서평 : 전인평, 『실크로드, 길 위의 노래』(소나무, 2003)

윤혜전 중앙아시아학회 2003 中央아시아硏究 Vol.8 No.-

Camurati-Engelmann 병의 뼈스캔 소견

윤혜전 ( Hai Jeon Yoon ),오소원 ( So Won Oh ),팽진철 ( Jin Chul Paeng ),이유경 ( You Kyung Lee ),최인호 ( In Ho Choi ),이동수 ( Dong Soo Lee ) 대한핵의학회 2009 핵의학 분자영상 Vol.43 No.6

Axillary Lymph Node-to-Primary Tumor Standard Uptake Value Ratio on Preoperative 18F-FDG PET/CT: A Prognostic Factor for Invasive Ductal Breast Cancer

김영환,윤혜전,김예미,김범산 한국유방암학회 2015 Journal of breast cancer Vol.18 No.2

Purpose: This study assessed the axillary lymph node (ALN)-toprimary tumor maximum standard uptake value (SUVmax) ratio (ALN/T SUV ratio) in invasive ductal breast cancer (IDC) on preoperative 18F-fluorodeoxyglucose positron emission tomography/ computed tomography (FDG PET/CT) to determine the effectiveness in predicting recurrence-free survival (RFS). Methods: One hundred nineteen IDC patients (mean age, 50.5±10.5 years) with pathologically proven ALN involvement without distant metastasis and preoperative FDG PET/CT were enrolled in the study. SUVmax values of the ALN and primary tumor were obtained on FDG PET/CT, and ALN/T SUV ratio was calculated. Several factors were evaluated for their effectiveness in predicting RFS. These included several parameters on FDG PET/CT as well as several clinicopathological parameters: pathologic tumor/ node stage; nuclear and histological grade; hormonal state; status with respect to human epidermal growth factor receptor 2, mindbomb E3 ubiquitin protein ligase 1 (MIB-1), and p53; primary tumor size; and ALN size. Results: Among 119 patients with breast cancer, 17 patients (14.3%) experienced relapse during follow-up (mean follow-up, 28.4 months). The ALN/T SUV ratio of the group with disease recurrence was higher than that of the group without recurrence (0.97±1.60 and 0.45±0.40, respectively, p=0.005). Univariate analysis showed that the primary tumor SUVmax, ALN SUVmax, ALN/T SUV ratio, ALN status, nuclear and histological grade, estrogen receptor (ER) status, and MIB-1 status were predictors for RFS. Among these variables, ALN/T SUV ratio with hazard ratio of 4.20 (95% confidence interval [CI], 1.74–10.13) and ER status with hazard ratio of 4.33 (95% CI, 1.06–17.71) were predictors for RFS according to multivariate analysis (p=0.002 and p=0.042, respectively). Conclusion: Our study demonstrated that ALN/T SUV ratio together with ER status was an independent factor for predicting relapse in IDC with metastatic ALN. ALN/T SUV ratio on preoperative FDG PET/CT may be a useful marker for selecting IDC patients that need adjunct treatment to prevent recurrence.

애착증진치료가 자폐적 양상 감소에 미치는 효과

주세진,윤혜전,전유정 한국특수교육학회 2006 한국특수교육학회 학술대회 Vol.2006 No.-

Factors associated with delayed emergency room visits in adult immigrant patients with mild abdominal pain in Korea

김도영,김대희,윤혜전,이운정,우선희,설승환,김한준 대한응급의학회 2019 Clinical and Experimental Emergency Medicine Vol.6 No.2

Objective To determine the factors associated with unmet needs in immigrant patients com­plaining of abdominal pain, by analyzing those associated with the time from symptom onset to emergency room visit.Methods We retrospectively reviewed the medical records of immigrants with abdominal pain who visited a tertiary hospital emergency department from January to December 2016. The de­pendent variable was the time from symptom onset to emergency room visit. The independent variables were age, sex, vital signs, disposition, health insurance status, date of visit, time of visit, level of education, employment status, economic satisfaction, marital status, living with family, duration of residence, having a native spouse, and subjective proficiency in Korean. We analyzed the association of the dependent variable with each independent variable.Results In total, 102 immigrant patients with abdominal pain were enrolled in this study. The patients who had earlier visits had good subjective proficiency in Korean, high economic satis­faction, longer durations of residence, a tendency to have a native spouse, and a high employ­ment rate. After linear regression analysis, the time from symptom onset to emergency room visit was negatively associated with employment (adjusted odds ratio, -13.67; 95% confidence interval, -23.25 to -4.09; P=0.006) and having a native spouse (adjusted odds ratio, -11.7; 95% confidence interval, -20.61 to -2.8; P=0.011).Conclusion The factors influencing the time from symptom onset to emergency room visit in immigrant patients with abdominal pain are associated with social capital, which improves ac­cess to emergency care. Policies that improve immigrant access to emergency care should be considered.

Factors Associated with Vancomycin-Resistant Enterococcus Colonization in Patients Transferred to Emergency Departments in Korea

김현순,김대희,윤혜전,이운정,우선희,최승필 대한의학회 2018 Journal of Korean medical science Vol.33 No.48

Background: Vancomycin-resistant enterococci (VRE) infections have become a major healthcare-associated pathogen problem worldwide. Nosocomial VRE infections could be effectively controlled by screening patients at high risk of harboring VRE and thereby lowering the influx of VRE into healthcare centers. In this study, we evaluated factors associated with VRE colonization in patients transferred to emergency departments, to detect patients at risk for VRE carriage. Methods: This study was conducted in the emergency department of a medical college- affiliated hospital in Korea. Every patient transferred to the emergency department and admitted to the hospital from January to December 2016 was screened for VRE using rectal cultures. In this cross-sectional study, the dependent variable was VRE colonization and the independent variables were demographic and clinical factors of the patients and factors related to the transferring hospital. Patients were divided into two groups, VRE and non-VRE, and previously collected patient data were analyzed. Then we performed logistic regression analyses of characteristics that differed significantly between groups. Results: Out of 650 patients, 106 (16.3%) had positive VRE culture results. Significant variables in the logistic analysis were transfer from geriatric long-term care hospital (adjusted odds ration [aOR]: 8.017; 95% confidence interval [CI]: 1.378–46.651), hospital days (4–7 days; aOR: 7.246; 95% CI: 3.229–16.261), duration of antimicrobial exposure (1–3 days; aOR: 1.976; 95% CI: 1.137–3.436), and age (aOR: 1.025; 95% CI: 1.007–1.043). Conclusion: VRE colonization in patients transferred to the emergency department is associated primarily with factors related to the transferred hospitals rather than demographic and clinical characteristics.

Photo-Guided Sentinel Node Mapping in Breast Cancer Using Marker-Free Photo-Gamma Fusion Lymphoscintigraphy

이은성,천인국,하승균,윤혜전,정소연,이시연,김석원,이은숙,김태윤,김광기,이병일,김태성,김석기 대한핵의학회 2013 핵의학 분자영상 Vol.47 No.1

Purpose Photo-gamma fusion lymphoscintigraphy (PGFLS)was developed by overlying a conventional planar gamma image on a photograph for the guidance of sentinel node biopsy. The feasibility and accuracy of PGFLS was assessed in breast cancer patients. Methods A digital camera and a gamma camera were coordinated to obtain photograph and gamma images from the same angle. Using the distance to the object and calibration acquisition with a flat phantom and radioactive markers, PGFLS was performed both in phantom and in patients without fiducial markers. Marker-free PGFLS was verified using flat phantom, anthropomorphic phantom with markers simulating sentinel nodes and breast cancer patients. In addition, the depth of the radioactive marker or sentinel node was calculated using two gamma images taken at right angles. The feasibility and accuracy of PGFLS were assessed in terms of mismatch errors of co-registration and depth with reference to the data from SPECT/CT. Results The mismatch error was less than 6 mm in the flat phantom image at a distance from 50 to 62 cm without misalignment. In the anthropomorphic phantom study,co-registration error was 0.42±0.29 cm; depth error was 0.51±0.37 cm, which was well correlated with the reference value on SPECT/CT (x scale: R200.99, p<0.01; y scale: R200.99, p<0.01; depth: R200.99, p<0.01). In ten patients with breast cancer referred for lympho-SPECT/CT, PGFSL enabled photo-guided sentinel lymph node mapping with acceptable accuracy (co-registration error,0.47±0.24 cm; depth error, 1.20 ±0.41 cm). The results from PGFSL showed close correlation with those from SPECT/CT (x scale: R200.99, p<0.01; y scale: R200.98,p<0.01; depth: R200.77, p<0.01). Conclusions The novel and convenient PGFLS technique is clinically feasible, showing acceptable accuracy and providing additional visual and quantitative information for sentinel lymph node mapping. This approach will facilitate photo-guided sentinel lymph node dissection in breast cancer.

외과계 병동 노인 수술 환자의 섬망 발생률과 위험요인

이은주,장미,김명화,윤혜전,김은미,정영인,김보경,임은수,홍경순 병원간호사회 2022 임상간호연구 Vol.28 No.2

Purpose: This retrospective chart review study was conducted to examine the frequency of delirium and to identify the risk factors of delirium in elderly surgical patients. Methods: The subjects of this study were 394 patients aged 65 years or older who underwent surgery. The diagnosis of delirium was based on the nursing assessment records with scores from the day of surgery to the 4th day after surgery. The collected data were analyzed by binary logistic regression analysis. Results: The incidence of delirium was 4.3%, and delirium occurred most frequently on the first day of surgery and lasted for 2.16 days on average. Of delirium patients, 76.5% underwent gastrointestinal surgery, and the most common delirium pattern was disorientation. In terms of the characteristics of the subjects, the occurrence of delirium was statistically different by age (x2=10.79, p=.005), systemic-specific disease (x2=9.63, p=.047), use of delirium-inducing drug(benzodiazepine) before surgery (x2=15.90, p<.001), walking ability before surgery (x2=7.65, p=.006), history of delirium (x2=35.92, p<.001), and emergency surgery (x2=16.40, p<.001). As risk factors of delirium, gastrointestinal surgery was found to increase the risk of delirium by 12.57 times (95% CI=2.45~64.46, p=.002), and the use of benzodiazepines before surgery was shown to increase delirium by 10.07 times (95% CI=2.21~45.87, p=.003). Conclusion: It is necessary for nurses to actively evaluate delirium using screening tools for early detection and prevention of delirium in elderly surgical patients with delirium risk factors. 목적: 본 연구는 노인 수술 환자의 섬망 발생률과 섬망 발생 관련 요인을 파악하기 위해 시행된 후향적 서술적 조사연구이다. 방법: 연구 대상자는 수술을 받은 만 65세 이상의 환자 394명이었다. 수술 후 섬망 진단은 간호사가 수술 당일부터 수술 후 4일까지 도구로 측정한 점수를 간호일지를 통하여 조사하였고, 수집된 자료는 Binary logistic regression으로 분석하였다. 결과: 연구 대상자의 섬망 발생률은 4.3%이었고, 섬망 발생시기는 수술 1일째에 가장 많이 발생해 평균 2.16일간 지속된 것으로 나타났다. 섬망 발생군 총 17명 중 76.5%가 위장관계 수술 환자였고, 섬망 양상은 지남력 저하가 100.0%로 가장 많았다. 대상자의 특성에 따른 섬망 발생은 나이(χ²=10.79, p=.005), 계통적 질환명(χ²=9.63, p=.047), 수술 전 섬망 유발 약물(벤조다이아제핀) 사용 여부(χ²=15.90, p<.001), 수술 전 활동상태(χ²=7.65, p=.006), 이전 섬망 경험(χ²=35.92, p<.001)과 응급수술 유무(χ²=16.40, p<.001)에 따라 통계적으로 유의한 차이를 보였다. 섬망 발생여부에 미치는 위험요인은 위장관계 수술인 경우 다른 수술에 비해 섬망 발생 위험이 12.57배(95% CI= 2.45∼64.46, p=.002), 수술 전 벤조다이아제핀 등 섬망 유발 약물을 복용했던 환자의 경우 10.07배(95% CI= 2.21∼45.87, p=.003) 증가하는 것으로 나타났다. 결론: 간호사는 노인 수술 환자의 섬망을 조기발견 및 예방하기 위해 선별 도구를 사용해서 적극적으로 섬망을 사정할 필요가 있다.

Factors Affecting Collaborations between a Tertiary-level Emergency Department and Community-based Mental Healthcare Centers for Managing Suicide Attempts

김대희,이운정,우선희,Kim Seong Hee,Ah Ram Seo,윤혜전,최승필 대한의학회 2020 Journal of Korean medical science Vol.35 No.38

Background: Community-based active contact and follow-up are known to be effective in reducing the risk of repeat suicide attempts among patients admitted to emergency departments after attempting suicide. However, the characteristics that define successful collaborations between emergency departments and community-based mental healthcare centers in this context are not well known. Methods: This study investigated patients visiting the emergency department after suicide attempts from May 2017 to April 2019. Patients were classified in either the successful collaboration group or the failed collaboration group depending on whether or not they were linked to a community-based follow-up intervention. Clinical features and socioeconomic status were considered as independent variables. Logistic regression analysis was performed to identify factors influencing the collaboration. Results: Of 674 patients, 153 (22.7%) were managed successfully via the targeted collaboration. Completion of hospital-based psychological counseling (adjusted odds ratio [aOR], 233.55; 95% confidence interval [CI], 14.99–3,637.67), supported out-of-pocket expenses (aOR, 11.17; 95% CI, 3.03–41.03), Korean Triage and Acuity Scale 1–3 (aOR, 4.31; 95% CI, 1.18–15.73), suicide attempt associated with mental disorder (aOR, 0.15; 95% CI, 0.04–0.52), and self-discharge against medical advice (aOR, 0.12; 95% CI, 0.02–0.70) were independent factors influencing the collaboration. Conclusion: Completion of hospital-based psychological counseling was the most highly influential factor determining the outcome of the collaboration between the emergency department and community-based mental healthcare center in the management of individuals who had attempted suicide. Completion of hospital-based psychological counseling is expected to help reduce the risk of repeat suicide attempts.

Value of imaging study in predicting pelvic lymph node metastases of uterine cervical cancer

정원근,박경란,이경자,김규보,이지혜,정송미,김이준,김지영,윤혜전,강병철,구혜수,성순희,조민선,박상희 대한방사선종양학회 2017 Radiation Oncology Journal Vol.35 No.4

Purpose: To evaluate the diagnostic accuracy of computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET/CT) in predicting pelvic lymph node (LN) metastases in patients with cervical cancer. Materials and Methods: From January 2009 to March 2015, 114 patients with FIGO stage IA1-IIB uterine cervical cancer who underwent hysterectomy with pelvic lymphadenectomy and took CT, MRI, and PET/CT before surgery were enrolled in this study. The criteria for LN metastases were a LN diameter ≥1.0 cm and/or the presence of central necrosis on CT, a LN diameter ≥1.0 cm on MRI, and a focally increased FDG uptake on PET/CT. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for pelvic LN metastases were estimated. Results: The sensitivity, specificity, PPV, NPV, and accuracy for detection of pelvic LN metastases were 51.4%, 85.9%, 41.3%, 90.1%, and 80.3% for CT; 24.3%, 96.3%, 56.3%, 86.8%, and 84.6% for MRI; and 48.6%, 89.5%, 47.4%, 90.0%, and 82.9% for PET/ CT, respectively. The sensitivity of PET/CT and CT was higher than that of MRI (p=0.004 and p= 0.013, respectively). The specificity of MRI was higher than those of PET/CT and CT (p=0.002 and p=0.001, respectively). The difference of specificity between PET/CT and CT was not statistically significant (p=0.167). Conclusion: These results indicate that preoperative CT, MRI, and PET/CT showed low to moderate sensitivity and PPV, and moderate to high specificity, NPV, and accuracy. More efforts are necessary to improve sensitivity of imaging modalities in order to predict pelvic LN metastases.