병리검사 처방오류 개선 시스템 구축

이현임,최영진,구숙희,양승주,김병로,김묘정,신일근,신미옥,서임선 한국의료QA학회 2006 한국의료질향상학회지 Vol.13 No.2

문제: 조직병리검사의 처방이 복잡하고 전문화됨에 따라 오류처방이 빈번하게 발생되고 이를 해결하기위한 프로세스가 복잡하여 부서간의 갈등과 업무의 가중, 또한 병원 수입 감소가 초래되었다. 목적: 발생된 오류처방의 유형과 발생율, 오류처방을 해결하기 위한 프로세스를 파악하여 이에 대한 문제점을 개선하여 업무의 효율성과 관련부서간의 부가업무 감소와 갈등해소, 더불어 병원수익을 향상시키는 것에 목표를 두고 활동하였다. 의료기관: 서울시에 소재한 종합병원 질 향상 활동: 조직병리검사 처방의 오류처방 발생 원인과 유형, 발생율을 조사하여 원인을 파악하고 개선을 위한 프로세스를 구축하여 질 향상을 도모하였다. 개선효과: 수술실에서 의뢰한 외과 입원환자의 일반조직병리검사 오류율은 개선 전 7.8%에서 개선 후 3.5%, 동결절편조직검사 오류율은 개선 전 28.6%에서 개선 후 0%로 이전보다 모두 개선되었다. 또한 수술실 간호사의 업무 만족도는 일반조직병리검사의 처방시 95%, 동결절편조직검사 처방시 90%로 높은 만족도를 보였다. 단 병리과의 경우 업무가 증가됨에 따라 초과근무시간이 증가하였다.

大邱 앞山 附近에 環狀岩脈으로 産出되는 石英몬조니岩質 岩類에 對한 岩石學的인 硏究

黃尙九,金鉉埈,尹相敦,李淑姬 慶北大學校 自然科學大學 地質學科 地質學硏究會 1977 伏賢地質 Vol.- No.3

The thesis deals with petrogenesis relating to environmental changes through emplacement of quartz monzonitic dikes distributed in the Apsan area in vicinity of Daegu, Korea. These dike rocks belongto monzonite series in the mineralogical composition. and their textures are characterized by a wide range of change from porphyritic at the border to more equigranular at the center portion of the dikes. The quartz monzonitic rocks are occurred as ring dikes around quartz monzonite stock exposed in southern portion of the study area. Throgh the consideration of the textural characteristics and crystallization process of the dike rocks, it is supposed that coarse grained plagioclase phenocrysts (about 8㎜ in diameter) might be already grown as almost present size during stoping at deeper level before the stage of uprising as ring dikes, and intermediate (about 3㎜) and fine (about 1㎜) grained phenocrysts might be nucleated and polymerized during development of conical joint and uprising of magma through the joints. In the viewpoint of plagioclase composition, An-content of the plagioclase phenocrysts decreases from border to center portion on several traverses that cross the dikes in different area, which reflects that marginal phase might be emplaced earlier than the inner phase and that degree of reaction between residual magma and plagioclase increases toward center owing to increasing diffusion rate. The continuous uprising of magma might be also revealed by the fact that tendency of accumulation of phenocrysts in central portion by flow differentiation according to crystal dispersive power in the dikes is not visible in the area. Thus, textural characteristics and composition of plagioclase of the dike rocks in the area, could be contributed as some indicators clarifying the process and mechanism of emplacement and environment of solidification of magma, especially the fact according to the important geological event which represents beginning of jointing and formation of dikes.

근로자 건강증진전략을 위한 행동변화에 대한 요구도 평가

이강숙,임현우,구정완,홍현숙,이정민,이원철,박정일,맹광호,M, O'Donnel 大韓産業醫學會 1999 대한직업환경의학회지 Vol.11 No.4

Objectives : In order to evaluate the stage of behavior change for health promotion strategy in workplace Methods : Questionnaire survey was carried out for 309 workers who employed in H Electronics company in Kyong-in area from September to October 1998. Results : According to need assessment of four step such as precontemplation stage, contemplation stage, action stage, maintenance stage which were to change of behavior for health promotion, the percent for quitting smoking were observed 48.8%, 43.1%, 8.1%, 0%, and for the restriction of drinking were 29.8%, 10.6%, 9.3%, 5.3%; for fitness 11.1%, 31.0%, 37.3%, 20.6% in male 26.6%, 27.8%, 26.6%, 19.0% in female, for regular diet 26.1%, 19.8%, 38.7%, 15.3% in male, 27.8%, 22.2%, 40.0%, 10.0% in female and for stress management 5.8%, 10.6%, 8.7%, 75.0% in male, 13.6%, 22.7%, 19.7%, 44.0% in female. In heavy smoker(p=0.017) and heavy drinker,(p=0.021) the percent of precontemplation stage was significantly higher than in lower drinker and light smoker. Conclusions : This study suggested that company support for health promotion in workplace was and workers of high risk group for smoking and drinking were in precontemplation stage. So before conducting the health promotion program, health risk appraisal and need assessment for stage of behavior change should be taken for the efficient health promotion strategy.

스트레스관리 프로그램이 만성정신분열병환자의 증상과 삶의 질에 미치는 효과

박현경,구정완,노영만,이강숙,박정일 가톨릭대학산업의학센타 산업의학연구소 2003 韓國의 産業醫學 Vol.42 No.1

This study examined the effects of stress-management programs on the symptoms and quality of life in the chronic schizophrenics. The subjects were the chronic schizophrenics who were registered and managed by one of the public health care centers in Seoul. The stress-management programs were provided 10 times. Positive and negative syndrome scale (PANSS) and quality of life were surveyed before and after the stress-management programs. The results were as follows. 1. The differences of positive symptoms, negative symptoms and general psychopathological symptoms before and after stress-management program were significantly different between the group which were provided with stress-management programs and the group which were not provided. 2. The differences of the quality of life before and after stress-management program were significantly different between the group which were provided with stress-management programs and the group which were not provided. These results indicate that stress-management programs have effects on relieving the symptoms and improving the quality of life of schizophrenics. Ultimately these results also suggest that stress-management programs be used as the supplementary means to treat schizophrenics.

서울시 대기오염과 호흡기 질환 환자와의 관련성에 대한 시계열적 연구

최병철,구정완,박성균,임현우,이강숙,이원철,박정일 大韓産業醫學會 2000 대한직업환경의학회지 Vol.12 No.1

목적 : 서울시의 대기오염 수준이 호흡기 질환 외래 환자수에 미치는 단기 영향을 파악하고자 하였다. 방법 : 1997년 7월부터 1998년 6월까지 서울시의 대기오염자료와 호흡기 질환에 대한 의료보험자료를 분석하였다. 추세변동과 기상요인, 요일 및 주별 효과등의 교란요인을 제어하고 관련성을 평가하기 위하여 generalized additive model(GAM)을 이용하였다. 결과 : 교란요인을 제어한 기본모델에 각 대기오염 물질을 포함시켜 분석한 결과, CO는 모든 연령층에서 일정하게 당일 농도가 가장 유의한 영향을 미치는 것으로 나타났고(RR=1.041∼1.051), NO₂역시 3일전의 농도가 모든 연령층에서 가장 유의한 영향을 미쳤다(RR=1.024∼1.050). O₃와 SO₂는 4일전 농도부터 당일 농도까지 지연시간이 길게 나타나는 특징을 보였으며, 15세 이하에서는 3일전 농도가(O₃RR=1.047, 95 % Cl=1.045∼1.049, SO₂RR=1.018, 95 % Cl=1.017∼1.020), 15-64fll (O₃RR=1.035, 95 % Cl=1.032∼1.037, SO₂RR=1.037, 95 % Cl=1.035∼1.039)와 65세 이상 (O₃RR=1.042, 95 % Cl=1.033∼1.051, SO₂RR=1,029, 95 % Cl=1.022∼1.036)에서는 당일 농도가 가장 유의한 결과를 나타냈다. PM□은 유의성이 낮게 나타났는데 15세 이하는 하루 전 농도(RR=1.011, 95 % 71=1.010∼1.013), 15∼64771(RR=1.021, 95 % Cl=1.019∼1.023)와 65세 이상(RR=1.025, 95 % Cl=1.018∼1.032)은 당일 농도가 유의하게 나타났다. 두 포염물질씩을 기본모델에 포함시켜 분석한 결과 CO, NO₂, O₃는 상대위험비가 '단일 오염물질모델'의 값과 거의 일정하게 통계적 유의성을 유지하였으나 SO₂는 15세 이하에서 NO₂와 같이 포함된 모델에서 통계적 유의성을 상실하였다. PM□은 모든 연령층에서 CO와 같이 포함된 모델에서 통계적 유의성을 상실하여 '단일 오염물질모델'에서 나타난 유의성이 CO에 의한 교란작용의 결과임을 알 수 있었다. 또한 15세 이하에서 NO₂, 15∼64세와 65세 이상에서 502와 같이 포함된 모델에서 역시 유의성을 상실하여 본 연구에서 살펴본 호흡기 질환에 미치는 PM□의 영향은 크지 않은 것으로 나타났다. 결론 : 본 연구의 결과는 서울시의 일상적인 대기오염이 여러 호흡기질환의 발생을 증가시킬 수 있음을 보여주었다. 따라서 대기오염의 효율적 규제에 대해 보다 적극적인 대책이 마련되어야 할 것이다. Objectives : This study was conducted to investigate whether air pollution levels in Seoul have short term effects on respiratory disease outpatients. Methods : We analyzed five air pollutants (CO, NO₂, O₃, SO₂, PM□) and daily counts of outpatient for respiratory disease divided by age group ((15yrs, 15-64yrs, 654yrs)during the period of July 1997-June 1998 using Generalized Additive Model (GAM) . Results : After controlling for seasonal trends, day of the week, week of the month, temperature and humidity, CO (RR=1.041 ∼1.051, 0-day lag) and NO₂(RR=1.024∼1.050, 3-day lag) were significantly associated with daily counts for respiratory disease in all age groups. O₃and SO₂were associated, with a 3-day lag in the age group under 15 years (O₃RR=1.047, 95% Cl=1.045-1.049; SO₂RR=1.018, 95% Cl=1.017-1.020) and with a 0-day lag in the age group 15 to 64 years (03 RR=1.035, 95% Cl=1.032-1.037; 502 RR=1.037, 95% Cl=1.035-1.039), in the age group over 65 years (O₃RR=1.042, 95% Cl=1.033-1.051; SO₂RR=1.029, 95% Cl=1.022-1.036). PMlo was weakly associated, with a 1∼day lag In the age group under 15 years (RR=1.011, 95% Cl=1.010-1.013) and with a 0-day lag in the age group 15 to 64 years (RR=1.021, 95% Cl=1.019-1.023), in the age group over 65 years(RR=1.025, 95% Cl=1.018-1.032) . In the' two pollutant model', the magnitudes of the recta alive risk for CO, NO₂nd O₃were maintained, but SO₂was not assoclated with daily counts for respiratory disease in the age group under 15 years after controlling for NO₂-PM□ was not associated in all age groups after controlling for CO, so the association with PM□ in the' single pollutant model' might be confounded by CO. In this study, the impact of PM□ on the respiratory disease was not large as compared with other pollutants. Conclusions : Air pollution in Seoul may Increase the Incidence of the respiratory disease, so more positive attention for the control of air pollution should be paid.

보건관리 대행사업 평가도구의 타당성, 신뢰도 및 인과관계 검증에 관한 연구

박정일,조병희,구정완,김광종,김현욱,원종욱,이명숙,정문희 가톨릭대학교 산업의학센터 2001 韓國의 産業醫學 Vol.40 No.1

In order to verify the validity, reliability and relativeness of preliminary evaluation tool for the group occupational health services(GOHS), a questionnaire survey for doctors, nurses and hygienists of 18 GOSH institutions, and employers, health managers and employees of 340 enterprises was conducted. A factor analysis and correlation test for the statistical validity of the variables in the evaluation tool, a Chronbach's Alpha value for the reliability in the evaluation indices and a regression analysis for the relations of the evaluation model were performed. The results were as follows: 1.In factor analysis, thirty-three variables among 43 variables were selected as significant variables, ie 9 out of 11 for input index, 11 out of 14 for throughout index and 13 out of 18 for out put index. 2.Three evaluation(outcome) scales(evaluation by employer, health manager and employee) which composed of 16 identical items were used. 3.The Chronbach's Alpha values of input, throughout, out put and outcome indices were 0.5221, 0.5473, 0.7122 and 0.8546 respectively. 4.Regression equations of independent variables on the evaluation scales of employer, health manager and employee were all statistically significant.

혈관성 파킨슨증의 경사에코 자기공명촬영 소견 : 환자-대조군 연구 A Case-Control Study

배희준,김병건,구자성,김현숙 대한치매학회 2002 Dementia and Neurocognitive Disorders Vol.1 No.2

Background & objective : Changes of signal intensity in the various Structures of basal ganglia(BG), Which can be detected by gradient echo MRI(GE-MRI). have been reported in different kinds of parkinsonism Altered iron content in these structures may be a possible explanation of above phenomenon Vascular parkinsonism is a kind of parkinsonism syndrome and is common However. There have been no reports about the BG signal changes on GE-MRI in vascular parkinsonism Methods : We investigated the difference of signal intensity in various BG and midbrain structures between 36 patients with vascular parkinsonism. which was defined as clinical parkinsonism+evidence of relevant vascular lesion on MRI+poor or no response to levodopa, and age-& sex- matched controls. The intensity of BG on GE-MRI was graded as 0-3 relative to cortical gray matter Results : There were no significant differences in clinical characteristics between two groups Among patients with vascular parkinsonism, hypointensity was observed in globus pallidus in 94.4%. in putamen in 58.3% in head of caudate in 33.3%, in substantia nigra in 72.2%,& in red nucleus in 52.8% There was no significant linear trend in the association between signal intensity of above structures and the presence of vascular parkinsonism (p>0 05 on Mantel-Haenszel chi-square test) However, the correlation between the degree of white matter lesions and the presence of vascular parkinsonism was statistically significant (p=003). Conclusions : Our GE-MRI study fails to prove that iron content of various BG structures in patients with vascular parkinsonism is different from controls.

동백종실 및 유박의 식품으로서의 이용성 검토

김영환,정현숙,김용두,최옥자,강성구 順天大學校 師範大學 附屬 科學敎育硏究所 1997 科學과 敎育 Vol.5 No.-

동백종실의 이용성을 검토하기 위해서 NaCl(1.5%), ethanol(99.9%), blanching의 방법으로 쓴맛을 제거하여 관능검사를 한 결과는 다음과 같다. 1. 동백종실의 쓴 맛을 제거하는데는 NaCl용액보다는 알콜이 더 효과적이었으며, blanching, NaCl용액 및 알코올을 병행처리 하였을때 쓴맛이 잘 제거되었다. 그러나 동백종실은 알맹이로 되어 있어 쓴맛의 제거에 많은 시간이 소요되고, 완전하게 쓴맛이 제거되지 않으므로 종실자체를 식품으로 이용하는 것은 문제점이 있다고 생각된다. 2. 동백유박의 쓴맛제거는 증류수와 NaCl용액에서도 쓴맛이 거의 제거되었으며, 알콜의 경우는 30% 농도일 때 가장 효과가 좋은 것으로 나타났다. 동백유박은 동백종실에 비하여 쓴맛의 제거가 훨씬 더 용이하였으며, 식품재료로서의 이용가능성에 대한 기호도가 높은 것으로 나타나 이를 이용한 식품의 개발은 가능하다고 생각된다. This study was carried out to investigate the utilization of Camellia seed and defatted Camellia seed flour as food. We removed bitter taste of Camellia seed and defatted Camellia seed flour by using NaCl solution, ethanol, and blanching method. The following are the results of a sensory evaluation. 1. It was bitter taste rather than color or flavor which has made a great effect on the possibility of utilization for food materials. Alcohol was more effective than NaCl solution in removing bitter taste of Camellia seed, while bitter taste was easily removed when the processing with blanching, NaCl solution, and alcohol was employed. Since Camellia seed was consisted of grain, however, much time was needed to remove bitter taste. Because bitter taste wasn't perfectly removed, it has a problem in using Camellia seed for food materials. 2. Bitter taste of the defatted Camellia seed flour was almost removed in the distilled water, NaCl solution, and alcohol with a variety of concentrations. When various concentrations of alcohol were used, 30% concentration worked best, Bitter taste of defatted Camellia seed flour was removed more easily than that of Camellia seed. In conclusion, it is thought to be possible to develop into food, because of a high possibility of utilization as food materials

골수이식 후 골밀도 및 골대사의 변화 : 2년 추적관찰 2-Year Prospective Study

이원영,강무일,오은숙,오기원,한제호,손현식,윤건호,차봉연,이광우,손호영,강성구,신완식,민우성,김춘추 대한내분비학회 2000 Endocrinology and metabolism Vol.15 No.4·5

동종골수이식 후 혈당 및 혈중 지질농도의 변화양상 및 관련인자

이원영,강무일,오은숙,오기원,손현식,윤건호,차봉연,이광우,손호영,강성구,신완식,민우성,김춘주 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.24 No.6

연구배경:골수이식은 비교적 젊은 연령의 환자들을 대상으로 하며 면역억제제의 사용기간이 비교적 짧으므로, 주로 고령의 만성 질환 환자에서 시행되는 고형장기이식에서와는 달리 당대사 및 지단백 대사에 있어서 많은 차이점이 있을 것으로 추측된다. 저자들은 전향적 연구를 통하여 골수이식 후 시기별로 혈당 및 혈중지단백 변화 양상을 알아보고 이와 관련된 임상인자들을 규명하고자 하였다. 방법:1998년 10월부터 1999년 8월까지 가톨릭대학교 성모병원에서 동종골수이식을 시행한 환자들 중 43명을 대상으로 이식 전 및 이식 후 1, 2, 3, 4주와 3개월, 6개월에 공복 혈당, 혈중 총 콜레스테롤, 중성지방, 고밀도지단백을 측정하여 골수이식 후 시기별 변화를 관찰하고 여러 임상인자들에 따른 차이를 알아보았다. 결과:1. 공복혈당은 골수이식 수 첫4주 동안 상승하였고 이후 감소하였으나 이식 6개월 시점의 평균 공복혈당은 이식 전보다 유의하게 높게 관찰되었다. 혈중 총 콜레스테롤은 이식 후 1주에 최고치를 형성하였고 이후 기저수준으로 회복되었다가 이식 수 3,6개월에 다시 증가하여 기저치에 비해 유의하게 높았다. 혈중 중성지방은 이식 후 1개월까지 유의하게 증가하였고 이후 감소하여, 3,6개월에는 기저치와 유의한 차이가 관찰되지 않았다. 혈중 고밀도지단백은 이식 후 2,3주에 이식 전보다 유의하게 감소하였고 이후 이식 전 수준으로 회복되었다. 혈중 저밀도지단백은 총 콜레스테롤의 변화와 매우 유사하였다. 2. 골수이식 후 6개월 시점에서 공복 혈당이 126㎎/dL이상인 환자는 7명(16%)이었다. 이들 환자들과 공복혈당 126㎎/dL 미만의 환자 36명을 비교한 결과, 공복혈당이 126㎎/dL 이상인 환자군에서 스테로이드 평균 투여량이 많았고 고밀도지단백이 유의하게 낮았다. 3. 이식편대숙주질환이 발생한 환자는 그렇지 않은 환자보다 이식 후 1, 2, 3주 및 6개월의 총 콜레스테롤이 더 낮았고, 3개월의 공복혈당이 더 높았다. 혈연골수이식 환자군은 비혈연골수이식 환자에 비해 투여된 스테로이드 용량이 더 적음에도 불구하고 이식 후 1, 2, 3주 및 6개월의 총 콜레스테롤 수치가 더 높았다. 스테로이드 고용량 투여군(하루 평균 7.5㎎기준)은 저용량군보다 이식 후 3개월 시점의 공복혈당이 더 높았으나 나머지 시점의 혈당, 혈중 지질농도에 있어서는 유의한 차이가 관찰되지 않았다. 결론:골수이식 후 초기시기에 주로 당 대사 및 지질대사이상이 관찰되며 이는 면역억제제 투여와 관련이 있음을 알 수 있었다. 면역억제제가 고용량 투여되는 합병증 발생 시 이들 대사이상에 관심을 기울여 대처해야 할 것이다. Background: In bone marrow transplantation(BMT), recipients are usually younger and immunosuppressants are open used in shorter period than in solid organ transplantation. Therefore, there might be a difference in glucose and lipid metabolism between BMT and solid organ transplantation. However, the serial changes of metabolic parameters following BMT have not been studied. Therefore, the aim of this study is to investigate the serial changes of blood glucose, lipids and the putative factors that are related with these changes after BMT. Methods: We have prospectively investigated 43 patients who underwent allogeneic BMT. Fasting plasma glucose(FPG), total cholesterol, triglyceride and high-density lipoprotein(HDL) were measured before BMT, and at 1, 2, 3, 4, 12 weeks and 6 months after BMT. The serial changes of these metabolic parameters according to clinical factors including type of BMT, mean daily steroid dosage, and occurrence of graft versus host disease (GVHD) were examined. Results: 1. Mean FPG level increased during 4 weeks after BMT and remained above basal value at post-transplant 6 months. Total Cholesterol level was increased during initial 4 weeks after BMT and was above basal value at post-BMT of 3 and 6 months. Triglyceride level was progressively increased during initial 4 weeks after BMT, but returned to basal value there after. HDL-cholesterol level was significantly decreased during initial 4 weeks after BMT, but returned to basal value there after. 2. Patients with FPG above 126 mg/dL and the other patients, the former received larger amounts of daily steroid and had lower HDL-cholesterol level. 3. The changes of metabolic parameters were different according to type of BMT, steroid dose, and occurrence of GVHD. Conclusion: Although there was increase of FPG, TC, TG and decrease of HDL-C during initial 4 weeks after BMT, these metabolic changes recovered slowly thereafter. Immunosuppressants are thought to be associated with these changes. Further observation will be needed for the long-term effect of BMT on metabolic changes(J Kor Diabetes Asso 24:689~698, 2000).