Ritodrine in external cephalic version: is it effective and safe?

김신애,차은환,천경철,김영아,고재환,한정열,황종희 대한산부인과학회 2022 Obstetrics & Gynecology Science Vol.65 No.5

ObjectiveThe external cephalic version (ECV) has been shown to lower the likelihood of cesarean section requirements amongpregnant women with breech presentations. In the current study, we investigated the effectiveness and safety of ritodrineas a tocolytic for ECV. MethodsA total of 407 pregnant women with breech presentations, who had no contraindications for ECV, were enrolled inthis study. Multivariable logistic regression analyses were used to assess the impact of ritodrine use on the safety andefficacy of ECV. ResultsThe overall success rate was 67.6%, and ritodrine use was associated with significantly higher odds of successfulECV after adjusting for confounders. Moreover, using ritodrine did not increase the risk of adverse effects, includingtemporary changes in fetal heart rate, need for elective or emergency cesarean section due to fetal distress duringECV, low Apgar scores, and perinatal mortality. ConclusionOur results suggest that using ritodrine as a tocolytic during ECV may increase the likelihood of ECV success and maynot increase adverse perinatal outcomes.

발달장애학생을 위한 웹기반 의사소통능력신장 프로그램의 개발과 적용 사례

김동현,유영환,김좌중,천경철,이청용,김봉수 국립특수교육원 2005 연구보고서 Vol.- No.10

발달장애학생의 의사소통능력은 단순한 언어문제 이상의 의미를 지닌다. 의사소통능력은 모든 학습의 기초가 되고 결국 인간의 삶의 질을 좌우하게 하는 중요한 요소가 되고 있기 때문에 의사소통능력에 문제가 많은 발달장애학생에게 있어서 의사소통능력 신장은 매우 중요하다. 발달장애학생의 언어 및 의사소통능력의 결함은 사회적 결함과 인지적 결함에 상호 관련성이 있어 다른 사람으로부터의 의사소통을 이해하는 능력과 자신의 생각을 표현하는 능력이 제한되어 다른 사람과의 상호관계를 맺는데 어려움이 많았다. 따라서 발달장애학생의 언어지도는 생활 장면에서 교수하는 것이 가장 바람직하다고 하겠다. 그러나 지금까지 주로 활용된 전통적인 언어지도 방법은 어휘를 증가시키고, 발화의 길이를 널리는 데는 효과가 있었지만, 학습된 내용을 생활 장면에서의 일반화에는 문제점이 있는 것으로 지적되고 있다. 발달장애학생의 언어지도 방법은 일상생활 속에서 학습 내용을 선정하고 이를 실생활 장면 혹은 이와 유사한 환경에서 효과적으로 지도할 수 있는 적절한 교수 방법이 필요하다. 그래서 발달장애학생의 의사소통능력 신장을 위한 환경중심 언어지도 방법을 활용한 웹(Web)기반 언어지도 프로그램을 개발하였다. 웹(Web)기반 언어지도 프로그램은 제7차 특수학교 기본교육과정과 국립특수교육원에서 발간한 ‘발달장애학생의 언어교육 프로그램(1998)’ 분석을 통하여 개인 · 가정생활, 학교 · 사회생활, 경제 · 여가생활 등의 6개 영역으로 구분하여 각 영역별 학습주제를 선정하였으며, 학습주제에 대한 학습의 진행 형태는 학습목표, 낱말학습, 상황학습, 평가로 진행할 수 있도록 하였으나, 학습자의 현재 수행 능력을 고려하여 능력에 따른 진행의 절차를 학습자가 선택할 수 있게 하였다. 본 프로그램을 적용해본 결과 다음과 같은 교육적인 효과를 얻을 수 있었다. 첫째, 웹을 활용한 가상체험을 통하여 적극적이고 흥미 있는 참여를 유도하며, 학습자 중심의 주도적인 학습과 안내자, 촉진자로서의 교사의 역할을 통해 발달장애학생의 의사소통 능력을 신장시킬 수 있었다. 둘째, 교실에서 이루어지는 지금까지의 수업방식을 탈피하여 학습자가 언제, 어디서나, 누구든지 학습할 수 있는 열린 학습체제의 교육환경을 조성할 수 있었다. 셋째, 문자정보, 그래픽, 애니메이션, 사진, 음성, 비디오 등 다양한 형태의 정보가 상호대화 형식으로 활용되며, 수준별 반복학습을 실시함으로써 교수-학습 방법의 개선뿐만 아니라 양질의 수업을 진행하는데 도움을 줄 수 있었다. 본 프로그램을 활용한 언어지도가 발달장애학생의 의사소통능력 신장을 위한 최선의 방법이라고 말할 수는 없으며, 언어지도의 한 가지 방법이라고 말할 수 있다. 따라서 본 프로그램의 활용한 언어지도는 학교에서 교사가 학생의 능력과 흥미를 고려하여 지도한다면 발달장애 학생의 의사소통능력 신장에 많은 도움이 될 것이다. The developmental disability of the metal handicapped children means more than simple linguistic problem. The developmental disability is the base of all the learning and important factor which decides the happiness of the human being finally, so the extension of mutual understanding ability is so important, in the case of the metal handicapped children who have a problem of the mutual understanding ability. In the case of the metal handicapped children, the defects of the mutual understanding and linguistic ability are related with the social defect and the defect of recognition, and the ability of understanding about mutual relations with other people and self-expression ability are limited. So they have many problems in mutual relations with other people. Therefore, the linguistic instruction of the metal handicapped children is recommended to be done in the living. But, the traditional linguistic instruction which's used mainly as yet, is effective in increase of a vocabulary and the length of a locutionary act, but it has a problem in the popularization of the learning in the real life. The method of the linguistic instruction for the metal handicapped children, should be selected as contents in the real life, and the right learning method which can be done under the real life or the similar environment with it, is needed. Because of the above realities, the linguistic teaching web-based program is developed, using the linguistic instruction which is focused on the environment, for the extension of the mutual understanding ability of the metal handicapped children. In the linguistic teaching web-based program, it is divided with 6 field (personal · home life, school · social life, economical · leisure life) and the educational subject classified by each field is selected, by the analysis of 'The linguistic educational program for the children who have developmental disability' published by the 7th basic education course of special school and the national special education organization. Besides, the progress form of learning about the educational subject is directed by educational goal, word learning, situation learning and valuation, but a learner can choose a procedure followed by ability, regarding to his accomplishment ability. As the result of the application of this program, the educational effects that we could get are the following : 1. We could lead a positive and interesting participation by virtual experience through WEB, and the communication ability of the metal handicapped children was extended by a role of a teacher, as a guide and promoter and a leading learning focused on a learner. 2. The teaching method which is done in school now, is dismissed and we could form the educational environment of the learning system that a learner could learn, without distinction of time, a place and a person. 3. The various form of information, like text, graphic, animation, photo, sound, video and so on, is applied as a form of communication. Therefore, the program was useful in not only the improvement of the teaching-learning method, but also the proceeding of the effective lesson. The linguistic teaching which use this program, can not be the best method of the extension of the mutual understanding ability and it's just one method of linguistic teaching. if the linguistic teaching which use this program is conducted, regarding to a ability and a interest of a student, it will be so useful in the extension of the mutual understanding ability, for the children who have developmental disability.

Knowledge of HPV and Surgery among Women Who Underwent Cervical Conization: A Korean Multi-Center Study

임명철,전소연,김세익,이정윤,이산휘,송용중,천경철,김재원,박상윤 연세대학교의과대학 2016 Yonsei medical journal Vol.57 No.5

Purpose: Human papillomavirus (HPV) infection is a well-known cause of cervical cancer, which, along with its precursors, can be diagnosed and treated with cervical conization (CC). This study aimed to assess HPV- and procedure-related knowledge among women who had undergone CC. Materials and Methods: Between February and May 2014, consecutive women who had undergone CC at five different educationalhospitals were recruited. All patients had undergone a loop electrosurgical excision procedure as the method of CC. A surveywas conducted with a self-developed, 29-item questionnaire, measuring knowledge related to HPV and CC. We analyzed the responses of 160 patients who completed the questionnaire. Results: Mean total knowledge scores (±standard deviation) for HPV and CC were 5.2±3.0 of a possible 13.0 and 8.3±4.2 of a possible16.0, respectively. While 73% of the patients knew that HPV is the main cause of cervical cancer, only 44% knew that HPV is sexually transmitted. The purpose of CC was correctly identified by 71% of the patients. However, 35% failed to indicate the anatomicalarea resected at the time of CC in the schematic diagram. Women who were younger (p<0.001), had higher education level (p<0.001), and higher family income (p=0.008) had higher knowledge scores. In contrast, neither interval from CC to survey nor disease severity were associated with total knowledge score. Conclusion: The level of knowledge related to HPV and CC was unexpectedly low in women who had undergone CC. Intuitive educational resources may improve this knowledge, and further cohort studies are warranted.

Pregnancy and neonatal outcomes after periconceptional exposure to isotretinoin in Koreans

차은환,김내리,곽호석,한혜지,주성홍,최준석,천경철,김영아,고재환,한정열 대한산부인과학회 2022 Obstetrics & Gynecology Science Vol.65 No.2

ObjectiveIsotretinoin should not be used during pregnancy because of the risk of birth defects. Most pregnant women exposedto isotretinoin choose voluntary pregnancy termination due to concerns about birth defects. However, birth outcomedata supporting the termination of pregnancy are lacking. This study aimed to evaluate pregnancy and neonataloutcomes after periconception exposure to isotretinoin. MethodsThis was a prospective cohort study. We evaluated pregnancy and neonatal outcomes after exposure to isotretinoin in151 pregnant women. Among 1,026 callers at the Korean Teratology Information Service from 2001 to 2017 exposedto isotretinoin during the periconception period, 151 pregnant women who received counseling on teratogenic riskafter visiting the clinic were included. ResultsAmong the 151 participants who visited the clinic, only 42 were evaluated using ultrasonography until approximately20 weeks of gestation. Ultimately, 23 patients were included in the study. The average gestation period during the lastexposure to the drug was 2 weeks, and the average daily exposure dose was 12 mg. There were two cases of majorbirth defects in the exposure group. Spontaneous abortion rates were 17.7% and 8.7% in the exposure and nonexposuregroups, respectively (P=0.035). There was no significant difference between the exposure and non-exposuregroups in terms of pregnancy and neonatal outcomes. ConclusionThere was no significant difference in pregnancy and neonatal outcomes, including birth defects, between theexposure and non-exposure groups. Further studies with larger sample sizes are required to validate our findings.