• 정보처리학회논문지:소프트웨어 및 데이터공학
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• 제9권4호
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• pp.137-144
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• 2020

섬망은 의식 장애, 주의력 장애 및 언어력 장애와 같은 일시적인 인지 장애가 있는 환자, 특히 노인에서 나타나는 가장 흔한 정신 장애 중 하나이다. 섬망은 환자와 가족에게 고통을 주고, 통증과 같은 증상의 관리를 방해할 수 있으며 노인 사망률 증가와 관련이 있다. 본 논문의 목적은 장기 요양 시설에서 섬망 환자를 구별하는데 사용될 수 있는 유용한 임상적 지식을 생성하는데 있다. 이러한 목적을 위해, 러프 하한 근사 영역을 갖는 로컬 커버링 규칙 기법을 활용하여 섬망과 관련된 임상적 분류 지식을 추출하였다. 제안된 방법의 임상적 적용 가능성은 전향적 코호트 연구로부터 수집된 데이터를 활용하여 확인하였다. 연구 결과, 섬망 기간이 12일 이상 지속될 수 있는 6가지 유용한 임상적 증거를 발견하였고, 체질량 지수, 동반질환 지수, 입원경로, 영양결핍, 감염, 수면박탈, 욕창, 기저귀 사용과 같은 8가지 인자들이 섬망 결과를 구별하는 데 중요한 요인이라는 것을 확인하였다. 제안된 방법의 분류 성능은 통계적 5-겹 교차검정 방법을 사용하여 3가지 벤치마킹 모델, 즉 ANN, RBF 커널 함수를 활용한 SVM, 랜덤 포레스트와 비교하여 검증하였다. 제안된 방법은 3가지 모델 중 가장 높은 성능을 제공한 SVM 모델과 비교했을 때 정확도와 AUC 기준에서 평균 0.6%와 2.7% 개선된 성능을 보였다.

• 대한한방소아과학회지
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• 제17권2호
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• pp.37-53
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• 2003

Objective : To find risk factor and symptoms for transferred newborn from postpartum care center Method : We performed a follow-up study using medical record. Subjects comprised 188 neonates(include 4 twins) and 184 women in childbed who were hospitalized in oriental postpartum care center from January, 1, 2002 to December, 31, 2002. Result: Transferred newborn was total 24, N.V.D. 17, C.S. 7, male and female were 12 separately. The symptom of transfer was fever(16), diarrhea(4), jaundice(3), convulsion(1) Transferred number and rate was male 12(10.7%), female 12(15.8%). In delivery method, total normal vaginal delivery(N.V.D.) was 136 and transferred 17(12.5%), total cesarean section(C.S.) was 52 and transferred 7(13.5%). Transferred rank was N.V.D. female(17.9%). C.S. male(15.6%), C.S. female(10%), N.V.D.(8.6%). Of the 188 neonates. immature infants were 2 and transferred 1(50%), term infants were 184, transferred 23(12.5%), post-term infants were 2 and transferred none(0%). In age of women in childbed, transferred ratio was 15.4%(over 35), 15.2%(25-29), 10.5%(30-34). In fever,. C.S. infants were more transferred than N.V.D. and male infant had a tendency to transfer in later period of hospitalization and female in early period. It seems that transfer was related to abortion. In diarrhea, all was N.V.D. and their diagnosis was rotavirus. The average age of women in childbed was yonger(28.5). In jaundice, all was 1st, and average birth weight was lighter(3153g). The average age of women in childbed was older(30). In convulsion, birth weight was lighter(3153g), and age of women in childbed was older(30). Conclusion : There's any relation with sex and delivery method, birth weight and mother's age in transfer. But we cannot find any statistically significance. Further prospective studies are needed to find risk factors in transfer.

• 대한추나의학회지
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• 제6권1호
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• pp.157-167
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• 2005

후종인대 골화증의 수술적 단계 이전의 환자에 대한 보존적 치료는 대증적 치료가 주가 되어 왔다. 본 증례에서는 침구요법, 부항요법, 한약물요법, 한방 이학요법, 추나요법을 시행한 후종인대 골화증 환자에서 시각적 상사척도의 각 치료기간별 감소 및 경추부 가동역의 증가와 더불어 JOA Score의 향상, OPLL의 임상적 등급이 호전되는 치료 효과를 나타내게 되었다. 향후 본 질환에 대하여 보다 심도있는 한의학적 연구가 진행된다면 후종인대 골화증의 보존적 치료에 있어서 한방요법이 뚜렷한 역할을 하리라 기대하며 보다 많은 증례와 더불어 본 질환에 대한 평가의 기준 및 한방적 치료의 지침에 대한 연구가 진행되어야 한다.

• 척추신경추나의학회지
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• 제11권1호
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• pp.65-74
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• 2016

Objectives : This study was designed to assess the general distribution, clinical effectiveness of Korean medical treatment on knee pain and the correlation between Korean medical therapy on knee pain and BMI. Methods : This is an observational study. 65 patients admitted to Daejeon Jaseng Hospital of Korean Medicine with musculoskeletal disorders were observed from July, 2014 to July, 2015. They were analyzed according to sex, age, pain lesion, body mass index(BMI) and treatment efficacy. All patients received a combination of treatments during hospitalization, including acupuncture, pharmacopuncture, herbal medicines and physical therapy. A zero to ten numerating rating scale (NRS) assessing pain, Western Ontario and McMaster Universities Arthritis Index(WOMAC) index and Range of Motion(ROM) was used before and after treatments. Statistical correlations among assessment measurements were evaluated by examining the paired t-test and the Pearson's correlation coefficients. Results : The average BMI of all patients was $24.03{\pm}2.95kg/m^2$. According to clinical definition of obesity by Korean Society for the Study of Obesity, 33.8% of all patients was within normal weight, 1.5% was underweight, 33.8% was overweight, 24.6% was obesity and 6.2% was morbid obesity. For knee pain patients, NRS (Numeric Rating Scale) decreased from $6.28{\pm}1.63$ to $3.94{\pm}2.03$(p<0.001). WOMAC index decreased from $48.14{\pm}17.63$ to $40.37{\pm}18.28$(p<0.001). But, there were no significant correlations in statistics among BMI, knee pain index and knee pain index improvement. Conclusions : Korean medical combination treatment might be effective in reducing pain and improving functional disorders for patients with knee pain. This study further confirmed the efficacy of Korean medical treatment on knee pain. But, more studies on correlation between knee pain and obesity and development of assessment measurement are needed.

• Journal of Trauma and Injury
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• 제25권4호
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• pp.196-202
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• 2012

Purpose: This study aimed to recognize the frequency of near-hanging patients with elevated Troponin-I (Tn-I), to obtain information necessary for treatment and prediction of prognosis by analyzing the clinical feature of near-hanging patients, and to evaluate the relevance of elevated Tn-I to abnormal result of other cardiac-related examinations. Methods: A retrospective review for the near-hanging patients, clinical record was conducted at two urban training hospitals between April, 2001 and December, 2011. We divided included patients into two groups, which one with elevated Tn-I level ($Tn-I{\geq}0.1ng/dL$) and one without it, and compared the differences in initial vital signs, cardiac enzyme tests, an electrocardiogram, echocardiography, chest X-ray, and the clinical outcomes. Results: A total of 39 patients were included, out of them, 14 patients showed rise in Tn-I level. The length of hospital stay and ICU hospitalization was more prolonged in the patient group with elevated Tn-I level than non-elevated group. As well as the incidence of endotracheal intubation and abnormal findings in echocardiography or chest X-ray was higher in the Tn-I elevated group, which is statistically significant. Conclusion: The rising of serum Tn-I level in near-hanging patients were not uncommonly observed. We believe that the cardiac-related test including Tn-I is necessary for near-hanging patients, and those who are shown abnormal result in cardiac-related test may need close observation and intensive care.

• Journal of Trauma and Injury
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• 제22권1호
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• pp.65-70
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• 2009

Purpose: Many studies have addressed a psychiatric analysis of self-injury patients who have self-injurious behavior and who have attempted suicide. Few studies on the injury characteristics of self-injury related trauma patients have been conducted. We analyzed the injury characteristics of self-injury patients. Methods: A retrospective review of the medical records extracted from the injury surveillance system of Wonju Christian Hospital for the period from August 2006 to February 2008 was conducted. Of the 121 cases extracted, 103 were included in this study. We analyzed the sex ratio, age group, place of injury, injury mechanism, location of injury, management results, injury severity, and relation with drinking. Results: One hundred three cases were included (sex ratio: 1.06), and the mean age was $33.9{\pm}14.2$ years old. Fifty-six patients (54.4%) were discharged from the emergency department (ED) on the day of injury after primary care, and 9 patients (8.7%) were discharged, because they refused treatment. Seven patients (6.8%) died. Of these, 4 patients (3.9%) died after attempted cardio-pulmonary resuscitation in the ED, 1 patient (1%) was dead on arrival, and 2 patients (1.9%) died after admission. Sixteen patients (15.5%) were admitted to the hospital, including 2 patients (1.9%) needing emergency surgery. Sixteen patients (15.5%) were transferred to other hospitals. Sixty-one cases (59.2%) involved drinking, and 31 (30.1%) did not; for 11 cases (10.7%), the involvement of drinking was unknown. The mean revised trauma score (RTS) was $11.26{\pm}2.52$, and 88 cases (85.4%) hat a RTS of 12. The mean injury severity score (ISS) was $5.80{\pm}14.56$, and 9 (8.7%) severely injured patients had scores of more than 15. Conclusion: Most self-injuries were mild traumas related to drinking and occurred at a young age. Most cases were not so severe, and the patients were discharged from the ED, but some patients needed hospitalization. Other patients had injuries so severe that they died.

• 의료법학
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• 제8권1호
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• pp.61-105
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• 2007

The Hospitalized Acquired Infection is defined as the case where the hidden infection or not found at the time of hospitalization occurs during the hospitalized period or, within 30 days to those who performed the surgery operation and then left the hospital. About 2/3 of the Hospitalized Acquired Infection are found as having the internal infection cases that are occurred by the patients' own virus due to the lowered immune system, while about 1/3 are found as having the external infection. The latter 1/3 of the external infection cases can be prevented through the infection management. And in case the new Hospitalized Acquired Infection case occur to the patient who was treated in the hospital, its responsibility issue will matter. As well in the disputes over the Hospitalized Acquired Infection cases, the cause-result relation between the damages and the medical staff's fault and as to whether there is failure of the medical staff or not. personnel should be proved in the medical-malpractice cases. In addition, the difficulties in proving such as expertise, secrecy propensity, discrete propensity and incompleteness will be considered to ease the burden of patient side's proving. Probability theory, Fact based assumption theory, Most adequate plaintiff preassumption or Expressed evidence theories are being discussed as the theories of eased burden of proof. In the result of gathering and reviewing Korea's precedent cases concerning the Hospitalized Acquired Infection, there are only a few accumulated prece dent cases and the attitude of the court also are also not consistent. Therefore, there are the precedents where the cause-result relation and the failure are immediately assumed when (1) timely proximity between the medical behavior and malpractice results, (2) proximity between the medical behavior-applied parts and the malpractice results-found parts, and (3) lack of other causes are separately evidenced; while the are the precedents only when 'the existence of the medical faults based on the common sense' is separately evidenced. It was found that the former and latter cases coexisted. The former is considered as based on the theory that separates the fault and cause-result relation not to consider them together, or regarded as based on the doubts that assumes the medical staff's neglect even though the Hospitalized Acquired Infection might be completely prevented by their efforts. However, the modern medical technology has the limitation as far as the prevention of the Hospitalized Acquired Infection. In conclusion, the assumption of the cause-result relation and that of the fault should be separately reviewed. Therefore, the latter precedents are considered as more reasonable, in the point the faulty behavior may be proved based on the common sense.

• 동의신경정신과학회지
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• 제21권4호
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• pp.219-231
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• 2010

Objectives : School refusal is usually considered as individual's behavioral problem. These days. however. the adolescents' school refusal needs some kind of medical approaches because it is related to mental disorder of the adolescents. Due to too much pressure and stress from the competition between classmates and from good performance in school. the number of adolescents who refuse to go to school is increasing. Despite this circumstance. school refusal is neither regarded as a single independent disorder nor endorsed as an officially classified disease. which makes difficult to conduct research on this issue and to establish standardized treatment for it. In addition. there is a lack of research on this topic. especially in oriental medicine. so there is no a case report or study on school refusal. This study is trying to comment on school refusal from the perspective of oriental medicine. Methods : We tried to examine the effect of oriental medicine treatment for school refusal with four adolescent cases. The patients commonly have at least more than one mental disorder (including depression disorder. anxiety disorder. and anorexia nervosa). have some problem with the relationship with their family. in particular with mother. do not have father or not be loved by their father. and have irregular eating habits. Thus. we diagnosed them as qi transforming into fire (氣鬱化矢) spleen-stomach deficiency cold (脾胃虛寒) and heart blood deficiency (心血虛) due to stress from the family issues and unhealthy eating habits. The patients received supportive therapy. family therapy. etc among many oriental mental treatments and their progress had been observed through hospitalization and outpatient treatment. Results : All four cases were reported positive progress on their symptoms and started coming back to school. We also examined whether they were well fitting into the school while they received outpatient treatment. and the results show that all four patients continue to settle down in normal school life. Conclusions : This study closely reviewed the mental disorder of school refusal cases and showed that the Oriental medical treatment was effective in helping the patients come back to school. More future research is required to better treatment for school refusal cases in oriental medicine.

• Pediatric Infection and Vaccine
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• 제24권1호
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• pp.1-6
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• 2017

목적: 본 연구에서는 delta neutrophil index (DNI)가 신생아 균혈증을 예측하는 지표로서의 효용성을 다른 지표들과의 비교를 통해 알아보고자 하였다. 방법: 원주세브란스 기독병원 신생아 중환자실에 발열을 주소로 입원한 환아들과 입원 중 발열이 있었던 생후 31일 미만 환아 146명을 대상으로 혈액배양검사와 동시에 시행한 총 백혈구 수, 절대호중구수, DNI, 혈소판 수, C-반응단백(C-reactive protein, CRP)에 대하여 분석하였다. 결과: 균혈증이 있었던 환아 77명의 평균 재태주수는 38.74주, 출생 체중은 3.20 kg였다. 대조군의 평균 재태주수는 33.34주, 출생 체중은 2.20 kg였다. 균혈증의 원인은 Staphylococcus aureus (22명), Staphylococcus epidermidis (18명), Streptococcus agalactiae (8명) 등이었다. DNI와 CRP만이 재태주수와 출생 체중 보정 후 균혈증과 연관성을 보여 area under the ROC curve를 조사하였고 DNI 0.70, CRP 0.68이었다. 결론: DNI는 신생아 균혈증을 예측하는 데 효과적인 지표이다. 다른 인자들과 함께 고려한다면 균혈증을 예측하는 데 더 도움이 될 것이다.

• Journal of Preventive Medicine and Public Health
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• 제42권4호
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• pp.251-260
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• 2009

Objectives : To estimate the annual socioeconomic costs of stroke in Korea in 2005 from a societal perspective. Methods : We identified those 20 years or older who had at least one national health insurance (NHI) claims record with a primary or a secondary diagnosis of stroke (ICD-10 codes: I60-I69, G45) in 2005. Direct medical costs of the stroke were measured from the NHI claims records. Direct non-medical costs were estimated as transportation costs incurred when visiting the hospitals. Indirect costs were defined as patients and caregivers productivity loss associated with office visits or hospitalization. Also, the costs of productivity loss due to premature death from stroke were calculated. Results : A total of 882,143 stroke patients were identified with prevalence for treatment of stroke at 2.44%. The total cost for the treatment of stroke in the nation was estimated to be 3,737 billion Korean won (KRW) which included direct costs at 1,130 billion KRW and indirect costs at 2,606 billion KRW. The per-capita cost of stroke was 3 million KRW for men and 2 million KRW for women. The total national spending for hemorrhagic and ischemic stroke was 1,323 billion KRW and 1,553 billion KRW, respectively, which together consisted of 77.0% of the total cost for stroke. Costs per patient for hemorrhagic and ischemic stroke were estimated at 6 million KRW and 2 million KRW, respectively. Conclusions : Stroke is a leading public health problem in Korea in terms of the economic burden. The indirect costs were identified as the largest component of the overall cost.