응급실을 내원한 약물중독 환자에 대한 다학제 응급협진체계의 효과 검증

강진오,김혜리,민경준,김나령,허윤경,김선미 한국정신신체의학회 2019 정신신체의학 Vol.27 No.2

Objectives:When a patient who attempts suicide visits the emergency room, it is important that the departments of emergency medicine, internal medicine, and psychiatry communicate with each other and prioritize treatment. This study was conducted to verify the effectiveness of the multidisciplinary emergency consultation system (ECS) for drug intoxicated patients. Methods:We retrospectively analyzed the data from medical records prior to the ECS, from July 2017 to May 2018, and after the ECS, from July 2018 to May 2019, to verify the effectiveness of the system. Results:After the ECS, admission to open wards was significantly higher than to the intensive care units (χ2= 8.567, p=0.014). In addition, the proportion of consultations to the department of psychiatry among patients admitted to other departments tended to increase (χ2=4.202, p=0.053), and the time required for consultation response decreased (Z=-2.031, p=0.042). As a result of the consultation, the proportion of the patients who had been transferred to the department of psychiatry was increased (χ2=4.692, p=0.043), and the time spent to transfer tended to decrease (Z=-1.941, p=0.052). Conclusions:After implementing the ECS for drug intoxicated patients, unnecessary intensive care unit admissions, consultation response time, and the time spent to transfer were reduced, and the rate of consultation referrals and transfer rates increased. This means that the multidisciplinary consultation system rapidly provided essential medical services to patients at lower medical costs. 연구목적자살시도로 음독을 시도한 환자가 응급실에 내원했을 때, 응급의학과, 내과, 정신건강의학과가 서로 의사소통을 하고 우선순위에 따른 처치를 하는 것은 중요하다. 본 연구는 약물중독 환자에 대한 다학제 응급협진체계(이하 약물중독 응급협진체계)의 효용성을 검증하고자 시행되었다. 방 법약물중독 응급협진체계 구축을 위해 정신건강의학과, 응급의학과, 내과의 전문의가 협의체를 구성하여, 응급실 내원 당시 복용 약물의 종류와 의식 수준에 따른 담당 진료과 및 협진의뢰과 배정, 각 과별 약물중독 환자 전담 교수 배정, 정기회의, 협진 응답 소요시간 제한, 원내 생명사랑위기대응센터 및 지역사회 자원 연계 등을 모두 프로토콜화하였다. 본 연구에서는 약물중독 응급협진체계가 시행되기 전인 2017년 7월부터 2018년 5월까지의 기간과, 시행 이후인 2018년 7월부터 2019년 5월까지의 의무기록 데이터를 후향적으로 통계분석하여, 약물중독 응급협진체계의 효과를 검증하고자 하였다. 결 과약물중독 응급협진체계 시행 후, 시행 전에 비해 중환자실보다 개방병동으로의 입원이 유의하게 증가하였다(χ2=8.567, p=0.014). 또한 타과로 입원한 환자 중 정신건강의학과로의 협진 비율이 증가하는 경향을 보였고(χ2= 4.202, p=0.053), 협진 응답 소요시간은 감소하였다(Z=-2.031, p=0.042). 한편, 협진 결과 전과된 환자의 비율이증가였하고(χ2=4.692, p=0.043), 전과까지 소요된 시간은 감소하는 경향을 보였다(Z=-1.941, p=0.052). 결 론약물중독 응급협진체계 시행 후 불필요한 중환자실 입원, 협진 응답 소요시간, 전과 소요시간이 감소하였으며, 협진 의뢰 비율 및 전과 비율은 증가하였다. 이는 다학제 협진체계가 환자에게 필수적인 의료서비스를 보다적은 의료비용으로 신속하게 제공하였음을 의미한다. 향후 약물중독 이외의 자살시도에 대해서도 응급협진체계를 구축하여, 각 과 간 명확하고 책임있는 의학적 권고를 신속하게 공유한다면, 환자의 치료 및 의료비용 측면에서 긍정적인 효과를 보일 수 있을 것으로 기대된다.

신선 동결 조직 절편에서 in situ RT PCR을 이용한 표피성장인자 수용체 mRNA 발현의 검색

강진오,이방섭,이원규,안희경,홍성언 경희대학교 1997 慶熙醫學 Vol.13 No.2

Current Status of Scientific Citation Index Expanded Article Publications and Relationship with the Human Resources of Medical Schools in Korea

강진오,박서현 대한의료정보학회 2009 Healthcare Informatics Research Vol.15 No.3

Objective: The purpose of this paper was to quantify both the output and the impact of the relationship between Korean medical schools and their human resource departments and their ability to support the basic data for research goals of Korean medical schools. Methods: The SCOPUS database was used to identify SCIE (scientific citation index expanded) articles produced by Korean medical schools between 1997 to 2008. The SCIE criteria, impact factors, and citation numbers were classified according to the database of Thomson Scientific Company. The human resources of medical schools were collected, such as the number of professors, graduate students, clinical fellows, residents, interns, and research assistants, through use of the medical deans’ association biannual report. Results: There was a significant difference across Korean medical schools in the number of the SCIE articles and citation numbers, resulting in only a few institutions producing most of the impact. Among the variables, the proportion of professors of basic medical science (p<.01) and the number of research faculties per professor (p<.01), were related significantly to the SCIE per professor. The only factor affecting both SCIE number and SCIE per professor was the number of research faculties per professor. The number of graduate students in the medical school had no impact on productivity. Conclusion: For the medical schools with restricted resources, the strategic plans for proper management of human resources are needed to promote scientific publication.

Prediction of Hospital Charges for the Cancer Patients withData Mining Techniques

강진오,정석훈,서용무 대한의료정보학회 2009 Healthcare Informatics Research Vol.15 No.1

Objective: Predictions of hospital charges for cancer patients are very important, because they provide a basis for allocating medical resources in the hospital and for establishing national medical policies. But previous studies to predict hospital charges were mainly based on statistical analysis, which has used only a small aspect among huge medical data so that the prediction power was limited. Thus we developed four data mining models, including two artificial neural network (ANN) models and two classification and regression tree (CART) models, to predict both the total amount of hospital charges and the amount paid by the insurance of cancer patients and compared their efficacies. Methods: The data was generated from 400,625 medical records of 1,605 cancer patients who had been hospitalized to Kyung Hee University Hospital from March 1, 2003 to February 29, 2004. Clementine 8.1 program was used to build four data mining prediction models, two for the total amount and two for the amount paid by insurance. The variables included all of the data fields of standard medical record form of Korea. The neural network model used feed-forward back propagation method, which had 2 hidden layers. For decision tree model, RELIEFF method was used and the maximum tree depth was set to 30. We divided the dataset into 67% of training dataset and 33% of test dataset, using stratified sampling. Linear correlation coefficient and gain chart were compared. Results: The ANN models showed better linear correlation coefficient than the CART models in predicting both the total amount (0.824 vs. 0.791) and the amount paid by insurance (0.838 vs. 0.699). The estimated accuracy of ANN model was more than 98% to predict both total amount and amount paid by insurance. The CART model for total amount showed that the relative importance of the variables were duration of admission(0.073), number of consultation(0.061), and treatment group 16(0.06). The CART model for the amount paid by insurance showed that the relative importance of the cariables were duration of admission (0.09), number of ICU admission (0.063), and number of consultations (0.062). The percent gain of ANN model shows better %gain than CART to predict total amount but to predict amount paid by insurance, ANN showed similar pattern to CART Conclusion: The ANN models showed better prediction accuracy than CART models. However, the CART models, which serve different information from ANN model, can be used to allocate limited medical resources effectively and efficiently. For the purpose of establishing medical policies and strategies, using those models together is warranted.

근치적 방사선 치료를 받은 자궁경부암 환자에서 p53과 Ki-67 과발현의 임상적 의의

강진오,김두순,신동오,홍성언,강동욱 경희대학교 2003 慶熙醫學 Vol.19 No.2

Analysis of Scientific Publication Networks among Medical Schools in Korea

강진오,박서현 대한의료정보학회 2010 Healthcare Informatics Research Vol.16 No.2

Objectives: This research was intended to analyze the special characteristics and structure of social networks among Korean medical schools for the purpose of providing knowledge regarding medical field structure, dynamics, and potential paradigm development. Methods: A collaborative 12-year data set of 35,469 published articles in the SCOPUS® database was analyzed. Among ISI subcategories, 61 having more than 20 articles were scrutinized. Following identification of correspondence and co-authorship, centralization indices and Key Player analysis were run for each subcategory. Medical schools were grouped into uniform clusters with convergence of iterated correlation (CONCOR) for structural equivalence. Finally, multidimensional scaling was used to visualize similarities. Results: All centralization indexes analyzed demonstrated a shift in the degree of centralization in the network of medical schools throughout the period examined. Betweenness centrality and eigenvector centrality in particular revealed a dramatic change indicating minimization of the role of a specific "gatekeeper". Key Player analysis confirmed Seoul National University as a constant ‘key player’ throughout the period evaluated and for the subcategories examined as well. Conclusions: This study provided insight into the scientific network among the medical schools of Korea. By understanding this network, a strategy to strengthen the basis of research may be developed.

The Analysis of Co-authorship and Networks among the Korean Pathologists

강진오,박서현,박용구 대한병리학회 2011 Journal of Pathology and Translational Medicine Vol.45 No.3

Background: To evaluate the characteristics of the co-authorship and its network within the Ko­rean Pathologists’ Society. Methods: In the KoreaMed database, 11,420 articles and 72,478 au­thors from 1991 to 2010 were searched. The patterns of co-authorship of the authors and institu­tions were analyzed to build a network matrix. The network centrality indices were measured with UCINET 6.0 and sociogram, and were drawn with Netdraw 5.0. KeyPlayer 1.44 was used for key player analysis. Results: The number of articles that pathologist participated in increased; how­ever, the number of articles that the pathologists are the first author did not increase. The central­ity degrees from 1991 to 2010 were 4.16% and 0.3% for the institutions and authors network, re­spectively. From 1991 to 2000, Seoul National University had the highest degree of centrality and was a key player. However, from 2001 to 2010, Ulsan replaced the position. For the authors, Chi, Je Geun was highest centrality author and key player during the 1991 to 2000 time period. From 2001 to 2010, Yoo, Jinyoung had the highest degree of centrality and Kim, Na Rae was a key player. Overall, most of the centrality indices were occupied by only a few institutions and au­thors. Conclusions: The network among the pathologist society is a typical small world society.

혈우병성 관절증에 대한 방사선 치료의 역할

강진오(Jin Oh Kang),홍성언(Seong Eon Hong),김상기(Sang Gi Kim),신동오(Dong Oh Shin) 대한방사선종양학회 2005 Radiation Oncology Journal Vol.23 No.2

목 적: 혈우병성 관절증의 치료는 응고인자의 공급과 관절강내 동위원소 주입 또는 수술적 요법을 시행하지 만 출혈의 빈도를 줄이는 데 있어서는 만족스러운 효과를 보고 있지 못하다. 저자들은 혈우병성 관절증의 원 인이 되는 관절강내 출혈을 줄이기 위해 방사선 치료를 시행하여 그 결과를 분석하였다. 대상 및 방법: 1997년부터 2001년까지 혈우병성 관절증으로 진단 받고 외부 방사선 조사를 시행 받은 34명 41예를 대상으로 분석하였다. 환자들의 나이는 최저 4세 최고 27세(중앙값 11세), 발목관절 35예, 무릎 관절 3예, 팔꿈치 관절 3예였다. 방사선은 6 MV 엑스선을 이용하여 150∼200 cGy를 하루 한번씩 일주일에 5회 시행하여 총 선량 900∼2,360 cGy를 조사하였다. 방사선 치료 전 1년간의 출혈 회수와 치료 후 1년간의 출혈회수를 비교하였다. 결 과: 11세 미만의 환자가 11세 이상의 환자에 비해 출혈 회수가 높은 경향을 보였으나(p=0.051), 11세 미만의 환자에서 방사선 치료 후 출혈 회수가 감소되는 경향이 더 높았다(p=0.057). 관절 통증(p=0.012), 관절 부종(p=0.033)이 있는 경우에서 유의하게 출혈 회수가 높았다. Arnold-Hilgartner 병기(p=0.739), 연골의 파괴 정도(p=0.718), 활액막 비대(p=0.07) 등은 출혈 회수와 관련이 없었다. 방사선 치료 후 33예에서 출혈의 빈도가 감소한 반면, 호전되지 않거나 출혈의 빈도가 증가한 경우가 8예에서 있었다. 방사선 치료 전 관절 내 평균 출혈 회수는 월 2.52회이었으나 방사선 치료 후 1.4회로 통계적으로 유의하게 감소하였다(p=0.017).결 론: 혈우병성 관절증 환자에서 외부 방사선 치료를 시행하여 출혈 빈도를 줄일 수 있었다. 반복적인 관절 강내 출혈을 보이는 환자에서 출혈의 빈도를 줄이기 위하여 저선량 방사선치료를 고려해야 할 것이다. Purpose: Repetitive bleeding into the joint space is the cause of debilitative hemophilic arthropathy. To interrupt this process, we treated the hemophilic patients suffering from repetitive joint bleeding with radiation therapy. Materials and Methods: From 1997 to 2001, a total of 41 joints from 37 hemophilic arthropathy patients were treated with radiation therapy at Kyung Hee University Hospital. The treated joints were 35 ankles, 3 knees and 3 elbows, respectively. The age of the patients ranged from 4 to 27 years (median age: 11 years). The radiation dose ranged from 900 cGy to 2360 cGy (median dose: 900cGy). The fraction size was 150 cGy, 180 cGy or 200 cGy. The number of bleeding in one year before and after radiotherapy was compared. Results: There was a tendency of frequent bleeding for the patients younger than 11 (p=0.051) but there was also a tendency for more improvement in this group (p=0.057). The number of joint bleedings was related with joint pain (p=0.012) and joint swelling (p=0.033) but not with the Arbold-Hilgartner stage (p=0.739), cartilage destruction (p=0.718) and synovial hypertrophy (p=0.079). The number of bleeding was reduced in thirty-three cases, and eight cases showed no improvement after radiation therapy. The average number of bleeding in a month was 2.52 before radiotherapy, but this was reduced to 1.4 after radiotherapy (p=0.017). Conclusion: Radiation therapy was effective for the hemophilia patients with repetitive joint bleeding to decrease the bleeding frequency and to prevent hemophilic arthropathy.

진행된 성문 상부암 환자에서 p53의 발현과 임상적 의의

강진오(Jin Oh Kang),홍성언(Seong Eon Hong) 대한방사선종양학회 1998 Radiation Oncology Journal Vol.16 No.1

목 적 : 진행된 성문 상부암 환자에서 p53 발현의 빈도와 예후 인자로서의 가능성을 조사하기 위하여 본 연구를 시행하였다. 대상 및 방법 : 완전 또는 부분 후두 절제술을 받고, 방사선 치료를 받은 성문 상부암 환자 21 예를 대상으로 하여 antihuman monoclonal p53 antibody를 이용하여 면역 염색을 실시하였다. 결 과 : 3기 환자 6명 중 3명에서 양성 반응을 보였고 4기 환자 15명 중 4명에서 양성반응을 보였다. 양군간의 발현의 빈도는 통계적으로 차이가 없었다(p=0.608). p53 음성 환자 군과 양성 환자군의 5년 생존율은 각각 93%와 86%이었으나 통계적인 차이는 없었다(p=0.776). p53의 발현은 연령(p=0.64), T stage(p=0.877), N stage(p=0.874) 등과도 연관성을 보이지 않았다. 결 론 : p53의 발현은 전통적인 임상 인자들과 통계적으로 유의한 관련성을 보이지 않았다. 진행된 성문 상부암에서 면역 염색을 통한 p53 발현의 검색은 예후 인자로서 임상적 유용성이 없을 것으로 생각된다. Purpose : To determine the incidence and prognostic effect of p53 expression in patients with advanced supraglottic cancer. Materials and Methods : Twenty-one cases of total 48 advanced supraglottic cancer patients who received postoperative adjuvant radiation therapy were evaluated by immunohistochemical staining employing p53 monoclonal antibody. Result : Three out of six stage Ⅲ patients and four out of fifteen stage Ⅳ patients showed p53 expression without statistically significant difference (p=0.608). Five year survival rates are 93% in p53 negative, 86% in p53 positive patients and there was no significant difference(p=0.776). p53 expression does not show statistically significant correlation with primary tumor status(p=0.877), lymph node status(p=0.874) and age(p=0.64). Conclusion : There was no statistically significant correlation between traditionally known risk factors and p53 expression.

유방암의 방사선 치료

강진오 ( Jin Oh Kang ) 경희대학교 경희의료원 2005 慶熙醫學 Vol.21 No.1