어린이 공공전문진료센터의 진료 역량: 상급종합병원과의 비교를 중심으로

오정윤,조수진,정진선,조진숙,박춘선 건강보험심사평가원 2022 HIRA RESEARCH Vol.2 No.2

소아청소년 복합만성질환자 수 및 진료비의 변화: 2011-2021년 건강보험청구자료 분석

오정윤,조수진,정진선,조진숙,박춘선 건강보험심사평가원 2023 HIRA RESEARCH Vol.3 No.2

Background: The number of children and adolescents has decreased by more than 3 million over the past 10 years. We analyzed changes in the number of children and adolescents with complex chronic conditions (CCCs) and their medical expenditures between 2011 and 2021. Methods: We used National Health Insurance claims data of patients under the age of 20 from 2011 to 2021. CCCs were classified as pediatric CCCs by Feudtner et al. Patients who repeatedly utilize medical services due to CCCs were defined as patients who sought medical care twice or more within the past 3 years. Their sex, age, CCC categories, and the number of CCC categories were presented using descriptive analyses. Results: The number of children and adolescents with CCCs increased from 345,320 (3.04%) in 2011 to 451,238 (5.33%) in 2021. Patients who repeatedly utilized medical services due to CCCs increased by 71,889 during the same period. The proportion of patients with two or more CCC categories increased from 35.80% in 2011 to 43.67% in 2021. In 2021, patients with other congenital or genetic defect were most common. Medical expenditures associated with CCCs increased from 475,654 million won (12.34%) in 2011 to 768,467 million won (19.11%) in 2021. Conclusion: The number of patients with CCCs and their medical expenditures increased in Korea between 2011 and 2021. The results indicate that consistent national efforts are required to maintain the specialized pediatric care. Further studies are needed to identify pediatric patients who require specialized medical services through various methods.

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.

음향방출법에 의한 탄소섬유강화 플라스틱의 파괴특성에 관한 연구 (2)

윤종희,이장규,박성완,우창기,김봉각,조진호 한국공작기계학회 2004 한국공작기계학회 춘계학술대회논문집 Vol.2004 No.-

This study is to investigate a fracture characteristics of carbon fiber reinforced plastics (CFRP) under the tensile loading as a function of acoustic emission (AE) according to the frequency analysis (transient mode) and AE source location (location mode). It was found that the fracture mechanism of AE frequency analysis was a useful tool for the estimation of different type of fracture in CFRP, i.e., matrix(epoxy resin) cracking, delamination and fiber breakage same as AE amplitude distribution.

상아질 표면 젖음성이 수종 자가접착레진시멘트의 인장접착강도에 미치는 영향

윤성영,박세희,김진우,조경모 대한치과보존학회 2009 Restorative Dentistry & Endodontics Vol.34 No.2

본 연구의 목적은 다른 표면 젖음성을 갖는 상아질에 대한 수종의 자가접착레진시멘트의 인장접착강도를 비교하고자 하는 것이다. 이번 실험을 위해 Rely-X Unicem (3M. ESPE. St. Paul. MN. USA). Embrace Wetbond (Pulpdent. Oakland. MA. USA). Maxcem (Kerr. Orangc. CA. USA) 3종의 자가접착레진시멘트를 사용하였다. 발거한 상, 하악 대구치 60 개를 미세절단기 (Acutom P-50, Struers, Copenhagen Denmark)를 이용해 한 치아에서 2 mm × 2 mm × 7 mm의 치아 시편 두개씩 얻었다. 상아질 표면을 건조 그룹은 10 초간 강한 공기로 건조시켰고, 습윤 그룹은 과잉의 수분을 2 초간 거즈로 압박해 제거하였다. 상아질 표면의 젖음성을 달리한 시편에 자가접착레진시멘트를 접착한 후 상온의 상대습도 100% 상태에서 24 시간 보관했고, 만능시험기 (EZ Test, Shimadzu corporation, Kyoto, Japan)를 이용해 인장접착강도를 측정했고, 분리된 접착면의 파절양상을 근관 치료용 현미경 (OPMI pro. Carl Zeiss. Oberkochen. Germany)을 이용해 20 배의 배율로 관찰하였다. SPSS™ Ver 10.0 (SPSS Inc.. Chicago. IL. USA)을 사용응하여 동일한 자가접착레진시멘트에서 상아질 젖음성에 따른 인장접착강도를 T-test로 비교하였으며, 각 자가접착레진시멘트간의 인장접착강도를 One way ANOVA test로 비교 분석하고 95% 유의수준에서 Scheffe's test로 사후검정 하였다. 실험 결과 자가접착레진시멘트의 인장접착강도는 상마질 젖음성에 영향을 받지 않았으며, 상아질 표면 젖음성과 상관없이 Maxcem의 인장접착강도가 Unicem과 Embrace의 인장접착강도보다 유의성 있는 낮은 값을 나타내었다. 또한 모든 시편의 분리된 접착면은 접착실패 양상을 나타내었다. 이상의 실험 결과로 볼 때 자가접착레진시멘트는 상아질 표면 젖음성에 상관없이 사용할 수 있을 것이라고 생각된다. The purpose of this study was to compare the tensile bond strength of several self-adhesive resin cements bonded to dentin surfaces with different wet conditions. Three self-adhesive resin cements:Rely-X Unicem (3M ESPE. St. Paul, MN USA). Embrace Wetbond (Pulpdent. Oakland. MA, USA). Maxcem (Kerr. Orange, CA USA) were used. Extracted sixty human molars were used. Each self-adhesive resin cement was adhered to the dentin specimens (two rectangular sticks from each molar) in different wet conditions. Tensile bond strength were measured using universal testing machine (EZ Test Shimadzu corporation Kyoto. Japan) at a crosshead speed of 1.0mm/min. After the testing bonding failures of specimens were observed by Operative microscope (OPMI pro. Carl Zeiss, Oberkochen, Germany). T-test was used to evaluate the effect of dentin surface wetness. One-way ANOVA test was used to evaluate the tensile bond strength of self-adhesive resin cements in the same condition. Scheffe's test was used for statistical analyzing at the 95% level of confidence. The result showed that wetness of dentin surface didn't affect tensile bond strength of self0adhesive resin cements and Maxcem showed the lowest tensile bond strength.

퍼지 이론을 이용한 해저면 분류 기법

조진석,윤관섭,박순식,나정열,석등우 한양대학교 이학기술연구소 2003 이학기술연구지 Vol.6 No.-

음파를 이용한 해저면 분류를 위하여 2003년 5월 19-25일까지 남해해역에서 음향 실험을 실시하였다. 실험 해역은 해저 구성물질이 각기 다른 6개의정점을 선정하였으며 5개의 주파수(30,50,80,100,12 kHz)를 이용하여 해저면 반사 신호를 측정하였다. 또한 피스톤 코어를 이용하여 해저 퇴적물의 입도분석을 실시하였다. 해저면의 분류를 위해서는 펴지 이론(fuzzy logic)을 사용하였으먀, 이때의 입력 소속함수(input membership function)는 주파수 종속성을 갖는 해저면 반사손실 모텔(HYBRL, Hanyang University Bottom Reflection Loss)이 이용되었으며 출력 소속함수(out membership function)는 해저면의 평균입도 값으로 출력되도록 구성하였다. 퍼지이론을 통해 역산된 평균입도(mean grain size)와 코어 분석 자료를 비교하여 퍼지이론을 이용한 해저면 분류 방법의 가능성을 확인하였다. Acoustic experiments are performed for seafloor classificaton from 19 May to 25 May 2003. The six differnet sites of bottom composition are settled and the bottom reflecton losses with frequencies(30, 50, 80,100,120 kHZ) are measured. The fuzzy logic is used to classify the seabed. In the fuzzy olgic, HYBRL(HanYang Univ. Bottom Refleciton Loss) of frequency dependence is used as a input Membership functions and the output membership functions are composed of the values of the mean grain size of the bottom. The possibility of the seafloor classsification is verified comparing the inversed mean grain size using fuzzy logic with the results of the coring.

소화관내 이물에 대한 고찰

윤한덕,류진호,박주경,허탁,조석주,김성근,민용일 大韓應急醫學會 1997 대한응급의학회지 Vol.8 No.1

We analyzed records at Chonnam university hospital from Sep. 1. 1993 to Aug. 31. 1996 to assess clinical significance of the foreign body in the gastrointestinal tract. There were 133 episodes consisting of 79 pediatric and 54 adult patients as possible to review. In the pediatric patients, the coin was the most common cause of foreign body ingestion, while adult patients were usually caused by bones and meat. We removed foreign bodies in the oral cavity and oropharynx in 12 cases using direct laryngopharyngoscpy and forcep. Endoscopy was performed successfully in 47 of 51 patients in which was attempted; there were two complications composed of an aspiration pneumonia and a mediastinitis due to esophageal perforation. There were spontaneous passage of foreign bodies in 48 cases. We observed complications in 6 cases in which 4 cases needed operations due to complications. Foreign bodies which pass into the stomach can be observed for development of complications, as 94% of foreign bodies which reach the stomach spontaneously pass. Only 4 patients required interventions, which was done without mortality.

인접한 고층건물의 豊荷重 상호간섭에 관한 연구

조강표,정진택,정명채,김윤석 대한건축학회 2003 대한건축학회 학술발표대회 논문집 - 계획계/구조계 Vol.23 No.2(구조계)

Wind load is evaluated based on Standard Design Loads for Building of AIK(Architectural Institute of Korea), which was obtained from wind-tunnel experiment for an isolated building in open country, actual wind load can be different from the code because of terrain, building geometry, wind direction, separation distance between the buildings. Among them. separation distance is the most important factor. This paper presents the interference factor for sqaue section high-rise building structure, focusing on the separation distance. Interference factor was obtain from the force balance test in a wind tunnel.

성인의 복잡성 복강내 감염증의 치료에서 Ertapenem 단독투여와 Ceftriaxone과 Metronidazole 병용투여의 안전성과 유효성 평가를 위한 다기관, 공개, 무작위, 비교 임상연구

조용균,이정남,서성옥,김선회,장진영,김상걸,윤영국,이우정,김민자 대한감염학회 2005 감염과 화학요법 Vol.37 No.6

Background : Ertapenem, a novel β-lactam agent with a wide range of activity, has a pharmacokinetic profile and antimicrobial spectrum that support its potential use as a once-a-day agent for the treatment of common mixed aerobic and anaerobic pathogens encountered in intraabdominal infections. Materials and Methods : The prospective, randomized, controlled, open, and multicenter trial was conducted to compare the clinical efficacy and safety of ertapenem with ceftriaxone plus metronidazole as therapy before or following adequate surgical management of complicated intraabdominal infections. Results : One hundred sixty-three patients were included in the modified intent-to-treat population, of which 134 were clinically evaluable. Patients with a wide range of infections were enrolled; perforated appendicitis or periappendiceal abscess were most common. As for the modified intent- to-treat groups, 71 of 72 (98.6%) patients treated with ertapenem and 73 of 80 (91.3%) treated with ceftriaxone/metronidazole showed favorable clinical response. Conclusion : In this study, the efficacy of ertapenem was equivalent to ceftriaxone plus metronidazole in the treatment of complicated intraabdominal infections. Ertapenem was generally well tolerated and had a similar safety and tolerability profile compared to ceftriaxone plus metronidazole. The results of this trial suggest that ertapenem could be considered as a useful option that could eliminate the need for combination and/or multi-dosed antibiotic regimens for the empiric treatment of complicated intraabdominal infections.

최근 10년간 마취에 관한 임상적 고찰 (Ⅲ)

조현숙,김윤희,손수창,김혜자,최세진 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

To evaluate the specificity and the historical trends of the anesthetic agents and anesthetic methods used in Chungnam national university hospital, anesthetic experiences of 53,291 in total performed at Chungnam national university hospital from January 1987 to December 1996 were analized statistically and clinically according to age, sex, surgical department, physical status, elective to emergency surgery, premedicants, induction agents, anesthetic methods, main anesthetic agent, anesthetic technique and muscle relaxants. The results were as follows : L The number of cases has been steadily increased in annually. 2. The distribution of the number of patients according to the age were cases 37,309(70.02%) in the group of 13-60 years. 3. There were 27,448 male (51.5%) and 25,843 female (48.5%) cases. 4. 9,208 cases (17.27%) were OB-GY, 9,162 cases (17.19%) in general surgery, 7,936 cases(14.89%) in orthopedic surgery, and 6,079 cases (11.4%) in ENT in order of numbers. 5. According to the ASA classification of physical status , most of the cases were belonged to the class 1 (38.69%) class 2 (40.33%) class 1E (5.52%) class 2E (5.71%). Almost cases were relatively in good physical status. 6. The number of elective to emergency was 7,833 (89.76%), to 5,458 (10.24%) cases. 7. As premedicants, a group of glycopyrrolate (35.20%) was given most frequently. 8. Thiopental sodium has been mainly used for intravenous induction agent. 9. General anesthesia has been used as main method of anesthesia. 10. Enflurane was the most commonly used anesthetic agent. 11. Vecuronium was the most commonly used non-depolarizing muscle relaxant.