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김진주 ( Jin Joo Kim ), 김나영 ( Nayoung Kim ), 박현경 ( Hyun Kyung Park ), 조현진 ( Hyun Jin Jo ), 신철민 ( Cheol Min Shin ), 이상협 ( Sang Hyup Lee ), 박영수 ( Young Soo Park ), 황진혁 ( Jin Hyeok Hwang ), 김진욱 ( Jin Wook Kim ), 정숙향) 대한소화기학회 2012 대한소화기학회지 Vol.59 No.5
Background/Aims: In spite of the improvement of medical treatment for the peptic ulcer disease (PUD), PUD is still one of the common upper gastrointestinal diseases. The purpose of this study was to evaluate the risk factors and general characteristics of Korean patients diagnosed as PUD at a single third referral center. Methods: A total of 310 patients, diagnosed as PUD through endoscopy during one year of 2007 at Seoul National University Bundang Hospital were, retrospectively, evaluated regarding age, gender, Helicobacter pylori (H. pylori) positivity, clinical manifestations, comorbidities and medications. In addition, PUD was analyzed in the aspect of ulcer location, type of visit, gastrointestinal bleeding, and age. Results: The mean age was 61.5 years old (48.1% over 65) and 208 (66.7%) patients were men. The rate of H. pylori infection was 47.8%, and any ulcerogenic medication history such as antiplatelet agents and NSAIDs was found to be 21.0% (65 patients). The rate of idiopathic peptic ulcer without evidence of H. pylori and NSAIDs was found to be 40.6% (126 patients). Among 310 PUD patients, bleeding symptoms such as melena, hematemesis and hematochezia occurred in 110 patients (35.5%). Conclusions: PUD was more prevalent in the elderly patients and frequently associated with bleeding. Substantial proportion of PUD patients had neither H. pylori infection nor history of ulcerogenic medications, suggesting of increasing prevalence of idiopathic PUD. (Korean J Gastroenterol 2012;59:338-346)
Cardiac arrest in infants, children and adolescents is rare but critical; survival from out-of-hospital pediatric cardiac arrest is estimated at 8% to 12%. Mild therapeutic hypothermia was shown to improve the neurologic outcome of postcardiac arrest syndrome in adults and neonatal hypoxic-ischemic encephalopathy, but its use has been limited in children. We report 3 cases where therapeutic hypothermia was successfully done in infants and children. The initial rhythm was ventricular fibrillation of a 13 year old child, asystole in an 11 month old infant, and in 7 aged children. Therapeutic hypothermia was induced and maintained successfully for 24 hours via endovascular and surface cooling methods. The older child with ventricular fibrillation awoke from being comatose after rewarming and cessation of sedatives. The 11 month old and the 7 aged children died during the 16 days following admission and being discharged with a neurologic disability. There is lack of evidence that therapeutic hypothermia improves neurologic outcomes in pediatric cardiac arrest patients, but in adults and in neonatal hypoxicischemic encephalopathy, we can speculate that therapeutic hypothermia in pediatric patients will have a good outcome. A multicenter randomized study is needed as are guidelines and common protocols about pediatric therapeutic hypothermia.
김진주 ( Jin Joo Kim ), 신종환 ( Jong Hwan Shin ), 임용수 ( Yong Su Lim ), 김정권 ( Chung Kwon Kim ), 김재광 ( Jae Kwang Kim ), 현성열 ( Sung Youl Hyun ), 양혁준 ( Hyuk Jun Yang ), 이근 ( Gun Lee ), 최영철 ( Young Cheol Choi ) 대한응급의학회 2008 大韓應急醫學會誌 Vol.19 No.5
Purpose: Relative adrenal insufficiency is common in intensive care unit patients. Basal cortisol and the cortisol response following the injection of synthetic corticotropin were prospectively evaluated in postresuscitation patients after cardiac arrest. Methods: This is a prospective cohort study of relative adrenal insufficiency of patients with return of spontaneous circulation (>24 hours) after cardiac arrest who were admitted to the intensive care unit over three-year period from January 2005 to December 2007. Relative adrenal insufficiency was measured the next day after return of spontaneous circulation following cardiac arrest. Results: Seventy-five patients were included over three years. Relative adrenal insufficiency developed in 41 patients. In patients with relative adrenal insufficiency, SOFA (sequential organ failure assessment) and lactate were elevated (p=0.03, 0.048), mortality was higher (p=0.014) and basal cortisol concentrations were significantly increased (p=0.001). In patients with therapeutic hypothermia, there were no significant differences with or without relative adrenal insufficiency (p=0.847). The factors associated with mortality, as assessed by multiple logistic regression were relative adrenal insufficiency, therapeutic hypothermia and the time from arrest to the start of cardiopulmonary resuscitation. Conclusion: Both basal cortisol and the cortisol response after the injection of synthetic corticotropine must be considered in predicting patients outcome. For patients with relative adrenal insufficiency, some specific treatments such as cortisol can be considered. More prospective multicenter study is needed.
연구목적: 본 연구는 특수학교에 재학하고 있는 중도ㆍ중복장애학생을 위한 개별화교육계획의 실태와 그에 대한 특수교사의 인식을 파악함으로써 현상의 문제점과 향후 바람직한 교육방향을 검토하고자 하였다. 연구방법: 현재 중도ㆍ중복장애학생을 지도하고 있는 특수교사 101명을 대상으로 설문지법을 이용하여 조사하고, 얻어진 모든 자료를 통계적으로 분석하였다. 연구결과: 개별화교육계획 수립단계에서는 학생들의 특성 파악을 위해서 주로 장애유형별 특성과 직접 관찰을 통하여 얻은 정보를 활용하고 있었다. 실행단계에서는 주로 의사소통 기술영역을 중점적으로 지도하고 있었고, 교수 장면의 제한성 등으로 인하여 개별화교육계획의 실행이 제대로 이루어지지 못하는 것으로 나타났다. 평가단계에서는 월1회 이상에 걸쳐 개별 학생별로 평가를 실시하고는 있었으나, 대부분의 경우 관찰조사에 의한 서술식 평가에 그치고 있었다. 이 같은 실태에 대한 특수교사의 인식은 전반적으로 부정적인 편으로 나타났고, 특히 자원영역에 대한 인식은 가장 부정적이었다. 이와 함께 특수교사의 인식은 소지자격, 지도하는 학생이 가지는 주 장애 변인에 따라 유의미한 차이가 있는 것으로 나타났다. 결론: 이러한 연구 결과에 따라 향후의 보다 바람직한 개별화교육계획의 지원 방향 등에 대한 시사점을 제시하였다. Purpose: This study is to examine the problems of the status quo and the desirable educational direction in the future by figuring out the status of individualized education plan for students with severe and multiple disabilities and perceptions of special education teachers. Method: The statistical analysis of the data collected by the survey targeting 101 special education teachers giving the guidance to the students with severe and multiple disabilities for now. Results: In the phase of establishing the individualized education plan, the data mainly obtained from the characteristics of the disabilities by type and the direct observation were used to figure out the characteristics of the students. In the implementation phase in which the guidance mainly focusing on the technology area of communication was given, the individualized education plan was found not to properly conducted due to the limitation of teaching scenes. In the evaluation phase in which the evaluations for the individual students more than once a month were conducted, most of the evaluations were just the narrative assessment by the observing survey. Perceptions of special education teachers for such situation was found to be negative, in particular, the ones for the resource area to be the most negative. With this, perceptions of special education teachers were found to show a significant difference in accordance with their license, the main variables in the disabilities of the students whom they gave a guidance to. Conclusion: Based on the research results, this study provides the insights on the desirable direction of supporting the individualized education plan in the future.
Snake bite during pregnancy is rare condition, and when it occurs there are two patients, mother and fetus. Timing is particularly important for pregnant women bitten by a snake. The earlier in the pregnancy the bite occurs, the more hazard to the fetus there is, and there are case reports of snake-bite-induced abortion and malformation of the fetus. The usefulness of antivenin during pregnancy is debatable. We report a case of snake bite during third-trimester pregnancy in a patient with general symptoms of envenomation and progressing edema in the bitten leg who was successfully treated with an emergency Caesarian section following the administration of antivenin.
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본 연구는 미래 진로에 걱정이 많은 고등학교 2학년을 대상으로 진로장벽과 진로자기효능감 및 학교적응 간의 관계를 분석하고, 청소년 진로상담과 학교생활에 대한 시사점을 얻고자 하였다. 이를 위해 경기지역의 전문계, 인문계 고등학생 732명을 대상으로 진로장벽과 진로자기효능감 및 학교적응에 관한 설문조사를 실시하고 그 결과를 분석하였다. 연구 결과, 첫째, 고등학생의 성별에 따른 진로장벽을 살펴본 결과, 여학생들이 남학생들 보다 진로장벽을 높게 지각한 것으로 나타났으며, 학교적응에서도 어려움을 더 느꼈다. 둘째, 인문계 고등학생들이 진로자기효능감의 하위요인인 목표선택을 더 높게 지각하였고, 실업계 학생들이 진로 장벽의 하위요인인 경제의 어려움을 더 높게 지각하였다. 셋째, 학교적응에서는 남학생이 여학생보다 교사, 학교규칙 및 환경에서 높게 나타났고, 인문계 학생이 학교수업과 친구에서 높게 나타났다. 이러한 결과를 바탕으로, 고등학생의 학교적응을 높이기 위해서는 특히 여학생들이 인식하고 있는 진로장벽을 낮추는 교육적 노력이 필요하며, 고등학생들의 진로목표설정을 높일수 있는 진로교육이 필요하다. The purpose of this study was to investigate the relationship among career barrier, career self-efficacy, and school adjustment of second grade students in high schools who were worrying about their future career and offer the implications for guidance of adolescents career counseling and their school life. The subjects of this study were 732 academic and vocational high school students in Kyounggi-Do. The results were as follows; First, female students had higher perceived career barriers and more difficulties in their school adjustment. Second, academic high school students had higher perceived selecting goals in sub-factors of career self-efficacy and vocational high school students had higher perceived economic hardship in sub-factors of career barrier. Third, male students had higher perceived teacher, school rule/environment in sub-factors of school adjustment, and academic high school students had higher perceived school lesson, friend in sub-factors of school adjustment. Results suggest that, to improve school adjustment of adolescents, educational efforts to reduce the career barriers are needed especially for female students. Also educations are needed to improve the skills for setting their career goals.