20세기 한국 임상의학의 발자취

宣熙湜 대한의사협회 1999 대한의사협회지 Vol.42 No.12

도시환경조성용 옛 농작물 선발

이정식,김양희,노희선 서울市立大學校 1996 論文集 Vol.30 No.-

To create good urban environment using old agricrltural crops, eight old crops were evaluated for growth and pollution injury at five districts in Seoul. The results are summarized as follows ; 1. In investigation of ten air pollutants in July and August, it was detected heavy contents at Kuroku districts, while Kwangzinku and Songpaku showed the least contents. There have resulted SO2 to be the most detection in Kuroku during experiment period. Whereas O3 showed them the most at Songpaku in August, while it was Soedaemunku in July. In dust content, Kuroku had the least in July, while Yongsanku was in August. 2. In the growths during three months of five districts in Seoul, Nicotiana tabacum was the worst, while five crops such as Perilla frutescens, Ricinis communis, Zea mays, Sorghum bicolor, Cassis tora were the best for growth. Yongsanku out of five districts was the worst them in general, however, there were the best growth in Sedaemunku. Perilla frutescens, Sorghum bicolor, Loix mayuen showed good overall everywhere. In pollution injury, it was quite different from distticts and crops, there showed more 3.0 grade of severe infury Gossypium nankion at Songpaku, Cassia tora at Kuroku, Nicoriana tabacum at Kuroku and Songpaku respectively. There were shown at Kuroku and Songpaku to be the heavy injury while three districts such as Seadaemunku, Yongsanku, Kwangzinku showed a little injury. 3. In contents of sulfur absorption in leaves among them, they were quite different from districts and crops. Sorghum bicolor, in Kwangzinku absorbed it the most, whereas there were the least it in Seodaemunku and Songpaku. Sorghum bicolor was the most absorption for it at Kwangzinku, while Ricinus communis at Kwangzinku, and Zea mays at Seodaemunku were analyzed the least for them. 4. Pollutant that showed overall the highest correlation coefficients with plant growths was O3, next was SO2 and NOx in order of them. The most crops had high correlation coefficients with O3. The crop which had high correlation coefficients for growth with O3 was particulary Perilla frutescens. They had correlation negatively between them in plant height, and plant width, while there were positively correlation between them with pollution injury. Sorghum bicolor showed also th have high correlation with O3, and Ricinus communis negatively correlation between O3 and plant width, and to have correlation positively between dust contents and no. of branches. Zea mays also gave results positively high correlation between O3 and injury leaves due to pollution while there were negatively high correlation for growth with it. Cassia tora showed also positively high correlation between pollution injury and O3.

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.

간세포암과 감별이 어려웠던 악성중피종 치험 1예

김선문,허원석,채경훈,강윤세,정재훈,김연수,박기오,문희석,이엄석,김석현,성재규,이병석,이헌영,신경숙,조준식,송인상,강대영 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Malignant peritoneal mesothelioma is a rare neoplasm that arises from the mesothelium of a serosal cavity and is a rapidly fatal disease with a median survival of 4 to 12 months for untreated cases. Recently, we experienced a case with malignant peritoneal mesothelioma who was suspected hepatocelluar carcioma by abdominal CT scan and was confirmed by biopsy including immunohistochemical stain(calretinin) after surgery. We performed tumor excisions and wedge resection of the liver(segment Ⅷ)and inserted Tencoff catheter in abdominal cavity at 25th day of post-operation. We treated with intraperitoneal paclitaxel(25mg/m^(2)/day for 5 days) six courses monthly. She was well tolerable and is still living without any evidence of recurrence for 14th month of post-operation.

구속된 비행 청소년들의 특성 및 석방 후 6개월간 재범여부와 관련된 변인

정선주,김원식,고승희,구영진,김홍창,서동혁 대한소아ㆍ청소년정신의학회 1999 소아청소년정신의학 Vol.10 No.2

놀이학습프로그램이 초등학생의 사회성 발달에 미치는 영향

박성식,임선희 금오공과대학교 2007 論文集 Vol.28 No.-

병원성 칸디다 혈증에 관한 임상적 고찰

고경식,권선희,김병준,김구엽,서환조 대한감염학회 1995 감염 Vol.27 No.5

목 적 : 최근 칸디다혈증의 발생율이 매우 증가하여 병원 감염의 중요한 원인으로 대두되고 있다. 이에 저자등은 칸디다혈증에 대한 임상적 특성을 알아보기위하여 다음과 같이 연구하였다. 방 법 : 1988년 1월부터 1993년 12월까지 경희대학부속병원에서 발생하였던 병원성 칸디다혈증 61예를 대상으로 의무기록지를 검토하였다. 결 과 : 1) 연도별 발생 빈도는 1988년 부터 1933년까지 각각 2예, 7예, 9예, 11예, 15예, 17예로 증가하였으며, 최근에는 non-albicans 균주에 의한 감염이 증가하고 있었다. 2) 연령분포는 4-83세였으며 평균연령은 51.0±17.4세였고, 남자 32예, 여자 29예였다. 50대와 60대가 57.3%로 가장 많았다. 3) 균주별 발생빈도는 C. albicans 30예, C. tropicalis 13예, C. parapsilosis 10예, C. glabrata 6예, C. guilliermondii 1예, C. krusei 1예로서 C. albicans가 가장 많았다. 4) 기저질환으로 뇌혈관계질환이 25예(41%)로 가장 많았으며, 외과적질환 11예(18%), 고형악성종양 10예(16.4%), 혈액종양질환 9예(14.8%), 기타 내과적질환 6예(9.8%)였다. 5) 균주간 선행인자는 비슷하였으나, C. albicans와 C. tropicalis에서는 수술을 시행받은 예가 많았고, C. parapsilosis는 정주 영양 공급을 받은 경우가 많았다. 6) Amphotericin B 치료군(20예)과 fluconazole 치료군(11예) 사이에 예후에서 유의한 차이는 없었다. 7) 총 61예중 28예에서 사망하여 사망율은 45.9%였으며 정형외과적 수술을 시행받은 경우(83.3%)와 C. glabrata인 경우 사망율이 가장 높았다(83.3%). 결 론 : 칸디다 혈증은 중요한 병원 감염으로 대두되고 있으며 최근에는 non-albicans 진균주에 의한 병원성 칸디다 혈증의 발생율이 증가하는 추세이다. Background : The aim of this study is to determine the annual occurrence of nosocomial candidemia, the relation between Candida species and underlying illness, the relation bewteen Candida species and predisposing factors, and also to compare between the outcome of candidemia of the amphotericin B treatment group and that of the fluconazole treatment group. Methods : We reviewed medical records of 61 cases with nosocomial candidemia between 1988 and 1993 in Kyung Hee University Hospital retrospectively. Results : Two cases occurred in 1988, 7 in 1989, 9 in 1990, 11 in 1991, 15 in 1992, and 17 in 1993. The incidence of candidemia by non-albicans species has increased during this period and accounted for 64.7% in 1993. The infecting candida species were C. albicans(30 cases, 49.2%), C. tropicalis(13 cases, 21.3%), C. parapsilosis(10 cases, 16.4%), C. glabrata(6 cases, 9.8%), C. guilliermondii(1 case, 1.8%), and C. krusei(1 case, 1.8%). The most common underlying disease was cerebrovascular disease(41%) followed by surgical disease(18%), solid cancer(16.4%), hematological malignancies(14.8%), and other medical illness. There were no significant differences between the amphotericin B treatment group(n=20) and the fluconazole treatment group(n=11) in mortality. Overall mortality was 45.9%. The highest mortality was in patients with previous orthopaedic surgery(83.3%) and with C. glabrata candidemia(83.3%). Conclusion : Candidemia emerged as an important hospital infection and candidemia caused by non-albicans species has significantly increased in recent years.

3개 대학병원의 주 진단 코딩사례 평가

서순원,김광환,부유경,서진숙,서정돈,윤석준,이영성,이무식,정희웅 한국의료QA학회 2002 한국의료질향상학회지 Vol.9 No.1

Background : Coding of principal diagnosis is essential component for producing reliable health statistics. We performed this study to evaluate the current practice of principal diagnoses determination and coding, and to give some basic data to improve coding of principal diagnosis. Method : Nineteen medical record administrators(MRAs) of 3 university hospitals participated in coding principal Dx. From August 1, 2001 to August 31, 2001. From each hospital, 10 medical records of patients with high frequency disease were selected randomly. Each 10 medical records were grouped into three(A,B,C). Then, these 30 medical records were given to each MRAs for coding. At the same time questionnaire was given to each of them. Questions were to prove how they decide and code the principal diagnosis among many current diagnoses ; how they decide and code the principal diagnosis when day see irrelevant diagnosis recorded as the principal diagnosis in medical record, when only tentative diagnoses were recorded without final diagnosis, and when different diagnoses were recorded in different sheets of same record. Agreement of coding among 3 hospitals were compared and survey results were analysed with SAS 6.12. Results : Agreement of coding was found in medical records 5-6 of each 10 medical records. Causes of disagreement were as follows. Difference of clinician’s opinion from each hospital; mixed use of guideline from KCD-3 and guideline from DRG; difference in 4th digit classification according to the absence of pathology report in the medical record; difference of abbreviations among hospitals. 57.9% of decided principal diagnosis after consulting to KCD-3 guideline. When there were difficulties in determining the principal diagnosis, 42.1% of MRAs decided principal diagnosis after discussion with the physician, 26.3% after discussion with fellow MRAs. Conclusion : There were differences in coding among hospitals. To minimize the difference, we suggest the development of disease-specific guidelines for coding in addition to the current general guideline such as KCD-3. To do this, Coding Clinic which can produce guidelines is needed.

일개 대학병원근무자들에서의 인플루엔자 예방 접종 순응도 관련요인

정희진,손장욱,최선주,엄중식,우흥정,천병철,김우주,박승철 대한감염학회 2004 감염과 화학요법 Vol.36 No.4

목적 : 병원근무자에서의 인플루엔자 예방 접종은 병원내에서 인플루엔자 전파를 막기위한 수단으로 적극 권장되고 있으나 매년 인플루엔자 백신을 접종하는 병원근무자들은 소수에 지나지 않는다. 본 연구는 병원근무자들에서의 인플루엔자 예방 접종률을 향상시키기 위한 목적으로 첫째, 백신 접종자에서의 인플루엔자 백신 접종 계기를 알아보고 둘째, 인플루엔자 백신접종의 장애요인을 분석하여 그 문제점을 해결하는데에 목표가 있다. 재료 및 방법 : 서울 1개 대학병원의 병원종사자들을 대상으로 1999년 10월 1개월에 걸쳐 인플루엔자 예방 접종을 하도록 한 후 2000년 3월에 접종군과 비접종군을 대상으로 구조화된 설문지를 이용한 설문조사를 실시하였다. 백신 접종군을 대상으로 백신접종의 동기(que to action), 비접종군을 대상으로는 접종에의 장애요인(barrier) 등을 조사하였다. 이 외에도 양군을 대상으로 인플루엔자에 대한 지식 척도, 인플루엔자 백신으로 기대되는 효과(benefit)등에 대한 설문조사를 시행한 후 정답률을 조사하였다. 결과 : 1) 설문 조사에 응한 총 수는 309명으로 간호사가 60% 이상이었다. 백신접종군은 평균연령, 평균 근무연수가 비접정군에 비하여 유의하게 길었으나 성별, 직종별 분포는 양 군간 차이가 없었다. 2) 인플루엔자 예방 접종의 필요성에 대한 지식정도에 있어 접종군의 934%가 그 필요성을 잘 인식하여 비접종군의 779%보다 유의하게 높았으나 예방 접종이 필요한 구체적 이유에 대한 정확한 이해는 접종군 113%, 비접종군 119%에 불과하였다. 3) 인플루엔자 예방 접종을 받은 의료인들의 행동계기는 ‘감염관리실의 홍보’와 ‘주위사람들의 권유’에 의한 경우가 26.9%, 21.6%로 가장 많았고 본인이나 가족, 친구들을 통한 일종의 감지된 위협 때문에 접종한 경우 31명(186%)의 순이었다. 4) 비접종자들에서 예방 접종을 시행치 않은 가장 흔한 이유는 ‘업무에 바쁘고 시간이 없어서’라는 항목이었으며(37.3%) 특히 의사 집단에서는 이러한 이유가 68.8%로서 압도적으로 많았다. 간호사나 기타 직종에 종사하는 직원들의 경우는 자신의 건강에 대한 확신이 30%내외에 달하였고 예방 접종 자체의 효과에 의문을 갖는 경우도 직종에 따라 6.3-29.7%에 달하였다. 결론 : 병원근무자에서 인플루엔자 예방 접종률을 향상시키기 위해서는 백신 접종의 장애물(효과의 의문, 부작용)을 효과적으로 제거하고 인플루엔자 백신의 필요성과 효과를 인식시키기 위한 교육과 함께 시간, 공간상의 제약을 배제할 수 있는 접근성의 문제를 해결하여야 할 것으로 사료된다. Background : In spite of yearly recalls, influenza immunization rate among healthcare workers (HCWs) remained low in Korea University Guro Hospital. This study was conducted to identify the causes of non-compliance against influenza immunization and to analyze the barrier factors for the immunization. Materials & Methods : Questionnaires were distributed in March of 2000 at Korea University Guro Hospital. We evaluated factors associated with acceptance of influenza vaccination and opinions regarding influenza prevention (knowledge about influenza vaccination efficacy, que to action in vaccinee, perceptible benefit, barrier to vaccination). Results : 309 completed questionnaires from HCWs were returned. Mean age and mean duration of work in hospital were higher and longer among vaccinee than non-vaccinee. Even though the necessity of influenza vaccination among HCWs were accepted well in vaccinee compared to nonvaccinee, the accurate reasons for vaccination were not quite understood among HCWs regardless of compliance. Vaccine campaign (30.8%) and advise from doctors (24.7%) were important for the promotion of vaccination among vaccinee. However, major reason for non-compliance among nursing staff and was mis-confidence that their bodies' self defense mechanisms would ward off infection (33.5%) and 'too busy to get injection' for doctors (65%). Conclusion : We conclude that regular education about perceptible benefits and wrong concerns about influenza vaccination among HCW's and easy accessibility to vaccination were important determinants to improve the influenza vaccination. On-site availability of a vaccination-nurse also proved to be important.

임신여성을 제외한 성인에서의 B군 연쇄구균 감염에 관한 임상적 고찰

고경식,권선희,안우석,이원욱,김구엽,서환조 대한감염학회 1995 감염 Vol.27 No.4

목적:B군 연쇄구균은 최근 보고에 의하면 만성 기저질환(당뇨병, 악성종양등)이 있는 성인에서 감염빈도 및 사망률, 이환율이 증가하고 있는 추세이며 그 중요성이 대두되고 있다. 이에 저자들은 B군 연쇄구균 감염의 임상양상, 기저질환(위험인자)을 알아보고, B군 연쇄구균 항균제 감수성등을 규명하고자 하였다. 방법:1986년 1월부터 1993년 12월까지 경희대학교 부속병원에서 B군 연쇄구균이 배양된 274예를 대상으로 의무기록지를 검토하였다. 결과: 1) 전체 연구대상은 274예로 98예(35.8%)가 남자였고, 176예(64.2%)가 여자였다. 이들의 연령분포를 보면 신생아군에서 감염이 많이 발생하였다 이후 감소추세를 보이다가 20대 이상에서 다시 증가 하는 추세를 보였다. 2) 감염 양상은 274명중 명확한 감염이 156명(56.9%), 추정감염이 55명(20.1%), 비감염이 63명(23.0%)이었다. 임신을 제외한 18세 이상의 성인은 231명으로 남자가 83명, 여자가 148명이었고 남여 비율은 1:1.78이었다. 이중 133예(57.6%)에서 명확한 감염이었고, 46명(19.9%)에서 추정 감염, 52명(22.5%)에서 비감염이었다. 명확한 감염환자 133명중 31명(23.3%)이 병원내 감염이였다. 3) 18세 이상의 성인 231명에서 Group B Streptococcus가 분리 동정된 감염 부위는 자궁 경부 77예(33.3%), 요 73예(31.6%), 객담및 상기도 39예(16.9%), 농 24예(10.4%)등이었다. 4) 명확한 감염을 가지고 있었던 성인 133명의 임상양상은 요로 감염 37명(28%), 자궁 경부염 37명(28%), 피부, 연조직 감염 23명(17%), 폐렴 10명(8%), 패혈증 8명(6%)등이었다. 5) 명확한 감염을 가지고 있었던 성인 133명중 92명(69%)에서 한가지 이상의 만성 기저질환이 있었으며, 이중 당뇨병 32%, 뇌 혈관 질환 21%, 고혈압 19%, 신부전 12%, 악성종양 5%등을 차지하였다. 6) 항균제 감수성 검사(251예)에서 penicillin 98.4%, cephalothin 99.6%, cefamandol 98.8%, erythromycin 96.0%, clindamycin 89.4%, oxacillin 88.8%, lincomycin 87.8%, methicillin 86.8%, minocycline 49.4%, trimethoprim-sulfamethoxazole 15.5%의 감수성을 보였다. 7) 명확한 성인 감염 133명중 6명(4.5%)이 사망하였다. 결론:B군 연쇄구균은 만성 기저질환이 있는 성인에서 감염 빈도가 높고, 치명적인 결과를 초래할수 있으므로 감염 예방 및 조기 발견, 적절한 항균제 감수성 검사에 따라 조기 치료로 사망률을 줄여야 할것으로 생각된다. Background: Several reports have suggested that the incidence of diseases caused by Group B streptococcus is increasing in nonpregnant adults, particularly those with serious underlying diseases. The objectives of this study were to define the clinical manifestations, underlying conditions(risk factors) of definite group B streptococcal diseases in nonpregnant adults and to obtain antimicrobial sensitivity of these infections. Methods: We analyzed the records of 274 cases of the Group B streptococcus isolated in Kyung-Hee University hospital between 1986 and 1993. Results: 1) Total Group B streptococcal isolates were 274 cases : Of these cases, 7 percent were 1 month of age or younger, 3 percent were older than 1 month but younger than 18 years of age, and 91 percent were 18 or older. 2) Men and nonpregnant women accounted for 87 percent (n=231) : 133 cases (57.6%) with definite infection, 46 cases(19.9%) with possible infection, and 52 cases(22.5%) with no infection. 31 cases of 133 (23.3%) nonpregnant adult with definite infection apeared to have acquired the disease nosocomially. 3) In the 133 nonpregnant adult patients, the most common clinical diagnosis were urinary tract infection(28%), and cervicitis(28%). 4) In the 133 nonpregnant adult patients, the underlying diseases or conditions were diabetes mellitus(32%), cerebrovascular accident(21%), hypertension(19%), renal failure(12%), and malignant neoplasm(5%), Sixty-nine percent of the cases had one or more underlying diseases. 5) In the antimicrobial sensitivity tests, 98.4% of isolates were sensitive to penicillin, 99.6% to cephalothin, 98,8% to cefamandol, 96.0% to erythromycin, 89.4% to clindamycin, and 49.4% to minocycline. 6) The case mortality rate was 4.5%(6 of 133). Conclusion:We found group B streptococcal infection to be a significant and apparently increasing cause of definite diseases in nonprognant adults, particularly in those with serious underlying diseases. Recognizing these infections early in the groups with serious underlying diseases will be helpful in lowering mortality.