자료포락분석(DEA)를 이용한 보건의료의 효율성 측정

김남송,박홍섭,김은진,김설화,김정숙,김현아,김경숙,신지혜,최은정,양은진,유선미,유수진 圓光大學校 醫科學硏究所 2007 圓光醫科學 Vol.22 No.1

Immobilization with Ketamine HCI and Tiletamine-Zolazepam in Cynomolgus Monkeys

Myung-cheol Kim,Sung-hyeok Hong,Soo-jin Lee,Young-suk Kim,Jae-il Lee 대한수의학회 2003 Journal of Veterinary Science Vol.4 No.2

with Ketamine HCl and Tiletamine-Zolazepam in Cynomolgus MonkeysJae-il Lee, Sung-hyeok Hong, Soo-jin Lee, Young-suk Kim and Myung-cheol Kim*Laboratory of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, Daejeon 305-764, KoreaReceived March 4, 2003 / Accepted July 2, 2003J. Vet. Sci. (2003), 4(2), 187-191JOURNAL OFVeterinaryScience*Corresponding author: Myung-cheol Kim Laboratory of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, Daejeon 305-764, Korea Tel: +82-42-821-6757, Fax: +82-42-822-4216 E-mail: mckim@cnu.ac.kr

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.

정신장애인 치료에 중요 역할 담당자의 정신질환에 대한 태도조사

김병후,정선욱,강연화,김윤,김창엽,홍진표,한오수,조맹제,김용익 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.5

Objectives : Attitudes of families of mentally ill, health personnels and community leaders to the mentally ill after the development and utilization of the community mental health program and reintegration of the chronically ill patients into society. This study was designed to compare the attitudes toward the mentally ill patient of the persons who have important role in treating the mentally ill and to find the variables influencing the attitudes. Methods : We measured attitudes toward mental illness in psychotic patients' families(N=139), community leaders(N=180) and health personnels(N=324) including mental health personnels before the implementation of community mental health services in Yonchon county and Seodaemun district area. The instrument used to measure attitudes was Opinion about Mental Illness(O. M. I.) scale. Results : 1) Health personnel showed lower Authoritarianism(Factor A) and higher Benevolence(Factor B) scores on the average than community leaders and psychotic patients families. 2) Current residence affect the attitudes in psychotic patients' families, not in community leaders and health personnels. Families in urban area showed lower Authoritarianism(Factor A) and Social Restrictiveness(Factor D) and higher Benevolence(Factor B) scores than in the rural areas. 3) Many patient variables were correlated to the attitudes of families. Duration of illness, number of recurrence, number of admission, age of patient and family burden were positively correlated mainly to Social Restrictiveness(Factor D). 4) Sex and religion of respondents showed no or weak relationship with the factor scores. Conclusions : Education for community leaders and families is required to achieve successful community mental health services. Community support program should be developed for chronic, recurrent and burdensome psychiatric patients in the first place.

주폐자충 폐렴으로 발현된 Felty 증후군 1예

김성호,남대근,문재현,김지홍,김보석,안진광,문태건,안병재,김성일 全南大醫大 2001 전남의대학술지 Vol.37 No.3

조혈모세포이식 환자에서 침습성 진균 감염에 대한 Micafungin의 예방 효과 및 안전성

김시현,이동건,최수미,권재철,박선희,최정현,유진홍,이성은,조병식,김유진,이석,김희제,민창기,조석구,김동욱,이종욱,민우성,박종원 대한감염학회 2010 감염과 화학요법 Vol.42 No.3

Background: Micafungin, a potent inhibitor of 1,3-β-D-glucan synthase, is a novel antifungal agent of the echinocandin class. In vitro study showed that micafungin was effective against Aspergillus species as well as Candida species, but clinical data on the prophylactic efficacy against invasive fungal infections (IFIs) other than candidiasis are still lacking. Materials and Methods: We identified 60 consecutive adult hematopoietic stem cell transplantation (HSCT) recipients who received at least 3 doses of micafungin during neutropenic period. Micafungin was started as an alternative in patients who were intolerant or had adverse events (AEs) to primary prophylactic antifungal agents. We retrospectively reviewed the medical records and analyzed the efficacy and safety of micafungin for prophylaxis against IFIs. Results: The patients either had autologous (n=9) or allogeneic (n=51: 1 syngeneic, 24 sibling, 26 unrelated donor) HSCT. Itraconazole oral solution (n=58) was the most frequently used first line antifungal agent for prophylaxis and was administered for median 11 days. The most frequent cause of switch to micafungin was vomiting (n=42). The duration of neutropenia and micafungin administration was median 13 and 12 days, respectively. A successful outcome was achieved in 45 (75%) patients. Empirical antifungal therapy was initiated in 13 (22%) patients. There were 2 cases (3.3%) of breakthrough fungal infections which comprised a probable invasive pulmonary aspergillosis and a possible invasive fungal sinusitis. There was no case of invasive candidiasis. A total of 53 (88%) patients experienced at least one AE regardless of causality during micafungin administration. The most frequent AEs were hypokalemia, vomiting, diarrhea, and elevated serum aspartate aminotransferase or alanine aminotransferase. Among the aforementioned AEs, only 1 case of diarrhea could be classified as a probable relation with micafungin when causality was assessed. There was no AEs that caused discontinuation of micafungin. Conclusions: Micafungin seems to be a safe and effective agent for prophylaxis of IFIs including aspergillosis as well as candidiasis in HSCT recipients. However, further large, prospective, and randomized comparative studies are warranted for aspergillosis.

중증 만성정신질환자 수의 추산 : Through Two Community Surveys 두 지역사회 조사를 중심으로

홍진표,김윤,배재남,정유진,강영호,양병국,김용익,김병후,이철,조맹제 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.2

국내 중증 만성정신질환자 수를 추정하기 위하여 일 농촌 및 대도시 지역의 지역의료보험 및 의료보호 대상자 중 1993년 1년간 의료기관에서 정신증 상병(ICD-9 code 상 290-299) 및 알콜 남용/중독, 성격장애 및 정신박약 진단하에 치료를 받은 적이 있는 사람에 대해 설문조사를 실시하였다. 연구자들이 개발한 진단도구를 이용하여 진단을 평가하고, Strauss-Carpenter scale 등을 이용하여 기능 장애를 평가하고 유병기간 등을 조사하였다. 결과를 요약하면 다음과 같다. 1) 진단평가상 정신분열병군(61.1%)이 가장 많았으며, 정동장애군(23.7%), 알콜장애군(11.2%), 기질성 정신장애군(4.0%)의 순서이었다. 2) 직업활동정도는 진단군별로 차이가 많았다. 지난 1년간 직업활동이 6개월 미만이거나 전혀 없는 환자 비율이 정신분열병군은 67.2%, 알콜장애군 52.0%, 정동장애20.8%의 순으로 정신분열병군이 가장 불량하였다. 3) 사회활동도 진단군별로 차이가 많아서 지난 1년간 의도적, 사회활동이 없는 비율이 정신분열병군이 가장 높았고(72.3%), 알콜장애군(32.0%), 정동장애군(20.7%)의 순이었다. 4) 국내 의료보험 및 사회복지시설 이용 자료 등을 토대로 본 조사 결과를 적용한 결과 국내중증 만성 정신질환자의 수는 약 8만 7천명으로 추산되었다. Objectives: The purpose of this study was to estimate the number of serious and persistent mentally ill patients in Korea. Methods : Study populations were recruited from medical insurance data of two district areas ; one rural and the other urban areas. Subject were all mentally ill who had ever visited any hospital in 1993 and were diagnosed as having psychosis, personality disorder and drug abuse. We conducted a home visiting survey applying semi-structured diagnostic interview, assessing the level of social adjustment with Strauss-Carpenter Scale, and past psychiatric history by the trained researchers, in October and November,1994. Results : According to diagnostic assessment schizophrenic patients constituted the major portion(61.1%) of study subjects. The distribution of occupational functions and social contacts was variable according to diagnosis. Most schizophrenic patients were unemployed or worked less than 6 months in the previous year(67.2%), and showed poor social contact(72.3%). But affective disorder patients were relatively independent in job maintenance and social relationship. Alcoholic patients lay between those of schizophrenic and affective disorder groups. It was estimated that about 87,000 adult Koreans were suffering from chronic mental disorders which seriously interfere with their daily life. Conclusions : Serious and persistent mentally ill patients were common in Korea. Community support program should be provided for them.

대퇴동맥을 통한 경피적 관동맥 중재시술 환자의 천자부위 지혈을 위한 Angioseal^(�) 사용과 고식적 용수 압박법의 비교 : 전향적 연구

김용훈,권현철,김필호,안석진,유철웅,최진호,이상철,김준수,김덕경,전은석,이상훈,홍경표,박정의,서정돈 대한내과학회 2004 대한내과학회지 Vol.66 No.5

목적 : 경피적 관동맥 중재술은 최근 양적 및 질적으로 급격한 발전을 보였지만 시술 시 천자부위의 혈관 합병증은 아직 해결해야 할 문제점이다. 저자들은 대퇴동맥을 통한 경피적 관동맥 중재술을 환자에게 천자부위 지혈을 위한 혈관폐쇄기구인 안지오실의 안전성과 유용성을 고식적인 용수 압박법과 비교 연구하고자 하였다. 방법 : 2002년 4월부터 2003년 5월 사이에 삼성서울병원 심장혈관센터에서 대퇴동맥을 통한 경피적 관동맥 중재술을 성공적으로 시행한 200명의 환자(안지오실 사용군: A군, 100명, 고식적 용수압박법 사용군 B군, 100명)를 대상으로 시술 후 주요 합병증 및 경한 합병증, 지혈 후 환자가 자리에 앉기까지의 시간, 보행개시 가능시간, 총 재원 기간과 시술 1주 후의 합병증을 전향적으로 조사하여 비교 연구하였다. 결론 : 두 군에서 연령, 성별, 기저질환, 심혈관 질환의 위험요소, 시술의 종류, 시술 중 사용한 헤파린의 양, clopidogrel의 양, ticlopidine의 양, 지혈 시 수축기와 확장기혈압, ACT (activated clotting time)는 차이가 없었다. A군이 B군에 비해 시술 후 자리에 앉기까지의 시간 (A군: 4.3±0.3시간, B군: 13.7±0.8시간, p=0.004) 및 보행개시까지의 시간(A군: 6.8±0.5시간, B군: 18.8±2.1시간, p=0.013)이 유의하게 짧았다. 시술 후 주요 합병증은 두군 모두에서 관찰되지 않았으며, 경한 합병증의 전체발생은 A군에서 유의하게 적었다(A군: 28명, B군: 19명, p=0.003). 반상출혈의 경우는 A군에서 유의하게 낮았지만(A군: 3명, B군: 12명, p=0.01), 혈종, 출혈의 발생은 두군간에 차이가 없었다. 총 재원기간에는 두 군간에 차이가 없었다(p=0.239). 시술 1주 후 경과관찰에서 주요합병증은 역시 두 군 모두에서 관찰되지 않았으며, 경한 합병증의 전체발생은 두 군에서 차이가 없었다(A군: 15명, B군: 13명 p=0.418), 반상출혈의 빈도는 차이가 없었지만 혈종의 발생은 A군에서 더 낮았다(A군: 2명, B군:6명, p=0.004). 두 군 모두에서 출혈은 발생하지 않았다. 결론 : 대퇴동맥을 통한 경피적 관동맥 중재술을 시행한 환자에서 안지오실의 사용은 고식적 용수 압박법에 비해 환자의 침상 안정시간을 줄여 조기 활동개시가 가능하게 하였으며 국소합병증의 위험도를 일부 낮추어, 시술에 따른 환자의 불편을 현저하게 감소시킬 수 있다고 할 수 있을 것으로 기대된다. Background : Although the number and the quality of percutaneous coronary intervention have been recently increased dramatically, the vascular complication at puncture site is still the major cause of patients' morbidity. We evaluated the safety and efficacy of newly of newly-developed collagen-based arterial closure device, Angioseal after transfemoral percuatenous coronary intervention. Methods : This study was designed as a prospective single center non-randomized comparative study. A total 200 patients undergoing transfemoral percutaneous coronary intervention were enrolled between April 2002 and May 2003. They were divided into two groups; Angioseal group (group A, n=100) and manual compression group (group B, n=100). The baseline clinical and angiographic characteristics were reviewed. The time to sit up, the time to ambulation, the duration of hospital stay, major and minor vascular puncture site complications were monitored. The patients were followed-up for 1 week after procedure by telephone. Results : The baseline clinical characteriwtics, clinical diagnosis, cardiocascular risk factors, typesof procedure, doses and numbers of anticoagulants were similar between two groups. The blood pressure and activated clotting time were also similar. The time to sit up (group A: 4.3±0.3 hours, group B: 13.7±0.8 hours, p=0.004) and the time to ambulation (group A: 6.8±0.5 hours, group B: 18.8±2.1 hours, p=0.013) were shorter in group A. No major vascular complications were noted. The incidence of hematoma and bleeding were not significantly different between two groups. The incidence of ecchymosis, however, was significantly lower in group A (group A:12%, group B: 3%, p=0.001) The duration of gospital stay was similar between groups. During 7 days of follow-up period incidence of hematoma was significantly lower in group A (p=0.004). Although the incidence of ecchymosis was not significantly different between two groups. Conclusion : The angioseal may be associated with earlier ambulation and less patients' morbidity with low incidence of local complication rate compared to manual compression after transfemoral percutaneous coronary intervention.

서울의 Penicillinase Producing Neisseria Gonorrhoeae 발생빈도(1994)

김재홍,안진균,정성재,김영태,김중환,김시영,이석종,이홍렬,서호석,김경훈,권혁진,정우권,고우석,이용석,안필수,오준규,오용섭 대한화학요법학회 1996 대한화학요법학회지 Vol.14 No.1

Background : In recent years gonorrhoea has been panendemic and remains one of the most common Sexually Transmitted Diseases in the world, especially in developing countries. Objective & Method : For the detection of a more effective therapeutic regimen and assessing the prevalence of Penicillinase Producing Neisseria Gonorrhoeae(PPNG), Ive have been trying to study the patients who have visited the VD Clinic of Choong-Ku Public Health Center in Seoul since 1980 by means of the chromogenic cephalosporin method. Results : In 1994, 168 strains of N. gonorrhoeae were isolated, among which 109 (64,9% ) were PPNG. Conclustion : Our results suggests that the prevalence of PPNG in Seoul is still increasing.

경막 내 colistimethate 투여로 치료한 다제 내성 cinetobacter baumannii 뇌실염

홍유아,유진홍,김진진,모은영,안건희,정희경,김진석,이현정,정미향,윤승배 대한감염학회 2009 감염과 화학요법 Vol.41 No.4

Acinetobacter species is a non-fermentative aerobic gram-negative coccobacillus that is an important pathogen found in nosocomial infections. Recently, multi-drug resistant Acinetobacter baumannii (MDR-AB) infections have been increasing and pose a serious problem. Most such infections present as bacteremia, pneumonia, or a wound infection; however, CNS infections are very rare. We herein present a case of ventriculitis caused by MDR-AB in a 37-year old man after a neurosurgical intervention. The patient was successfully treated with intrathecal colistimethate.