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.

초·중·고등학교 학생·학부모·일반교사의 보건교육 영역별 요구도와 보건교육

윤순녕,김영임,최정명,조희순,김영희,박영남,오경순,이분옥,조선녀,조소영,한선희,하영미 韓國學校保健學會 2005 韓國學校保健學會誌 Vol.18 No.1

Purpose: The purpose of this study was to identify the needs of health education in students, their parents and teachers in the elementary, middle and high schools and the current situation of health education class. Method: The subjects of this study were a total of 9450 persons including students, their parents and teachers from 279 schools throughout the country. They were selected through convenient sampling. Data were analyzed through x^(2)­test and ANOVA. Result: Students, their parents and teachers replied that 18 dimensions of health education class (DHEC) are necessary. The four DHEC - healthier life style, sex education, mental health and safety education - showed high educational needs in students, their parents, and teacher. High school students had higher educational need of 'symptom management for daily living' than elementary and middle school students. Students, their parents and teachers in elementary school had higher educational needs of 17 DHEC that those in middle and high school. The percentages of schools with health education class taught by health teachers were 99.2%, 75.5% and 66.0% respectively in elementary, middle and high schools. Health education was given mainly using physical education classes at elementary schools, and creative class hours at middle and high schools. In general, health education took 1-3 hours per week at elementary schools, and less than an hour at middle and high schools. Conclusion: Therefore, based on the results, systematic health education class should begin from elementary school to meet the need of health education in students, their parents and teachers, and further study should be made on the number of hours required and the amount of contents of 18 DHEC.

초·중·고등학교 학생, 학부모, 일반교사의 보건교육 요구

윤순녕,김영임,최정명,조희순,김영희,박영남,오경순,이분옥,조선녀,조소영,한선희,하영미 韓國學校保健學會 2004 韓國學校保健學會誌 Vol.17 No.2

Purpose : The purpose of this study was to identify needs of health education of the students, parents, general teachers, and health teacher of the elementary, middle, and high schools. Method : 279 schools of elementary, middle, and high school were sampled nonproportionally during the period from June 28 to July 26, 2004 . The data were collected by the questionnaire from 1,888 students, 1,876 parents, 1,695 general teachers, 279 health teachers. A frequency, % and χ2-test were used to analysis by SAS program. Result : 1. It showed that 98.1% of elementary school students, 92.3% of middle school students, 89.6% of high school students answered that they need health education. The most of students, parents, and general teachers had high interests in health education. 2. In the case of students, main causes of needs of health education was 'to prevent diseases or accidents''. But parents answered that it was 'to build up a healthier behavior'. General teachers answered that it was 'more effective systematic and continuous health education'. 3. Over 80% of students, parents, and general teachers about the question of who qualified person is to teach health education as a regular class responded that health teacher is available. Especially 93% of elementary school students answered like that. 4. The most of students, parents, and general teachers answered that health education in the classroom is favorable 1 to 2 hours per week. Conclusion : As results of the study , the majority of students, parents, general teachers agreed needs of health education. Therefore, on the basis of this study, systematic and continuous health education is necessary. Additionally the establishment of independent health subject is required certainly.

패류중 중금속함량에 관한 연구

신현수,허옥순,이진하,김세은,주인선,신동우,강석종,박만종,김지연,김근희,강숙경,정래석,허숙진,소유섭,최장덕,문병우,김진수 식품의약품안전청 2001 식품의약품안전청 연보 Vol.5 No.-

본 연구는 패류중 중금속함량 측정을 위한 분석효율이 높고 간편한 분해법을 찾아내어 그 방법에 의끓 유종중인 패류중 중금속함량을 파악하고자 수행하였다. 시료를 분해시키는 Microwave와 습식, 건식회법을 비교한 결과 변형습식회화르가 가장 적합하였다. 변형습식회차딘는 려린0,3+C104+H2SOf의 혼찰산을 쪼 · j 1 (v/v)의 비율로 혼합하여 사용하였 을 때 회수을 Pb린틴. Cd 97.8, Cu 94.2, Zn 92.8%를 나타내었근 분해시간은 2~2.5시간 소요되었다. 유통중인 패류중 중금속함량 」최소~최대(평균), mgAgl 은 Pb 0.028~o.528(0.153), Cd 0.OO7~1,832(0.587), Cu 0.360~37.375(4.6691, Zn 6.317~233.2iO(38.881), Hg 0.001 ~O.151(0.012)mg/ltg으로 나타났다. 또한 유통중인 5종의 패류중 중금속평균항량이 생산지 하재지역에서 구입한 패류에 비해 모든 중금속언써 약간 높은 함량을 보였으나 오염된 수준이 아닌 자연함유량수준이었다. This study was conducted to improve the digestion method for the determination of heavy metals in shellfishes and to estimate the contents of heavy metal in commercial shellfishes by their digestion method. This digestion method was compared microwave with wet and dry ash digestion for shellfish samples, obtained results showed that the modified wet ash Ⅱ digestion was convenient and easy to use. For the modified wet ash Ⅱ digestion, The mixed acid of HNO₃+HClO₄+H₂SO₄(25:5:1, v/v) was used. Under this condition, Recoveries were Pb 94.3, Cd 97.8, Cu 94.2 and Zn 92.8% and digestion time was ∼2.5 hours. The contents of heavy metal [minimum∼maximum (mean), mg/kg in commercial shellfishes were as follows ; Pb:0.028∼0.528(0.153), Cd:0.007∼1.832(0.587), Cu:0.360∼37.375(4.669), Zn:6.317∼233.250(38.881), Hg:0.001∼0.151(0.013). The contents of heavy metal in commercial shellfishes of five species were slightly greater than those of shellfishes purchased at Hajae. There was no great difference between the contents of heavy metal of Hajae and those of shellfishes purchased at Whole market.

국내에서 유행하는 HIV의 전파 경로에 따른 Subtype 분포

이주실,남정구,김성순,강춘,최병선,김옥진,박미선,성봉모,서순덕,전수경,변승옥,신영오,조해월 대한감염학회 2001 감염 Vol.33 No.5

Background : Previous data have been reported that subtype B is prevalent in South Korea, but neither the extent nor the proportion of subtypes could be evaluated. This study was designed to analyze the distribution of HIV-1 subtypes, temporal instructions and transmission dynamics between epidemiological groups. Methods : 1,280 Koreans had been diagnosed as HIV seropositive during the period 1985 to 2000. Among them, 134 individuals were selected for this molecular epidemiological study. 134 DNAs were isolated from uncultured or cultured peripheral blood mononuclear cells. V3-V5 (0.7 kb) fragment of HIV-1 env gene was amplified by nested polymerase chain reaction and was sequenced. Results : HIV-1 isolates from thirty-seven homosexuals were all subtype B (100%). On the other hand, 66 isolates from 94 heterosexuals were subtype B (70%) and 28 were non B subtypes (30% : 13 A, 4 C, 2 D, 8 E , 1 G). Only subtype B strains were isolated from 73 males who were infected with HIV inside Korea while 16 B and 20 non B subtype strains were isolated from 36 males who were HIV infected outside of Korea. However, B and non B strains were isolated half and half from females who were infected inside Korea except one. Conclusion : The HIV-1 subtype B strains are prevalent in Korea from the early HIV infection until present in both homo and heterosexuals. Non B strains have been transmitted from men who were infected outside Korea to their spouses and casual partners. So, we need further study to monitor subtype B and non B HIV transmission in epidemiological groups of Korea, (Korean J Infect Dis 33:311∼318, 2001)

수두백신의 역가시험법 표준화를 위한 연구

민경일,백선영,신진호,김재옥,류승렬,민복순,김병국,김도근,김훈,이석호,박순희 식품의약품안전청 2001 식품의약품안전청 연보 Vol.5 No.-

수두(chicltenpo즈) 및 대상포진(shingles)의 예방을 위해 사용되는 수두 생 바이러스 백근은 현재 국내 -외 제조사들이 정상사람 2배체 폐 태아 세포 주들을 이용하여 바이러스를 배양 · 증식시켜 생산하고 있으나, 품질관리를 쒸한 역가 시험에는 t·fRC튼 띤 LB딘EL 세포 주외에 제조사가 설정한 세포 주를 이용하고 있으며, 역파신험 방법인 fH Ui'rFO Plaque 3SSaIT에도 조사별로 다소 차이가 있는 시헌법을 사용하고 있다. 그러므로 일반적으로 세포 주간우 감수성 차이, 계대력(passa딩e level)간의 차이,varicelta-zoster virus(4'2V) diluent medium 등에 의한 차이에 의해 역가시힘 결과에 많은 차이를 나타낼 수 있다. 이에 본 연구에서는 역가 시험 결과꼭 편차를 촉소화 할 수 있는 시헌방법을 극힙하고자 Ok퍼 백신 주와 세로 주간 및 기타 요인에 따른 차이를 비교 분석하고 이를 표준확하여 일관겅있는 국가 및 제조사의 품질관리예 활용하고 나아가 수두 생 바이러스 백신 역가시헌 국가 표준품 거달에 활용하고자 하는데 목적이 운.다. 수두 생 바이러스 빅신의 역가 시험에 영향을 띠칠 수 꿀.는 모민으로 우선 바이러스 흡착에 사용되는 1#Z)·'diluent medium이 가장 큰 오인으로 확인되.고. 현개까기 최종적으로 if4 sucrose, 10% FBS, 0.1% sodiun) rrlonog)utamate in PBS(-), fIH 7.2가 가당 두수글 L'z).「 린luent medium 조성으로 확인되었단. 또한 '·:~l포 주별로 다소의 차이는 잇.으나 최대 바이러스 흡착시간은 90분으론:÷잰착인 되었다. 다른 negati)Fe effect를 보일 수 있는 요인으로 항생물질 및 항츤 제인 fuugiBone이 곡이러스의 역가에 영향을 미치는 것으로 확인되었다 따라서 이러한 항생물 띤 항균제를 standard solid agarose overla?·(5.tO) 시헌방법에는 사용하지 않는 것이 역가 시험의 편차를 줄일 수 있는 요인이라 판단된다. 최적의 조건하데서 Oka 수두 백신 주의 j 종의 세포 쭈에 대한 역가시험 수행 결과 각 세포 주의 감수성의 차이는 크지 않았으나, 반복시헌에 대한 표준편차는 다소 차이를 나타났다. Until now in Korea, the international and domestic vaccine maufacturers produce and sale live attenuated daricella vaccines, used to prevent chickenpox and shinglees, which are propagated in and done the potency test with various originated human diploid embryonic lung cells. Also manufacturers perform in vitro plaque assay with a little different methods to their quality control tests. Therefore, in general, there is slight or big difference among in vitro plaque assay results because of the difference in susceptibility of various originated human diploid embryonic lung cells and in assay methods. The purpose of this study is to confirm what factors occurring deviation to establish the standardized method which minimize deviation intracellularly and intercellularly. Eventually the standadized method will be used in consistent national and manufacturer's quality control and moreover intra and inter laboratory's validation assay of national standard for live varicella vaccine candidate. We confirmed VZV diluent medium was the biggest factor influencing in vitor plaque assay and the excellent composition of VZV diluent medium was final 5% sucrose, 10% FBS, 0.1% sodium monoglutamate in PBS(-), pH 7.2. We confirmed 90 minutes was maximum and optimum VZV adsorption time, but a little different among cells Also we recommended not use antibiotics and antimycotic, fungizone in standard solid agarose overlay assay in varicella potency test. Eventually 5 different originated human diploid embryonic lung cells showed little difference in susceptibility to Oka vaccine strain, but showed a lot of difference in reproducibility.

Β-thiocyanatobenzylidene malonic acid ester 유도체의 합성에 관한 연구

김순옥,홍사미,고정희 성신여자대학교 기초과학연구소 1992 基礎科學硏究誌 Vol.9 No.-

The derivatives of β-thiocyanatobenzylidene malonic acid ester were synthesized by the nucleophillic vinyllic substitution of thiocyanate, were obtained in 30-65% yield. The reactivity and yield were related to the structures of benzylidene malonic acid ester derivatives and the effect of the substituent of the para-substituted benzaldehydes were decresed the order of -NO2> -H, -CI> -OMe and also the reactivity of the malonic acid derivatives were reduced in order of diesters>cyanoacetyl ester>dinitrile. The separation and purification of β-thiocyanatobenzylidene malonic acid esters were carried out by column chromatography and recrystallization. The structure of synthetic compounds were identified by the NMR and IR spectroscopy.

압박띠와 Lidocaine 전처치 및 Pentothal 전처치를 이용한 Propfol 정주통의 예방효과

옥시영,김순임,김선종 순천향대학교 교수학습개발센터 2004 Journal of Soonchunhyang Medical Science Vol.10 No.3

Background: Pain on injection of propofol is a common problem, the cause of which remains unknown, We evaluated the effect of a tourniquet with intravenous lidocaine and pentothal pretreatments, to decrease the incidence and intensity of pain during intravenous propofol injection. Methods: One hundred fifty five patients scheduled for general anesthesia were randomly divided into three groups. Each patient received one of the pretreatment drugs via 18 G angiocatheter inserted in the antecubital fossa. Control group (CG) (n=31) recived 2 ml normal saline and lidocaine group (LG) (n=31) received 40 mg (2%, 2 ml) and pentothal group (PG) (n=31) received 50 mg (2.5%, 2 ml) and lidocaine tourniquet group (LTG) (n=31) received 40 m g(2%, 2ml) under tourniquest 1 minute inflated and pentothal tourniquet group(PTG) (n=31) received 50 mg (2.5%, 2 ml) under tourniquet 1 minute inflated followed intravenous injection of 2 mg/kg of propofol at a rate of 1 ml/sec. after 50 mg of proplfol were injected, patients were assessed for pain score. The severity of pain was classified as 0, 1, 2, 3 (none, mild, moderate, severe) by one observer. Results: The severity and incidence of pain were significantly reduced in lidocaine group and pentothal group compared with control group for intravenous injection of propofol (P<0.05). But effect of tourniquet is minimal. And the quantity and quality of analgesic effect of lidocaine and petothal on propofol iv injection is similar. Conclusions: Lidocaine 40 mg or pentothal 50 mg pretreatment to induction by propofol revealed a good analgesic effect for propofol injection pain. But effect of tourniquest is minimal.

2.5% Pentothal sodium 전처치가 Propofol 정주시 발생되는 통증에 미치는 효과

옥시영,김순임,김선종 순천향대학교 교수학습개발센터 2004 Journal of Soonchunhyang Medical Science Vol.10 No.3

Background: propofol has a high incidence of pain with intravenous injection, and many different methods have been used to minimize the incidence and severity of this pain. In this study, we have compared the effect of saline pretreatment with that of 2.5% pentothal 50 mg pretreatment of propofol injection pain. Methods: Sixty two patients scheduled for general anesthesia were randomly divided into two groups. each patient received one of the pretreatment drugs via 18 g angiocatheter inserted in the antecubital fossa. Control group (n=31)received 2 ml of 0.9% saline pretreatment, 2.5% pentothal group (n=31) received 50 mg of pentothal pretreatment followed intravenous injection of 2 mg/kg of propofol at a rate of 1 ml/sec. After 50 mg of propofol were injected, patients were assessed for pain score. The severity of pain was classified as 0, 1, 2, 3 (none, mild, moderate, severe) by one observer. Results: The severity of pain were significantly reduced in 2.5% pentothal group compared with ontrol group for intravenous injection fo propofol (p<0.05) but incidence is similar. Conclusions: 2.5% pentothal 2 ml (50 mg) pretreatment could significantly reduce the sever the severity of pain for intravenous injection of propofol.

여대생의 체중조절 경험과 비만도, 신체상, 스트레스대처에 관한 연구

김경혜,김옥란,정경옥,정경순,이은주 김천과학대학 2004 김천과학대학 논문집 Vol.30 No.-

Purpose: The purpose of this study was to investigate about weight control experience and to search the relationship between body image and stress coping in college female students according to obesity. Method: The subjects of this study consisted of 187 college female students. The data was collected from November to December of 2003. A self-rating questionnaire was used to collect data. The data was analysed by the SPSS computer program and it included descriptive statistics, frequency, percentage, X² -test, t-test, ANOVA and the pearson correlation coefficient. Result: The 67.9 percent of subjects had a experience of the diet, why of the diet was because of the appearance at 94.5% and because of the health at 5.5%. The mean score on body image was 111.61(SD=13.58). There was a significant difference in body image among under weight, normal weight, and overweight groups. The mean score of body image in under weight was the highest compared to others. The mean score on stress coping was 73.61(SD=7.91). There was not a significant difference in stress coping among the three groups. There was a significant positive correlation between body image and stress coping. Conclusion: The findings of this study give useful information to construct further studies in intervention program relating overweight control for college female students.