Causes and Predictive Factors Associated with “Diagnosis Changed” Outcomes in Patients Notified as Tuberculosis Cases in a Private Tertiary Hospital

( Byung Ju Kang ),( Kyung Wook Jo ),( Tai Sun Park ),( Jung Wan Yoo ),( Sei Won Lee ),( Chang Min Choi ),( Yeon Mok Oh ),( Sang Do Lee ),( Woo Sung Kim ),( Dong Soon Kim ),( Tae Sun Shim ) 대한결핵 및 호흡기학회 2013 Tuberculosis and Respiratory Diseases Vol.75 No.6

Background: The aim of our study was to evaluate the “diagnosis changed” rate in patients notified as tuberculosis (TB) on the Korean TB surveillance system (KTBS). Methods: A total of 1,273 patients notified as TB cases on the KTBS in one private tertiary hospital in 2011 were enrolled in the present study. Patients were classified into three groups: “diagnosis maintained”, “diagnosis changed” (initially notified as TB, but ultimately diagnosed as non-TB), and “administrative error” (notified as TB due to administrative errors). Results: Excluding 17 patients in the “administrative error” group, the “diagnosis maintained” and “diagnosis changed” groups included 1,097 (87.3%) and 159 patients (12.7%), respectively. Common causes of “diagnosis changed” were nontuberculous mycobacterial (NTM) disease (51.7%, 61/118), and pneumonia (17.8%) in cases notified as pulmonary TB, and meningitis (19.5%, 8/41) and Crohn`s disease (12.2%) in cases notified as extrapulmonary TB. Being older than 35 years of age (odds ratio [OR], 2.18) and a positive acid-fast bacilli stain (OR, 1.58) were positive predictors and a TB-related radiological finding (OR, 0.42) was a negative predictor for a “diagnosis changed” result via multivariate logistic regression analysis in pulmonary TB cases. Conclusion: Because of a high “diagnosis changed” rate in TB notifications to the KTBS, the TB incidence rate measured by the KTBS may be overestimated. Considering the worldwide trend toward increased NTM disease, the “diagnosis changed” rate may increase over time. Thus, when reporting the annual TB notification rate in Korea, the exclusion of “diagnosis changed” cases is desirable.

Causes and Predictive Factors Associated with "Diagnosis Changed" Outcomes in Patients Notified as Tuberculosis Cases in a Private Tertiary Hospital

Kang, Byung Ju,Jo, Kyung-Wook,Park, Tai Sun,Yoo, Jung-Wan,Lee, Sei Won,Choi, Chang-Min,Oh, Yeon-Mok,Lee, Sang-Do,Kim, Woo Sung,Kim, Dong Soon,Shim, Tae Sun The Korean Academy of Tuberculosis and Respiratory 2013 Tuberculosis and Respiratory Diseases Vol.75 No.6

Background: The aim of our study was to evaluate the "diagnosis changed" rate in patients notified as tuberculosis (TB) on the Korean TB surveillance system (KTBS). Methods: A total of 1,273 patients notified as TB cases on the KTBS in one private tertiary hospital in 2011 were enrolled in the present study. Patients were classified into three groups: "diagnosis maintained", "diagnosis changed" (initially notified as TB, but ultimately diagnosed as non-TB), and "administrative error" (notified as TB due to administrative errors). Results: Excluding 17 patients in the "administrative error" group, the "diagnosis maintained" and "diagnosis changed" groups included 1,097 (87.3%) and 159 patients (12.7%), respectively. Common causes of "diagnosis changed" were nontuberculous mycobacterial (NTM) disease (51.7%, 61/118), and pneumonia (17.8%) in cases notified as pulmonary TB, and meningitis (19.5%, 8/41) and Crohn's disease (12.2%) in cases notified as extrapulmonary TB. Being older than 35 years of age (odds ratio [OR], 2.18) and a positive acid-fast bacilli stain (OR, 1.58) were positive predictors and a TB-related radiological finding (OR, 0.42) was a negative predictor for a "diagnosis changed" result via multivariate logistic regression analysis in pulmonary TB cases. Conclusion: Because of a high "diagnosis changed" rate in TB notifications to the KTBS, the TB incidence rate measured by the KTBS may be overestimated. Considering the worldwide trend toward increased NTM disease, the "diagnosis changed" rate may increase over time. Thus, when reporting the annual TB notification rate in Korea, the exclusion of "diagnosis changed" cases is desirable.

아세틸 콜린 유발 검사시 허혈성 심전도 변화와 흉통의 발생이 내피세포 기능장애에 미치는 영향

최철웅(Cheol Ung Choi),나승운(Seung-Woon Rha),김선원(Sun Won Kim),나진오(Jin Oh Na),임홍의(Hong Euy Lim),김진원(Jin Won Kim),김응주(Eung Ju Kim),한성우(Seong Woo Han),박창규(Chang Gyu Park),서홍석(Hong Seog Seo),오동주(Dong Joo Oh) 대한임상노인의학회 2010 대한임상노인의학회지 Vol.11 No.4

연구배경: 아세틸 콜린 유발 검사시 발생하는 흉통과 허혈성 심전도 변화가 아세틸 콜린에 의해 발생하는 관상동맥의 내피세포 기능에 어떤 영향을 주는지 알아보고자 했다. 방법: 흉통으로 내원하여 관상동맥 조영술과 아세틸 콜린 유발검사를 시행받은 1,085명의 환자를 대상으로 하였다. 아세틸 콜린 유발 검사를 하는 동안 허혈성 심전도 변화 및 흉통의 발생 유무에 따른 관상동맥 내피세포 기능의 특징을 비교하였다. 결과: 539명의 환자에서 아세틸 콜린 검사시 내피세포 기능 장애가 발생 하였다. 허혈성 심전도 변화가 있었던 그룹이 심전도 변화가 없었던 그룹보다 흉통이 더 많았고(78.1% vs. 60.8%, P=0.007), 관상동맥 조영술상 다발성 관상동맥 경련이 빈번하였고(59.4% vs. 40.6%, P=0.004), 관상동맥의 경련 정도도 더 심하였다(64.1% vs. 46.5%, P=0.006). 흉통이 있었던 그룹이 흉통이 없었던 그룹보다 허혈성 심전도 변화의 빈도가 더 높았다(14.7% vs. 7.5%, P=0.007). 또한 흉통이 있었던 그룹이 관상동맥 경련이 다발성으로 발생하는 경우가 많았고 (50.7% vs. 29.5%, P<0.001), 미만성으로 발생하는 경우가 많았고(87.1% vs. 75%, P<0.001), 관상동맥의 경련의 정도도 더 심하였다(51.6% vs. 43.5%, P=0.041). 결론: 아세틸 콜린 유발검사시 발생하는 허혈성 심전도 변화와 흉통은 관상동맥 경련의 정도와 경련이 발생하는 관상동맥 개수와 연관이 있다. Background: ECG changes and chest pain during acetylcholine (Ach) provocation tests may constitute important clinical parameters for Ach-induced endothelial dysfunction. We investigated the association between ischemic ECG changes and chest pain during the Ach-provocation test and angiographic characteristics of Ach-induced endothelial dysfunction. Methods: A total of 1,085 patients with anginal symptoms underwent diagnostic coronary angiography (CAG) and Ach-provocation tests. We compared angiographic characteristics of Ach-induced endothelial dysfunction according to the presence of ECG change and chest pain. Results: A total of 539 patients experienced Ach-induced endothelial dysfunction. Patients who experienced ECG change group suffered more frequent chest pain (78.1% vs. 60.8%, P=0.007), angiographically more frequent multiple coronary artery spasm (59.4% vs. 40.6%, P=0.004), and more severe coronary artery spasm (64.1% vs. 46.5%, P=0.006) than patients without ECG change. However, there was no difference in the length of endothelial dysfunction between the groups. The incidence of ischemic ECG changes in patients with chest pain was higher than in patients without chest pain (14.7% vs. 7.5%, P=0.007). Patients who experienced chest pain more often experienced multiple (50.7% vs. 29.5%, P<0.001), diffuse (87.1% vs. 75%, P<0.001), and severe coronary artery spasm (51.6% vs. 43.5%, P=0.041) than patients without chest pain. Conclusion: Ischemic ECG changes and chest pain during the Ach-provocation test are associated with multi-vessel involvement and severe coronary artery spasm. Chest pain is associated with the length of endothelial dysfunction, but ischemic ECG change is not.

트라이애슬론 스포츠폭력 사건에 투영된 트라이애슬론 선수들의 경험과 인식

김희주 ( Kim Hee-ju ),장덕선 ( Chang Duk-sun ) 한국융합과학회 2022 한국융합과학회지 Vol.11 No.8

연구목적 본 연구는 故 최숙현 선수의 희생이 헛되지 않기를 바라는 마음으로 시작되었다. 연구대상은 2020년 스포츠폭력에 의해 고인이 된 최숙현 선수의 사망사건을 직·간접적으로 경험한 철인3종경기 선수 30명이다. 연구방법 연구방법은 내러티브의 3차원적 공간 중 개인적·사회적 차원과 내적·외적 지향에 중점을 두고, 연구 참여자의 스포츠폭력에 대한 인식과 경험을 개방형 질문으로 조사하였다. 이 후 추가적 심층면담을 실시하였다. 특히 참여자들이 현역선수들이기 때문에 연구참여중단의 가능성과 익명성을 보장하였다. 연구자는 25년간 트라이애슬론 선수로 활동을 하였으며, 직접 피해자이기도 하다. 결과 자료의 귀납적 범주화 결과, 스포츠폭력 사건에 대한 인식에는 기본신념 붕괴, 제도적 문제, 우려, 감정 등이 나타났다. 인지된 내적 변화에는 부정적 영향 없음, 제도적 문제, 간접 트라우마 등이 나타났다. 인지된 외적 변화로는 부정적 영향 없음, 간접 트라우마 등이 나타났다. 지각된 변화로는 변화와 기타로 나타났다. 변화의 시발점은 처벌에 대한 생각, 감정, 제도적 문제 등이 도출 되었으며 변화의 방향성으로는 2차 피해 우려, 확실한 변화 요구, 제도적 해결책 필요 등으로 나타났다. 결론 결과를 토대로 트라이애슬론의 스포츠폭력 사건에 대한 답변을 시간의 흐름 순으로 정리하여 새로운 패러다임 모형을 제시하였다. Purpose This study was started with the hope that the sacrifice of the deceased player, Sook-Hyun Choi, would not be in vain. The subjects of this study were 30 Korean triathletes who directly or indirectly experienced the case of Choi Sook-hyeon, who died of sports violence in 2020. Methods The research method focused on personal and social dimensions and internal and external orientation among the three-dimensional space of the narrative, and conducted an open-ended questionnaire about the research participants' perceptions and experiences of sports violence. After that, additional in-depth interviews were conducted during the analysis process to collect data. In particular, since the participants are active players, the possibility of discontinuation of research participation and anonymity were guaranteed in consideration of ethical issues that may arise from this. In addition, the research was conducted in consideration of the fact that the researcher had been active as a triathlete for 25 years and was also a victim. Result As a result of inductive categorization of the collected data, the perception of sports violence incidents revealed a breakdown of basic beliefs, institutional problems, concerns, and emotions. There were no negative effects on perceived internal changes, institutional problems, and indirect trauma. As for the perceived external changes, there were no negative effects and indirect trauma. Changes and others were perceived as changes. As the starting point of change, thoughts, feelings, and institutional problems about punishment were derived. As for the direction of change, concerns about secondary damage, a clear demand for change, and the need for an institutional solution were shown. Conclusion A new paradigm model was presented by arranging the responses to the three types of sports violence cases in the order of time flow.

변색 실활치에 대한 carbamide peroxide gel의 표백효과

박선아,김선호,황윤찬,오병주,윤창,박영준,정선와,황인남,오원만 大韓齒科保存學會 2002 Restorative Dentistry & Endodontics Vol.27 No.4

The bleaching of discolored nonvital teeth is conservative treatement that satisfy the cosmetic desire. The most common method for this treatement, walking bleaching, is using 30% hydrogen peroxide and sodium perborate. Many alternatives are suggested for preventing the external cervical root resorption that is the common complication of the nonvital teeth bleaching with 30% hydrogen peroxide. The same extent of oxidation reactions as that resulted by the bleaching with the application of 30% hydrogen peroxide and sodium perborate can also be acquired more safely by materials that contain 10% carbamide peroxide, used primarily for the bleaching of vital teeth. Therefore, this study was performed to evaluate the efficacy of 10% and 15% carbamide peroxide bleaching gel in nonvatal teeth bleaching. The internal bleaching of intentionally discolored teeth was performed in vitro with 10% carbamide peroxide (Group 1), 15% carbamide peroxide (Group 2), mixture of distilled water and sodium perborate (Group 3), and mixture of 30% hydrogen peroxide and sodium perborate (Group 4). The bleaching materials were refreshed following 3, 6, 9 and 12 days. To evaluate the bleaching effect, the color change of the crowns was measured at 1, 2, 3, 4, 7 and 15 days of bleaching using the colorimeter. The results were as follows : 1. L^* and ΔE^* values were increased with time in all bleaching agents(p<0.01). 2. There was no significant difference in L^* and ΔE^* value among bleaching agents. 3. Δ^* value higher than 3 was shown after 3 days of bleaching with 10% carbamide peroxide gel, 1 day with 15% carbamide peroxide gel, 4 days with mixture sodium perborate and distilled water and 4 days with mixture sodium perborate and 30% hydrogen peroxide, respectively. These results revealed that the use of 10% and 15% carbamide peroxide bleaching gel in non-vital teeth bleaching is as effective as mixture of distilled water and sodium perborate and mixture of 30% hydrogen peroxide and sodium perborate. Accordingly, carbamide peroxide could be used clinically to bleach discolored non-vital teeth.

백서에서 Depulpin®과 Formocresol에 대한 치수와 치근단 조직의 반응

문형인,김선호,황윤찬,오병주,황인남,김선헌,정선와,윤창,오원만 大韓齒科保存學會 2002 Restorative Dentistry & Endodontics Vol.27 No.4

One fifth dilution of formocresol is usually for pulpotomy of the primary teeth and emergency pulpotomy of the permanent teeth. However, the use of formaldehyde has been subjected to criticism because it may be absorbed into the blood stream and become distributed systemically, it may also alter the pulp tissue rendering it immumologically active, and have carcinogenic potential. Recently Depulpin®(VoCo., Germany) gains popularity as a devitalizing agent during root canal therapy in spite of high concentration of 49% paraformaldehyde because it facilitate devitalization of pulp and make root canal therapy easier. But there have been not enough publications about the reaction of pulp and periapical tissue caused by Depulpin. This study was performed to evaluate the histological changes in pulp and periapical tissue of rats after pulpotomy using formocresol and Depulpin and to elucidate the toxic effects of these agents. Thirty six Sprague-Dawley rats were anesthetized by intraperitoneal injection of ketamine. Maxillary first molar teeth were used for pulpotomy with formocresol and Depulpin. Rats were sacrificed after 2 days, 4 days, 1 week, 2 weeks, 3 weeks and 4 weeks respectively. Specimens were histologically observed by light microscope changes in pulp and periapical tissue. The obtained results were as follows. 1. Formocresol group A zone of fixed tissue, in which odontoblasts could clearly be defined, was present directly underneath the pulpotomy dressing in almost all teeth of this group. This was followed by an area of necrotic tissue which resembled dried out fibrous tissue with no cellular detail except some pyknotic nuclei. In the specimens of after 2 days, 4 days, 1 week, 2 weeks in which vital tissue was present. it was separated from the fibrous area by a zone of inflammation. In the specimens of after 3 weeks and after 4 weeks, inflammatory infiltrate was in the periodontal ligament adjacent to the apical foramina of the teeth. 2. Depulpin® group The area of necrotic tissue which had no cells and fibers , was present adjacent to the dressing. This was followed by dried out fibrous tissue with no cellular details except some pyknotic nucleli. A short stump of vital pulp with odontoblasts was present at the end of the canal after 2 days. Inflammatory infiltrate was in the periodontal ligament after 4 days and after 1week. Severe root resorption and necrosis of periapical tissue opposite the root resorption site were defined after 2 weeks and after 3 weeks. Periapical lesion which consist of necrotic tissue surrounded by a fibrous connective wall. was found after 4 weeks. The results indicated that Depulpin can cause more adverse reaction to the dental pulp and periapical tissue than formocresol, and further studies are needed for its clinical use with safety.

지열시스템의 그라우트 및 수온변화가 미생물에 미치는 영향 실험

조윤주,이진용,김창균,한지선,Jo, Yun-Ju,Lee, Jin-Yong,Kim, Chang-Gyun,Han, Ji-Sun 한국지하수토양환경학회 2009 지하수토양환경 Vol.14 No.4

Objective of this study was to examine the effects of grouts and temperature change on microorganisms in geothermal heat pump. Groundwater samples were obtained from wells in the heat pump system during installation (Oriental medicine hospital) and in the heat pump system under operation (Business incubation center). Grouts are the volclay sodium bentonite. Real-time PCR was used to evaluate total bacterial number and 16S rDNA. The results showed that total bacterial number of groundwater in the heat pump operation was greater than that of non-operation case, which indicates a temperature effect on the bacterial culture. In addition, high concentration of grout showed an elevated bacteria number. In the mean time, a long-term field monitoring is essentially required to confirm the effects of the grouts and the temperature changes. 본 논문은 지열시스템의 설치 시 사용되는 그라우트와 운영에 따른 수온변동이 유발할 수 있는 미생물학적 영향을 실내실험을 통해 살펴보았다. 시료는 지열히트펌프가 아직 가동되지 않는 관정(한방병원)과 지열 히트펌프가 가동 중인 곳(창업보육센터)에서 채취하였다. 실험에 사용한 그라우트는 볼클레이 벤토나이트로 나트륨(Na)계이며 Real-time PCR을 사용하여 각 시료에서 추출된 총 유전자 DNA 중 세균이 가지고 있는 16S rDNA를 정량함으로써 전체 세균의 양을 평가하였다. 실험 결과 지열히트펌프가 가동 중인 지하수에서 총 세균양이 가장 많았으며 벤토나이트를 주입하면서 세균수가 증가하는 경향을 보였다. 한편 그라우트 및 수온영향을 보다 명확하게 파악하기 위해서는 장기적인 현장모니터링이 요구된다.

Propylthiouracil 투여에 의한 갑상선 기능저하 흰쥐 조직에서 알코올 탈수소효소 활성의 변화

백상현,김동선,이창범,박용수,안유헌,김태화,기춘석,강주섭 한양대학교 의과대학 2001 한양의대 학술지 Vol.21 No.2

Background: Thyroid hormone has been known to affect hepatic alcohol dehydrogenase (ADH) activity. Although the liver is the principal site of ethanol metabolism, stomach is also responsible in part for ethanol oxidation. The effects of thyroid hormone on ADH activity in gastric mucosa and other tissues of rats had not been previously examined. Method: The effects of thyroid hormone on liver, stomach, lung, and kidney ADH activities (nM of NADH/min/mg of cytosolic protein) have been investigated in male Sprague Dawley rats treated with propylthiouracil (50 mg/kg) for 14 days. Results: Whereas hepatic ADH activities were not changed by treatment with PTU(42.9(8.6 vs 45.2 (10.1), gastric ADH activities in PTU-treated rats increased by 258.8% of control rat (6.3 ( 0.6 vs 2.2 ( 1.2, p〈0.001). In the activities of other tissues, PTU treatment decreased lung ADH activity by 59.7% of control, and increased kidney ADH activities by 247.1% of control rats. Conclusion: These data suggest that hypothyroidism causes an increase of gastric alcohol metabolism, and that the increase of gastric ADH activity can partly restore the first pass metabolism of ethanol in hypothyroid rats.

기관에서 발생한 전이성 갑상선 유두상 암종 1례

장선호,박철규,이병돈,장혁순,강주원 순천향의학연구소 1995 Journal of Soonchunhyang Medical Science Vol.1 No.2

Papillary adenocarcionma has been common malignant tumor of human thyroid gland, and metastasize to the lung and bone as well. But endotracheal meastasis of papillary adenocarcinoma is very unusual. A 75 years old woman was presented with a metastatic papillary thyroid adeno- carcinoma in the trachea, 10 years after total thyroidectomy. The tumor mass was located in the anterior wall of tracheal lumen. The mass was confirmed with pathologic finding. We describe a case of tracheal papillary adenocarinoma of thyroid gland origin and discuss the current recommendation for management.

간호사의 이직의도 구조모형

김창희,양승순,김연자,손연정,유미애,송주은 대한간호학회 간호행정학회 2009 간호행정학회지 Vol.15 No.4

Purpose: The purpose of this study was to construct and test a structural equation model of nurses' turnover intention. Method: The participants were 716 nurses at 4 university hospitals. Data were collected by a self-report questionnaire in 2008 and analyzed using SPSS 12.0 and AMOS 4.0 Win program. Results: The fit indices of modified model were x²=285.928(p<.001),x²/df=1.958GFI=0.964, RMSEA=0.037, AGFI=0.944, NFI=0.947, NNFI=0.961, CFI=0.973, PNFI=0.658 and showed high compatibility with the empirical data. In the final model, job stress and satisfaction were found to have significant direct effects on nurses' turnover intention, while organizational culture and emotional labor were very important factors to have indirect effects on turnover intention via job stress and satisfaction. Nurses' turnover intention was accounted for 41.2% of covariance by these factors. Conclusions: Comprehensive nursing interventions for decreasing nurses' turnover intention should be focused on reducing job stress and increasing job satisfaction. Also, Nursing strategy for enhancing positive organizational culture and decreasing emotional labor would be helpful for decreasing nurses' turnover intention, too. Further studies are needed to prospectively conduct to verify these causal relationships with larger sample.