• 제목/요약/키워드: Risk Severity

검색결과 778건 처리시간 0.023초

경구용 활성효소 억제제 복용 암환자의 잠재적 약물상호작용 연구 (Potential Drug Interactions in Cancer Patients on Oral Kinase Inhibitors)

  • 정은희;방준석;이유정
    • 한국임상약학회지
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    • 제23권2호
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    • pp.129-136
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    • 2013
  • Objectives: Among many new drugs that are under investigation with intent to treat cancer, oral kinase inhibitors are proven to be effective in numerous clinical trials and easy to administer. Due to these advantages the use of oral kinase inhibitors is increasing. Oral kinase inhibitors are metabolized by CYP450 which can result either increase of adverse effect or decrease of drug effect by drug interaction when used concurrently with other agents. In this research, the medication records of patients on oral kinase inhibitors from Oct. 2010 to Nov. 2011 were reviewed to investigate potential drug interactions. Methods: From Oct. 2010 to Nov. 2011, cancer patients in Inha University Hospital who took oral kinase inhibitors more than once were included. The patients' medication records were reviewed to list out concurrent medications that have interaction potential with oral kinase inhibitors, the frequency of concurrent use, and the severity of interaction result using Micromedex$^{(R)}$ and Lexicomp-online$^{(R)}$ as references. Results: As a result, 90 cases of drug with interaction potential were prescribed by Micromedex$^{(R)}$ and 179 cases by Lexicomp-online$^{(R)}$ data. In case of severity, 33.3% by Micromedex$^{(R)}$ and 26.3% by Lexicomp-online$^{(R)}$ were categorized as Major and 65.6% by Micromedex$^{(R)}$ and 72.6% by Lexicomp-online$^{(R)}$ as Moderate. The number of adverse events was 92 cases which 58.7% were on skin and 19.6% on Gastro-intestinal tract. Conclusions: Considerable number of drug with interaction potential was used though each oral kinase inhibitors showed differences in extent. Hence there exists the risk of drug interaction in patients taking oral kinase inhibitors with other drugs.

영양부족 환자의 조기발견을 위한 선별검사의 적용 및 효용성 평가 (Application and Efficacy Evaluation of Nutritional Screening Tool)

  • 남궁환
    • 한국건강관리협회지
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    • 제4권1호
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    • pp.1-11
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    • 2006
  • "본 논문은 대한외과학회지 2006년 제70권제1호에 실렸던 논문으로 대한외과학회 편집위원회 승인을 득하고 본 협회지에 게재함. Purpose: Malnutrition has been frequently reported for patients on their admission to the hospital and it has been associated with an increase in morbidity, mortality and the length of the hospital stay. Although a number of screening tools have been developed to identify those patients at risk for malnutrition, there is no' gold standard' for defining malnutrition and the malnourished patients remain largely unrecognized. The aim of this study is to evaluate the efficacy of a nutritional screening tool for use in Dankook University Hospital. Methods Nutritional evaluation was performed for 53 patients who were admitted to the department of surgery and internal medicine between October and December 2004. The screening tool was completed by the ward nurse and the nutritional support team nurse on the same patients within24 hours of admission. The nutritional support team nurse performed the full assessment. The screening sheet included 4 questions regarding body mass index, recent unintentional weight loss, food intake and disease severity. Each answer was scored and a total of 5 was tested as the criterion fey malnutrition. The full assessment included current body weight, recent weight loss, triceps skinfold thickness, mid-arm muscle circumference, serum albumin)in and total lymphocyte count. Malnutrition was defined by 3 or more values below the reference values. The reliability of the screening tool was assessed using kappa statistic. Sensitivity, specificity and accuracy were calculated to evaluate the validity of the screening tool. The receiver operating characteristic(ROC) curve was drawn to choose a cutoff valve that maximizes sensitivity and specificity. Results' The level of agreement between the ward nurse and the NST nurse was good for BMI and food intake and moderate for weight loss and disease severity. The full assessment identified7 patients(13.2%) as malnourished. The screening sheet had a sensitivity of 86% and a specificity of 80%. According to the ROC curve, a score of 5 points provided the best validity. Conclusion The nutritional screening tool is reliable when completed by different observers and it is valid for nutritional assessment.

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식품산업체가 겪는 위기의 분류와 위기 수준 판단 (Classification of Food Safety Crises and Standard Setting for Crisis Level in Food Industry)

  • 김종규;김중순
    • 한국환경보건학회지
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    • 제41권2호
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    • pp.133-145
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    • 2015
  • Objectives: Food safety has become one of the major public-concerning issues in Korea. In order to set guidelines to create manuals for the response to a food safety crisis by food industry, this paper classified food safety crises and suggested techniques to determine crisis level. Methods: This study clarified common terminologies and definitions including in food safety crises. It reviewed various food safety crises and described characteristics, types, and states of crises. Results: The results of this study suggested that a food safety crisis implied a situation in which hazards/risk spreading in the food supply chain was widely described, causing strong public concern followed by a socioeconomic impact, and therefore, requiring the implementation of a prompt and full response regarding the situation. In terms of seeking response plans, food safety crises might be classified according to the penalties resulting from violations of laws and regulations, causative substances, stages of the food supply chain, and first contact point for incidents. The crisis level for a food safety crisis could be classified according to its severity parameters. The guideline matrix was divided into four major stages: Blue/guarded, Yellow/elevated, Orange/high, and Red/severe. This study also suggested several methods for determining the crisis level, such as the simple judgement method, scoring methods using a check-list and a weighted check-list. Conclusion: The severity of related parameters might be of great importance in understanding a crisis and determining response options/challenges for crisis levels.

Spontaneous Cerebellar Hemorrhage with the Fourth Ventricular Hemorrhage : Risk Factors Associated with Ventriculoperitoneal Shunt

  • Shin, Donguk;Woo, Hyun-Jin;Park, Jaechan
    • Journal of Korean Neurosurgical Society
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    • 제52권4호
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    • pp.320-324
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    • 2012
  • Objective : The purposes of this study are to investigate the factors that may be related to ventriculoperitoneal (VP) shunt in patients with cerebellar hematoma and the effect of severe fourth ventricular hemorrhage, causing obstructive hydrocephalus on subsequent VP shunt performance. Methods : This study included 31 patients with spontaneous cerebellar hematoma and concomitant fourth ventricular hemorrhage, who did not undergo a surgical evacuation of hematoma. We divided this population into two groups; the VP shunt group, and the non-VP shunt group. The demographic data, radiologic findings, and clinical factors were compared in each group. The location of the hematoma (whether occupying the cerebellar hemisphere or the vermis) and the degree of the fourth ventricular obstruction were graded respectively. The intraventricular hemorrhage (IVH) score was used to assess the IVH severity. Results : Ten out of 31 patients underwent VP shunt operations. The midline location of cerebellar hematoma, the grade of fourth ventricle obstruction, and IVH severity were significantly correlated with that of VP shunt operation (p=0.015, p=0.013, p=0.028). The significant variables into a logistic regression multivariate model resulted in statistical significance for the location of cerebellar hemorrhage [p=0.05; odds ratio (OR), 8.18; 95% confidence interval (CI), 1.00 to 67.0], the grade of fourth ventricle obstruction (p=0.044; OR, 19.26; 95% CI, 1.07 to 346.6). Conclusion : The location of the cerebellar hematoma on CT scans and the degree of fourth ventricle obstruction by IVH were useful signs for the selection of VP shunt operation in patients with spontaneous cerebellar hematoma and concomitant acute hydrocephalus.

만성피로증후군의 증상관리를 위한 추나요법의 유용성: 체계적인 문헌고찰과 메타분석 (Benefit of chuna for managing symptoms in chronic fatigue syndrome patients: A systematic review and meta-analysis)

  • 송정윤;김준열;남동현
    • 대한한의학회지
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    • 제41권3호
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    • pp.205-220
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    • 2020
  • Objectives: The aim of this review is to assess the clinical benefit of chuna for managing symptoms in chronic fatigue syndrome (CFS) Methods: We searched eligible studies from the following 11 databases with no language restriction: Pubmed, CENTRAL, Embase, CNKI, CQVIP, Wanfang, CiNii, OASIS, RISS and Koreamed. We selected randomized controlled trial (RCT), quasi-randomized controlled trial (Quasi-RCT) and controlled clinical trial (CCT) in which patients with chronic fatigue syndrome were treated with chuna. The results of the included studies were synthesized through meta-analysis, and their risk of bias were also assessed. Results: We searched 914 potentially relevant studies, and only 20 studies were selected for this systematic review. Meta-analysis showed that chuna was more effective in improving general symptoms (n=291, RR 0.19 [95% CI 0.11 to 0.32], Z=6.08, p<0.00001, I2=0%), fatigue (n=487, SMD -0.95 [95% CI -1.19 to -0.71], Z=7.76, p<0.00001, I2=37%) and sleep disorder (n=139, SMD -0.58 [95% CI -0.92 to -0.24], Z=3.36, p=0.0008, I2=0%) compared to health supplements or usual care. When chuna was used as an added intervention, it was more effective in improving general symptoms(n=729, RR 0.25 [95% CI 0.15 to 0.42], Z=5.19, p<0.00001, I2=0%) and fatigue severity alone(n=217, SMD -1.21 [95% CI -1.53 to -0.89], Z=7.45, p<0.00001, I2=15%) compared to control. Conclusion: We found that chuna was beneficial for improving severity of general symptoms and fatigue at post treatment in CFS patients.

미계측 유역에서의 확률강우에 대한 돌발홍수지수 산정 (Estimation of the Flash Flood Index by the Probable Rainfall Data for Ungauged Catchments)

  • 김응석;최현일;지홍기
    • 한국방재학회 논문집
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    • 제10권4호
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    • pp.81-88
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    • 2010
  • 최근 들어 기상 이변에 따라 단시간 동안에 특정 소유역에 집중하는 호우 또는 초과우량에 의한 국지성 돌발홍수가 빈번히 발생함에 따라, 이로 인한 인명과 재산의 상당한 위험과 손실은 전 세계적인 것으로서 우리나라도 증가일로에 있다. 돌발홍수는 일반적으로 급경사 소유역에서 집중적인 강우에 의해 발생하여 빠른 유출과 토석류를 동반하기 때문에, 홍수피해를 대비하기 위한 사전 홍수예보시간이 부족할 정도로 급격히 빠른 홍수의 특성을 보인다. 본 연구의 목적은 대상유역의 확률강우량으로부터 돌발홍수지수(flash flood index, FFI)를 산정하여 돌발홍수의 심각성 정도를 정량적으로 분석하고자 한다. 특히 미계측 유역하천에서의 지역 홍수예 경보를 위한 기초자료를 제공할 수 있도록, 대상유역에 대하여 상대적인 돌발홍수심도를 제시할 수 있는 FFI-D-F(돌발홍수지수-지속시간-빈도) 관계곡선을 개발하였다. 또한 FFI-D-F 관계곡선은 현존 및 계획 방재시설물의 돌발홍수 대응능력 및 잔여홍수위험 평가에 활용될 수 있을 것으로 기대된다.

자살을 시도한 우울증 환자에서 혈장 ${\beta}$-Nerve Growth Factor 농도의 변화 (Alteration of Plasma ${\beta}$-Nerve Growth Factor Concentration in Depressed Patients with Suicidal Attempt)

  • 심세훈;원성두;이분희;한창수;양종철;권영준;김용구
    • 생물정신의학
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    • 제13권2호
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    • pp.95-102
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    • 2006
  • Object : Nerve growth factor(NGF) is a protein involved in neuronal survival and plasticity in the central nervous system, which might play an important role in stress, depression and suicide. This study was performed to determine whether there is an alteration in plasma NGF concentrations in depressed patients with suicidal attempt. Methods : The subjects were 32 depressed patients who attempted suicide and admitted in emergency room. Forty-four hospitalized non-suicidal depressive patients and the 30 normal controls were closely matched with the suicidal group in terms of age and sex. Individuals in all 3 groups were evaluated independently by a semi-structured interview for the purpose of establishing a DSM-IV criteria diagnosis. The severity of depressive symptoms was evaluated using Hamilton depression rating scale(HDRS). The severity of the suicidal behavior was evaluated by Weisman and Worden's risk-rescue rating(RRR) system and the Lethality Suicide Attempt Rating Scale(LSARS). Plasma NGF level was measured by the enzyme linked immunosorbent assay(ELISA) method. Results : There were no statistically significant differences of the plasma NGF levels among groups. LSARS and RRR did not reveal any significant correlation with ${\beta}$-NGF level in suicidal depressive patients. Conclusion : This study do not support an association between ${\beta}$-NGF and suicidal depression. However it is necessary to investigate this association through other route such as postmortem brain.

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발병연령에 따른 공황장애 임상 양상의 차이 (Comparison of the Clinical Features According to the Age of Onset in Panic Disorder)

  • 신은숙;하주원;김형태;임세원;신동원;신영철;오강섭
    • 대한불안의학회지
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    • 제10권2호
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    • pp.108-114
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    • 2014
  • Objective : The correlation between age of onset and symptoms/severity of panic disorder has not yet been determined. The aim of this research is to determine the different clinical features of panic disorder according to the age of onset. Methods : Patients diagnosed with panic disorder were placed into two groups according to onset of age. The subjects were checked for 13 different panic symptoms presented in the DSM-IV. The investigation was also executed by severity, the anxiety sensitivity index, the scale for depression and anxiety. Results : The early onset group had significantly higher frequencies than the late onset group in the areas of "choking feeling" and "derealization or paresthesia". It was found that only "choking feeling" was statically significant as a risk factor of early onset panic disorder. Among the objective anxiety scale, the subscale of psychological anxiety was higher in the early onset group compared to the late onset group. Conclusion : "Choking feeling" was the only panic symptom that showed a significant difference in accordance with onset age. Earlier onset patients tend to experience a more frequent "choking feeling," which is related to respiratory symptoms. This could mean that earlier onset patients are more likely to have higher psychological anxiety.

고체 로켓 추진 기관의 신뢰성 분석을 위한 준-정량적 FMECA (Semiquantitative Failure Mode, Effect and Criticality Analysis for Reliability Analysis of Solid Rocket Propulsion System)

  • 문근환;김진곤;최주호
    • 대한기계학회논문집A
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    • 제39권6호
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    • pp.631-638
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    • 2015
  • 본 연구에서는 고체 로켓 추진 기관의 신뢰성 분석을 위해 준-정량적 FMECA를 수행하였다. 준-정량적 FMECA는 고장모드 및 영향 분석(FMEA)과 치명도 분석(CA)를 포함하는 분석 기법으로서, FMECA 수행을 위해서 FMEA는 고체 로켓 추진 기관을 43개의 부품으로 나누어 각 부품에 대하여 도출된 총 137개의 고장모드에 대해 수행하였다. 또한 일부 고장모드의 고장률 데이터를 이용하여 치명도 분석을 수행하였다. 준-정량적 FMECA 수행을 통하여 고체 로켓 추진 기관의 각 부품에서 발생 할 수 있는 잠재적 고장모드와 고장원인 및 영향을 분석, 정리할 수 있었으며, 우선적인 개선 조치가 필요한 중요 고장모드를 확인할 수 있었다.

고도 중증외상 환자에서 급성 혈액응고장애가 초기 및 조기 사망에 미치는 영향 (The Effect of Acute Coagulopathy in Profoundly Traumatic Patients on Acute and Early Deaths)

  • 노민수;양성수;경규혁
    • Journal of Trauma and Injury
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    • 제27권4호
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    • pp.158-164
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    • 2014
  • Purpose: Numerous studies have investigated the pattern of traumatic death with a focus on the injury mechanism, the severity of the injury and the presence of hemorrhage. Acute coagulopathy has been treated as only one of many complications. The purpose of this study was to investigate the influence of acute coagulopathy on acute and early death due to trauma. Methods: A retrospective analysis of trauma patients with injury severity score (ISS)${\geq}25$ who had been treated between January 2011 and December 2012 was conducted. Based on the time of injury, traumatic death was categorized into acute (within 48 hours) and early (from 3 to 7 days). The correlations between various parameters within 24 hours after injury and time of death were analyzed. Results: A total of 124 patients were enrolled. Of them, 8.1% (n=10) of the patients experienced acute mortality. For those patients, significant differences in initial systolic blood pressure, coagulopathy score, amount of transfusion, abbreviated injury scale of the head and neck, the abdomen and the extremities were noted. Early mortality was experienced by 7.0% (n=8) of the patients, only coagulopathy score was found to be a significant independent risk factor for acute (odds ratio: 3.127; 95% confidence interval: 1.185-8.252; p=0.021) and early mortality (odds ratio: 2.470; 95% confidence interval: 1.029-5.929; p=0.043). Conclusion: Acute traumatic coagulopathy has an important role in the mortality, even after the acute phase. Early management and prevention of acute coagulopathy may improve survival of trauma patients.