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      • KCI등재

        일개 한방병원에 내원한 산욕초기 산모의 한국표준질병・사인분류 분석

        김평화 대한한방부인과학회 2019 大韓韓方婦人科學會誌 Vol.32 No.1

        Objectives: The purpose of this study is to collect and analyze the KCD codes applied to the treatment of 27 postpartum women who had been treated with Korean traditional medicine in a Korean medicine hospital, so that this study may be used as a basic data for setting the direction of postpartum Korean medical treatment research. Methods: It was approved by the Institutional Review Board (IRB) of ⃝⃝ University medical center (IRB approval number : WSOH IRB H1708-02-01). Twenty-seven postpartum women who had been treated at ⃝⃝ University medical center were received outpatient treatment for two weeks (from September 27, 2017 to January 5, 2018), and the KCD codes applied to the mothers were collected after obtaining the consent. On the day of registration of the study, the fertility, obstetric history and high-risk pregnancies were identified through an interview. Results: 1. The mean age of the 27 subjects was 33.33±3.99 years old. Among the subjects, 17 mothers (63.0%) were high-risk pregnancy and 10 mothers (37.0%) were normal. 2. Among the 22 major disease categories, 8 categories were used. M code (musculoskeletal system) was used 243 times (70.85%), followed by R code (unclassified symptom) of 51 times (14.87%) and U code (special purpose code) of 23 times (6.71%). 3. The most commonly used code among the ten frequently used codes was M25.57 (joint pain, ankle and foot), a total of 47 times. Of the remaining nine codes, except for R60.1 (systemic edema) and U68.4 (The deficiency of yang in Bi), all codes were M codes (musculoskeletal system). 4. The M code (musculoskeletal system) was the most used major disease category in high-risk group, a total of 159 times. But in specific categories, the most commonly used code was R60.1 (systemic edema), a total of 28 times. 5. In normal group, the M code (musculoskeletal system) was the most used major disease category, a total of 84 times. Also, in specific categories, the most commonly used code was M25.57 (joint pain, ankle and foot), total 29 times. 6. The U code, corresponding to 'the diagnosis of childbirth and other obstetrical medical use', was used 23 times (6.71%), O code three times (0.87%) and Z code two times (0.58%), which was less than 10% of the total number of codes used. Conclusion: When analyzing KCD codes related to Korean medicine treatment for postpartum diseases, it is important to select the KCD codes that reflect the actual clinical state. 목적 : 일개 한방병원에서 한의치료를 받은 산욕초기 27명의 산모를 대상으로 치료 시 적용된 KCD 코드를 수집, 분석하여 산후의 한의진료 자료구축 연구에 대한 방향 설정의 기초자료로 활용하고자 하였다. 방법 : OO대학교기관생명윤리위원회(Institutional Review Board, 이하 IRB)의 승인을 받아 실시하였다(IRB 승인 번호 (WSOH IRB H1708-02-01). 2017년 9월 18일부터 2018년 1월 5일까지 OO대학교 부속한방병원 한방부인과에서 한의치료를 받은 초기 산욕기 산모 27명의 동의를 얻어 2주간 외래를 방문하여 한의치료를 받을 때마다 적용된 KCD코드를 수집하였다. 연구등록당일에는 문진을 통하여 출산력, 산과력 및 고위험산모 여부를 확인하였다. 결과 : 1. 대상자 27명의 평균 연령은 33.33±3.99세였으며, 고위험 산모가 17명(63.0 %), 일반 산모가 10명(37.0 %)이었다. 2. 전체 22개의 질병 대분류 8개의 분류가 사용되었으며, M코드(근골격계통)가 243회(70.85%), R코드(달리 분류되지 않은 증상)가 51회(14.87%), U코드(특수목적 코드)가 23회(6.71%) 순이었다. 3. 다빈도 상위 10개 세분류 상병코드 중 가장 많이 사용 된 코드는 총 47회로 M25.57(관절통, 발목 및 발)이었고, 나머지 9개의 코드 중 R60.1(전신부종), U68.4(비양허증)을 제외하면, 7개의 코드가 모두 M코드(근골격계통)였다. 4. 고위험군의 질병대분류 또한 M코드(근골격계) 가 159회로 가장 높았으나, 세분류 상병코드 중 가장 많이 사용된 것은 총28회로 R60.1(전신부종)이었다. 5. 일반군의 질병대분류 또한 M코드(근골격계) 가 84회로 가장 높았으며, 세분류 상병코드 중 가장 많이 사용된 것은 총29회로 M25.57(관절통, 발목 및 발)이었다. 6. ‘분만 및 기타 산과 의료이용 진단코드’에 해당하는 U코드가 23회(6.71%), O코드가 3회(0.87%), Z코드가 2회(0.58%)사용되어, 전체 사용된 코드 건수의 10% 미만이었다. 결론 : 출산 후의 한방의료 이용질환에 관한 상병코드 분석 시, 실제 임상현장을 반영한 상병코드의 선정이 중요함을 알 수 있다.

      • KCI등재

        Carthami Semen Pharmacopuncture Combined with Electroacupuncture on Carpal Tunnel Syndrome: A Retrospective Case Series Study

        김평화,Seon Choe,Kyungsun Han,Changsop Yang,Jinbok Lee,Sungha Kim,Minseop Shin 대한약침학회 2021 Journal of pharmacopuncture Vol.24 No.2

        While carpal tunnel syndrome (CTS) is the most common entrapment neuropathy affecting the wrist, resulting in substantial physical, psychological, and economic effects, there is no gold standard therapy for CTS. In this case series study, we aimed to report CTS patients treated with Carthami Semen Pharmacopuncture (CSP) and electroacupuncture (EA) showing improvements in their symptoms, and the combinatorial effects of CSP and EA. We collected medical records of CTS outpatients who received CSP and EA at Chuku Acupuncture & Moxibustion Korean Medicine Clinic from August 2017 to September 2018. The outcome measures were the visual analog scale (VAS) for pain, paresthesia, the Korean version of the Boston carpal tunnel questionnaire (K-BCTQ) score, and changes in nocturnal pain, Tinel sign, and Phalen’s test. We included patient satisfaction at the completion of all treatments. 17 patients were included for this case series study. After treatment, VAS for pain decreased significantly from 50.41 ± 16.19 to 9.59 ± 9.46, VAS for paresthesia also decreased significantly from 63.50 ± 11.49 to 14.75 ± 12.97, and KBCTQ symptom severity scale decreased from 2.48 ± 0.68 to 1.89 ± 0.70 (all p < 0.001). Nocturnal pain, Tinel signs, and Phalen’s test showed improvements after all the treatments. All the patients reported favorable overall satisfaction with the treatments, and 69.23% wanted future pharmacopuncture treatments if CTS recurred. No complications were detected. The combination of CSP and EA could be an effective and safe option in treating CTS.

      • 주의집중 자기점검법이 지적장애학생의 독립적 과제수행행동과 성취에 미치는 영향

        김평화 한국특수교육교과교육학회 2012 특수교육교과교육연구 Vol.5 No.3

        '스콜라' 이용 시 소속기관이 구독 중이 아닌 경우, 오후 4시부터 익일 오전 9시까지 원문보기가 가능합니다.

        The purpose of this study was to investigate the effect of using self-monitoring of attention on the independent on-task behavior and task performance of students with intellectual disability. To achieve this purpose, this study selected three students with intellectual disability who had inattention and external control problem among those who received special education at elementary schools in C-city, C-province and trained them to self-monitor for attention. As a single subject research, the investigator found the independent on-task behavior and the result of accomplishment during the baseline period, intervention and maintenance period in order, using multiple probe baseline design across subjects. The investigator used some math problems as a independent question which is suitable for students' current level and needs the proficiency. And she measured task completion and accuracy as well as on-task behavior using timing sampling which divides 10 minutes for watching into 60 periods. The results of this study were as follows. First, all the surveyed students increased the independent on-task behavior more than baseline period after they implemented the self-monitoring of attention. Second, using only self-monitoring of attention improved students' accomplishment, that is task completion and accuracy even if it showed different results according to each student. Third, the effect of self-monitoring of attention was still maintained 3 weeks after the end of intervention. Therefore the self-monitoring of attention can be an effective way for students with intellectual disability who have low concentrations and show high dependent attitudes for studying to improve the independent on-task behavior and completion. 본 연구는 주의집중 자기점검법이 지적장애학생의 독립적 과제수행행동과 성취에 미치는 영 향을 알아보기 위한 목적으로 실시된 실험 연구이다. 본 연구는 목적을 달성하기 위해 주의집 중 자기점검법의 사용은 자율학습 시간 동안에 지적장애학생의 독립적 과제수행행동과 독립적 과제 성취을 변화시키는가?와 주의집중 자기점검법의 사용으로 변화된 지적장애학생의 독립적 과제수행행동 및 성취 수준은 중재가 종결된 3주 후에도 유지될 것인가?를 연구문제로 설정하 였다. 본 연구는 문제를 해결하기 위해 C도 C시에 소재하는 3개의 초등학교 특수학급에 재학하 고 있는 학생들 중 지적장애학생 3명을 연구대상으로 선정하여 주의집중 자기점검법 훈련을 시행 하고,시간표집법을 활용하여 과제수행행동과 과제 완수율 및 정확률을 측정하였다. 본 연구의 결 과 주의집중 자기점검법을 사용한 대상학생 모두 기초선에 비해 독립적 과제수행행동이 증가하였 다. 그러므로 주의집중 자기점검법의은 혼자 해야 하는 독립적 과제에 대한 주의집중이 취약하고 외부의존성 경향이 높은 지적장애학생의 과제수행행동을 증가시키기 위한 효과적인 학습전략이라 고 할 수 있으며, 대상 학생마다 차이가 있는 결과를 나타내었지만 주의집중 자기점검법을 단독으 로 사용하여도 성취, 즉 과제 완수율과 정확률이 향상되었고, 독립적 과제수행행동과 성취에 미친 주의집중 자기점검법의 효과는 중재가 종결된 3주 후에도 유지되었다. 따라서 과제를 수행할 수 있는 능력이 있으면서도 독립적으로 과제를 해결하는 상황에서 주의집중도가 낮고 외부 의 존적인 학습태도를 보이는 지적장애학생의 과제수행행동과 성취를 향상시키기 위해 주의집중 자기점검법이 효과적인 방법이라고 할 수 있다.

      • KCI등재

        Children’s Hepatic Tumors International Collaboration-Hepatoblastoma Stratification (CHIC-HS) System for Pediatric Patients with Hepatoblastoma: A Retrospective, Hospital-Based Cohort Study in South Korea

        김평화,신현주,윤희망,최영훈,남궁정만,대연,고경남,이미정,윤혜성,류철주,한정우,한승민,조영아 대한암학회 2022 Cancer Research and Treatment Vol.54 No.1

        Purpose In 2017, the Children’s Hepatic Tumors International Collaboration-Hepatoblastoma Stratification (CHIC-HS) system was introduced. We aimed to evaluate the accuracy of CHIC-HS System for the prediction of event-free survival (EFS) in Korean pediatric patients with hepatoblastoma. Materials and Methods This two-center retrospective study included consecutive Korean pediatric patients with histopathologically confirmed hepatoblastoma from March 1988 through September 2019. We compared EFS among four risk groups according to the CHIC-HS system. Discriminatory ability of CHIC-HS system was also evaluated using optimism-corrected C-statistics. Factors associated with EFS were explored using multivariable Cox regression analysis. Results We included 129 patients (mean age, 2.6±3.3 years; female:male, 63:66). The 5-year EFS rates in the very low, low, intermediate, and high-risk groups, according to the CHIC-HS system were 90.0%, 82.8%, 73.5%, and 51.3%, respectively. The CHIC-HS system aligned significantly well with EFS outcomes (p=0.004). The optimism-corrected C index of CHIC-HS was 0.644 (95% confidence interval [CI], 0.561 to 0.727). Age ≥ 8 (vs. age ≤ 2; hazard ratio [HR], 2.781; 95% CI, 1.187 to 6.512; p=0.018), PRE-Treatment EXTent of tumor (PRETEXT) stage IV (vs. PRETEXT I or II; HR, 2.774; 95% CI, 1.228 to 5.974; p=0.009), and presence of metastasis (HR, 2.886; 95% CI, 1.457 to 5.719; p=0.002), which are incorporated as the first three nodes in the CHIC-HS system, were independently associated with EFS. Conclusion The CHIC-HS system aligned significantly well with EFS outcomes in Korean pediatric patients with hepatoblastoma. Age group, PRETEXT stage, and presence of metastasis were independently associated with EFS. Purpose In 2017, the Children’s Hepatic Tumors International Collaboration-Hepatoblastoma Stratification (CHIC-HS) system was introduced. We aimed to evaluate the accuracy of CHIC-HS System for the prediction of event-free survival (EFS) in Korean pediatric patients with hepatoblastoma.Materials and Methods This two-center retrospective study included consecutive Korean pediatric patients with histopathologically confirmed hepatoblastoma from March 1988 through September 2019. We compared EFS among four risk groups according to the CHIC-HS system. Discriminatory ability of CHIC-HS system was also evaluated using optimism-corrected C-statistics. Factors associated with EFS were explored using multivariable Cox regression analysis.Results We included 129 patients (mean age, 2.6±3.3 years; female:male, 63:66). The 5-year EFS rates in the very low, low, intermediate, and high-risk groups, according to the CHIC-HS system were 90.0%, 82.8%, 73.5%, and 51.3%, respectively. The CHIC-HS system aligned significantly well with EFS outcomes (p=0.004). The optimism-corrected C index of CHIC-HS was 0.644 (95% confidence interval [CI], 0.561 to 0.727). Age ≥ 8 (vs. age ≤ 2; hazard ratio [HR], 2.781; 95% CI, 1.187 to 6.512; p=0.018), PRE-Treatment EXTent of tumor (PRETEXT) stage IV (vs. PRETEXT I or II; HR, 2.774; 95% CI, 1.228 to 5.974; p=0.009), and presence of metastasis (HR, 2.886; 95% CI, 1.457 to 5.719; p=0.002), which are incorporated as the first three nodes in the CHIC-HS system, were independently associated with EFS.Conclusion The CHIC-HS system aligned significantly well with EFS outcomes in Korean pediatric patients with hepatoblastoma. Age group, PRETEXT stage, and presence of metastasis were independently associated with EFS.

      • 교량 구조물 안전진단 및 유지관리 BIM 적용 연구

        김평화,한휘석,권영웅,강영종 한국구조물진단유지관리공학회 2016 한국구조물진단유지관리공학회 학술발표대회 논문집 Vol.2016 No.10

        This study aims to establish complementary relationship among designer, builder, and maintenance manager by combining BIM(Building Information Modeling) technology with bridge safety diagnosis and maintenance to secure its effectiveness and systematization. To establish and maintain database by organizing quantities of data about existing case of safety diagnosis and maintenance, and develop the system to be used by practitioners.

      • 접착 요소를 이용한 단일 겹침 접착 체결부의 강도 예측

        김평화,명준,임승규,박정선 한국항공우주학회 2015 한국항공우주학회 학술발표회 논문집 Vol.2015 No.4

        복합재료 구조물에서 접착제를 이용한 체결부는 파손에 취약한 부분이다. 따라서 접착 체결부에 대한 신뢰성 있는 강도 예측이 요구되며, 최근에는 접착 요소를 이용한 유한요소해석 기법이 적용되고 있다. 본 논문에서는 에폭시 접착제를 이용한 단일 겹침 접착 체결부의 시편 시험 및 유한요소해석을 바탕으로 접착 요소의 물성 및 정적 강도 예측에 관한 연구를 수행하였다. 접착 요소에 적용되는 파괴 모드별 접착 영역 모델의 물성 변화에 따른 체결부의 강도 특성을 분석하고, 이를 바탕으로 실제 시험 데이터와 유사한 파괴 거동을 예측하였다. 또한 접착 요소의 국부적 모델링 기법을 통하여 체결부의 실제 균열 진전 형태를 모사하였다. Adhesively bonded joint is the weakest part of composite structure. Futhermore, reliable strength prediction is required for adhesively bonded joint. Recently, the Cohesive Zone Model (CZM) is used to predict the strength of adhesive joint. This paper represents a prediction of cohesive element"s properties by test and finite element analysis for a single-lap joint bonded with an epoxy adhesive. We analyze strength characteristics of the single-lap joint due to change in properties of cohesive zone model determined for each failure mode. Also, a fracture behavior is predicted similar to the actual test data and crack growth behavior by using a local modeling technique of cohesive element.

      • KCI등재

        한의치료를 받은 산모의 산후 6주간 증상에 대한 전향적 관찰 연구

        김평화,안나,장현철,이은희,Kim, Pyung-Wha,Kim, An-Na,Jang, Hyun-Chul,Lee, Eun-Hee 대한한방부인과학회 2017 大韓韓方婦人科學會誌 Vol.30 No.4

        Objectives: This study aims to investigate the changes of women's postpartum symptoms, including their weights, edema index and quality of life (QOL) over the first six weeks after childbirth. Methods: The study participants were 31 postpartum women treated in the Dept. of Obstetrics & Gynecology, at Woo-Suk University Korean Medicine Hospital, from May 20th to August 5th, 2016. In the first 2 weeks of the postpartum period, the main data collection method was to interview each patient and write down all of their complaints, and additionally referring to each participant's PHR (Personal Health Records). At the 3rd, 4th, 5th and 6th week, the researcher interviewed participants by phone once a week. The participants' weight, edema index (ECW/TBW) and the quality of life (by EQ-VAS) were measured at 1st and 2nd week after childbirth. And, EQ-VAS was assessed once more at the 6th week after childbirth. As a last step, the participants responded to a survey on satisfaction regarding their postpartum care with Korean Medicine. Results: 1. In the 1st one week after childbirth, edema was the most frequent complaint. It was about joint pain of the upper limbs in the 2nd and 3rd weeks, sweating in the 4th week, and joint pain of the upper limbs in the 5th and the 6th weeks. 2. In the 1st two weeks of the postpartum period, the weight of the participants decreased from $66.33{\pm}9.30kg$ to $62.60{\pm}8.92kg$ (p<0.001) and the edema index ECW/TBW decreased from $0.399{\pm}0.010$ to $0.385{\pm}0.0 4$ (p<0.001). The EQ-VAS significantly improved from $61.77{\pm}17.72$ to $73.51{\pm}14.67$ (p<0.001). In the last 4-weeks of the postpartum period, the EQ-VAS decreased from $74.30{\pm}14.25$ to $73.63{\pm}13.35$, but this difference was not statistically significant (p=0.749). 3. Regarding the satisfaction with postpartum care with Korean Medicine, 60% of the participants responded that it was 'Excellent' and 40% said it was 'Good'. Conclusion: Over the entire postpartum period, the most frequent complaints were about musculoskeletal symptoms. Postpartum care with Korean Medicine treatments in the early postpartum period improves various postpartum symptoms and the quality of life for postpartum women.

      • KCI등재

        부모학대 및 방임 경험이 보호관찰소 보호처분학교 밖 청소년의 우울 및 불안에 미치는 영향: 자아존중감의 매개효과

        김평화,이경상 한국청소년학회 2018 청소년학연구 Vol.25 No.10

        The purpose of this study was to investigate the effects of parental abuse and neglect on depression and anxiety among school dropout adolescents under protective disposition by the probation and parole office, as well as the mediating effect of self-esteem within that relationship. In this study, 7,859 were selected from 56 probation and parole offices nationwide. For the analysis, 28 probation centers, 50% of the 56 probation centers nationwide, were selected by probability sampling, and then data were collected for 1,467 school dropout adolescents who agreed to participate in the survey. The data collection was conducted from July 6 to September 30, 2015 for three months. Results concluded that while there was a direct relationship between abuse experienced by the adolescents and their depression and anxiety levels, there was no mediating effect between abuse experienced and self-esteem levels. Looking at the effect of experienced neglect on depression and anxiety among dropout adolescents under protective disposition, there was found to be a direct effect of parental neglect on the adolescents’ depression and anxiety. Furthermore, self-esteem was found to have a mediating effect on the influence of neglect on depression and anxiety. Based on these results, we presented policy and practical implications for alleviating depression and anxiety among adolescents under protective disposition to aid their healthy return to society. 본 연구는 부모의 학대 및 방임 경험이 보호관찰소 보호처분 학교 밖 청소년의 우울 및 불안에 미치는 영향과 이들 관계에서 자아존중감이 매개효과를 가지는지를 살펴보았다. 분석을 위해, 전국의 56개 보호관찰소 중 50%인 28개 보호관찰소를 확률표집한 후, 보호처분 학교 밖 청소년들 중 조사에 동의한 1,467명의 청소년들을 대상으로 자료를 수집하였다. 자료수집은 2015년 7월 6일~9월 30일까지 3개월간 실시하였다. 분석결과, 보호관찰소 보호처분 청소년들의 학대경험은 우울과 불안에 직접적인 영향을 미치는 것으로 나타났으며 자아존중감의 매개효과는 나타나지 않았다. 보호관찰소 보호처분 청소년들의 방임경험과 우울 및 불안 간의 영향력을 살펴본 결과, 부모의 방임은 우울과 불안에 직접적인 영향을 미치는 것으로 나타났으며, 자아존중감은 우울과 불안에 대한 방임의 영향력을 매개하는 것으로 나타났다. 이 결과를 바탕으로 보호관찰소 보호처분 청소년들의 우울과 불안을 감소시키고, 건강한 사회복귀를 위한 정책적 및 실천적 함의를 제안하였다.

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