find out various subjective symptoms cancer patients had, 2) to find out the quantitative difference of symptoms occurring according to the area of cancer, current treatment methods, and relapse of the cancer and 3) to analyze the relationship between the occurrence of symptoms. Methods: This study was a survey about the various subjective symptoms cancer patients had. The subjects were 48 cancer patients in a double-blinded randomized controlled trial about the effectiveness of Korean Red Ginseng (KRG) treatments. Surveys were examined before Korean Red Ginseng (KRG) treatments. The questionnaire consisted of demographic research, patient history and accompanying symptoms. The symptoms part consisted of 4 questions on general symptoms (vertigo, hot flush, rash, insomnia), 2 questions on digestion symptoms (anorexia, dyspepsia), 2 questions on excretions (diarrhea, constipation), and 5 questions on symptoms in different body parts (headache, dryness of lips, chest pain, aphthous ulcer, nose bleeding). The questionnaire was used to research presence of symptoms and relationships between the occurrence of symptoms. Results: A total of 48 patients took part in this survey. Dizziness was the most frequent subjective symptom patients had (64.58%), followed by dry mouth (43.75%), headache (43.75%), insomnia (41.67%), anorexia (37.5%) and chest discomfort (37.5%). The presence of these subjective symptoms was partially related to the patient's history details - type of cancer, method of cancer treatment (chemotherapy, radiotherapy), termination of treatment, presence of pain, fatigue and recurrence, etc. Factor analysis was conducted to analyze the relationship between the occurrence of symptoms. It suggested 5 factors as a result, but there was a limitation that only a low level of correlation was shown among them. Conclusions: We were able to analyze the occurrences and the relationships among them for accompanying subjective symptoms in cancer patients. However the results of the study are limited in that only 48 patients participated. The symptoms in cancer patients showed a tendency for clustering, occurring simultaneously or continuously rather than occurring alone. The study of these symptom clusters is worth further study, for it is similar to the Symptom Differentiation System in Traditional Korean Medicine. For effective approach to the treatment of cancer in Traditional Korean Medicine, further research on the Korean traditional view of cancer patients should be done based on this research, regarding various symptoms and those relationships on a larger scale.

건망(健忘)의 변증분형(辨證分型)에 대(對)한 연구(硏究) (A Bibliographic Study on the Types of Differential Diagnosis of Amnesia)

  • 최용준;성강경;문병순
    • 대한한의학회지
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    • 제17권1호
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    • pp.374-406
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    • 1996
  • This study has been carried out to investigate the types of differential diagnosis of amnesia. The results are as follows; 1. Amnesia has various types of differential diagnosis(辨證分型) ; deficiency of both the heart and spleen(心脾兩虛型), deficiency of the heart(心虛型), deficiency of the kidney(腎虛型), breakdown of the coordination between the heart and the kidney(心腎不交型), mental confusion due to phlegm(痰迷心竅型), accumulation of stagnant blood(蓄血型), internal injury by seven emotion (七情所傷型). 2. The type of deficiency of both the heart and spleen(心脾兩虛型) occurs when the heart and spleen is injured by overthinking(思慮過度), The symptoms are heart palpitation(心悸), continuous palpitation(??), insomnia(少寐), hypochondric discomfort(心煩), dream disturbed sleep(多夢), being easy to be scared(易驚), dizziness(眩暈), these are caused by blood deficiency of the heart(心血不足), poor appetite(飮食不振), loss of appetite(納?), short breath(氣短), sense of turgid abdormen(腹部膨滿感), loose stool(泥狀便), these are caused by deficiency of the spleen(脾虛), lassitude and weakness (身倦乏力), lassitude of the extremities (四肢無力), dim complexion (面色少華), pale lips(舌質淡), thready and feeble(脈細弱無力), these are caused by deficiency of both qi and the blood(氣血虛損). The remedy is nourishing the heart-blood(養心血) and regulating the spleen(理脾土). I can prescribe the recipes such as Guibitang(歸脾湯), Gagambosimtang(加減補心湯), Seongbitang(醒脾湯), Insin-guisadan(引神歸舍丹), Insamyangyoungtang(人蔘養榮湯), Sojungjihwan(小定志丸), Yungjigo(寧志膏), Palmijungjihwan(八味定志丸), etc., 3. The type of deficiency of the heart(心虛型) occurs when the heart-blood is injured by the mental tiredness(神勞) and so blood cannot nourish the heart. The symptoms are amnesia(健忘), short breath(氣短), heart palpitation(心悸), perspire spontaneously(自汗), facial pallidness(顔面蒼白), pale lips (舌質淡白), feeble pulse and lassitude(脈虛無力), intermittent pulse(結代脈). The remedy is nourishing the hart and blood and allaying restlessness(補心益血安神). I can prescribe the recipes such as Chenwangbosimdan(天王補心丹), Jeongji-hwan(定志丸), Gaesimhwan(開心丸), Youngjigo(寧志膏), Chilseonghwan(七聖丸), Baegseogyoungtang(白石英湯), Oseohwan(烏犀丸), Yangsinhwan(養神丸), Guisindan(歸神丹), Bogsinsan(茯神散), Jinsamyohyangsan(辰砂妙香散), Cheongeumboksinsan(千金茯神散), Samjotang(蔘棗湯), jangwonhwan(壯元丸), Sa gunjatang(四君子湯) minus rhizoma atractylodis macrocephalae(白朮) plus rhizoma acori graminei(石菖蒲), radix polygalae(遠志), cinnabaris(朱砂), etc. 4. The type of deficiency of the kidney(腎虛型) occurs when the kidney-qi and kidney-essence is deficient(腎氣腎精不足) and so it cannot nourish the brain. The symptoms arc amnesia(健忘), ache at the waist and lassitude in the lower extremities(腰산腿軟), dizziness and tinnitus(頭暈耳嗚), emmission and premature ejaculation(遺精早泄), burning sensation of the five centres(五心煩熱), flushed tongue(舌紅), rapid and small palse(脈細數). The remedy is nourishing the kidney and strengthen the essence(補腎益精). I can prescribe the recipes such as Gagamgobonhwan(加減固本丸), Jeongjihwan(定志丸), Gongseongchlmjungdan(孔聖枕中丹), Yugmigihwanghwan(六味地黃丸) plus ra-dix polygalae(遠志), fructus schizandrae(五味子), Yugmigihwanghwan(六味地黃丸) plus radix polygalae(遠志), fructus schizandrae(五味子), rhizoma acori graminei(石菖蒲), semen zizyphi spinosae(酸棗仁), Palmihwan(八味丸) plus fructus schizandrae(五味子), semen zizyphi spinosae(酸棗仁). etc., 5. The type of breakdown of the coordination between the heart and the kidney (心腎不交型) occurs when the heart-fire(心火) and kidney-fluid(腎水) are imbalanced. The symptoms are amnesia(健忘), hypochondric discomfort(心煩), insomnia(失眠), dizziness and tinnitus(頭最耳嗚), feverish sensation m the palms and soles(手足心熱), emmision(遺精), ache at the waist and lassitude in the lower extremities(腰?腿軟), flushed tongue(舌紅), rapid pulse(脈數). The remedy is coordinating each other(交通心腎). I can prescribe the recipes such as Gangsimdan(降心丹), Jujaghwan(朱雀丸), Singyotang(神交湯), Simsinyang- gyotang(心腎兩交湯), Yugmihwan(六味丸) plus fructus schizandrae(五味子), radix polygalae(遠志), Yugmihwan(六味丸) plus fructus schizandrae(五味子), radix polygalae(遠志), rhizoma acari graminei(石菖蒲), semen zizyphi spinosae(酸棗仁), etc., 6. The type of mental confusion due to phlegm(痰迷心竅型) occurs when the depressed vital energy(氣鬱) create phlegm retention(痰飮) and phlegm stagnancy(痰濁) put the heart and sprit(心神) out of order. The symptoms arc amnesia(健忘), dizziness(頭暈), chest distress(胸悶), nausea(惡心), dull(神思欠敏), dull and slow facial expression(表情遲鈍), tongue with yellow and greasy fur(舌苔黃?), sliperry pulse(脈滑). The remedy is removing heat from the heart to restore consciousness and dispersing phlegm(淸心化痰開竅) I can prescribe the recipes such as Gamibogryeongtang(加味茯?湯), Goa-rujisiltang(瓜蔞枳實湯), Jusaansinhwan(朱砂安神丸), Dodamtang(導痰湯) plus radix saussurea(木香), Yijintang(二陳湯) plus succus phyllostachyos(竹瀝), rhizoma zingiberis(生薑) Ondamtang(溫膽湯) plus rhizoma acori graminei(石菖蒲), rhizoma curcumae aromaticae(鬱金), etc., 7. The type of accumulation of stagnant blood(蓄血型) occurs when the blood is accumulated in the lower part of body. The symptoms are amnesia(健忘), chest distress(胸悶), icteric skin(身黃), rinsing the mouth but don't wanting eat(漱水不欲燕), madness(發狂), black stool(屎黑), pain in the lower abdomen(小腹硬痛). The remedy is dispersing phlegm and absorb clots (化痰化瘀), I can prescribe the recipes such as Jeodangtang(抵當湯), Daejeodanghwan(代抵當丸), Hyeolbuchugeotang (血府逐瘀湯) plus rhizoma acori graminei (石菖蒲), rhizoma curcumae aromaticae(鬱金), Jusaansinhwan(朱砂安神丸) plus rhizoma curcumae aromaticae(鬱金), radix polygalae(遠志), semen persicae(桃仁), cortex moutan radicis(收丹皮), etc., 8. The type of internal injury by seven emotion(七情所傷型) occurs when the anger injures the will stored in the kidney(腎志). The symptoms are amnesia(健忘), heart palpitation(心悸). hot temper(易怒), being easy to be scared(善驚), panic(易恐). The remedy is relieving the depressed liver and regulating the circulation of qi(疏肝解鬱). I can prescribe the recipes such as Tongultang(通鬱湯), Sihosogantang(柴胡疏肝湯) plus rhizoma acari graminei(石菖蒲), rhizoma curcumae aromaticae(鬱金), etc.

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추후관리가 필요한 만성질환 퇴원환자 가정간호 시범사업 운영 연구 (An Operations Study on a Home Health Nursing Demonstration Program for the Patients Discharged with Chronic Residual Health Care Problems)

  • 홍여신;이은옥;이소우;김매자;홍경자;서문자;이영자;박정호;송미순
    • 대한간호학회지
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    • 제20권2호
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    • pp.227-248
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    • 1990
  • The study was conceived in relation to a concern over the growing gap between the needs of chronic patients and the availability of care from the current health care system in Korea. Patients with agonizing chronic pain, discomfort, despair and disability are left with helplessly unprepared families with little help from the acute care oriented health care system after discharge from hospital. There is a great need for the development of an alternative means of quality care that is economically feasible and culturally adaptible to our society. Thus, the study was designed to demonstrate the effectiveness of home heath care as an alternative to bridge the existing gap between the patients' needs and the current practice of health care. The study specifically purports to test the effects of home care on health expenditure, readmission, job retention, compliance to health care regime, general conditions, complications, and self-care knowledge and practices. The study was guided by the operations research method advocated by the Primary Health Care Operations Research Institute(PRICOR) which constitutes 3 stages of research : namely, problem analysis solution development, and solution validation. The first step in the operations research was field preparation to develop the necessary consensus and cooperation. This was done through the formation of a consulting body at the hospital and a steering committee among the researchers. For the stage of problem analysis, the Annual Report of Seoul National University Hospital and the patients records for last 5 years were reviewed and selective patient interviews were conducted to find out the magnitude of chronic health problems and areas of unmect health care needs to finally decide on the kinds of health problems to study. On the basis of problem analysis, the solution development stage was devoted to home care program development asa solution alternative. Assessment tools, teaching guidelines and care protocols were developed and tested for their validity. The final stage was the stage of experimentation and evaluation. Patients with liver diseases, hemiplegic and diabetic conditions were selected as study samples. Discharge evaluation, follow up home care, measurement and evaluation were carried out according to the protocols of care and measurement plan for each patient for the period of 6 months after discharge. The study was carried out for the period from Jan. 1987 to Dec. 1989. The following are the results of the study presented according to the hypotheses set forth for the study ; 1. Total expenditures for the period of study were not reduced for the experimental group, however, since the cost per hospital visit is about 4 times as great as the cost per home visit, the effect of cost saving by home care will become a reality as home care replaces part of the hospital visits. 2. The effect on the rate of readmission and job retention was found to be statistically nonsignificant though the number of readmission was less among the experimental group receiving home care. 3. The effect on compliance to the health care regime was found to be statistically significant at the 5% level for hepatopathic and diabetic patients. 4. Education on diet, rest and excise, and medication through home care had an effect on improved liver function test scores, prevention of complications and self - care knowledge in hepatopathic patients at a statistically significant level. 5. In hemiplegic patient, home care had an effect on increased grasping power at a significant level. However. there was no significant difference between the experimental and control groups in the level of compliane, prevention of complications or in self-care practices. 6. In diabetic patients, there was no difference between the experimental and control groups in scores of laboratory tests, appearance of complications, and self-care knowledge or self -care practices. The above findings indicate that a home care program instituted for such short term as 6 months period could not totally demonstrate its effectiveness at a statistically significant level by quantitative analysis however, what was shown in part in this analysis, and in the continuous consultation sought by those who had been in the experimental group, is that home health care has a great potential in retarding or preventing pathological progress, facilitating rehabilitative and productive life, and improving quality of life by adding comfort, confidence and strength to patients and their families. For the further studies of this kind with chronic patients it is recommended that a sample of newly diagnosed patients be followed up for a longer period of time with more frequent observations to demonstrate a more dear- cut picture of the effectiveness of home care.

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전신 PET/CT 검사에서 팔의 위치에 따른 감약 정도와 SUV 변화 평가 (The Evaluation of Attenuation Difference and SUV According to Arm Position in Whole Body PET/CT)

  • 곽인석;이혁;최성욱;석재동
    • 핵의학기술
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    • 제14권2호
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    • pp.21-25
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    • 2010
  • PET/CT검사에 있어서 CT는 해부학적인 정보를 제공할 뿐 아니라 PET영상에 대한 감약 정보를 제공하는 역할을 하고 있다. CT의 감약차를 이용하는 것으로서 검사 부위에 존재하는 여러 가지 변수에 의해 그 정도가 달라질 수 있다. 이것은 현재 본 원에서 PET/CT검사 시에 팔을 몸 옆에 두고 검사하는 것에도 적용할 수 있으며, 이에 본 논문에서는 일부 타 병원에서 시행하고 있는 팔을 머리 위로 올리고 검사하는 방법과 함께 CT값의 변화에 따른 표준섭취계수의 변화를 비교 연구했다. NEMA 1994 PET 모형의 삽입체와 모형의 부피를 고려하여 4:1의 비율로 $^{18}F$-FDG를 주입하였다. 먼저 테플론 삽입체 두 개를 NEMA 1994 PET 모형의 양 옆에 고정시켜 팔을 내리고 있는 상태를 가정하여 영상을 얻었으며 테플론 삽입체를 제거하여 팔을 머리 위로 올린 상태를 가정하여 영상을 얻었다. 앞의 과정을 거쳐 얻은 영상을 재구성 하여 Volume Viewer를 이용해 한 영상면 당 5개의 관심 체적을 설정했고 각 측정값을 평균하여 얻어낸 CT값과 표준섭취계수로 그 변화를 측정하였다. 측정된 값과 폐 관련 암환자의 간에 관심 영역을 설정하고 측정한 값을 비교하여 실제 임상 영상에서의 차이를 측정하였다. 모형 실험결과 테플론 삽입체를 부착하였을 때보다 테플론 삽입체를 부착하지 않았을 때 CT값이 -5.8 HU에서 0 HU으로 평균 5.8 HU 증가하였고 표준섭취계수는 24.64에서 24.29로 평균 0.35 감소하였다. 축방향 균일도는 0.064에서 0.052로 평균 0.012 감소하였다. 환자 실험결과 팔을 내리고 검사하였을 때보다 팔을 머리 위로 올리고 검사하였을 때 CT값은 54.1 HU에서 59.9 HU로 평균 5.8 HU 증가하였고 표준섭취계수는 2.02에서 1.85로 평균 0.17 감소하였다. 테플론 삽입물을 부착한 상태로 검사할 때 보다 테플론 삽입물을 부착하지 않은 상태로 검사할 때 CT값은 증가하고 표준섭취계수는 감소하는 양상을 보였다. 이러한 현상이 일어나는 이유는 감약의 정도와 표준섭취계수의 상관관계에서 찾을 수 있다. CT값이 증가할수록 감약 계수는 비례하여 증가하는데 이것은 결국 CT값이 증가될수록 감약이 증가된다고 볼 수 있다. 따라서 팔에 의해 감약이 과다하게 측정될 수 있으므로 결국 표준섭취계수의 증가로 이어진다고 판단된다. 하지만 그 값의 차이가 매우 적어 진단적으로 유의한 범위라고 볼 수 없다. 팔을 머리 위로 올리고 검사하는 자세가 어깨 및 팔에의 $^{18}F$-FDG섭취와 환자의 고통을 야기하게 된다는 점들을 종합하여 고려해 보았을 때, PET/CT검사 시에는 팔을 내리고 검사하는 것이 합리적이나, 환자의 상태 및 영상의 질적 측면을 고려하여 결정하여야 하겠다.

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공연장에서 다중 몰입도 측정을 위한 시스템 개발 (System Development for Measuring Group Engagement in the Art Center)

  • 류준모;최일영;최이권;김재경
    • 지능정보연구
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    • 제20권3호
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    • pp.45-58
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    • 2014
  • 몰입은 관람객이 콘텐츠를 관람할 때 관람객들이 콘텐츠에 몰두하고 있는 심리적 상태를 의미하는 것으로, 관람객의 몰입경험은 콘텐츠의 만족도에 긍정적인 영향을 미친다. 따라서 공연 같은 콘텐츠를 제공하는 기업들은 콘텐츠의 흥행을 위해 관람객의 몰입도를 측정하는 것은 매우 중요하다. 설문 등의 표본조사 방법을 통해 관람객의 몰입도를 측정 연구는 방송분야 등 에서 널리 사용되고 있다. 이러한 몰입도 측정방법은 콘텐츠 관람 이후 설문을 실시하기 때문에 몰입도를 실시간으로 측정할 수 없을 뿐만 아니라 몰입도 측정의 정확성이 저하되는 문제 등이 있다. 이러한 문제를 해결하기 위하여 생리적 반응이나 얼굴 표정 분석, 그리고 움직임 관찰 방법 등을 이용하여 몰입도를 측정하는 연구가 수행되고 있다. 생체 신호를 이용하여 몰입도를 측정하는 연구의 경우, 1인을 대상으로 생체신호를 측정할 뿐만 아니라, 많은 데이터 처리 시간과 비용이 소모되는 단점이 있어 많은 관람객이 관람하는 공연장에 적용하기에는 한계가 있다. 얼굴 표정인식 통해 몰입도를 측정하는 경우도 1인을 대상으로 하고 있으며, 밝은 조명의 실험실 환경에서만 가능하다는 단점이 존재한다. 또한 관람객들의 움직인 동기화를 이용하여 몰입도를 특정한 연구는 다중관객을 대상으로 하였지만, 이는 실험실 환경에 한정하여 적용된 사례이다. 따라서 본 연구에서는 공연장, 시사회관 등 많은 관람객들이 콘텐츠를 관람하는 실제 환경에서 다중관람객이 다중몰입도의 정량적 평가를 위한 시스템을 설계하고 개발하였다. 제안된 시스템은 외부장치, 서버, 내부장치 등의 3부분으로 구성되어 있다. 서울시 마포구 상암동에 위치한 DMC 홍보관에 상설 전시장으로 운영하고 있으며, 관람객들을 대상으로 데이터를 획득하고 있다. 제안하고 있는 시스템을 활용하면 콘텐츠의 어느 구간에서 관객들이 몰입을 하고 있는지, 어느 구간에서 몰입을 하고 있지 못한지 분석가능하기 때문에, 향후 콘텐츠 제작 및 마케팅에 유용하게 활용할 수 있을 것으로 기대된다.

내장신경차단에 관한 임상적 연구 (A Clinical Evaluation of Splanchnic Nerve Block)

  • 김수연;오흥근;윤덕미;신양식;이윤우;김종래
    • The Korean Journal of Pain
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    • 제1권1호
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    • pp.34-46
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    • 1988
  • Intractable pain from advanced carcinoma of the upper abdomen is difficult to manage. One method used to control pain associated with these malignancies is to block off the splanchnic nerve. In 1919 Kappis described a technique by which the splanchnic nerve of the upper abdomen could be anesthetized, using a percutaneous injection. This method has been used for the relief of upper abdominal pain due to hematoma and cancer of the pancreas, stomach, gall bladder, bile duct, and colon. During the Period from November 1968 to January 1986, this method was used in 208 cases of malignancy at Severance Hospital and clinically evaluated. Patients were retroactively grouped according to the stage of development of technique used. Twelve patients who received the treatment in the period from November 1968 to March 1977 were designate4i as group 1, 26 patients from April 1977 to April 1979 as group 2, and 170 from May 1979 to January 1986 as group 3. The results are as follows: 1) The number of patients receiving splanchnic nerve block has been increasing since 1977. 2) A total of 208 patients, including 133 males and 75 females, ranging in age from 18 to 84 and averaging 51. 3) The causes of pain were stomach cancer 90, pancreatic cancer 69, and miscellaneous cancer 49 cases respectively. 4) There were 57.7% who had surgery. and 3.7% of whom had chemotherapy before the splanchnic nerve block was done. 5) These blocks were carried out with the patient in the prone position as described by Dr. Moore. For group 2 and 3, C-arm image intensifier was used. In group 1, a 22 gauze loom long needle was inserted at the lower border of the 12th rib on each aide about 7\;cm from the midline. The average distance from the midline was $6.60{\pm}0.61\;cm$ on the left side and $6.60{\pm}0.83\;cm$ on the right side in group 2, and $5.46{\pm}0.76\;cm$ on the left side and $5.49{\pm}0.69\;cm$ on the right side in group 3. The average depth to which the needle was inserted was $8.60{\pm}0.52\;cm$ on the left side and $8.74{\pm}0.60\;cm$ on the right side in group 2, and $8.96{\pm}0.63\;cm$ on the left side and $9.18{\pm}0.57\;cm$ on the right side in group 3. 6) The points of the inserted needles were positioned in the upper quarter anteriorly, 51.8% on the left side and 54.4% n the right side of the L1 vertebra by lateral roentgenogram in group 3. The inserted needle points were located in the upper and anterolateral part, of the L1 vertebra 68.5% on the left side and 60.6won the right side, on the anteroposterior rentgenogram in group 3. The needle tip was not advanced beyond the anterior margin of the vertebral body. 7) In some case of group 3, contrast media was injected before the block was done. It shows, the spread upward along the anterior mal gin of the vertebral body. 8) The concentration and the average amount of drug used in each group was as follows: In group 1, $39.17{\pm}6.69\;ml$ of 0.5% -l% lidocaine or 0.25% bupivacaine were injected for the test block and one to three days after the test block $40.00{\pm}4.26\;ml$ of 50% alcohol was injected for the semipermanent block. In group 2, $13.75{\pm}4.88\;ml$ of 1% lidocaine were used as the test block and followed by $46.17{\pm}4.37\;ml$ of 50% alcohol was injected as the semipermanent block. In group 3, $15.63{\pm}1.19\;ml$ of 1% lidocaine for test block followed by $15.62{\pm}1.20\;ml$ of pure alcohol and $16.05{\pm}2.58\;ml$ of 50% alcohol for semipermanent block were injected. 9) The result of the test block was satisfactory in all cases. However the semipermanent block was 83.3 percent of the patients in group 1 who received relief from pain for at least 2 weeks after the block, 73.1% in group 2, and 91.8% in group 3. In these unsuccessful cases, 2 cases in group 1 were controlled by narcotics but 7 cases in group 2 and 14 cases in group 3 received the same splanchnic nerve block 1 or 2 times again within 2 weeks. But, in some cases it was 3 to i months before the 2nd block and in 1 cases even 7 years. 10) The most common complications of splanchnic nerve block were hypotensino(25.5%) occasional flushing of the face, nausea, vomiting, and chest discomfort. 11) For the patients in group 3, the supplemental block most commonly used was a continuous epidural block; it was used as a diagnostic block and to afford relief from pain before the splanchnic nerve block was done. 12) The interval between the receiving of the alcohol block and discharge was from 5 to 8 days in 61 cases(31.1%) and from 1 to 2 days in 48 cases(24.5%). From the above results, it can be concluded that the splanchnic nerve block done in the prone position with pure and 50% alcohol immediately after an effective test block with 1% lidocaine under C-arm fluoroscopic control is satisfactory and reliable. How to minimize the repeat block is still a problem to be solved.

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중(中)·고등(高等) 학생(學生)들의 책상 및 의자(椅子)의 표준호식(標準號數) 사용여부(使用與否)와 통증(痛症) 호소율(呼訴率) (Pain Complaint according to Usage of Standard-Sized Desks and Chairs for Middle and High School Students)

  • 강경열;차병준;박재용
    • 한국학교보건학회지
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    • 제8권2호
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    • pp.219-232
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    • 1995
  • 대구지역 중 고등학교 학생들의 학교 책상과 의자의 표준 호수 사용 여부와 그에 따른 신체적 자각 증상 호소율을 조사하기 위하여 1995년 3월 20일에서 4월 19일 사이에 대구지역내에 소재한 남.여, 중 고등학교 전학년 학생 1,201명을 대상으로 설문 조사를 실시하여 분석한 결과는 다음과 같다. 중 고등학교 학생들이 사용하는 책상과 의자는 표준 호수보다 1~3호 정도 높은 것이 대부분이었으며, 희망 호수 역시 조금 높은 것을 선호하는 것으로 나타났다. 표준 호수를 사용하고 있는 학생은 책상 30.5%, 의자 21.0%였고. 표준호수보다 큰 호수를 사용하고 있는 경우는 책상 61.3%, 의자65.2% 였으며 표준 호수 보다 작은 경우는 각각 8.2%, 13.8%였다. 중학교의 표준 호수 사용율은 책상 44.1%, 의자 26.8%로 고등학교의 16.1% 및 14.7%보다 높았고, 남학생은 책상 31.5%, 의자 24.5%로 여학생의 29.6% 및 17.6%보다 높았다. 공립학교의 표준 호수 사용율은 책상 34.2%, 의자 24.5%로 사립학교의 27.1%, 및 17.5%보다 높은 편이지만 양군 모두 표준호수 사용율은 낮았다. 책상 사용시 가장 불편한 점으로는 낡았다, 서랍이 좁다, 낮다, 면이 고르지 않다의 순이었고. 의자 사용시 가장 불편한 점은 의자면이 딱딱하다, 등받이가 딱딱하다, 낡았다, 낮다, 높다, 면이 좁다의 순이었다. 책상 및 의자의 사용으로 인한 신체부위별 통증 호소율은 중학교 남.여학생에선 목 어깨 호소율이 각각 32.2%, 36.0%로 가장 높았고, 고등학교 남.여학생은 허리 호소율이 각각 37.9%, 44.1%로 가장 높았다. 신장이 증가할수록 허리 통증 호소율이 높은 것으로 나타났으며, 목 어깨 통중은 전반적으로 높게 호소했다. 책상 및 의자를 표준 호수로 사용활 경우 목 어깨 통증 호소율은 각각 25.4% 및 23.8%인데 비해 표준 호수보다 큰 책상이나 의자를 사용하는 경우는 각각 31.5% 및 31.8%로 호소율이 높았으며, 작은 경우 역시 26.5% 및 28.9%로 높았다. 표준 호수 보다 크거나 작은 책상 및 의자를 사용하는 경우에 비해 표준 호수를 사용할 경우 허리통증 호소율이 모두 낮았다. 대구지역 중 고등학교 학생들의 책상 및 의자의 표준 호수 사용율은 매우 낮았으며, 사용하는 책상과 의자 호수가 자신이 희망하는 호수와 많은 차이를 보이고 있으며, 이에 따른 신체 부위별 통증 호소율은 비교적 높게 나타났다. 따라서 학생들의 체격조건을 고려하여 책상과 의자를 구입, 배분하는데 최대한의 배려를 하여야 할 것이며, 표준호수와 선호도를 반영한 다양한 호수의 잉여책상과 의자의 보유비율을 높여야 할 것으로 생각한다.

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