• 대한치과보철학회지
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• 제56권4호
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• pp.330-337
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• 2018

무치악 환자에게 임플란트 지지 고정성 보철수복 치료는 그 효용성이 검증되었으나, 복잡한 치료과정이 수반된다. 반면, 현대 치의학에서 디지털 기술력은 나날이 발전하여 현재 무치악 환자의 임플란트 수복치료까지 그 범위를 확장하였다. 본 증례에서는 66세 하악 무치악 환자의 임플란트 고정성 보철 수복에 대하여 진단부터 수술, 임시수복물 및 최종수복물의 디자인과 제작까지 디지털 시스템을 모든 단계에 이용하였다. 수술 전 진단단계에서 구강스캐너를 이용한 점막스캔과 환자의 안정적인 기존 총의치 교합을 토대로 임시수복물을 디자인하였다. 수술가이드를 이용하여 무절개 임플란트 식립 후에 사전제작한 임시수복물을 임플란트와 연결하여 즉시 임시수복물로써 사용하였다. 디지털 기술을 이용하여 안정적인 교합이 형성된 임시수복물의 수직고경과 중심위를 이전하여 최종수복물을 디자인 및 제작 하였다. 디지털 기술을 활용하여 환자의 수직고경과 교합을 보전하는 방법을 사용함으로써 무치악환자에서 복잡할 수 있는 임플란트 치료의 간단한 프로토콜을 정립하였기에 보고하는 바이다.

• Journal of Radiation Protection and Research
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• 제20권1호
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• pp.25-36
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• 1995

The purpose of this research is to develop stereotactic localization and radiation measurement system for the efficient and precise radiosurgery. The algorithm to obtain a 3-D stereotactic coordinates of the target has been developed using a Fisher CT or angio localization. The procedure of stereotactic localization was programmed with PC computer, and consists of three steps: (1) transferring patient images into PC; (2) marking the position of target and reference points of the localizer from the patient image; (3) computing the stereotactic 3-D coordinates of target associated with position information of localizer. Coordinate transformation was quickly done on a real time base. The difference of coordinates computed from between Angio and CT localization method was within 2 mm, which could be generally accepted for the reliability of the localization system developed. We measured dose distribution in small fields of NEC 6 MVX linear accelerator using various detector; ion chamber, film, diode. Specific quantities measured include output factor, percent depth dose (PDD), tissue maximum ratio (TMR), off-axis ratio (OAR). There was small variation of measured data according to the different kinds of detectors used. The overall trends of measured beam data were similar enough to rely on our measurement. The measurement was performed with the use of hand-made spherical water phantom and film for standard arc set-up. We obtained the dose distribution as we expected. In conclusion, PC-based 3-D stereotactic localization system was developed to determine the stereotactic coordinate of the target. A convenient technique for the small field measurement was demonstrated. Those methods will be much helpful for the stereotactic radiosurgery.

• 구강회복응용과학지
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• 제19권4호
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• pp.297-308
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• 2003

Face-bow is used to transfer models to the articulator in diagnosing the patient or treating problems associated with occlusion. However, there have been few reports on the reliability of the face-bow procedure and the relationship between the experience of the operator and the reliability of the face-bow procedure. The purposes of this study are to examine the reliability of the face-bow procedure and to evaluate whether the face-bow transferring has any training effect. Nine dentists working at M hospital conducted a face-bow transfer in one patient having a normal dentition and interdental relationship. The procedure was done two times a week for four weeks. The maxillary model was mounted to the articulator every time, then the landmarks on the maxillary right first molar, the maxillary left central incisor, and the maxillary left first molar were measured with a special three-dimensional instrument. These data were input into a computer, and evaluated statistically. The results were as follows ; 1. When examined with ANOVA test, the results were p=0.2040 in maxillary right first molar, p=0.0578 in maxillary left incisor, and p=0.1433 in maxillary left first molar. There was no significant(0< $p{\leq}0.05$). 2. Training 1) The correlation coefficient between trial and rejection was -0.578 when analyzed with T-distribution. The more we tried, the less errors we found. 2) When the S.D. of the first three trials was compared to the S.D. of the last three trials in face-bow transfer, the results showed that the former was larger than the latter in thirty-nine times, and the latter was larger than the former in fifteen times. The more we tried face-bow transfer, the less errors we found. 3. When the S.D. of x, y, z coordinates were examined, the S.D. of x coordinates had the largest measurement in five times, the S.D. of y coordinates had the largest measurement in four times, and the S.D. of z coordinates had the largest measurement in nine times. The possibility which the error can occur in z coordinate was the highest.

• Journal of Trauma and Injury
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• 제23권2호
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• pp.75-82
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• 2010

Purpose: In Korea, trauma is the $3^{rd}$ most common cause of death. The trauma treatment system is divided into pre-hospital and hospital stages. Deaths occurring in the pre-hospital stage are 50% of the total death, and 20% of those are deaths that are preventable. Therefore, the purpose of our study is to calculate the preventable death rates caused by trauma in our current pre-hospital system, to analyze the appropriateness of the treatment of traumatized patients and to draw a conclusions about the problems we have. Methods: The study was done on traumatized patients who expired at the emergency department from January 1, 2005, to December 31, 2009, at the Korea University Medical Centers in Anam, Guro and Ansan. The data on the patients were reviewed retrospectively based on characteristics, conditions on admission and trauma severity. The patient's RTS (revised trauma score) and ISS (injury severity score) was calculated. Preventable death rate was calculated by TRISS (the trauma score-injury severity score). Results: A total of 168 patients were enrolled. All patients were intubated and underwent CPR. Of the total, 72% patients were male, and traffic accidents were the most common form of trauma (52.4%), falls being second (28.6%). Head injury, solitary or multiple, was the most common cause of death (55.4%). Thirty-eight (38, 22.6%) deaths were preventable. The 22.6% preventable death rate consisted of 15.5% potentially preventable and 7.1% definitely preventable deaths. Based on a logistic regression analysis, the relationship between the time intervals until transfusion and imaging and death was statistically significant in the hospital stage. In the pre-hospital stage, transit time from the site of the injury to the hospital showed a significant relationship with the mortality rate. Conclusion: One hundred sixty-eight (168) patients died of trauma at the 3 hospitals of Korea University Medical Center. The TRISS method was used to calculate the preventable death rate, with a result of 22.6%. The only factor that was significant related to the preventable death rate in the pre-hospital stage was the time from injury to hospital arrival, and the time intervals until transfusion and imaging were the two factors that showed significance in the hospital stage. Shortening the time of treatment in the field and transferring the patient to the hospital as quickly as possible is the most important life-saving step in the pre-hospital stage. In the hospital stage, the primary survey, resuscitation and diagnosis should proceed simultaneously.

• Journal of Trauma and Injury
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• 제25권4호
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• pp.159-165
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• 2012

Purpose: For trauma patients, an early-transport and an organized process which are not delayed in hospital stage are necessary. Our hospital developed a procedure, the trauma Critical Pathway (CP), through which a traumatic patient has the priority over other patients, which makes the diagnostic and the therapeutic processes faster than they are for other patients. Methods: The records of patients to whom Trauma CP were applied from January 1, 2011 through April 15. 2012. were reviewed. We checked several time intervals from ER visiting to decision of admission-department, to performing first CT, to applying angio-embolization, to starting emergency operation and to discharging from ER. In addition, outcomes such as duration of ICU stay, hospital stay and mortality were checked and analyzed. Results: The trauma CP was applied to a total of 143 patients, of whom, 48 patients were excluded due to pre-hospital death, ER death, transferring to other hospital and not severe injury. Thus 95 patients (male 64, 67.3%) were enrolled in this study. Fifty-nine patients(62.1%) were injured by the traffic accident. The mortality rate was 10.5% and the mean Revised Trauma Score (RTS) of the patients was $6.4{\pm}2.0$. After visiting ER, decision making for admission was completed, on average, in 3 hours 10 seconds. The mean time intervals for the first CT, angio-embolization, surgery and discharge were 1 hour 20 minutes, 5 hours 16 minutes, 7 hours 26 minutes and 6 hours 13 minutes, respectively. Conclusion: The trauma CP did not show the improvement of time interval outcome, as well as mortality rate. However, this test did show that the trauma CP might be able to reduce delays in procedures for managing trauma patients at the university-based hospitals. To find out the benefit of CP protocol, a large scaled data is required.

• 한국재난정보학회 논문집
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• 제18권4호
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• pp.839-846
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• 2022

연구목적:감염병 유행시 감염병 의심 환자의 구급활동을 위해 출동한 소방대원의 안전을 확보하고, 현장에서 수집된 정보를 바탕으로 지역별 감염병 의심환자 발생 현황을 파악하여 현장 통제 및 지원이 가능한 소방 감염병 관리 시스템을 개발하고자 한다. 연구방법: 감염병 의심 환자를 분류할 수 있는 스마트폰 앱을 개발하여 감염병 의심 여부를 확인하고, 감염병 의심 환자로부터 감염을 방지하기 위해 환자 식별용 NFC 태그를 1회용 형태로 개발한다. 현장에서 입력되는 감염병 의심 응급환자 관련 데이터를 수집하고 분석할 수 있는 관리 시스템을 개발하여 해당 업무 관련자에게 제공하여 감염병 의심 응급환자의 이송을 개선하는지 평가한다. 연구결과: 실험결과 스마트폰 앱에 구현된 알고리듬을 통해 감염병 의심 여부를 판단할 수 있었으며, 적정 이송병원으로 이송함으로써 재이송 비율히 현저히 감소되었다. 결론:본 연구를 통해 응급의료 서비스에 ICT 기술을 적용하여 응급의료 서비스를 개선할 수 있는 가능성을 확인하였으며, 특히 감염병 의심환자에 대한 적정병원 이송으로 이송시간 단축 및 응급환자의 소생률 향상과 함께 구급대원의 안전을 적극적으로 확보할 수 있을 것으로 기대된다.

• 의료법학
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• 제25권1호
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• pp.87-115
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• 2024

우리나라는 급격한 발전과 더불어 많은 성장을 이루는 과정에서 스트레스에 노출이 정신적 고통을 수반하게 되었고 다양한 사회문제로 나타나며, 응급입원의 빈도가 높아지고 있다. 정신질환자의 경우 '비자의 입원'이 문제가 되며, 경찰, 119구급대원이 정신질환자의 신체억제를 시도하며, 많은 문제점이 노출되고 있다. 이는 정신건강복지법 상 응급입원의 조항의 구성요건이 현실을 반영하지 못해 하나의 정신질환자를 두고 각 기관이 다른 입장을 내며, 응급입원이 원활하게 진행되지 않거나, 관계기관의 마찰로 이어지며 정신질환자의 안전이나, 타인의 안전이 확보되지 못하는 경우가 발생하고 있다. 응급입원은 주체가 '정신질환자로 추정되는 사람으로 자신의 건강 또는 안전이나 다른 사람에게 해를 끼칠 위험이 큰 사람을 발견한 사람'으로 정하고 있으며, 그 상황이 매우 급박하여 스스로 입원을 결정하는 입원절차를 거칠 시간적 여유가 없는 경우 의사와 경찰관의 동의를 얻어 응급입원을 의뢰할 수 있다고 규정하고, 이 경우 119구급대원이 정신의료기관까지의 호송하도록 하고 있다. 이러한 응급입원의 조항은 정신의료기관까지 이송하는 과정에 많은 문제를 내포하고 있다. 실무를 담당하는 경찰관이나 119구급대원이 응급입원과정 중 '물리력'을 사용하게 되면, 필연적으로 부작용이 발생하게 되는데, 업무상과실이 문제가 될 수 있으며, 구체적으로는 물리력을 행사할 때 법령에 근거하고 비례원칙에 따른 필요최소한도의 신체억제가 필요하게 되는데, 법령상 119구급대원이나 경찰관의 주의의무의 부재가 결국 다른 법령을 적용하여 해결하게 된다는 것이다. 이에 정신건강복지법 상 응급입원 조항의 주체를 경찰, 소방기관의 장점을 살려 주체를 변경하고, 정신보건법의 시행규칙으로 신체보호대 사용을 정의하고, 규정함으로써 119구급대원과 경찰관의 주의의무를 설정하고 정신질환자가 안전하게 치료받을 수 있도록 이송에 대한 환경을 조성함으로써 자기 또는 타인의 위험을 내포하고 있는 정신질환자 또한 안전한 환경에서 정신의료기관으로 이송될 수 있는 계기가 될 것이다.