• 제목/요약/키워드: Non-emergency

검색결과 632건 처리시간 0.029초

Single Centre Experience on Decision Making for Mechanical Thrombectomy Based on Single-Phase CT Angiography by Including NCCT and Maximum Intensity Projection Images - A Comparison with Magnetic Resonance Imaging after Non-Contrast CT

  • Kim, Myeong Soo;Kim, Gi Sung
    • Journal of Korean Neurosurgical Society
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    • 제63권2호
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    • pp.188-201
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    • 2020
  • Objective : The purpose of this study was to suggest that computed tomography angiography (CTA) is valuable as the only preliminary examination for mechanical thrombectomy (MT). MT after single examination of CTA including noncontrast computed tomography (NCCT) and maximum intensity projection (MIP) improves door-to-puncture time as well as results in favorable outcomes. Methods : A total of 157 patients who underwent MT at Dong Kang Medical Center from April 2015 to March 2019 were divided into two groups based on the examination performed prior to MT : CTA group who underwent CTA with NCCT and MIP, and NCCT+magnetic resonance image (MRi) group who underwent MRI including perfusion images after NCCT. In the two groups, time to CTA imaging or NCCT+MRi imaging after symptom onset, and time to arterial puncture and reperfusion were characterized as time-related outcomes. The evaluation of vascular recanalization after MT was defined as a modified thrombolysis in cerebral infarction (mTICI) scale. National Institutes of Health Stroke Scale (NIHSS) was assessed at the time of the visit to the emergency room and modified Rankin Scale (mRS) was assessed after 90 days. Results : Typically, there were 34 patients in the CTA group and 33 patients in the NCCT+MRi group. A significantly shorter delay for door-to-puncture time was observed (mean, 86±22.1 vs. 176±47.5 minutes; <0.01). Also, a significantly shorter door-to-imege time in the CTA group was observed (mean, 13±6.8 vs. 93±30.8 minutes; p<0.01). Moreover, a significantly shorter onset-to-puncture time was observed (mean, 195±128.0 vs. 314±157.6 minutes; p<0.01). Reperfusion result of mTICI ≥2b was 100% (34/34) in the CTA group and 94% (31/33) in the NCCT+MRi group, and mTICI 3 in 74% (25/34) in the CTA group and 73% (24/33) in the NCCT+MRi group. Favorable functional outcomes (mRS score ≤2 at 90 days) were 68% (23/34) in the CTA group and 60% (20/33) in the NCCT+MRi group. Conclusion : A single-phase CTA including NCCT and MIP images was performed as a single preliminary examination, which led to a reduction in the time of the procedure and resulted in good results of prognosis. Consequently, it is concluded that this method is of sufficient value as the only preliminary examination for decision making.

석면 분석방법에 대한 고찰 (Review on asbestos analysis)

  • 함승헌;황성호;윤충식;박동욱
    • 한국산업보건학회지
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    • 제19권3호
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    • pp.213-232
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    • 2009
  • This document was prepared to review and summarize the analytical methods for airborne and bulk asbestos. Basic principles, shortcomings and advantages for asbestos analytical instruments using phase contrast microscopy(PCM), polarized light microscopy(PLM), X-ray diffractometer (XRD), transmission electron microscopy(TEM), scanning electron microscopy(SEM) were reviewed. Both PCM and PLM are principal instrument for airborne and bulk asbestos analysis, respectively. If needed, analytical electron microscopy is employed to confirm asbestos identification. PCM is used originally for workplace airborne asbestos fiber and its application has been expanded to measure airborne fiber. Shortcoming of PCM is that it cannot differentiate true asbestos from non asbestos fiber form and its low resolution limit ($0.2{\sim}0.25{\mu}m$). The measurement of airborne asbestos fiber can be performed by EPA's Asbestos Hazard Emergency Response Act (AHERA) method, World Health Organization (WHO) method, International Standard Organization (ISO) 10312 method, Japan's Environmental Asbestos Monitoring method, and Standard method of Indoor Air Quality of Korea. The measurement of airborne asbestos fiber in workplace can be performed by National Institute for Occupational Safety and Health (NIOSH) 7400 method, NIOSH 7402 method, Occupational Safety and Health Administration (OSHA) ID-160 method, UK's Health and Safety Executive(HSE) Methods for the determination of hazardous substances (MDHS) 39/4 method and Korea Occupational Safety and Health Agency (KOSHA) CODE-A-1-2004 method of Korea. To analyze the bulk asbestos, stereo microscope (SM) and PLM is required by EPA -600/R-93/116 method. Most bulk asbestos can be identified by SM and PLM but one limitation of PLM is that it can not see very thin fiber (i.e., < $0.25{\mu}m$). Bulk asbestos analytical methods, including EPA-600/M4-82-020, EPA-600/R-93/116, OSHA ID-191, Laboratory approval program of New York were reviewed. Also, analytical methods for asbestos in soil, dust, water were briefly discussed. Analytical electron microscope, a transmission electron microscope equipped with selected area electron diffraction (SAED) and energy dispersive X-ray analyser(EDXA), has been known to be better to identify asbestiform than scanning electron microscope(SEM). Though there is no standard SEM procedures, SEM is known to be more suitable to analyze long, thin fiber and more cost-effective. Field emission scanning electron microscope (FE-SEM) imaging protocol was developed to identify asbestos fiber. Although many asbestos analytical methods are available, there is no method that can be applied to all type of samples. In order to detect asbestos with confidence, all advantages and disadvantages of each instrument and method for given sample should be considered.

재난상황에서 작업치료사의 역할에 대한 고찰 (The Role of Occupational Therapist in Disaster Management)

  • 김정헌
    • 대한지역사회작업치료학회지
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    • 제6권2호
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    • pp.21-30
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    • 2016
  • 목적 : 2016년 10월 경주지역에서 우리나라 관측사상 최고인 5.1과 5.8 규모의 지진이 발생하였다. 비록 피해가 크지는 않았지만 우리나라에서도 언제든지 재난상황을 일으키는 재해가 발생할 수 있다는 것을 암시한다. 이번 지진을 계기로 재난상황에 대해 비정부 기관과 여러 나라의 재난에 대한 보건의료 체계를 작업치료사의 역할을 중심으로 알아보고자 하며, 우리나라의 재난대응 보건의료 체계 개선을 위한 기초자료를 제공하고자 한다. 연구방법 : 재난대응 관련 보건의료 체계와 작업치료사의 역할 및 활동에 대한 문헌을 중심으로 고찰하였으며 영문 및 한글 문헌으로 한정하였다. 결과 : 재난상황에서 작업치료사는 약 10년 전부터 활동하게 되었으며 이것은 1994년 적십자사의 '인도주의적 복구' 강령에 따라 소외 및 취약계층인 노인, 어린이 그리고 장애인에 대해 편견 없는 지원이 활발해지면서 시작되었다. 또한 대규모의 인명피해로 인하여 영구 장애의 피해자들이 대규모로 발생하며 재활 서비스가 중요성이 부각되고 작업치료사의 역할이 더욱 강조되었다. 재난대응에 있어서 작업치료사는 준비단계, 대응단계 그리고 회복단계에 따라 역할을 나눌 수 있으며, 재난상황에서 작업치료 주 대상자는 어린이, 노인, 장애인등 취약계층 그리고 복구 지원에 투입된 자원봉사자들이다. 결론 : 세계의 비정부기관과 각 나라에서는 재난대응 보건의료팀 지원체계에 '재활' 개념을 도입하고 있으나 우리나라의 재난대응 보건의료 체계는 응급의료 수준에 머무르고 있다. 세계의 재난대응 보건의료 체계에서와 같이 작업치료사 등 다양한 보건 분야 전문인력을 우리나라의 보건의료 체계에도 포함시켜 보완해야 할 것이다. 이를 통하여 불가항력적으로 발생할 수 있는 재난 발생 시 피해자들의 장애를 최소화하고 안정적인 재활과 더불어 건강한 생활복귀를 이룩할 수 있을 것이다.

Inhibition of Transient Receptor Potential Melastain 7 Enhances Apoptosis Induced by TRAIL in PC-3 cells

  • Lin, Chang-Ming;Ma, Ji-Min;Zhang, Li;Hao, Zong-Yao;Zhou, Jun;Zhou, Zhen-Yu;Shi, Hao-Qiang;Zhang, Yi-Fei;Shao, En-Ming;Liang, Chao-Zhao
    • Asian Pacific Journal of Cancer Prevention
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    • 제16권10호
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    • pp.4469-4475
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    • 2015
  • Transient receptor potential melastain 7 (TRPM7) is a bifunctional protein with dual structure of both ion channel and protein kinase, participating in a wide variety of diseases including cancer. Recent researches have reported the mechanism of TRPM7 in human cancers. However, the correlation between TRPM7 and prostate cancer (PCa) has not been well studied. The objective of this study was to investigate the potential the role of TRPM7 in the apoptosis of PC-3 cells, which is the key cell of advanced metastatic PCa. In this study, we demonstrated the influence and potential function of TRPM7 on the PC-3 cells apoptosis induced by TNF-related apoptosis inducing-ligand (TRAIL). The study also found a novel up-regulated expression of TRPM7 in PC-3 cells after treating with TRAIL. Suppression of TRPM7 by TRPM7 non-specific inhibitors ($Gd^{3+}$ or 2-aminoethoxy diphenylborate (2-APB) ) not only markedly eliminated TRPM7 expression level, but also increased the apoptosis of TRAIL-treated PC-3 cells, which may be regulated by the phosphatidylinositol 3-kinase/protein kinase B (PI3K/AKT) signaling pathway accompany with up-regulated expression of cleaved Caspase-3, (TRAIL-receptor 1, death receptors 4) DR4, and (TRAIL-receptor 2, death receptors 5) DR5. Taken together, our findings strongly suggested that TRPM7 was involved in the apoptosis of PC-3 cells induced by TRAIL, indicating that TRPM7 may be applied as a therapeutic target for PCa.

기후변화가 가뭄 위험성에 미치는 영향 평가 (Impact Assessment of Climate Change on Drought Risk)

  • 김병식;권현한;김형수
    • 한국습지학회지
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    • 제13권1호
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    • pp.1-11
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    • 2011
  • 우리나라는 1990년대 이후 겨울에서 봄철로 이어지는 시기에 지역적으로 만성적인 가뭄이 계속되고 있고, 특히 2001년에는 기상관측이래 때 이른 무더위와 극심한 가뭄으로 전국적으로 피해를 입었다. 가뭄에 대한 경제적인 손실은 홍수에 비해서 2~3배정도 달하고 있으며 미국 해양기상청(NOAA)이 선정한 20세기 최대의 자연재해 중 세계 각지에서 발생한 4개의 가뭄이 상위 5위안에 랭크된 바 있고, 미국 국립가뭄경감센터(NDMC)에서 발표한 통계재해 유형별 연평균피해액 중 가뭄피해가 가장 큰 것으로 분석되었다. 국내에도 2001년 봄 가뭄 시 국내총생산 성장률 0.45% 소비자물가 0.31% 상승하는 등 가뭄에 의한 경제적인 손실과 영향력은 막대하였음에도 불구하고 홍수 등에 대비해서는 수해방지종합대책 등 국가차원의 사전대책을 마련하여 시행하고 있는 반면, 가뭄에 대해서는 종합적인 사전예방대책보다는 응급복구 위주로 되어 있고 가뭄상황을 객관적으로 표현할 수 있는 지표도 명확하지 않아 이에 대한 체계적인 연구가 시급한 실정이다. 본 연구에서는 RCM 강수모의 자료를 이용하여 표준강수지수(SPI)를 산정하여 가뭄의 변동성을 평가하였다. 또한 산정 되어진 표준강수지수를 이용하여 가뭄의 시공간적인 변동성 분석을 실시하여 2015년대, 2045년대 및 2075년대로 나누어 가뭄지수의 주성분 분석을 통하여 현재와의 차이점을 확인하였다.

한국보건행정학회 30주년 기념 특별호 (Special Issue for the 30th Anniversary of the Korean Academy of Health Policy and Management)

  • 박은철
    • 보건행정학회지
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    • 제28권3호
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    • pp.195-196
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    • 2018
  • The Korean Academy of Health Policy and Management (KAHPM) has shown remarkable achievements in the field of health policy and management in Korea for the last 30 years. The KAHPM consists of experts in various fields of health policy and management, and has been the leading academic discussion forum for health policy agendas of interest to the public. Health Policy and Management (HPM), the official journal of the KAHPM, published the first issue of volume 1 in October, 1991 and is publishing the second issue of volume 28 as of 2018. Currently, it is one of Korea' main journals in the field of health policy and management. HPM has published a special issue in commemoration of the 30th anniversary of the KAHPM. The HPM invited authors, including former presidents of the KAHPM and current board members, to write about main issues in health policy and management. Although the HPM tried to set up an invited author on all subjects in the health policy and management field, 19 papers are published, that completed the peer review process by August, 2018. The authors of the special issue of the 30th anniversary of the KAHPM include six former presidents, a senior professor, and 12 board members. The subjects of this issue are reform of the healthcare delivery system, health insurance and medical policy, reform of health system governance, the role of National Health Insurance Service (NHIS), the Korea Institute for Health and Social Affairs (KIHASA) and the National Evidence-based healthcare Collaborating Agency (NECA), ethical aspects of health policy change, regional disparities of healthcare, healthcare accreditation, new healthcare technology evaluation system, globalization of the healthcare industry, the epidemiological investigator system, the quarantine system, safety and disaster, and official development assistance. There are some remaining topics to deal with for the KAHPM: aged society, anti-smoking, non-infectious disease, suicide, healthcare resources, emergency medical care, out-of-pocket money, medical fee payment system, medical aid system, long-term care insurance, industrial accident compensation insurance, community-centered health welfare system, and central government and local government of health. The HPM will continue to publish review articles on the main topics in health policy and management. This is because the KAHPM, which has been the leading academic society of Korea's health policy and management for the last 30 years, feels responsible for continuing its mission for the next 30 years.

고등학생에게 적용한 기본심폐소생술 실기교육프로그램 효과 (The Effect of Basic Cardiopulmonary Resuscitation Training Education Program for High School Students)

  • 김순심;감신
    • 보건교육건강증진학회지
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    • 제23권4호
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    • pp.155-171
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    • 2006
  • Objective: The purpose of this study was to apply the Basic CPR(Cardiopulmonary resuscitation) training education program and identify its effects on knowledge of Basic CPR and skills of Basic CPR in second grade high school students. Methods: The training program was conducted for 16 weeks between March 26 and July 9, 2005 using a non-equivalent control group pretest-post test design by dividing 60 students in a half for both the experimental group and the control group. General characteristics, the effect of the education were evaluated with $x^2-test$, t-test, ANCOVA, Repeated Measure ANOVA and Bonferonni with SPSS 11.0/pc. Result: After the CPR education program application, knowledge score in the experimental group increased to 20.57 right after the education from 9.32, the score measured before the training, 19.11 after 8 weeks and 18.29 after 12 weeks. On the contrary, the control group's score showed no significant before the training. According to the result of knowledge score comparison between the experimental and control group at each point in time, the experimental group had a significantly high score in knowledge at every point(p<0.001). In the effect durability for knowledge of the training education program in process time after the training program in the experimental group, the durability of effect was identified despite the elapsing time. Scores of skills for Basic CPR increased from 1.21, the score measured before the training program, to 30.07 right after the education, 23.50 after 8 weeks and 17.57 after 12 weeks in experimental group. On the contrary, the control group showed an immaterial increase. According to the result of skill score comparison between the experimental and control group at each point in time, the experimental group had a significantly high score in skill at every point(p<0.001). The score for skill increased significantly right after the education compared to the score prior to the education. Conclusions: These findings suggest that Basic CPR training education program facilitate knowledge of CPR and skill of CPR in high school students. Therefore, it would be necessary to include the Basic CPR training program in high school education curriculum. However, the effect of Basic CPR knowledge maintains for a few period, and the effect of maintaining the skill is shorter than the maintenance of knowledge so regular reeducation is considered to be needed.

고압산소치료의 구강악안면영역에서의 임상적 이용에 관한 연구 (A STUDY ON CLINICAL USE OF HYPERBARIC OXYGEN THERAY OF THE ORAL AND MAXILLOFACIAL REGION)

  • 류정호;엄기훈;배준수;유준영;장명진;김용관
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • 제27권5호
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    • pp.447-452
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    • 2001
  • Hyperbaric oxygen therapy(HBO) is defined as breathing 100% oxygen while in an enclosed system pressurized to greater than on atmosphere(sea level). This increased oxygen delivery furthers your body's ability to kill germs and to increase healing. HBO is a supplemental therapy to be used in addition to the current medical and surgical therapy you are receiving. HBO typically is used to complement treatments of medical problems such as bone infections, complication of radiotherapy, and certain chronic, non-healing wounds. On an emergency basis, the chamber also is used to treat problems such as carbon monoxide poisoning and the decompression sickness. We analysed stastically cases which are treated by hyperbaric oxygen therapy in point of oral and maxillofacial region on the Kangnam General Hospital for aid in comprehension and application of this therapy. Total 760 patients were treated at Gangnam General Hospital from July 1996 to September 1999. They were classified by region to Decompression sickness(DCS), Carbon monoxide poisoning(CO), General surgery(GS), Orthopedics(OS), Oral and Maxillofacial surgery(OMFS), others. Patients of Oral and Maxillofacial surgery were divided by diseses to Osteomyelitis, Osteoradionecrosis, Reconstruction, Bone graft, Difficult wounds, others. The results were as follows. 1. This institute conducts HBO therapy for DCS which takes up 62% and 10.5% for OMF region. 2. In OMF region, Osteomyelitis is 40%, Osteoradionecrosis is next, Bone graft, and Reconstruction is a row. 3. According to our precious study, HBO has been frequently conducted in OMF region compared to past, however, it is less actively conducted in this area for research than other conturies. Therefore, We need further application to the clinical use.

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과립구집락자극인자 투여로 치료한 범혈구감소증과 피부 박리를 보인 붉은사슴뿔버섯 중독 1례 (A Case of Podostroma Cornu-Damae Intoxication Induced Pancytopenia and Skin Desquamation: Successful Treatment with Granulocyte Colony Stimulation Factor (G-CFS))

  • 김중석;김규원;정재일;심명기;윤기철;최용훈;이하람;최인주;심찬섭;한정호
    • 대한임상독성학회지
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    • 제13권1호
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    • pp.50-54
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    • 2015
  • Podostroma cornu-damae is a rare species of fungus belonging to the Hyocreaceae family. Its fruit body is highly toxic, as it contains trichothecene mycotoxins. The morphology is similar to that of immature Ganoderma lucidum, making identification difficult for non-experts. We experienced such a case of a 56- year-old male who picked and consumed podostroma cornu-damae, and consumed. Later that day, he developed digestive system symptoms, including nausea, vomiting, and abdominal pain. He presented to the emergency room (ER), there were no abnormal physical findings, symptoms improved after gastric lavage, and the patient voluntarily discharged himself on the same day. The following day, as the symptoms gradually deteriorated, he was admitted via the ER. He was presented with severe pancytopenia, alopecia, desquamation of skin, and acute renal failure. He recovered without any complications after conservative care, antibiotics therapy, and granulocyte colony stimulating factor administration. The most commonly reported complications of podostroma cornu-damae intoxication were reported pancytopenia, infection, disseminated intravascular coagulation, acute renal failure, etc. since Prevention is especially important because its toxicity can be lethal and there is no particular treatment to date, prevention is especially important. Promotion and education for the public are needed.

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의사소통 기술과 해부학 실습 설명의 융합 : 의과대학 학생들의 자기평가 요소와 학문적 성취감의 상관관계 (Convergence of Explanation Meeting in Cadaveric Dissection with Communication Skill : Correlation between Self-evaluation Factor and Academic Achievement of Medical Students)

  • 박정현;임희경;김지희
    • 디지털융복합연구
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    • 제14권8호
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    • pp.363-370
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    • 2016
  • 본 연구의 목적은 해부학실습에서 의과대학 학생들의 설명을 도입하여 만족도, 전공과의 연계성, 운영의 적절성, 언어적, 비언어적 의사소통을 포함한 자기평가요인과 학업성취도의 상관관계를 알아보고자 하였다. 의과대학 학생들은 보건관련학과 학생들에게 해부학 실습을 통해 시신의 구조를 설명과 토의를 하였다. 그 직후, 102명의 의과대학 학생들은 자기 평가요인과 의사소통의 영향에 관한 자기기입식 설문을 작성하였다. 연구기간은 2012년 6월부터 9월까지였다. 자료는 빈도 분석, t-test, 변량분석으로 처리되었다. 성별, 나이, 해부학 설명회의 경험에 관계없이 학생들은 자기평가요인의 모든 질문에서 높은 점수를 기록하였다. 그 중에서, 전공과의 연계성, 언어적 의사소통 요인은 학업성취도와 밀접한 관계가 있었다 (p<0.05). 언어적, 비언어적 의사소통 요인 또한 0.580의 높은 상관관계를 보였다. (p<0.01). 해부학 설명 과정은 의과대학 학생들에게 긍정적인 태도로 더 배우려는 기회를 제공하였고, 학업 동기를 부여하였다.