제2형 당뇨병 환자의 치료에서 복약순응도가 혈당 조절에 미치는 영향

김경선,김민정,박소현,박영주,허정순,이은경,김선영,이수형,김상수,강양호,손석만,김인주,김용기 한국병원약사회 2009 병원약사회지 Vol.26 No.2

Abstract: As known in clinical trial like DCCT, UKPDS, tight glycemic control is essential to prevent complications from diabetes mellitus(DM). In type 2 diabetes taking multiple medication, nonadherence to medications is common problem. The aim of our study is to investigate adher-ence rate of patients with type 2 DM and to evaluate association between many factors including adherence rate and HbA_(1C). 441 patients with type 2 DM who visited Busan National University Hospital endocrine internal department from Aug 13 to Sep 2, 2008(3weeks) were enrolled. We conducted a man-to-man questionnaire survey about general knowledge about diabetes mellitus, medicine and adherence, and measured HbA_(1C). Among them, 305 patients taking oral hypo-glycemic agent(OHA) were analyzed to investigate correlation between adherence rate and glycemic control. We studied 305 patients(male 126, female 179, average age 61.2±9.8 years, DM duration 8.6±6.4 years, average adherence 88.8±16.2%, average HbA_(1C) 7.03± 1.18%). HbA_(1C) showed significant relation with DM duration(r=0.137, p=0.017), number of aHA in regimen (r=0.135, p=0.018), dosage frequency(r=0.132, p=0.026), Medication Refill Adherence(MRA)(r=-0.124, p=0.030) and adherence(r=-0.168, p=0.003). Adherence had significant relation with MRA(r=0.148, p=0.010) but didn't have statical corelationship with DM duration, number of aHA and dosage frequency. Patients that their adherence rate exceed 90% took fewer OHA(p=0.011) and went on a better dietary treatment(p=0.007). In patients controlling diabetes mellitus with aHA, when adherence rate and MRA was higher, HbA_(1C) was lower. As a result, to improve adher-ence rate, it is necessary to enhance patient education, do careful consideration about prescrip-tion medicine number and dosage frequency

단기교육으로 시행가능한 심실기능평가법

김원,임경수,오병연,홍은석,김영식,김선만,이부수,현석천,김영득 대한응급의학회 2000 대한응급의학회지 Vol.11 No.4

Background: The initial history, physical examination, and ECG assessment should focus on identification of potentially serious noncardiac or cardiac disorders, including coronary artery disease, congestive heart failure, and electrical instability at the emergency room. additionally, it is essential to define disease severity, stability and need for emergency therapy. echocardiography is a useful tool for this purpose. especially Doppler echocardiography may be more sensitive and time-saving diagnostic tool for the evaluation of patients presenting with cardiogenic symptoms. So we evaluate the feasibility of the echocardiographic measurement by emergency physicain after short-term course. Method and Results: Twenty volunteers(10 male, 38.8±9.3 years) were included in the study for measurement of myocardial performance index and established parameters of ventricular function using conventional echo-Doppler methods. Myocardial performance index: (ICT+IRT)/ET, was obtained by subtracting ejection time(ET) from the interval between cessation and onset of the mitral inflow velocity to give the sum of isovolumic contraction time(ICT) and isovolumic relaxation time(IRT). The most of mean values of echocardiogrphic parameters were not significantly different between those of cardiologist and those of emergency physicians(p<0.01). The duration for measuring myocardial performance index was shortest among echocardiographic parameters. the validity of echocardiographic parameters measured by emergency physicians was proved relatively good. Conclusion: It is proved to be feasible for emergency physician to perform echocardiographic evaluation of ventricular function after short-term course

신축학교 실내공기질이 초등학생들의 인지기능에 미치는 영향

김태섭,김선주,박시영,전만중,김규태,김창윤,정종학,백성옥,사공준 대한산업의학회 2007 대한직업환경의학회지 Vol.19 No.1

목적: 신축초등학교와 대조학교를 선정하여 교실 내 포름알데히드와 TVOCs를 측정하고 컴퓨터 신경행동검사를 이용하여 실내공기 오염물질이 학생들의 인지기능에 미치는 영향을 평가하였다. 방법: 신축초등학교 5학년 71명을 실내공기 오염물질 노출군으로 하고, 개교한지 12년째인 대구시의 일개 초등학교 5학년 2학급 63명을 대조군으로 하여 실내공기 오염물질농도 측정 및 컴퓨터 신경행동검사를 실시하였다. 결과: 신축학교에서 의도적으로 창문을 개방한 학급에서 1교시 포름알데히드 농도는 34.6 ㎍/㎥, 4교시에는 27.3 ㎍/㎥, 창문을 개방하지 않은 학급에서 1교시 80.2 ㎍/㎥, 4교시 127.1 ㎍/㎥, 대조학교에서는 2학급 각각 1교시에 12.6 ㎍/㎥, 7.5 ㎍/㎥, 4교시에 19.8 ㎍/㎥, 25.2 ㎍/㎥였다. TVOCs의 경우 신축학교의 의도적으로 창문을 개방한 학급에서 1교시에 농도는 487.2 ㎍/㎥, 4교시에 428.2 ㎍/㎥, 창문을 개방하지 않은 학급에서 1 교시에 농도는 1,283.5 ㎍/㎥, 4교시에 1,715.4 ㎍/㎥, 대조학교의 경우 2학급에서 각각 1교시에 농도는 240.9 ㎍/㎥, 150.8 ㎍/㎥, 4교시에 농도는 371.9 ㎍/㎥, 448.0 ㎍/㎥였다. 부호숫자 짝짓기의 평균반응시간은 대조학급이 1교시에 2,585 msec에서 4교시에 2,459 msec으로 감소한 반면 신축학교의 창문을 의도적으로 개방한 학급은 2,343 msec에서 2,510 msec으로, 평소대로 수업한 학급은 2,340 msec에서 2,563 msec으로 반응시간이 각각 167 msec, 223 msec 증가하였다. 1교시의 부호숫자 짝짓기 의 반응시간을 100%로 했을 때 창문을 의도적으로 개방 한 학급은 4교시에 5.9% 증가하였고(p<0.01), 평소대로 수업한 학급은8.3% 증가하였다(p<0.01). 반면에 대조학급은 4교시에 5.0% 감소하였다(p<0.01). 결론: 향후 학교의 실내공기질의 안전성 평가는 샘플링 된 공기의 오염수준의 측정뿐만 아니라 학생들의 건강영향도 함께 고려되는 것이 바람직할 것이다. Objectives: Most studies on the indoor air quality of newly built schools have focused only on the number of schools exceeding a standard or on subjective symptoms, such as sneezing, irritated eyes and an irritated nose. However, there has been no report on how poor indoor air quality affects children's academic performance. This study evaluated the effects of indoor air quality on the neurobehavioral performance of elementary school children. Methods: This study measured the indoor air pollutants and compared children's performance, using a computerized neurobehavioral test, between a newly built and a 12-year-old school. In addition, a questionnaire was administered regarding the indoor air quality related symptoms of children in a newly built and a 12-year-old school. Results: In the newly built school, the formaldehyde levels in the 1^(st) and 4^(th) classes with an open window were 34.6 and 27.3 μg/㎥, respectively. The levels in the 1^(st) and 4^(th) classes with the window closed were 80.2 and 127.1 μg/㎥, respectively. In the 12-year-old school, the formaldehyde levels in 1^(st) and 4^(th) class with open and closed window were 12.6 and 7.5 μg/㎥, and 19.8 and 25.2 μg/㎥, respectively. With respect to total volatile organic compounds, the levels in the 1^(st) and 4^(th) classes with the window open in the newly built school were 87.2 and 428.2 μg/㎥, respectively. In the 1^(st) and 4^(th) classes with the window closed, the total volatile organic compounds were 1,283.5 and 1,715.4 μg/㎥, respectively. In the 12-year-old school, the total volatile organic compounds were 240.9 and 150.8 μg/㎥, and 371.9 and 448.0 μg/㎥ in the 1^(st) and 4^(th) classes, respectively. In the case of a newly built school, the performance of the students in the neurobehavioral test in the 4^(th) class with the window closed was 8.3% lower than for those in the 1^(st) class with the window closed, but was only 5.9% lower when the windows were open. There was a statistical significant difference in the total numbers of symptoms between the two schools. Conclusions: These results suggest a proper evaluation of the indoor air quality within schools is required into both the level of contamination and the health effects of these contaminants toward children.

위절제술 환자의 표준진료지침 개발 및 적용 효과

김은희,김철규,이순교,김순덕,이혜옥,권정순,이경미,이민미,심순미,유용만,신종식,강은희,이상일,김병식,오성태,육정환,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.2

Background : Gastric cancer is the most common malignant tumor in Korea. surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for recucing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and unplanned readmission rate between the pre-pathway group(n=67) and the post-pathway group(n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days(p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was of satistically significant(p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korea hospital settings.

Diffusion of Choline Chloride in Aqueous Solutions of Chondroitin Sulfate

Jung, Ok-Sun,Kim, Si-Joong,Kim, Hyoung-Man Korean Chemical Society 1984 Bulletin of the Korean Chemical Society Vol.5 No.6

Mutual diffusion coefficients of choline chloride were determined by using the diaphragm cell method in aqueous solutions of chondroitin sulfate A at $25^{\circ}C$. The diffusion coefficients of choline chloride in 0.1g/100ml, 0.5g/100ml and 1g/100ml respectively of chondroitin sulfate solutions were compared with those of binary systems of water-choline chloride. At low concentrations, the diffusion coefficients of the choline chloride in the presence of chondroitin sulfate were significantly smaller than the values obtained in the absence of chondroitin sulfate, indicating a strong interaction between these solutes. The effect of this interaction on the diffusion of choline ion is largest at higher chondroitin sulfate concentrations and at lower choline chloride concentrations. The influence of chondroitin sulfate is overcome at higher choline chloride concentrations. Self-diffusion coefficients of choline ion in the presence of chondroitin sulfate are also obtained. Excellent agreements were obtained between the experimental data and the calculated values obtained by using the Manning's equations. These observations suggest that the interaction between choline chloride and chondroitin sulfate involves primarily a long range electrostatic effect and there is no appreciable "condensation" or binding of choline ion to the chondroitin sulfate.

AVPU scale과 Glasgow Coma Scale의 상관관계 : 외상환자의 의식상태 평가법 THE EVALUATION METHODS OF MENTAL STATUS IN TRAUMA

김 현,임경수,이강현,김영식,김선만,황성오 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

Background: The emergency treatment of multiple trauma patient includes rapid evaluation of mental status, triage and resuscitation. The principles of Advanced Trauma Life Support consist of primary survey & resuscitation, secondary surveys and definitive cares. In primary survey, the mental status is evaluated by AVUP scale, and GCS(Glasgow coma scale) is used in secondary survey because the calculation of GCS needs more times than AVPU scale. Purposes: Is there a correlation between AVPU scale and GCS as an evaluation method of mental status in trauma? Subjects: 434 injured patients(male 321, female 113, mean age 35.9 years) who had visited the emergency center of Wonju Christian Hospital was evaluated prospectively. The mental status was evaluated by AVPU scale and GCS by emergency physician as soon as the patients was admitted to emergency center. Results: Alert patients as AVPU scale were ranged from 14 to of GCS, patients who responded to verbal command were from 9 to 14 of GCS, patients who responded to pain stimuli were from 4 to 10 of GCS, and patients who did not respond to pain stimuli were from 3 to 5 of GCS. The linear correlation of AVPU scale and GCS was seen(r2=0.90). Conclusion: This study suggest that AVPU scale was vey closely correlated with GCS.

W-CDMA 수신기 RF system 성능 분석 및 설계

김성호,지만구,김학선 한밭대학교 산업과학기술연구소 2001 논문집 Vol.5 No.-

In this paper, the RF system of the W-CDMA receiver is analyzed and designed. In order to obtain precise receiving performance parameter, we calculated each parameter which complied with specification(3GPP TS 34.121 V3.2.0). Noise Figure(NF) which is key parameter of receiver is derived from the specification. Linear characteristic and noise characteristic of the receiver system are analyzed by Phase Noise(PN) and Third Order Intercept Point(IP3) respectively. In addition, sweeping of the nonlinear component parameter which affects the linear performance is examined. Finally, we designed RF system which follows the available maximum parameters and introduced it in each part.

거리측정 시스템의 설계 및 제작

金洪錫,朴勝玉,朴正萬,金成培,金善泰 대진대학교 1993 大眞論叢 Vol.1 No.-

We constructed an optical distance meter using intensity modulated laser beam It is based on the measurement of the phase difference between the transmitted and the reflected beam. The diode laser beam is modulated at one of two frequences, 15MHz or 150KHz. These frequencies have effective modulation wavelengths of 10m and 1000m, respectively. It has the ability to measure the distance within one kilometer with several centimeter resolution

히트파이프식 히트싱크의 열전달에 관한 연구

김선정,박종섭,조만호 大田産業大學校 1998 한밭대학교 논문집 Vol.15 No.1

The heat pipe has been paid attention as the effective cooler of electronic equipment. In this study, the distilled water, as working fluid was filled in the copper container. To increase the heat transfer area of cooling, the heat pipe type heat sink attached aluminium fin is made. To examine the heat transfer characteristics of heat pipe type heat sink, the experimented conditions of cooling air temperature are 20℃, 25℃ and 30℃, those of working fluid injection quantity are 30%, 40% and 50% of the container volume and those of heat exchange quantity are 15W, 25W, 35W, 45W and 55W respectively and then the effects are compared and analysed by the variables. According to working fluid injections quantity variable, heat exchanges quantity variable and cooling air temperatures variable, we could see the fact that the condition of working fluid injection quantity is the optimum. In the case of 40% of working fluid injection quantity, the heat pipe thermal resistance is 0.36℃/W and the heat sink total thermal resistance is 0.49℃/W without the significant change according to heat exchange quantity.

흰쥐에서 말초신경 손상후 뒤뿌리신경절세포의 신경영양인자와 그 수용체의 발현 양상

백선용,양만석,문총석,김봉선,김재봉,김진정 대한해부학회 1999 Anatomy & Cell Biology Vol.32 No.2