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.

일부 농촌부인의 자궁경부암 집단검진시 수진과 관련된 결정요인의 분석연구

金順德,廉容泰,李明淑 고려대학교 의과대학 1988 고려대 의대 잡지 Vol.25 No.3

Among the females in Korea, cervical cancer is the most common malignant tumor. Exfoliative cytology is a highly sensitive and inexpensive screening technique for cervical cancer and its precursors. The detection and eradication of the precursors have led to a significant fall in cervical cancer incidence and mortality rates in those areas of some developed countries in which there has been widespread and prolonged use. Interviews were carried out during the period from December,1986 to March, 1987 to study the determinants of the positive health seeking behavior of married women living in Jeomdong Myon, Yeoju Kun, Kyonggi Province focusing on the cervical cancer screening. Interviewed were 291 married women who participated in the cervical cancer screening and 249 who didn't. The path analysis and the discriminant analysis were used to identify major determinants for the health behavior concerned with cervical cancer screening. The results of this study were summarized as follows: 1. Belief, motive and action levels to the cervical cancer screening were 87.5%, 70.2% and 53.9% each. Belief and motive levels were 95.5%, 62.8% in the participants of the screening, and 78.2%, 33.3% in nonparticipants. 2 Determinants for the belief were age, regular health check up, benefit, susceptibility, level of knowledge, marital status, and interpersonal interaction. These determinants were able to explain 28.5% of the belief. 3. Determinants for the motive were belief, symptom, acquaintance who participated in cervical cancer screening, benefit, age, regular health check up, interpersonal interaction, acquaintance of cancer cases other than cervical cancer, and level of knowledge. These determinants were able to explain 26.9% of the motive. 4. Determinants for the action were occupation, age, symptom, belief, marital status, acquaintance who participated in cervical cancer screening, motive, some basic medical equipment kept in home, interpersonal interaction, acquaintance with cervical cancer patient, and mass media communications. These determinants were able to explain 37.8% of the actions. The variables having indirect effects on the actions through the belief and motive were susceptibility, benefit, level of knowledge, acquaintance with cancer cases other than cervical cancer, and regular health check up. 5. The belief was able to explain 18.2% of the motive, belief and the motive was able to explain 9.8%of the action. 6. The hit ratio was 78.82% for the prediction of the action in the discriminant analysis with the discriminating variables.

Periapical cemental dysplsia의 진단에 대한 치험례

이순영,이찬영,노병덕 大韓齒科保存學會 2005 Restorative Dentistry & Endodontics Vol.30 No.1

Periapical cemental dysplasia(PCD) is a condition most commonly seen in the mandibular incisor region. Radiographically it passes through the three phases(osteolytic stage, intermediate stage, and mature stage). At osteolytic stage, the lesion is similar to features associated with granuloma or cyst that arise following pulpal necrosis. So, it is important to confirm the vitality of the pulp to diagnosis. In this case, it is difficult to confirm the vitality of involved tooth because the tooth was covered with PFG bridge. And it is unusual that the PCD lesion at mandibular incisors has occurred at first and the lesion of mandibular canine and mandibular premolar were occurred afterward. 치근단 백악질 이형성증은 대부분 하악 전치부에서 발생하는 병소로 시간의 흐름에 따라 3단계의 독특한 방사선 사진상의 변화 양상을 보인다 (방사선 투과성기, 혼합기, 방사선 불투과성기). 특별히 1단계인 방사선 투과성기의 방사선 사진 상의 양상은 치수 괴사로 인해 발생하는 치근단 육종이나 치근단낭과 매우 유사하다. 따라서 이를 감별하기 위해서는 정기적인 방사선 사진 검사와 함께 치수의 생활력을 검사가 매우 중요하다고 할 수 있다. 하지만 본 증례에서는 해당 부위의 치아가 PFG bridge로 수복되어 있는 치수 생확력 검사를 정확하게 할 수 없었다. 또한 병소가 처음에는 하악 전치부에 발생하였으나 뒤이어 하악 견치와 소구치부에서도 연달아 발생한 특이한 소견을 보였다.

국민학교 지리 교수 방법에 관한 고찰

임덕순 釜山敎育大學 1970 부산교육대학 논문집 Vol.6 No.2

At the Seoul Seminar of Social Studies Teaching, September 1969, a pronouncement that the Concrete teaching methods based upon the combination of professional disciplines and instructional studies had to be developed was upheld by a member of the seminar. To meet this pronouncement and to equilibriate unbalanced outputs of studies of teaching contents are aims of this study. Twenty eights methods(approaches) derived from the "frame of reference" of areal and topical aspects in elementany school geopraphy curriculum are categorized and described according to the E. B. Wesley's mechanism of arrangement as follows: 1. Methods based upon the approach to social realities. a. methods based upon field work (1) School-yard approach (2) Neighborhood approach (3) Community-study approach (4) Excursion method (5) Journey method b. Methods based upon indoor work (1) Documentary approach (2) Graphic-representation method (3) Specimen approach (4) Vicarious-learning approach 2. Methods based upon organization of materials. a. Expanding-environment approach b. Sample-study approach c. Comparative-study approach d. Historical approach e. Current-geographical approach 3. Methods based upon teacher purpose a. Model training b. Memoriter study c. Reinforcemental-process approach 4. Methods based upon pupil purpose a. Inquiry method b. Socialized recitation C. Dramatized method 5. Methods based upon the degree of independence of thought a. Inductive approach 6. Methods based upon physical senses a. Picture-study approach b. Musical approach 7. Methods associated with basic concepts of geography a. Man-land approach b. Topical approach c. Systematic approach d. Factual approach e. System-analysis approach Each method has advantages and weakness in the different teaching-learning situations. Geography teachers must try to direct students to the fundamentals and key points of geography and to develop geographic contents from simple examples to complex and various knowledges. These are the general and meaningful cautions in teaching of geography. It is valuable for the teachrs and researchers to have many repertories of methods. The future studies of this field ought to be oriented to more theoritical, concept-centered, mathematical, inquiring, and discipline-centered methods or approaches. The author expects many critiques to this paper of geographers and professional students of geognaphy teaching.

工業廢水中의 重金屬類의 微生物的 處理

洪淳德,金鍾國 慶北大學校 1981 論文集 Vol.31 No.-

大邱地域의 공업단지 및 하천의 폐수와 汚泥로 부터 Pb, Zn, Hg에 내성을 갖는 균주를 분리하여 이들 균주를 동정한 결과 Pb, Zn, Hg내성군주 (H-1, H-2, H-3)는 각각 Staphylococcus aureus, Bacillus alvei, Pseudomonas mendocina 혹은 그 類綠菌으로 추정되었다. Pb, Zn은 500ug/㎖ 농도까지는 生育에 영향이 없었으나 그 이상의 濃度에서는 生育이 지연되었으며 Zn의 경우는 1000ug/㎖ 농도에서 5시간 以後부터 증식이 可能하였다. Hg내성균주는 100ug/㎖ 濃度에서도 현저하게 生育이 지연되었다. 또 이들 각균은 1800ug/㎖의 pb, 1100ug/㎖의 Zn, 400ug/㎖의 Hg까지 生育이 가능한 균주로서 Pb 또는 Zn 100ug/㎖의 농도에서 24시간(30℃) 배양한 건조균체에 각각 154.1㎎의 Pb, 70.5㎎의 Zn이 축적되었다. Three resistant strains against Lead, Zink, and Mercury were screened from amongst the microorganisms isolated from the sewage of Taegu industrial area and Dalseochen, which were identified as a Staphylococcus aureus, Bacillus alvei, Pseudomonas mendocina, respectively. The tolerant strains against Pb or Zn respond well in the 500ug/㎖ of Pb or Zn, but the growth was highly decreased in the higher concentrations. The Zn tolerant strain took 5 hours as a lag phage at 1000ug/㎖. The growth of Hg tolerant strain markedly decreased in 100ug/㎖ of Hg. Each of these strains could tolerate the concentration of 1800ug/㎖ of Pb, 1100ug/㎖ of Zn and 400ug/㎖ of Hg. 154.1㎎/g Pb and 70.5㎎/g Zn could be recovered from each of the tolerant strains dried at 105 C, 24 hours after culturing in the media containing 100ug/㎖ of Pb or Zn at 30℃ for 24 hours.

看護問題 把握을 위한 體系的인 患者 査定道具

兪德順 한양대학교 의과대학 간호학과 1974 한양간호학회지 Vol.- No.1

Modern clinical nursing care lays stress on the comprehensive nursing care. The professional nurse takes care of the patient as person with foolings and needs, treating with her skill, knowledege, and independent judgement upon which nurse will make decisions for the purpose of performing the patient-centered nursing care. The organized assessment tool could be utilized to identify the patients' nursing problems and needs caused from their disease and surroundings. The purpose of this study is to discuse the importance of the assessment and utilization of the assessment tool. The conclusion of this study was as follows. (1) This assessment tool was prepared to identify the patient's functional abilities, to understand the patient's reactions to illness, hospitalization, and care, and to systematically collect the information about the physiological, psychological, and social behavior of the patient. (2) The data collected by means of such assessment tool provided the rationale for determining the patient's nursing needs and served as the basis for making nursing diagnosis, for planning and evaluating the nursing therapy, and for writing the various nursing orders. (3) It takes about half an hour to make initial assessment. During the assessment process better nurse-patient relationship could be formed, so that the the-rapeutic effect in giving patient-centered nursing care and the patient's assurance could be obtained. (4) It was pointed out that with the recognition of patient's patterns of behavior and normal functioning, his present status can be identified and tentative goals can be set up for his future level of function so that be able to change the living-pattern he may himself.

Bacillus licheniformis에 의한 Alkaline Phosphatase의 生成 및 그 酸素의 特性

洪淳德,河相哲 慶北大學校 1984 論文集 Vol.37 No.-

Optimum culture condition of Bacillus licheniformis for the production of alkaline phosphatase and some properties of the partially purified enzyme were investigated. The production of alkaline phosphatase was at best when the culture medium contained 0.2% fructose, 1.5% neopeptone, 0.2% (NH_4)_2SO_4, 0.2mM K_3PO_4, and 10mM MgCl_2 at a initial pH of 9.0. The enzyme was purivied by ammonium sullfate fractionation and DEAE-cellulose chromatography. The specific activity at the partially purified enzyme was 250 times higher than that of the crude extract and the yield was 10%. The enzyme showed a optium pH of 9.0 and was stable in the range of 8.0-9.5. It had a optimum temperature of 60℃ and was also thermostable retaining 85% of it's activity when exposed to 60℃ for 30 min. The enzyme activity was promoted in the presence of Mg^++ and Co^++ but inhibited in the presence of Hg^++. Km value of the enzyme was determined to 0.1 mM with p-nitrophenylphosphate at pH 9.0

大學柔道選手들의 Body Density 推定回歸式 作成

남덕현,장은경,박순호 龍仁大學校 體育科學硏究所 1995 體育科學硏究論叢 Vol.5 No.1

The purpose of this study was to measure accurately the body fat of 37 male university Judo players based on the underwater weighing method, to calculate the body density and the body fat using Futrex, Impedance, Caliper, Skyndex and Ultra-sound and to present the prediction formula of residual volume and calculate the body density by regression equations based on the data from anthropometric measurements. 1. The body % fat of Judo players from the underwater weighing method was 72± 2.44%. 2. The residual volume was 1.3350±0.2476(1) by the oxygen rebreathing method and 1.0977±0.1238(1) by the indirect method of vital capacity. The regression equation using the vital capacity was : Residual volume(1)=0.2165+0.000245×vital capacity. 3. The regression equations of the body density calculated from the measurement of skinfold thickness were as follows: The body density by Caliper(g/ml)=1.0941-0.00088×subscapular-0.001026×triceps. The body density by Skyndex(g/ml)=1.0932-0.001137×subscapular-0.00070×triceps. The body density by Ultra-sound(g/ml)=1.1095-0.00306×triceps-0.0015×femoral. 4. The regression equations of the body density caculated from anthropometric measurements were as follow: 1) The regression equation of the body fat on skinfold thickness The body density(g/ml)+1.1007+0.000507×grith of hip-0.00145×grith of thigh+0.00122×grith of lower thigh. 2) The regression equation of the body density based on skinfold thickness by Caliper, grith of the body, height, weight and age. 3) The regression equation of the body density based on skinfold thickness by skyndex, grith of the body, height, weight and age. The body density(g/ml)=1.0808-0.0010The regression equation of the body density based on skinfold thickness by subscapular-0.0011The regression equation of the body density based on skinfold thickness by triceps+0.0002×height-0.0016×age. 4) The regression equation of the body density based on skinfold thickness by Ultra-sound, grith of the body, height, weigth, and age. The body density(g/ml)=1.1228-0.0030×triceps-0.0017×femora+0.0004×minimum grith of lower thigh-0.0010×age.

Hard type ABS 分解菌의 分離 同定 및 生理化學的 硏究

洪淳德,河炫八 慶北大學校 1983 論文集 Vol.35 No.-

A microorganism to enhance the biodegradability of hard type ABS of commercial synthetic detergents was isolated from the sewage sludge of Apt. areas and identified as Klebsiella pneumoniae. In the basic mediums to grade the ABS concentration, growth of the selected strain was inhibited above ABS 2,000ppm and degradability of hard type ABS was higher as the start concentration was lower. When the start concentration of ABS was especially 40ppm, degradable rate leaded to about 70% within 15 hr culture. PH range for the culture of the selected strain was between 5 and 10. Hg^++ ion of 11 metal ions was the most sensitive to the growth of the selected strain in the basic medium with ABS 400ppm; the minimum concentration of Hg^++ at complete growth inhibition was 10^-2mM. Degradability of Na-DBS by the strain in shaking culture was higher than that in static culture until 3 day culture. The degradable rate of Na-DBS by the selected strain was generally higher that of Na-SSE, and after 7 day culture the former was 81%, the latter 69%, respectively. The selected strain cultured in the basic medium with Na-DBS 5,000ppm did not show its nucleus and black spots regarded as condensation of nucleus near the cell wall were formed. And also the forms of cell wall and cell division were not abnormal.

Sisomicin고생산 균주의 예비선별과 이들의 생리적 특성

洪淳德,金鐘國,李相瀚,河相哲 慶北大學校 1991 論文集 Vol.51 No.-

In order to isolate selectively sisomicin over-producers during mutagenesis, several conditions required for fragmentation, mutagen treatment, and selection of mutants were examined. As a result, up to 30% yield-up of the antibiotic production of a candidate was achieved. For the step of scale-up, effect of antifoaming agent in small scale with flasks was studied. Palm oil was very effective within the range of without inhibiting of growth. Water addition during the fermentation enhanced 10% of sisomicin productivity than that of control.