• 대한한방부인과학회지
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• 제37권1호
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• pp.40-59
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• 2024

Objectives: Since infertility has been big social issue in Korea, this study aims to analyze the domestic study trends in Korean Medicine (KM) for female infertility treatment. Methods: Case studies applying KM treatment on female infertility were selected through 5 domestic journal databases. General characteristics, interventions, outcomes and results and the quality of the reports were analyzed. Especially, the quality assessments of studies were made using CAse REport (CARE) guideline and Joanna Briggs Institute (JBI) critical appraisal checklist. Results: 14 studies (22 cases) were finally selected for the analyzation. The mean age of the participants was 35.1 and the most common factor of female infertility in this study was Uterine factor. Herbal medicine was applied in all studies, and acupuncture was also used frequently. Most cases reported pregnancy of the participants. According to quality assessment, 'Diagnostic challenges', 'Intervention adherence and tolerability', 'Adverse and unanticipated events', 'Patient perspective' and 'Informed consent' were showed low reporting rates. Conclusions: Korean Medicine treatment for female infertility is expected to be effective. In quality evaluation, there were some items with low reporting rates. Further clinical studies have to be conducted to establish the evidence for the treatment.

• 대한영상의학회지
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• 제82권2호
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• pp.347-358
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• 2021

외상은 40세 이하에서 가장 흔한 사망의 원인 중에 하나이다. 과거에는 외상 환자의 치료로 대부분 수술적 치료가 우선 되었다. 하지만 점차 외상 환자의 치료에서 장기 보존이 중요하게 되었으며, 외상 후 환자의 치료는 수술적 치료에서 비수술적 치료로 바뀌고 있다. 외상 환자의 적절한 치료를 위해서는 다양한 분야의 협력이 필요하다. 그중 인터벤션 영상 의학은 외상 환자를 평가하고 치료하는데 중요한 역할을 담당하고 있다. 이에 본 논문은 인터벤션 치료가 급성 외상 환자에서 중요한 역할을 했던 다양한 증례들에 대해 소개해 보고자 한다.

• Korean Circulation Journal
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• 제54권6호
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• pp.295-310
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• 2024

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 has led to a global health crisis with substantial mortality and morbidity. To combat the COVID-19 pandemic, various vaccines have been developed, but unexpected serious adverse events including vaccine-induced thrombotic thrombocytopenia, carditis, and thromboembolic events have been reported and became a huddle for COVID-19 vaccination. Vaccine-related myocarditis (VRM) is a rare but significant adverse event associated primarily with mRNA vaccines. This review explores the incidence, risk factors, clinical presentation, pathogenesis, management strategies, and outcomes associated with VRM. The incidence of VRM is notably higher in male adolescents and young adults, especially after the second dose of mRNA vaccines. The pathogenesis appears to involve an immune-mediated process, but the precise mechanism remains mostly unknown so far. Most studies have suggested that VRM is mild and self-limiting, and responds well to conventional treatment. However, a recent nationwide study in Korea warns that severe cases, including fulminant myocarditis or death, are not uncommon in patients with COVID-19 VRM. The long-term cardiovascular consequences of VRM have not been well understood and warrant further investigation. This review also briefly addresses the critical balance between the substantial benefits of COVID-19 vaccination and the rare risks of VRM in the coming endemic era. It emphasizes the need for continued surveillance, research to understand the underlying mechanisms, and strategies to mitigate risk. Filling these knowledge gaps would be vital to refining vaccination recommendations and improving patient care in the evolving COVID-19 pandemic landscape.

• Journal of Gastric Cancer
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• 제5권2호
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• pp.95-100
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• 2005

목적: Critical pathway (CP)는 특정질환 표준화를 통해 적정한 진료 및 최소한의 표준진료를 행하여 진료의 질을 높이고 비용을 감소시켜 환자 및 의료진의 만족도를 높이기 위해 시도되고 있다. 본 연구는 위암수술 환자에서 CP를 개발 및 적용하고 이를 통해 치료결과의 향상을 이룰 수 있는지 알아보고자 하였다. 대상 및 방법: 2003년 10월부터 2004년 8월까지 가톨릭대학교 의과대학 강남성모병원에서 위암으로 수술 받은 185명의 환자 중 타장기 원발암이 없고, 근치적절제술을 시행 받은 환자 117예에서, CP를 적용한 26예와 동기간 동안 CP를 적용하지 않은 환자 91예의 임상적 특성, 수술 후 경과, 진료비용, 입원기간 및 환자 91예의 임상적 특성, 수술 후 경과, 진료비용, 임원기간 및 환자 만족도 등을 비교하여 위암수술에서 CP의 유용성을 알아보았다. CP를 개발하기 위하여 진료, 간호, 원무, 영양과 등이 참여하는 팀을 구성하여 외래검사 흐름도, 수술 전, 후 처방지, 경과기록 등을 표준화한 프로토콜을 작성하였다. 결과: CP환자 26명 중 1명은 십이지장 단단부 누출로, 1명은 술 후 위정체로 인한 장기 입원 및 재수술이 불가피 하여 제외되어 최종 분석된 환자는 24명이었다. 24명의 환자 중 8명에서 재원기간의 지연으로 인한 변이가 발생하였는데 6명은 환자가 자의적으로 퇴원을 거부하여 수술후 $1\∼2$일이 지연되었으며, 1명은 술 후 위정체로 2일 지연되었고, 1명은 수술 후 중환자실 입원 및 관찰기간이 필요하여 4일간 지연되어 변이율(variance rate)은 8/26 ($30.8\%$)였다. 평균 재원기간은 CPrns은 11.3일($10\∼15$일)이었고, Non-CP군은 17.5일($9\∼68$일)로 CPrns이 약 6일 짧았다(P<0.05), 술 후 평균 재원기간의 경우 CP군과 Non-CP군 각각 8.3일($7\∼12$일), 10.3일($7\~68$일)로 차이가 있으나 통계적으로 유의하지는 않았다(P>0.05). 양 군에서의 재원기간 중 총 진료비는 CP군이 평균 4,863,685원, Non-CP군이 평균 6,292,200원으로 CP군의 진료비가 낮았으나, 일당 진료비는 CP군은 430,414원, Non-CP군에서 높았음을 알 수 있었다(P<0.05). 13가지 항목의 만족도 조사에서도 CP군이 Non-CP군에 비해 높았다(P<0.05). 결론: 저자들이 개발하여 위암수술 환자에 적용한 CP 프로그램은 재원기간을 줄이고 총 진료비를 감소시킨 반면 일일 진료비의 상승과 환자 및 의료진의 만족도를 높일 수 있었다. 향후 다기관이 참여하는 전향적인 연구를 통해 보다 적절한 표준진료지침을 개발하여 그 효용성을 객관화 시켜야 할 것으로 사료된다.

• Neonatal Medicine
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• 제25권2호
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• pp.78-84
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• 2018

Purpose: To investigate the hemodynamic risk factors for necrotizing enterocolitis (NEC), we analyzed the characteristics of descending aorta (DA) blood flow in preterm neonates, who later developed NEC. Methods: This was an observational case-control study on 53 preterm neonates at a tertiary referral center. Clinical and echocardiographic data were collected from 23 preterm neonates with NEC (NEC group), and compared with those of 30 preterm neonates without NEC (control group). Echocardiography was done at a median (interquartile range) of 5 (3-9) days after birth and 2 (1-2.5) days before the diagnosis of NEC. Results: Basic clinical characteristics including gestational age, birth weight, Apgar score, breast feeding status, use of umbilical catheters, and mode of invasive ventilator care were similar between the groups. Compared with the control group, the lowest diastolic velocity of DA was significantly decreased, whereas the diastolic reverse flow and the ratio of diastolic reverse to systolic forward flows were significantly increased in the NEC group. In addition, the resistive index (RI) of DA was significantly increased in the NEC group and showed a positive association with the development of NEC. Multivariate logistic regression analysis showed that increasing RI of DA was an independent risk factor for the development of NEC (P=0.008). Conclusion: Significant changes in DA flow characteristics including decreased diastolic velocity and increased diastolic reverse flow along with increased peripheral vascular resistance were observed before the development of NEC in preterm neonates. These findings may help clinicians stratify in advance neonates at a risk of developing NEC and may help improve outcomes in these neonates.

• Perspectives in Nursing Science
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• 제13권2호
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• pp.88-95
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• 2016

Purpose: Gestational weight gain and prepregnancy body weight are important factors of childbirth outcomes, which further cause obesity, metabolic diseases, or psychological problems later in women's lives. Changes in diet, westernized lifestyle, traditional postpartum care, and childbirth at older age are thought to be threats to proper weight management in Korean women of reproductive age. Public health and antenatal care need to focus on the proper body weight management of women by carefully planning pregnancy to postpartum periods. Purpose: This study explored the body weight changes from pregnancy to postpartum and the related characteristics in women within 12 months after childbirth. Methods: A cross-sectional, retrospective study was conducted with 102 Korean women within 12 months after childbirth. Data were collected using an online survey system, and a structured questionnaire available for electronic self-administration was modified to include demographics, obstetrical history, and body weight at 6 time points. The International Physical Activity Questionnaire and Eating Habit Measurement instruments were also used in data collection. A professional survey agency recruited the participants, and data were automatically saved and then analyzed. Results: The average age of the participants was 33.8 years, 48% were housewives and were well-educated. Seventy-two percent of the participants were primiparas and 82% had breastfed their babies. The body mass index (BMI) ranged from 17.3 to 27.8, indicating that 21.5% of the participants were overweight or obese. The mean gestational weight gain was 11.8 kg, and weight loss was apparent during the first 3 months postpartum. The mean decline in weight was 3.4 kg at one year after childbirth. Women wanted to lose 5.6 kg (range: 3~20 kg), however 44% of them reported that they had not engaged in any weight control efforts. Further, 72% of them reported having engaged in a low level of physical activity. Body weight was not associated with women's characteristics, physical activity score, and diet. Conclusion: Women's awareness of gestational weight gain, lifestyle modification, and the risk of prolonged weight retention should be promoted through the antenatal and women's healthcare systems. As pregnancy and childbirth are critical events that affect women's health, integrative education to ensure healthy transition to life after delivery is required.

• Journal of Korean Neurosurgical Society
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• 제66권3호
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• pp.316-323
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• 2023

Objective : Owing to advances in critical care treatment, the overall survival rate of preterm infants born at a gestational age (GA) <32 weeks has consistently improved. However, the incidence of severe intraventricular hemorrhage (IVH) has persisted, and there are few reports on in-hospital morbidity and mortality. Therefore, the aim of the present study was to investigate trends surrounding in-hospital morbidity and mortality of preterm infants with severe IVH over a 14-year period. Methods : This single-center retrospective study included 620 infants born at a GA <32 weeks, admitted between January 2007 and December 2020. After applying exclusion criteria, 596 patients were included in this study. Infants were grouped based on the most severe IVH grade documented on brain ultrasonography during their admission, with grades 3 and 4 defined as severe. We compared in-hospital mortality and clinical outcomes of preterm infants with severe IVH for two time periods : 2007-2013 (phase I) and 2014-2020 (phase II). Baseline characteristics of infants who died and survived during hospitalization were analyzed. Results : A total of 54 infants (9.0%) were diagnosed with severe IVH over a 14-year period; overall in-hospital mortality rate was 29.6%. Late in-hospital mortality rate (>7 days after birth) for infants with severe IVH significantly improved over time, decreasing from 39.1% in phase I to 14.3% in phase II (p=0.043). A history of hypotension treated with vasoactive medication within 1 week after birth (adjusted odds ratio, 7.39; p=0.025) was found to be an independent risk factor for mortality. When comparing major morbidities of surviving infants, those in phase II were significantly more likely to have undergone surgery for necrotizing enterocolitis (NEC) (29.2% vs. 0.0%; p=0.027). Additionally, rates of late-onset sepsis (45.8% vs. 14.3%; p=0.049) and central nervous system infection (25.0% vs. 0.0%; p=0.049) were significantly higher in phase II survivors than in phase I survivors. Conclusion : In-hospital mortality in preterm infants with severe IVH decreased over the last decade, whereas major neonatal morbidities increased, particularly surgical NEC and sepsis. This study suggests the importance of multidisciplinary specialized medical and surgical neonatal intensive care in preterm infants with severe IVH.

• Tuberculosis and Respiratory Diseases
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• 제64권6호
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• pp.445-450
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• 2008

연구배경: 최근 노인 인구가 급격히 증가하면서 중환자실로 입원하는 노인 환자도 증가하는 추세이다. 내과계 중환자실에서 30일 이상 장기간 기계환기를 받은 노인 환자들의 임상적 특징 및 예후에 대하여 알아보고자 하였다. 방 법: 2004년 4월부터 2007년 3월까지 을지대학병원 내과계 중환자실에 입원했던 환자들 중에서 연속해서 30일 이상 기계환기를 받았던 65세 이상 환자 41명을 대상으로 임상적 특징과 예후에 대하여 후향적으로 조사하였다. 결 과: 대상 환자 41명의 평균 연령은 $74.6{\pm}6.0$세이었고, 남자가 27명(65.9%)이었다. 중환자실로 입원한 주된 이유는 급성호흡부전 30명(73.2%)으로 가장 많았고 패혈증 5명(12.2%), 신경계장애 4명(9.8%), 위장관출혈 2명 (4.9%) 순이었다. 평균 APACHE II 점수는 $26.9{\pm}4.5$이었다. 중환자실 평균 입원 기간은 $49.3{\pm}23.0$일 이었으며 기계환기의 평균 기간은 $57.5{\pm}32.8$일이었다. 사망한 환자는 25명(60.9%)이었으며 사망과 관련있는 인자는 APACHE II 점수(p=0.038)와 수혈(p=0.007) 등이었다. 결 론: 장기간 기계환기 치료를 받은 노인 환자들에서 호흡부전이 가장 흔한 중환자실 입원 이유이었으며 사망률은 60.9%이었고 사망에 영향을 주는 인자는 APACHE II 점수와 수혈 등이었다.

• 한국지역지리학회지
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• 제21권4호
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• pp.751-763
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• 2015

지표를 활용한 대기오염 취약성 평가에서는 지표의 선정과 함께 지표별 가중치 결정이 중요한 문제이다. 본 연구는 전국 249개 시군구를 대상으로 엔트로피 가중치 산정법을 활용하여 오존을 중심으로 한 대기오염 취약성을 평가하고, 엔트로피 가중치 방법론의 활용가능성을 검토하였다. 연구방법은 대기오염 취약성 지표를 선정하고 이들을 표준화하고, 엔트로피를 이용한 가중치를 적용하여 취약성을 평가하는 방식을 활용하였다. 노출 지표는 기상요인과 대기오염요인을 고려하였고, 민감도는 취약대상과 취약환경요인을, 지자체별 적응능력은 지역의 사회 경제적 요소, 보건의료요인, 대기관리 요인을 적용하였다. 취약성 평가 결과는 단순합산의 경우 화성시, 광진구, 김포시, 광주시, 군포시 순으로 취약성이 높게 나타났으며, 취약성-탄력성 지표(VRI) 방식도 단순합산 결과와 유사한 취약지역 공간 분포 패턴을 나타내었다. 본 연구에서 제시한 엔트로피 가중치를 이용한 대기오염 취약성 평가는 자료에 기반한 객관적인 취약성 평가로 불확실성을 동반하는 기후변화와 대기오염 취약성 평가에 활용가치가 높을 것으로 보인다. 또한 취약성 평가결과는 지자체별 특성이 반영된 것으로 세부적인 분석을 통해 지역 맞춤형 정책수립에 활용될 수 있다.