• 제목/요약/키워드: Clinical guideline

검색결과 846건 처리시간 0.023초

2002년 제주도 폐결핵 등록환자의 관리실태 조사 (A Survey of the Controlling System for the Pulmonary Tuberculosis in Jejudo, 2002)

  • 김유옥;양원현;배종면
    • Tuberculosis and Respiratory Diseases
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    • 제56권4호
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    • pp.356-363
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    • 2004
  • 2002년도 제주도내 폐결핵 발생자로 등록된 262명에 대한 조사를 실시한 결과 보건소의 관리실태와 비교해 볼 때, 의원급의 진단 및 추구검사 시행이 제대로 되지 않고 있는 것을 확인하였다. 이런 상황에서 의원 및 병원의 치료 성공률은 각각 38.5%, 63.3%로, 이를 합친 민간의료기관에서의 치료 성공률은 59.8%로 조사되어 보건소의 치료 성공률 80%에 비하여 낮은 수준을 보였다. 민간의료기관에서 치료 실패의 주 원인은 임의의 치료중단 이라는 점에서, 현재 국가결핵관리사업의 이원화된 체계 하에서 민간의료기관에 대한 시급한 시스템보완이 필요하다.

자궁경부암 여성의 삶의 적응에 관한 근거이론적 접근 (A Grounded-theory Approach to the Process of Life Adaptation in Women with Cervical Cancer)

  • 이숙희;김증임;이혜경;강남미;김혜원;이은희;허명행;박영숙
    • 여성건강간호학회지
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    • 제10권1호
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    • pp.32-41
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    • 2004
  • Purpose: The purpose of this study was to explore and describe the process of life adaptation in women with cervical cancer. Method: A grounded theory method with guided data collection and analysis was used. Fifteen women with cervical cancer who had some kind of treatment at the hospital were asked open-ended and descriptive questions with a guideline. All interviews were tape-recorded and transcribed verbatim. Result: The core category that emerged from the comparative analysis was "overcoming cancer" named as a process of life adaptation in the participants. The process of overcoming cancer evolved three stages - "admitting reality", "attempting health-care" and "continuing health-care". Depending on the paradigm model, the central phenomena of the experiences was "powerlessness". The internal factors motivating women to overcome cancer were "denial of cancer" and "desire for life". Strategies of overcoming cancer included "living as a cancer patient," "selective food eating," "steady exercising," "getting rid of stress," and "preparing for death". The intervening conditions, "supportive system," "forms of life," and "burden on family," influenced overcoming cancer. Conclusion: The results of this study could help clinical nurses to understand life adaptation in cervical cancer patients and establish efficient coping strategies in dealing with the problems they face.

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국내 연하장애 기능적 전기 자극치료기 사용 현황과 장비관리 실태 분석 (Bio-signal Based Rehabilitation Program and Data Management)

  • 허서윤;박진혁;이근민
    • 재활복지공학회논문지
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    • 제8권1호
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    • pp.57-66
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    • 2014
  • 본 연구는 현재 국내 연하장애 환자를 대상으로 하는 연하장애 기능적 전기 자극 치료 장비의 사전 사후 점검과 유지 보수와 관련한 설문조사를 실시하고 장비사용 현황과 관리 실태를 분석함으로서 체계적인 치료 장비 관리 가이드라인 개발의 필요성을 제시하는데 그 목적이 있다. 연구대상은 상급종합 병원, 종합병원, 재활병원, 요양병원을 포함하는 총62개 기관 중 최종적으로 설문에 응답한 50개 기관이었다. 연하장애 기능적 전기 자극 치료 장비의 사전 사후 점검과 유지 보수 현황과 실태를 파악하기 위한 설문지를 개발한 후, 이를 기초로 2013년 8월 21일부터 2013년 11월 10일간의 연구 자료를 분석에 사용하였다. 연구 결과, 장비는 활발히 사용하고 있었으나 장비의 사용 전 작동 검사, 사용 후 작동 검사, 유지 및 보수, 소독 보관 등의 항목에서 체계적인 관리를 하지 않고 있었다. 혼수상태이거나 인지가 현저히 저하된 환자에게 적용하는 방법과 관련한 항목에서도 표준화된 방법이 없거나 가이드 라인이 제시되었더라 하더라고 실제 사용하지 않고 있는 것으로 밝혀졌다. 이는 장비의 사전 사후 점검과 유지 보수에 대한 표준화된 가이드라인 및 질 관리 지표 개발에 대한 연구의 필요성을 제시한다.

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Targeted presurgical decompensation in patients with yaw-dependent facial asymmetry

  • Kim, Kyung-A;Lee, Ji-Won;Park, Jeong-Ho;Kim, Byoung-Ho;Ahn, Hyo-Won;Kim, Su-Jung
    • 대한치과교정학회지
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    • 제47권3호
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    • pp.195-206
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    • 2017
  • Facial asymmetry can be classified into the rolling-dominant type (R-type), translation-dominant type (T-type), yawing-dominant type (Y-type), and atypical type (A-type) based on the distorted skeletal components that cause canting, translation, and yawing of the maxilla and/or mandible. Each facial asymmetry type represents dentoalveolar compensations in three dimensions that correspond to the main skeletal discrepancies. To obtain sufficient surgical correction, it is necessary to analyze the main skeletal discrepancies contributing to the facial asymmetry and then the skeletal-dental relationships in the maxilla and mandible separately. Particularly in cases of facial asymmetry accompanied by mandibular yawing, it is not simple to establish pre-surgical goals of tooth movement since chin deviation and posterior gonial prominence can be either aggravated or compromised according to the direction of mandibular yawing. Thus, strategic dentoalveolar decompensations targeting the real basal skeletal discrepancies should be performed during presurgical orthodontic treatment to allow for sufficient skeletal correction with stability. In this report, we document targeted decompensation of two asymmetry patients focusing on more complicated yaw-dependent types than others: Y-type and A-type. This may suggest a clinical guideline on the targeted decompensation in patient with different types of facial asymmetries.

간호대학생을 위한 의사소통 능력 증진 프로그램의 효과: 체계적 문헌고찰 및 메타분석 (Effects of Communication Ability Enhancement Program for Nursing Students in Korea: A Systematic Review and Meta-analysis)

  • 한미화;이경희
    • 한국간호교육학회지
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    • 제23권1호
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    • pp.15-26
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    • 2017
  • Purpose: This study evaluated the efficacy of a communication ability enhancement program for nursing students in Korea through a systematic review of literature and meta-analysis. Methods: The researchers searched data-bases, including the Data Base Periodical Information Academic, Research Information Sharing Service, National Digital Science Library and National Assembly Library. The key words used included 'communication' and 'nursing student'. The researchers evaluated articles published up to July 2016. Out of 381 selected articles, 20 clinical trial studies were meta-analyzed. Each article was evaluated in accordance with the Checklist of Scottish Intercollegiate Guideline Network. The effect size of communication ability, self-efficacy and interpersonal relations were synthesized by a random effects model from analysis software (R 3.2.3). The heterogeneity of effect size was analyzed by exploratory and confirmatory moderator analysis. Results: The overall effect size of the program was of a moderate level (SMD=0.78, 95% CI: 0.49~1.07) along with each outcome of self-efficacy (SMD=0.80, 95% CI: 0.23~1.37), and interpersonal relations (SMD=0.47, 95% CI: 0.14~0.80). For heterogeneity, moderator analysis was performed, by grade, and a statistically significant moderator was found. Conclusion: It is evident that a communication ability enhancement program for nursing students is moderately effective in improving communication ability, self-efficacy and interpersonal relations.

Evaluation of Dietary Risk Factors for Abnormal Serum Cholesterol in Korean Sedentary Male Adults

  • Jjn, Bok-Hee;Kim, Young-Ok
    • 대한지역사회영양학회지
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    • 제2권5호
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    • pp.721-727
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    • 1997
  • This study investigated whether dietary factors are more influential factor than other health behavior such as drinking, smoking and exercise on abnormal serum cholesterol level inspite of Korean dietary pattern differences compared to Europeans and Americans. A double case control study model has been used for the study design. One model consisted of high blood cholesterol cases and control. the other model consisted of low blood cholesterol cased and controls. 5.398 sedentary male workers who had taken medical examinations at a university hospital were used as the study subjects. Out of the study subjects, 36individuals with high blood cholesterol cases and 30 individuals with low blood cholesterol cases were selected. For the 66 individual control selection, the individual control selection, the individuals matching method was adopted. The food frequency method was used to collect the data for assessment of the dietary factors. A standardized questionnaire was used to investigate other health behavior. logistic regression analysis was employed to measure the relative importance between the factors considered. There were no statistically significant differences observed in nutrients consumption or other health behavior among the low, normal and high blood cholesterol groups, An overmatching effect had been suspected as the cause of those findings. However, the results of logistic regression analysis to identify the factors influencing high serum cholesterol showed that odd ratios of dietary factors such as tocopherol(3.0) and saturated fatty acid(1.6) were higher than I. I of smoking and 1.2 of drinking. Similar results were also observed incases of low serum cholesterol. The above findings imply that although the dietary pattern is quite different from that of Europeans and America, the dietary factor is still a significant factor for abnormal blood cholesterol in Koreans. Therefore, the dietary risk factor identified in high fat consumption populations are still relevant for the relatively healthy Korean as guideline for preventive health practices. (Korean J Community Nutrition 2(5) : 721∼727, 1997)

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Risk Factors of Red Blood Cell Transfusion in Isolate off Pump Coronary Artery Bypass Surgery

  • Chung, Eui Suk;Park, Kay-Hyun;Lim, Cheong;Choi, Jinho
    • Journal of Chest Surgery
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    • 제45권5호
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    • pp.301-307
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    • 2012
  • Background: Perioperative transfusion of red blood cell (RBC) may cause adverse effects. Bloodless-cardiac surgery has been spotlighted to avoid those problems. Off pump coronary artery bypass (OPCAB) surgery can decrease the transfusion. However, the risk factors of transfusions in OPCAB have not been investigated properly. Materials and Methods: One hundred and thirteen patients (male:female=35:78, mean age=$66.7{\pm}9.9$ years) who received isolated OPCAB were retrospectively analyzed from March 2006 to September 2007. The threshold of RBC transfusion was 28.0% of hematocrit. Bilateral internal thoracic arteries graft were used for 99 patients (87.6%). One hundred and three (91.1%) and 35 patients (31.5%) took aspirin and clopidogrel just before surgery. Results: Sixty-five patients (47.5%) received the RBC transfusion (mean $2.2{\pm}3.2$ units). Mortality and major complications were not different between transfusion and no-transfusion group. But, ventilator support time, intensive care unit stay and hospitalization period had been reduced in no-transfusion group (p<0.05). In multivariate analysis, patients risk factors for RBC transfusion were preoperative low hematocrit (<37.5%) and clopidogrel medication. Surgical risk factors were longer graft harvesting time (<75 minutes) and total operation time (<5.5 hours, p <0.05). Conclusion: We performed the transfusion according to transfusion guideline; over 40% cases could conduct the OPCAB without transfusion. There were no differences in major clinical results between transfusion and non-transfusion group. In addition, when used together with accurate understanding of transfusion risk factors, it is expected to increase the proportion of patients that do not undergo transfusions.

갑상선결절내 석회화소견과 갑상선암종과의 연관성 (Patterns of Calcification in Thyroid Nodules; Significance and Malignant Potentiality)

  • 최종욱;이재용;정근;최건
    • 대한두경부종양학회지
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    • 제13권1호
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    • pp.30-34
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    • 1997
  • Objectives: Calcification of the thyroid nodule has been reported to have a close relationship with differentiated thyroid carcinoma, however there are limited studies on the relationship between the calcified thyroid nodule and thyroid malignancy. The authors studied the clinical significance of calcification within the thyroid nodule. Materials and Methods: There were total of 60 patients who underwent surgery for calcified thyroid nodules which were identified from plain neck X-ray, ultrasound and computed tomography during the period January 1991 to June 1996 at the Department of Otorhinolaryngology-Head and Neck Surgery of Korea University Hospital. Six patients were not included because of recurrence and previous thyroid surgery. Histopathologic and radiologic analysis was done on the remaining 54 patients. Results: Results showed that 25 of 54 cases(46%) to be malignant histopathologically. Of the 25 malignant cases, papillary carcinoma was the most common with 22 cases followed by 2 cases of undifferentiated carcinoma and I case of medullary carcinoma. Statistically high incidence of malignancy was observed when the consistency of calcified thyroid nodule was solid, shape of calcification was irregular and inhomogenous, and adhesion of calcified thyroid nodule to the regional structure was present. Conclusion: The probability that a thyroid nodule is malignant has been reported to be 3­20%. However, about half of the thyroid nodules with calcification found to be malignant on this study, calcification of the thyroid nodule can be used as a guideline for detecting thyroid malignancy.

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한국형 작업균형 평가(Occupational Balance Assessment)의 동시타당도 연구 (The Concurrent Validity of the Korean Occupational Balance Assessment(OBA) Tool)

  • 홍소영;홍덕기
    • 대한지역사회작업치료학회지
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    • 제10권2호
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    • pp.1-9
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    • 2020
  • 목적 : 본 연구는 한국형 작업균형 평가(Occupational Balance Assessment: OBA)의 동시타당도를 검증하고자 실시하였다. 연구방법 : 본 연구는 2019년 10월 1일부터 10월 25일까지 1016명을 대상으로 실시하였다. 자료 수집은 OBA와 작업균형 설문지(Occupational Balance Questionnaire11: OBQ11)를 사용하였다. 자료 분석은 기술통계와 피어슨 상관관계 분석을 실시하였다. 결과 : OBA의 세 가지 영역별 점수와 OBQ11의 총점 간에 유의한 상관관계를 보였다(p<.01). 세 가지 영역 모두 양의 상관관계로 분석되었다. 시간사용 영역(r=.554)과 작업빈도 영역(r=.574)은 상관관계가 있는 것으로 나타났으며, 작업특성 영역의 하위요인(중요도 r=.582, 목표성취 r=.633, 즐거움 r=.649, 건강 r=.650)은 대부분 높은 상관관계로 분석되었다. 결론 : OBA는 작업균형을 평가하기 위해 타당한 평가도구임을 검증하였다. 향후에는 임상적 유용성을 위해 작업균형에 대한 가이드라인을 제시할 수 있는 연구가 필요할 것이다.

공황장애 약물 치료에 대한 한국형 알고리듬 개발(3) - 인지행동치료 - (Development of the Medication Algorithm for Panic Disorder(3) - Cognitive Behavioral Therapy -)

  • 이상혁;양종철;윤세창;서호석;김찬형;유범희;김민숙
    • 대한불안의학회지
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    • 제4권1호
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    • pp.28-33
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    • 2008
  • Objective : A working group of psychiatrists from the Korean Academy of Anxiety Disorders was established to determine the appropriate medication algorithm for treating patients with panic disorder. In this article, we discussed the consensus among psychiatrists regarding the use of cognitive behavior therapy (CBT) in the development of a treatment algorithm for panic disorder in Korea. Methods : Based on the guidelines or algorithms published by the American Psychiatric Association, National Institute for Clinical Excellence, and Canadian Psychiatric Association, we constructed questionnaires regarding the core components and contents of CBT for patients with panic disorder. Fifty-four experts in panic disorder completed the questionnaires. Results : There was statistically significant consensus among the experts in the belief that cognitive reconstruction and psychological education are the core components of CBT for the treatment of patients with panic disorder. However, there was some inconsistency between the opinions of some experts regarding the content and frequency of CBT and the results of studies published outside of Korea. Conclusions : CBT, especially the psychological education and cognitive reconstruction components, should be considered when treating patients with panic disorder. However, further consideration needs to be put into the design of a more detailed treatment guideline for the use of CBT in the treatment of patients with panic disorder.

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