정신과 입원환자의 서비스 만족척도의 개발

김철권,이지연,송영선,김규호,김경률,김제원,이동기,최병무 大韓神經精神醫學會 2006 신경정신의학 Vol.45 No.3

목적 본 연구의 목적은 국내 정신의료기관(정신병원, 종합병원 정신과)에서 간편하게 사용할 수 있는 신뢰도와 타당도가 검증된 입원환자의 서비스 만족척도를 개발하기 위한 것이다. 방법 여러 단계를 거쳐 국내 실정에 맞는 문항을 개발하였고,정신병원, 종합병원, 대학병원 정신과 병동에서 퇴원하는 348명의 환자들을 대상으로 신뢰도와 타당도를 조사하였다. 요인분석 결과 5개의 요인이 추출되었으며 전체 변량의 63.04%를 설명하였다. 내적 일관성에 대한 신뢰도 계수 (Crohnbach's α)는 0.95로 상당히 높은 수준이었고, 수정된 개별문항-총점 상관계수는 0.50부터 0.72까지의 범위에 속하였다. 요인분석을 통해 추출된 서비스 만족척도의 각 하위척도 점수와 서비스 만족척도에 첨부된 각 영역에 대해 전반적인 만족도를 묻는 세 개의 문항 점수 간의 상관성 역시 유의하게 높았다. 결과 진단명에 따른 서비스 만족척도의 전체 점수에서는 불안/신체형/강박장애 환자군과 기분장애 환자군이 각각 정신분열병 및 기타 정신병 환자군과 알코올중독 장애 환자군에 비하여 유의하게 높은 점수를 보였으며, 입원형태에 있어서는 자발적 입원군이 강제 입원군에 비하여 전체 만족점수가 유의하게 높았다. 그러나 성별, 월수입, 학력, 직업, 종교, 결혼상태 등의 변수에서는 서비스 만족척도의 전체 점수에서 유의한 차이가 발견되지 않았으며, 마찬가지로 연령, 입원일수, 입원횟수, 첫 발병나이, 유병기간 등의 임상적 변수에서도 서비스 만족척도의 전체 점수와 유의한 관계를 보이지 않았다. 서비스 만족척도의 전체점수에서 대학병원 환자군이 정신병원 환자군과 종합병원 환자군에 비하여 각각 유의하게 높았다. 결론 결론적으로 국내 정신의료기관에 입원한 환자들의 서비스 만족을 평가하기 위한 목적으로 개발된 본 척도는 높은 수준의 신뢰도와 타당도를 보였으며, 또 국내 정신의료 환경에 맞는 요인구조를 보였다. 따라서 정신의료 서비스에 대한 정신과 환자의 만족도에 대한 연구가 거의 없는 실정에서 본 척도의 개발은 향후 국내 정신의료의 질과 치료결과를 높이는 도구로 활용될 수 있을 것으로 기대된다. Objectives : To develop and test the validity and reliability of a brief self-completed questionnaire (Service Satisfaction Scale : SSS) for routinely assessing the quality of service in psychiatric ward inpatients. Methods : A 30-item multidimensional questionnaire was developed by several steps of face validity and content validity. The questionnaire was administered to inpatients (n=348) discharged from psychiatric hospitals, general hospitals, and University hospitals. Construct validity was supported by performing principal component analysis. Reliability was estimated by calculating internal consistency of Cronbach's alpha. Results : Factor analysis yielded five factors comprising staff attitude, treatment quality, ward environment, access/cost, and ward rule, which account for 63.04% of the common variance. The internal consistency of the scale was high (Cronbach's alpha=0.95). The concurrent validity was supported by the significant correlation of each of five factors with item that measured overall satisfaction of SSS. Patients with neurosis (anxiety disorder, somatoform disorder, obsessive compulsive disorder) and mood disorders were significantly satisfied than those with psychosis and alcoholic disorders. Patients who admitted voluntarily were more significantly satisfied than those who admitted involuntarily. Sociodemographic variables such as age, gender, marital status, monthly income, education level, employment status and religion were not significantly different at the total scores of SSS. Similarly, clinical characteristics such as age of onset, duration of illness, lengths of hospital stay and number of previous hospitalization did not associate significantly with the total scores of SSS. Patients discharged from university hospitals were significantly more satisfied than those of the general and psychiatric hospitals. Conclusion : SSS performed well in the validity and reliability, indicating that it can be a useful tool for measuring Satisfaction of psychiatric inpatients in Korea.

Urinary tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7 as biomarkers of patients with established acute kidney injury

( Won Yong Cho ),( Sung Yoon Lim ),( Ji Hyun Yang ),( Se Won Oh ),( Myung-gyu Kim ),( Sang-kyung Jo ) 대한내과학회 2020 The Korean Journal of Internal Medicine Vol.35 No.3

Background/Aims: Urinary tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) have been recently discovered and validated as sensitive biomarkers that can predict stage 2 or 3 acute kidney injury (AKI) development in high-risk patients. We aimed to assess whether these biomarkers could predict adverse outcomes and renal recovery in established AKI patients. Methods: This was a single-center study prospectively enrolling 124 patients diagnosed with AKI. TIMP-2, IGFBP7, neutrophil gelatinase-associated lipocalin (NGAL), and kidney injury molecule 1 (KIM-1) levels were measured at the time of diagnosis and the predictive performance of short-term outcomes and renal recovery was assessed. Results: Patients were divided into 4 quartiles according to the initial urinary TIMP-2/IGFBP7 levels. Stage 3 AKI (odds ratio [OR], 17.86), classified by the Kidney Disease Improving Global Outcomes (KDIGO), as well as the third and fourth quartiles of TIMP-2/IGFBP7 (OR, 5.75 and 44.98, respectively), were found to be independent predictors of renal replacement therapy at the time of AKI diagnosis. In addition, KDIGO stage 3 AKI (OR, 2.468) or the third of fourth quartiles of urinary TIMP-2/IGFBP7 (OR, 1.896 and 3.622, respectively) were also found to be useful in predicting nonrecovery of renal function. In a separate analysis of patients with renal recovery at discharge, initial urinary TIMP-2/IGFBP7 or urinary IGFBP7 at discharge could also predict new-onset or progressive chronic kidney disease (CKD). Conclusions: In AKI patients, urine TIMP-2/IGFBP7 could serve as a biomarker for predicting adverse outcomes, renal recovery, or the development and progression of CKD.

다발성 대장암 간전이 환자의 간절제를 위한 새로운 시도

주종우,김형철,임철완,신응진,조규석,유기원,송옥평,홍대식,박성진,조준희,이혜경,김희경,권계원,고은석 순천향의학연구소;Soonchunhyang Medical Research Institute 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Multiple bilobar liver matastases (MBLM) are the main cause of low resectability in the colon cancer liver metastases. The authors experienced one case of initially non-resectable colon cancer liver metastases. He was curatively and safely treated with a two-stage hepatectomy using the new method of future remnant liver volume growing. A 54-year-old man was referred to our department with the sigmoid colon cancer combined with MBLM, which were checked in two small metastatic lesions in the left lobe and five large sized lesions in the right lobe in the computed tomogram (CT). A laparoscopic assisted anterior resection was primarily performed. We performed the 1^(st) stage hepatectomy 3 weeks after the colon resection. Intra-operative Ultrasonogram (US) found 9 small superficial metastatic lesions in the left lobe. All that lesions were completely removed by non-anatomical wedge resection. An occlusion ballon catheter was placed in the right portal vein through a small branch of the inferior mesenteric vein at that time. The future remnant liver volume was sufficiently increased 3 weeks after the 1^(st) hepatectomy. A right hepatectomy was safely performed 22 days after the 1^(st) hepatectomy. The patient received a regional chemotherapy (interleukin2 based immuno-chemotherapy through hepatic artery) for 4 months, then received 9 cycles of systemic chemotherapy (biweekly Oxaliplation, leucovorin, plus 5-fluorouracil) without any recurrence evidence.

Kidney Toxicity Induced by 13 Weeks Exposure to the Fruiting Body of Paecilomyces sinclairii in Rats

Jeong, Mi-Hye,Kim, Young-Won,Min, Jeong-Ran,Kwon, Min,Han, Beom-Suk,Kim, Jeong-Gyu,Jeong, Sang-Hee Korean Society of ToxicologyKorea Environmental Mu 2012 Toxicological Research Vol.28 No.3

Paecilomyces sinclairiis (PS) is known as a functional food or human health supplement. However concerns have been raised about its kidney toxicity. This study was performed to investigate the kidney toxicity of PS by 13 week-oral administration to rats. Blood urea nitrogen (BUN), serum creatinine, and kidney damage biomarkers including beta-2-microglobulin (${\beta}2m$), glutathione S-transferase alpha (GST-${\alpha}$), kidney injury molecule 1 (KIM-1), tissue inhibitor of matrix metalloproteinase 1 (TIMP-1), vascular endothelial growth factor (VEGF), calbindin, clusterin, cystatin C, neutrophil gelatinase-associated lipocalin (NGAL) and osteopontin were measured during or after the treatment of PS. BUN, creatinine and kidney damage biomarkers in serum were not changed by PS. However, kidney cell karyomegaly and tubular hypertrophy were observed dose-dependently with higher severity in males. KIM-1, TIMP-1 and osteopontin in kidney and urine were increased dose dependently in male or at the highest dose in female rats. Increased urinary osteopontin by PS was not recovered at 2 weeks of post-exposure in both genders. Cystatin C in kidney was decreased at all treatment groups but inversely increased in urine. The changes in kidney damage biomarkers were more remarkable in male than female rats. These data indicate that the PS may provoke renal cell damage and glomerular filtration dysfunction in rats with histopathological lesions and change of kidney damage biomarkers in kidney or urine. Kidney and urinary KIM-1 and cystatin C were the most marked indicators, while kidney weight, BUN and creatinine and kidney damage biomarkers in serum were not influenced.

Kidney Toxicity Induced by 13 Weeks Exposure to the Fruiting Body of Paecilomyces sinclairii in Rats

Mihye Jeong,Young-Won Kim,Jeong-Ran Min,Min Kwon,Beom-Suk Han,Jeong-Gyu Kim,Sang-Hee Jeong 한국독성학회 2012 Toxicological Research Vol.28 No.3

Paecilomyces sinclairiis (PS) is known as a functional food or human health supplement. However concerns have been raised about its kidney toxicity. This study was performed to investigate the kidney toxicity of PS by 13 week-oral administration to rats. Blood urea nitrogen (BUN), serum creatinine, and kidney damage biomarkers including beta-2-microglobulin (β2m), glutathione S-transferase alpha (GST-α), kidney injury molecule 1 (KIM-1), tissue inhibitor of matrix metalloproteinase 1 (TIMP-1), vascular endothelial growth factor (VEGF), calbindin, clusterin, cystatin C, neutrophil gelatinase-associated lipocalin (NGAL) and osteopontin were measured during or after the treatment of PS. BUN, creatinine and kidney damage biomarkers in serum were not changed by PS. However, kidney cell karyomegaly and tubular hypertrophy were observed dose-dependently with higher severity in males. KIM-1, TIMP-1 and osteopontin in kidney and urine were increased dose dependently in male or at the highest dose in female rats. Increased urinary osteopontin by PS was not recovered at 2 weeks of post-exposure in both genders. Cystatin C in kidney was decreased at all treatment groups but inversely increased in urine. The changes in kidney damage biomarkers were more remarkable in male than female rats. These data indicate that the PS may provoke renal cell damage and glomerular filtration dysfunction in rats with histopathological lesions and change of kidney damage biomarkers in kidney or urine. Kidney and urinary KIM-1 and cystatin C were the most marked indicators, while kidney weight, BUN and creatinine and kidney damage biomarkers in serum were not influenced.

LCC 분석을 통한 도시가스와 지열 냉 난방설비의 경제성 평가

이일규(Lee, Il-Gyu),강현욱(Kang, Hyun-Wook),원유만(Won, Yoo-Man),김용수(Kim, Yong-Su) 대한건축학회 2011 大韓建築學會論文集 : 構造系 Vol.27 No.10

The purpose of this study is economic analysis of heating and cooling systems that are using gas, geothermal energy through life cycle cost analysis. The adapted research method selected the office building in Seoul region. The building is 15 stories and have total floor area of 270,000㎡. And the capacity of heating and cooling system applied in new building is 700RT to 750RT as a scale of heating and cooling system that can provide same capacity. The Adapted LCC Analysis period on 40 years. Comparing and analyzing life cycle cost about each heating and cooling system in cases, economical evaluation is estimated. The results are as follows: 1) The total life cycle cost of gas heating and cooling system is approximately 7,979million won, the total life cycle cost of geothermal heating and cooling system is approximately 8,073million won. 2) The cost of the geothermal heating and cooling system is higher than gas heating and cooling system about 1.18%. Thus, optimal plan is the gas heating and cooling system.

태권도 선수의 운동상해 예방을 위한 조사연구 : 전국 고등학교 태권도 선수들을 대상으로

김원규,이종희,장완성 경희대학교 체육대학 한국체육과학연구소 2003 體育學論文集 Vol.31 No.-

Taekwondo players by analyzing the primary factor of exercise injury and researching on the actual condition related to media treatment. To dot it, male and female players at 14 High Schools in Korea, who are registered in Korea, Taekwondo Association, were selected as the subjects of this study. The result of this research is as follows. 1) 73 males(52.5%) and 59 females(42.4%) appeared to have exercise injury. 2) The parts of exercise injury about male appeared to be ankle joint 87 times (11.0%), foot 80 times (10.1%), knee joint 59 times (7.4%) in the order of the frequency of occurrence and about female to be ankle joint 87 times (11.0%), foot 74 times (9.3%), knee joint 63 times (8.0%) 3) The type of exercise wound in male appeared to be bruise 154 times (19.4%), muscular pain 94 times(11.8%), and in female bruise happen 134 times(16.9%) and muscular pain 73 times(9.2%) in the order of the frequency. 4) Injury was experienced during exercise among 22 persons(15.8%) in class pin and among 19 persons (13.7%) in both class bantam and feather. 5) All pin, flight, bantam, feather and heavy weight classes showed ankle as the most frequent exercise injury region among all the injury parts during exercise. Light weight class had knee joint 25 times (3.2%) and both welter and middle classes indicated foot area as the most often wounded part. 6) In injury types happened during exercise, bruise turned out to be 298 times(31.7%), the highest level. Next, the occurrence rate of muscular pain was 20.8%(167 times). 7) It is true 165Cm to 170Cm tall persons have most exercise injuries : 39 persons (28.1%). Next, 170 Cm to 175Cm tall players with injury were 28 persons (20.1%). 8) The area injured most often during exercise was that of ankle joint as 174 times (21.9%) in 160 to 165Cm, 165 to 170 Cm 170 to 175Cm tall players and players over 185Cm Foot was most frequently hurt part as 21 times (27%) in 175Cm to 180Cm tall players. Hand & foot joint and knee joint 7 times (0.9%) in 180 to 185 Cm tall players. 9) Players under 160Cm height and 160 to 165Cm, 165 to 170Cm, 170 to 175Cm tall players and players over 185Cm, showed the highest rate of bruise as the type of injury occurred during exercise and next to it, muscular pain. 175 to 180 Cm players experienced muscular pain 33 times (4.1%), bruise 31 times(3.9%) and 180 to 185 Cm players went through with bruise 17 times(2.l%) and fracture of a bone 8 times (1.0 %). 10) When it comes to total exercise period, 54 persons(38.8%), the highest rate of male, exercise over 4 hours and as to female, 50 persons The purpose of this study is to investigate to offer the basic materials essential for protection from exercise injury of (36.0%) exercise over 4 hours. 11) The injured cause of exercise in male was their carelessness (30 persons : 22.7%), the lack of preparatory exercise and the foul of opponent players (10 persons each : 7.6% each), Instead, for women, excessive work was the cause of exercise injury in 13 persons (9.8%) and their carelessness was that of the injury in 11 persons(8.3%). 12) Male chose emergency treator as following : medical experts(19 persons : 14.4%), the person himself, a coach or an inspector (16 persons : 111%). Female chose emergency treaters following : medical expert (21 persons : 15.9%) and a coach or an inspector (16 persons : 12.1%). 13) Thorough warm-up & arrangement exercise (47 persons : 14.0%), complete recovery from tiredness, wearing protective device, being well-nourished, mental & psychological stability, reasonably held matches in numbers, and etc are shown in order as the protective way of exercise injury in males. On the other hand, in females, complete recovery from tiredness(43 persons : 12.8%), thorough warm-up & arrangement exercise, wearing protective device, mental & psychological stability, being well-nourished, reasonably held games in numbers, appear in the order of frequence.

오염물질의 횡확산을 고려한 하천수질 관리계획

김원규 동의공업대학 2000 論文集 Vol.26 No.1

A model is proposed for finding the optimal wastewater treatment level to control the water quality in a river which consists of several upstream tributaries and intakes throughout its length and where transverse dispersion occurs. The mixing ratio is used for predicting that solute concentration in tribuaries have an effect on the water quality at downstream intakes. A mathematical model which predicts steady state two-dimensional distribution of solute concentration in meandering nonuniform natural channel is presented for computing the mixing ratio or each tributary. Two features of the convection-diffusion equation derived here in are that it employs the transverse cumulative discharge as an independent variable replacing the transverse distance and that it is developed in an orthogonal curvilinear (natural) coordinate system which follows the general direction of the channel flow. With the help of continuity equation of water the transverse convection term which cannot be neglected in a natural channel is eliminated from the dispersion equation by a transformation where in cumulative discharge replaces transverse distance. In this paper, it is found that the mixing ratio of each tributary has an important effect on the water quality at downstream intakes. Therefore, When programming for optimal water quality management is made out, it is showed that it is reasonable to consider mixing ratio by introducing two-dimensional model for water quality.

간헐적 양압호흡기를 이용한 호흡운동치료 후 근 이영양증 환자의 폐기능 변화

김기송,이규완,오덕원 한국전문물리치료학회 1999 한국전문물리치료학회지 Vol.6 No.3

범하수체 기능저하증을 동반한 일차성 중추성 림프종의 1예

김원영,김원,조규종,홍정석,이미우,장성은,오세현,임경수 대한응급의학회 2001 대한응급의학회지 Vol.12 No.4

A primary central nervous system lymphoma(PCNSL) is defined as a lymphoma limited to the cranial-spinal axis without systemic involvement. PCNSLs were formerly very rare, only 0.5∼ 1.2% of all intracranial neoplasms, and were usually associated with acquired immuno-deficiency syndrome(AIDS) and other immune-compromised states. Recently, there has been a clear rise in the incidence of this disease among normal individuals. We describe a 77-year-old female with hyponatremia who presented with a confused mental state. Computed tomography(CT) of the brain demonstrated a suprasellar mass with enhancement. We evaluated the basic hormonal studies and the magnetic resonance imaging(MRI). A ventricular biopsy was done, and the result was a diffuse, large, B-cell-type malignant lymphoma. She presented panhypopituitarism and partial central diabetes insipidus. She received chemotheraphy and was discharged in an improved condition. We report a case of panhypopituitarism due to PCNSL and give a review of the literature.