• 한국융합학회논문지
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• 제9권6호
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• pp.1-7
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• 2018

최근 IT 기술이 발달함에 따라 병원에서 사용되고 있는 의료 장비도 고사양의 성능을 요구하고 있다. 그러나, 사용자는 사용자의 상황에 따라 서로 다른 병원을 내원하기 때문에, 병원에서 진료 받은 의료 정보가 병원마다 분산되어 있다. 본 논문에서는 서로 다른 병원에 내원한 사용자의 헬스케어 정보 수집을 위해서 병원에 저장되어 있는 사용자의 헬스케어 정보를 효율적으로 통합하기 위한 모델을 제안한다. 제안모델은 사용자 중심의 헬스케어 정보 수집을 위해서 개인 웨어러블 장치로부터 수집된 사용자의 헬스케어 정보를 서로 동기화한다. 또한, 제안 모델은 헬스케어 서비스 센터와 데이터 공유를 원활하게 수행하기 위해서 클라우드 환경에 존재하는 데이터베이스에서 사용자의 헬스케어 정보와 관련된 무결성 및 유효성 검사를 수행한다. 특히, 제안모델은 모바일 플랫폼으로부터 수집된 사용자의 헬스케어 정보를 원활하게 관리하기 위해서 트리기반의 데이터 처리를 수행할 수 있도록 하였다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제5권2호
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• pp.186-191
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• 2002

구토, 심한 보챔, 고열, 복수를 동반한 복부 팽만 등 급성 복막염의 양상을 보인 10개월 된 여아에서 복부 천자 후 담즙성 복막염 의심하에 $^{99m}Tc$ DISIDA 간담도 스캔을 시행하여 진단된 총 담관낭의 자연 천공에 의한 담즙성 복막염 1례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• Journal of Trauma and Injury
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• 제34권4호
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• pp.299-304
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• 2021

Atypical hemolytic uremic syndrome (aHUS) is a rare, progressive, life-threatening condition of thrombotic microangiopathy characterized by thrombocytopenia, microangiopathic hemolytic anemia, and renal impairment. The mechanisms underlying aHUS remain unclear. Herein, we present the first case in the literature of aHUS after a traumatic injury. A 55-year-old male visited the emergency department after a traumatic injury caused by a tree limb. Abdominal computed tomography revealed a rectal wall defect with significant air density in the perirectal space and preperitoneum, implying rectal perforation. Due to the absence of intraperitoneal intestinal perforation, we performed diverting sigmoid loop colostomy. An additional intermittent simple repair was performed due to perianal and anal injuries. One day postoperatively, his urine output abruptly decreased and serum creatinine level increased. His platelet level decreased, and a spiking fever occurred after 2 days. The patient was diagnosed with acute renal failure secondary to aHUS and was treated with fresh frozen plasma replacement. Continuous renal replacement therapy (CRRT) was also started for oliguria and uremic symptoms. The patient received CRRT for 3 days and intermittent hemodialysis thereafter. After hemodialysis and subsequent supportive treatment, his urine output and renal function improved. The hemolytic anemia and thrombocytopenia also gradually improved. Dialysis was terminated on day 22 of admission and the patient was discharged after recovery. This case suggests that that a traumatic event can trigger aHUS, which should be considered in patients who have thrombocytopenia and acute renal failure with microangiopathic hemolytic anemia. Early diagnosis and appropriate management are critical for favorable outcomes.

• 대한두경부종양학회지
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• 제38권1호
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• pp.17-24
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• 2022

Background/Objectives: This study analyzed the prognostic significance of clinico-pathologic factors including comprehensive nodal factors in parotid gland cancers (PGCs) patients and constructed a survival prediction model for PGCs patients using machine learning techniques. Materials & Methods: A total of 131 PGCs patients were enrolled in the study. Results: There were 19 cases (14.5%) of lymph nodes (LNs) at the lower neck level and 43 cases (32.8%) involved multiple level LNs metastases. There were 2 cases (1.5%) of metastases to the contralateral LNs. Intraparotid LNs metastasis was observed in 6 cases (4.6%) and extranodal extension (ENE) findings were observed in 35 cases (26.7%). Lymphovascular invasion (LVI) and perineural invasion findings were observed in 42 cases (32.1%) and 49 cases (37.4%), respectively. Machine learning prediction models were constructed using clinico-pathologic factors including comprehensive nodal factors and Decision Tree and Stacking model showed the highest accuracy at 74% and 70% for predicting patient's survival. Conclusion: Lower level LNs metastasis and LNR have important prognostic significance for predicting disease recurrence and survival in PGCs patients. These two factors were used as important features for constructing machine learning prediction model. Our machine learning model could predict PGCs patient's survival with a considerable level of accuracy.

• Journal of Hospice and Palliative Care
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• 제25권2호
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• pp.76-84
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• 2022

Purpose: We compared cost-effectiveness parameters between inpatient and home-based hospice-palliative care services for terminal cancer patients in Korea. Methods: A decision-analytic Markov model was used to compare the cost-effectiveness of hospice-palliative care in an inpatient unit (inpatient-start group) and at home (home-start group). The model adopted a healthcare system perspective, with a 9-week horizon and a 1-week cycle length. The transition probabilities were calculated based on the reports from the Korean National Cancer Center in 2017 and Health Insurance Review & Assessment Service in 2020. Quality of life (QOL) was converted to the quality-adjusted life week (QALW). Modeling and cost-effectiveness analysis were performed with TreeAge software. The weekly medical cost was estimated to be 2,481,479 Korean won (KRW) for inpatient hospice-palliative care and 225,688 KRW for home-based hospice-palliative care. One-way sensitivity analysis was used to assess the impact of different scenarios and assumptions on the model results. Results: Compared with the inpatient-start group, the incremental cost of the home-start group was 697,657 KRW, and the incremental effectiveness based on QOL was 0.88 QALW. The incremental cost-effectiveness ratio (ICER) of the home-start group was 796,476 KRW/QALW. Based on one-way sensitivity analyses, the ICER was predicted to increase to 1,626,988 KRW/QALW if the weekly cost of home-based hospice doubled, but it was estimated to decrease to -2,898,361 KRW/QALW if death rates at home doubled. Conclusion: Home-based hospice-palliative care may be more cost-effective than inpatient hospice-palliative care. Home-based hospice appears to be affordable even if the associated medical expenditures double.

• Asian Pacific Journal of Cancer Prevention
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• 제14권3호
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• pp.2037-2042
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• 2013

Background: Different methods of diagnosis have been found to be inefficient in terms of screening and early diagnosis of lung cancer. Cancer cells produce proteins whose serum levels may be elevated during the early stages of cancer development. Therefore, those proteins may be recognized as potential cancer markers. The aim of this study was to differentiate healthy individuals and lung cancer cases by analyzing their serum protein profiles and evaluate the efficacy of this method in the early diagnosis of lung cancer. Materials and Methods: 170 patients with lung cancer, 53 under high risk of lung cancer, and 47 healthy people were included in our study. Proteomic analysis of the samples was performed with the SELDI-TOF-MS approach. Results: The most discriminatory peak of the high risk group was 8141. When tree classification analysis was performed between lung cancer and the healthy control group, 11547 was determined as the most discriminatory peak, with a sensitivity of 85.5%, a specificity of 89.4%, a positive predictive value (PPV) of 96.7% and a negative predictive value (NPV) of 62.7%. Conclusions: We determined three different protein peaks 11480, 11547 and 11679 were only present in the lung cancer group. The 8141 peak was found in the high-risk group, but not in the lung cancer and control groups. These peaks may prove to be markers of lung cancer which suggests that they may be used in the early diagnosis of lung cancer.

• 한국산학기술학회논문지
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• 제12권6호
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• pp.2668-2676
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• 2011

손상입원환자의 재원일수 변이요인을 분석하기 위해 질병관리본부의 퇴원손상환자 자료를 이용하여 재원일수 중증도 보정모형을 개발하였다. 이 모형을 적용, 보정값을 산출하고 실측값과의 차이를 이용하여 재원일수를 표준화한 후 재원일수의 변이를 분석하였다. 입원손상환자의 중증도 보정 재원일수에 영향을 미치는 주요 요인은 중증도, 수술유무, 연령, 손상기전, 입원경로 등으로 나타났다. 의사결정나무 모형에 의하여 재원일수의 보정값을 산출하여 실측값과의 차이를 분석한 결과 병원규모(병상수)별, 보험유형별, 기관 소재지별로 통계적으로 유의한 차이가 있는 것으로 나타났다. 따라서 재원일수의 변이를 줄이기 위해 국가차원에서 진료행위프로토콜을 개발하여 의료기관에서 이를 활용하도록 유도하고, 더 나아가 이를 체계적으로 평가하여 지속적으로 노력하여야 할 것이다.

• Journal of Chest Surgery
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• 제24권1호
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• pp.15-25
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• 1991

From February 1988 to December 1990, 42 patients underwent so called REV operation for pulmonary stenosis or atresia with or without anomalies of ventriculoarterial connection and truncus arteriosus. The principles of operative technique are mobilization of pulmonary arterial tree beyond the pericardial reflection, transection of pulmonary trunk between the pulmonary ventricle and pulmonary artery, suture of distal pulmonary arterial stump to the upper margin of Pulmonary ventriculotomy site with absorbable suture, and anterior patch with 0.625% glutaraldehyde fixed autologous pericardium with monocusp inside it. Age at operation ranged 3-156months [mean 41.8 month] with twelve of whom infants. Operative indications were pulmonary atresia, with ventricular septal defect[16], and pulmonary stenosis with double outlet right ventricle[8], with ventricular septal defect[16], with double outlet right ventricle[8], with complete transposition of the great arteries[8], with corrected transposition of the great arteries[6], with Fallot`s tetralogy[3], and truncus arteriosus[1]. There were six hospital deaths[14%] and no late death. Twenty-four of 36 survivals were followed up more than 12 months with good clinical results. Postoperative angiocardiogram was performed in fifteen patients. Hemodynamically, two patents had residual pressure gradients along the pulmonary outflow tract, one patient showed severe pulmonary regurgitation; morphologically, there were six significant stenosis of left pulmonary arterial tree, two of whom showed significant pressure gradients. Our present experience with REV operation suggests that this technique make it possible to perform anatomic repair in a wide variety of congenital anomalies of abnormal ventriculoarterial connection associated with pulmonary outflow tract obstruction without using the prosthetic material, even in infants, with relatively low mortality and morbidity.

• 중환자간호학회지
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• 제11권3호
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• pp.45-57
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• 2018

Purpose : This study was performed to identify the influencing factors of unplanned intensive care unit (ICU) readmission. Methods : The study adopted a Rretrospective case control cohort design. Data were collected from the electronic medical records of 844 patients who had been discharged from the ICUs of a university hospital in Incheon from June 2014 to December 2014. Results : The study found the unplanned ICU readmission rate was to be 6.4%(n=54). From the univariate analysis revealed that, major symptoms at $1^{st}$ ICU admission, severity at $1^{st}$ ICU admission (CPSCS and APACHE II), duration of applying ventilator application during $1^{st}$ ICU admission, severity at $1^{st}$ discharge from ICU (CPSCS, APACHE II, and GCS), and application of $FiO_2$ with oxygen therapy, implementation of sputum expectoration methods, and length of stay of ICU at $1^{st}$ ICU discharge were appeared to be significant; further, decision tree model analysis revealed that while only 4 variables (sputum expectoration methods, length of stay of ICU, $FiO_2$ with oxygen therapy at $1^{st}$ ICU discharge, and major symptoms at $1^{st}$ ICU admission) were shown to be significant. Conclusions : Since sputum expectoration method was the most important factor to predictor of unplanned ICU readmission, a assessment tool for the patients' capability of sputum expectoration needs to should be developed and implemented, and standardized ICU discharge criteria, including the factors identified from the by empirical evidences, might should be developed to decrease the unplanned ICU readmission rate.

• 한국지능시스템학회논문지
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• 제21권6호
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• pp.730-736
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• 2011

본 연구는 순차적인 시계열 자료들에서 가장 최근의 추세가 반영될 수 있는 패턴분류 모델을 설계하였다. 의사결정을 지원하는 데이터마이닝 패턴분류 모델을 설계할 때 통계 기법과 인공지능 기법을 융합한 모델들이 기존의 모델보다 우수함을 입증하였다. 특히 퍼지이론과 융합된 패턴분류 모델들의 적중률이 상대적으로 더 향상되었다. 예를 들어, 통계적 이론을 기반으로 한 SVM모델과 퍼지소속함수와의 결합, 혹은 신경망과 FCM을 결합한 모델들의 성능이 우수하였다. 실험에서 사용한 패턴분류 모델들은 BPN, PNN, FNN, FCM, SVM, FSVM, Decision Tree, Time Series Analysis, Regression Analysis 등이다. 그리고 데이터베이스는 시계열 속성을 지닌 금융시장의 경제지표 DB(한국, KOSPI200 데이터베이스)와 병원 응급실의 부정맥환자에 대한 심전도 DB(미국 MIT-BIH 데이터베이스)들을 사용하였다.