한방소아·청소년과 외래 환자 주소증의 최근 경향에 대한 연구

이은주,이보람,이지홍,장규태,Lee, Eun Ju,Lee, Bo Ram,Lee, Ji Hong,Chang, Gyu Tae 대한한방소아과학회 2016 대한한방소아과학회지 Vol.30 No.1

Objectives The purpose of this study is to investigate about chief complaints of Korean pediatrics and adolescent outpatients in the ${\bigcirc}{\bigcirc}$ university hospital for their recent trend. Methods The study was composed of 4,677 new patients aged between 1 month and 20 years who had been visited pediatrics in ${\bigcirc}{\bigcirc}$ university hospital from 2012 January to 2015 December. Results 1. Among those patients, majority was early childhood as 51.4%, followed by early childhood, late childhood, infancy, and adolescence. 2. Chief complaints in this population have been recorded in the fall the most as 29.6%, but the distribution was inconsistent. 3. To categorize, digestive-related chief complaints were the highest as 30.6%, followed by respiratory, supplemental use, growth, psychiatrics. Respiratory-related chief complaints increased dramatically in the fall. 4. In infancy and early childhood, digestive/respiratory complaints were common, whereas, growth complaints were common in late childhood and adolescence. 5. Digestive/respiratory complaints have been over 50% out of all chief complaints annually. Psychiatric and growth-related complaints have been trending up, whereas, supplemental/skin complaints have decreased every year. 6. Specifically, anorexia were the most common in digestive complaints, and rhinitis/sinusitis were top among respiratory complaints. Precocious puberty and developmental disability increased every year. Conclusions The most common chief complaints were digestive and respiratory-related, and precocious puberty and growth issues have been trending up lately. Based on this result, more studies that targets precocious puberty and growth problems are needed.

병원 밖에서 이송된 환자의 구급대원과 응급의학과 전공의의 주증상 파악의 차이

나현,정진우,이슬기,김기운 대한응급의학회 2013 대한응급의학회지 Vol.24 No.4

Purpose: Addressing a patient’s chief complaint is the first and key element of treating patients. This study determined the effectiveness of emergency medical technician and residents of an emergency department in addressing a patient’s chief complaints. If emergency and hospital personnel misunderstand the chief symptoms of patients it could result in erroneous transport and treatment, thus losing precious time in finding the proper treatment. Methods: A retrospective chart review study was performed in 1137 patients (at least 18 years of age), who visited one university hospital, for a period of 3 months. Patients who were did not undergo trauma, addiction, and cardiac arrest were included. Results: A total of 150 cases (13.2%) did not match the chief symptoms reported by 119 emergency medical personnel and emergency medicine residents. Systemic symptoms,nervous system symptoms, and psychiatric symptoms were the main categories inconsistently assessed. The rank and certification of emergency medical technicians did not make a difference, but older patients (59 years of age or older) were statistically different. The assessment fo chief symptoms by an emergency medical resident tended to be more accurate than assessment of emergency medical technicians in the final diagnosis. Conclusion: Systemic symptoms, nervous symptoms, and psychiatric symptoms, were chief complaines easily misreported for older patients. This likely reflects a difficulty in the evaluation of obscure symptoms in older patients. It will require specific additional training programs to improve the response to these chief complaints.

우리나라 지역사회 거주 정상 노년층에서 관찰되는 삼킴 곤란 주호소

김한결(Han Kyeol Kim),김자영(Ja Young Kim),김수민(Soomin Kim),김가영(Ga-Young Kim),조남빈(Nam-Bin Cho),남석인(Seok-In Nam),유희천(Heecheon You),김향희(HyangHee Kim) 한국언어청각임상학회 2021 Communication Sciences and Disorders Vol.26 No.2

배경 및 목적: 정상 노년층은 노인성 삼킴 곤란(presbyphagia)을 경험할 수 있다. 본 연구는 삼킴 평가 프로토콜(Swallowing Monitoring & Assessment Protocol, SMAP)의 ‘삼킴 기능 자가보고’ 18문항(5점 척도: 0, 1, 2, 3, 4)을 활용하여 특정 질환이 없는 정상 노년층이 호소하는 주요 삼킴 문제를 확인하고, 노화로 인한 삼킴 곤란 특색을 알아보았다. 방법: 신경학적 질환자, 삼킴 연관 질환자, 인지 문제가 있는 자를 제외한 만 65세 이상의 정상 노인 총 822명(평균 연령=76.88±5.60세; 남:여=277:545)을 대상으로 삼킴 기능 자가보고 총점을 조사한 후, 문항별 평균 점수를 기준으로 순위를 알아보았다. 연령집단 간 순위를 Spearman 순위상관분석으로 비교하고, 연령집단에 따른 총점의 차이를 Mann-Whitney 검정으로 살펴보았다. 결과: 정상 노년층의 18문항 자가보고 설문 평균 총점은 7.81±7.63점(범위 0-58점)으로 나타났다. 문항 순위를 살펴본 결과, ‘구강건조’, ‘식사량 및 시간’, ‘사레’에 관한 문제들이 주호소로 조사되었다. 연령집단별로는 만 65-74세 집단과 만 75세 이상 집단의 문항 순위 간 유의한 정적 상관관계가 있었다. 평균 총점은 만 75세 이상의 집단이 만 65-74세 집단보다 유의하게 높은 점수를 보였다. 논의 및 결론: 정상 노년층이 보고하는 삼킴 관련 주호소는 노화에 따른 삼킴 문제로 간주할 수 있다. 정상 노화로 인해 발생하는 삼킴 문제를 파악하여 노인성 삼킴 곤란에 대한 조기 탐지 및 중재에 힘쓸 필요가 있다. Objectives: Normal older persons often experience presbyphagia due to aging. This study utilized the 18-item self-reported questionnaire of the Swallowing Monitoring & Assessment Protocol (SMAP) to identify swallowing difficulties that might appear during natural aging. Methods: After excluding those with neurological disorders, dysphagia-related disorders, and/or cognitive problems, a total of 822 healthy older adults aged 65 or older (mean age=76.88±5.60; men:women=277:545) were surveyed by the self-reported swallowing function questionnaire of the SMAP. The total score of the 18-item questionnaire (5-point Likert scale: 0, 1, 2, 3, 4) was extracted and the ranking was determined based on the mean score of each item. Ranking among two age groups (aged 65-74 and aged 75≤) was compared with a Spearman rank correlation, and the difference in total scores by age group was examined with the Mann-Whitney test. Results: The mean total score was 7.81±7.63 (range 0-58). Swallowing problems related to ‘dry mouth’, ‘meal volume’, ‘mealtime’, and ‘choking on water or liquid’ were regarded as chief complaints. There was a significant correlation between the ranking of questions by age group. The mean total score was significantly higher for groups aged 75 or older (n=494; mean age=80.46±3.98) than those aged 65 to 74 (n=328; mean age=71.49±2.51) (p<.01). Conclusion: The chief complaints for swallowing reported by older adults can be considered as main swallowing problems caused by aging. By identifying precise swallowing difficulties that appear during normal aging, we should be able to alleviate presbyphagia via early detection and intervention.

서울대학교 치과병원 교정과에 내원한 부정교합 환자의 최근 경향

임동혁,김태우,남동석,장영일 대한치과교정학회 2003 대한치과교정학회지 Vol.33 No.1

최근 치의학이 눈부시게 발전하고, 소득이 증가하면서 이에 따라 일반인의 의식이 점차 변하면서 외모에 대한 관심도도 점차 높아지고 있다. 본 연구는 내원환자의 부정교합의 유형, 치료방법의 변화를 파악하여 내원환자와 보다 적절한 의사소통을 위한 정보를 제공하고, 교정치료 요구의 특성을 파악하여 부정교합의 역학적 자료를 제공하고자 본 연구를 시행하였다. 이를 위해 2002년 상반기와 1992년 상반기에 서울대학교 치과병원 교정과에 내원한 환자중 진료기록부가 잘 보존된 676명을 대상으로 하여 부정교합의 유형과 내원 환자의 지역분포 및 주소의 변화, 치료방법의 변화를 조사 연구한 결과 다음과 같은 결론을 얻었다. 1. 내원 환자의 남녀 비율은 1992년 1:2.1에서 2002년 1:1.5로 남자환자가 많이 증가했음을 알 수 있다. 2. 연령별 내원 환자의 분포에서 2002년에는 7세에서 12세군이 32.0%로 가장 높게 나타났으며, 그 다음으로는 19세에서 24세군이 24.0%, 13세에서 18세군이 21.6%, 25세 이상군이 14.2%, 4세에서 6세군이 5.8%, 0세에서 3세군이 2.4%로 가장 낮았다. 1992년도 내원 환자의 연령 분포와 비교시 성인 환자의 비중이 증가하였다. 3. Angle 분류법에 의한 내원환자의 분포에서 2002년에는 Ⅲ급 부정교합이 48.1%로 가장 높게 나타났으며, Ⅰ급 부정교합이 25.0%, Ⅱ급 1류 부정교합이 20.9%, Ⅱ급 2류 부정교합이 3.4%로 나타났다. 4. 내원환자의 지역별 분포에서 서울 북동지역의 환자가 37.0%, 서울 남동지역이 13.2%, 서울 남서지역이 12.3%, 서울북서지역의 환자가 6.5%로 나타났다. 1992년도와 비교시 서울 북동지역환자의 내원 비율이 증가하고 그 외 지역내원 환자의 비율은 감소한 것으로 나타났다. 5. 주소(chief complaint)별 내원 환자의 분포는 2002년에 하악 전돌이 17.5%로 가장 높게 나타났으며, 크라우딩이 14.2%, 안면 비대칭이 11.8%로 나타났다. 1992년의 주소별 내원 비율과 비교시 안면 비대칭을 주소로 내원한 환자의 비율이 유의하게 증가하였고, 내원 동기가 매우 다양해졌다. 6. 2002년도 내원 환자의 치료방법은 고정식 장치가 38.0%, 악교정 수술이 25.0%, 성장 관찰이 13.0%로 나타났다. 1992년도와 비교시 chin cap의 사용이 줄었으며, 상대적으로 악교정 수술과 성장관찰을 요하는 환자의 비중이 유의할 만하게 증가하였다. Over the past decades, the number of patients seeking orthodontic treatment has increased markedly with socioeconomic development and change of recognition on appearance. The purpose of this study was to provide an epidemiologic data base related to the orthodontic treatment need. We could take an adequate information regarding the characteristics of orthodontic patients, and the changing trends about treatment mordality. Distrubution and treands were investigated in 676 patients who had been examined and diagnosed at Departnent of orthodontics, Dental Hospital, Seoul National University from January to June in 1992 and 2002. 1. Sex distribution of patients changed from 1:2.1 to 1:1.5(male:female). 2. In 2002, age distribution had shown 7∼12 vear-old group being the largest (32.0%) and percentage of 19∼24, 13∼18, over 25, 4∼6, 0∼3 year-old group were 24.0%, 21.6%, 14.2%, 5.8%, 2.4% respctively. Compared with data in 1992, the number of adult patients highly increased. 3. With regard to angle classification, each percentage of ClassⅠ, Class Ⅱ div 1, Class Ⅱdiv 2, and Class Ⅲ malocclusion were 25.0%, 20.9%, 3.4%, and 48.1% respectively in 2002. 4. Geographic distribution showed that most of the patients visited (37.0%) lived in northeast of Seoul in 2002. 5. Mandibular prognathism showed the highest percentage in chief complaints. The percentages of crowding and facial asymmetry were 14.2% and 11.8% in 2002. Patients with facial asymmetry increased significantly. 6. Percentages of patients treated with fixed appliance and orthognathic surgery were 38.0% and 25.0% in 2002. Patients needed to observe the growth pattern comprised 13.0% with increasing trends. The use of chin cap reduced and the percentage of orthognathic surgery and growth observation increased significantly.

119 구급서비스의 시간 분석

장경호,강경희,장윤희,한경동 한국화재소방학회 2016 한국화재소방학회논문지 Vol.30 No.4

The ambulance service time interval, in particular the response time, has been used as an important indicator for thequality control of ambulance services in that it can be improved to increase the probability of survival and decrease thesequela-related disability. Based on the 2011~2014 Prehospital Care Reports in a metropolitan city, this study analyzed thetime interval of ambulance services considering the patient’s characteristics and chief complaints. If the definition of thetime of ambulance services can be refined further, and a variety of economic and social factors and local characteristicswould can be analyzed, the quality of the ambulance service is expected to be enhanced significantly. 구급서비스의 소요 시간, 특히 반응시간은 생존 확률을 향상시키고 후유 장해를 감소시킬 수 있다는 점에서 구급서비스의 품질 관리를 위한 중요한 지표로 활용되고 있다. 이에 본 연구에서는 2011년부터 2014년까지 4년 동안 ○○시의신고 접수, 출동, 구급활동 자료를 이용해 환자 특성, 주증상 등을 고려한 구급서비스의 시간(time interval)을 분석하였다. 구급서비스의 시간에 대한 정의를 세분화하고 각각의 소요 시간에 미치는 다양한 경제사회적 요인이나 지역적 특성을 분석하여 효율적으로 관리할 수 있다면 구급서비스의 품질은 크게 제고될 것으로 기대 된다.

아동의 응급의료서비스 이용실태

전혜진,김소선,배현아,유일영 한국아동간호학회 2008 Child Health Nursing Research Vol.14 No.1

Purpose: This study was done to describe utilization status of emergency medical service for children at one university affiliated hospital located in Seoul. Data were obtained from the medical records of patients under 13 years of age who visited the ER from January 1 to December 31, 2006. Method: Medical records missing the time of discharge were excluded in the analysis of waiting time, which resulted in 19,766 cases. Data were analyzed using SPSS WIN 14.0 version. Result: There were slightly more boys (58.4%), average age of the children was 3.97 years of age. More children at the aged 1 to 3 years (51.3%) visited the ER. Fever was the most frequent complaint: 5,180 cases (24.38%). The other complaints were head or facial laceration (10.55%), vomiting (9.63%), abdominal pain (8.06%), cough (7.67%), and painful limb swelling (6.34%). Average waiting time before the first medical examination was 17 minutes, and average ER stay time was 3 hours and 23 minutes. Conclusion: The results suggest the need to assign a nurse specialist for pediatric ER to provide more efficient care for the children. Also, extra staff assignment during the evening shift or extending office hours of local pediatricians should be considered.

척추전문 한방병원 응급실에 내원한 환자군의 성별간 경향 차이 연구

정유화(You-Hwa Jung),김희정(Hee-Jung Kim),이승열(Seung-Yeo Lee),배상은(Sang-Eun Bae),김철수(Chul-Su Kim) 대한스포츠한의학회 2014 대한스포츠한의학회지 Vol.14 No.2

Objective We evaluated the trend of the patients who visited the emergency room of spine specialty in korean medicine hospital. Methods We performed a study of 329 patients who visited the emergency room of an oriental medicine hospital, from January 6, 2014 to September 31, 2014. We evaluated the characteristics of patients who visited the emergency room of spine specialty Korean medicine hospital, such as age, sex, first&second visit, visit form, pharmacopuncture and herbal medicine. And we analysed the association of the sex and chief complaints, using chi-square test. Results The majority of Chief Complaints is Low back pain(50%), second group is Neck pain(18%). Sex differences is not associated with first&second visit(P<0.348) and age group(P<0.375). But significantly associated with Chief Complaints differences(P<0.002). Male group’s most common Chief Complaints is LBP(66%), and second Chief Complaints is Neck(16%). Female group’s most common Chief Complaints is also LBP(52%), second Chief Complaints is Neck(28%). But Compared with Male and Female, Neck pain and Joint pain takes up more proportion at Female group than Male group. Conclusions First&second visit and age is not associated with sex, but Chief Complaints is significantly associated with sex. LBP takes up more proportion at Male group, compared with Neck pain and Joint pain is likely to occur in Female group.

경희의료원 한방소아.청소년과 외래 환자의 주소증에 대한 연구(2009년 3월~2010년 2월)

최민형,김덕곤,이진용,Choi, Min-Hyung,Kim, Deog-Gon,Lee, Jin-Yong 대한한방소아과학회 2010 대한한방소아과학회지 Vol.24 No.3

Objectives: The purpose of this study is investigate about chief complaints of pediatric outpatients in the oriental medicine hospital and search for a latest of patients and their symptom. Methods: The study was composed of 3024 new patients aged between 0 and 20 who had been visited pediatrics in Kyung Hee oriental medicine hospital from 2009 March to 2010 February. Results: In age distribution, 1 year old child have most visited, and the number of the patients have fallen sharply as age have increased. The most visited month is August, and the least is November. In systemic division of chief complaints, in order of respiratory part, growth part, restorative herb medicine part, digestive part, neurologic & psychologic part, dermatologic part visited in patients number, and in single chief complaints, in order of growth, restorative herb medicine, anorexia, rhinosinusitis, cold, atopic dermatitis, seizure & epilepsy have visited. As for age and systemic division, between 1 and 6 years old, the patients of respiratory division have most visited, more than 7 years old, growth division. As for age and single chief complaints, in 0 year old, seizure & epilepsy have most visited, between 4 and 6 years old, rhinosinusitis, more than 7 years old, growth. Growth and respiratory division have increased the most in August, restorative herb medicine and digestive division have increased the most in September. In single chief complaints, patients of growth have most visited in most of time, but in September and November patients of restorative herb medicine have visited the most. Conclusions: The most visited division was respiratory part, and the most visited chief complaints was growth. More data of patients should be accumulated for further study, and we expect more specific study would be done about many kinds of disease in basis of this study.

서울시 강동구 소재 한방병원 한방부인과 외래 환자의 주소증 분석

우혜린 ( Hye-lin Woo ),박경선 ( Kyoung-sun Park ),황덕상 ( Deok-sang Hwang ),이창훈 ( Chang-hoon Lee ),장준복 ( Jun-bock Jang ),이진무 ( Jin-moo Lee ) 대한한방부인과학회 2017 大韓韓方婦人科學會誌 Vol.30 No.1

Objectives: We analyzed chief complaints of patients visiting Korean Gynecology clinic to figure out their characteristics and expand medical fields of Korean Gynecology. Methods: We analyzed chief complaints of 1,690 female patients who visited Korean Gynecology clinic of ○○ University Hospital from 2013 to 2015. Results: 1. Average age of outpatients were 38.68±12.44 and the age group distribution showed 30s were most (41.4%), followed by 40s, 20s, and 50s. 2. The season distribution showed patients were most in winter (28.0%), and least in summer (22.7%). 3. The disease distribution showed patients of puerperal disease were most (18.9%). 4. Patients of menstruation-associated disease were most in 20s and less, puerperal disease in 30s, supplemental and postoperative care in 40s, reproductive and endocrine disease in 50s, abnormal sense disease in 60s, and supplemental and postoperative in 70s and more. 5. The age group distribution of chief complaints showed cold hypersensitivity in hands and feet in 20s, and the season distribution showed puerperal winds in summer and cold hypersensitivity in hands and feet in winter. 6. The distribution of all chief complaints showed puerperal care were most (10.1%), and the percentage of all-kind care were high (29.9%). Conclusions: The clinical fields of Korean Gynecology can be expanded in general health care of women as well as treatment of diseases.

Proposal of Laboratory Test Panel Based on Patients’ Chief Complaints in Emergency Department

이현철,김유경,송정흡,송경은 대한진단검사의학회 2010 Annals of Laboratory Medicine Vol.30 No.4

Background : A test panel is a group of tests that are simultaneously performed for diagnosis and follow-up of patients. Organ-specific or disease-specific test panels are currently available. Since the patient’s chief complaint plays a key role in obtaining the personal and medical history and performing physical examinations, we proposed a test panel based on the chief complaints of the patients. Methods : We collected data from 3,127 adults with apparent symptoms who visited the emergency department from April 2009 to May 2009. Subsequently, we classified the patients’ chief complaints, ordered the laboratory tests on the basis of these complaints, considered the patients’ disease entities,and reviewed the relevant literature. Results : The patients were categorized into 14 groups on the basis of the most common chief complaints presented in the emergency department. We first selected the basic test panels and then organized the test panel for each chief complaint to enable differential diagnosis. Conclusions : We proposed test panels based on the chief complaints of the patients; these test panels could allow rapid diagnosis and be more useful than the organ-specific or disease-specific tests in critical pathway development. The next step will be evaluating the efficiency and cost effectiveness of the test panel that we suggested. (Korean J Lab Med 2010;30:444-50)