• 산업융합연구
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• 제20권10호
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• pp.51-59
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• 2022

본 연구의 목적은 입원환자가 낙상사고 전후에 따라 건강상태 관련 특성의 차이를 확인하기 위함이며, 2016년 1월 1일부터 2020년 12월 31일까지 입원 후 낙상사고가 발생하여 환자안전보고시스템에 보고된 환자 328명의 데이터를 활용한 후향적 연구이다. 연구대상자의 연령은 평균 68.57±14.13세로서 70대가 30.49%로 가장 많았고, 입원 이후 평균 13.86±25.03일이 경과 시에 낙상사건이 발생하였고, 발생 시간대는 야간(22:30- 06:59)이 42.99%로 가장 많았다. 입원 후 낙상 전후에 배변문제(x²=314.0, p<.001), 배뇨문제(x²=284.0, p<.001), 정맥수액요법(x²=85.16, p<.001), 걸음걸이의 허약감(x²=69.77. p<.001), 와상(x²=51.60, p<.001), 의식이 불명하거나 자신의 기능을 과대평가한 경우(x²=17.52, p<.001) 비협조적 태도(x²=220.17, p<.001)에서 통계적으로 유의한 차이가 있었다. 낙상 전후 환자의 건강상태 관련 특성의 차이를 파악하여 환자의 특성에 맞는 적절한 낙상예방 및 개별적인 교육중재활동을 모색할 필요가 있다.

• 한방재활의학과학회지
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• 제32권1호
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• pp.89-106
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• 2022

Objectives In this study, a scoping review was conducted to inform decision-making related to traditional Korean medicine for people with disabilities in the future. Methods Seven databases were searched to find previous studies on traditional Korean medicine for people with disabilities. Studies published until August 2021 were considered. Using the methodology of scoping review, research on traditional Korean medicine for people with disabilities was reviewed with the following steps: 1) drawing research questions, 2) searching for related studies, 3) selecting studies, 4) extracting data, and 5) analyzing and reporting results. Results Out of 2,072 studies, 7 research papers and 10 reports were finally selected. The research papers included 5 cases studies, 1 survey study, and 1 chart review. Most studies used herbal medicine and acupuncture treatment, but the reports on the interventions were not detailed. The reports included policy studies, project performance guidelines, and project results reports, and most of the evaluation indicators tended to be standardized. Conclusions This study reviewed the literature on traditional Korean medicine for people with disabilities. It presents future directions for clinical research on traditional Korean medicine for people with disabilities and can be used to inform healthcare policies and clinical practice. In the future, quantitative research such as clinical trials, meta-analysis, and health insurance big data analysis is needed to understand the current status and effects of traditional Korean medicine for people with disabilities. In addition, qualitative research is necessary to identify unmet demands of traditional Korean medicine for people with disabilities.

• Korean Journal of Radiology
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• 제22권6호
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• pp.867-879
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• 2021

Objective: To compare the screening performance of diffusion-weighted (DW) MRI and combined mammography and ultrasound (US) in detecting clinically occult contralateral breast cancer in women with newly diagnosed breast cancer. Materials and Methods: Between January 2017 and July 2018, 1148 women (mean age ± standard deviation, 53.2 ± 10.8 years) with unilateral breast cancer and no clinical abnormalities in the contralateral breast underwent 3T MRI, digital mammography, and radiologist-performed whole-breast US. In this retrospective study, three radiologists independently and blindly reviewed all DW MR images (b = 1000 s/mm² and apparent diffusion coefficient map) of the contralateral breast and assigned a Breast Imaging Reporting and Data System category. For combined mammography and US evaluation, prospectively assessed results were used. Using histopathology or 1-year follow-up as the reference standard, cancer detection rate and the patient percentage with cancers detected among all women recommended for tissue diagnosis (positive predictive value; PPV2) were compared. Results: Of the 30 cases of clinically occult contralateral cancers (13 invasive and 17 ductal carcinoma in situ [DCIS]), DW MRI detected 23 (76.7%) cases (11 invasive and 12 DCIS), whereas combined mammography and US detected 12 (40.0%, five invasive and seven DCIS) cases. All cancers detected by combined mammography and US, except two DCIS cases, were detected by DW MRI. The cancer detection rate of DW MRI (2.0%; 95% confidence interval [CI]: 1.3%, 3.0%) was higher than that of combined mammography and US (1.0%; 95% CI: 0.5%, 1.8%; p = 0.009). DW MRI showed higher PPV2 (42.1%; 95% CI: 26.3%, 59.2%) than combined mammography and US (18.5%; 95% CI: 9.9%, 30.0%; p = 0.001). Conclusion: In women with newly diagnosed breast cancer, DW MRI detected significantly more contralateral breast cancers with fewer biopsy recommendations than combined mammography and US.

• Korean Journal of Radiology
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• 제24권10호
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• pp.1028-1037
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• 2023

Objective: To evaluate the computed tomography (CT) features for diagnosing metastatic cervical lymph nodes (LNs) in patients with differentiated thyroid cancer (DTC) and validate the CT-based risk stratification system suggested by the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) guidelines. Materials and Methods: A total of 463 LNs from 399 patients with DTC who underwent preoperative CT staging and ultrasound-guided fine-needle aspiration were included. The following CT features for each LN were evaluated: absence of hilum, cystic changes, calcification, strong enhancement, and heterogeneous enhancement. Multivariable logistic regression analysis was performed to identify independent CT features associated with metastatic LNs, and their diagnostic performances were evaluated. LNs were classified into probably benign, indeterminate, and suspicious categories according to the K-TIRADS and the modified LN classification proposed in our study. The diagnostic performance of both classification systems was compared using the exact McNemar and Kosinski tests. Results: The absence of hilum (odds ratio [OR], 4.859; 95% confidence interval [CI], 1.593-14.823; P = 0.005), strong enhancement (OR, 28.755; 95% CI, 12.719-65.007; P < 0.001), and cystic changes (OR, 46.157; 95% CI, 5.07-420.234; P = 0.001) were independently associated with metastatic LNs. All LNs showing calcification were diagnosed as metastases. Heterogeneous enhancement did not show a significant independent association with metastatic LNs. Strong enhancement, calcification, and cystic changes showed moderate to high specificity (70.1%-100%) and positive predictive value (PPV) (91.8%-100%). The absence of the hilum showed high sensitivity (97.8%) but low specificity (34.0%). The modified LN classification, which excluded heterogeneous enhancement from the K-TIRADS, demonstrated higher specificity (70.1% vs. 62.9%, P = 0.016) and PPV (92.5% vs. 90.9%, P = 0.011) than the K-TIRADS. Conclusion: Excluding heterogeneous enhancement as a suspicious feature resulted in a higher specificity and PPV for diagnosing metastatic LNs than the K-TIRADS. Our research results may provide a basis for revising the LN classification in future guidelines.

• Korean Journal of Radiology
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• 제23권11호
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• pp.1102-1111
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• 2022

Objective: To evaluate the ultrasonography (US) features for diagnosing metastasis in cervical lymph nodes (LNs) in patients with thyroid cancer and compare the US classification of risk of LN metastasis between European and Korean guidelines. Materials and Methods: From January 2014 to December 2018, US-guided fine-needle aspiration was performed on 836 LNs from 714 patients for the preoperative nodal staging of thyroid cancer. The US features of LNs were retrospectively reviewed for the following features: size, presence of hilum, margin, orientation, cystic change, punctate echogenic foci (PEF), large echogenic foci, eccentric cortical thickening, abnormal vascularity, and cortical hyperechogenicity. A multiple logistic regression analysis was performed to identify the independent US features for the diagnosis of metastatic LNs. The diagnostic performance of independent US features was subsequently evaluated. LNs were categorized according to the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and European Thyroid Association (ETA) guidelines, and the correlation between the two sets of classifications was assessed. Results: Absence of the hilum, presence of cystic changes, PEF, abnormal vascularity, and cortical hyperechogenicity were independent US features of metastatic LNs. Cystic changes, PEF, abnormal vascularity, and cortical hyperechogenicity showed high specificity (86.8%-99.6%). The absence of the hilum had the highest sensitivity yet low specificity (66.4%). When LNs were classified according to the ETA guidelines and K-TIRADS, they yielded similar categorizations of malignancy risks and were strongly correlated (Spearman coefficient, 0.9766 [95% confidence interval, 0.973-0.979]). According to the ETA guidelines, 9.8% (82/836) of LNs were classified as "not specified." Conclusion: Absence of hilum, cystic changes, PEF, abnormal vascularity, and cortical hyperechogenicity were independent US features suggestive of metastatic LNs in thyroid cancer. Both K-TIRADS and the ETA guidelines provided similar risk stratification for metastatic LNs with a high correlation; however, the ETA guidelines failed to classify 9.8% of LNs into a specific risk stratum. These results may provide a basis for revising LN classification in future guidelines.

• Korean Journal of Radiology
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• 제20권5호
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• pp.759-772
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• 2019

Objective: To investigate the value of ultrasound (US) microflow assessment in distinguishing malignant from benign solid breast masses as well as the association between US parameters and histologic microvessel density (MVD). Materials and Methods: Ninety-eight breast masses (57 benign and 41 malignant) were examined using Superb Microvascular Imaging (SMI) and contrast-enhanced US (CEUS) before biopsy. Two radiologists evaluated the quantitative and qualitative vascular parameters on SMI (vascular index, morphology, distribution, and penetration) and CEUS (time-intensity curve analysis and enhancement characteristics). US parameters were compared between benign and malignant masses and the diagnostic performance was compared between SMI and CEUS. Subgroup analysis was performed according to lesion size. The effect of vascular parameters on downgrading Breast Imaging Reporting and Data System (BI-RADS) category 4A masses was evaluated. The association between histologic MVD and US parameters was analyzed. Results: Malignant masses were associated with a higher vascular index (15.1 ± 7.3 vs. 5.9 ± 5.6), complex vessel morphology (82.9% vs. 42.1%), central vascularity (95.1% vs. 59.6%), penetrating vessels (80.5% vs. 31.6%) on SMI (all, p < 0.001), as well as higher peak intensity (37.1 ± 25.7 vs. 17.0 ± 15.8, p < 0.001), slope (10.6 ± 11.2 vs. 3.9 ± 4.2, p = 0.001), area (1035.7 ± 726.9 vs. 458.2 ± 410.2, p < 0.001), hyperenhancement (95.1% vs. 70.2%, p = 0.005), centripetal enhancement (70.7% vs. 45.6%, p = 0.023), penetrating vessels (65.9% vs. 22.8%, p < 0.001), and perfusion defects (31.7% vs. 3.5%, p < 0.001) on CEUS (p ≤ 0.023). The areas under the receiver operating characteristic curve (AUCs) of SMI and CEUS were 0.853 and 0.841, respectively (p = 0.803). In 19 masses measuring < 10 mm, central vascularity on SMI was associated with malignancy (100% vs. 38.5%, p = 0.018). Considering all benign SMI parameters on the BI-RADS assessment, unnecessary biopsies could be avoided in 12 category 4A masses with improved AUCs (0.500 vs. 0.605, p < 0.001). US vascular parameters associated with malignancy showed higher MVD (p ≤ 0.016). MVD was higher in malignant masses than in benign masses, and malignant masses negative for estrogen receptor or positive for Ki67 had higher MVD (p < 0.05). Conclusion: US microflow assessment using SMI and CEUS is valuable in distinguishing malignant from benign solid breast masses, and US vascular parameters are associated with histologic MVD.

• 한국농림기상학회지
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• 제8권4호
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• pp.229-241
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• 2006

본 연구에서는 실측 일기상자료 대신 예측 기후평년 값을 적용하여 기후변화와 그에 상응한 벼 작황의 지리적 분포양상을 복원함으로써 지구온난화에 따른 우리나라 벼농사지대의 생산성을 재평가하였다. 기상청 56개 지점 종관자료(일 최고/최저 기온의 월별 평균값)를 1971-2000년 30년 단위로 수집하여 270m 해상도의 수치기후도를 작성하고, 벼논픽셀에 해당되는 기후자료를 추출하였다. 동일한 시군에 속하는 벼논픽셀의 기후자료를 평균함으로써 시군단위의 '벼논맞춤형 기후자료'를 준비하였다. 같은 방법으로 기상연구소에서 제작한 2011-2100년 기간의 3개 평년(2011-2040, 2041-2070, 2071-2100) 기후시나리오에 근거하여 해당 평년의 기후자료를 추정하였다. 농촌진흥청의 정밀토양도로부터 해당 픽셀의 토성과 토심정보를 검색하고 이를 토대로 유효수분 조견표에 의해 토양자료를 준비하였다. 자포니카형 벼의 특성을 갖도록 개조한 벼 생육모형(CERES-Japonica)에 이들 자료를 입력하고 조생종(오대벼), 중생종 (화성벼), 만생종 (동진벼)의 생육을 모의하였다. 시군 공간평균을 기준으로 3품종 모두 가까운 미래(2011-2040년)에는 출수기가 일주일 정도 빨라지고, 먼 미래(2071-2100년)에는 최대 20일 까지 단축될 수 있다. 생리적 성숙기는 3품종 모두 가까운 미래(2011-2040년)에는 15일 정도 단축되고, 먼 미래(2071-2100년)에는 최대 한달까지도 빨라질 수 있어 출수기에 비해 단축정도가 심하다. 평야지 수량의 경우 조생종인 오대벼는 10a당 6-25%, 중생종 화성벼는 3-26%, 만생종 동진벼는 3-25%까지 감소하였다. 하지만 산간지역에서는 발육속도가 빨라지고 수량이 증가하거나 큰 변화가 없는 곳도 많아 온난화조건에서도 지역별 정밀기후 추정과 이에 근거한 최적품종의 선택, 이앙기 및 수확기 등 생육기간의 조절이 온난화 대응기술로서 유효할 것으로 기대된다.

• 핵의학기술
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• 제16권2호
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• pp.149-155
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• 2012

혈중 Insulin 농도는 췌장 ${\beta}$세포의 인슐린 분비기능을 반영하고 당뇨병의 진단, 병태 파악, 내당능 이상의 원인감별에 유용한 지표이다. 핵의학검사실에서 사용하고 있는 혈중 Insulin 측정용 시약들은 제조회사마다 검사방법 뿐만 아니라 비용효과 측면, 정밀도 등 정도관리 측면에서도 다소 차이를 보이고 있다. 따라서 Insulin 측정용 방사면역측정법 시약들의 제조 회사별 비교를 통해 진단적 성능을 평가하고자 본 연구를 시행하였다. 2009년 8월 59명의 환자 검체를 대상으로 시행된 3개 제조회사(Biosource, Siemens, TFB)의 혈중 Insulin측정치와 2011년 12월 68명의 환자 검체를 대상으로 시행된 4개 제조회사(Immunotech, Izotope, BNIBT, Cisbio)의 혈중 Insulin측정치를 비교 평가하였다. 이들 7개 제조회사별 Insulin측정치에 대하여 정밀도, 회수율, 상관관계를 살펴보았으며 일부 인슐린 고농도 특이검체를 가지고 희석시험을 통해 혈중 Insulin측정치를 상호 비교 평가하였다. 혈중 Insulin 측정은 시약 내 설명서의 권고사항을 준수하여 실시하였으며 결과 검증을 위한 통계 프로그램은 SPSS 12.0을 이용하였다. 측정 내 정밀도는 Biosource, Siemens, TFB, Immunotech, Izotope, BNIBT, Cisbio 7개 제조회사 모두 5.0% 이하의 변이계수를 보였다. 회수율은 저, 중, 고 세가지 농도의 혈청에서 Biosource, Siemens, TFB시약이 각각 94.2~103.7%, 99.0~104.6%, 99.7~107.6% 구간을 보였고 Immunotech, Izotope, BNIBT, Cisbio 시약에서 각각 93.5~99.1%, 91.4~99.1%, 99.2~131.0%, 84.8~102.3% 구간의 회수율을 보였다. Biosource 시약을 기준으로 비교한 상관관계에서 Siemens 시약이 R2=0.96(P<0.01), TFB시약이 R2=0.99(P<0.01)를 보였으며 TFB 시약을 기준으로 비교한 상관관계에서는 BNIBT시약(R2=0.80, P<0.01)을 제외한 대부분의 시약에서 강한 상관관계(R2=0.96 이상, p<0.01)를 보였다. 200 ${\mu}IU/ml$ 이상 고농도 희석시험에서는 당뇨병환자 검체를 대상으로 했을 때 7개 제조회사 시약 모두 고농도값을 정상적으로 측정하였다. 하지만, 인슐린 종양 검체를 대상으로 측정한 검사에서는 TFB, Siemens, Izotope, Cisbio시약들은 고농도값을 정상적으로 측정하였지만 Biosource와 Immunotech 시약에서 각각 47.4 ${\mu}IU/ml$, 72.3 ${\mu}IU/ml$의 측정치를 보였다. 혈중 Insulin 측정용 방사면역측정법 시약들은 전반적으로 성능이 임상 적용 가능한 범위의 측정 정밀도를 보이면서, 우수한 회수율과 양호한 상관관계를 보였지만 일부 시약에서 고농도 특이검체를 대상으로 Insulin을 측정한 검사에서 고농도값을 제대로 측정하지 못했다. 따라서 여러가지 요인을 놓고 볼 때 비용 효과측면과 자동화 장비에 대한 호환성, 검사 반응시간등 각 검사실 환경에 맞는 시약과 진단적 성능이 보다 우수한 시약을 선정하여 사용한다면 정확하고 신속한 결과보고에 있어서 많은 도움이 된다고 사료된다.

• 한국과학교육학회지
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• 제15권2호
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• pp.173-184
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• 1995

The purpose of this study was to analyse the problems of 'Science Inquiry Experiment Contest(SIEC)' which was one of 8 programs of 'The 2nd Student Science Inquiry Olympic Meet(SSIOM)'. The results and conclusions of this study were as follows: 1. It needs to reconsider the role of practical work within science experiment because practical work skills form one of the mainstays in current science. But the assessment of students' laboratory skills in the contest was made little account of. It is necessary to remind of what it means to be 'good at science'. There are two aspects: knowing and doing. Both are important and, in certain respects, quite distinct. Doing science is more of a craft activity, relying more on craft skill and tacit knowledge than on the conscious application of explicit knowledge. Doing science is also divided into two aspects, 'process' and 'skill' by many science educators. 2. The report's and checklist's assessment items were overlapped. Therefore it was suggested that the checklist assessment items were set limit to the students' acts which can't be found in reports. It is important to identify those activities which produce a permanent assessable product, and those which do not. Skills connected with recording and reporting are likely to produce permanent evidence which can be evaluated after the experiment. Those connected with manipulative skills involving processes are more ephemeral and need to be assessed as they occur. The division of student's experimental skills will contribute to the accurate assess of student's scientific inquiry experimental ability. 3. There was a wide difference among the scores of one participant recorded by three evaluators. This means that there was no concrete discussion among the evaluators before the contest. Despite the items of the checklists were set by preparers of the contest experiments, the concrete discussions before the contest were necessary because students' experimental acts were very diverse. There is a variety of scientific skills. So it is necessary to assess the performance of individual students in a range of skills. But the most of the difficulties in the assessment of skills arise from the interaction between measurement and the use. To overcome the difficulties, not only must the mark needed for each skill be recorded, something which all examination groups obviously need, but also a description of the work that the student did when the skill was assessed must also be given, and not all groups need this. Fuller details must also be available for the purposes of moderation. This is a requirement for all students that there must be provision for samples of any end-product or other tangible form of evidence of candidates' work to be submitted for inspection. This is rather important if one is to be as fair as possible to students because, not only can this work be made available to moderators if necessary, but also it can be used to help in arriving at common standards among several evaluators, and in ensuring consistent standards from one evaluator over the assessment period. This need arises because there are problems associated with assessing different students on the same skill in different activities. 4. Most of the students' reports were assessed intuitively by the evaluators despite the assessment items were established concretely by preparers of the experiment. This result means that the evaluators were new to grasp the essence of the established assessment items of the experiment report and that the students' assessment scores were short of objectivity. Lastly, there are suggestions from the results and the conclusions. The students' experimental acts which were difficult to observe because they occur in a flash and which can be easily imitated should be excluded from the assessment items. Evaluators are likely to miss the time to observe the acts, and the students who are assessed later have more opportunity to practise the skill which is being assessed. It is necessary to be aware of these problems and try to reduce their influence or remove them. The skills and processes analysis has made a very useful checklist for scientific inquiry experiment assessment. But in itself it is of little value. It must be seen alongside the other vital attributes needed in the making of a good scientist, the affective aspects of commitment and confidence, the personal insights which come both through formal and informal learning, and the tacit knowledge that comes through experience, both structured and acquired in play. These four aspects must be continually interacting, in a flexible and individualistic way, throughout the scientific education of students. An increasing ability to be good at science, to be good at doing investigational practical work, will be gained through continually, successively, but often unpredictably, developing more experience, developing more insights, developing more skills, and producing more confidence and commitment.

• 대한임상검사과학회지
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• 제36권1호
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• pp.13-18
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• 2004

This study was designed to establish working range for reoportable range in own laboratory in order to cover the upper and lower limits of the range in test method. We experimented ten times during 10 days for setting of reportable range with between run for method evaluation. It is generally assumed that the analytical method produces a linear response and that the test results between those upper and lower limits are then reportable. CLIA recommends that laboratories verify the reportable range of all moderate and high complexity tests. The Clinical Laboratory Improvement Amendments(CLIA) and Laboratory Accreditation Program of the Korean Society for Laboratory Medicine states reportable range is only required for "modified" moderately complex tests. Linearity requirements have been eliminated from the CLIA regulations and from others accreditation agencies, many inspectors continue to feel that linearity studies are a part of good lab practice and should be encouraged. It is important to assess the useful reportable range of a laboratory method, i.e., the lowest and highest test results that are reliable and can be reported. Manufacturers make claims for the reportable range of their methods by stating the upper and lower limits of the range. Instrument manufacturers state an operating range and a reportable range. The commercial linearity material can be used to verify this range, if it adequately covers the stated linear interval. CLIA requirements for quality control, must demonstrate that, prior to reporting patient test results, it can obtain the performance specifications for accuracy, precision, and reportable range of patient test results, comparable to those established by the manufacturer. If applicable, the laboratory must also verify the reportable range of patient test results. The reportable range of patient test results is the range of test result values over which the laboratory can establish or verify the accuracy of the instrument, kit or test system measurement response. We need to define the usable reportable range of the method so that the experiments can be properly planned and valid data can be collected. The reportable range is usually defined as the range where the analytical response of the method is linear with respect to the concentration of the analyte being measured. In conclusion, experimental results on reportable range using concentrated control sample and zero calibrators covering from highest to lowest range were salicylate $8.8{\mu}g/dL$, phenytoin $0.67{\mu}g/dL$, phenobarbital $1.53{\mu}g/dL$, primidone $0.16{\mu}g/dL$, theophylline $0.2{\mu}g/dL$, vancomycine $1.3{\mu}g/dL$, valproic acid $3.2{\mu}g/dL$, digitoxin 0.17ng/dL, carbamazepine $0.36{\mu}g/dL$ and acetaminophen $0.7{\mu}g/dL$ at minimum level and salicylate $969.9{\mu}g/dL$, phenytoin $38.1{\mu}g/dL$, phenobarbital $60.4{\mu}g/dL$, primidone $24.57{\mu}g/dL$, theophylline $39.2{\mu}g/dL$, vancomycine $83.65{\mu}g/dL$, valproic acid $147.96{\mu}g/dL$, digitoxin 5.04ng/dL, carbamazepine $19.76{\mu}g/dL$, acetaminophen $300.92{\mu}g/dL$ at maximum level.