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.

임신 종결 후 발생한 자궁 동정맥 누공에서 자궁동맥색전술로 치료한 1예

김종민,이해혁,김태희,남계현,심일구,이권해,김형문,이임순,장종호 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Arteriovenous fistula of uterus is rarely reported disease. This vascular malformation is very dangerous condition because Dilatation & curettage can cause massive uterine bleeding without accurate diagnosis. The diagnosis is made by angiography, gray scale ultrasonography, color and duplex doppler ultrasonography, computed tomography, and magnetic resonance imaging is helpful. Especially color and duplex doppler ultrasonography is allows convincing detection and diagnosis of arteriovenous fistula. Recently transcatheter uterine artery embolization is treatment of choice. We have experienced a case of arteriovenous fistula of uterus. Which is presented with a brief review of literature.

여호와의 증인 환자에서 산과적 출혈 후 무수혈 치료 2예

김재령,여소진,이해혁,김정식,김태희,남계현,이권해,이임순,박진화,황경호 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Jehovah's Witness comprise a unique obstetric population. Their refusal of blood stems from an interpretation of a literal translation of the Bible, and it is this belief that puts them at an increased risk of morbidity and mortality if hemorrhage occurs. We report two cases of a Jehovah's Witness who bled massively due to obstetric hemorrhage, refused blood transfusion and had profound anemia. The patients were treated with recombinant human erythropoietin, parenteral iron and oxygen. And they were treated on an intensive care unit with intermittent positive pressure ventilation. We reviewed with literature considering the therapy for acutely anemic patients who refuse transfusion to decrease the duration of the most severe anemia.

Assessment of In Vitro Assay System for Thyroid HormoneDisruptors Using Rat Pituitary GH3 Cells

Hee Jin Kim1,Hae Young Park1,Jeonga Kim1,Il Hyun Kang2,Tae Sung Kim2,Soon Young Han2,Tae Seok Kang2,Kui Lea Park2,Hyung Sik Kim1 한국독성학회 2006 Toxicological Research Vol.22 No.4

The development of in vitro assays has been recommended to screening and test-ing the potential endocrine disruptors (EDs). These assay systems focus only on identifying thethe thyroid hormone (TH) disruptors. The aim of this study was to evaluate a test system to detectTH disruptors using rat pituitary tumor GH3 cells. The test system is based on the TH-dependentincrease in growth rate. As expected, L-3,5,3-triiodothyronine (T3) markedly induced a morphologicalchange in GH 3 cells from flattened fibroblastic types to rounded or spindle-shaped types. T3 stimu-lated GH3 cell growth in a dose-dependent manner with the maximum growth-stimulating effect9 M. In addition, T3 increased the release of growth hor-mone and prolactin into the medium of the GH3 cells culture. Using this assay system, the TH-dis-rupting activities of bisphenol A (BPA) and its related compounds were examined. BPA,dimethylbisphenol A (DMBPA), and TCI-EP significantly enhanced the growth of GH3 cells in therange of 1 × 10-5M to 1 × 10-6M concentrations. In conclusion, this in vitro assay system might bestandardization before it can be used as a broad-based screening tool.

석고법을 이용한 상지 견갑골부위의 체표변화에 따른 여유량 설정에 관한 연구

김혜경,서추연,박순지 연세대학교 생활과학연구소 1999 生活科學論集 Vol.13 No.-

This study was performed to determine the ease amount of upper arm and scapula whose motion range and capacity were highest in the upper body. Subjects were 10 women aged 23 to 25 and suing gypsum method, the body surface change according to the motion of upper arm were obtained. The results obtained from this study were as follows ; 1. In the upper arm area, increasing the motion, sleeve width increased but height of sleeve cap and armhole girth dcreased. In the scapula area, shoulder length showed the highest contraction ratio of 36.2%. 2. It was the sleeve width area including anterior and posterior armpit points that indicated the highest change ratio, demanding ease amount. 3. Overapping of body suface draft and sleeve pattern, the appropriate height of sleeve cap were A.H./4+3∼3.5㎝ in M1∼M3 and A.H./5 in M4. 4. Analyzing the shape of scapula according to the motion of upper arm by means of Moire´ Photography increasing to the motion, moire´contour line moved to the shoulder point.

종격동 종괴를 의심케한 우대동맥궁 1례

김만우,백학연,정춘해,장경식,홍순표,조건국,김종진 朝鮮大學校 附設 醫學硏究所 1987 The Medical Journal of Chosun University Vol.12 No.1

Developmental anomalies of the aortic arch, commonly known as vascular rings, are relatively rare congenital vascular anomalies which can compress the trachea and esophagus. One routine chest film of a patient who was checked and hepatoma-diagnosed in Internal Medicine, Chosun University Hospital left the room for doubt of mediastinal mass. But no subjective symptoms for the mass was told by the patient. This is to report our experience of a patient having right side aortic arch with aberrant left subclavian artery, as proved by diagnosis, but none of congenital heart disease. This right side aortic arch with aberrant left subclavian artery is the most frequent type among right aortic arch, the anomaly of which is usually detected from the incidental suspicion for mediastinal mass at routine chest film; because no symptoms are accompanied therewith.

문제중심학습(Problem Based Learning; PBL) 패키지 개발 : 지각·조정장애상황을 중심으로

김애리,김영경,송영선,신경림,안혜정,이지순,조계화 성인간호학회 2001 성인간호학회지 Vol.13 No.3

The Purpose of this study is to present an actual example for procedures for developing a PBL package based on philosophical backgrounds derived from Problem-based learning. To perform a systemic study on the operations of an intergrated curricula under multi-disciplines, a research team made up of several professors with different academic backgrounds was formed. Among the four situations for the patients with perception-adjustment disorder, especially a procedure for the development of PBL package which can be used in the emergency room situation has been proposed. The little(2000)'s PBL package model has been applied for this study. Tha package includes course objectives, learning objectives, concept map, situation scenario. tutor guide, and evaluation method. It is believed that learning objectives achievement procedures designed as a part of a problem-based learning package development procedures for the nursing of patients with perception-adjustment can be achieved at the same level as the learning objectives for the science of nursing founded by the Korean Nurses Association.

임상간호사의 자아실현과 정신건강에 관한 연구

김혜순,강익화 京畿專門大學 1994 京畿專門大學 論文集 Vol.- No.22

등고선 지도에서의 등고선 복원/인식에 관한 연구

金俊植,金基順,金海正 湖西大學校工業技術硏究所 1999 工業技術硏究所論文集 Vol.18 No.-

In this paper, we proposed the algorithm which extracts the contour lines in the contour map and reconstructs the broken ones. The contour lines is extracted by the algorithm using fairing method. Then the broken lines by symbols and the height number datum are reconstructed by using the Bezier polynomial function. In the reconstruction process, the control points which is searched by tracking the extracted contour lines are used. The reconstruction results is affected by the selection of the control points. The best selection is the choosing respectively the position of 6/10 between starting point and the cross point and between ending point and the cross one. The proposed algorithm has solved the problems with the conventional method by the division of the processing steps between the main contour lines and others. In the simulation results, the proposed method can be used in the digital elevation map generation. Also because the proposed one is consist of the automatic processing step, all the results can be obtained by the processing of computer.

감귤하우스 토양과 노지토양의 화학적 성질과 미생물상

김찬식,강순선,오명협,현해남 濟州大學校亞熱帶農業硏究所 1996 亞熱帶農業硏究 Vol.13 No.-

SummaryDistributions of actinomycetes, bacteria, and fungi were examined in citrus house and field soils sampled from volcanic ash soil area. pH, electrical conductivity, and exchangeable K, Ca, and Mg content in citrus house soil were higher than them in citrus field soil, however, total nitrogen content in citrus house soil is lower than that in citrus field soil.Number of total microorganisms in citrus house soil was about 3.1×105, which was 10 times lower than that in citrus field soil, and also that was remarkably lower than similar group of volcanic ash soil in cultivating and upland soil. Number of actinomycetes and bacteria in citrus house soil were similar to citrus field soil, however, that of fungi in citrus house soil was lower than that in citrus field soil.Electical conductivity and Bray No. 1 P in citrus field soil and pH and exchangeable Mg content in citrus house soil were positively correlated with distribution of actinomycetes in soils and Bray No. 1 P in citrus field soil and exchangeable Mg content in citrus house soil were negatively correlated with distribution of fungi in soils Keywords : volcanic ash citrus orchard soil, soil chemical property, actinomycetes, bacteria, fungi in soils