• 한국산학기술학회논문지
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• 제19권11호
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• pp.126-136
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• 2018

본 연구는 머신러닝을 활용하여 급성 뇌졸중 퇴원 환자의 중증도 보정 사망 예측 모형 개발을 목적으로 시행하였다. 전국 단위의 퇴원손상심층조사 2006~2015년 자료 중 한국표준질병사인분류(Korean standard classification of disease-KCD 7)에 따라 뇌졸중 코드 I60-I63에 해당하는 대상자를 추출하여 분석하였다. 동반질환 중증도 보정 도구로는 Charlson comorbidity index(CCI), Elixhauser comorbidity index(ECI), Clinical classification software(CCS)의 3가지 도구를 사용하였고 중증도 보정 모형 예측 개발은 로지스틱회귀분석, 의사결정나무, 신경망, 서포트 벡터 머신 기법을 활용하여 비교해 보았다. 뇌졸중 환자의 동반질환으로는 ECI에서는 합병증을 동반하지 않은 고혈압(hypertension, uncomplicated)이 43.8%로, CCS에서는 본태성고혈압(essential hypertension)이 43.9%로 다른 질환에 비해 가장 월등하게 높은 것으로 나타났다. 동반질환 중중도 보정 도구를 비교해 본 결과 CCI, ECI, CCS 중 CCS가 가장 높은 AUC값으로 분석되어 가장 우수한 중증도 보정 도구인 것으로 확인되었다. 또한 CCS, 주진단, 성, 연령, 입원경로, 수술유무 변수를 포함한 중증도 보정 모형 개발 AUC값은 로지스틱 회귀분석의 경우 0.808, 의사결정나무 0.785, 신경망 0.809, 서포트 벡터 머신 0.830로 분석되어 가장 우수한 예측력을 보인 것은 서포트 벡터머신 기법인 것으로 최종 확인되었고 이러한 결과는 추후 보건의료정책 수립에 활용될 수 있을 것이다.

• Tuberculosis and Respiratory Diseases
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• 제82권3호
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• pp.234-241
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• 2019

Background: The utility of computed tomography (CT) in the differential diagnosis of patients with chronic obstructive pulmonary disease (COPD) exacerbation remains uncertain. However, due to the low cost associated with CT scan along with the impact of Koreas' health insurance system, there has been a rise in the number of CT scans in the patients with initial diagnosis of COPD exacerbations. Therefore, the utility of CT in the differential diagnosis was investigated to determine whether performing CT scans affect the clinical outcomes of the patients with an initial diagnosis of COPD exacerbation. Methods: This study involved 202 COPD patients hospitalized with an initial diagnosis of COPD exacerbation. We evaluated the change in diagnosis or treatment after performing a CT scan, and compared the clinical outcomes of patient groups with vs. without performing CT (non-CT group vs. CT group). Results: After performing CT, the diagnosis was changed for two (3.0%) while additional diagnoses were made for 27 of the 64 patients (42.1%). However, the treatment changed for only one (1.5%), and six patients (9.3%) received supplementary medication. There were no difference in the median length of hospital stay (8 [6-13] days vs. 8 [6-12] days, p=0.786) and intensive care unit care (14 [10.1%] vs. 11 [16.7%], p=0.236) between the CT and non-CT groups, respectively. These findings remained consistent even after the propensity score matching. Conclusion: Utility of CT in patients with acute COPD exacerbation might not be helpful; therefore, we do not recommend chest CT scan as a routine initial diagnostic tool.

• 한국산학기술학회논문지
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• 제20권5호
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• pp.394-405
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• 2019

본 연구의 목적은 허약노인에 대한 개념의 명확한 속성 규명과 이론적 근거를 마련하는 것이다. 연구방법은 Walker와 Avant(2005)의 개념분석을 위한 기본 원리에 근거하여 절차에 따라 진행하였다. 허약노인에 대한 개념 사용의 연구결과는 허약노인은 건강과 질병의 중간상태에 있다. 허약노인은 신체적으로 근감소증, 염증, 인슐린 저항성에서 신체적으로 취약하고, 진행된 질병의 결과로 입원, 낙상, 장애, 사망에 이를 수 있다. 생리적, 심리적, 사회적 생활습관, 경제적 요인과 관련된 다면적 속성을 가지며, 일상생활에 제한으로 다른 사람의 도움을 필요로 하여 의존적이며, 회복시간과 회복의 정도가 저하되는 것과 소진(exhaustion)의 속성을 가지고 있는 것으로 확인되었다. 즉, 역동적 과정(dynamic process), 다면적 요소(multidimensional factors), 의존성(dependency), 취약성(vulnerability)이다. 허약노인은 건강과 질병의 중간 상태로 변화 가능성을 내포한 역동적 과정이며, 신체적, 정신적, 인지적, 사회 환경적 요소를 포함한다. 또한 일상생활에 어려움이 있는 노인으로, 신체적 취약성과 함께 적응에 어려움을 가지고 있는 노인을 의미하였다. 결론적으로 본 연구는 허약노인의 개념분석과 이해를 통해 노인의 허약 수준을 파악하고, 체계적으로 관리함으로써 장기요양상태에 이르지 않도록 지역사회 방문간호를 포함한 보건의료체계 마련을 위한 기초자료 제공에 기여할 것이다.

• 대한임상독성학회지
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• 제16권2호
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• pp.141-148
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• 2018

Purpose: The Korean government approved selected nonprescription drugs (Over-The-Counter drug; OTC drug) to be distributed in convenience stores from 15. Nov. 2012. This study examined the changes in the incidence and the clinical outcome of acute pharmaceutical drug poisoning after the deregulation of OTC drug sales. Methods: This study analyzed the data of Emergency Department based Injury In-depth Injury Surveillance (EDIIS), Korea Centers for Disease Control and Prevention, from 2011 to 2014. The following items were examined: age, gender, intention, alcohol association, pharmaceutical drugs resulting acute poisoning, the clinical outcomes in emergency department, and the admission rate of intensive care unit (ICU). This is a retrospective cross section observational study. Results: A total of 10,162 patients were subject to pharmaceutical drug poisoning. Acute poisoning by acetaminophen and other drugs were 1,015 (10.0%) and 9,147 (90.0%) patients, respectively. After the deregulation of OTC drug sales, acute poisoning by other drugs increased from 4,385 to 4,762 patients but acute poisoning by acetaminophen decreased from 538 to 477 patients (p<0.05). The rate of admission of acetaminophen poisoning increased from 36.1% (194/538) to 46.8% (223/477). The admission rate to the ICU by acetaminophen poisoning increased from 4.6% (25/538) to 11.3% (54/477) after the deregulation of OTC drug sales (p<0.05). Conclusion: Since the deregulation of OTC drugs sales, pharmaceutical drug poisoning has increased but acetaminophen poisoning has decreased. The rate of hospitalization and ICU admission by pharmaceutical drug poisoning with or without acetaminophen has also increased.

• Pediatric Infection and Vaccine
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• 제26권1호
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• pp.22-31
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• 2019

목적: 캄필로박터 장염은 박테리아 장염의 흔한 원인 중 하나로 알려져 있다. 그러나 국내에서 소아에서의 캄필로박터 장염의 빈도와 임상 양상에 대한 연구는 드물다. 본 연구는 단일 병원 소아청소년과 환자에서 경험한 캄필로박터 장염의 빈도와 임상적 특징을 파악하고자 시행하였다. 방법: 2012년 1월부터 2017년 12월까지 을지대학교 을지병원 소아청소년과에 급성 위장관염으로 방문한 18세 이하 소아환자로부터 대변 검체를 확보하였다. 그 중에서 배양 혹은 polymerase chain reaction을 통해 캄필로박터 장염으로 진단된 환자들의 의무기록을 후향적으로 검토하였다. 결과: 총 123명의 환자가 캄필로박터 장염을 진단받았으며 환자의 나이 중앙값은 12 세(사분위수, 8-16세)이었다. 캄필로박터 장염은 일년 내내 발생했지만 주로 6월과 9월 사이에 86명(69.9%)으로 집중적으로 발생하였다. 증상은 설사(97.6%), 발열(96.7%), 복통(94.3%), 구토(37.4%)와두통(34.1%) 순으로발생하였다. 복부컴퓨터단층촬영은 25.2%의사례에서시행되었다. 다른 치료군과 비교했을 때, azithromycin 3일 요법으로 치료하는 것이 더 짧은 입원 기간과 관련이 있었다 (P<0.05). 결론: 캄필로박터 장염은 청소년기와 여름철에 흔하다. 설사 증상을 보이기 전에 심한 복통과 열이 발생하여 병원에 내원하게 된다. 캄필로박터 장염에 대한 올바른 이해를 수반한다면 적절한 진단과 항생제 사용을 통해 장염의 이환시간을 줄일 수 있을 것으로 보인다.

• 대한응급의학회지
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• 제29권6호
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• pp.671-678
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• 2018

Objective: This study examined the predictive factors for prolonged length of stays of adult patients with acute appendicitis (AA) in an emergency department (ED). Methods: This was a retrospectively clinical study including patients in an ED. All patients were diagnosed from the clinical symptoms and a typical physical examination, and had undergone a computed tomography (CT) evaluation on the ED visiting date. All data were collected from the electrical medical records. The clinical parameters analyzed were the laboratory data, including the white blood cell count with differential values, C-reactive protein (CRP) level, initial vital signs, duration of admission, coexisting perforation of the appendix in the CT findings. The relationship between the clinical parameters and length of stay was assessed. Results: A total of 547 patients with AA were enrolled in this study. Among them, there were 270 male patients with a mean age of $40.7{\pm}15.8years$. The baseline characteristics, initial clinical features, laboratory, and imaging studies results of 129 patients in the prolonged length of stay (pLOS) group, and 418 patients of the non-pLOS group in AA were compared. Multivariable logistic regression analysis revealed the predictive factors related to pLOS in AA to be as follows: age 40 years or older, body temperature over $37.3^{\circ}C$, CRP level greater than 5.0 mg/dL, and evidence of perforation in CT findings (P<0.001). Conclusion: If we check age, fever, CRP level and find evidence of perforation, it might be helpful for predicting the increasing period of length of hospital stay for patients with AA in ED.

• 병원약사회지
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• 제35권4호
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• pp.409-417
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• 2018

Background : Febrile neutropenia (FN) is one of the side effects in the patients treated with chemotherapy, and the patients who have FN generally need immediate treatment with extended-spectrum antibiotics and hospitalization. Pegfilgrastim and pegteograstim, which are used for the prevention of FN as a granulocyte-colony stimulating factor (G-CSF), have been granted insurance coverage in the Republic of Korea for certain breast cancer patients using doxorubicin and cyclophosphamide (AC) from September 2016. Methods : The data of the patients with breast cancer using AC regimen and G-CSF were collected retrospectively. This study involves cost-utility analysis of pegfilgrastim and pegteograstim. In this study, we constructed a simple decision tree model for short-term observation and calculated quality-adjusted life year (QALY) and the direct medical costs from the medical provider's perspective. Results : From September 2016 to May 2017, 15 patients were treated with pegfilgrastim and 15 patients were treated with pegteograstim. As a result of dividing the average cost by QALY for each treatment group, it was observed that pegfilgrastim and pegteograstim were consumed 24,923,384 won and 22,808,336 won per 1QALY, respectively. Consequently, incremental cost effectiveness ratio (ICER) showed 2,115,048 won more per pegfilgrastim than pegteograstim per 1QALY, and the cost per 1QALY of both the drugs was lower than 30,500,000 won; the Koreans were willing to pay this amount. Conclusions : This study suggests that pegfilgrastim and pegteograstim can be used to improve the quality of life of breast cancer patients undergoing AC therapy. Among the two drugs, pegteograstim seems to be more cost-effective. However, since this study was conducted as a retrospective observation method on a small scale, it is associated with many limitations. Therefore, a long-term prospective cohort study is needed to supplement the present findings.

• Journal of Rhinology
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• 제25권2호
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• pp.75-79
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• 2018

Background and Objectives: To investigate the common site of recurrent epistaxis after initial intervention such as packing and cauterization had failed and to evaluate the efficacy of surgical endoscopic electrocautery. Subjects and Method: Retrospective review of 47 patients with recurrent and uncontrolled idiopathic epistaxis between October 1995 and March 2016. All patients underwent endoscopic examination in the operating room after hospitalization. We performed electrocautery when a bleeding site was found. Results: The most common sites of bleeding were the inferior meatus (28%), sphenoethmoid recess (23%), superior septum around the olfactory cleft (13%), and the posterior end of the middle turbinate (15%). There was no serious complication during the one week after surgery. In 46 (98%) patients, refractory epistaxis was successfully controlled. One patient had recurrent epistaxis after electrocautery and underwent endoscopic sphenopalatine artery ligation. Conclusion: In patients with refractory idiopathic epistaxis after failure of first-line treatment, endoscopic examination through a surgical approach and electrocautery for suspected bleeding are effective.

• 디지털융복합연구
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• 제19권4호
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• pp.467-475
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• 2021

목적: 병동에서 급성악화 환자가 발생할 때 환자에게 집중치료가 필요한지 여부에 대한 결정은 환자의 예후를 향상시키기 위해서는 매우 중요하나, 특히 사용 가능한 ICU 자원이 제한적일 때는 ICU 전동 여부를 결정하기에는 어려움이 있다. 따라서 본 연구는 일반병동 급성 악화 환자를 대상으로 중환자실 전동 위험요인을 확인하고자 한다. 연구방법: 후향적 조사연구로서 대상자는 일 상급종합병원 일반병동에 입원한 18세 이상의 성인 환자 중 악화상태를 보여 신속대응팀에 의뢰된 환자 2,945명을 대상으로 하였다. 중환자실 전동 위험요인을 파악하기 위해 다변량 로지스틱 회귀분석을 시행하였다. 연구결과: 다변량 로지스틱 회귀분석 결과 입원시 고형암을 진단받은 경우 (odds ratio [OR] 0.39, 95% CI 0.32-0.47), 악화원인이 호흡문제인 경우 (OR 1.51, 95% CI 1.17-1.95), MEWS (OR 1.22, 95% CI 1.17-1.28)와 SpO2/FiO2 score (OR 2.41, 95% CI 2.23-2.60)가 중환자실 전동 위험요인으로 나타났다. 결론: 본 연구 결과는 중환자실 전동 위험이 높은 환자의 조기 예측을 가능하게 하여 환자의 예후를 향상시키는데 도움이 될 것으로 사료된다.

• Tuberculosis and Respiratory Diseases
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• 제84권2호
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• pp.134-139
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• 2021

Background: Intrapleural urokinase is one of the most widely used fibrinolytic agents in the treatment of complicated parapneumonic effusion (CPPE). However, little research has been performed on the optimal urokinase dosage. The aim of this study was to evaluate the treatment efficacy of half dose urokinase compared with conventional dose urokinase. Methods: We retrospectively enrolled 92 patients with CPPE or empyema who underwent intrapleural urokinase treatment at two tertiary hospitals. Patients received antibiotics, chest tube drainage, and other treatments as part of routine care. The primary outcome was the treatment success rate in the half dose urokinase group (50,000 IU daily for maximal 6 days) and the conventional dose urokinase group (100,000 IU daily). Treatment success was defined as clinical and radiological improvements without surgical treatment or re-admission within one month. Results: Forty-four patients received half dose urokinase, whereas 48 patients were treated with conventional dose urokinase. Both groups were relatively well matched at baseline, excluding higher serum white blood cell count and higher empyema prevalence in the half dose urokinase group. The treatment success rate was not different between the two groups (p=0.048). There were no differences in the rate of in-hospital death and surgical treatment, hospitalization duration, and indwelling catheter duration. In the multivariate analysis, urokinase dose was not a predictor of treatment success. Conclusion: Half dose intrapleural urokinase is equally effective conventional dose urokinase in treating patients with CPPE or empyema.