• 제목/요약/키워드: First-visit patient

검색결과 212건 처리시간 0.028초

안면 마비의 재건에서 광배근 유리피판과 박근 유리피판의 비교 연구 (Comparative Study of the Latissimus Dorsi and Gracilis Muscle Reconstruction for Reanimation of a Paralyzed Face)

  • 강동희;임찬수;구상환;박승하
    • Archives of Plastic Surgery
    • /
    • 제34권3호
    • /
    • pp.336-341
    • /
    • 2007
  • Purpose: The most accepted method for the reanimation of a paralyzed face is the two-stage method that combines cross-face nerve grafting with free-muscle transfer. Although the results of reconstruction with this method are satisfactory, there is an excessive delay between the stages, which prolongs the period of rehabilitation. In order to overcome this drawback, a one- stage, neurovascular free-flap reconstruction method using free neurovascular muscle flaps is introduced. Methods: From 1994 to 2004, 35 patients with longstanding facial palsy were treated. Fifteen patients underwent the single-stage reconstruction with the latissimus dorsi muscle, and 20 patients underwent the two-stage reconstruction method with the gracilis muscle. We compared the long-term results of the two methods of reconstruction. The mean follow-up period was 28.7 months for one-stage reconstruction, and 35.2 months for the two-stage, respectively. Results: In the patient group of the single stage reconstruction, both mouth corner excursion and animation grade were markedly improved at the final postoperative visit. Moreover, the first muscle contraction occurred earlier in this group, than in the two-stage reconstruction group. However, four patients in the single stage group never achieved a first muscle contraction or mouth corner excursion. Conclusion: Facial palsy is a very challenging condition for cosmetic surgeons to deal with. Traditional methods for treatment of chronic facial palsy use a two-stage muscle flap which is time-consuming and burdensome to patients, many of whom are averse to waiting 8 to 12 months to complete the two stages. The one-stage reconstruction method described herein uses a latissimus dorsi free-flap and has demonstrated consistent positive outcomes in clinical assessments.

의료정보를 활용한 14세 이하 외상환자 응급실 총 경유시간에 미치는 요인 (A Research on the Total Emergency Room Time for Child Patients under 14 years suffering from External Injuries using Medical Information)

  • 전은주;김광환
    • 한국병원경영학회지
    • /
    • 제13권4호
    • /
    • pp.27-45
    • /
    • 2008
  • This research focused on a total of 378 patients with external injuries under the age of 14 who visited the emergency center at a university hospital in Korea, during the months of January, April, August and November between January and December of 2007. In addition, the survey was conducted only on even number days and ranged across the whole year to reflect the impact of seasonal characteristics on the collected data. The research focused on determining the characteristics and inflicting cause of these patients with external injuries, analyzed the total time spent in the emergency room and obtained the following results. 1. When classifying the patients into different genders, the proportion of males (67.5%) was higher than that of females (32.5%). According to the different age groups, the highest ratio, at 61.1 %, was patients under the age of six. 2. Looking at the total number of minutes spent in the emergency room, the longest amount of time occurred during April with 162.7 minutes, followed by 121.9 minutes in January and 92.4 minutes in November. August had the shortest period of time spent in the emergency room, a significant statistical difference from the other periods of the year (p<0.001). 3. Regarding the amount of time required for each examination, patients required to provide a urine test spent an average of 204.7 minutes while those who did not spent 113.5 minutes on average. This is a 5% statistical difference among the two groups (p>0.05). 4. Looking at the five most commonly diagnosed problems in the emergency room, the total number of people with these top five commonly diagnosed illnesses comprised 55.6%, or 210 patients out of 378. 5. Utilizing the Decision Tree Model to estimate the total number of minutes required per visit, the first classifications were made using a chemical examination factor. People subject to chemical classification spent an average of 177.7 minutes, which was longer than the overall average of 115.2 minutes, and those exempt from chemical examination spent an average of 103.8 minutes, which was shorter than the average Conclusion; Effort to curtail the total time spent in emergency rooms is vital in guaranteeing efficient management of hospitals and providing medical services. The delay experienced by many comprehensive professional medical centers must be resolved through the establishment of effective delivery of medical services, increased supply of patient rooms and other policy oriented implementations. However, for now, this problem must be resolved by increasing the level of patient satisfaction and guaranteeing effective operation of patient rooms, which will significantly contribute to the general management and success of hospitals and institutions.

  • PDF

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
    • /
    • 제20권2호
    • /
    • pp.227-248
    • /
    • 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.

  • PDF

Axenfeld-Rieger Syndrome 환자의 증례보고 (AXENFELD-RIEGER SYNDROME WITH DENTAL PROBLEM : A CASE REPORT)

  • 성민경;신터전;김영재;김정욱;장기택;이상훈;김종철;현홍근
    • 대한장애인치과학회지
    • /
    • 제8권2호
    • /
    • pp.113-117
    • /
    • 2012
  • 저자는 ARS를 가진 15세 여자 환아에 대한 임상적, 방사선학적 관찰을 통해 다음과 같은 지견을 얻었다. 1. 환아는 Axenfeld-Rieger Syndrome의 안과적 증상인 전안부 형성부전을 나타낸다. 2. 환아의 구강 및 구개악안면 소견으로 다수의 영구치 결손 및 왜소치, 상악 형성 부전, 구치부의 반대교합이 관찰되었다. 3. 환아의 성장에 따른 주기적인 치과적 검진과 추가적인 치료가 필요할 것으로 생각된다.

콘택트렌즈 착용에 따른 사용자 실태조사 (The Current State of Lens Care in Contact Lens Wearer)

  • 유근창;김인숙
    • 한국안광학회지
    • /
    • 제7권1호
    • /
    • pp.15-20
    • /
    • 2002
  • 콘택트렌즈 착용에 따른 사용자의 실태조사는 안경원과 안과에 내원한 콘택트렌즈 사용자 237명(남자 56명, 여자 181명)을 대상으로 문진과 세극 등 검사, 각막곡률 검사, 굴절검사 등을 하였다. 연구 결과 연령에 따른 현재 착용하고 있는 콘택트렌즈 착용률은 10대 40.9%, 20대 52.3%, 30대 5.5%, 40대 1.3%로 조사되었으며, 콘택트렌즈의 종류는 소프트콘택트렌즈의 경우 10대의 착용률은 82.5%, 20대 83.1%, 30대 38.5%이었으며, 하드 콘택트렌즈 착용률은 10대 17.5%, 20대 16.9%, 30대 61.5%로 조사되었다. 콘택트렌즈 착용목적은 전체 조사자의 40.5%는 안경이 불편해서, 32.1%는 미용목적으로 9.7%는 스포츠를 목적으로 17.7%는 시력교정목적으로 착용한 것으로 조사되었으며, 렌즈관리 시스템의 경우 전체 조사자의 16.5%는 매일세척을 하였으며, 29.1%는 매일 세척과 단백질 제거를 한 것으로 조사되었고, 21.9%는 매일세척과 다목적용액을 사용하였으며, 32.5%는 매일세척과 단백질제거 그리고 다목적용액을 사용한 것으로 조사되었다. 렌즈 착용시간은 10시간 이내가 31.6%, 11~13시간 미만의 경우가 41.3%, 14시간이상은 27%로 조사되었다. 콘택트렌즈 보관방법에서 62%는 보존액, 38%는 식염수를 사용하였다. 콘택트렌즈 교체 이유는 렌즈분실 35%, 렌즈손상 37.6% 이물질 침착 21.9%, 5.5%는 렌즈수명의 이유로 렌즈를 교체하였다. 현재 사용 중인 콘택트렌즈의 주요 자각증상은 급성 충혈의 자각증상 21%, 이물감 20.8%, 통증 19.6%, 건조감 9.4%, 흐린 시야 5.5%, 시야감소 3.8%, 유루 3.7%, 삼출물 2.8%, 가려움 2.6%, 자각증상이 없는 착용자는 10.2%로 조사되었다. 콘택트렌즈 사용자의 렌즈관리 교육에 대한 만족도에서 51%는 만족하였으나 28.7%는 불만족을 나타냈다. 착용자의 정기검사에서 81.1%는 정기검사를 하지 않았으며, 18.1%는 정기검사를 하고 있는 것으로 조사되었다.

  • PDF

로웨 증후군 환아의 치아우식 치료 증례 보고 (DENTAL TREATMENT UNDER GENERAL ANESTHESIA IN A PATIENT WITH LOWE SYNDROME : A CASE REPORT)

  • 류지연;신터전;현홍근;김영재;김정욱;장기택;김종철;이상훈
    • 대한장애인치과학회지
    • /
    • 제12권2호
    • /
    • pp.82-86
    • /
    • 2016
  • 저자는 백내장, 지적장애, 신수질 석회화(medullary nephrocalcinosis), 근 긴장저하 증상을 보이는 로웨 증후군 환아의 다발성 치아우식 치료를 시행하였다. 협조도 부족 및 근 긴장저하로 인한 흡인 가능성을 고려하여 전신마취 하 술식을 진행하였다. 치료 결과의 유지를 위하여 적절한 구강위생 관리가 중요하며 향후 나타날 수 있는 구강내 증상의 진단과 관리를 위해 정기적이 검진이 필요하다.

상악 완전 무치악 및 하악 부분 무치악 환자에서 임플란트 지지형 고정성 보철물을 이용한 전악 수복 증례 보고 (Full-mouth rehabilitation with implant-supported fixed dental prostheses for the edentulous maxilla and partially edentulous mandible: A case report)

  • 김태형;오경철;문홍석
    • 대한치과보철학회지
    • /
    • 제57권4호
    • /
    • pp.374-381
    • /
    • 2019
  • 넓은 영역의 무치악 부위를 수복하기 위한 전통적인 방법은 의치를 이용한 치료다. 하지만, 임플란트를 활용할 경우 보철물의 안정과 유지, 그리고 지지의 측면에서 더 유리하며, 저작효율이 향상되는 등 기능적으로 더 양호한 결과를 얻을 수 있다. 이 같은 임플란트를 이용한 치료방법은 크게 가철성과 고정성 방식으로 분류될 수 있으며, 치조골의 흡수정도, 악간관계, 환자의 선호도, 사회 경제적 요인 등을 고려하여 적절한 접근 방식을 선택하여야 한다. 한편, 지르코니아의 물성이 크게 개선됨에 따라, 임플란트 지지형 고정성 보철물의 재료로서 단일구조 지르코니아가 각광을 받고 있다. 단일구조 지르코니아는 지르코니아 코어에 세라믹을 비니어링 한 보철물이나 금속 도재관보다 파절과 chipping의 빈도가 적으며 지르코니아 자체가 충분한 두께를 가질 수 있어 구조적으로 좋은 물성을 지닐 수 있다. 최근에는 투명도가 증진된 단일구조 지르코니아도 출시되어, 전치부 보철물을 위한 재료로도 널리 사용되고 있다. 본 증례의 남환은 상악 양측 구치부의 결손 및 다수 잔존치의 중등도 이상의 전반적 만성 치주염 이환으로 인해, 하악 양측 견치 및 좌측 제1, 2 소구치를 제외한 모든 치아를 발치한 후, 상악 8개 및 하악 3개의 임플란트 식립을 동반한 전악 수복 치료를 받았다. 보철물 장착 후 1년 간의 경과 관찰 기간 동안 기능적, 심미적으로 만족할만한 결과를 얻어 이를 보고하는 바이다.

비정형 유기형/간상 종양(Atypical teratoid rhabdoidal tumor) 환자의 전신마취 하 치과치료 (DENTAL TREATMENT IN A PATIENT WITH ATYPICAL TERATOID RHABDOIDAL TUMOR UNDER GENERAL ANESTHESIA)

  • 김현태;송지수;현홍근;김영재;김정욱;장기택;이상훈;신터전
    • 대한장애인치과학회지
    • /
    • 제15권1호
    • /
    • pp.74-78
    • /
    • 2019
  • AT/RT를 갖는 환자는 빈번하게 MRI촬영을 시행하게 된다. MRI의 경우 강자성 효과(ferromagnetic effect)로 인해 스테인레스스틸 기성금속관의 탈락이 발생할 위험성이 있고 영상의 인공물(artifact)의 형성을 유발할 수 있으므로 유치의 전장관 수복 전에 재료의 선택에 있어서 이러한 위험성에 대해 고려해야 한다. 이 경우 기성 지르코니아 전장관은 AT/RT 환자들의 크라운 수복에 있어서 좋은 수복재료로 사용될 수 있다. 또한 항암치료로 인해 AT/RT 환아들은 우식발생율이 높으므로 구강위생 관리 및 전문가 불소도포 등의 주기적인 정기검진이 요구된다.

보철물 수복 형태에 따른 T-Scan Novus와 Dental prescale II를 이용한 교합력 평가 활용 증례 (Evaluation of occlusal strength using T-Scan Novus and Dental prescale II in dental prosthodontic treatments: A case report)

  • 최수현;최유성;이종혁;하승룡
    • 대한치과보철학회지
    • /
    • 제61권2호
    • /
    • pp.160-178
    • /
    • 2023
  • 보철 치료 시 교합관계의 진단과 분석은 중요한 요소 중 하나이다. 치료 시행 전 면밀한 교합분석 및 평가가 선행되어 안정적인 악간 관계를 회복시켜 주어야 하며, 치료 과정 및 정기 검진 시에도 이에 대한 평가는 필수적이다. 최근, 치과용 기기와 디지털 처리 방식의 발달로 환자의 교합관계를 기록할 수 있는 새로운 정량적 분석 방법들이 소개되고 있다. 그 중 T-Scan Novus (Tekscan Inc., S. Boston, MA, USA)는 압력측정센서를 이용하여 상하악 치아의 초기접촉점과 교합접촉점의 상대적인 강도를 나타내며 치아의 교합접촉 시간, 교합력의 전후방, 좌우균형을 비교할 수 있다. Dental prescale II (GC Co., Tokyo, Japan)는 압력감지필름을 이용하여 교합접촉점을 스캔하여 접촉점의 밀도를 분석하는 방법으로 최대한 자연스러운 교합상태 치열의 교합력 분포와 강도를 측정할 수 있다. 환자의 치아 상실 부위와 범위에 따라 4-unit 고정성 국소의치, 가철성 국소의치, 총의치, 완전구강회복술을 시행하였다. 적절한 교합 분석을 위해, 초진, 각 치료 단계, 치료 직후 및 정기검진 시의 환자의 교합을 T-Scan Novus와 Dental prescale II를 이용하여 정량적으로 비교, 평가하였다. 보철수복 치료과정에서 교합 분석에 대한 이해도를 제고할 수 있었고, 기능 및 심미적으로 환자와 술자 모두 만족할 만한 결과를 얻었기에 이를 보고하고자 한다.

득기와 침의 항소양 효과 간의 상관관계 분석 (The Relation between Deqi and Anti-itching Effect of Acupuncture Stimulation)

  • 박지은;김애란;정소영;김정은;정현정;강경원;정희정;김태훈;신미숙;박효주;최선미
    • Korean Journal of Acupuncture
    • /
    • 제29권2호
    • /
    • pp.290-299
    • /
    • 2012
  • Objectives : 'Obtaining qi(deqi)' is a sensation experienced by a patient or an acupuncturist during acupuncture treatment, and it is considered to be an important factor in acupuncture treatment. However, previous studies reported conflicting results about the relationship between 'obtaining qi(deqi)' sensation and the effect of acupuncture treatment. Also, most of the previous studies investigating 'obtaining qi(deqi)' and the acupuncture effect, dealt with the analgesic effect of acupuncture. The objective of this study was to analyze the relation between the 'obtaining qi(deqi)' and the anti-itching effect of acupuncture treatment. Methods : Twenty one healthy subjects participated in this study. At the first visit, itch was induced to all subjects using intradermal injection of histamine on the lower arm. At the second visit, acupuncture treatment was applied using LI11 and 'obtaining qi(deqi)' was assessed. After acupuncture treatment, itch was induced again, and itch VAS and skin flare were assessed. Results: At the 6,8,10 minutes after histamine injection, the change of itch VAS between before and after acupuncture treatment was significant. Among 'obtaining qi(deqi)', subjects reported that 'dull ache', 'pricking', 'heavy' were most strong. Total score of 'obtaining qi(deqi)' sensation was not related to the change of itch VAS or skin flare. The 'electric shock' sensation is related to the change of itch VAS, and 'bruised' and 'heavy' sensations were related to the change of skin flare. Conclusions : Total 'obtaining qi(deqi)' is not related to the anti-itching effect of acupuncture, but several sensations showed relationship with the effect of acupuncture on itch severity and skin flare. Further researches based on various symptoms or acupuncture points, are needed.