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.

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

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.

독일통일 이후 동독여성의 생활변화에 관한 사례연구 : Case Study

김해순 이화여자대학교 한국여성연구원 1998 여성학논집 Vol.14-15 No.-

<Abstract> This case study deals with the change in living circumstances of women in the former East Germany based on nine biographical interviews since the reunification. For comparison, a man was also interviewed to show the effects of the working structure in a workplace with predominantly West Germans. The interviews were carried out with the goal of better understanding the experiences and opinions of women from the former East Germany and gaining insight into the radical social changes. Contradictions between the expectations or hopes for a better future and the present reality were expected. For this case study, qualitative methods were applied in the interviews and their analysis. This should be complemented by quantitative-based methods having the goal of establishing average values for the indicators of social change. All of the interviewed women indicated fundamental changes in their living circumstances and that these changes were continuing. All of them emphasized that contact between people before the reunification was much closer than today. This is seen as a question of the available time then, and also the need for exchange with other like-minded people. The solidary community also formed a kind of bastion against the control and arbitrariness from above. Almost all people had work and material security even though the choice of work and the possibilities for a free lifestyle were limited. In the new society, the close connection of social relationships has dissolved and all of the interviewees are more concerned with themselves. With the change in values, opinions have differed. Two-thirds of the women have changed their jobs since the reunification, and all felt an increasing intensity of work and competitive pressure. Many of the interviewed women work in a place where West Germans are dominant in terms of hierarchy, number of employees, mode of working, etc. The women who could use their own previous knowledge were able to build on these strengths. At the time of the former East Germany, the state provided and directed vocational education. Many people, especially the young who are unemployed and untrained, are rightly having problems coping with the self-responsibility expected today. Both the positive and negative experiences from the German reunification can be valuable for the unification of Korea. Choices and dangers become clear by this, therefore each person is challenged to prepare themselves both mentally and culturally.

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.

Cu-Ca-Sio₂촉매의 제조 및 특성

金海源,李淳錫 慶一大學校 1997 論文集 Vol.14 No.2

By using the precipitation method, a Cu-Ca catalyst in an alkali treated silica support was prepared. This catalyst showed the catalytic activity in the dehydrogenation reaction of cyclohexanol to convert cyclohexanone. The maximum conversion and the maximum selectivity of the Cu-Ca catalyst were found when Cu content was 60%. The maximum conversion and the maximum selectivity recorded were better than any other previously known Cu family catalysts. X-ray diffraction as well as XPS results showed that the oxidation states of Cu and Ca were Cu(Ⅱ) and Ca(Ⅱ), respectively and the chemical composition of the catalyst was CuO-CaO-SiO

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.