• 한국산학기술학회논문지
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• 제17권8호
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• pp.662-672
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• 2016

본 연구의 목적은 간호 대학생을 대상으로 표준화환자를 활용한 통합시뮬레이션실습프로그램을 개발 및 적용하여 그 효과를 평가하기 위함이다. 본 연구는 일 종합대학 간호학과 4학년 30명을 대상으로 한 단일군 사전사후설계로 지역사회에 거주하는 당뇨를 동반한 만성알코올중독대상자 간호를 위한 시나리오를 개발하였다. 연구결과 통합시뮬레이션실습프로그램 후 의사소통 능력은 프로그램 실시 전보다 유의하게 향상하였으나(t=4.24, p<.001) 전이동기와 학습 자기효능감은 프로그램 전과 후를 비교하였을 때 통계적으로 유의한 향상을 나타내지 못하였다. 또한 의사소통능력과 학습자기효능감, 의사소통능력과 전이동기 사이의 상관관계는 유의하지 않았으나, 학습효능감과 전이동기 사이에는 양적 상관관계가 측정되었다(r=.758, p<.01). 이는 학생들의 학년과 실습경험을 바탕으로 한 적절한 사례를 개발하여 적용함으로서 전이동기를 높이고 문제해결을 통한 학습자기효능감을 증가시키는 것을 알 수 있었다. 본 연구를 통해 표준화환자를 활용한 시뮬레이션학습은 의사소통 능력과 같은 대상자중심의 간호능력을 향상시킬 수 있는 통합실습프로그램으로서 유용함을 확인하였으며, 향후 의사소통능력 뿐 아니라 학습 자기효능감과 전이동기의 향상을 위한 다양한 통합시뮬레이션학습 시나리오개발에 관한 연구가 필요하다.

• 한국방사선학회논문지
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• 제9권6호
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• pp.357-362
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• 2015

테크네슘을 이용한 침샘검사의 시간-방사능 곡선에서 다양한 기능매개변수지표를 획득하여 환자 군과 건강한 정상군과의 비교를 통해 유용성을 알아보고자 하였다. 2014년 12월부터 2015년 2월까지 구강 건조증으로 침샘검사를 시행한 환자군 30명과 건강한 정상군 10명을 대상으로 하였다. 99mTc-과산화테크네슘 370 MBq을 정맥으로 주사 후 20분에 비타민C 파우더를 입안에 투여하여 10분 동안 촬영하였다. 분석방법은 귀밑샘과 턱밑샘의 관심영역을 정하여 시간-방사능 곡선을 그린 후 곡선의 각 위치에서 다양한 기능매개변수 지표를 획득하고, 구강 건조증 환자군와 정상군을 비교하였다. 비교 및 측정에 적용된 방법으로는 섭취율(uptake ratio, UR), 최대 방사능 시간(time at maximum counts, Tmax), 최소 방사능 시간(time at minimum counts, Tmin), 최대 축적율(maximum accumulation, MA), 축적 속도(accumulation velocity), 최대 배출율(maximum secretion, MS), 최대 자극 배출율(maximum stimulation secretion, MSS), 배출속도(secretion velocity, SV)를 사용하였다. 환자군과 정상군간의 기능매개변수지표 비교에서 환자군의 최소 방사능 시간(Tmin)을 제외한 모든 지표에서 건강한 정상군이 환자군에 비하여 유의한 차이를 보였고, 시간에 따른 변화량에서도 정상군이 환자군에 비하여 유의한 차이를 보였다. 결론적으로 침샘검사에서 다양한 기능매개변수지표를 이용한 정량분석은 구강 건조증 환자의 침샘 기능을 객관적이고 표준화된 정보로 평가하는데 유용할 것으로 사료된다.

• 핵의학기술
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• 제14권2호
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• pp.93-99
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• 2010

위암 환자의 PET/CT검사 시에 전신 검사를 한 후 물을 약 300 mL 정도 마시게 한 후 환자의 위가 위치한 부분을 추가적으로 검사를 진행하고 있다. 이는 오랜 금식으로 인해 위의 위-아래 위벽이 붙어있어 진단에 어려움이 있기에 물을 마시게 함으로써 위벽을 팽창시켜 진단의 효율을 높이기 위함이다. 검사 시에 보통 환자의 자세는 앙와위즉, 바르게 누운 자세에서 검사가 이루어지고 있다. 본 연구에서는 같은양의 물을 먹이고 복와위 즉, 바르게 엎드린 자세에서 촬영하여 앙와위에서 촬영 시와 위 체부의 용적의 팽창 정도를 비교하고, 이를 바탕으로 위의 구조상 하단부에 위치한 유문부와 위의 아래쪽 병변에 대한 정확한 위치와 진단의 효율을 높이고자 한다. 또한, 두 자세의 검사 영상을 비교하여 위의 용적의 차이를 수치화 시키고, 표준화 섭취계수의 변화가 있는지의 여부를 알아보고자 한다. 본원에서 2009년 7월-2010년 1월까지 조기 위암과 진행성 위암을 진단 받고, 수술을 하기 전의 환자와 부분절제를 한 후 추적 검사를 하고 있는 30명을 대상으로 하였다. 검사를 위해 환자에게 $^{18}F$-FDG 7.4 MBq(0.2 mCi/kg)을 정맥주사하고 60분간 누운 자세로 안정을 취하도록 하였다. 검사 시작 전 물을 300 mL 마시게 한 후 먼저 환자를 앙와위로 눕히고 위 부분을 PET/CT 촬영하고, 전신 촬영 한 후 환자에게 다시 물을 300 mL 마시게 한 후 복와위로 눕히고 위 부분을 PET/CT 촬영하였다. 위 체부의 용적을 앙와위와 복와위에서 비교해본 결과 30명의 환자에서 앙와위 평균 위 체부의 용적은 460.29 $mm^2$이고, 복와위 평균 위 체부의 용적은 641.39 $mm^2$로 평균적으로 약 41.3%확장된 것으로 나타났다. 그리고, 앙와위와 복와위에서 위 종양의 최대 표준화 섭취 계수를 각각의 환자에게서 비교해 보았을 때 거의 차이가 없는 것으로 나타났다. 위의 결과로 보았을 때 앙와위 검사보다 복와위에서 환자의 검사가 위 체부의 용적이 보다 더 확장된다는 것을 알 수 있었다. 또한 표준화 섭취 계수의 변화가 없는 것으로 나타났기 때문에 앙와위에서의 판독 결과와 다르지 않다는 것을 보여주고 있다. 거동이 불편한 환자에게는 복와위 추가 촬영이 어렵겠지만, 앙와위 추가 촬영과 더불어 복와위 추가 촬영을 한다면 위암환자의 진단에 많은 도움이 되리라 생각되고, 거동이 불편한 환자에게 사용할 수 있는 복와위 에서의 보조용구의 연구에도 도움이 되리라 사료된다.

• 대한임상독성학회지
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• 제15권1호
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• pp.17-23
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• 2017

Purpose: Activated charcoal (AC) has been widely used as a universal antidote. Currently, emergency medical centers in Korea cannot administer AC due to discontinuation of the supply of commercial ready-mixed AC suspension. This study was conducted to investigate the proportion of emergency medical centers that administer AC to poisoning patients and provide basic information for emergency physicians and toxicologists. Methods: A prospective telephone survey of all of the included emergency medical institutions was conducted. The type of emergency medical institution, average annual number of patients admitted to the emergency department, annual average number of patients who were poisoned and whether the hospital currently utilizes gastric lavage and administration of AC were determined. Results: AC was administered to poisoning patients in 40% of regional emergency medical centers, 59.3% of local emergency medical centers, and 45.9% of local emergency medical rooms. Overall, 37% of total emergency medical institutions did not administer AC due to discontinuation of the commercial ready-mixed AC suspension. Additionally, 77% of emergency physicians in institutions without AC knew AC is necessary for poisoning patients. The rate of vomiting experienced by the medical staff according to types of charcoal showed that the average rate of vomiting was 33% for commercial ready-mixed activated charcoal suspension and 51% for self-prepared charcoal powder (p=0.02). Conclusion: AC should be secured promptly in emergency medical institutions. Before the supply of commercial ready-mixed AC suspension becomes again it is essential to develop a standardized regimen for self-preparation of charcoal powder and to educate emergency physicians and toxicologists to its use.

• 지역사회간호학회지
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• 제14권2호
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• pp.312-322
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• 2003

Purpose: This study is aimed to analyze the trend of research on pulmonary rehabilitation of patients with COPD (Chronic Obstructive Pulmonary Disease), and to suggest a direction for future research of pulmonary rehabilitation of COPD. Method: A total of 39 studies published from 1991 to 2002 were examined according to the year of publication, type of journal, characteristics of patients, rehabilitation program, research design, and instruments and research findings. Results: 1) The number of studies related to pulmonary rehabilitation of COPD patients has rapidly increased since 1996's (87.18%) 2) There were 10 studies published in the chest. There were 6 studies published in domestic journals and 33 studies published in international journals. 3) The samples in the studies were mostly outpatients whose lung function was moderate. 4) The total period of the pulmonary rehabilitation program shown in the literature was 5 to 12 weeks. The programs included exercise interventions, educational interventions and psychosocial interventions. 5) The outcomes of the pulmonary rehabilitation were measured with lung function, 6-minute walk test, dyspnea, and chronic respiratory disease questionnaire. Research findings were found to be effective on 6-minute walk test, dyspnea, and chronic respiratory disease questionnaire but not on lung function. Conclusion: Based on these findings, pulmonary rehabilitation should be further emphasized, and standardized protocols and community based pulmonary rehabilitation programs need to be provided. More qualitative research should also be conducted in the future to describe the experiences of the pulmonary rehabilitation of patients with COPD.

• Asian Pacific Journal of Cancer Prevention
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• 제15권3호
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• pp.1281-1283
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• 2014

Background: Gallbladder cancer (GBC) is a rare malignancy characterized by high invasiveness and poor survival. In a nation-wide cancer survey, the age-standardized incidence rate of GBC was the highest in Jeju Island compared to 15 other provinces in Korea. The purpose of this study was to compare the clinical outcomes of GBC according to the nature of diagnosis, that is, incidental versus non-incidental. Materials and Methods: Consecutive patients who were newly diagnosed with GBC at the Digestive Disease Center and Department of Internal Medicine, Cheju Halla General Hospital, between November 2008 and November 2011, were enrolled and divided into 2 groups: incidental gallbladder cancer (IGBC) and non-incidental gallbladder cancer (NIGBC). Clinical outcomes were retrospectively compared between the two groups. Results: Seventy-nine patients were enrolled and analyzed in our study. Thirty-three (41.8%) and 46 (58.2%) were identified as IGBC and NIGBC, respectively. The proportions of patients with gallstone disease, gallbladder polyp, and cholecystectomy were significantly different between the two groups. Additionally, the median survival rate was significantly higher for patients with IGBC than for those with NIGBC (11.4, 95% confidence interval, 5.6-13.7 vs 4.0, 95% confidence interval 3.03-5.96 months; p=0.01) during a median follow-up period of 5.7 months. Conclusions: Patients with IGBC showed better clinical prognosis than those with NIGBC. Therefore, patients with gallstone disease or gallbladder polyps, major predictive risk factors for IGBC, should undergo advanced work-up for chelecystectomy.

• 한국임상약학회지
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• 제27권3호
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• pp.161-170
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• 2017

Background: There is recent evidence that insulin resistance is responsible for increasing the risk of developing cognitive dysfunction. To systematically review the influence of intranasal insulin treatment on the cognitive function in Alzheimer's disease patients. Methods: Randomized controlled trials comparing the cognitive effects of intranasal insulin therapy in Alzheimer's disease patients with controlled interventions were retrieved from Pubmed, Medline, Embase and Cochrane library. Meta-analysis was conducted on the cognitive measurements with a subgroup analysis by dose, gender and apolipoprotein E allele 4 (ApoE ${\varepsilon}4$) status. Results: Seven randomized controlled trials were eligible for inclusion. Intranasal insulin had a positive influence on the cognitive function as compared to placebo without a statistical significance (standardized mean difference; SMD = 0.109; 95% confidence interval; CI -0.04 to 0.26; P=0.14). In subgroup analysis, a 20 IU dose of intranasal insulin induced a significant improvement in cognitive function (SMD = 0.14; 95% CI 0.05 to 0.24; P=0.004), but 40 IU did not show this effect (SMD = -0.01; 95% CI -0.11 to 0.09; P=0.82). ApoE ${\varepsilon}4$ positive patients showed a significant decline in cognitive function as compared to ApoE ${\varepsilon}4$ positive patients in the control group (SMD = -0.213; 95% CI -0.38 to -0.04; P=0.015). Such an effect was not apparent in ApoE ${\varepsilon}4$ negative patients. Gender had no influence on the cognitive outcomes. Conclusion: The results indicate that intranasal insulin may have beneficial effect in improving the cognitive function in Alzheimer's disease patients.

• 한국임상약학회지
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• 제30권2호
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• pp.92-101
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• 2020

Background: Delirium is a neuropsychiatric disorder characterized by sudden impairments in consciousness, attention, and perception. The evidence of successful pharmacological interventions for delirium is limited, and medication recommendations for managing delirium are not standardized. This study aimed to provide evidence of antipsychotics for symptomatic treatment of delirium in cancer patients receiving palliative care. Methods: We retrospectively reviewed adult cancer patients in palliative care who received antipsychotic delirium treatment at Severance Hospital between January 2016 and June 2019. The efficacy was evaluated primarily by resolution rates. The resolution of delirium was defined as neurological changes from drowsiness, confusion, stupor, sedation, or agitation to alertness or significant symptomatic improvements described in the medical records. The safety was studied primarily by adverse drug reaction incidence ratios. Results: Of the 63 enrolled patients, 60 patients were included in the statistical analysis and were divided into three groups based on which antipsychotic medication they were prescribed [quetiapine (n=27), haloperidol (n=25) and co-administration of quetiapine and haloperidol (n=8)]. The resolution ratio showed quetiapine to be more effective than haloperidol (p=0.001). No significant differences were seen in adverse drug reaction rates among the three groups (p=0.332). Conclusions: Quetiapine was considered the most effective medication for delirium, with no significant differences in adverse drug reaction rates. Therefore, quetiapine may be considered a first-line medication for treating delirium in cancer patients receiving palliative care. However, further studies comparing more diverse antipsychotics among larger populations are still needed.

• 한국산학기술학회논문지
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• 제17권2호
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• pp.66-74
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• 2016

본 연구는 소책자를 이용한 간호정보제공이 내시경 점막하 박리술 환자의 시술 전 불안 및 불확실성에 미치는 효과를 알아보기 위한 유사실험 연구로 비동등성 대조군 전후 시차설계 연구이다. 자료 수집은 2013년 2월 13일 부터 4월 26일 까지 46명을 대상으로 시행되었다. 대조군 23명은 기존의 중재 방법인 구두설명과 표준화된 양식 없이 일반적인 시술전 교육을 받았고 실험군 23명은 본 연구자가 개발한 소책자를 통한 간호정보제공을 받았다. 수집된 자료는 SPSS 21.0을 이용하여 ${\chi}^2$ test, Fisher's exact t-test로 분석하였다. 실험군은 대조군보다 불안(t=3.319, p=.002), 불안 행동반응(t=3.508, p=.001)이 유의하게 감소하였으나 불확실성은 차이를 보이지 않았다(t=.745, p=.460). 소책자를 이용한 간호정보제공은 위내시경시술 환자의 시술 전 불안을 감소시키는데 유용한 간호중재이다.

• 한국의료질향상학회지
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• 제10권1호
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• pp.42-56
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• 2003

Background : The purpose of this study is to investigate the influencing factors on the length of emergency department stay of patients with acute myocardial infraction. Methods : we reviewed medical records of all patients who were Hospitalized with acute myocardial infraction from March 1, 2002 to February 28, 2003. Results : The average length of stay in the emergency room of the subjects was 182.74 minutes. After the emergency room treatment, 48.1% of the subjects were transferred to intensive care unit. The hospitalization through emergency room mostly took place in the office hours. There were more patients on Monday. The influencing factors on the length of stay in the emergency room of patients with acute myocardial infraction were emergency room arrival time which was classified in seasons, treatment hours of specialized doctors, medical care insurance and required time of radiologic examination. Conclusion : In order to reduce the length of emergency room stay, it might be an available solution secure enough spaces, facility, and staff of the radiologic test only for the patients of the emergency room. And the effective use of emergency facility and space, establishment of standardized treatment guideline, and provision of emergency treatment support system are also needed.