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주요우울장애 환자에서 향후 안정반응을 예측하는 조기 개선 기준의 절단값 산정 : 일 대학병원 후향적 의무기록 연구
이은샘,왕희령,우영섭,전태연,박원명 대한우울조울병학회 2017 우울조울병 Vol.15 No.1
Objectives : This study investigates whether an early improvement in depressive symptoms, commonly defined as a reduction of 20% or more, after 2 weeks of pharmacotherapy could predict a stable response after 4 weeks for patients with a major depressive disorder (MDD). We also investigate which definition of early improvement could most accurately predict a stable response. Methods : We retrospectively reviewed the medical chart records of 64 patients with MDD. We initially performed a logistic regression analysis to investigate whether an early improvement predicts a stable response after 4 weeks. Furthermore, we performed a comparison of the ROC curves with differing definitions of an early response. Results : Early improvement, defined as a reduction of 20% or more, in the 17-item Hamilton Depression Rating Scale (HAMD-17) at week 2 was significantly associated with stable response after week 4 (OR=4.451, p=0.042). A comparison of the ROC curves according to differing definitions showed that an early improvement defined as a reduction of 15% or more in the HAMD-17 score at week 2 most accurately predicts a stable response after week 4 with a sensitivity of 92.7% and specificity of 39.1% (AUC=0.659, p=0.036). Conclusion : This study showed that an early improvement, defined as a reduction of 15% or more, in HAMD-17 at week 2 could be adequately used as a predictor for future treatment among patients with MDD.
응급실에 내원한 발열 환자에서 암 진단 유무에 따른 임상증상의 중증도에 대한 후향적 조사 연구
이은샘,강푸름,신유경,설근희,Eun Seam Lee,Purum Kang,You Kyoung Shin,Geun Hee Seol 한국기초간호학회 2023 Journal of korean biological nursing science Vol.25 No.2
Purpose: This study aimed to understand the general characteristics and biomarkers of inflammation in adult patients who visited the emergency department with fever and to determine whether the severity of clinical symptoms varies according to cancer diagnosis. Methods: Data were collected retrospectively from 4,002 adult patients with fever who visited the emergency department at a tertiary hospital from January 2018 to December 2018 using medical records. Results: On average, cancer patients were older than non-cancer patients (p < .001), and differences were observed between cancer and non-cancer patients in the origin of fever and biomarkers associated with inflammation. A higher proportion of cancer patients than non-cancer patients had a Korean Triage and Acuity Scale level of 1 to 3 (p < .001), and more cancer patients than non-cancer patients met two or more criteria for systemic inflammatory response syndrome (p = .001). More life-saving interventions in the emergency department were required in cancer patients than in non-cancer patients (p < .001), and cancer patients spent more time in the emergency department than non-cancer patients (p < .001). Conclusion: This study showed that the general characteristics and biomarkers of inflammation differed among adult patients with fever depending on cancer diagnosis. Furthermore, among adult patients with fever, cancer patients had more severe clinical symptoms than non-cancer patients. The results of this study are hoped to be helpful as a basis of nursing knowledge for adult patients with fever in the emergency department and as evidence for the classification of severity in patients with fever according to cancer diagnosis.
거절민감성과 우울의 관계에서 반추와 사회적 회피의 순차적 이중매개효과
김은지,이은샘,현명호 한국건강심리학회 2018 한국심리학회지 건강 Vol.23 No.1
This study was conducted to examine the sequential dual mediating effects of rumination and social avoidance between rejection sensitivity and depression in undergraduate students. For this purpose, this study used self-reported versions of the Rejection Sensitivity Scale(RSQ), Rumination Response Scale(RRS), Cognitive-Behavior Avoidance Scale(CBAS) and Depression Scale(CES-D) in 282 undergraduate students(female 172, male 110). The sequential dual mediating effects were analyzed by the use of a structural equation model. The findings of this study show that rejection sensitivity affected the types of maladaptive ruminations, brooding and depressive rumination. And the rumination affected the cognitive and behavior social avoidance in sequence, after these variables affected on the depressive symptoms of the participants. The results of this study suggest that if university students who have indicated a high level of rejection sensitivity ruminate and avoid interpersonal relationships, they are going to experience depressive symptoms as a result of this experience. This study was meaningful for focusing on the phenomenon of social avoidance, which is specifically related to rejection sensitivity, and suggesting one integrative model about related variables. Based on these results, the limitations of this study were discussed, as well as a discussion was provided regarding possible therapeutic methods that can useful to intervene in maladaptive rumination and social avoidance of the students, which is useful for preventing rejection sensitivity which is likely linked to depression. 본 연구는 대학생 집단을 대상으로 거절민감성과 우울과의 관계에서 반추와 사회적 회피가 순차적 이중매개효과를 갖는지를 검증하고자 하였다. 이를 위해 대학생 282명(여자 172명, 남자 110명)을 대상으로 거절민감성 척도(RSQ), 반추적 반응 척도(RRS), 인지-행동 회피 척도(CBAS), 우울 척도(CES-D)를 실시하고, 구조방정식 모형을 사용하여 순차적 이중매개효과를 검증하였다. 연구 결과는 거절민감성이 부적응적 반추 유형인 몰두 및 우울 반추를 통해 인지, 행동적 사회 회피에 영향을 미치고, 그에 따라 우울 증상에 영향을 미치는 것으로 나타났다. 이러한 결과는 거절민감성이 높은 대학생이 대인관계 상황에 대한 반추 및 사회적 회피를 하여 우울 증상을 경험할 수 있다는 점을 시사한다. 본 연구는 거절민감성과 특정적으로 연관된 사회적 회피에 초점을 두고, 관련 변인 간의 관계를 정리하여 단일한 통합 모델로 제시하였다는 점에서 의의가 있다. 이러한 결과를 바탕으로 본 연구의 제한점과 거절민감성향이 우울로 이어지지 않을 수 있도록 부적응적인 반추 및 사회적 회피에 개입할 수 있는 치료 방안에 대해 논의하였다.