새로운 의과대학 교육과정 시안

홍창의(Chang Yee Hong),배직현(Chik Hyun Pai),이정신(Jung Shin Lee) 한국의학교육학회 1990 Korean journal of medical education Vol.2 No.1

The medical educators in Korean are acutely aware of the need for the revision of the medical education programs in Korea which have many drawbacks. In planning for a new medical curriculum, we examined the problems of the traditional curricula of medical schools in Korea, followed by a review of the integrated curricula of other countries. Finally, we have chosen a program that we consider best adaptable to the medical schools in Korea. We believe that the objectives of the new medical curriculum should be to prepare the student to acquire sufficient knowledge, skills, and attitudes which on graduation will allow him to further pursue various specialities of medicine, including areas of basic medicine and a career as a medical scientist. Our approach to medical education in that of (a) integrated teaching, (b) medically and patient oriented, (c) problem-oriented, (d) student-centered, (e) identifying both the core and marginal material in course content and (f) encouraging and motivating for self-learning. The major portion of the program for the new curriculum includes eight weeks of introductory course followed by 52 for the body system courses, which run on an interdisciplinary basis between basic sciences and clinical disciplines during the first two years. The student will then enter the final two years of clerkship with various clinical rotations. We also propose the establishment of a learning center where most of the audio-visual materials used in the curriculum will be shelved. Finally, We propose the administrative structure of the medical programme which will allow the interdisciplinary approach to medical education.

중합 효소 연쇄 반응을 이용한 Salmonella typhi 편모 항원 j 변이체의 검출

송재훈(Jae Hoon Song),김유겸(Yoo Kyum Kim),배직현(Chik Hyun Pai) 대한내과학회 1992 대한내과학회지 Vol.43 No.2

N/A Background: Most species of Salmonella have the phenomenon of phase variation of flagellar antigens, the alternation between expression of two flagellin genes, at loci called H1 (fli C) and H2 (flj B). Salmonella typhi, the etiologic agent of typhoid fever, typically has only a phase-1 flagellar antigen, H,-d, but some isolates, found only in Indonesia, have antigenj (H1-j) instead as a phase-1 antigen. H,-j antigen consists of 1269bp sequence resulting from the deletion of 261bp from the total 1530bp of the H1-d antigen and could be detected by polymerase chain reaction (PCR). The ex5ct prevalence of H1-j strain in other parts of the world and its clinical significance ere still open questions. Methods: To investigate the presence of H1-j strains among Korean isolates of S. typhi, we performed PCR for 46isolates from Asan Medical Center, Seoul, Korea. A 1530-bp fragment of H., d antigen was amplifed with specific primers and was analyzed by 1.5% agarose gel electrophoresis. H1-j antigen, if present, could be identifed as a 1269-bp fragment in this PCR- electrophoresis. Results; Of the 46 isolates examined, only one was found to possess the 1269-bp H,-j antigen. Other 45 isolates showed the 1530 bp fragments of H1-d antigen. The isolate with H1-j antigen was cultured from a Korean-Indonesian who was symptomatic in Indonesia when he left for Korea. Conclusions: These results suggest that there are no H1-j strains S. tyPhi among those endemic in Korea. This study will be extended to the larger scale including more S. typhi isolates in Korea.

항생제를 사용하고 있었던 인공호흡이 연관 폐렴환자에서의 원인균 발견을 위한 소량 기관지폐포세척술의 진단적 효용성에 관한 연구

문두섭 ( Doo Seop Moon ),임채만 ( Chae Man Lim ),배직현 ( Chik Hyun Pai ),김미나 ( Mi Na Kim ),전재용 ( Jae Yong Chin ),심태선 ( Tae Sun Shim ),이상도 ( Sang Do Lee ),김우성 ( Woo Sung Kim ),김동순 ( Dong Soon Kim ),김원동 ( Won D 대한결핵 및 호흡기학회 1999 Tuberculosis and Respiratory Diseases Vol.47 No.3

항균제내성 추이 파악을 위한 병동별 집중감시조사

이성희,배직현 대한감염학회 1996 감염 Vol.28 No.3

목적: 일반적으로 항균제감수성 양상은 병원 전체환자에서 분리된 균들에 대한 통계를 기준으로 한다. 하지만 항균제감수성이 심각한 중환자실의 문제는 균수가 많은 전체를 기준으로 한 통계에서는 알아낼 수가 없다. 그러므로 본 연구에서는 중환자실(ICU)과 중환자실이 아닌 병동(nonICU)을 분리하여 집중감시조사 (focused microbiologic surveillance)를 실시하므로써 ICU에서의 심각한 내성을 알아내는 데 있어서 유용성을평가해 보고자 하였다. 방법: 1994년 10월부터 1995년 9월까지 서울중앙병원 임상병리과에 의뢰된 모든 임상검체에서 분리된균 중 숫자가 50이 넘는 병원균들을 대상으로 표준 디스크확산법과 자동화된 액체배지희석법을 이용하여 항균제감수성검사를 실시하였으며, 그 결과를 ICU에서 분리된 균과 nonICU에서 분리된 균들로 나누어 비교하였다. 결과: P. aeruginosa는 ICU와 nonICU에서의 항균제감수성이 서로 비슷하였으나, S. aureus, coagulase-negative staphylococci, Enterobacter species, Acinetobacter species등은 ICU에서의 항균제감수성이 nonICU 보다 유의하게 낮았다(p<0.05). 결론: 항균제의 사용이 빈번하며 내성이 높은 중환자실의 항균제 내성의 추이를 알기 위해서는 특정 unit만을 대상으로 하는 집중감시조사 (focused microbiologic surveillance)가 유용할 것으로 사료된다. Background: Traditionally, trends in antibiotic susceptibility are detected by hospital-based antimicrobial susceptibility derived from cumulative information generated from all clinical wards. However, these data may underestimate the bacterial resistance in high antibiotic-use wards such as the intensive care units(ICUs). To overcome this problem, focused surveillance techniques have been suggested to study the epidemiology of microorganisms, and guide for specific antimicrobial therapy. In present study, we attempted to evaluate the utility of focused surveillance in following the resistance patterns of isolates from the intensive care units. Methods: Major pathogenic organisms recovered from clinical specimen were tested for antimicrobial susceptibility by the standard disk diffusion method or automated microdilution method in the microbiologic laboratory in Asan Medical Center during 12 months period from October 1994 to September 1995. The susceptibility patterns of isolates from patients in ICU were compared with those of isolates from general wards(NonICU). Results: The patterns of susceptibility of Pseudomonas aeruginosa from ICU, were similar to those from nonICU. However, isolates of Staphylococcus aureus and coagulase-negative staphlococci from the ICU were significantly more resistant to cephalothin, ciprofloxacin, erythromycin, and oxacillin than those isolated from nonICU. Similarly, Enterobacter and Acinetobacter species were more resistant to ampicillin, cefotaxime, piperacillin, and aminoglycosides. Conclusion: We concluded that focused microbiologic surveillance by specific hospital unit provide a sensitive means to identify unit-specific antimicrobial resistance patterns and is a useful guide for the specific antimicrobial therapy in hospital.

그람양성균 감염에 대한 Teicoplanin의 임상적 효과

최강현,송재훈,조구영,유빈,김형호,서철원,배직현 대한감염학회 1993 감염 Vol.25 No.1

Backgrounds: Gram-positive cocci have been an increasing cause of nosocomial infections in recent years. Treatment of these infections is often difficult, particularly infections by methicillin-resistant Staphylococcus aureus (MRSA). Teicoplanin, a new glycopeptide antibiotic, has been reported to have an excellent in vitro and in vivo effect against various gram-positive infections. To evaluate the clinical efficacy of teicoplanin in the treatment of patients with gram-positive bacterial infection and to compare the in vitro susceptibility of teicoplanin with other antimicrobials, we performed a prospective open trial of teicoplanin. Methods: Twenty patients with infections by gram-positive organism were enrolled. The patients were received 400mg of teicoplanin followed by 200 mg from next day as maintenance dose. During the follow-up period, clinical features and laboratory parameters were ckecked to evaluate clinical efficacy and appropriate cultures were followed to determine the microbiologic efficacy. The adverse effects of teicoplanin were also observed. Results: The enrolled patients were 16 males and 4 females, whose mean age was 51±13 years. The categories of infections were bacteremia (5), skin and soft tissue infection (4), empyema (3), UTI (2), pneumonia (1), catheter associated infection (1) and infective endocarditis (1). The etiologic organisms isolated were MRSA (9), coagulase-negative Staphlycoccus (5), S. viridans (2), group D streptococcus (2), S. pneumoniae (1), and E. faecalis (1). All 20 patients treated with teicoplanin showed clinical cure (13/20) or clinical improvement (7/20), whereas 90% of isolated organisms were eradicated after teicoplanin therapy. The adverse effect of teicoplanin was minimal. Conclusion: Teicoplanin is safe and effective in the therapy of many different infections caused by gram-positive oragnisms.

Superbacteria(VRSA)의 출현

裵直炫 대한의사협회 1999 대한의사협회지 Vol.42 No.7

원내감염과 원외감염에서 분리된 원인균의 항균제 감수성 비교

송재훈,김미나,정재심,김봉철,배직현 대한감염학회 1993 감염 Vol.25 No.4

The selective pressure of the widespread use of antimicrobials has resulted in an increasing spread of resistant genes. Thus it would be anticipated and, in fact, has been shown by several studies that organisms from nosocomial infections are more resistant to antimicrobial agents than the same species of organisms causing community-acquired infection in a particular geographic area or medical center. However, such data are not available from any medical center in Korea. We, therefore, examined the susceptibility data of the nosocomial versus community-acquired pathogens that were isolated in a large university hospital in Seoul. Major pathogenic organisms of 2,015 isolates, 545 nosocomial and 1,470 community acquired pathogens, recovered from clinical specimen in the microbiology laboratory in Asan Medical Center during 6-months period from June to November 1992 were tested for antimicrobiai susceptibility by the standard disk diffusion method or automated microdilution minimum inhibitory concentration method (Vitek??). The nosocomical or community origin of the isolates were determined by the Infection Control Office through the Nosocomial Infection Surveillance Program. Staphylococcus aureus and coagulase-negative Staphylococcus isolated from nosocomial infections were significantly less susceptible than those from community-acquired infection to oxacillin, cephalothin, ciprofloxacin, gentamicin, and erythromycin (p<0.01). Similar findings were obtained for Escherichia coli and Klebsiella pneumoniae to cephalothin, cefotaxime, tobramycin, and gentamicin, and for Pseudomonas aeruginosa to ceftazidime, ofloxacin, piperacillin, and tobramycin. Enterococcus faecalis isolated from nosocomial infections were significantly more resistant to penicillin and ampicillin (p<0.05). However, Acinetobacter calcoaceticus, Enterobacter cloacae, and Serratia marcescens did not show a significant difference between nosocomial and community acquired isolates. We conclude that the susceptibility patterns of nosocomial and community-acquired pathogens are sufficiently different to warrant separate reports of susceptibility data, which would be useful to improve empirical antimicrobial therapy of nosocomial infections.

글루콘산클로르헥시딘과 이소프로필알코올의 살균효과

노환성,최상희,정재심,배직현 울산대학교 의과대학 1993 울산의대학술지 Vol.2 No.2

A 0.5% chlorhexidine gluconate in 70% isopropyl alcohol tincture(H-Tincture) has been shown to be highly efficacious for skin disinfection and is used widely in hospitals as a skin cleansing agent for patients and health-care personnel. However, the optimum and the most cost effective combination of two disinfectants is net known. we examined the bactericidal effect of chlorhexidine gluconate and isopropyl alcohol singly or in combination at various concentrations against clinical isolates of Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa. Pure cultures of the test organisms were incubated in disinfectant solutions for up to 15 minutes and 0.01 ml aliquots were cultured in broth for viability. Chlorhexidine gluconate solutions alone at the concentration of 0.5% and 0.1% were as bactericidal as in combination with isopropyl alcohol at various concentrations. The most cost-effective combination of the two disinfectants was shown to be 0.05% chlorhexidine gluconate in 30% isopropyl alcohol. These results suggest that the concentrations of chlorhexidine gluconate and isopropyl alcohol could be reduced from the current formula of H-Tincture without compromising its antimicrobial activity and warrant further studies in clinical setting to define the most cost-effective combination of the disinfectants.

Aminoglycosides 고도내성인 enterococci에 대한 항균제 병합요법의 in-vitro 효과

김미나,배직현 울산대학교 의과대학 1993 울산의대학술지 Vol.2 No.1

For serious enterococcal infections, synergistic combination of penicillin and aminoglycosides is recommended for bactericidal therapy. However, an optimal synergistic combination for infection caused by enterococcal strains demonstrating a high-level resistance to aminoglycosides has not been established. The present study ezamined the in-vitro effects of combinations of penicillin plus trimethoprim/sulfamethoxazole(Sxt), ciprofloxacin, teicoplanin, vancomycin, and fosfomycin and compared with single drug therapy of ampicillin of low(5㎍/mL) and high doses(10, 20㎍/mL) in strians of Enterococcus with high-level resistance to gentamicin, amilkacin, and streptomycin by time kill studies. The minimal bactericidal concentrations of these antibiotics were also determined. Sxt and ampicillin were most active single agents on both MIC/MBC test and time kill study, but not consistently bactericidal. Only penicillin-ciprofloxacin combination exhibited significant bactericidal synergy but the bactericidal effect was strain and inoculum-size dependent and not more significantly effective than high-dose ampicillin or Sxt only.

병원감염 관리체계 및 미생물부의 역활

배직현 대한감염학회 1990 감염 Vol.22 No.4