• Journal of Korean Neurosurgical Society
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• 제56권3호
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• pp.248-253
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• 2014

Objective : Cortical dysplasia (CD) is one of the common causes of epilepsy surgery. However, surgical outcome still remains poor, especially with frontal lobe epilepsy (FLE), despite the advancement of neuroimaging techniques and expansion of surgical indications. The aim of this study was to focus on surgical strategies in terms of extent of resection to improve surgical outcome in the cases of FLE with CD. Methods : A total of 11 patients of FLE were selected among 67 patients who were proven pathologically as CD, out of a total of 726 epilepsy surgery series since 1992. This study categorized surgical groups into three according to the extent of resection : 1) focal corticectomy, 2) regional corticectomy, and 3) partial functional lobectomy, based on the preoperative evaluation, in particular, ictal scalp EEG onset and/or intracranial recordings, and the lesions in high-resolution MRI. Surgical outcome was assessed following Engel's classification system. Results : Focal corticectomy was performed in 5 patients and regional corticectomy in another set of 5 patients. Only 1 patient underwent partial functional lobectomy. Types I and II CD were detected with the same frequency (45.45% each) and postoperative outcome was fully satisfactory (91%). Conclusion : The strategy of epilepsy surgery is to focus on the different characteristics of each individual, considering the extent of real resection, which is based on the focal ictal onset consistent with neuroimaging, especially in the practical point of view of neurosurgery.

• Journal of Korean Neurosurgical Society
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• 제56권3호
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• pp.224-229
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• 2014

Objective : To report long-term clinical and radiological outcomes of minimally invasive posterior cervical foraminotomy (MI-PCF) performed in patients with unilateral single-level cervical radiculopathy. Methods : Of forty-six patients who underwent MI-PCF for unilateral single-level radiculopathy between 2005 and 2013, 33 patients were included in the study, with a mean follow-up of 32.7 months. Patients were regularly followed for clinical and radiological assessment. Clinical outcome was measured by visual analogue scale (VAS) for the neck/shoulder and arm, and the neck disability index (NDI). Radiological outcome was measured by focal/global angulation and disc height index (DHI). Outcomes after MI-PCF were evaluated as changes of clinical and radiological parameters from the baseline. Mixed effect model with random patients' effect was used to test for differences in the clinical and radiological parameters repeat measures. Results : There were no complications and all patients had an uneventful recovery during the early postoperative period. VAS scores for neck/shoulder and arm improved significantly in the early postoperative period (3 months) and were maintained with time (p<0.001). NDI improved significantly post-operatively and tended to decrease gradually during the follow-up period (p<0.001). There were no statistically significant changes in focal and global angulation at follow-up. Percent DHIs of the upper adjacent or operated disc were maintained without significant changes with time. During the follow-up, same site recurrence was not noted and adjacent segment disease requiring additional surgery occurred in two patients (6%) on the contra-lateral side. Conclusion : MI-PCF provides long-term pain relief and functional restoration, accompanied by good long-term radiological outcome.

• 의학교육논단
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• 제15권1호
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• pp.31-38
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• 2013

This paper focuses on the outcome-based curriculum of Inje University College of Medicine to describe our curriculum development process and results. Starting in 2006, we have revised the curriculum based on the competency-based clinical presentation curriculum. We stated clearly the learning outcomes from the social needs and educational goal of our university. We defined 8 exit outcomes and specified phase outcomes, course outcomes, lesson outcomes, and outcome objectives. By 2012, we identified 128 clinical presentations and 149 basic scientific concepts. Various evaluation and assessment methods and teaching-learning strategies were assigned to each outcome. Problem-based learning, standardized patient practice, and learning portfolios are the main strategies of our curriculum. We have performed a progress test to assess the level of achievement of students' outcomes. We have also collected feedback from students and faculty members about the curriculum, including every lesson, course, and the overall curriculum. To maintain this change of the curriculum, we reorganized the curriculum committee, educational faculty and teams, and administrative support system. To fine tune this curriculum, we have held three 3-day workshops on curriculum development and weekly meetings. We believe this is just the beginning of developing the curriculum of Inje University. Further upgrades will be necessary to continue to improve medical education.

• Journal of Korean Neurosurgical Society
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• 제62권5호
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• pp.551-560
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• 2019

Objective : Intracranial aneurysms are not common in young age patients. We sought to find the characteristics of the intracranial aneurysms in patients under 20 years of age. Methods : We reviewed 23 consecutive patients ${\leq}20$ years of age treated for their intracranial aneurysms during the period from 1995 to 2017. From medical records and imaging studies, we gathered data on age, sex, presentation, associated medical condition, location and characteristics of aneurysms, treatment and clinical outcomes. Results : The patients' ages ranged from 13 months to 20 years (median, 14 years). There were 16 males and seven females (male to female ratio, 2.3 : 1) with 31 aneurysms. Clinical presentations included sudden severe headache in 61%, followed by altered mentality in 17% and seizure in 17%. More than one-fourth patients had specific medical conditions related to the development of the cerebral aneurysms. The majority of aneurysms occurred in the anterior circulation (71%), and were saccular (71%). There were each three patients with false aneurysms (13%) and giant aneurysms (13%), and only one patient with multiple aneurysms (4%). We treated 22 patients : 21 aneurysms with the endovascular methods, three with open surgery, and one with combined treatment. Good functional outcome could be achieved in 86% during the follow-up period. Conclusion : In this series, the young-age patients with intracranial aneurysms were characterized by male predominance, related specific medical conditions, low incidence of multiple aneurysms, high incidence of giant aneurysms and good functional outcome after treatment.

• 대한골관절종양학회지
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• 제18권2호
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• pp.66-71
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• 2012

목적: 천골에 발생한 척색종의 치료결과 분석을 통해 생존율 및 종양의 국소조절과 연관된 예후인자에 대하여 알아보고자 하였다. 대상 및 방법: 1990년 1월부터 2010년 2월까지 본원에서 치료받은 19예를 대상으로 하였다. 평균연령은 56세였으며 남자9예, 여자 10예였다. 15명의 환자에서 후방접근법을 이용한 절제술을 시행하였으며 4명의 환자는 방사선 치료만을 시행하였다. 종양의 위치가 S3 보다 근위부를 침범한 경우가 6예였으며 이중 4예에서 방사선 치료만을 시행하였다. 광범위 절제 6예, 변연부 절제 8예, 병소내 절제 1예였다. 평균 추시 기간은 63개월(25-144개월)이었다. 결과: 5년 무병 생존율 및 전체 생존율은 각각 34.7%, 79.7%였다. 재발은 9예, 원격전이는 7예에서 발생하였다. 생존율에 관계된 예후 인자는 종양의 제3천추 상방 침범유무(p=0.033), 종양의 크기(p=0.032)였다. 수술 후 합병증으로 배뇨 및 배변 장애가 발생한 경우가 9예였으며 이중 2예에서는 자가도뇨 시행이 필요하거나 중증의 요실금이 발생하였다. 결론: 종양의 절제 가능성 여부와 더불어 전반적인 환자상태와 수술 후 발생 가능한 합병증을 고려한 치료방법의 선택이 생존율과 함께 삶의 질을 높일 수 있는 방법으로 생각된다.

• 보건행정학회지
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• 제15권3호
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• pp.60-78
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• 2005

The main objective of this study is to define the nature of the patient service quality of Health Centers, and based on that, to examine the causal relationship of Health Center visitor's perceived service quality with overall satisfaction, intention to revisit and intention to recommend. Data are collected on the basis of the second field survey of '3rd Regional Health Care Planning' operated by the Ministry of Health and Welfare(MOHW). In this study, the 24 patient satisfaction questions are used as outcome indicators. The samples are 3,091 patients who visited 68 Health Centers. The reliability and validity of patient service quality items was evaluated. Finally, the Structural Equation Modeling(SEM) analysis was conducted to find a causal relationship of service quality, patient satisfaction, intention to revisit and intention to recommend. This study shows firstly, the dimension of patient service quality was categorized into 3 dimensions, that is, facilities and environment, staff kindness, and convenience of utilization process. Secondly, the reliability and validity of patient service quality items was satisfied. Lastly, the total effect of convenience of utilization process factor on satisfaction(path coefficients=1.721), intention to revisit(0.843) and intention to recommend(0.696) is more higher than other variables. These findings imply that the quality of various services concerning convenience of utilization process at Health Centers should be improved to satisfy the health need of community people and improve the service quality of Health Centers.

• 대한간호학회지
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• 제33권1호
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• pp.122-129
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• 2003

Purpose: The purpose of this study is to examine the difference of direct nursing activity and patient outcomes as mortality rate, complication rate, readmission rate and length of stay related to graded fee of nursing management for inpatient. Method: The subjects of this study were 44 general hospitals with more than 500 beds. Data totaled to 86,044 claims provided to inpatients in Jan. 2001 requested by an electronic data interchange from a Health Insurance Review Agency. The data was analyzed by SPSS win(ver.10.0) and statistical methods used were frequency, one-way ANOVA, $X^2$-Test and regression. Result: Synthetic judgment through performance index and 95% confidence interval, direct nursing activity showed to provided adequate quality of nursing care on 2nd, 3rd, 4th and 6th nursing degree. Also, patient outcomes showed difference by graded fee of nursing management for inpatient. Mortality rate of 2nd was the lowest with P.I. 67.9, 3rd, 5th, 6th, 4th in order. In case of complication rate, 2nd, 3rd and 4th were lower than other nursing degree. Readmission rate of 4th and 5th was the lowest. Length of stay of 2nd was the shortest with P.I. 88.3, 3rd, 4th, 5th, 4th, 6th in order. Conclusion: The findings from this study showed that, the higher nurse-to-patient ratio, the greater amount of direct nursing care activity for the patient. Also, the more direct nursing activities influenced a lower mortality rate, complication rate and readmission rate, shorter length of stay.

• 한국융합학회논문지
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• 제10권6호
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• pp.365-379
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• 2019

본 연구의 목적은 환자-가족중심 의료서비스의 특성과 성과를 체계적 문헌고찰 방법으로 분석하여 서비스의 융합적 유효성을 평가하는 것이다. 15개 전자 데이터 베이스에서 환자-가족중심 의료서비스의 성과를 연구한 RCT 문헌 검색, 선정, 자료 추출, 질 평가를 시행하였다. 선정된 21편 문헌의 환자-가족중심 의료서비스의 공통적 특성은 정보제공과 교육, 의사소통, 가족 및 친구의 참여였다. 환자-가족중심 의료서비스의 성과 측정 변수는 89개였고, 환자 성과는 사망률, 재원기간 등으로 측정되었으며 18편의 문헌에서 환자 성과가 유의하게 향상되었다. 본 연구는 환자-가족중심 의료서비스의 성과를 통합적으로 제시하여 서비스의 유효성을 증명함으로써 의료기관과 지역사회의 지속적인 의료질 향상 활동을 위한 당위성을 제공하였으며 향후 의료의 질 향상과 환자안전을 위한 환자-가족중심 의료서비스의 융합적 적용과 이에 대한 근거기반 연구가 필요함을 제언한다.

• 구강회복응용과학지
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• 제35권3호
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• pp.170-179
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• 2019

상악 전치부의 보철 수복은 치과 분야에서 심미성이 크게 요구되는 치료이다. 상악 전치부의 보철 수복을 통하여 치아의 외형, 배열, 색조 등을 개선하면 심미성을 향상시키는 것이 가능하다. 특히 전치부 심미 수복을 위해서는 진단과정에서 환자의 안모 및 치아와 입술과의 관계, 치아와 치은 관계 등을 평가하고, 환자가 요구하는 바를 정확히 파악할 필요가 있다. 환자와 술자 및 기공사 간의 원활한 의사소통을 통하여 환자의 요구사항을 충실히 반영하기 위한 도구로서 DSD (digital smile design) 개념을 적용할 수 있다. 이 증례에서는 상악 중절치의 선천적 결손으로 인하여 대칭성을 구현하기 불가능한 상황에서 DSD를 활용하여, 환자 안모와 상악 전치부의 전체적인 조화를 추구하는 것을 목표로 하였으며, 이를 통해 환자와 술자 모두 만족할 만한 심미적인 결과를 얻었기에 이를 보고하고자 한다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제22권2호
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• pp.117-128
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• 2022

Background: Moderate sedation is an integral part of dental care delivery. Target-controlled infusion (TCI) has the potential to improve patient safety and outcome. We compared the effects of using TCI to administer remifentanil/manual bolus midazolam with manual bolus fentanyl/midazolam administration on patient safety parameters, drug administration times, and patient recovery times. Methods: In this retrospective chart review, records of patients who underwent moderate intravenous sedation over 12 months in a private dental clinic were assessed. Patient indicators (pre-, intra-, and post-procedure noninvasive systolic and diastolic blood pressure, respiration, and heart rate) were compared using independent t-test analysis. Patient recovery time, procedure length, and midazolam dosage required were also compared between the two groups. Results: Eighty-five patient charts were included in the final analysis: 47 received TCI-remifentanil/midazolam sedation, and 38 received manual fentanyl/midazolam sedation. Among the physiological parameters, diastolic blood pressure showed slightly higher changes in the fentanyl group (P = 0.049), respiratory rate changes showed higher changes in the fentanyl group (P = 0.032), and the average EtCO₂ was slightly higher in the remifentanil group (P = 0.041). There was no significant difference in the minimum SpO₂ levels and average procedure length between the fentanyl and remifentanil TCI pump groups (P > 0.05). However, a significant difference was observed in the time required for discharge from the chair (P = 0.048), indicating that patients who received remifentanil required less time for discharge from the chair than those who received fentanyl. The dosage of midazolam used in the fentanyl group was 0.487 mg more than that in the remifentanil group; however, the difference was not significant (P > 0.05). Conclusion: The combination of TCI administered remifentanil combined with manual administered midazolam has the potential to shorten the recovery time and reduce respiration rate changes when compared to manual administration of fentanyl/midazolam. This is possibly due to either the lower midazolam dosage required with TCI remifentanil administration or achieving a stable, steady-state low dose remifentanil concentration for the duration of the procedure.