• 한국응급구조학회지
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• 제8권1호
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• pp.149-160
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• 2004

Background : To save out-of-hospital cardiac arrest cases is a major concern for Korea. Cardiac arrest is a very common problem, with > 18,000 cases dying each year in Korea. Overall, survival to hospital discharge remains poor. Resuscitation has become an important multidisciplinary branch of medicine, demanding a spectrum of skills and attracting a plethora of specialities and organizations. Since the "Utstein Style" was advocated in 1991, many reports about out-of-hospital cardiac arrest have been published based on this guideline. These differences prevent valid inter-hospital and international comparisons. However, we do not know the true effectiveness of resuscitation. There are no guideline for reviewing, reporting, conducting research on resuscitation in Korea. This study evaluated the out-of-hospital factor associated with survival discharge of out-of-hospital cardiac arrest, was especially to provide basic data for the unified reporting guideline of resuscitation in Korea. Methods : From January 1990 to July 2004, we collected data about out-of-hospital cardiac arrest at Wonju Christian Hospital(WCH-CAD), Ewha Women University Mokdong Hospital(Ewha-CAD), I used same record form based on the "Utstein Style". The "Utstein Style" is internationally recommended guidelines for reporting outcome data from resuscitation events. Results : Resuscitation was performed in 1443 out-of-hospital cardiac arrest patients at 2 hospitals. Five hundred eighty(40.25%) patients recovered the spontaneous circulation at least once and One hundred sixty eight(11.66%) patients discharged alive. Initial EKG showed Ventricular Tachycardia/Ventricular Fibrillation in One hundred thirty five(9.33%) patients, asystole in one thousand nine(69.73%) patients and other rhythms in one hundred thirty nine(20.94%) patients. Among one hundred two cardiogenic cardiac arrest patients, two(2.0%) patients was discharged alive. Conclusion : Overall survival rate of out-of-hospital cardiac arrest patients was 11.66% which was poorer than that of the western country. The proportion of the cardiogenic cause was 33.38% which was only half of the western country. VT/VF is relatively not common ac a initial EKG rhythm. These differences might be to due difference in the prevalence pattern of out-of-hospital cardiac arrest as well as prematurity of the EMSS. It is needed that the best survival can be achieved if all following links have been optimized : rapid access, early CPR, early defibrillation, early ACLS.

• Journal of Korean Neurosurgical Society
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• 제56권4호
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• pp.295-302
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• 2014

Objective : This study was conducted to clarify the association factors and clinical significance of the CT angiography (CTA) spot sign and hematoma growth in Korean patients with acute intracerebral hemorrhage (ICH). Methods : We retrospectively collected the data of 287 consecutive patients presenting with acute ICH who arrived within 12 hours of ictus. Baseline clinical and radiological characteristics as well as the mortality rate within one month were assessed. A binary logistic regression was conducted to obtain association factors for the CTA spot sign and hematoma growth. Results : We identified a CTA spot sign in 40 patients (13.9%) and hematoma growth in 78 patients (27.2%). An elapsed time to CT scan of less than 3 hours (OR, 5.14; 95% CI, 1.76-15.02; p=0.003) was associated with the spot sign. A CTA spot sign (OR, 5.70; 95% CI, 2.70-12.01; p<0.001), elevated alanine transaminase (GPT) level >40 IU (OR, 2.01; 95% CI, 1.01-4.01; p=0.047), and an international normalized ratio ${\geq}1.8$ or warfarin medication (OR, 5.64; 95% CI, 1.29-24.57; p=0.021) were independent predictors for hematoma growth. Antiplatelet agent medication (OR, 4.92; 95% CI, 1.31-18.50; p= 0.019) was significantly associated with hematoma growth within 6 hours of ictus. Conclusion : As previous other populations, CTA spot sign was a strong predictor for hematoma growth especially in hyper-acute stage of ICH in Korea. Antithrombotics medication might also be associated with hyper-acute hematoma growth. In our population, elevated GPT was newly identified as a predictor for hematoma growth and its effect for hematoma growth is necessary to be confirmed through a further research.

• Journal of Trauma and Injury
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• 제26권3호
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• pp.190-197
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• 2013

Purpose: Trauma is one of the major cause of death in Korea. This study focused on the survival rate and the neurologic outcome for patients with traumatic cardiac arrest (CA) at one emergency center. Methods: We retrospectively reviewed the medical records of patients with traumatic CA who were seen at a regional emergency medical center from January 2010 to December 2011. From among major trauma patients at that medical center, adults older than 18 years of age who had CA were included in this study. CA included out-of-hospital CA with arrival at the Emergency Department (ED) within three hours and in-hospital CA. We checked the survival rate and the neurologic outcome. Results: A total of 61 patients were analyzed: 32 patients had return of spontaneous circulation (ROSC), 6 patients survived to discharge (survival rate: 9.84%), and 4 were still alive 90 days after discharge. The Cerebral performance category (CPC) scores at 6 months after discharge showed 1 good and 5 poor in neurologic outcomes. Factors such as initial rhythm of CA, part with major injury, Revised Trauma Score (RTS) and pH, were significant for ROSC, survival, and neurologic outcome in patients with traumatic CA. Conclusion: In this study, patients who had traumatic CA showed a 9.84% survival rate and a 1.64% good neurologic outcome. The results are poorer than those for CA caused by disease. Multi-center, prospective studies are needed.

• Journal of Preventive Medicine and Public Health
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• 제33권1호
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• pp.17-24
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• 2000

Objectives : To propose the referential data to evaluate the health impacts of Vietnam veterans' children whose father were exposed to herbicides in Vietnam War. Methods : Vietnam veterans who visited to Pusan Veteran Hospital for medical care were recruited from April to October, 1998. They were 71 and asked about their own combat history, symptoms and illness, and health status of their 182 children. The informations were collected by direct and phone interview. Exposure estimation was also performed as exposure score depending on year and unit of participation, and personal episodes related to exposure to herbicide in the war. It classified into three groups; lower(<18.0), moderate(18-53), high$(\geq53)$ exposure group. Results : The mean age and the period into the combat of the veterans were 52.8 years and 15.0 months. The mean exposure score was $18.1{\pm}9.9$, and mainly distributed in lower (46.5%) and moderate(52.1%) exposure group. Most(90.1%) of them were diagnosed as sequelae(21 cases) and suspected sequelae(43 cases) of the herbicides by Korean veteran's hospital diagnostic criteria. The major sequelae was peripheral neuropathy 13 cases, chloracne 5 cases, and the major suspected sequelae was hypertension 20 cases, diabetes mellitus 18 cases, liver disease 12 cases, central neuropathy 11 cases, etc. About birth, 42.2% and 16.9% experienced spontaneous abortion and stillbirth, respectively. The mean exposure score was higher in stillbirth experience group(p<0.05). About half of the children(90 cases, 49.5%) hold the abnormal health status: those were skin pigmentation 38 cases, rash 23 cases, congenital anomaly 15 cases, general weakness 12 cases, purpura 8 cases, visual disturbance 8 cases, etc. These health problems had no association with father's exposure level(p>0.05). Conclusions : These results were depend on their own answers, and expectation for compensation did not excluded, therefore, this study may have limitations: inaccuracy of informations due to recall bias and response bias. Nevertheless, through this study, we could image the fundamental aspect for health impacts of Vietnam veterans' children for preparing the national control program and policy. A large scale epidemiologic study with valid exposure assessment on the health impacts of Vietnam veterans' children is recommneded.

• 재활치료과학
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• 제9권4호
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• pp.55-67
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• 2020

목적 : 본 연구는 현상학적 연구방법을 통해 병원급 의료기관에서 근무하는 작업치료사의소진의 본질을 탐구함으로써 소진을 완화하기 위한 방법을 개발하는데 필요한 기초자료를 제공하고자 한다. 연구방법 : 병원급 의료기관에서 근무하는 작업치료사 6명을 대상으로 8주간 심층면담을 실시하였다. 면담 자료는 Colaizzi의 현상학적 연구방법을 통해 분석하였고, 자료 전사 및 주제생성과, 범주화 과정에 파랑새 2.0 소프트웨어를 사용하였다. 결과 : 수집된 자료를 통해 14개의 주제, 9개의 주제모음, 3개의 범주를 도출하였다. 분석 결과, 소진의 원인은 병원 작업치료 업무에서 오는 소진, 업무 환경에서 오는 소진 등으로 확인되었고, 소진이 개인의 삶에 미치는 영향은 내면 심리변화와 타인에 대한 영향이었다. 소진에 대한 대처 전략으로는 개인 삶의 풍요화, 자기 인식과 철학, 인식적 접근, 사회적 지지, 삶의 새로운 목표 설정 등으로 나타났다. 결론 : 반복되는 재활과정에서 오는 타성과 치료 효과에 대한 확신 부재에서 경험하는 직업 정체성 갈등을 해결하고 작업치료의 가치 제고를 위한 자생적 노력이 필요함을 제언한다. 또한 소진예방을 위한 조직 차원의 규정 및 교육 프로그램 마련과 수평적인 인간관계를 지향하는 조직문화의 확립이 필요할 것이다.

• 대한약침학회지
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• 제17권3호
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• pp.31-39
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• 2014

Objectives: This study was performed to analyze the toxicity and to find the lethal dose of the test substance Water-soluble Carthami-flos pharmacopuncture (WCF) when used as a single intravenous-dose in 6-week-old, male and female Sprague-Dawley rats. Methods: The experiment was conducted at Biotoxtech according to Good Laboratory Practices. 20 female and 20 male Spague-Dawley rats were divided into 4 groups of 5 female and 5 male animals per group. The rats in the three experimental groups received single intravenous injections with 0.125-mL, 0.25-mL and 0.5-mL/animal doses of WCF, Groups 2, 3, and 4, respectively, and the control group, Group 1, received a single intravenous injection with a 0.5-mL dose of normal saline. Clinical signs were observed and body weight measurements were carried out for 14 days following the injections. At the end of the observation period, hematology, clinical chemistry, histopathological tests and necropsy were performed on the injected parts. Results: No deaths occurred in any of the groups. Also, no significant changes in body weight, hematological parameters or clinical chemistry test results between the control group and the experimental groups were observed. Visual inspection after necropsy showed no abnormalities. Histopathological tests on the injected parts showed no significant differences, except for Group 1 females; however, the result was spontaneous generation and had no toxicological meaning because it was not dose-dependent. Therefore, this study showed that WCF had no effect on the injected parts in terms of clinical signs, body weight, hematology, clinical chemistry, and necropsy. Conclusion: As a result of single intravenous-dose tests of the test substance WCF in 4 groups of rats, the lethal dose for both males and females exceeded 0.5 mL/animal. Therefore, WCF is a relatively safe pharmacopuncture that can be used for treatment, but further studies should be performed.

• Tuberculosis and Respiratory Diseases
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• 제72권5호
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• pp.441-447
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• 2012

Background: Chest tube drainage (CTD) is an indication for the treatment of pneumothorax, hemothroax and is used after a thoracic surgery. But, in the case of incomplete lung expansion, and/or persistent air leak from CTD, medical or surgical thoracoscopy or, if that is unavailable, limited thoracotomy, should be considered. We evaluate the efficacy of bronchoscopic injection of ethanolamine to control the persistent air leak in patients with CTD. Methods: Patients who had persistent or prolonged air leak from CTD were included, consecutively. We directly injected 1.0 mL solution of 5% ethanolamine oleate into a subsegmental or its distal bronchus, where it is a probable air leakage site, 1 to 21 times using an injection needle through a fiberoptic bronchoscope. Results: A total of 15 patients were enrolled; 14 cases of spontaneous pneumothorax [idiopathic 9, chronic obstructive pulmonary disease (COPD) 3, post-tuberculosis 2] and one case of empyema associated with broncho-pleural fistula. Of these, five were patients with persistent air leak from CTD, just after a surgical therapy, wedge resection with plication for blebs or bullae. With an ethanolamine injection therapy, 12 were successful but three (idiopathic, COPD and post-tuberculosis) failed, and were followed by a surgery (2 cases) or pleurodesis (1 case). Some adverse reactions, such as fever, chest pain and increased radiographic opacities occurred transiently, but resolved without any further events. With success, the time from the procedure to discharge was about 3 days (median). Conclusion: Bronchoscopic ethanolamine injection therapy may be partially useful in controlling air leakage, and reducing the hospital stay in patients with persistent air leak from CTD.

• 정신신체의학
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• 제8권1호
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• pp.58-64
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• 2000

연구목적 : 본 연구는 정상 성인에서 성격의 일반적인 특정으로서의 감정표현불능증과 신체적 호소, 정서상태 및 어휘와의 상관관계를 알아봄으로써 감정표현불능증에 대한 이해를 넓히고자 하였다. 방법 : 신체적 질환을 가지고 있지 않은 정상 성인에서 한국판 20항목 Toronto 감정표현불능증 척도(TAS-20K), 신체적 호소, 연상한 단어의 수, 우울과 불안을 정도를 측정하여 그 결과들간의 상관관계를 알아 보았다. 총 662명을 평가한 후 체계적 표본추출 방법을 이용하여 다시 204명을 선택하였다. 결과 : 1) 감정표현불능증의 정도는 신체적 호소, 불안, 우울의 정도와 유의한 상관관계를 보였다. 2) 신체적 호소는 불안, 우울의 정도와 유의한 상관관계를 보였다. 3) 연상한 단어의 수는 나이와 부적 상관관계를 보였다. 4) 강정표현불능증의 정도는 연상한 단어의 수와 유의한 상관관계를 보이지 않았다. 결론 : 감정표현불능증의 정도가 심할수록 신체적 호소는 더 많으며 이는 불안, 우울의 정도와 연관되어 있었으나 어휘의 양과는 유의한 관계를 발견할 수 없었다.

• 한국안광학회지
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• 제13권2호
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• pp.43-50
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• 2008

목적: 실제 굴절검사(PR, Practical Refraction)를 위한 교육용 시뮬레이터인 가상 굴절검사(VR, Virtual Refractor) 의 효과를 평가하는데 있다. 방법: 안경광학과 3학년에 재학 중인 24명이 VR교육에 지원하였다. 학생 스스로 VR교육에 참가하여 연습을 하였고, 1개월 후 학생들은 가상 굴절검사에서 가상 피검자 3명과 실제 굴절검사에서 실제 피검자 1명에 대해 굴절검사를 실시하여 평가 결과를 제출하였고, 가상과 실제 굴절검사의 평가 결과를 비교하였다. 또한 5점 리커척도를 기준으로 한 자가 평가 설문을 자발적 참여도, 굴절검사에 대한 기여도, VR과 PR의 일치도 및 VR의 필요성과 같은 영역에 대하여 실시하였다. 결과: 가상 굴절검사와 실제 굴절검사의 평가에서 Spearman 상관계수는 0.71(p<0.01)로 뚜렷한 상관관계를 보였다. 설문에서 영역들의 평균은 3.67${\pm}$0.96로 VR 이용이 유익한 것으로 나타났고, 이들 영역 간에 0.91~0.68(p<0.01)의 높은 상관관계를 보였다. 결론: VR은 연습의 집중도를 높이고 실제 상황에 맞는 체계적 접근과 역할이 되도록 보완이 필요하지만, VR과 실제 굴절검사 사이에 높은 상관성을 보 였으며 VR은 실제 굴절검사에 도움이 되는 긍정적 평가를 보였다.

• Journal of Radiation Protection and Research
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• 제41권3호
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• pp.196-205
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• 2016

Background: The emergency planning zone (EPZ) of the city of Busan is divided into the precautionary actions zone (PAZ) and the urgent protective action planning zone; which have a 5-km radius and a 20-km to 21-km radius from the nuclear power plant site, respectively. In this study, we assumed that a severe accident occurred at Shin-Kori nuclear unit 3 and evaluated the dispersion speed of radiological material at each distance at various wind speeds, and estimated the effective dose equivalent and the evacuation time of PAZ residents with the goal of supporting off-site emergency action planning for the nuclear site. Materials and Methods: The total effective dose equivalent, which shows the effect of released radioactive materials on the residents, was evaluated using the RASCAL 4.2 program. In addition, a survey of 1,036 residents was performed using a standardized questionnaire, and the resident evacuation time according to road and distance was analyzed using the VISSIM 6.0 program. Results and Discussion: According to the results obtained using the VISSIM and RASCAL programs, it would take approximately 80 to 252.2 minutes for permanent residents to move out of the PAZ boundary, 40 to 197.2 minutes for students, 60 to 232.2 minutes for the infirm, such as elderly people and those in a nursing home or hospital, and 30 to 182.2 minutes for those temporarily within the area. Consequently, in the event of any delay in the evacuation, it is estimated that the residents would be exposed to up to $10mSv{\cdot}h^{-1}$ of radiation at the Exclusion Area Boundaries (EAB) boundary and $4-6mSv{\cdot}h^{-1}$ at the PAZ boundary. Conclusion: It was shown that the evacuation time for the residents is adequate in light of the time lapse from the initial moment of a severe accident to the radiation release. However, in order to minimize the evacuation time, it is necessary to maintain a system of close collaboration to avoid traffic congestion and spontaneous evacuation attempts.