• Korean Journal of Radiology
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• 제24권12호
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• pp.1284-1292
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• 2023

Objective: We investigated the impacts of computed tomography (CT) added to ultrasound (US) for preoperative evaluation of patients with papillary thyroid carcinoma (PTC) on staging, surgical extent, and postsurgical survival. Materials and Methods: Consecutive patients who underwent surgery for PTC between January 2015 and December 2015 were retrospectively identified. Of them, 584 had undergone preoperative additional thyroid CT imaging (CT + US group), and 859 had not (US group). Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were used to adjust for 14 variables and balance the two groups. Changes in nodal staging and surgical extent caused by CT were recorded. The recurrence-free survival and distant metastasis-free survival after surgery were compared between the two groups. Results: In the CT + US group, discordant nodal staging results between CT and US were observed in 94 of 584 patients (16.1%). Of them, CT accurately diagnosed nodal staging in 54 patients (57.4%), while the US provided incorrect nodal staging. Ten patients (1.7%) had a change in the extent of surgery based on CT findings. Postsurgical recurrence developed in 3.6% (31 of 859) of the CT + US group and 2.9% (17 of 584) of the US group during the median follow-up of 59 months. After adjustment using IPTW (580 vs. 861 patients), the CT + US group showed significantly higher recurrence-free survival rates than the US group (hazard ratio [HR], 0.52 [95% confidence interval {CI}, 0.29-0.96]; P = 0.037). PSM analysis (535 patients in each group) showed similar HR without statistical significance (HR, 0.60 [95% CI, 0.31-1.17]; P = 0.134). For distant metastasis-free survival, HRs after IPTW and PSM were 0.75 (95% CI, 0.17-3.36; P = 0.71) and 0.87 (95% CI, 0.20-3.80; P = 0.851), respectively. Conclusion: The addition of CT imaging for preoperative evaluation changed nodal staging and surgical extent and might improve recurrence-free survival in patients with PTC.

• 대한영상의학회지
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• 제85권1호
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• pp.184-196
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• 2024

목적 인지기능 저하를 진단하기 위해서 자기공명영상을 이용한 영상 소견의 진단능을 평가하였다. 대상과 방법 총 138명의 주관적인 인기지능 저하를 호소하며, MRI 검사를 시행한 환자를 대상으로 하였다. 이 환자 그룹은 신경정신학적 평가를 통해 알츠하이머군과 비알츠하이머군으로 분류되었다. 우리는 이들의 white matter hyperintensity와 cerebral microbleed를 평가하였으며, Kruskal- Wallis test를 통해 그룹 간의 비교를, receiver operating characteristic (이하 ROC)를 통해 영상학적 소견의 진단능을 평가하였다. 결과 인지기능 정상인 경우와 경도인지장애 환자와 비교해서 알츠하이머 환자에서 엽 혹은 심부 미세출혈이 빈번하게 관찰되었으며, 심한 심부 혹은 뇌실주위, 전체 백질 신호강도 또한 인지기능 정상에 비해서 알츠하이머 환자에서 많이 관찰되었다. 알츠하이머 환자와 다른 환자 그룹(정상 혹은 경도인지장애)을 비교할 때 엽미세출혈과 뇌실주위 뇌백질 신호강도 증가가 같이 존재하는 경우 가장 높은 진단능을 보였다(area under the ROC curve = 0.702[95% 신뢰구간: 0.599-0.806], p < 0.001). 결론 자기공명영상에서 확인한 영상 소견을 바탕으로 인지기능 저하의 진단능을 평가하였다. 인지기능 저하의 진단에 있어서 엽미세출혈과 뇌실주위 뇌백질 신호강도 증가가 같이 존재하는 경우에 높은 진단능을 보였으며, 이러한 소견을 바탕으로 인지기능 저하를 진단하는 데 있어 영상 소견이 도움을 줄 수 있을 것이라는 가능성을 보여주었다.

• Pediatric Infection and Vaccine
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• 제14권1호
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• pp.91-96
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• 2007

목 적 : RSV 감염증 진단을 위한 여러 가지 신속 진단법이 이용되고 있다. 본 연구는 하기도 감염 소아의 비인두흡인물에서 RSV를 검출하는데 있어서 lateral-flow immunoassay 법을 이용하여 국내에서 개발된 RSV 조기 진단 kit인 바이오라인 알에스브이$^{TM}$(Standard Diagnostics, Inc., 용인, 대한민국)의 성적을 세포배양과 면역 형광법 결과와 비교 평가하기 위하여 수행되었다. 방 법 : 2002년 7월부터 2007년 2월까지 서울대학교 어린이병원의 응급실을 방문하거나 입원한 하기도 감염소아로부터 채취한 비인두 흡인물 319개를 대상으로 하여 RSV를 검출하는데 있어서 바이러스 배양과 면역 형광법을 기준으로 하여 바이오라인 알에스브이$^{TM}$ 검사의 성적을 평가하였다. 바이오라인 알에스브이$^{TM}$ 검사는 각 검체의 바이러스 배양과 면역 형광법 결과를 모르는 검사자에 의해서 두번 이상씩 시행되었다. 결 과 : 면역 형광법과 바이러스 배양이 모두 양성인 검체 110개 중 107개(97.3%), 면역 형광법만 양성인 검체 33개 중 29개(87.9%), 바이러스 배양법만 양성인 검체 26개 중 20개(76.9%)가 바이오라인 알에스브이$^{TM}$로 검사한 결과 양성으로 나타났으며, 두 가지 기준 검사에서 모두 음성인 검체 150개 중 140개(93.3%)가 바이오라인 알에스브이$^{TM}$ 검사 결과 음성이었다. 면역 형광법 또는 바이러스 배양법에 대한 바이오라인 알에스브이$^{TM}$ 검사의 민감도는 92.3%(156/169, 95% confidence interval[CI], 87.1-97.5%), 특이도는 93.3%(140/150, 95% CI, 88.4-98.2%), 양성 예측도는 94.0%(156/166, 89.5-98.5%), 음성 예측도는 91.5%(140/143, 95% CI, 86.0-97.0%), 일치도는 95.9%(306/319, 92.1-99.7%)이었다. 결 론 : 국내에서 개발된 RSV 감염 조기 진단 kit인 바이오라인 알에스브이$^{TM}$는 높은 민감도와 특이도를 보였다. 간단한 검사 방법과 신속한 결과라는 장점이 있어 향후 유행 시기에 유용한 진단법으로 사용될 수 있을 것으로 보인다.

• 대한핵의학회지
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• 제32권5호
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• pp.403-413
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• 1998

목적: 좌심실의 부피와 구혈률을 Cedars 소프트웨어로 구하였을 때 정량한 값과 심근벽운동과 심근의 수축기 두꺼워짐을 등급으로 평가한 방법의 재현성을 알아보고자 하였다. 대상 및 방법: 33명의 무작위 추출된 환자를 상대로 통상의 이중동위원소 휴식/부하 심근관류 SPECT 때 부하 Tc-99m-MIBI 게이트 SPECT를 촬영한 후 이어서 같은 자리에서 게이트 SPECT를 한번 더 촬영하였다. 재구성한 후 Cedars 소프트웨어로 확장기말 부피와 수축기말 부피, 구혈률을 측정하여 연속 측정의 재현성을 평균변이계수와 Bland Altman 도표를 그려 분석하였다. 벽운동을 5등급으로 점수를 매겨 연속촬영한 영상의 판독 재현성을 조사하였다. 심근벽의 수축기 두꺼워짐을 역시 4등급으로 점수를 매겨 판독 재현성을 조사하였다. 결과: 확장기말 부피와 수축기말부피는 평균변이계수가 5.0 ml, 3.9 ml이고 구혈률의 평균변이계수는 1.9%이었다. 2표준편차 범위는 확장기말 부피는 18 ml, 수축기말부피는 17 ml이었다. 심근벽운동과 심근의 수축기 두꺼워짐은 kappa 값이 0.7로 판독재현성이 우수하였다. 결론: 이 연구의 결과로 같은 환자를 같은 위치에서 두 번 연이어 게이트 심근 Tc-99m-MIBI SPECT를 촬영할 때, 우리가 산출한 변이가 우수하고 약물효과를 판정할 때 기준으로 삼을 오차범위를 어느 정도로 정해야 하는지 확립하였다.

• 대한방사선치료학회지
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• 제30권1_2호
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• pp.73-81
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• 2018

목 적 : 다발성 뇌 전이의 방사선치료 시 jaw tracking(JT)과 fixed jawFJ)를 이용한 용적세기조절회전치료(Volumetric Modulated Arc Therapy, VMAT)를 비교하고 유용성을 평가하고자 한다. 대상 및 방법 : JT를 이용하여 치료받은 다발성 뇌 전이(Multiple Brain Metastasis) 환자 중 6개 이상의 종양이 있고 조사면 크기가 $14{\times}14cm^2$ 이상인 환자 10명을 대상으로 하였다. Eclipse(Ver 13.6 Varian, USA)로 JT와 FJ의 전산화치료계획을 각각 수립하였으며, 전자포털영상장치(Electronic Portal Imaging Device, EPID)를 이용하여 감마지수(Gamma Index, 3 mm, 3 %, 95 % 신뢰구간) 및 최대선량차이(Max. Dose Difference)를 측정하였다. 또한 손상위험장기(Organ At Risk, OAR)의 $D_{max}$ 및 $D_{mean}$을 산출하고 비교하였으며 처방선량지수(Conformity Index, CI), 선량균질지수(Homogeneity Index, HI)를 평가하였다. 결 과 : JT와 FJ의 측정값을 평가한 감마지수는 모든 Case에서 허용 기준(3 mm, 3 %, 95 % 신뢰구간)에 충족하였으며, 최대선량차이값은 Leaf End Transmission이 발생하는 영역에서 시계방향(Clockwise, CW)은 최대 98.4 %, 평균 43.6 %, 반시계방향(Counter-Clockwise, CCW)은 최대 67.9 %, 평균 41.0 %로 측정되었다. 손상위험장기는 JT를 사용하였을 때 각 정상장기에 대한 $D_{max}$의 최대값은 15.36 %~74.59 %, 평균값은 2.84 %~39.80 % 감소, $D_{mean}$의 최대값은 27.90 %~65.23 %, 평균값은 7.70 %~41.71 %로 감소하였으며, 처방선량지수와 선량균질지수값은 차이가 없었다. 결 론 : 다발성 뇌 전이에서 VMAT으로 치료할 경우 JT를 이용하면 치료계획용적(Planning Target Volume, PTV)의 선량분포에 영향을 미치지 않으면서 불특정 영역에서 발생하는 방사선의 누설 및 투과로 인한 불필요한 피폭을 감소시키고 정상장기에 더 낮은 선량으로 방사선치료가 가능할 것으로 사료된다.

• 기독교교육논총
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• 제72권
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• pp.245-271
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• 2022

연구 목적 : 본 연구는 간호대학생을 대상으로 사례기반학습 및 코티칭을 적용한 간호 임상실습 교육모형을 개발하고, 개발된 모형의 타당성 확보를 목적으로 한다. 연구 내용 및 방법 : 간호 임상실습 교육모형의 타당성 검증을 위해 전주시 소재 J대학교 2021학년도 2학기'건강 반응과 간호 VI(지각·인지) 실습'과목에 적용하고 모형에 대한 교수자 반응평가를 실시하였고, 학습자 반응평가를 위해 임상 수행 자신감, 교수학습 모형에 대한 설문조사와 포커스 그룹 인터뷰를 진행하였다. 선행문헌 고찰과 사례 연구를 통해 사례기반학습 단계와 코티칭 요소를 도출한 후 전문가 검토를 받아 초기 모형을 구안하였고, 구안한 모형은 간호교육 전문가에게 내적 타당화를 검토받은 후 수정·보완하였다. 외적 타당화 검증을 위해 임상실습 교과에 모형을 적용한 후 실시한 학습자 반응평가 결과 임상 수행 자신감은 4.22점, 교수학습 모형 만족도는 4.68점으로 높게 나타났다. 포커스그룹 인터뷰 결과를 종합하면, 사전학습의 중요성과 실제 사례를 기반으로 선정한 사례를 학습하면서 전문용어, 전문지식 등을 습득함으로써 실습 현장에 대한 두려움이 없어지고 익숙함을 느꼈고, 다양한 사례를 학습하며 실습 현장에서 학습하였던 지식을 정리하는 시간을 통해 비판적 사고를 할 수 있었다고 하였다. 또 코티칭을 통하여 현장지도자와 지도교수가 함께 사례를 통해 이론과 실무적인 측면을 동시에 교수함으로써 실무와 더 가까워진 실습교육을 경험한 것으로 나타났다. 결론 및 제언 : 본 연구를 통하여 개발한 사례기반학습 및 코티칭을 적용한 간호 임상실습 교육모형은 이론과 실무 간의 차이를 줄여주고 간호 대학생의 임상수행 능력을 향상시킬 수 있는 효과적인 교수학습모형이 될 것으로 기대한다.

• 지능정보연구
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• 제22권1호
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• pp.63-82
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• 2016

최근 정보기술의 발달로 인해 소비자들은 온라인상에서 많은 정보를 쉽고 빠르게 획득할 수 있다. 소비자가 제품 구매시에는 소비자들이나 전문가들이 작성한 제품 후기 정보를 주로 탐색한다. 기존의 연구들이 소비자들이 창출한 제품 후기 중심으로 주로 진행되어 왔기 때문에, 전문가 제품 후기의 영향력에 대해서는 상대적으로 소수의 연구들만 존재하고 있다. 본 연구는 전문가가 생성하는 제품 후기에 초점을 맞추어, 방대한 실제 비정형데이터인 전문가의 후기를 어떻게 언어학적인 차원과 심리학적인 차원으로 나눌 수 있는지의 방법론을 제안하며, 실제 전문가 제품 후기를 사용하여 의미 있는 다섯 가지 차원의 새로운 변수들을 도출하였다. 그 결과 소비자들이 전문가 후기에서 반응하고 있는 언어적 특성은 제품에 대한 깊이 있는 정보의 양이나 충분한 설명을 나타내는 변수인 Review Depth, 그리고 전문가가 기술하는 방식이 제품에 대한 확신이 없는 듯한 말투를 나타내는 변수인 Lack of Assurance는 소비자의 전반적인 제품평가에 유의한 상관관계가 있는 것으로 밝혀졌다. 또한, 제품에 대한 칭찬이나 긍정적인 면을 서술하는 방식인 Positive Polarity가 소비자의 제품 평가에 영향을 미치지 않았지만, 전문가가 하는 제품에 대한 비관적인 평가인 Negative Polarity는 소비자들의 평가와 유의한 음의 상관관계가 있었다는 점이다. 전문가가 스토리텔링 관점에서 자주 사용하는 Social Orientation 특성은 유의한 관계를 미치지 못함이 밝혀졌다. 본 연구는 새로운 방법론을 제안하고 이를 실제로 활용한 결과를 보여준다는 차원에서 이론적이고 실무적인 공헌을 가진다.

• 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.

• 대한간호
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• 제29권1호
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• pp.59-71
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• 1990

Although the usefulness and importance of clinical application of nursing diagnosis are well recognized by the academic circle, it is not yet generally practiced. In order to provide data for establishing a policy for clinical nursing diagnosis; a study was made at a seminar, sponsored by the Department of nursing, Severance Hospital, with participation of 190 nurses from 33 hospitals. The objective of the study was to find out; 1) if the nurses agree with the academic community in recognizing the benefits and problems of clinical application of nursing diagnosis; 2) how the nurses evaluate their ability to carry out nursing diagnosis; and 3) if educational programs would help enhance ability of nursing diagnosis among nurses. The summary of findings by the study is as follows; 1. While all nurses responded positively on the question of benefits improving science and quality of nursing, thus elevating credibility and position of nurses, some expressed concern on the practicality of the system in setting up nursing objectiveness, confirming the nursing problems and utilizing patient information. For the 20 questions and the scale of 1~5, the lowest average score was 3.223 and the highest 4.066. 2. The study attempted to find out the opinion of the nurses on the problems that 'would make difficult to adopt the nursing diagnosis in clinics. The result of the study indicates the nurses believe the major problems are the fact that the subject of nursing diagnosis are not well defined and that the form sheets do not match with the ones that are currently being used. However, comparing it with the result of the previous study on the same question (inadequate manpower and insufficienf time allocated for the job were two major problems pointed out then.), it can be said that the opinion of the nurses studied this time was much more positive and it suggests that they believe the system can be adopted without increasing manpower and only by giving additional training and by adjusting the format of nursing record sheets. It suggests that the future for adopting a clinical nursing diagnosis is very bright. 3. As the most urgent problem to be solved for adopting clinical nursing diagnosis, 38. 5% responded that it was "education of nurses, "and 34.2% responded that it was "staffing adequate number of nurses". 4. For the 10 questions asked for self-evaluation of ability to adopt the system, with the scale of 1~5, average score was lower than 3. This indicate that they evaluate their ability to adopt the system is low. 5. The results of study taken before and after the educational programs for clinical nursing diagnosis were compared with overall score in order to determine if such program would cause changes in the response to the effect of clinical application of nursing diagnosis, and it was found that there was statistically significant changes suggesting that the education contributed to positive change in the response. 6. The results of study taken before and after the educational programs for clinical nursing diagnosis were compared with overall score in order to determine how the proble~ ms for adopting nursing system would be effected by such educational programs, and it was found that those problems be not soived with a short course of training. 7. The results of study taken before and after the educational programs for clinical nursing diagnosis were compared with overall score in order to determine if such programs would bring changes in the self-evaluation of nurses on the ability of nursing diagno sis, and it was found that program improve score of self-evaluation their ability of the nursing diagnosis. As seen in the above reports, it was found that the nu'rses are very positive about the clinical nursing diagnosis, that educational program for the clinical nursing diagnosis helps nurses for positively changing their attitude for ,the nursing diagnosis, for their self-confidence on their ability to perform nursing diagnosis. With improved know-how and self"confictence of nurses gained through educational and .training programs, the future of clinical application of nursing diagnosis is very bright.diagnosis is very bright.

• 기본간호학회지
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• 제6권3호
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• pp.532-543
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• 1999

This study was conducted to provide the basic data necessary for the improvement of the teaching method for basic nursing practice as well as the effectiveness of the practice by examining the students' competency in cleansing enema after doing the self study instead of the traditional education. To examine the competency in cleansing enema after the self study, this study is an one group pretest-posttest design that subjects did the enema practice through the self study. The subjects were 89 sophomore students at Y University. College of Nursing. In basic nursing lab practice class, cleansing enema self study module was given to the students which was developed by the researcher based on the literature review and asked them to finish doing the pre study and checking the self study evaluation criteria after reading the goal, learning activities and theoretical guideline. After watching the video tape, students practiced the process in the module by themselves. For the competency in cleansing enema. repeated autonomous practices were done during the open lab other than the regular class. Whenever the practice was done, the frequency and time were measure and documented. When the student felt confident through repeated practices, the competency was evaluated by the researcher and two assistants based on the evaluation criteria. And the process was repeated till the student could perform all the items on evaluation criteria completely. The data were collected for 42 days from Oct. 15 to Nov. 26 in 1996. Collected data were analyzed by frequency, percentage, Pearson correlation coefficient and variance analysis. The results are summarized as follows : 1. 43.2% of the students were favorable to nursing and 63.6% like lecture, but 71.6% like practice. So they were more interested in practice than in lecture. 2. 62.3% of the students scored high in written test, 97.8% scored high in practice. So the practice score was better. 3. The frequency of repeated practice to pass the test ranged from 1 to 4 and the average is 2.2. 4. The average time needed in preparation and the performance was nearly the same regardless of the frequency. It took 5 to 38 minutes for those who passed the test after practicing once and the average was 16 minutes. 5 to 60 minutes were taken for those who practiced twice to pass the test and the average was 21 minutes. Those who passed the test after three practices needed 8 to 30 minutes and the average was 15 minutes, which was similar to the time that the students who passed the test for the first trial. Only one student passed the test after 4 practices and it took 10 minutes. 5. 64% of the students agreed that the context and the content of the module were appropriate for the self study and 68.2% were satisfied. And 71.9% said that the module helped them to practice the enema self study 6. Though only 42% of the students were satisfied with the video. 50.6% said that it was helpful for the self study. 7. 52.3% of the students were satisfied with the self study method, and 86.6% obtained self-confidence when performing the enema. 8. The lower the student's practice score was, the more practices were needed for them to pass the test(r=-.213, P<.05). As a result, for performing the enema practice competently, two or more practice opportunities were needed to be given. And it is possible to obtain the less complex nursing skills through the self study, when enough learning resources and assistance such as learning guidance or video tapes are provided. Based on this study. I want to suggest that. 1. There must be college policy that can support the new method instead of the traditional learning method for the students to attain the proficiency in basic nursing skills. 2. The assistant materials should be developed as soon as possible to promote the self study of basic nursing skills.