• 제목/요약/키워드: Patient complaints

검색결과 426건 처리시간 0.028초

Clinical features and risk factors for missed stroke team activation in cases of acute ischemic stroke in the emergency department

  • ;;;;정시경
    • 대한응급의학회지
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    • 제29권5호
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    • pp.437-448
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    • 2018
  • Objective: Acute ischemic stroke (AIS) requires time-dependent reperfusion therapy, and early recognition of AIS is important to patient outcomes. This study was conducted to identify the clinical features and risk factors of AIS patients that are missed during the early stages of diagnosis. Methods: We retrospectively reviewed AIS patients admitted to a hospital through the emergency department. AIS patients were defined as ischemic stroke patients who visited the emergency department within 6 hours of symptom onset. Patients were classified into two groups: an activation group (A group), in which patients were identified as AIS and the stroke team was activated, and a non-activation group (NA group), for whom the stroke team was not activated. Results: The stroke team was activated for 213 of a total of 262 AIS patients (81.3%), while it was not activated for the remaining 49 (18.7%). The NA group was found to be younger, have lower initial National Institutes of Health Stroke Scale scores, lower incidence of previous hypertension, and a greater incidence of cerebellum and cardio-embolic infarcts than the A group. The chief complaints in the A group were traditional stroke symptoms, side weakness (61.0%), and speech disturbance (17.8%), whereas the NA group had non-traditional symptoms, dizziness (32.7%), and decreased levels of consciousness (22.4%). Independent factors associated with missed stroke team activation were nystagmus, nausea/vomiting, dizziness, gait disturbance, and general weakness. Conclusion: A high index of AIS suspicion is required to identify such patients with these findings. Education on focused neurological examinations and the development of clinical decision tools that could differentiate non-stroke and stroke are needed.

Postinfectious Glomerulonephritis Associated with Pneumococcus and Influenza A Virus Infection in a Child: a Case Report and Literature Review

  • Huh, Homin;Lee, Joon Kee;Yun, Ki Wook;Kang, Hee Gyung;Cheong, Hae Il
    • Pediatric Infection and Vaccine
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    • 제26권2호
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    • pp.118-123
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    • 2019
  • 감염 후 사구체신염(postinfectious glomerulonephritis, PIGN)은 주로 Streptococcus pyogenes에 의해 발생하지만, 다른 병원체와 관련된 PIGN도 문헌에서 확인된다. 기침, 발열, 우측 흉통을 주소로 내원한 6세 남아에서 폐구균 및 인플루엔자 A 바이러스의 감염이 확인되었고 항생제와 항바이러스제가 투약되었다. 입원 중 전신 부종, 혈뇨, 단백뇨, 혈압의 상승이 관찰되었고, 따라서 이뇨제가 투약되었다. 환자는 육안적 혈뇨가 관찰되는 상태로 퇴원하였고, 퇴원 후 14주에 현미경적 혈뇨까지 사라졌다. 폐구균 또는 인플루엔자 A 바이러스 감염이 확인된 환아에서 신염의 증상이 보이는 경우 감염 후 사구체신염의 조기발견을 위해 소변검사 및 혈압의 측정이 이루어져야 한다. 본 저자들은 폐구균 및 인플루엔자 A 바이러스에 의한 감염 후 사구체신염 사례를 경험하였기에 이를 보고하는 바이다.

COVID-19 발현 초기 119 구급대를 경유해 응급실로 내원하는 환자들의 이송 시간과 호소하는 증상의 변화 : 부산지역 일개 응급의료센터로 이송된 환자의 구급활동일지를 중심으로 (Comparing the "pre-COVID-19 period" and the "COVID-19 early-stage period" for emergency medical services)

  • 강지훈;지재구;장윤덕;이시원;김성주
    • 한국응급구조학회지
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    • 제24권3호
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    • pp.161-169
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    • 2020
  • Purpose: This study aims to identify changes in patients' transport time and chief complaints visiting the emergency room via emergency medical services from the "pre-COVID-19 period" compared to the "COVID-19 early-stage period". Methods: This retrospective observational study analyzed the emergency medical services reports at two time periods defined by the COVID-19 virus outbreak in Korea. The study was conducted in Busan, the Republic of Korea, from January 19 through May 6, 2019. Results: The transfer time of patients transported during the "COVID-19 early-stage period" was significantly delayed compared to the "pre-COVID-19 period" (p<.05). We found a significant increase in transport time for patients complaining of respiratory infections compared to patients without symptoms (p<.05). During the "COVID-19 early-stage period", there was a significant increase in the number of patients with respiratory infections and patients complaining of general symptoms compared to the "COVID-19early-stage period" (p<.05). Conclusion: The spread of the COVID-19 virus infection delayed patient transport and increased the number of patients reporting respiratory infection symptoms. Emergency medical services will need administrative and economic support to transport the increased number of patients requiring services.

재발된 췌장암 환자의 한의 기반 통합 암 치료에 대한 증례보고 (A Case Report of Traditional Korean Medicine Based-Integrative Oncology of Recurrent Pancreatic Cancer)

  • 주한음;김재욱;박지혜;조영민;서현식;고은주;박소정;유화승
    • 대한암한의학회지
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    • 제27권1호
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    • pp.1-12
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    • 2022
  • Objectives: To report recurrent pancreatic cancer treated by Korean medicine based-integrated oncology treatment, who is improved quality of life without progression of cancer Method: A 63-year-old female patient diagnosed with recurrent pancreatic cancer in April, 2022 received Chemotherapy with Korean medicine based integrative oncology treatment. Radiologic outcome was assessed by Abdomen Computed Tomography (CT) based on Response Evaluation Criteria In Solid Tumors (RECIST). Clinical outcomes were assessed by National Cancer Institute Common Terminology Criteria for Adverse Event (NCI-CTCAE), Eastern Cooperative Oncology Group (ECOG), Numeric Rating Scale (NRS) Result: During 2months of treatment, Cancer size was stable in Abdominal CT. Chief complaints, Abdominal pain and dyspepsia, were improved and ECOG score was improved from grade 2 to 1. There were no toxicity on laboratory test and no side effects of grade 3 or higher on NCI-CTCAE. Conclusion: This report shows that Korean medicine based integrative oncology treatment might contribute to synergetic effect to Chemotherapy and improvement of quality of life

Investigation of Dental Hygienists' Practice about Rules on Dental Disputes Prevention

  • Hae-in Yoon;Im-hee Jung;Chae-lin Lee;Eun-su Lee;Yoo-jin Baek;Ju-hee Suk;Ye-jun Park;Tae-yang Kim;Jun-yeong, Kwon;Hee-jung, Lim
    • 치위생과학회지
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    • 제22권4호
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    • pp.206-214
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    • 2022
  • Background: This study analyzed the practice of dental medical dispute prevention rules of dental hygienists to present an improvement plan for improving perceived importance and practice and provide data for the development of effective medical dispute prevention programs. Methods: A self-administered questionnaire survey was conducted targeting dental hygienists who were providing assistance at dental hospitals and dental clinics in Seoul and Gyeonggi-do regions from March 22 to April 28, 2022. The questionnaire collected from 273 dental hygienists consisted of eight questions on general characteristics, 30 questions on medical dispute experience, and 14 questions on medical dispute prevention. Results: Complaints showed a high experience rate in 'Consultation & reservation', medical disputes in 'Patient handling (unkind) related', and 'Prosthesis installation and cement removal'. In both the importance and practice of medical dispute prevention rules, 'Preservation of medical records and other medical-related data' was high, and 'Management of patients on standby for a long time' was low in terms of practice. 'Lack of time' and 'Lack of manpower' were cited as reasons for not resolving dental treatment disputes. The importance of dental dispute prevention rules was found to be significant according to age and position, and it was also found to affect the level of practice. Conclusion: Seventy-six-point six percent of the respondents said that education on the prevention of medical disputes was necessary, although they lacked recognition of prevention rules compared to their perceptions and experiences. This study suggested specifying prevention rules in dental hygiene subjects and expanding education, improvement of dental treatment system, revise the law on the range of work to improve the recognition and practice of prevention rules.

항생제 처방 질 관리를 위한 항생제 처방 지침의 개발 (Development of antibiotic prescription guidelines for antibiotic prescription quality management)

  • 김혜성;오정규
    • 대한치과의료관리학회지
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    • 제5권1호
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    • pp.45-54
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    • 2017
  • 이 연구의 목적은 치과 진료실에서 항생제 남용에 대처하기 위해 항생제 투여의 필요성을 결정하는 과정을 소개하고 적절한 항생제의 선택과 사용에 대한 정보를 공유하고, 지속적인 모니터링을 통해 항생제 처방의 적절성을 증가시키는 것이다. 본 병원의 가이드라인은 최신의 항생제 처방에 대한 연구 결과에 따랐으며, 향후에도 지속적인 항생제 처방 가이드 라인에 대한 보완이 필요할 것이다. 본 가이드라인에 의하면, 병력 검사에 의한 페니실린 알레르기 조사와 피부에서의 페니실린 알레르기 검사를 통해 아목시실린을 일차 선택적 항생제로 처방하였다. 증상의 경과에 대한 재평가 과정을 거친 후 아목시실린에 의한 약물 효과가 없다면 보다 광범위한 항생제로 대체하였고, 증상이 호전되지 않으면 환자를 상급병원으로 전원하도록 설계하였다. 사과나무치과병원 직원은 정기적으로 항생제 처방에 대해 모니터링을 하였고 이 결과에 대해 주기적으로 교육을 받도록 하였다. 현재의 가이드라인은 지속적으로 보완되어야 하며, 항생제 남용의 제어에 긍정적인 결과를 가질 것으로 생각되며, 전반적 치과 진료의 흐름에도 기여할 것으로 보인다.

Diagnostic performance of emergency medical technician for ST-segment elevation myocardial infarction

  • Soo Hoon Lee;Daesung Lim;Seo Young Ko
    • Journal of Medicine and Life Science
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    • 제21권2호
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    • pp.31-39
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    • 2024
  • This study was conducted to determine whether level-1 emergency medical technicians (EMTs) can adequately recognize ST-segment elevation myocardial infarction (STEMI) in the emergency department (ED) and whether their ability to do so differs from that of emergency medicine physicians (EMP). From December 2022 to November 2023, patients aged 20 years or older visiting the ED with chief complaints suggesting acute coronary syndrome (ACS) were enrolled. As soon as the patient arrived at the ED, a level-1 EMT conducted a 12-lead electrocardiogram (ECG) to assess STEMI; an EMP subsequently assessed whether to activate the percutaneous coronary intervention team. Demographic characteristics, test results, and final diagnoses were collected from the medical records. Among the 723 patients with case report forms, 720 were included in the analysis. These were categorized as follows: 117 (16.3%) with STEMI, 159 (22.1%) with non-ST-segment elevation ACS, and 444 (61.7%) with other conditions. STEMI was correctly recognized in 100 patients (91.7%) by level-1 EMTs and in 104 patients (95.4%) by EMPs (kappa=0.646). EMTs with less than 1 year of ED work experience correctly recognized 60 out of 67 STEMI patients (89.6%), which was comparable with the EMPs who recognized 65 out of 67 STEMI patients (97.0%, kappa=0.614). EMTs with more than 1 year of ED work correctly recognized 40 out of 42 STEMI patients (95.2%), and therefore performed better than EMPs, who recognized 39 out of 42 STEMI patients (92.9%, kappa=0.727). The level-1 EMTs adequately recognized STEMI using a 12-lead ECG and were in substantial agreement with the evaluations of the EMPs.

오른쪽 서혜부 탈장에 의해 이차적으로 발생한 대망의 염전 및 경색 (Omental Torsion and Infarction Secondary to Omental Hernia in the Right Inguinal Canal)

  • 이유현;임재훈;하헌균
    • 대한영상의학회지
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    • 제81권4호
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    • pp.1003-1007
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    • 2020
  • 대망의 서혜부 탈장에 의한 이차성 대망 염전은 급성 복통의 원인으로써 드물게 보고된 바 있다. 그러나 만성 복통의 원인으로써 이차성 대망 염전이 섬유성 벽을 가진 거대하고 단단한 종괴로 발견되는 것은 이전까지 보고되지 않았기에 이를 보고하고자 한다. 74세 남자 환자가 한 달간 지속된 만성적인 하복부 복통과 우하복부에 만져지는 종괴를 주소로 내원하였다. 시행한 서혜부 초음파상에서 양쪽 서혜부 탈장이 관찰되었다. 컴퓨터단층촬영상에서 오른쪽 서혜관으로 대망의 일부가 빠져나갔고 그 축을 중심으로 대망 염전이 있었다. 염전 줄기의 원위부 대망은 우하복부와 골반강에 걸쳐 단단한 섬유성 벽을 가진 약 30 cm 정도의 거대한 종괴를 형성하였다. 환자는 복강경하 장막 절제술 및 양쪽 탈장 수술을 시행 받은 뒤 퇴원하였다.

만성통증 환자의 통증 조절 (Chronic pain control in patients with rheumatoid arthritis)

  • 은영
    • 근관절건강학회지
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    • 제2권1호
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    • pp.17-40
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    • 1995
  • Rheumatoid arthritis is the one of the chronic diseases, one of its major symptoms is a chronic pain. Despite developing medical treatment and surgical techniques, it is suggested that to control the pain is the goal of the treatment. But pain is an inner experience and even those closest to the patient cannot truly observe its progress or share in its suffering. The National Academy of Sciences Institute of Medicine's report on Pain and Disability concluded that there is no objective measure of pain-(exactly) no pain thermometer-nor can there ever be one, because the experience of pain is inseparable from personal perception and social influence such as culture. To explore chronic pain experience is to understand the process and property of the patient's perception of pain through the response to pain, the coping with pain, and the adaptation to pain. Therefore a qualitative study was conducted in order to gain an understanding of pain experience of patients with RA in korea. I used naturalistic inquiry as a research methodology, which had 5 axioms, the first is that realities are multiple, constructed, and holistic, the second is that knower and known are interactive, inseparable, the third is only time and context bound working hypotheses(idiographic statements) are possible, the forth is all entities are in a state of mutual simultaneous shaping, so that it is impossible to distinguish causes from effects and the last is that inquiry is value-bound. Purposive sampling was conducted as a sampling. 20 subjects who experienced pain over 10 years, lived in middle-sized city and big city in Korea, and 17 women and 3 men. The subject's age was from 32 to 62 (average 48.8), all were married, living with their spouse and children, except two-one divorced and the other widow before they became ill. I collected data using In depth structured interview. I had interviews two or three times with each subject, and the interviews were conducted at each subject's home. Each interview lasted about two hours an average. A recording was taken with the consent of the subject. I used inductive data analysis-such as unitizing and categorizing. unitizing is a process of coding, whereby raw data are systematically transformed and aggregated into units. Categorizing is a process wherby previously unitized data are organized into categories that provide descriptive or inferential information about the context or setting from which the units were derived. This process is used constant comparative method. The pain controlling process is composed of behavior of pain control. The behaviors of pain control are rearranging of ADL, hiddening role conflict, balancing treatment, and changing social relation. Rearranging of ADL includes diet management, sleep management, and the adjustment of daily life activities. The subjects try to rearrange their daily activities by modified style of motions, rearranging time span & range of activities, using auxillary facilities, and getting help in order to keep on the pace of daily life. Hiddening role conflict means to reduce conflicts between sick role and their role as a family member. In this process, the subjects use two modes, one is to control the pain complaints, and the other is to internalize the value which is to stay home is good for caring her children and being a good mother. To control pain complaints is done by 'enduring', 'understanding' the other family members, or making them undersood in order to reduce pain. Balancing treatment is composed of two aspects. One is to keep the pain within the endurable level, the other is to keep in touch with medical personnel in order to get the information of treatment and emotional support. Changing social relation is made by information seeking and sharing, formation of mutual support relation, and finally simplification of social relationships. The subjects simplify their social relationships by refraining from relations with someone who makes them physically and psychologically strained. In particular the subjects are apt to avoid contact with in-laws, and the change of relation to in-laws results in lessening the family boundary. In the course of this process, they confront the crisis of family confict result in family dissolution. This crisis is related to the threat of self-existence. Findings from this study contribute to understanding the chronic pain experience. To advance this study, we should compare this result with other cases in different cultural contexts. I think to interpret these results, korean cultural background should be considered. Especially the different family concept, more broader family members and kinship network, and the traditional medical knowledge influences patients' behavior.

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3차진료기관 외래약국 투약대기시간에 영향을 주는 요인 (Factors Affecting Patient Waiting Times at the Outpatient Pharmacy Department in a Tertiary Care Hospital)

  • 박하영;한옥연;나현오
    • 한국의료질향상학회지
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    • 제1권2호
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    • pp.60-72
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    • 1994
  • Background: The number of outpatients visiting large university teaching hospitals has increased drastically with the introduction of a nationwide health care insurance in 1989 and the improvement of the socio-economic status of the population. This resulted in long waiting times for services, particularly prescribed drugs, which have been patients' chief complaints. Hospitals have tried to solve the problem with limited success because their approach lacked comprehensive research. The objective of this study is to investigate associations between waiting times and variables defining a total work system. Methods: Data for the outpatient pharmacy department in a tertiary care university teaching hospital located in Seoul was analyzed to achieve the study objective. Associations of pharmacy system variables -- work load, work force, pharmacist work schedule, machine problems, and inventory control -- with mean and 99th percentile of waiting times were examined by the hierarchical stepwise regression method. Day was a unit of the analyses. Results: The regression models explained 65.8% of variance in the mean waiting time and 61.34% in the 99th percentile of waiting times. The break-down of the printer for drug envelops, Automatic Tablet Counters (ATCs), and main computer system lasted longer than 30 minutes increased the mean for 7.7 minutes, 4.5 minutes, and 7.0 minutes, respectively, and the 99th percentile for 14.8 minutes, 9.0 minutes, and 15.7 minutes, respectively. Concerning the work force, study results showed that there were significant differences in the productivity of pharmacists with work experience more than three years, one to three years, and less than one year, and showed that peak time aid work by pharmacists at job assignments other than the outpatient pharmacy, part-time pharmacists, and the installation of ATCs were effective in reducing waiting times, Finally, study findings indicated that the operational policy of work assignment and rotation schedule, supply and inventory of drugs at work tables, and readiness for undisrupted work during the work hours could have a significant effect on waiting times. Conclusion: The study results indicated that efforts to reduce waiting times for prescribed drugs should be geared toward every components of the pharmacy work system ranging from work schedule of pharmacists and supply of dugs at work tables. These findings should provide hospital managers with right directions in battling the problem.

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