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제왕절개 분만율의 지역간 변이에 영향을 미치는 의료기관 특성요인 분석 -의료보험관리공단 대상자를 중심으로-
안형식,권영대,이영성,김명기,김용익,신영수 한국보건행정학회 1991 보건행정학회지 Vol.1 No.1
The purpose of this study is to estimate cesarean section rate in Korea and analyze characteristics of health care institution which affect regional variation in the rate. We have searched vaginal and cesarean section deliveries among Diagnosis Related Group dat based upon insurance claim bills which have been submitted to Korean Insurance Corporation for two years since March, 1985. The results are as follows: 1. Out of all delivery cases of 87,500, cesarean section rate was 16.3% (14,299 cases). 2. Cesarean section rate varied according to size and ownership of health care institutions. In above 6- bed sized hospitals, the rate was at about 20% higher than small sized institutions, but rather in hospitals that have more than 500 beds, it was somewhat low. Classified by the hospital ownership, the rate was low at 18.4% in hospitals of religious organization and highest at private or corporate hospitals. 3. This study shows large regional variation in cesarean section rate; there are two times differences between region with the highest and lowest rate. Strongly related factors in that variation was the ownership of health care institution and urbanization variables. Low level of cesarean section rate in a region is explained by high proportion of delivery cases at institutions of religious organization and at insitutions in county level site. This result shows that apart from medical conditions of patients, indications of cesarean section differs from health care providers, and especially ownership of institution strongly affect them. Cesarean section rate in Korea is supposed to be at high level and development of utilization review programs to keep appropriate cesarean section rate is needed.
역행성 제1 배부 중수지동맥 섬피판을 이용한 수무지 첨부손상재건의 치험례
안형식 순천향의학연구소;Soonchunhyang Medical Research Institute 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2
Reconstruction after traumatic loss of thumb tip portion is of utmost important for the function of the hand but distal thumb injury is a difficult problem for hand surgeons. More recently various microsurgical free flaps from the first and second toe and web space of the foot were described as favorable solution for this problem. Without underestimating the usefulness of these flaps, I introduce another possibility for thumb tip converage using reversed first dorsal metacarpal artery island flap. Reversed first dorsal metacarpal artery island flap can easily reach the distal areas of the thumb and rich vascular supply, relatively simple surgical procedure, no major scarring. So that we will have an alternative method of thumb tip reconstruction because of using reversed first dorsal metacarpal artery island flap.
관상동맥우회술의 중증도 측정과 병원 사망률 비교에 관한 연구
안형식,신영수,권영대,Ahn, Hyung-Sik,Shin, Young-Soo,Kwon, Young-Dae 대한예방의학회 2001 Journal of Preventive Medicine and Public Health Vol.34 No.3
Objective : Health insurers and policy makers are increasingly examining the hospital mortality rate as an indicator of hospital quality and performance. To be meaningful, a risk-adjustment of the death rates must be implemented. This study reviewed 5 severity measurement methods and applied them to the same data set to determine whether judgments regarding the severity-adjusted hospital mortality rates were sensitive to the specific severity measure. Methods : The medical records of 584 patients who underwent coronary artery bypass graft surgery in 6 general hospitals during 1996 and 1997 were reviewed by trained nurses. The MedisGroups, Disease Staging, Computerized Severity Index, APACHE III and KDRG were used to quantify severity of the patients. The predictive probability of death was calculated for each patient in the sample from a multivariate logistic regression model including the severity score, age and sex to evaluate the hospitals' performance, the ratio of the observed number of deaths to the expected number for each hospital was calculated. Results : The overall in-hospital mortality rate was 7.0%, ranging from 2.7% to 15.7% depending on the particular hospital. After the severity adjustment, the mortality rates for each hospital showed little difference according to the severity measure. The 5 severity measurement methods varied in their statistical performance. All had a higher c statistic and $R^2$ than the model containing only age and sex. There was a little difference in the relative hospital performance evaluation by the severity measure. Conclusion : These results suggest that judgments regarding a hospital's performance based on severity adjusted mortality can be sensitive to the severity measurement method. Although the 5 severity measures regarding hospital performance concurred, more often than would be expected by chance, the assessment of an individual hospital mortality rates varied by the different severity measurement method used.
고압산소환경이 신생 및 성숙백서의 폐 superoxide dismutase 활성도에 미치는 영향에 관한 실험적 연구
안형식,조수헌,윤덕로,이동율,김용식,Ahn, Hyeong-Sik,Cho, Soo-Hun,Yun, Dork-Ro,Lee, Dong-Ryool,Kim, Yong-Sik 대한예방의학회 1989 예방의학회지 Vol.22 No.1
To investigate the effect of hyperbaric oxygenation on superoxide dismutase activity, neonatal rats (7-10 days old) and adult rats (approximately 100 days old) were continuously exposed to hyperbaric oxygen environment of 2.4ATA for 8 hours and their superoxide dismutase activity were measured. Neonatal rats, all survived through exposure, showed significant increases in the pulmonary superoxide dismutase activity at immediately and 24 hours after exposure. Adult rats, whose 8 hour survival rates were 14%, did not show any significant increase in the activity of pulmonary superoxide dismutase as compared to the control adult rats. These findings are indicating that increased tolerance to oxygen toxicity in neonatal animals during exposure may be attributed to the increase in activity of superoxide dismutase in neonatal rats.