정신분열병 환자의 반응시간

최형식,정범석,김한규,송현주,이재원,김창윤 大韓神經精神醫學會 2000 신경정신의학 Vol.39 No.5

연구배경: 주의력은 인지적인 정보처리과정(information processing)의 가장 기본적인 단계이다. 반응시간 (reaction time)은 주의력을 가장 잘 반영하는 검사 중 하나로서, 자극이 제시된 후 반응이 시작되기까지 반응 여부를 결정하는데 걸리는 시간인 판단 시간(decision time)과 반응이 시작되면서 목표에 도달할 때까지 시간인 운동시간(motor time)으로 나누어 볼 수 있다. 기존의 연구결과로는, 정신분열병 환자군에서 반응시간의 수행이 떨어져 있다는 보고는 많이 되어왔으나 차이가 없다는 보고도 있으며, 판단시간과 운동시간 중 어느 부분에 장애가 있는지 명확하지 않다. 또한 반응시간 측정값은 질병의 진단적 유형(diagnostic subtype), 증상, 경과 등의 영향을 받으며 개체간의 변동(inter-individual variation)이 크고, 같은 피험자라도 측정시점이 다를 때마다 차이를 보이는 개체내 변동(intra-individual variation)이 커서 검사결과마다 차이를 보이고 있는 상태이다. 목적: 환자군은 개체간 변동이 크고 다른 임상적 요소에 의해 영향받는 점을 고려하여, 임상적으로 안정적인 경과에 있는 정신분열병 환자만을 대상으로 정상인 군과 반응시간의 차이를 비교하고자 하였다. 또한 반응시간을 판단시간과 운동시간으로 나누어 측정하여 각각을 비교분석 하고자 하였고, 개체내 변동이 큰점을 고려하여 25회 반복 측정을 실시하고 이에 따른 변동의 경향성을 조사하고자 하였다. 방법: DSM-Ⅳ에 의해 '정신분열병'으로 진단된 환자로서, 급성기 이후 항정신병약물을 유지하고 있으며BPRS(brief psychiatric rating scale) 30점 이하의 임상적으로 안정적인 상태가 3개월 이상 유지된10명이 환자군으로 포함되었고, 정상인은 자원자 10명이 포함되었다. 검사도구는 비엔나 테스트 시스템 반응유닛(Reation Unit) 파라미터 S8을 이용하였다. 총 6가지의 자극이 무작위로 1측정시기(session) 당 총 32회 주어지고, 피험자는 이중 특정 자극에 8번만 반응하도록 되어 있다. 시작 전 1회 연습 후 총 25측정시기를 5분 간격으로 반복하였다. 반응 시간을 판단시간과 운동시간의 합으로 정의하고 세 가지 모두 컴퓨터를 이용하여 자동 측정되었다. 반응·판단·운동 시간의 비교에는 반복 측정을 고려한 분산분석(repeated measures analysis of variance)을 사용하였다. 결과: 환자군은 정상인에 비하여 유의하게 반응시간의 수행속도가 저하되어 있었다(p<0.01). 판단시간과 운동시간으로 나누어 볼 때, 환자군에서 판단시간이 유의하게 느렸고(p<0.01), 운동시간은 수행저하의 경향을 보였으나 통계적으로 유의하지는 않았다. 25회 반복측정시 양군 모두 측정시기에 따른 유의한 변화를 보였고(p<0.01), 환자군의 반응시간은 개체간의 차이뿐 아니라 개체내 변동이 큰 경향을 보였다. 옳게 반응한 횟수(correct response)는 환자군에서 저하되는 경향을 보였으나 통계적으로 유의하지는 않았다. 고찰: 정신분열병 환자군에서 판단시간이 유의하게 저하된 것은, 반응시간의 저하가 운동요소 보다는 인지적 요소에 의한 것임을 시사하는 것으로, 정보처리과정의 기본적인 단계인 주의력 장애를 보여주는 것으로 생각된다. 비교적 안정적이고 임상적인 특성이 동일한 환자군에서도 반응시간이 대조군에 비해 큰 개체간 차이와 개체내 변동성의 경향을 보였으며, 이는 단순한 측정오차라기 보다는 정신분열병 환자군의 인지기능의 특성을 반영하는 것으로 생각된다. 중심단어:정신분열병·반응시간·판단시간·운동시간·개체간 변동·개체내 변동. The reaction time(RT) has been known to reflect attention that controls the flow of information processing. Extensive research has demonstrated cognitive impairment in schizophr-enia subjects using RT taske. However, little work has been done examining the relative contribution of DT(decision time) and MT(motor time) to slowed RT in schizophrenics. Also, recent investigators have observed that schizophrenic patients exhibit larger intra-individual variability in RT than do normal comparison subjects. The purpose of this study, using multi-stimulus convergent RT task, was to explore the speed of RT, relative contribution of decision time(DT) and motor time(MT) to slowed RT, overall sequential profile in 25 repeated-time measurements in 10 schizophrenic out-patients and 10 normal control subjects. Overall reaction time and decision time were slower in schizophrenic subjects than in normal controls. The motor time was not shown to be significantly different between the two groups with 0.05 significance level, although there was some trend indicating schizophrenic subjects were slower consistently in repreated measurements over time. These results suggested that the slower reaction time in schizophrenic subjects was mostly determined by cognitive component, decision time rather than motor time. Sequential profile of repeated measurements showed greater intraindividual and interindividual variations in schizphrenics than in normal controls. These results indicate that high variabilities are not merely measurement errors but characteristic of schizophrenic psychopathology. KEY WORDS: Schizophrenia·Reaction time·Decision time·Motor time·Inter-individual variation·Intra-individual variation.

치과위생사의 감염관리 실태에 관한 연구

조윤정,윤석준,안형식,김순덕,박형근 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.2

Background : Dental hygienists are at risk of acquiring infections through exposure to infectious agents. This study explores the frequency of exposure to infectious agents and infection control practices among dental hygienists. Methods : We undertook a cross-sectional survey to examine the exposure to infectious agents and infection control practices among dental hygienists through questionnaire. Data were obtained from 124 dental hygienists attending educational conferences. A multiple logistic regression analysis was conducted to determine the factors that effect infection control practices in to age, completion of infection control education, recognition of their own serum hepatitis Ag/Ab status, the number of one day patients, location of clinics, type of clinics, and career years. Results : Of the 124 dental hygienists, 91.7% were exposed to at least one accident such as needle strike injuries during their practices periods. The health screening coverage rate in dental hygienists was 16.5%. The number of one day patients and career years were important in relation to infection control practices among dental hygienists. The adjusted odds ratio estimates for career years were 5.049 times greater(95% CI 1.238-20.597)for groups with 4 career years than under 2 career years. That for the number of one day patients were 0.261(95% CI 0.071-0.0955)lower for through 20 up to 30 patients, 0.531(95% CI 0.102-2.78)lower for through 30 up to 40 patients and 0.498(95% CI 0.123-2.017)lower for more than 40 patients than under 20 patients. Conclusion : From these results, prevalence of infection control practices among dental hygienists is related to the number of one day patients and career years. Prevention of cross infection and reduction of future transmission should be a priority to dental hygienists for promotion of infection control and further efforts to educate newcomers on infection prevention should be made.

종합병원 전자건강카드 도입에 영향을 미치는 요인

안이수,윤석준,안형식,홍석원 한국의료QA학회 2005 한국의료질향상학회지 Vol.12 No.2

Objective : This research is focused on understanding the current status of the Health Smart Card already in use in other advanced countries. This research will analyze the current status of the medical institutions Health Smart Card system adoption process and its effects, and provide a basis for future policy decisions for the effective adoption and diffusion of a Health Smart Card system, in the medical field, through the completed research and analysis. Method : This research surveys the domestic, and foreign, status of Health Smart Card usage. The research also presents up-to-date methodology for the evaluation of the effects of medical and health care technology. The research also conducts a survey of the domestic medical institutions that have implemented a Health Smart Card system, and then analyzes the results of the survey. Additionally, the research carried out a survey and analysis of medical institutions with no Health Smart Card system implemented, and considered the factors affecting the diffusion of Health Smart Card systems in considering an effective policy for the introduction and diffusion of such a system. Research Results : Through the study of the methodology of medical and health care information technology in advanced countries, the methodology for assessing Health Smart Card technology has been established, and focuses on 6 aspects. The study on the status of foreign implementation has shown a model for the Health Smart Card system. A survey was conducted on the current status of medical institutions with an implemented Health Smart Card system, and the survey results have been analyzed. Also, factors influencing the adoption of Health Smart Card systems have been analyzed through the survey on those medical institutions that have not implemented a Health Smart Card system. Conclusion : The government must provide institutional measures for sharing medical records by constructing an IT infrastructure at the national level to enable the adoption and diffusion of a Health Smart Card system. Such a network will make connections between medical institutions possible, thus making the diffusion of the Health Smart Card system nationwide. For the successful adoption and diffusion of a Health Smart Card system, a model system development, under a medical record sharing system, should be conducted. Additionally, a regional unit based model should be developed for the model project, as is done in advanced countries, along with the application of such results.

의약정보담당자(MR)의 기능 및 역할에 관한 연구

이동일,제해관,윤석준,안형식,문영배 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.1

Background : Aim of this study is focused on the analysis of the needed abilities of medical representatives resulting in building up the market and increasing sales. It is to propose methods to increase this ability ensuring continuous growth in market share and profit. Methods : A survey was conducted between January 6 and May 31, 2003. Using SPSS(Version 10.0), the collected data was analyzed by Hotelling T2, factor analysis. Some hypotheses were selected to include the conclusion. Some questionnaires for physicians working in hospitals or clinics and the medical representatives working in a pharmaceutical company were created and asked to them to either prove or reject those hypotheses. The results were analyzed to find the primary factors that effect the interactions between physician and the medical representatives. These factors were also studied along with the theoretical research based on published references. Results : The results were as follows. The main reasons for the physician to meet with a medical representatives were collection of product informations needed for patient treatment and collection of informations on current medical issue and as well as personal interests. The main parameters by which physicians evaluate the medical representatives are human relationship including sincerity and manners and supply of accurate and unbiased information on products. Overall, the medical representatives’ perception on the importance of medical knowledge and ability to deliver it are lower than that expected by physicians. Conclusion : Medical and pharmaceutical companies’ environment are changed rapidly. And those changes forced medical representatives to set new roles and competency. In order to drive away from the past ‘rule of thumb’ and ‘adaptation to circumstance’, optimal method and systemic development to train and support the medical representatives should be quipped. They will help ,medical representatives to be specialists in medical knowledge and to understand the exact need of health care professions. Product competitiveness will be increased and eventually successful business can be achieved through it.

사체간이식 환자와 생체간이식 환자들의 삶의 질 비교 연구

김금희,윤석준,안형식,이준영,박형근,서경석 한국의료QA학회 2004 한국의료질향상학회지 Vol.11 No.1

Objective : The aim of this study were to measure quality of life(QOL) in liver transplant recipicnts, to ocmpare QOL between living donor liver transplant recipicnts and cadavcric live transplant recipients and to investgatre whether SF-36 may be used as a disease-specific instrument in liver transplant recipients. Methods : We conducted a single-center cross-sectional study of 133 LT recipients ages 13 to 65 years, all of whom had had Liver Transplantion(LT) at least 1 months previously. QOL was assessed using a self-completion questionnaire consisting of the Bang Whal Ran(1991) instruments and the 36-Item Short-Firm Health Survey(SF-36) health status profile measure. We investigated whether the SF-36 instrument may be used as a disease-specific instrument in LT recipients. Individual scale scores range from 0 to 100 , with higher score reflecting better health. Data on demograpics, clinical status at pre transplantation 1 day, post transplantation clinical statns, and graft gunction were collected to identify predictors of post transplantation QOL. Results : Standard measures for test-rtest reliability, internal consistency, and discriminant and concurrent validity were examined. The reliability of the SF-36, as measured by test-retest correlation(Pearson coeffocoents: 0.729, p=0.002) and by internal consistency (Cronbach's alpha: 0.9431) exceeded conbentional acceptability criteria. The correlation between domain scores of SF-36 and the Bang Whal Ran(1991) was clear and logical in that the clinical characteristics of SF-36 strongly correlated with the clinical component summary score of the Bang Whal Ran(1991)(r = 0.8155, P<01). SF-36 scale scores were compared between Cadaveric Liver Transplant recipients and Living Donor Liver Transplant recipients. Donor types of post LT did not influence HRQOL(P >0.05). 87% of the liver transplant recipients were safisfied to get LT. Satisfaction of post LT showed significantly greater HRQOL(p<0.001). Conclusion : SF-36 is found reliable and valid. This study indicates thet Donor Type did not influence HRQOL after LT. The information gained from this study will help us to better define expectations and the colinical course after liver transplantation to patients and their families.

기능성 Catechol-O-Methyltransferase 유전자 다형성과 한국인 정신분열병의 관련성

박태원,홍영준,박임순,김형섭,최인미,배수영,윤경식,강대희 大韓神經精神醫學會 2001 신경정신의학 Vol.40 No.4

연구목적 : Catechol-O-Methyltransferase(COMT)는 카테콜아민 신경전달물질의 불활성화를 담당하는 효소로서, 정신분열병과 관련된 후보 유전자로서 알려져 왔다. 최근, 기능성 COMT유전자 다형성과 정신분열병의 관련성이 제기되었는데, 한국인 정신분열병에서도 이러한 관련성이 있는지를 살피기 위해 본 연구를 시행하였다. 방 법 : 정신분열병으로 진단된 환자군 103명과 성별 및 연령별로 1:1 짝짓기 대조군 사이에 유전자형과 대립유전자의 분포를 비교하였다. 또한, 환자군은 공격적 행동, 가족력, 아동기 발병 여부에 따라 두 군으로 나누어 비교하였다. DNA의 다형성 부의를 중합효소연쇄반응에 의해 증폭한 후 ,NlaⅢ제한효소법과 전기영동을 실시하여 유전자형을 판별하였다. 결 과 : 환자군 전체와 대조군 사이에 유전자형과 대립유전자 빈도의 차이가 없었다. 가족력이 있는 환자군을 대조군과 비교하였을 때는, 대립유전자 L을 포함하는 유전자형과 그렇지 않은 유전자형의 분포에 있어 유의한 차이를 보였다(p=0.02, OR=3.9, 95% Cl=1.1∼14.3). 결 론 : 한국인 정신분열병과 기능성 COMT 유전자 다형성 사이에 유의한 관련성이 없었다. 따라서, 기능성 COMT 유전자 다형성이 한국인 정신분열병의 발병에 영향을 주지 못한다. 그러나, 정신분열병 가족력과 기능성 COMT유전자 다형성의 관련성이 시시돠어, 향후 본 연구에서 나타난 방법론적인 문제점을 보완하고 추가 대상자를 확보한 연구가 필요하다. Objectives : Catechol-O-methyltransferase(COMT) is involved in the degradation of catecholamine meurotransmitters and has been investigated as a candidate gene in schizophrenia. Recently, possible relationship between functional COMT gene polymorphism and schizophrenia has been suggested. To address the possible role of functional COMT gene polymorphism in the predisposition to schizophrenia, we carried out an association study in Korean schizophrenic patients and controls. Methods : One hundred and three Korean inpatients diagnosed as schizophrenia and 103 age and sex matched controls were selected as study subjects. Patients were subgrouped into two groups on the basis of history of aggressive behavior, family history of schizophrenia and related disorders, and age at onset. We determined COMT genotypes using PCR of the relevant region followed by digestion with NlaⅢ and electrophoresis. Results : No significant differences of allele and genotype frequencies were noted between patients and controls. However, when patients were categorized by the presence of family history of schizophrenia and related disorders, patients with family history showed almost 4 fold higher frequency of having COMT L allele containing genotype compared to controls(p=0.02, OR=3.9, 9.5% CI=1.10-14.33). Conclusion : Although our results do not support an association between functional polymorphism of COMT gene and schizophrenia overall, the findings suggest an association between functional COMT gene polymorphism and familial schizophrenia. Further studies with large samples are needed to confirm this association.

In vitro maturation, an alternative option for patients with peas without compromising pregnancy outcomes

( Hyeong In Ha ),( Hyun Ha Seok ),( You Shin Kim ),( In Pyung Kwak ),( Woo Sik Lee ),( Tae Ki Yoon ),( Sang Woo Lyu ) 대한산부인과학회 2015 대한산부인과학회 학술대회 Vol.101 No.-

농촌 주부들의 요통발병률

윤능기,윤형렬,서석권,이승훈,이무식,안은주,홍대용,이종영 啓明大學校 醫科大學 1992 계명의대학술지 Vol.11 No.1

To investigate low back pain in rural women, 452 housewives living in the rural areas of Kyungnam province were interviewed during August 1990, and 444 subjects completely done were used for analysis. Attack rate of low back pain during the previous six months was 50.2%. In logistic regression analysis,a history of back injury(odds ratio - 3.439) and presence of other mus-culoskeletal disorders(odds ratio=2.047)were sighificantly independent of attacks of low back pain(p<<0.001), but age and parity were not. Excluding those 70 years old and over or no parity , the frequency of parity showed a significantly independent effect as odds ratio of 1.199(p<0.01)

Sudden Hemiplegia by Epidural Hematoma in a Patient Treated with Warfarin and Therapeutic Range International Normalized Ratio

Hyeong-Won Seo,Hyung Wook Park,Ki Hong Lee,Joon-Ho Ahn,Nam Sik Yoon,Jeong Gwan Cho 순천향대학교 순천향의학연구소 2015 Journal of Soonchunhyang Medical Science Vol.21 No.2

Spontaneous spinal epidural hematoma is extremely rare. It can cause fatal complication such as permanent neurologic deficit. Even though the exact cause of epidural hematoma is not known in most cases, anticoagulation treatment is associated in some cases. In this situation, prompt reversal of anticoagulation and immediate decompression surgery is required. Seventy-year-old woman presesnted with sudden hemiplegia. She had history of hypertension, dyslipidemia, and paroxysmal atrial fibrillation and had taken antihypertensive agent, statin, and warfarin. She did not have any history of trauma and her international normalized ratio was within therapeutic range during follow-up and at the time of event. Physical examination revealed decreased right extremities’ motor and sensory function but cognitive function was normal. Detailed neurologic examination and spinal magnetic resonance imaging identified extensive, spontaneous spinal epidural hematoma. After the reversal of anticoagulation with vitamin K injection, the patient underwent emergent hematoma removal surgery and recovered completely. Our case suggests epidural hematoma should be considered in sudden hemiplegia patients with anticoagulation therapy. Immediate reversal of anticoagulation and decompression surgery can avoid neurologic deficit.

GG-19 : Treatment outcome with methotrexate for the interstitial pregnancy

( Hyeong In Ha ),( Hyeon Ha Seok ),( Mi Ra Kim ),( Mi Kyeong Kim ),( Seok Ju Sung ),( Woo Sik Lee ),( Tae Ki Yoon ),( Yong Wook Jung ) 대한산부인과학회 2014 대한산부인과학회 학술대회 Vol.100 No.-

목적: The purpose of this study is to evaluate the treatment outcome with methotrexate (MTX) for the interstitial pregnancy with respect to the success rate of MTX treatment and the result of subsequent pregnancy. 방법: This study is a retrospective study that performed in an urban university based hospital from Jan 2005 to July 2014. Total 101 cases of interstitial pregnancy were diagnosed and treated surgically or medically in the department of obstetrics and gynecology, CHA Gangnam Medical Center. Of those 38 cases were initially treated with MTX conservatively. The authors collected patient demographics, treatment regimen, number of doses administered, treatment results, and subsequent pregnancy outcomes by reviewing patients` medical records. 결과: Initially 7 patients were treated with combination of systemic MTX and direct MTX injection into gestational sac under the guidance of transvaginal sonography. 29 patients were treated with systemic MTX only. Of those, 6 (85.7 %) patients and 17 (58.6%) patients were successfully treated with combination MTX and systemic MTX, respectively. 12 patients tried to be pregnant. 10 (83.3%) patient were pregnant. There were several complication related to pregnancy including a case of uterine rupture from treatment failure , 3 cases of preterm deliveries. The median age of patients were 32 (range, 24-40). The b-hCG level at the diagnosis was 79312 (range, 374.8 - 159000). Fetal heart beat was noted in 5 cases (13.1%). A subject who tried to be pregnant experienced heterotopic pregnancy including tubal pregnancy. 결론: Methotrexate treatment for interstitial pregnancy may be an alternative for surgical approach. However, further study will be required to determine the factors that affect treatment results.