• Title/Summary/Keyword: clinical character

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The Use of Nursing Diagnosis in Practice (간호진단의 임상적용 현황, 문제점 및 개선방안)

  • 박신애;강현숙;문희자;김광주;이향련;조미영;조결자;김윤희;김귀분
    • Journal of Korean Academy of Nursing
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    • v.19 no.1
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    • pp.24-39
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    • 1989
  • This study was conducted to investigate the present situation and problems related to the use of nursing diagnosis in practice. The data were obtained from 332 subjects (27 director of nursing service, 302 staff nurses) who worked in university hospitals in Korea from July through August 1988 using a mailed questionnaire. Data were analyzed by frequency, X$^2$ test and t-test. The findings were as follows ; 1, Clinical use of nursing diagnosis by directors of nursing service and staff nurses. 1) The majority of the nursing departments (88.9%) conducted group education on nursing diagnosis during the last 5 years and 81.5% of them kept a record format for nursing diagnosis : 88.9% of them had had prior experience with the nursing diagnosis. 2) Most of nurses (97.0%) had received education on nursing diagnosis. 2. Factors related to the clinical use of nursing diagnosis in nursing service departments and by staff nurses. 1) The one factor related to the use of nursing diagnosis in the nursing service department was the existence of a record. 2) Factors related to the use of nursing diagnosis by the staff nurses were the organization style of the nursing service department, group education during the last 5 years, existence of a record, the attitude of the director of nursing service, and prior experience of the use of the nursing diagnosis as characteristics of nursing service department and educational experience of nursing diagnosis as a character of nurse. 3. Problems with the use of nursing diagnosis. 1) The primary problem was the lack of time and personnel (mean : 3.757) ; the second problem was the lack of knowledge and will to use nursing diagnosis in practice by the staff nurses(mean : 3.546). 2) There was no significant difference in problems expressed by the director of nursing services and the nurses. The majority of nurses who worked in the university hospitals expressed interest in and concern about the use of nursing diagnosis. Most of the nurses had had education about on nursing diagnosis but use in practice was limited. The primary problem was lack of time and manpower. Strategies for improving use of the nursing diagnosis in practice : 1) Strengthening the education about nursing diagnosis and a holistic approach to understanding human beings. 2) Develop protocols for the use of nursing diagnosis. 3) Eliminate the language barrier regarding nursing diagnosis by translation into in Korean. 4) Decentralization of the nursing service to promote accountability by individual nurses for use of nursing diagnosis.

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Clinical Characteristics of Panic Disorder with Comorbid Major Depressive Disorder (주요우울장애를 동반한 공황장애 환자군의 임상적 특징)

  • Lee, Sun-Woo;Lee, Kang Soo;Lee, Sang-Hyuk
    • Korean Journal of Biological Psychiatry
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    • v.25 no.3
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    • pp.45-52
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    • 2018
  • Objectives The objective of this study was to investigate the differences in sociodemographic and clinical characteristics, temperaments, and quality of life between panic disorder (PD) patients with and without major depressive disorder (PD+MDD and PD-MDD patients, respectively). Methods We compared 411 PD-MDD and 219 PD+MDD patients. All patients who were drug-free for at least 1 month were assessed at initial outpatient visits before the administration of medication. The following instruments were used for assessment: the NEO Personality Inventory-Neuroticism (NEO-N) ; the Temperament and Character Inventory-Harm Avoidance (TCI-HA) ; the State-Trait Anxiety Inventory (STAI) ; the Intolerance of Uncertainty Scale-Short (IUS); the Anxiety Sensitivity Index-Revised (ASI-R); the Beck Depression Inventory (BDI) ; the Beck Anxiety Inventory (BAI); the Penn State Worry Questionnaire (PSWQ) ; the Generalized Anxiety Disorder for 7 item (GAD-7) ; the Albany Panic and Phobia Questionnaire (APPQ) ; the Panic Disorder Severity Scale (PDSS) ; the Early Trauma Inventory Self Report-Short Form (ETISR-SF) ; the Scale for Suicidal Ideation (SSI) ; the World Health Organization Quality of Life Scale Abbreviated Version (WHOQOL-BREF) ; the Sheehan Disability Scale (SDS) ; and the Short Form health survey (SF-36). Results Compared to the PD-MDD patients, the PD+MDD patients were younger and more likely to be unmarried. They showed higher rates of unemployment, lower levels of education and income, younger age of onset, more previous suicide attempts, a greater incidence of agoraphobia, and more previous treatments. The PD+MDD patients showed significantly higher scores on the NEO-N, the TCI-HA, the STAI, the IUS, the ASI-R, the BDI, the BAI, the PSWQ, the GAD-7, the APPQ, the PDSS, the ETISR-SF, and the SSI. In addition, the PD+MDD patients showed significantly lower quality of life than did the PD-MDD patients. In contrast with previous studies, we observed no significant differences between the two groups in terms of gender, duration until treatment, and psychiatric comorbidities. Conclusions This study showed that the PD+MDD patients have more early trauma experiences, higher levels of anxiety-related temperaments, more severe panic and depressive symptoms, and lower quality of life than the PD-MDD patients.

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Peripheral Dose Distributions of Clinical Photon Beams (광자선에 의한 민조사면 경계영역의 선량분포)

  • 김진기;김정수;권형철
    • Progress in Medical Physics
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    • v.12 no.1
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    • pp.71-77
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    • 2001
  • The region, near the edge of a radiation beam, where the dose changes rapidly according to the distance from the beam axis is known as the penumbra. There is a sharp dose gradient zone even in megavoltage photon beams due to source size, collimator, lead alloy block, other accessories, and internal scatter ray. We investigate dosimetric characteristics on penumbra regions of a standard collimator and compare to those of theoritical model for the optimal use of the system in radiotherapy. Peripheral dose distribution of 6 W Photon beams represents penumbral forming function as the depth. Also we have discussed that the peripheral dose distribution of clinical photon beams, differences between calculation dose use of emperical penumbral forming function and measurements in penumbral region. Predictions by emperical penumbral forming functions are compared with measurements in 3-dimensional water phantom and it is shown that the method is capable of reproduceing the measured peripheral dose values usually to within the statistical uncertainties of the data. The semiconductor detector and ion chamber were positioned at a dmax depth, 5cm depth, 10cm depth, and its specific ratio was determined using a scanning data. The effective penumbra, the distance from 80% to 20% isodose lines were analyzed as a function of the distance. The extent of penumbra will also expand with depth increase. Difference of measurement value and model functions value according to character of the detector show small error in dose distribution of the peripheral dose.

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The role type analysis of nursing leader for effective environment at the practice field that nursing students recognize - Q methodology - (간호 대학생이 인식하는 실무현장의 효과적 환경을 위한 간호리더자의 역할유형분석)

  • Sim, In Ok;Song, Geon Woo;Lee, Ji Hyun
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.16 no.11
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    • pp.7801-7811
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    • 2015
  • Nursing students do a variety of learning at the practice field during clinical practice. They can recognize the importance and effectiveness of nursing leader. The purpose of this study was to categorize the types by analyzing what are important aspects of nursing leader's role to make effective practice environment nursing students experienced from training course. This research was used Q methodology to understand how nursing students recognize deeply. Participants were involved 30 nursing students who have experienced nursing practices. Q samples included 36 statements gathered from interviews with students who experienced clinical practices and literatures regarding types of nursing leader's role. Furthermore, major factors were analyzed and categorized by using QUANL PC program. As a result of research, there are 4 types of nursing leader's role. The first type is "Maintaining justice and level-headed", the second type is "Creating environment for motivation", the third is "Respecting character and growing capacity up" and the fourth is "Relationship center through confidence". Through the research process, this study is about to make evidences by understanding role of nursing leader for effective environment of practice field.

A Study on Qian Yi(錢乙)'s Medical Though (전을(錢乙)의 의학사상(醫學思想)에 관(關)한 연구(硏究))

  • Oh, Jun Hwan;Kim, Ki Wook;Park, Hyun Kook
    • The Journal of Korean Medical History
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    • v.14 no.2
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    • pp.109-152
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    • 2001
  • Throughout this paper, I adjusted the study of 'Qian Yi'(錢乙)'s Medical Thought, and the following is the summary. 1. 'Qian Yi' wrote 'Xiao Er Yao Zheng Zhi Jue'("小兒藥證直訣", edited by 誾季忠), and there were 'Shang Han Lun Zhi Wei'("傷寒論指微"), 'Ying Ru Lun', however those are loss of the record. 2. Qian Yi's 'Zhi Jue'("直訣") was influenced by 'Lu Xin Jing', yet if we compare the quality of 'Sheng Li, Byeng Li, Bang Jae'(生理, 病理, 方劑), 'Lu Xin Jing' cannot be the foundation of 'Zhi Jue'. He took over 'Nei Jing, Shang Han Lun, Jin Gui Yao Lue, Shen Long Ben Cao Jing, Tai Ping Sheng Hui Fang'("內經", "傷寒論", "金?要略", "神膿本草經", "太平聖惠方") and put them together to the direct clinical experiences of pediatrics. 3. There is no reference regarding the difficulties of pediatric diagnosis and diseases in 'Huang Di Nei Jing'("黃帝內經") Before 'Bei Song'(北宋), regardless of the lack of data related to pediatric diseases, 'Qian Yi' established the pediatric system in 'Xiao Er Yao Zheng Zhi Jue' for the first time. 4. In his diagnosis of the pediatric diseases, he 'Si Zhen He Can'(四診合參), also considered in the eye exam seriously. In addition, he closely combined 'Wu Zang Bian Zheng'(五臟辨證), and diagnosis the pediatric diseases. 5. 'Wu Zang Bian Zheng', what Qian established method was based on 'Zheng Ti Guan'(整體觀) in 'Huang Di Nei Jing'. It was based on clinical experiences and established the perspectives of 'Tian Ren Xiang Ying'(天人相應). First of all, he pinpointed 'Zhu Zheng'(主證) clearly. Secondly, he pinpointed the relationships to symptoms and then, he distinguished a generic character of 'Xu, Shi, Han, Re'(虛, 實, 寒, 熱). Finally, he made an induction from genealogical pediatric physiology. 6. 'Qian Yi' took a serious view of 'Ban Zhen'(斑疹), the inadequate field in those days. At that time, he criticized on the habituation of the misuse of medication. He treated separately which 'Ji Jing'(急驚) as 'Liang Xie'(凉瀉) and 'Man Jing'(慢驚) as 'Wen Bu'(溫補). He proposed 'Cong Gan Zhu Feng, Xin Zhu Jing'(從肝主風, 心主驚) theory and formulated 'Jing Feng'(驚風) theory as well. 7. As an opponent of a tendency to misusage of medicine, 'Qian Yi' made out a prescription with pliant medicine. He emphasized on the treatment to 'Gong Bu Shang Zheng, Bu Bu Zhi Xie, Xiao Bu Jian Shi'(攻不傷正, 補不滯邪, 消補兼施) because he had so lucid demonstration to 'Xu Shi Han Re'(虛實寒熱) of the five viscera in the field of 'Bang Yak'(方藥). 8. There were no pediatrics schools at that time, however, the pediatrics was being made up gradually by 'Jin Yuan Si Da Jia'(金元四大家) who was influenced by 'Qian Yi'. He raised an objection to medical treatment using pliant medicine. 'Qian Yi' applied 'Qu Xia'(驅下) treatment using 'Han Liang'(寒凉) medicine. 'Han Liang Pai'(寒凉派) is greatly influenced by Qian. 'Chen Wen Zhong'(陳文中) had a great impact on 'Han Liang Pai' who used a 'Zao Shu Wen Bu'(燥熟溫補) medicine for treatment. Since 'Song Jin'(宋金), he had a tremendous influence on pediatrics treating patients in both 'Han Wen'(寒溫) ways. 9. 'Qian Yi' had an influence on his medical thoughts on future generations, especially to 'Wan Quan'(萬全) of 'Ming Dai', 'Wu Tang'(吳塘) of 'Qing Dai'(淸代) and 'Yun Shu Jie'(?樹珏) of 'Min Guo'(民國). 'Wan Quan' is an advocate of 'You Yu, Bu Zu Zhi Shuo'(有餘, 不足之說)of 'Xiao Er Wu Zang'(小兒五臟) that he revealed Qian's 'Wu Zang Bian Zheng'(五臟辨證). 'Wu Tang' disclosed Qian's 'Xiao Er Ti Zhi Shuo'(小兒體質說) and 'Xiao Er Ke'(小兒科)'s 'Yong Yao Lun'(用藥論), therefore, he uncovered pediatric physiological characteristics through the advocate of Qian's 'Zang Fu Rou Ruo, Ji Gu Nen Qie, Yi Xu Yi Shi, Yi Han Yi Re' (臟腑柔弱, 肌骨嫩怯, 易虛易實, 易寒易熱). 'Yun Shu Jie' developed intrinsic relationships among time, symptom and 'Tian Ren Xiang Ying Guan'(天人相應觀), What 'Qian Yi' stated about them. And also, he developed Qian's 'Di Huang Wan'(地黃丸), 'Xie Qing Wan'(瀉靑丸), 'Yi Huang San'(益黃散) clinical usages as well. 10. Regarding Qian's 'Wu Zang Xu Shi'(五臟虛實), it has an influence on 'Zhang Yuan Su'(張元素)'s 'Zang Fu Bing Ji Bian Zheng'(臟腑病機辨證). 'Di Huang Wan', 'Xie Qing Wan', 'Xie Xin Tang'(瀉心湯), 'Yi Huang San', 'Xie Huang San'(瀉黃散) are the standard prescription of 'Wu Zang Bu Xie'(五臟補瀉). It is under the influence of Qian's treatment. Besides, 'Qian Yi' took a serious view of 'Xiao Er'(小兒)'s 'Pi Wei'(脾胃). 'Qian Yi' had an impact on 'Li Dong Yuan'(李東垣) one of the member of 'Bu Tu Pai'(補土派). 'Di Huang Wan', which placed great importance on 'Bu Yi Shen Yin'(補益腎陰), had a great impact on 'Da Bu Yin Wan'(大補陰丸) and 'Jin Yuan Si Da Jia' as well. 11. In a theory of Qian's 'Wu Zang Bian Zheng', though it had been stated clearly in 'Wu Zang Bian Zheng', but he neglected in 'Liu Fu Bian Zheng'(六腑辨證). In prescription field, The problem with the medicine is that it is either toxic or mineral, therefore, we are not able to use those medicine in a clinical testing at the present time.

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A Study of the "Ikkando Medicine" in Japanese Oriental Medicine (일본(日本) 한방의학(韓方醫學)의 체질의학(體質醫學)인 《일관당의학(一貫堂醫學)》에 관(關)한 고찰(考察))

  • Joh, Kiho;Park, Seong Sik;Terasawa, Katsutoshi;Shimada, Yutaka;Lee, Won Chul
    • Journal of Sasang Constitutional Medicine
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    • v.9 no.1
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    • pp.339-352
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    • 1997
  • The oriental medicine based on the traditional chinese medicine has developed according to the historical and racial character respectively in China, Korea and Japan etcs. Particularly, the distinctive feature of Korea & Japan is characterized by the development of constitutional medicine compared with chinese medicine; Sasang Medicine of Korea and Ikkando Medicine of Japan. The constitutional medicines were so far developed by many clinical doctors, and in recent years much interest has centered on the application of these medicines in regarding originality, easiness and effectiveness etcs in treatment. Thus far only few attempts have been made at Ikkando medicine in Korea, what seems to be lacking, however, is practical application in clinic. Thus authors intend to help the clinical application by introducing Ikkando medicine to Korea oriental medicine through this paper. The Ikkando medicine was established by Dohaku Mori(1869~1931) and was known through the "Kampo Ikkando Medincine" which was published by his disciple, Kaku Yakazu(1893~1966), classified human beings into three types; type of blood stasis, type of stroke and type of allergy. The type of blood stasis may be responsible for factors which have occurred by a state of insufficient bleed circulation and blood stasis causing lesione of endothelial cells, and Tongdosan is mainly administrated. The predisposing factor of stroke's type is known as the excessive diet, and the prevalence of cerebrovascular accident is probably higher. In this type, it is likely that patients are prevented and cured with Bangpungtongsunsan. Allergy's type have three distinct types of childhood, adolescence and adult as to the age. Allergy's type of childhood predisposes patients such as these to upper respiratory infection and tuberculosis etcs, and Sihocheonggansan is frequently administrated. Allergy's type of adolescence has a tendency to rhinitis and infection of face legion etcs, and Heunggyeyeoungyotang is mainly administrated. Allergy's type of adult is subject to urogenital infection, and is more commonly treated with Yongdamsagantang. Judging from the above, we can say with fair certainty that Ikkando Medicine has considerable validity to clinical practice, though it should not be pushed too far.

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A Clinical Study of Tinnitus (耳鳴에 관한 임상적 연구)

  • Choi, In-Hwa
    • The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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    • v.14 no.2
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    • pp.134-145
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    • 2001
  • Introduction: Noises in the ear, whether real or imagined, are called tinnitus. Subjective causes of tinnitus(which is heard only by the patient) are extremely common and the majority of them are treated conservatively. For certain individuals their tinnitus is a major handicap; for others a trivial concern. The most common from of subjective tinnitus is a rushing, hissing or buzzing noise; it is frequently associated with sensorineural heanng loss. The patient may be unaware of the hearing loss, especially if it is a high frequency deficit of moderate severity. The character of the tinnitus may give a clue to the etiology. But the patient often has difficulty in explaining his/her tinnitus in absolute terms, as they have no other tinnitus with which to compare it but their own Tinnitus, like pain, is a subjective state and trying to objectively assess the severity is problematic. Audiological techniques to match subjective loudness to machine-produced noise may offer some help, in that sound intensity matches can bear little correspondence to subjective complaint. In spite of many studies, most patients presently seen complaining of tinnitus are told by their doctors that there is no treatment and that they will have to learn to live with this symptom. Objectives: To perform a clinical analysis of tinnitus and estimate the efficacy of Oriental Medical treatment according to the Byeonjeung(辨證). Subject: We studied 34 patients with complaints of tinnitus who had visited Pundang Cha Oriental Medicine Hospital Department of Otorhinolaryngology from March 1998 to February 2000. All of them had been treated 2 or 3 times a week with acupuncture treatment and had taken herbs according to the Byeonjeung(辨證) method. It was therefore possible for me to know whether their symptoms improved or not. Parameters Observed and Method: We treated them with acupuncture & herb-medication. Sometimes we gave them moxibustion or negative therapy with bloodletting at the acupuncture points(耳門, 聽宮, 聽會). Parameters Observed 1) Distribution of age & sex 2) Chief complaints 3) The sites of tinnitus 4) The quality of tinnitu 5) The duration of disease 6) The problem induced tinnitus 7) Factors increasing disease severity 8) The classification of the Byeonjeung(辨證) 9) The efficacy of treatments Results: 1. Age and sex distribution: The most common occurrence was found in males in their twenties: 6 males($17.7\%$), and in females in their thirties and over sixty: 8 females($23.5\%$). Total patient numbers for men and women were 20 men($58.8\%$), 14 women ($41.2\%$). 2. The most frequent major complaints were hearing disturbances related to tinnitus; and dizziness with tinnitus; each comprising 10 cases($29.4\%$). There were also 7 patients($20.6\%$) with only tinnitus. 3. Tinnitus sites: 13($38.2\%$) said that they felt tinnitus in both ears, equally. In the right ear, 9($26.5\%$), in the left, 6($17.7\%$). 4. The most frequent descriptive symptoms of tinnitus were: humming, hissing, buzzing etc. 5. The duration of disease. 14cases($41.2\%$) had a duration of less than 1 year. 6. 15cases($44.1\%$) complained that it was hard to watch TV or make a phone call because of tinnitus. 10 cases($29.4\%$) complained about depression. 7. Factors increasing severity of tinnitus: ⅰ) fatigue: 18cases($52.9\%$) ⅱ) stress/ tension: 10 cases($29.4\%$) ⅲ) alcohol and tobacco: 5cases($l4.7\%$) 8. Classification through Byeonjeung : ⅰ) 19 cases($55.9\%$) were classified as showing Deficiency syndrome. ⅱ) 15 cases($44.l\%$) were classified as showing Excess syndrome. The deficiency of Qi was 7($20.6\%$), deficiency of Xue, 8($23.5\%$) and insufficiency of the Kidney Yin & Yang, 4($11.8\%$). The flare of Liver fire was 8($23.5\%$) and phlegm-fire, 7($20.6\%$), 9. The efficacy of treatments showed: an improvement in 17cases($50.0\%$); no real improvement or changes in 13 cases($38.2\%$); and some worsening in 4 cases($11.8\%$). In the group with deficiency in Qi, 4($57.1\%$) improved, 1($14.3\%$) showed no change and 2($28.6\%$) were aggravated. In the cases of deficiency in Xue, 6($75.0\%$) improved, 2($25.0\%$) showed no change. In the cases of insufficiency of Kidney Yin & Yang, 3($75.0\%$) showed no change and 1($25.0\%$) were aggravated. In the group of flare of Liver fire, 4($50.0\%$) improved, 3($37.5\%$) no change and 1($12.5\%$) were aggravated. In the cases of phlegm-fire, 3($42.9\%$) improved, 4($57.1\%$) showed no change. Conclusion: We would recommend that any further studies of tinnitus utilize trial treatments of longer than 2 months duration, as any positive effects observed in our study showed that improvement occurred fairly slowly. And we suggest that this study could be utilized as a reference for clinical Oriental Medical treatment of tinnitus. If we try to apply music or sound therapy treatment properly combined with ours, we expect it to provide psycological stability in addition to inducing masking effects, even though it may not directly decrease or completely remove tinnitus.

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A Study of Health Condion and Shift Service of the Nurse in (종합병원 간호사의 교대근무와 건강상태에 관한 연구)

  • Kim, Soon-Ok
    • Journal of Korean Academy of Nursing Administration
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    • v.3 no.1
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    • pp.119-133
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    • 1997
  • Continuing shift service of clinical nurses can be not only the cause of occupational dissatisfaction by being connected with the change of circadian rhythm and the burden of duties to be applicable to such changes. But also of inviting the lowering of nursing quality by being affected to the resignation of the nurses as the threat to the health of the nurses. This study has selected 500 nurses at random under non-probability sampling who have been serving by shift in 7 general hospitals which have over 400 sickbeds for the purpose of cross-sectional survey design from Sep. 7 through 20, 1996. Standardized modification of the CMI has been used which was designed for Koreans with Cornell Medical Index developed by Broadman and his fellow workers as the study device. The structure of the device was composed of 35 questions on physical appeal(Chronbach's ${\alpha}=8507$) and 22 questions of mental appeal(Cronbach's ${\alpha}=.8166$ totalling 57 questions. The collected data has been computerrized by using SPSS. General character, present symptom, perceived symptom and others are sought by practical number and percentage, and the health condition comparison followed by general characters was conducted by t-test and ANOVA. The post test was by Duncan's test by the level of p<.05. 1) The items of the answer that they have the physical symptom presently by 50% or over of the nurses were as "Do you often have spells of severe dizziness", "Are your eyes often red or inflamed", "Does press or pain in the head often make like miserable", "Are your ankles often badly swollen", "Do pains in the back make it hard for you to keep up with your work". 2) The items of the answer by over 50% of the nurses as the mental symptom at present were "do you fell bad when criticized?", "Do you get angry when everything is against your will?", "do you get angry when ordered to do this and that?", "do you feel uneasy by such a trifle thing?", "do you tremble or are you freightened by sudden sound?". The mental and physical symptoms which have appeared presently in connection with the shift service have been agreed with each other. But the physical condition has been worse than the mental one. 3) In the physical health conditions followed by demosociological character, there were the significant differences by sex, religion and place of residence(p<.05), and in the mental health conditions, there were the significant differences by age, marital status, residence place and the required time for attending hospital(p<.05). 4) There was significant difference by the degree of satisfaction about the duty in both the physical and mental health conditions. In short, the higher the degree of duty satisfaction, the better the health conditions. 5) There were the significant difference according to the times of night duty and whether they take the drug or not or the kinds of the drugs in the physical health conditions related with the characters of night shift. Mental health conditions in the night shift case showed significant differences according to their taking drug or not or the kinds of the drugs(p<.05). I can confirm that the nurses have been affected continuously by the shift service mentally and physically. The maintenance of the physical and mental health of the nurses and its promotion are very important problem to guarantee the quality nursing in the performance of the nursing service continuously and effectively, so the hospital should make every effort to improve the duty conditions by finding out the causes affecting to their health. In the nursing management viewpoint, I think that elevating the satisfaction degree about the duty would be a great help to the promotion of physical and mental health conditions. But what is most important is that the nurses themselves should take care of themselves in maintaining the good conditions in their service in the hospital.

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A Clinical Analysis of Abdominal Stab Wounds (복부 자상의 치료 방법에의 접근)

  • Park, Ji-Yeon;Chung, Min;Lee, Yeong-Don;Lee, Jung-Nam;Lee, Woon-Ki;Park, Yeon-Ho;Baek, Jung-Heum;Park, Heung-Gyu;Kim, Keon-Kuk;Kang, Jin-Mo;Choi, Sang-Tae;Lee, Won-Suk;Park, Seung-Youn
    • Journal of Trauma and Injury
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    • v.23 no.2
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    • pp.134-141
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    • 2010
  • Purpose: A classic approach to abdominal stab wounds has been a routine laparotomy for the purpose of diagnosis or treatment. However, management protocols for abdominal stab wounds are still contentious in most trauma centers. We examined the relationship between the character of the stab wound and the injured intraabdominal organs by retrospectively analyzing the medical records of patients with abdominal stab wounds admitted to Gil hospital, and the findings for our patients are then confronted with a review of the literature. We aimed to propose proper management protocols to approach abdominal stab wounds. Methods: The medical records of all 80 patients sustaining abdominal stab wounds, admitted at the Department of Surgery, Gil Hospital, Gachon Medical School, from January 2004 to December 2008 were retrospectively reviewed. All the abdominal stab wounds were collated based on the site and the character of the injury, investigations performed on admission, results of investigations, operations performed and findings at the time of the operation. Results: The most prevalent age group was patients in their forties and the average age of the patients was 41 years for both genders. The stab wounds were most commonly located at the periumbilical area (16.9%), followed by the epigastric area (15.6%), and 18.2% of the patients had multiple wounds. The most commonly eviscerated organ was the omentum (9 out of 16 cases); 61.7% of non-eviscerated patients underwent a therapeutic laparotomy while 81.3% of eviscerated patients underwent a therapeutic laparotomy. The small bowel was the most commonly injured organ (22.7%, 17 out of 75 injuries). The review revealed a relatively common diaphragmatic injury in abdominal stab wound patients (8 cases, 10.5%). The average hospital stay was 11 days. Conclusion: This review revealed commonly eviscerated and injured intraabdominal organs in abdominal stab wound patients and their relationship with a therapeutic laparotomy. Although the management is still controversial, the authors suggest indications for an immediate laparotomy and a protocol for managing abdominal stab wounds. Hemodynamic instability and peritoneal irritation signs are definite indicators for an immediate laparotomy, but the review revealed intraabdominal organ evisceration alone not to be a statistically significant factor. In addition, the authors suggest that abnormal CT findings can be valuable for making a decision on management of hemodynamically stable stab wound patients. Further study may clarify a role for a more selective approach to operative intervention and for a more extensive use of selective observation.

A Retrospective Cross-sectional Study on Leukorrhea in Relation with Lower Abdomen Temperature and Physical Symptoms (대하증(帶下症)과 하복부온도 및 기타 동반 증상과의 연관성에 대한 후향적 단면연구)

  • Ahn, Ji-Yoon;Choi, Seok-Young;Hwang, Deok-Sang;Lee, Jin-Moo;Jang, Jun-Bock;Lee, Kyung-Sub;Lee, Chang-Hoon
    • The Journal of Korean Obstetrics and Gynecology
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    • v.26 no.3
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    • pp.93-102
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    • 2013
  • Objectives: This study aims to research character of the patients with leukorrhea including Digital Infrared Thermal Imaging (DITI) and symptoms associated with leukorrhea in view of Korean medicine theory. Methods: We studied 71 patients visiting ${\bigcirc}{\bigcirc}$ Korean Hospital from April, 2012 to March, 2013. The subjects were categorized in two groups, leukorrhea group (n=40) and control group (n=31). We investigated the difference of DITI and other physical symptoms between two groups. Results: The average temperature of CV4 in leukorrhea group ($29.56{\pm}0.80^{\circ}C$) were significantly lower than that of control group ($30.12{\pm}0.54^{\circ}C$)(p<0.01). And there is no statistical difference of temperature of CV17 located in chest area between two groups. But temperature difference between CV17 and CV4 (${\Delt}T$) in leukorrhea group ($1.18{\pm}0.55^{\circ}C$) is significantly higher than control group ($0.68{\pm}0.43^{\circ}C$)(p<0.01). There is no correlation between leukorrhea and some sypmtoms, like menorrhea, irregular menstruation, fatigue, constipation and loss of appetite. But leukorrhea group is more likely to suffer from dyspepsia and insomnia than control group. Conclusions: Leukorrhea group is related to lower temperature in lower abdomen than control group. And patients with leukorrhea are more likely to appear dyspepsia and insomnia than no leukorrhea group.