6 시그마 기법을 이용한 임상약동학 자문 업무의 효율성 개선 : 신속성과 정확성을 중심으로 Focusing on Speed and Accuracy of CPS

김민영,박효정,박향미,손기호,최경업,박영하 한국병원약사회 2001 병원약사회지 Vol.18 No.2

연구 배경 : 적정한 약물요법을 순발력 있게 시행하기 위해서는 CPS 업무가 신속, 정확하게 수행되는 것이 필수적임에도 불구하고 지금까지 CPS 업무의 신속성, 정확성을 향상시키기 위한 객관적인 업무 표준은 물론 그의 측정까지도 전무한 실정이었다. 이에 수요자인 의사의 측면에서, CPS 자문결과의 신임도에 영향을 미치는 업무의 순발력과 정확성을 향상시키기 위해 CPS 업무의 신속성, 정확성에 영향을 미치는 요인을 파악, 분석하고 이를 향상시킬 수 있는 업무 표준을 개발하는 것을 목표로 6-Sigma 기법을 사용하여 본 연구를 진행하였다. 방 법 : CPS 업무의 신속성 평가를 위해 전체 업무 과정과 부분별 업무 과정에 대한 소요 시간을 측정하였고, 정확한 평가를 위해 예측되는 Cpeak와 실제 측정된 Cpeak를 비교하였다. CPS 업무에 대해 6-Sigma 기법을 사용하여 개선이 필요한 사항을 파악하고 이에 대한 개선활동을 한 후, 개선 활동 전과 후의 CPS 업무의 신속성과 정확성의 σ 수준을 각각 측정하여 이의 향상 정도를 잠재적인 경제적 이익으로 환산하였다. 결 과 : 신속성은 제 1차 자료수집 기간(대조군, 현황 파악 기간) 중 총 소요시간은 평균 930.6±583.2이었으며, 채혈-검체 접수 : 140.4±8705분, 검체접수-약물농도 결과보고: 48.4±23.1분, 결과보고-CPS 보고서 작성 : 741.8±510.6분으로 측정되었다. σ 수준은 총 소요시간의 경우는 0.56σ, 단계별로는 각각 0.45σ, 5.70σ, 0.30σ이었다. 제 2차 자료수집 기간(개선군, 개선활동 평가 기간) 중 총 소요시간은 평균 659.1±344.1분이었고 단계별로는 각각 92±66.2분, 48±28.0분, 518.9±340.7분이 소요되었다. σ 수준은 총 소요시간은 1.75σ이고, 단계별로는 1.32σ, 4.70 σ, 1.10σ로서 총 소요시간과 단계별 소요시간이 1차 자료수집기간에 비해 향상되었다. 정확성 측면에서는, 대조군의 경우, 예측 Cpeak와 실측 Cpeak의 차이는 평균은 0%, 분산 ±27.10%, σ 수준은 -0.56σ이었고 개선군의 평균과 분산 그리고 σ 수준은 각각 0%, ±15.10%, 0.14σ로 향상되었다. CPS 신속성, 정확성 향상으로 인한 경제적 이익은 정확성 측면에서 380만원/년, 신속성 측면에서 1350만원/년으로 총 1730만원/년의 비용절감 효과가 있었다. 결 론 : CPS 업무 흐름에 따라 CPS 효율성에 영향을 미치는 요인을 분석한 결과 CPS 효율성 향상을 위해서는 투약관련 의무 기록의 정확성, 임상병리 검사의 정도관리 향상, 그리고 관련 부서와의 원활한 업무 협조가 가장 중요하였다. The effectiveness of CPS (Clinical Pharmacokinetics Service), one of pharmacist's clinical services, was emphasized by many studies since 1985 it was introduced Korea about. But in the view of clinicians (medical doctors), customers, it's convenience or reliability was not properly evaluated for applying it to patient's care. To improve quality of Clinical Pharmacokinetics Service (CPS), the speed and the accuracy of CPS, the key points of efficiency in CPS, were evaluated by using 6-Sigma method. The speed of CPS was evaluated using total hours it took from blood sampling by a nurse to sending a CPS report to the patient's chart by a clinical pharmacist. Total hours were divided into blood sampling-to-sampling registering, sampling registering-to-C_(peak) result reporting, and C_(peak) result reporting-to-pharmacist's CPS report. The accuracy of CPS was evaluated by the difference between expected C_(peak) and measured C_(peak). Then the speed and the accuracy of CPS were expressed as σ level. After the campaign for improvement by Six Sigma method, the speed was improved by 1.19σ (before and after the campaign; 0.56σand 1.75σ, respectively) and the accuracy was improved by 0.7σ (before and after the campaign, -0.56σand 0.14σ, respectively). Exact recordings of dosing time, drug infusion hours and blood sampling time were shown to have profound effect on the accuracy of CPS. The improvement in the speed and the accuracy of CPS could produce potential financial benefit of U.S.$ 15,300 a year. There have not been studies on evaluating and objectifying as numerical value for the speed and the accuracy of CPS; thus, 6-Sigma method for improving efficiency in manufacturing process was applied to CPS process by expressing as σlevel. The speed and the accuracy of CPS could be improved by tightly controlling many factors related to CPS efficiency.

수입각증후군에 의한 급성 복증 1례

정은욱,지삼룡,이영태,박지훈,김동기,제인수,채두근,박성재,박은택,이연재,이상혁,설상영,정정명 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Afferent loop syndrome is an uncommon complication of a gastrectomy and Billroth Ⅱ reconstruction. It may cause symtoms at any time from the first postoperative day to many years after the gastrectomy. Afferent loop syndrome is characterized by abdominal pain, vomiting and elevation of serum amylase. Thus, it is difficult to differentiate afferent loop syndrome from other cause of acute pancreatitis. However, the history of gastrectomy can be an important clue for diagnosing afferent loop syndrome. We experienced one case of chronic afferent loop syndrome with acute pancreatitis. After appropriate management, the abdominal pain disappeared and serum amylase level decreased. We report this case with a review of relevant literatures.

틸라피아의 웅성개체 생산에 관한 연구

朴起永 강릉대학교동해안지역연구소 1990 東海岸硏究 Vol.1 No.3

틸라피아의 수컷만을 생산하기 위하여 Oreochromis niloticus 치어에 웅성호르몬 처리에 의한 성전환율과 O. niloticus와 O. mossambicus 간의 종간 교배에 의한 수컷 생산율을 구하고, 호르몬 처리가 성장과 생존율에 미치는 효과를 조사하였다. 초기 치어기의 성분화가 일어나기 전 부화 후 7일째부터 MT를 30, 60 및 100ppm농도로 10∼40일간 처리하여 성전환율 90%이상의 수컷이 생산되었고, 처리시기가 늦을수록 수컷으로의 성전환율이 저조하였다. 그리고, 100ppm 처리 농도에서는 처리 시기가 늦어도 성전환율이 다소 높은 경향을 나타내었다. 잡종 O. niloticus(♀)와 O. mossambicus(♂)을 교배하여 66.9%의 수컷을 생산하였고 잡종 O. mossambicus(♀)와 O. niloticus(♂)을 교배하여 62.8%의 수컷을 생산하여 종간교배는 계통간에 잡종이라도 수컷생산에 효과가 있음을 알 수 있었다. 호르몬 처리가 끝난 직후 모든 농도별, 처리기간별 전장의 측정결과는 대조군과 유사하였고, 60, 100ppm 농도에서 40일간 처리군은 성장이 고르지 못하였다. MT처리가 끝난 다음 처리농도별, 기간별로 부화후 69, 90, 120일간 사육한 치어의 전장과 체중의 측정결과는 대조군에 비해 비교적 뚜렷한 성장증가를 보여 MT처리가 성장에 매우 양호한 영향을 미치고 있음을 알 수 있었다. MT처리한 O. niloticus의 부화 후 6개월 동안 사육한 생존율은 89.3∼93.7%였으며, 치어 초기에는 수컷이 암컷보다 잘 죽는다는 것을 알 수 있었다. The effectiveness of 17α- methlytestosterone(MT) for sex reversal, growth, and survival in Oreochromis niloticus and practical aspects of the production of all male tilapia hybrid(O. niloticus×O. mossambicus) were studied in culture experiments. Wild-spawned fry were treated with 30, 60 and 100㎍ ?? diet for 10, 20, 30 and 40 days. The fish were grown on for 180 days after the hormone treatment period in indoor fish culture tanks. When treated with 30, 60 and 100㎍ ?? diet for 10, 20, 30 and 40 days in fry 7 days after hatching, the percentage of males was more than 90%. And tilapia treated with 30 and 60㎍ ?? diet for 30 and 40 days showed all males. In interspecific crosses of O. niloticus females and males with O. mossambicus females and males, the percentage of males ranged from 62.8 to 66.9%. Growth of tilapia treated with MT by treatment concentration was similar to that of untreated fish through all treatment periods. And tilapia treated with 60 and 100㎍ ?? diet for 40 days showed irregular growth. Growth of tliapia treated with MT for 60, 90 and 120 days significantly increased compared with control. It is suggested, therefore, that 17α- methlytestosterone reflects the growth of tilapia. Survival rates of O. niloticus treated with MT for 6 months ranged from 89.3∼93.7%.

실내사육한 보리새우, Penaeus japonicus BATE 유생의 에너지 수지

朴起永 강릉대학교동해안지역연구소 1990 東海岸硏究 Vol.1 No.1

實驗室에서 飼育시킨 보리새우, Penaeus japonicus幼生의 에너지수지를 분석하여 섭이와 성장 및 대사에 따른 에너지흐름의 동태를 파악하였다. 보리새우는 전유생기간을 통해 0.56㎈의 에너지를 體成長에 사용하였다. 성장에 수반되어 탈피체로 손실된 에너지는 0.05㎈였으며, 전체 유생기간을 통해 0.52㎈를 호흡에 사용하였다. Zoea유생기의 총섭이량에 따른 에너지는 1.06㎈이고, mysis유생기는 5.32㎈로서 전유생기간 동안 섭이에너지는 6.38㎈이었다. Zoea유생기의 배설과 배출로 방출된 에너지는 0.77㎈이며, mysis유생기에는 4.49㎈의 에너지를 방출하여, 전유생기간 동안 5.26㎈의 에너지를 尿와 糞으로 배출하였다. 섭취한 먹이에 대한 同化效率은 17.62%이었다. 성장으로 전환된 에너지의 섭이에너지에 대한 백분율인 총성장효율(K₁)은 9.52%였으며, 성장으로 전환된 에너지의 동화에너지에 대한 백분율인 순성장 효율(K₂)은 54.04%이었다. 동화에너지가 體成長에 사용된 비율은 49.6%였으며, 동화에너지에 대한 대사 에너지의 백분율은 45.95%이었다. 유생기에서 탈피에너지 손실은 동화에너지의 4.45%를 차지하였다. The energy budget of the oriental brown shrimp, Penaeus japonicus BATE larvae reared in the laboratory from nauplius I to mysisⅢ was studied. Energy used by the reared shrimp larvae were calculated from data on feeding, growth, molting, and metabolism. The energy used by growth during the total larval stages was 0.56㎈. Molting energy loss was estimated to be 0.05㎈ during the total larval stages. Energy use in respiration was estimated to be 0.52㎈ during the larval stages. The energy intake from feeding was 1.06㎈ for the zoea-larval stage, 5.32㎈ for the mysis- larval stage, respectively. Energy loss by excretion during the total larval stages was 5.03㎈. Larvae assimilated 17.62% of ingested food, investing 49.6% of assimilated energy in somatic growth. The gross growth efficiencies(K₁) showed 9.52% for larvae, and the net growth efficiencies (K₂) showed 54.04% for larvae. Maintenance costs were estimated at 49.95% of assimilated energy in larvae. Molting loss was estimated about 4.45% of assimilated energy in larvae.

組織素 分解酵素를 生成하는 高溫性 곰팡이의 分離 및 特性

성낙계,강인수,박채규,정영철,김두현 慶尙大學校 1990 論文集 Vol.29 No.1

고온에서 잘 생육하고 cellulose 및 xylan 분해력 이 우수한 곰팡이를 분리할 목적으로 pH5.0, 50℃, Czapek-Dox pulp 배지에서 celluase complex와 xylanase생산이 우수한 곰팡이 H-702균주를 최종선정하여 균학적 성상을 조사한 결과, Aspergillus속과 거의 일치하였으며, 본 공시균주가 효소 생산에 미치는 영향과 효소학적 성질의 결과를 요약하면 다음과 같다. 생육 및 효소생성의 최적온도는 50℃이고, 균체증식 최적 pH는 5.0, cellulase 생산 최적 pH 는 4.5 xyanases는 4.0으로 나타났으며, 효소최대 생성 배양 4일째에, 균체증식은 약 3일경에 최대에 도달하였다.또한 α-1, 4-linkage를 가진 섬유성 물질 왕성하였으며 glucose 와 같은 저분자물질에서는 효소생합성이 현저히 저해되었는데 이런 결과로 볼때 이균주는 carbon catabolite repression을 받고 있었다. 효소생산에 적합한 탄소원으로는 α-cellulose,avicel, filter paper 등 이였으며, 질소원으로는 암모니아가 효과적이었으며 무기염류는 Ca??, Mg??, Mn??, Co??에서 효소생합성이 좋은것으로 나타났다. 계면활성제는 0.15% Tween 80이 좋았다. 개선된 KD배지에서는 각종 효소활성도가 1.2-1.6배 증가하였으며 또한 KD배지에서 각종탄소원을 지질로하여 효소 생합성을 조사한 결과 3% a-cellulose 에서 효소활성도가 좋았고 값싼 기질인폐신문지에서도 효소활성이 높게 나타났다. 조효소의 최적 온도는 cellulas complex 는 70℃, xylanase는 60℃로 나타났으며 열안정성은 cellulas complex 70℃까지는 30분간 , 80℃에서는 잔존활성이 약 93%였고 xylanase는 70℃에서도 거의 안정하였다.최적 pH는 cellulas complex는 5.0, xylanase는 5.5였으며, pH안정성은 3.0-8.0까지 안정하였다.조효소의 미치는 금속이온의 영향은 Ca??,Mg?? Mn??에의해 활성화 되었으며 Pb??, Cu??, Mg?? 에 의해 현저히 저해 현상을 나타냈다. In order to isolate a fungus which grow well in the high temperature and has the excellent decomposing power of cellulose and xylose a fungus. H-702 which produced potently cellulase complex(CMCase,avicelase and β-glucosidase) and xylanase in Czapek-Dox pulp medium (pH 5.0, 50℃) was finally selected. Then as a result of its bacteriological properties investigated it was almost the same properties as Apergillus sp.. The effect influencing to the enzyme production of the isolated strain and enzymological properties are followed. The optimal temperature and pH for cell growth and enzyme production were 50℃, 5.0, 4.5 and 4.0.respectively . The highest production of enzyme was shown when the culture time was three days and the greatest growth of cell was shown about after two days. In the cellulosic materials(CMC.avicel and α-cellulose etc.) containing α-1.4-linking the vigorous production if enzyme was shown and in the small molecular substance such as glucose was remarkably repressed. According to these results, this stain was under the control of carbon catabolite repression.α-cellulose , avicel and filter paper were suitable for carbon source in the enzyme production and NH? for nitrogen source and Ca??, Mg??, Mn?? and Co?? for inorganic salt. 0.15% Tween 80 was a good surface active agent. In improved KD medium each enzyme activity was increased 1.2 to 1.4 times. As a result of investigating enzyme biosynthesis, which each carbon source was used as substrate in the KD medium, it was shown a good enzyme activity. The optimal temperature of crude enzyme in cellulase complex and xylanase were 70 ℃and 60℃, respectively. Thermal stability was shown for 30 minutes until 70℃in cellulase complex and its residual activity at 80℃ was about 93%. It almost was stable at 70℃in xylanase. The optimal pH for cellulase complex and xylanase were 5.0 and 5.5.respectively and they were stable in the range of pH 3.0 TO 8.0. The crude enzyme was activated by Ca?? , Mg??and Mn?? but inhibited by Pb??, Cu?? and Ag?? remarkably.

호알칼리성 Bacillus sp.F204와 Bacillus sp.K17의 원형질체 융합

성낙계,노종수,박석규,정영철 순천대학교 기초과학연구소 1990 基礎科學硏究誌 Vol.1 No.-

To develop cellulase and xylanase-producing strain by protoplast fusion, alkalophilic Bacillus sp. F204 and K17 were treated with NTG(N-methyl-N'-nitro-N-nitrosoguanidine) and isolated antibiotics resistant strains of S20 (Km', Cm') and G70(Str'). The frequency of protoplast formation was about 95% when cells of mid-log phase were treated with 200㎍/㎖ lysozyme at 37℃ for 30-45 minutes. Under addition of 0.4-0.5M sodium succinate, 0.5% casamino acid, 1.5% polyvinylpyrrolidone, 25mM MgCl_2 and 50mM CaCl_2 to the regeneration medium, the regeneration frequency of Bacillus sp. F204 and K17 was 24.9% and 26.2%, respectively. the fusion frequency was 6.6×10^-6 in the presence of 30% polyethylene glycol 6000 containing 50mM Ca^++ at 45℃ for 5 minutes. Cellulase complex and xylanase activities of fusant were compared with parental strains.

沙上地域 産業體 勞動者의 職場體育 參與擴大 方案

安永弼,鄭琮勳,鄭三鉉,金海禮,趙在基,朴俊東,金垠利,張禎允,金福善,孔庚鎬 東亞大學校附設스포츠科學硏究所 1989 스포츠科學硏究論文集 Vol.7 No.-

베체트병 환자에서 Azathioprine으로 유발된 급성 췌장염 1례

김기향,권민정,김동기,김애란,김윤정,박지훈,이영태,박보민,김동욱 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Although many drug are thought capable of initiating acute pancreatitis, following azathioprine administration represents the 5% incidence by far the highest recorded incidence to date. We report a 35-year-old male who developed acute pancreatitis in the course of treatment with azathioprine for Behcet's disease. He was admitted due to abdominal pain, diarrhea, and fever for 10 days. Serum amylase and lipase levels were 510U/L and 3702U/L respectively. The abdominal CT scan revealed diffuse enlargement of the pancreas. There was no history of alcohol use or gall bladder disease. We considered drugs, especially azathioprine, as the cause of acute pancreatitis. We diagnosed it as acute pancreatitis. The patient was treated conservatively with hydration and analgesics. The symptom subsided within four days. Five days later, azathioprine was resumed. And the patient complained of abdominal pain. The elevated levels of serum amylase and lipase confirmed the recurrence of pancreatitis. His symptom subsided when azathioprine intake the stopped, and the serum amylase and lipase levels returned to normal level within five days.

S-366 : Clinical Outcomes of Focal Segmental Glomerulosclerosis Pathologic Variants in Korean Adult Patients

( Young Eun Kwon ),( Jeong Hae Kie ),( Seong Yeong An ),( Yung Ly Kim ),( Kyoung Sook Park ),( Ki Heon Nam ),( Ah Young Leem ),( Hyung Jung Oh ),( Jung Tak Park ),( Tae Ik Chang ),( Ea Wha Kang ),( Se 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1

Background: Many studies have shown that clinical characteristics and outcomes differ depending on pathologic variants of focal segmental glomerulosclerosis (FSGS). However, these are not well defined in Asian populations. Methods: This retrospective study evaluated clinical features and outcomes of pathologic FSGS variants in 111 adult patients between January 2004 and December 2012. Primary outcome was the composite of doubling of baseline serum creatinine concentrations (D-SCr) or onset of end-stage renal disease (ESRD). Secondary outcome included complete (CR) or partial remission (PR). Results: There were 70 (63.1%), 20 (18.0%), 17 (15.3%), 3 (2.7%), and 1 (0.9%) patients with not-otherwise specified (NOS), tip, perihilar, cellular, and collapsing variants, respectively. Nephrotic syndrome occurred more commonly in tip lesion than in other variants. The overall 5- and 8-year renal survival rates were 76.8% and 56.3%, respectively. During a median follow-up of 34.5 months, only 1 (5.0%) patient reached the composite outcome compared to 2 (11.8%) and 12 (17.1%) patients in perihilar and NOS variants, but this difference was not statistically significant in an adjusted Cox model. However, tip lesion was associated with a significantly increased probability of achieving CR (p=0.044). Conclusions: Similar to other populations, Korean adult patients with FSGS have distinct clinical features with the exception of a rare frequency of cellular and collapsing variants. Although pathologic variants were not associated with overall outcome, the tip variant exhibited favorable outcome in terms of achieving remission. Further studies are required to delineate long-term outcome and response to treatment of the pathologic variants.

EvoSNP-DB: A database of genetic diversity in East Asian populations

Young Uk Kim,Young Jin Kim,Jong Young Lee,Kie Jung Park 생화학분자생물학회(구 한국생화학분자생물학회) 2013 BMB Reports Vol.46 No.8