• 대한임상독성학회지
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• 제12권2호
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• pp.77-84
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• 2014

Purpose: Carbamate insecticides are potent cholinesterase inhibitors capable of causing severe cholinergic toxicity. Use of carbamate rather than organophosphate insecticides has been increasing. Compared with organophosphate poisoning, relatively few studies have investigated carbamate-associated acute pancreatitis. We investigated general characteristics and pancreatitis of carbamate poisoning and the predictors, among those readily assessed in the emergency department. Methods: We performed a retrospective review of consecutive patients, aged over 18 years, who were admitted between January 2008 and April 2012 to an emergency department (ED) of an academic tertiary care center for treatment of carbamate poisoning. Patients who exhibited poisoning by any other material, except alcohol, were excluded. After application of exclusion criteria, patients were divided according to carbamate-induced pancreatitis and non-pancreatitis groups. Results: A total of 41 patients were included in this study. Among these 41 patients, the prevalence of acute pancreatitis was 36.6% (15 patients). Initial blood chemistry tests showed a statistically higher glucose level in the pancreatitis group, compared with the non-pancreatitis group (222, IQR 189-284 vs. 137, IQR 122-175 mg/dL, P<0.05). Regarding clinical courses and outcomes, a significantly higher proportion of patients developed pneumonia [10 (66.7%) vs. 6 (23.1%), P<0.05] and had a longer hospital stay (7 days, IQR 6-12 vs. 5 days, IQR 2-11, P<0.05), but no difference in mortality, in the pancreatitis group vs. the non-pancreatitis group. In multivariate analysis, the initial glucose was showing significant association with the presentation of carbamate-induced acute pancreatitis (odds ratio 1.018, 95% confidence interval 1.001-1.035, P<0.05). Conclusion: Carbamate-induced acute pancreatitis is common, but not fatal. Initial serum glucose level is associated with acute pancreatitis.

• 융합정보논문지
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• 제12권5호
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• pp.246-255
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• 2022

본 연구는 임상간호사의 돌봄인성과 코로나19에 대한 지식이 대인돌봄행위에 미치는 영향을 확인하고자 시도되었다. 연구대상은 서울시의 1개 상급종합병원과 경기도 내의 2개 종합병원에서 근무하는 간호사였으며, 자료수집 기간은 2021년 10월15일부터 11월 5일까지였다. 총 130명의 간호사가 온라인 설문에 참여하였다. 수집된 자료는 SPSS/Win 27.0을 이용하여 단계적 다중 선형 회귀분석을 실시하여 분석하였다. 연구결과, 임상간호사의 대인돌봄행위에 영향을 미치는 요인은 돌봄인성(β=.50, p<.001), 나이(β=-.24, p=.002), 직업만족도(β=.16, p=.040)였으며 이들은 대인돌봄행위의 36.0%를 설명하였다(F=24.49, p<.001). 이를 통해 임상간호사의 대인돌봄행위를 향상시키기 위해서 돌봄인성과 직업만족도의 향상이 필요함을 알 수 있었다. 간호사의 돌봄인성 함양교육과 직무만족도 향상을 위한 병원의 노력이 필요하다.

• 한국콘텐츠학회논문지
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• 제22권2호
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• pp.794-802
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• 2022

본 연구의 목적은 심장판막 수술 받은 환자를 대상으로 전자의무기록 검토를 통해 퇴원 후 30일 내 비계획적 재입원군의 특성과, 재입원 영향요인을 규명하고자 하는 후향적 조사연구이다. 대상자는 S시에 위치한 상급종합병원에서 2018년 1월부터 2019년 8월까지 심장판막수술을 받고 포함기준에 맞는 퇴원환자 423명이었다. 비계획적 재입원 대상자는 총 48명(11.3%)이었고, 그 원인은 심방세동 13건 (27.1%)과 수술부위 통증이 13건(27.1%)으로 가장 많았고, 와파린의 치료농도가 안 맞는 경우 10건 (20.8%), 전신 위약감 7건 (14.6%). 저혈압 5건 (10.4%). 심낭삼출 4건 (8.3%), 수술상처 감염 3건 (6.3%), 출혈 3건 (6.3%), 고열 3건 (6.3%), 뇌경색 1건(2.1%)이었다. 재입원에 영향을 미치는 변수는 암의 병력 (OR=2.60, 95% CI 1.13-6.03, p=.025), 퇴원 후 거주지는 병원이 아닌 집으로 간 경우 (OR=2.91, 95% CI 1.33-6.36, p=.008), 판막수술종류로서 승모판막성형술이 대동맥판막 치환술보다 재입원률이 높았다(OR=1.21, 95% CI 1.21-4.98, p=.012). 비계획적 재입원 감소를 위해 환자와 돌봄 제공자에게 퇴원 전 만성질환병력관리와 재입원의 위험 요인을 미리 사정하고 병원 방문할 수 있도록 하는 개별화된 교육프로그램이 필요하다.

• 서비스연구
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• 제13권4호
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• pp.113-130
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• 2023

본 연구는 환자와 의료진의 경험을 중심으로 상급종합병원 권역응급의료센터의 서비스디자인을 적용한 단일 사례 연구이다. 서비스디자인 기법을 활용하여 의료 서비스 경험을 측정 및 개선하고, 그 효과를 검증하는 것을 목표로 한다. 환자와 의료진으로부터 심층적인 경험 데이터를 수집하기 위해 민족지학(ethnography)과 디자인 워크숍을 중심으로 한 질적 사례 연구를 진행했다. 이 연구는 응급 의료 서비스에서 직면한 문제에 특히 중점을 두고 환자와 의료진 간의 주요 경험 차이를 확인하였으며, 권역응급의료센터 환경의 복잡한 역학을 이해하기 위해 환자와 의료진 인터뷰, 디자인씽킹 워크숍을 통해 수집된 정성 데이터를 대해 종합적으로 분석하고 디자인에 반영했다.연구 결과, 환자와 의료진의 요구를 반영한 디자인 현황을 3가지 주요 측면인 소통 개선, 환자 흐름 관리, 환경 개선의 필요성이 강조되었으며, 환자와 의료진 두 그룹의 특정 요구 사항의 차이점을 분석하여 권역응급의료센터의 서비스 개선을 위해 디자인 주도의 실행 과정을 적용 할 수 있었다. 이 연구는 의료 분야에서 디자인의 역할과 중요성을 강조하며, 이론적인 연구와 실제 디자인 실행 간의 효율적인 방법을 제시하고 있다. 이를 통해 더욱 빠르고 효과적이며 만족도가 높은 의료 서비스 환경을 만드는 데 기여할 수 것이다. 그리고 서비스디자인이 환자와 의료진 모두의 만족을 위한 새로운 혁신 과정의 핵심으로 보는 새로운 계기가 되기를 기대한다.

• Asian Pacific Journal of Cancer Prevention
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• 제13권9호
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• pp.4373-4378
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• 2012

Introduction: Hypercalcemia is mainly caused by bone resorption due to either secretion of cytokines including parathyroid hormone-related protein (PTHrP) or bone metastases. However, hypercalcemia may occur in patients with or without bone metastases. The present study aimed to describe the effect of chemotherapy treatment, regimens and doses on calcium levels among breast and lung cancer patients with hypercalcemia. Methods: We carried a review of medical records of breast and lung cancer patients hospitalized in years 2003 and 2009 at Penang General Hospital, a public tertiary care center in Penang Island, north of Malaysia. Patients with hypercalcemia (defined as a calcium level above 10.5 mg/dl) at the time of cancer diagnosis or during cancer treatment had their medical history abstracted, including presence of metastasis, chemotherapy types and doses, calcium levels throughout cancer treatment, and other co-morbidity. The mean calcium levels at first hospitalization before chemotherapy were compared with calcium levels at the end of or at the latest chemotherapy treatment. Statistical analysis was conducted using the Chi-square test for categorical data, logistic regression test for categorical variables, and Spearman correlation test, linear regression and the paired sample t tests for continuous data. Results: Of a total 1,023 of breast cancer and 814 lung cancer patients identified, 292 had hypercalcemia at first hospitalization or during cancer treatment (174 breast and 118 lung cancer patients). About a quarter of these patients had advanced stage cancers: 26.4% had mild hypercalcemia (10.5-11.9 mg/dl), 55.5% had moderate (12-12.9 mg/dl), and 18.2% severe hypercalcemia (13-13.9; 14-16 mg/dl). Chemotherapy lowered calcium levels significantly both in breast and lung cancer patients with hypercalcemia; in particular with chemotherapy type 5-flurouracil+epirubicin+cyclophosphamide (FEC) for breast cancer, and gemcitabine+cisplatin in lung cancer. Conclusion: Chemotherapy decreases calcium levels in breast and lung cancer cases with hypercalcemia at cancer diagnosis, probably by reducing PTHrP levels.

• 한국산학기술학회논문지
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• 제18권9호
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• pp.334-346
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• 2017

본 연구는 병원에서 근무하고 있는 간호사의 업무 스트레스를 극복하고 직무를 지속할 수 있게 하는 내면적 특성을 파악하여 병원 간호사의 조기 이직을 감소시키고 근무 지속력을 향상시키기 위한 방법을 모색하는데 기여하고자 수행되었다. 서울과 경기 지역 내 위치한 상급종합병원 2곳과 종합병원 3곳에서 근무하고 있는 경력 5년 이상의 간호사 12명을 추천 받아 포커스 그룹 면담을 3차례에 걸쳐 수행하였다. 자료 수집 기간은 2016년 1월 27일부터 4월 20일까지였다. 면담 내용을 내용분석 방법으로 분석한 결과, 병원에서 직무를 지속하고 있는 경력 간호사의 내면적 특성 및 강점이 4개의 범주와 13개의 하위범주로 나타났다. 연구에서 도출된 4개의 범주는 '자기극복을 위한 노력', '긍정적인 자세', '주변 관계와의 소통과 지지', 그리고 '간호전문직으로서의 성장 도모'였다. 연구에서 드러난 이러한 간호사의 강점을 강화시킬 수 있는 중재의 적용이 필요하며, 그를 위해서 자기 극복력을 강화하고 긍정적 자세와 소통 능력을 신장시키며 직업 정체성을 확립시키게 하는 자기성찰 훈련 및 교육이 필요함을 제언한다.

• Journal of Trauma and Injury
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• 제27권2호
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• pp.13-19
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• 2014

Purpose: In general, X-ray examinations are not recommended for radial head subluxation (pulled elbow) patients. The purpose of this study was to determine the frequency of X-ray examinations and to investigate the factors associated with the decision to perform an X-ray examination on a patient with a pulled elbow. Methods: Patients who visited the pediatric emergency department (ED) of one tertiary hospital from January 1, 2011, to December 31, 2012, with a diagnosis of radial head subluxation at discharge were enrolled in this study. Through retrospective chart reviews, factors that could have influenced the decision to perform an X-ray examination and their statistical relevance were analyzed. Results: A total 308 patients were enrolled, and 101 patients (32.8%) underwent X-ray examinations. Among the 252 patients with a typical pulled elbow, 65 underwent X-ray examination. This result showed statistical significance compared to atypical pull-elbow group (25.8% vs. 64.3%, p<0.001). Factors associated with the decision to perform an X-ray examination were analyzed using the Chi-square test and the Fisher's exact test. The mechanism of injury and consultation with an orthopedic surgeon (p=0.001) showed statistical significance. In the multivariable logistic regression, the odds ratio (OR) for the injury mechanism was 4.7 (95% CI: 1.8~8.8, p<0.001) and that for consultation with an orthopedic surgeon was 8.0 (95% CI: 1.6~40.7, p=0.004). Conclusion: One third of patients with a pulled elbow underwent X-ray examination, and patients with an atypical mechanism of injury underwent more frequent X-ray examinations than did patients with a typical mechanism of injury. The factors that could have influenced the decision to perform an X-ray examination were mechanism of injury and consultation with an orthopedic surgeon.

• 대한후두음성언어의학회지
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• 제30권1호
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• pp.39-47
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• 2019

Background and Objectives : Pediatric vocal health problems are relatively common. However, it is not yet well studied whether uniform diagnosis and treatment is done properly in South Korea. The purpose of this study was to investigate the methods that the Korean speech therapists use to diagnose and treat pediatric voice problem. Materials and Method : An anonymous online questionnaire was administered to 32 speech language therapists registered at the Korean laryngeal speech linguistics society detailing demographics, employment institution, general management of pediatric patients with vocal problem including assessment and treatment procedures. Results : Current practice patterns were analyzed on 32 speech language therapists providing services in South Korea mostly working at tertiary university hospital. One third of pediatric patients were assessed without proceeding to treatment. One fifth of patients were treated without assessment. Perceptual assessment was the main pretreatment assessment methods used. Treatment was done in the following order : Voice rest, SOVT, yawn-sigh and resonant voice. Post-treatment evaluation was used in the following order : Instrumental assessment, clinical judgment, and recording comparison. Conclusion : Speech language therapists practice in South Korea mostly follows the ASHA practice guidelines. However, there are still great amount of cases in which only the evaluation was done without appropriate treatment. Further research is needed to make SPLs more systematic and efficient for evaluating and treating pediatric vocal patients.

• 대한간호학회지
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• 제24권4호
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• pp.584-596
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• 1994

The objective of the study is to explore the relationships between the variables of nursing productivity on the framework of system del in the tertiary university based care hospital in Korea. Productivity is basically defined as the relation-ship between inputs and outputs. Under the proposition that the nursing unit is a system that produces nursing care output using personal and material resources through the nursing intervention and nursing care management. And this major conception of nursing productivity system comproises input, process and output and feed-back. These categorized variables are essential parts to produce desirable and meaningful out-put. While nursing personnel from head nurse to staff nurses cooperate with each other, the head nurse directs her subordinates to achieve the goal of nursing care unit. In this procedure, the head nurse uses the leadership of authority and benevolence. Meantime nursing productivity will be greatly influenced by environment and surrounding organizational structures, and by also the operational objectives, the policy and standards of procedures. For the study of nursing productivity one sample hospital with 15 general nursing care units was selected. Research data were collected for 3 weeks from May 31 to June 20 in 1993. Input variables were measured in terms of both the served and the server. And patient classification scores were measured drily by degree of nursing care needs that indicated patent case-mix. And also nurses' educational period for profession and clinical experience and the score of nurses' personality were measured as producer input variables by the questionnaires. The process varialbes act necessarily on leading input resources and result in desirable nursing outputs. Thus the head nurse's leadership perceived by her followers is defined as process variable. The output variables were defined as length of stay, average nursing care hours per patient a day the score of quality of nursing care, the score of patient satisfaction, the score of nurse's job satis-faction. The nursing unit was the basis of analysis, and various statistical analyses were used : Reliability analysis(Cronbach's alpha) for 5 measurement tools and Pearson-correlation analysis, multiple regression analysis, and canonical correlation analysis for the test of the relationship among the variables. The results were as follows : 1. Significant positive relationship between the score of patient classification and length of stay was found(r=.6095, p.008). 2. Regression coefficient between the score of patient classification and length of stay was significant (β=.6245, p=.0128), and variance explained was 39%. 3. Significant positive relationship between nurses’ educational period and length of stay was found(r=-.4546, p=.044). 5. Regression coefficient between nurses' educational period and the score of quality of nursing care was significant (β=.5600, p=.029), and variance explained was 31.4%. 6. Significant positive relationship between the score of head nurse's leadership of authoritic characteristics and the length of stay was found (r=.5869, p=.011). 7. Significant negative relationship between the score of head nurse's leadership of benevolent characteristics and average nursing care hours was found(r=-.4578, p=.043). 8. Regression coefficient between the score of head nurse's leadership of benevolent characteristics and average nursing care hours was significant(β=-.6912, p=.0043), variance explained was 47.8%. 9. Significant positive relationship between the score of the head nurse's leadership of benevolent characteristics and the score of nurses' job satis-faction was found(r=.4499, p=050). 10. A significant canonical correlation was found between the group of the independent variables consisted of the score of the nurses' personality, the score of the head nurse's leadership of authoritic characteristics and the group of the dependent variables consisted of the length of stay, average nursing care hours(Rc²=.4771, p=.041). Through these results, the assumed relationships between input variables, process variable, output variables were partly supported. In addition it is also considered necessary that-further study on the relationships between nurses' personality and nurses' educational period, between nurses' clinical experience including skill level and output variables in many research samples should be made.

• Tuberculosis and Respiratory Diseases
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• 제58권3호
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• pp.285-290
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• 2005

연구 배경 : 면역 기능 저하를 초래하여 결핵의 재활성화에 관여할 것으로 생각되는 주기적인 항암화학요법치료 중인 고형암 환자에서 발생한 결핵의 임상적 특징과 치료 반응을 파악하고자 하였다. 대상 및 방법 : 2000년 1월부터 2004년 7월까지 국내 일개 3차 병원에서 항암화학요법 치료 중에 세균학적으로, 병리학적으로 또는 임상적으로 진단된 결핵 환자 중 기존에 알려진 결핵 재활성화의 위험 요인이 없는 22명을 대상으로 후향적 연구를 시행하였다.. 결 과: 22명의 평균 연령은 56.5세(21세-78세)였고, 남녀비는 3.4:1였다. 폐결핵이 가장 흔한 양상이었으며 (20례, 90.9%), 기저 질환으로 위암 (10례, 45.4%)과 림프종(4례, 18.2%)이 흔하였으며, 폐암, 두경부암, 유방암, 자궁경부암 및 난소암 순이었다. 15례 (68.2%)에서 환자가 흉부 방사선 사진 상 결핵 반흔이 있었다. 간기능이 저하된 1명을 제외한 21명이 isoniazid와 rifampicin을 기본으로 하는 초치료를 시작하였으며, 평균 치료기간은 $9.9{\pm}2.4$개월이었다. 기저 질환으로 사망한 5명을 제외하면 70.6%의 환자가 치료를 완료하였다. 결 론 : 항암화학요법 치료 중에 발생한 결핵의 임상적인 특징 및 치료에 대한 반응은 기존에 보고된 일반 인구에서 발생한 폐결핵의 특성과 크게 다르지 않았다.