• 제목/요약/키워드: Pediatrician

검색결과 94건 처리시간 0.021초

림프절 종대 (Lymphadenopathy)

  • 정낙균
    • Clinical and Experimental Pediatrics
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    • 제51권8호
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    • pp.797-803
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    • 2008
  • Lymphadenopathy is a common problem in children and adolescents. A wide variety of diseases and conditions may present as lymphadenopathy and an understanding of these conditions is essential to determine the most appropriate diagnostic work-up for each patient. A detailed history and physical examination with careful attention to the anatomical regions drained by the involved lymph node or mass often leads to the appropriate diagnosis. A majority of these children will prove to have a benign disorder; however, it is important for the pediatrician to have an appreciation for the malignant diseases or serious systemic illnesses that may initially present with lymphadenopathy, to ensure the timely diagnosis of a serious disease.

소아기 수면 장애 (Sleep disorders in childhood)

  • 차병호
    • Clinical and Experimental Pediatrics
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    • 제50권8호
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    • pp.718-725
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    • 2007
  • Sleep disorders are very common among pediatric patients. Its prevalence is between 10% and 45% in preschool- and school-aged children. However parents commonly do not concern about their children's sleeping habits and for many pediatricians, there is not part of the routine office visit about a childs sleep. Sleep disorders were classified by International Classification of Sleep Disorder (ICSD) as dyssomnias, parasomnias, sleep disorders associated with mental, neurologic, or other medical disorders, and proposed sleep disorders. There are lots of differences in the causes, manifestations, and managements of sleep disorders between children and adult. The sleep disorders in childhood may manifest themselves as bedtime resistance, refusal to go to bed at a parentally described time, sleep-onset delay, inability to fall asleep within a reasonable time, prolonged nighttime awakening, and inability to return to sleep without assistance after waking during the night, and so have wide-ranging influences on children's behavior, mood, school performance, and family life. It's very important for pediatrician to concern about the sleep disturbances in childhood and so the problems of sleep in children should be early detected and managed.

Development of a knowledge-based medical expert system to infer supportive treatment suggestions for pediatric patients

  • Ertugrul, Duygu Celik;Ulusoy, Ali Hakan
    • ETRI Journal
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    • 제41권4호
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    • pp.515-527
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    • 2019
  • This paper discusses the design, implementation, and potential use of an ontology-based mobile pediatric consultation and monitoring system, which is a smart healthcare expert system for pediatric patients. The proposed system provides remote consultation and monitoring of pediatric patients during their illness at places distant from medical service areas. The system not only shares instant medical data with a pediatrician but also examines the data as a smart medical assistant to detect any emergency situation. In addition, it uses an inference engine to infer instant suggestions for performing certain initial medical treatment steps when necessary. The applied methodologies and main technical contributions have three aspects: (a) pediatric consultation and monitoring ontology, (b) semantic Web rule knowledge base, and (c) inference engine. Two case studies with real pediatric patients are provided and discussed. The reported results of the applied case studies are promising, and they demonstrate the applicability, effectiveness, and efficiency of the proposed approach.

변화에 부응하는 보건의료정책 전환이 필요하다 (Healthcare System Needs to be Reinforced toward the Environmental Changes)

  • 이선희
    • 보건행정학회지
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    • 제32권4호
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    • pp.345-346
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    • 2022
  • 2022 was a time when the global healthcare system was challenged and has grown in response to the coronavirus disease 2019 pandemic. In addition, various issues accumulated in the process of quantitative growth have emerged in the Korean healthcare system. For instance, problems of sustainability in health insurance finances and removing bubbles from excessive medical utilization should be urgently resolved as tasks that occurred in the process of expanding the coverage of the health insurance system. The deficit of applicants for the pediatrician residency program suggests that expanding health insurance coverage alone has limitations in providing essential medical services. There is a need to incentivize doctors who provide essential medical care services. In 2023, we hope that efforts to enhance and internally reinforce the healthcare system will be concentrated.

Worldwide national intervention of developmental screening programs in infant and early childhood

  • Kim, Seunghyo
    • Clinical and Experimental Pediatrics
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    • 제65권1호
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    • pp.10-20
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    • 2022
  • The prevalence of developmental disabilities is increasing worldwide over time. Developmental issues in infancy or early childhood may cause learning difficulties or behavioral problem in school age, further adversely affecting adolescent quality of life, which finally lead to low socioeconomic status in family, increase in medical expenses, and other relevant issues in various ways. Early childhood has brain plasticity, which means there is a high chance of recovering from developmental issues by early detection and timely intervention. Pediatricians are placed an ideal position to meet with young children till 6 years of age, of which age range is the time applicable to early intervention. Determining child's developmental status can be made by 2 pathways such as developmental surveillance and developmental screening tests. For better results, pediatricians should update their knowledge about developmental issues, risk factors, and screening techniques through varying educational program or other relevant educating materials. This paper will update reports on the prevalence of developmental disabilities and review the recent results of the Korean developmental screening test and discuss relevant issues. Finally, it will be addressed the pediatrician's role in early detecting developmental issues and timely intervention.

소아과 의사에 의해 시행된 복부 초음파 검사 1,000예에 대한 분석 (Analysis of 1,000 Cases of Abdominal Ultrasonography Performed by a Pediatrician)

  • 배상인;박재홍
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • 제10권1호
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    • pp.28-35
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    • 2007
  • 목 적: 소아에서 초음파 검사는 복부 질환의 진단에 중요한 역할을 한다. 소아의 특성을 잘 알고 있는 소아과 의사에 의해 시행된 복부 초음파 검사의 경험을 분석하였다. 방 법: 2003년 1월부터 2005년 6월까지 부산대학교 병원 소아과에서 복부 질환의 증상으로 내원하여 복부 초음파 검사를 받았던 1,000명의 환자를 대상으로 병력지와 초음파 검사 소견을 후향적으로 분석하였다. 초음파 검사는 1명의 소아과 의사에 의해 시행되었으며 초음파 기기는 Sequoia System$^{(R)}$을 이용하고 3종류의 탐촉자를 사용하였다. 결 과: 남아가 584명(58.4%), 여아가 416명(41.6%)이었고, 평균 연령은 $4.7{\pm}4.0$세였다. 1세 미만이 274명 (27.4%), 1~5세가 310명(31.0%), 6~10세가 267명(26.7%), 11세 이상이 149명(14.9%)이었다. 내원 시 주증상은 복통이 439명(43.9%)으로 가장 많았고, 구토, 간 효소치의 증가, 황달, 설사, 복부팽만 등이 있었다. 검사 결과 정상 소견이 421명(42.1%), 비정상 소견이 579명(57.9%)이었다. 비정상 소견으로는 장간막 림프절염이 182명(31.5%)으로 가장 많았고, 그 외 지방간, 간염, 간비종대, 장중첩증 등이 있었다. 복통으로 검사한 경우는 장간막 림프절염이 32.6%로 가장 많았고, 그 외 장중첩증, 급성 충수돌기염, 요로결석, 급성 췌장염, 담석 등이 있었다. 구토로 검사한 경우는 장간막 림프절염이 12.7%명으로 가장 많았고, 그 외 특발성 유문협착증, 급성 충수돌기염, 장폐쇄증 등이 있었다. 간효소치 상승으로 검사한 경우는 지방간이 30명(25.4%)으로 가장 많았고, 그 외 간염, 총 담관낭, 간외 담도 폐쇄, 간경변증 등이 있었다. 비뇨생식계 질환과 관련된 55예의 초음파 검사 소견 중에서는 수신증이 25명 (45.4%)으로 가장 많았고 신결석, 낭종성 신질환, 종양 등이 있었다. 결 론: 소아에서 복부 초음파 검사는 복부 질환의 진단에 있어서 간편하고, 신속하며, 비침습적이며, 선별검사로 진단적 가치가 높다. 소아에서 복부 초음파 검사는 소아과 의사가 검사할 경우 보다 빨리 그리고 필요할 때 즉시 시행할 수 있으며, 환자의 경과 관찰을 위한 검사에도 효율적이다.

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의료공급자 단체에 대한 공정거래법상 사업활동제한 적용 -달빛어린이 병원 사건을 중심으로- (Antitrust Regulation on the Restriction of Business Activities by Healthcare Providers' Organization)

  • 정재훈
    • 의료법학
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    • 제19권2호
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    • pp.75-98
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    • 2018
  • 최근 서울고등법원은 대상판결(서울고판 2018. 4. 5, 2017누58580)을 통하여 대한소아청소년과 의사회의 소아과병원이나 소아과의사에 대한 제한 행위가 독점규제 및 공정거래에 관한 법률(이하 '공정거래법'이라고 한다) 제26조 제1항 제3호에 위반되는 지에 관하여 공정거래위원회(이하 '공정위'라고 한다)의 처분을 취소함으로써 이를 부정하였다. 대상판결은 종전에 확립된 대법원 판결에 따라 공정거래법 제26조 제1항 제3호에 있어서도 경쟁제한성이 필요하다는 전제에서 사업활동제한 행위가 성립하는지, 그 행위에 경쟁제한성이 있는지 등을 중심으로 심리하였다. 대상판결에 대하여는 다음과 같은 분석이 가능하다. 첫째, 공정거래법 제26조 제1항 제3호의 '제한'은 '과도한 제한'으로 해석하는 것이 바람직하다. 사업자단체가 구성원에 대하여 제한을 가하는 것은 원칙적으로 허용되지만, 예외적으로 공익적 차원에서 공정위가 규제를 한다는 취지에서 제한적으로 해석하는 것이 상당하다. 둘째, 대상판결은 원고의 행위가 구성사업자의 가격, 수량, 품질 등을 제한하여 경쟁제한성이 인정된다고 보기 어렵다고 판단하였다. 대상판결은 종전에 확립된 대법원 판결에 따라 공정거래법 제26조 제1항 제3호에 있어서도 경쟁제한성이 필요하다는 전제에 선 것으로 수긍할 수 있다. 그런데, 의료시장의 가격이 정부에 의하여 강력하게 통제되는 상태에서 경쟁제한성 판단을 위한 핵심적인 논제는 공급량 감소의 문제로서, 공급량이 경쟁제한효과를 유발할 정도로 감소하였음이 수량적으로 증명된다면 경쟁제한효과를 인정하는데 어려움이 없을 것이지만, 이는 일반적으로 증명하기 어려우며, 실제 이 사건에서 공정위가 공급량 감소를 증명할 유력한 증거를 제출하지 못한 것으로 보인다. 다른 한편, 공정거래법상 경쟁제한성은 경쟁제한의 우려가 있는 경우에도 인정되므로, 이 사건에서 경쟁제한효과가 발생할 우려가 있었는지의 증명이 문제된다. 이 사건은 공급량을 줄이기 위한 직접적인 의도와 목적이 드러나고 경험칙상 공급량이 지속적으로 감소할 것임을 인정할 수 있는 사건임에 비추어 대상판결의 논지에 대하여는 동의하기 어렵다. 대상판결이 사업자단체 규제를 통하여 경쟁제한성의 근본적인 문제를 다룬 것은 이론적인 측면에서나, 실무적인 측면에서나 의미가 있다. 대상판결은 경쟁제한성의 이해, 경쟁제한효과의 판단, 경쟁제한효과의 증명 수준 등에 관하여 의료서비스의 공급량을 매개로 하여 흥미로운 판단을 하였고, 대법원이 이를 어떻게 판단할지에 관하여 관심이 집중되고 있다.

아토피피부염 영아의 영양장애 사례보고와 채식주의에 관한 고찰 (Marasmus and Kwashiorkor by Nutritional Ignorance Related to Vegetarian Diet and Infants with Atopic Dermatitis in South Korea)

  • 정상진;한영신;정승원;안강모;박화영;이상일;조영연;최혜미
    • Journal of Nutrition and Health
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    • 제37권7호
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    • pp.540-549
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    • 2004
  • Infants and children with food related Atopic Dermatitis (AD) need extra dietary efforts to maintain optimal nutrition due to food restriction to prevent allergy reactions. However, nutrition ignorance and food faddism make patients even more confused and practice desirable diet more difficult. The objective of this study was to report the AD patients' malnutrition cases in Korea. We report on 2 cases of severe nutritional deficiency caused by consuming macrobiotic diets which avoid processed foods and most animal foods, i.e. one of vegetarian diet. Case 1, a 12-month-old male child, was admitted with severe marasmus. Because of a history of AD, he was started on mixed grain porridge at 3 months without any breast milk or formula feeding. His caloric intake was 66% and protein intake was 69% of the recommended dietary allowance. Patient's height and weight was under 3th percentile. On admission the patient was unable to crawl or roll over. Case 2, a 9-month-old AD female patient, was diagnosed with kwashiorkor and rickets. She was also started on mixed grain porridge at 100 days due to AD. Her caloric intake has been satisfied recommended dietary allowance until 7 months, however, she conducted sauna bath therapy and reduced both energy and protein intake at 8 months. The amount of protein intake for case 2 was higher than recommended dietary allowance, but, sauna therapy and severe AD with intakes of low guality protein may increase patient's protein requirement resulting in kwashiorkor. Case 2 patient's height and weight was on 3th percentile. Both cases showed low intake of calcium, iron, zinc, vitamin A, vitamin E and especially very low intake of vitamin B$_{12}$ and vitamin D. Allergy tests for certain foods had not done prior to admission for both cases. They followed the dietary advise operated by macrobiotic diet internet site. In conclusion, AD infants' parents and caregivers should contact a pediatrician trained as a specialist in allergy for accurate diagnosis. For infant patients, breast or formula feeding including hypoallergenic formula should be continued until their one year of age. When certain foods need to be restricted or to follow special diets such as vegetarian diet, consultation with pediatrician and dietitian is needed.d.

한 농촌지역에서 실시한 소아 급성호흡기감염 관리사업의 평가 -항생제 사용을 중심으로- (Evaluation of Acute Respiratory Infections(ARI) Control Programme in a Korean Rural Community -The Patterns of Antibiotic Prescription-)

  • 이영성;김창엽;김용익;신영수;고재욱
    • 농촌의학ㆍ지역보건
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    • 제18권2호
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    • pp.105-119
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    • 1993
  • The purpose of this study was to evaluate the program for the control of acute respiratory infections(ARI) in children in a Korean rural area(Yonchon county). Evaluating the program, we focused on the pattern of prescription and appropriateness of antibiotics prescribed by the health personnel who had participated in the ARI Control Program. It was implemented at the primary health care setting in rural area, such as district hospital, health subcenters, and health posts. During six-months programme monitoring period, medical records were reviewed and collected data were analysed by the pediatrician, research coordinator of this study. The baseline data were collected from medical records of the same period(six months) of one year before the implementation of the ARI programme. The study results were as follow : 1. Common cold was the most prevalent disease(78.7%. 594 cases) among the all ARI cases (755 cases). The less frequent cases were bronchitis(11.9%), acute pharyngitis(5.2%), and pneumonia(1.8%). 2. Significant reduction in the use of antibiotics was observed after the programme implementation. Ninety three(15.7%) of 594 common cold cases were received antibiotics compared with 282(35.2%) of 802 in the baseline period. In the cases of bronchitis and acute pharyngitis, the reduction rates were 15.1% and 23.2% respectively compared to the baseline period. 3. Mean duration of antibiotics prescription was 1.81-1.75 days, similar to the baseline data. 4. The appropriateness rate of antibiotics prescriptions were 84.3%(common cold), 35.6% (bronchitis) and 28.2%(acute pharyngitis). In the case of pneumonia, the antibiotics prescription was compatible to the criteria developed. 5. Pediatrician prescribed antibiotics more appropriately for all cases than general practitioners in health sub-center, and nurse practitioners in health posts. 6. Antibiotics therapy was shown to be of no effect in the treatment of the all ARI cases. At the 5 and 10 days check-up of common cold cases after visits, proportion of improved patients were 58.3% in the antibiotics-used group and 51.4% in the control group. In the other cases of ARI, the patterns of response were similar to common cold. None of the differences in outcome between the antibiotics-used and control group was statistically significant. This ARI programme may have substantial a substantial impact on antibiotics use at the public health institutions(district hospital, health subcenters, health posts) which are of major domain for primary health care in Korean rural areas.

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급성 복통 (Acute Abdominal Pain in Children)

  • 강기수
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • 제11권sup2호
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    • pp.11-18
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    • 2008
  • 소아의 급성 복통은 많은 환자들이 복통의 성격에 대해 적절히 표현하지 못하므로 진단에 어려움을 겪는 경우가 많다. 연령별 급성 복통의 원인들을 잘 숙지하고, 복통의 위치에 따른 진단적 접근을 시행한다. 가장 우선적으로 외과적 복통 여부를 가능한 빠른 시간 내에 감별해야 하며, 다음으로 장 폐쇄, 궤양성 질환, 간담도계 질환 등을 확인해야 한다. 이 때 주의해야 할 것은, 환자의 복통이 완전히 좋아질 때까지 반복적인 문진과 진찰을 게을리 하지 않아야 하는 것이다. 이렇게 함으로써 진단이 지연되거나 피할 수 없는 오진으로 인해 발생하는 환자의 고통을 최소한으로 줄일 수 있을 것이다. 끝으로, 지금까지 금기시 해왔던 급성 복통 환아들에 대한 통증 치료에 대한 인식의 전환이 필요한 때이다.

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