Bi-factor MIRT True-Score Equating for Testlet-Based Tests

이규민(Gue min Lee),Won Chan Lee,Michael J Kolen,박인용(In Yong Park),Dong In Kim,Ji Seung Yang 한국교육평가학회 2015 교육평가연구 Vol.28 No.2

Lee and Lee (2014) proposed bi-factor multidimensional item response theory model (BFM) "observed-score" equating procedures. The main purposes of this study were to develop BFM "true-score" equating procedures, and to investigate applicability of the proposed procedures with actual data. Eight equating methods (including both true- and observed-score) based on dichotomous IRT (2-parameter logistic model: 2PL), polytomous IRT (graded response model: GRM), testlet response model (TRM), and BFM were compared with target equipercentile equating. Data for this study were from the Reading Comprehension test for a large-scale state assessment program, which consisted of several passages and corresponding groups of items. True- and observed-score equating methods based upon 2PL and BFM produced similar equating results. The GRM true- and observed-score equating methods provided equating results somewhat different from others, and more similar to the target equipercentile equating. Lee와 Lee(2014) 연구는 혼합형 검사에서의 bi-factor 다차원 문항반응모형을 적용한 IRT "관찰점수" 동등화 절차를 제안하였다. 이 연구는 Lee와 Lee(2014) 연구의 추수연구로 단위검사를 대상으로 bi-factor 다차원 문항반응모형을 적용한 IRT "진점수" 동등화 절차를 제안하고, 그 적용 가능성을 실제 자료를 이용하여 탐색하고자 하였다. 이를 위해 단위검사로 구성된 대규모 독해 검사 자료를 이용하여, 2모수 로지스틱 모형(2-parameter logistic model: 2PL), 등급반응모형(graded response model: GRM), 단위검사모형(testlet response model: TRM), bi-factor 모형(bi-factor model: BFM)을 적용하였으며, 관찰점수 및 진점수 동등화를 시행하여 총 8개의 동등화 방법을 적용하고, 산출된 결과를 동백분위 동등화 결과와 비교하였다. 연구 결과, 2PL과 BFM을 적용한 관찰점수 및 진점수 동등화는 유사한 결과를 산출하였으며, GRM을 적용한 관찰점수 및 진점수 동등화 방법은 다른 방법들과 다소 차이를 보이는 결과를 산출하였고, 비교 기준이 된 동백분위 동등화 결과와 보다 유사한 결과를 보였다.

동맥혈 채혈후 시간 경과 및 온도 변화가 가스분압 및 PH 에 미치는 영향에 관한 연구

김동수,이승환,김건식,강화자,신광일,여민구 대한마취과학회 1989 Korean Journal of Anesthesiology Vol.22 No.6

Blood gas samples are highly susceptible to preanalytic error due to improper methods of obtaining or handling the sample prior to delivery to the laboratory. The errors in the measurement of blood gas analysis are currently derived from the exposure of sample to atmosphere, effects of anticoagulant itself, temperature difference between the measuring electrode and drawn blood and the delay in running the sample. To study the effects of the delay in measuring the sample and the temperature difference between the measuring electrode and drawn blood on values of blood gases and pH, we analyzed the arterial sampling from the 24 patients who were taking elective surgery or on his/her recovery period with indwelling arterial catheter. The plastic sampling syringes were kept at 4。C (refrigerator) or 22。-24。C (room temperature) and analyzed at regular intervals (1, 10, 30, 60,120 min) for 120 minutes. The following results were obtained: 1) When the arterial blood drawn from the anesthetized patients were stored 4。C, partial pressure of oxygen (PaO₂) decreased significantly after 20 min, whereas those stored at room temperature decreased significantly after 10 min. 2) When the arterial blood drawn from the recovery patients were stored at 4。C, PaO₂ did not decrease significantly through the experimental period of 120 min. Although those stored at room temperature did not decrease significantly through the period of 120 min. 3) Partial pressure of carbon dioxide in the arterial blood (PaCO₂,) drawn from the anesthetized patients increased significantly by 120 min. at 4。C, whereas those at room temperature increased significantly after 20 min. 4) PaCO₂, of the recovery patients increased signigicantly by 120 min. at 4。C, whereas those at room temperature increased significantly after 30 min. 5) pH of the arterial blood drawn from either anesthetized or recovery patients decreased significantly by 120 min. at 4。C, whereas those at room temperature decreased significantly after 60 min. 6) No significant changes al oxygen saturation (SaO₂) and content (CaO₂) were noted in either anesthetized or recovery. patients in accordance with time elapsed at 4。C or room temperature. In summary, as the changes of PO₂ in particular higher than physiologic PO₂ and PCO₂ in the arterial blood stored at room temperature are significant in accordance with the delay in measuring, it would be advisable to analyze the sample in a short period of time or to store it in a cool place when the measuring will be delayed.

대장내시경검사의 전처치로서 항콜린제 사용에 관한 연구 : 전향적, 이중맹검법으로

박경남,한동수,이민호,최호순,박준용,손주현,이오영,함준수,전용철,송승찬,기춘석,윤병철,이종희 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.3

Background: Use of antispasmodic medication prior to colonoscopy is controversial but someone believes antispasmodic may improve visualization of colonic mucosa and ease colonoscope insertion. So, we designed a study to assess the effect of premedication with the antispasmodic, hyoscine-N-butyl bromide(Buscopan') on the performance of colonoscopy. Methods: This study was prospective, double blinded, randomized, controlled study, One hundred three consecutive patients were randomized to receive intravenous buscopan lml(n=52) or placebo(n=51) combined with our standard initial medication(me- peridine 50 mg and midazolam 2 mg). Insertion of colonoscopy was timed, and 100 mm visual analogue scales (VAS) were used for asscssing difficulty of procedure, colonic motility, frequency of positional change, frequency of external compression, difficulty of assistance and degree of discomfort experienced by the patients. Results: There were no significant differences of intubation time between buscopan group(mean time, 7.23 min., range 2~15) and placebo group(7.07 min., range 3-25), (p=0.83) and withdrawal time between buscopan group (6.46 min., range 2-22) and placebo group(6.76 min., range 2 25), (p=0.69). Also, there was no significant differences in intubation time between males and females(buscopan; males 7.00 min., females 7.60 min., p=0.34, placebo; males 7.0~5 min., females 7.08 min., p 0.44). The VAS scores checked by endoscopist(p=0.29), assistant(p=0.32) and patient (p=0.15) were not significantly different in both groups. There were no significant differences in intubation time, VAS scores nf endoscopist, assistant, and patients. Conclusion: Premedication with intravenous bu.opan has no advantage on colonoscopy procedure. Use of antispasmodic medication prior to colonoscopy was not considered as recommendable agent.

A comparison of Min’s glasses and conventional occlusion therapy in the treatment of amblyopic children: a prospective study

Byung Moo Min,Seung Young Kim,Kil Hwan Ko,Seong Bok Lee 대한안과학회 2000 Korean Journal of Ophthalmology Vol.14 No.1

Min’s glasses are specially manufactured in order to enhance the satisfaction of the wearer and increase treatment effectiveness. We compared the effectiveness of Min’s glasses with that of conventional occlusion therapy in amblyopic pediatric patients. We prospectively studied 60 amblyopic patients. For four to 30 months, 24 of the patients were treated with conventional patch occlusion (patch group) and 36 of them were treated with Min’s glasses (glasses group). We compared the improvement in visual acuity and the treatment compliance between both groups, according to age (over six and less than six), sex, type of amblyopia, and the duration of treatment. Sixteen patients (66.7%) in the patch group and 32 patients (88.9%) in glasses group showed improvement in visual acuity (p=0.002). The pre-treatment average log MAR acuity was 0.56±0.25 in the patch group, and 0.59 ±0.25 in the glasses group. The average improvement in visual acuity was a 0.17 log MAR score in the patch group, and a 0.31 log MAR score in the glasses group (p=0.004). Compliance was 59.54% in the patch group and 83.44% in the glasses group (p=0.012). The pre-treatment average log MAR acuity was 0.49 ± 0.23 for children over six years of age in the patch group, and 0.58±0.28 for children over six years of age in the glasses group. For children over six years of age in the glasses group the improvement in visual acuity (0.29 log MAR score) was greater than for children over six years of age in the patch group (0.06 log MAR score) (p=0.0003). The pre-treatment average log MAR acuity was 0.55±0.22 for female patients in the patch group, and 0.60±0.25 for female patients in the glasses group. Female patients in the glasses group also showed a greater visual acuity improvement (0.29 log MAR score) than female patients in the patch group (0.14 log MAR score) (p=0.0028). However, there were no differences between the groups in patients less than six years of age and in male patients. In conclusion, Min’s glasses were more effective than conventional treatment with a patch in improving visual acuity and encouraging compliance in pediatric amblyopic patients, especially in children over six years of age and in girls.

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

건강한 청년의 단시간 공해노출과 일회성 운동이 폐기능과 생리반응에 미치는 영향

김민주(Min-Joo Kim),이대택(Dae-Taek Lee),송국섭(Gook-Sup Song),방승기(Seung-Ki Pang) 한국생활환경학회 2015 한국생활환경학회지 Vol.22 No.1

This study examined whether an acute exercise during a short-term exposure to a polluted environment affected pulmonary function and physiological responses in healthy young adults. Thirteen men (mean = 22.4 yrs) were randomly exposed to a polluted air (PA) or to clean air (CA) in a chamber. During the exposure, they rested for 30 min followed by a bench stepping exercise (40 cm height, 120 bpm) for 10 min. And they recovered from the exercise for 15 min in the chamber. The pulmonary function, heart rate, blood lactate, and blood pressure were measured during the exposure. At the end of 30 min resting, peak expiratory flow rate (PEFR) was higher in PA than CA. Immediately after the exercise, forced expiratory volume at 1 sec (FEV1) was higher in PA than CA. At 15th min of recovery, forced vital capacity, FEV1, and PEFR were significantly higher in PA than CA. No differences in cardiovascular and blood lactate responses were noticed. The results suggest that an acute intensive physical work out with breathing of volatile organic compounds induced changes of pulmonary function but not physiological adjustments.

Sustained-release praziquantel tablet : pharmacokinetics and the treatment of clonorchiasis in beagle dogs

Hong, Sung-Tae,Lee, Sang Hyup,Lee, Seung-Jin,Kho, Weon-Gyu,Lee, Mejeong,Li, Shunyu,Chung, Byung-Suk,Seo, Min,Choi, Min-Ho 梨花女子大學校 藥學硏究所 2003 藥學硏究論文集 Vol.- No.12

Praziquantel is rapidly absorbed and secreted; and thus fractional doses are recommended for the treatment of cestode and trematode infections. In the present study, we developed a new praziquantel tablet formula allowing sustained-release (SRP). In vitro dissolution of SRP tablets showed that praziquantel at 300 ㎎/tablet combined with hydroxypropyl methylcellulose dissolved completely at a constant rate over 10 h, whereas the conventional praziquantel tablet (PZQ) was only 40% dissolved. Pharmacokinetic studies in dogs confirmed that SRP was absorbed more slowly than PZQ. The mean value of the area under the concentration/time curve from 0 h to the final observation time, the maximum concentration in serum, and the time of maximum concentration in serum for SRP were 3.471.500 ng/min for 0.25 ㎖, 10,300 ng for 0.25 ㎖, and 192 min. while the values for PZQ were 688,600 ng/min for 0.25㎖, 2,500 ng for 0.25㎖, and 135 min. The cure rate in dogs with a heavy infection (500 metacercariae) treated with a single dose of SRP (150 ㎎/tablet) at 50 ㎎/㎏ was 80%, while in dogs treated with a single dose of SRP (300 ㎎/tablet) at 30 mg/kg it was 60%, and the cure rate with PZQ was 20%. In each case. the egg reduction rate was similar (over 90%). No abnormal liver functions or hepatic or renal pathologies were observed in dogs administered with SRP at 30 ㎎/㎏. The SRP tablet showed sustained release and slow absorption; and it had an improved anthelmintic efficacy against Clonorchis sinensis in experimental dogs. compared with conventional praziquantel.

피프로닐 오염도 조사를 위한 분석법 정립

조순길 ( Soon-kil Cho ),이미진 ( Mi-jin Lee ),이정민 ( Jeong-min Lee ),김호진 ( Ho-jin Kim ),박수민 ( Soo-min Park ),박혜진 ( Hye-jin Park ),이승화 ( Seung-hwa Lee ),안종성 ( Jong-sung Ahn ) 한국환경농학회 2018 한국환경농학회 학술대회집 Vol.2018 No.-

2017년 유럽에서 피프로닐에 오염된 계란이 유통된데 이어 국내에서 생산된 일부 계란에서도 살충제가 검출되었다. 피프로닐은 진드기 방제 목적으로 사용되는 살충제로 sulfide, sulfone, amide, sulfoxide의 대사산물을 생성한다. 피프로닐은 물에 1.9 mg/L 정도 용해되고, 아세톤에 545.9g/L가 용해되는 성질이 있어 시료 채취시 아세톤을 사용한다. 농장시설 등에 부착된 피프로닐을 제거하기 위해 5% 탄산나트륨(Na2CO3)과 15% 과산화수소(H2O2)를 권장하고 있다. 이는 피프로닐을 피프로닐설폰으로 산화시킨 다음 반복적으로 사용하여 제거한다. 이러한 제거 작업을 통해 피프로닐이 제거된 정도를 조사할 필요가 있고, 이를 위한 분석법 정립이 필요하다. 시료를 250 mL 용기에 넣고 1% 함유 아세토니트릴 100 mL을 주가하여 10분간 격렬하게 진탕한 후, 3500 rpm으로 원심분리를 하였다. 추출액 1 mL을 0.2 um 멤브레인필터로 여과하여 시험용액으로 하였다. 칼럼은 C18(2.0 mm I.d×50mm, 3 um)을 사용하였고, 이동상은 0.1% 포름산 함유 메탄올과 0.1% 포름산 및 5 mM 아세트산암모늄이 함유된 물을 사용하였다. 분석조건으로 피프로닐의 선구이온은 437 m/z, 생성이온은 368, 255, 290 m/z, positive 조건으로 분석하였고, 피프로닐 설폰의 선구이온은 451 m/z, 생성이온은 415, 282, 244 m/z negative 조건으로 분석하였다. 분석법의 정량한계는 피프로닐 0.92 ug/kg, 피프로닐설폰 0.70 ug/kg이었다. 피프로닐과 피프로닐 설폰을 각각 1, 5, 10, 50, 100 ug/kg 수준으로 검량선을 작성한 결과, r2는 모두 0.9999이었다. 10 ug/kg과 50 ug/kg 수준의 3반복 회수율 실험결과, 10ug/kg 수준에서 피프로닐은 74.7±0.56%, 피프로닐 설폰은 88.9± 0.27%로 나타났다. 50 ug/kg 수준에서는 피프로닐은 78.6±0.11%, 피프로닐 설폰은 95.2±0.02%로 유효회수율 범위(70~120%)에 포함되었다. 머무름 시간은 피프로닐 5.3 mim, 피프로닐 설폰은 5.7min에서 검출되었다. 교차확인 목적으로 LC/MS/MS로 분석한 시료를 GC/μ-ECD로 분석을 하였다. 분석조건은 주입구 온도 250℃, (5%-Phenyl)-methylpolysiloxane이 충진된 30 m×0.25 mm×0.25 um길이의 칼럼이다. 오븐온도는 130℃에서 300℃까지 승온 조건으로 분석하였고, 머무름시간은 피프로닐 11.64 min, 피프로닐 설폰12.79 min으로 LC/MS/MS와 GC/μ-ECD 모두 표준물질과 시료의 결과가 일치함을 알 수 있었다. 정립된 분석법은 피프로닐 오염도조사를 위한 분석법으로 활용할 수 있을 것으로 판단된다.

Comparative evaluation of the algorithms for parametric mapping of the novel myocardial PET imaging agent ¹⁸ F-FPTP

Kim, Ji Who,Seo, Seongho,Kim, Hyeon Sik,Kim, Dong-Yeon,Lee, Ho-Young,Kang, Keon Wook,Lee, Dong Soo,Bom, Hee-Seung,Min, Jung-Joon,Lee, Jae Sung Springer Japan 2017 Annals of nuclear medicine Vol.31 No.6

<P><B>Objective</B></P><P>(<SUP>18</SUP>F-fluoropentyl)triphenylphosphonium salt (<SUP>18</SUP>F-FPTP) is a new promising myocardial PET imaging tracer. It shows high accumulation in cardiomyocytes and rapid clearance from liver. We performed compartmental analysis of <SUP>18</SUP>F-FPTP PET images in rat and evaluated two linear analyses: linear least-squares (LLS) and a basis function method (BFM) for generating parametric images. The minimum dynamic scan duration for kinetic analysis was also investigated and computer simulation undertaken.</P><P><B>Methods</B></P><P><SUP>18</SUP>F-FPTP dynamic PET (18 min) and CT images were acquired from rats with myocardial infarction (MI) (<I>n</I> = 12). Regions of interest (ROIs) were on the left ventricle, normal myocardium, and MI region. Two-compartment (<I>K</I><SUB>1</SUB> and <I>k</I><SUB>2</SUB>; 2C2P) and three-compartment (<I>K</I><SUB>1</SUB>–<I>k</I><SUB>3</SUB>; 3C3P) models with irreversible uptake were compared for goodness-of-fit. Partial volume and spillover correction terms (<I>V</I><SUB><I>a</I></SUB> and <I>α</I> = 1 − <I>V</I><SUB><I>a</I></SUB>) were also incorporated. LLS and BFM were applied to ROI- and voxel-based kinetic parameter estimations. Results were compared with the standard ROI-based nonlinear least-squares (NLS) results of the corresponding compartment model. A simulation explored statistical properties of the estimation methods.</P><P><B>Results</B></P><P>The 2C2P model was most suitable for describing <SUP>18</SUP>F-FPTP kinetics. Average <I>K</I><SUB>1</SUB>, <I>k</I><SUB>2</SUB>, and <I>V</I><SUB><I>a</I></SUB> values were, respectively, 6.8 (ml/min/g), 1.1 (min<SUP>−1</SUP>), and 0.44 in normal myocardium and 1.4 (ml/min/g), 1.1 (min<SUP>−1</SUP>), and 0.32, in MI tissue. Ten minutes of data was sufficient for the estimation. LLS and BFM estimations correlated well with NLS values for the ROI level (<I>K</I><SUB>1</SUB>: <I>y</I> = 1.06<I>x</I> + 0.13, <I>r</I><SUP><I>2</I></SUP> = 0.96 and <I>y</I> = 1.13<I>x</I> + 0.08, <I>r</I><SUP><I>2</I></SUP> = 0.97) and voxel level (<I>K</I><SUB>1</SUB>: <I>y</I> = 1.22<I>x</I> − 0.30, <I>r</I><SUP><I>2</I></SUP> = 0.90 and <I>y</I> = 1.26<I>x</I> + 0.00, <I>r</I><SUP><I>2</I></SUP> = 0.92). Regional distribution of kinetic parametric images (<I>αK</I><SUB>1</SUB>, <I>K</I><SUB>1</SUB>, <I>k</I><SUB>2</SUB>, <I>V</I><SUB>a</SUB>) was physiologically relevant. LLS and BFM showed more robust characteristics than NLS in the simulation.</P><P><B>Conclusions</B></P><P>Fast kinetics and highly specific uptake of <SUP>18</SUP>F-FPTP by myocardium enabled quantitative analysis with the 2C2P model using only the initial 10 min of data. LLS and BFM were feasible for estimating voxel-wise parameters. These two methods will be useful for quantitative evaluation of <SUP>18</SUP>F-FPTP distribution in myocardium and in further studies with different conditions, disease models, and species.</P><P><B>Electronic supplementary material</B></P><P>The online version of this article (doi:10.1007/s12149-017-1171-6) contains supplementary material, which is available to authorized users.</P>

2003년 국내 중증급성호흡기증후군 진료 현황 및 문제점 분석

이진수,김은실,정문현,백제중,정선화,안주희,최영화,이선희,고철우,김성범,김민자,박승철,기현균,송재훈,최상호,김양수,이상오,조용균,박영훈,정숙인,김연숙,이흥범,손창희,장성희,정희진,김우주 대한감염학회 2004 감염과 화학요법 Vol.36 No.3

목적 : 2002년 말 중국에서 SARS가 발생한 이후 국내에서도 2003년 10월까지 총 3명의 추정환자, 17명의 의심환자가 보고되었다. 향후 추가적인 SARS의 유행이 우려되는 상황에서, 그간의 SARS 환자 진료에 있어서의 실질적인 준비사항, 진료 현황 등에 대한 조사를 통해 문제점을 파악하여, 향후 더 나은 대비가 될 수 있도록 개선점을 제시하고자 하였다. 재료 및 방법 : SARS로 의심되는 환자를 진료 경험이 있는 병원의료진을 대상으로 2003년 10월에 설문조사를 실시하였다. 설문에는 SARS 환자 진료 시의 실질적인 조치, 진료 현황, 병실, 응급실 및 외래에서의 격리 시설과 준비사항, 보건당국의 관리와 지원에 관한 사항을 포함하였다. 결과 : 대상이 되는 22개 병원 중 17개(17/22, 77.2%) 병원이 설문에 응하였다. SARS 환자를 위한 격리실은 응급실, 외래, 일반병실 및 중환자실에서 각각 9개(9/17, 52.9%), 5개(5/17, 29.4%), 15개(15/16, 93.7%), 4개(4/16, 25%) 병원에서 음압처리가 되어있지 않은 일인실 혹은 다인실이 사용되었고, 1개(1/16, 6.3%) 병원에서만 일반병실에서 음압격리실이 운영되었다. 입원환자의 진찰 시 개인보호구의 착용은 거의 모든 의료기관에서 이루어졌다. 보건당국에서 SARS지정병원의 시설 등을 사전에 확인한 곳은 1곳(1/12, 8.3%)이였고, 14개 병원(14/15, 93.3%)에서는 보건당국에 의뢰한 검사결과를 통하 받지 못하였다. 결론 : 의료기관에서 SARS 환자용 격리실뿐만 아니라 기존의 격리실 설비 등이 미흡하였으며, 특히 중환자실 및 외래의 준비가 더욱 부족하였다. 보건당국의 의료기관에 대한 종합적인 지원이 부족하였고, 병원과의 원활한 연계가 잘 이루어지지 않았다. SARS 만이 아닌 격리를 필요로 하는 질환의 적절한 진료를 위해 향후 병원 시설의 정비와 정부차원에서의 보다 구체적이고 실질적인 대책마련이 필요하다. Background : There was an worldwide outbreak of the Severe Acute Respiratory Syndrome (SARS) originated from China in late 2002. During that period three cases of suspected SARS and 17 cases of probable SARS were reported in Korea. With the concerns about the reemergence of SARS-coV transmission, it is important to be prepared for any possibility. So, this study is aimed to analysis the past measures in managing SARS and propose the amendatory plans to improve the preparedness. Materials & Methods : Questionnaires were collected among clinicians with any experience in managing the probable or suspected SARS cases in Oct. 2003. 17 out of 22 hospitals responded to the questionnaire. The contents in the questionnaire were practical activities, personal equipments, response plans, isolation facilities in emergency centers, outpatient clinics, general wards and intensive care units, and relationship with the public health department. Results : The dedicated isolation rooms in emergency centers, outpatient clinics, general wards, and intensive care units were prepared in 9 (9/17, 52.9%), 5 (5/17, 29.4%), 15 (15/16, 93.7%), and 4 (4/16, 25.0%) hospitals, respectively. Except for one hospital that newly made negative pressure room for SARS, single or multi-bed rooms without airborne infection control were used in all the other hospitals. The personal precaution principles were kept quite well in general wards. Before the designation of SARS hospital by the public health department prior evalution to see if the hospital was suitable for managing SARS was conducted in only 1 (1/12, 8.3%) hospital. The results of laboratory diagnosis were reported back in 1 (1/15, 6.6%) hospital. Conclusions : The isolation facilities which can control airborne infection were almost deficient not only for SARS but also for other respiratory transmissible diseases. For the infection control of transmissible diseases including SARS, more investment is needed on medical facilities and comprehensive support from the public health department required.