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.

1. 06㎛ Nd : YAG Laser를 이용한 요추간판탈출증의 경피적 수핵감압술

이흥선,변박장,최순관,신원한,권귀향,이인수,이경석,김범태 순천향대학교 1994 논문집 Vol.17 No.4

The 1.06㎛ Neodymium-YAG Laser(800 micron hemisherical) is revealed a useful tool for percutaneous laser disc decompression(PLDD). Especially PLDD would be applied to the management of lumbar disc herniation with minimal intervention. Total irradiated energy to one level of disc space was bout 1000 to 2000 joules. We performed this method at 10 levels, in 7 cases of patients, consisting of 4 males and 3 females with an average age of 37.7 years. Five cases showed excellent and good results, were observed. In two cases, open surgery was required because of unsatisfactory results. The best results were obtained in the protrusion type of disc herniation. We have summarized some advantages of PLDD: a) safe and simple procedure in an outpatient setting, b) avoiding general anesthesia, late spinal instability, c) possibility of repetitive use.

축하중과 첨가질량이 작용하는 적층복합판의 진동해석

이봉학,김경진,원치문,성기태 江原大學校 産業技術硏究所 1995 産業技術硏究 Vol.15 No.-

A method of calculating the natural frequency corresponding to the first mode of vibration of beams and tower structures, with irregular cross-sections and with arbitrary boundary conditions was developed and reported by D. H. Kim in 1974. IN this paper, hte result of application of this method to the laminated plates with axial forces and with attached point mass/masses is presented. Both N? and N? forces are considered. The solution for the laminated plates with arbitrary boundary conditions and irregular section can be obtained by simply obtaining the deflection influence coefficients by any method. The effect of neglecting the mass of the plates on the natural frequency, as the ratio of the point mass/masses to the plate mass increases, is thoroughly studied. The influence of N? and N? is also carefully investigated.

전신적인 피부병변으로 발현한 모세포성 NK세포 림프종 1예

이근욱,윤탁,김동완,김태유,허대석,박영주,김노경 대한내과학회 2004 대한내과학회지 Vol.66 No.4

저자들은 다른 장기의 침범 없이 전신적인 피부 병변만으로 발현한 모세포성 NK세포 림프종 1예를 국내에서 처음으로 경험하였기에 이를 문헌고찰과 함께 보고하는 바이다. Reports of blastic natural killer (NK)-cell lymphoma are rare. In previous reports, primary cutaneous blastic NK-cell lymphomas were even rarer. In asian patients, most CD56+ lymphomas are classified as nasal type extranodal NK/T-cell lymphoma and mostly associated with the presence of Epstein-Barr virus (EBV) and have an aggressive clinical course. Few cases of blastic NK-cell lymphoma were reported previously in Korea but there was report about blastic NK-cell lymphoma initially presented as disseminated skin lesions without any other organ involvement. We report such a young patient who was treated by systemic chemotherapy.

우리나라 암등록 사업자료의 충실성에 관한 연구

이태용,조혜경,김광환 한국보건통계학회 2003 한국보건정보통계학회지 Vol.28 No.2

This research analyzed and compared centrally-required items and individual hospitals-developed items for cancer registration, as well as items for regional cancer registration projects. We then suggested additional item for standardization and improvement measures. We worked with a total of 161 medical agencies consisting of 118 general hospitals and 43 specialized general hospitals which take part in nation wide cancer registration statistics in Korea. A thesis submitted to the Committee of Graduate School of Public Health, Chungnam National University in partial fulfillment of the requirements for the degree of Master of Public Health conferred in August 2002. The following are the findings. First, the items of family disease history, smoking history, drinking history and favorite food surveyed only 0.6%-2.5% of the entire agencies, 2.3%-7.0% of the specialized general hospitals and 0.0%-0.8% of the general hospitals. Second, the items of TNM staging system, summary staging, and sites of metastasis investigated only 3.7%-5.0% of the total 161 agencies, 14.0% of the specialized general hospitals and 0.0%-1.7% of the general hospitals. Third, the items related to death and treatment investigated less than 2.5% of the entire hospitals, only 0.0%-7.0% of the specialized general hospitals and general hospitals not investigated. Finally, the items related to discharge and hospital utilization surveyed less than 4.3% of the entire hospitals, only 2.3%-11.6% of the specialized general hospitals and only 0.0%-1.7% of the general hospitals. Conclusively, the most hospitals missed important items. For that reason, investigation of valuable data insufficience. Therefore, improvement of nationwide cancer registration be caused by calculation of hospital, activated medical record library. The survey of cancer patients and medical treatment should be more efficiently and effectively conducted.

몇 소나무類의 葉綠素 含量의 月別 變化

李慶學,金甲泰,朱洸영,曺炅眞,李敦求 서울大學校 農科大學 1985 서울대농학연구지 Vol.10 No.2

植物體는 生存 또는 生長을 위해 光合成作用을 하며, 綠色植物은 이를 위한 色素로서 葉綠體를 가지고 있다. 따라서 이의 含量은 生長能力이나 各種 stress에 대한 生理的 活成變化를 나타내는 指標로 이용되는데 이에 對한 硏究報告는 基礎的 資料로서의 重要性에도 불구하고 林木 특히 소나무類에 있어서는 극히 드물었다. 이에 서울大學交 農科大學 構內에 있는 소나무類 5樹種에 對한 針葉單位生重量當 葉綠素含量을 月別測定한 結果 樹種間의 含量差異는 뚜렷하니지 않았으나 測定時期間에는 差異를 보였다. 總葉綠素의 含量變化는 葉綠素 a의 含量變化에 起因하며 이는 여름철에는 높고 겨울철에는 낮았다. 또한 最大値는 2年生 針葉을 7, 8月에 測定했을 때 나타났다. 이러한 結果를 綜合해 볼 때 소나무類의 生理的 生活은 葉綠素 a와 密接한 關係를 갖고 있는 것으로 思料된다. To obtain the fundamental data about the chlorophyll contents of some conifers, monthly measurements of them per unit fresh weight(g) of needles were performed. The results were summarized as follows. 1. Difference of total chlorophyll contents between measuring times in a species was clear but not between species. Total chlorophyll content in summer showed high value and that in winter did low value. 2. In general, the total chlorophyll contents of the conifers showed the highest values in two-year-old needles, measured in July or August. 3. Monthly change of total chlorophyll contents was mainly due to that of the contents of chlorophyll a, and the contents of chlorophyll b was not varied greatly with measuring times. 4. It seems that the physiological activity of needles was closely related with the contents of chlorophyll a.

불소화합물 국소도포된 법랑질 표면의 산부식 시간이 레진접합력이 미치는 영향에 관한 연구

이경태,한세현 大韓小兒齒科學會 1990 大韓小兒齒科學會誌 Vol.17 No.1

The purpose of this in vitro study was to determine the effect of etching time on bonding strength of composite resin after applying topical fluoride agents to the primary anterior teeth when the acidetching technique was used in pedodontic treatment. The shear bond strength of composite resin was tested with Instron and surface topography was examined with a Scanning Electron Microscope. The results were as follows: 1. Resin bond strength of experimental group A which was applied topical fluoride agents, etched for 30 seconds was very weak. 2. Resin bond strength of experimental group C which was applied topical fluoride agents, etched for 120 seconds was approach to that of control group. 3. After applying topical fluoride agents, the more the etching time was increased, the more adherent surface coating was removed. 4. The more the etching time was increased, the more the etching degree was.

八段錦의 원리와 수련에 대한 연구

이용태,김경철 동의대학교 한의학연구소 1997 동의한의연구 Vol.1 No.-

The principle and training of PAL DAN PUM is studied and the results is as follows : 1. PAL DAN GUM is the method to be belonged the course of "TONG GI" for the base of GI GONG training. 2. As the body is extended and for a short time the breath is stopped, Meridian is stimulated by PAL DAN GUM. 3. PAL DAN GUM have to be acted in the condition of the whole unity of the heart, the breath and the body.

도시지역 노인의 건강행위 실천 실태

이태진,배상수,이기홍,임재영,강경화 노인간호학회 2008 노인간호학회지 Vol.10 No.1

Purpose: The purpose of this study was to identify the health status and health behavior practices of elders living in urban areas. Methods: The participants were selected by convenience sampling and consisted of 137 elders 65 or over living in a city in Kyunggi Province. Data collection was done through interviews using a structured questionnaire. Results: Of the participants. 66.4% perceived their health status as 'not healthy'. The average number of present illnesses reported by the elders was 1.7. The average scores for health behavior practices were low (smoking cessation: 1.64, drinking abstinence: 1.79, exercise: 0.40, regular diet: 1.54, weight control: 1.67, regular physical check-up: 0.77). The scores for health behaviors practices showed significant differences according to general characters and health status. Conclusion: Health promotion programs for elders should be designed to enhance health behaviors practices.

박복되는 현훈으로 발현한 보크트-고야나기-하라다 증후군 1예

이태경,남상원,박선아,성기범 대한평형의학회 2003 Research in Vestibular Science Vol.2 No.2