미국, 캐나다, 영국의 재입원율 활용 현황

이상아,주영준,신재용,박은철,이후연,Lee, Sang-Ah,Ju, Yeong-Jun,Shin, Jae-Yong,Park, Eun-Cheol,Lee, Hoo-Yeon 한국의료질향상학회 2016 한국의료질향상학회지 Vol.22 No.1

Readmission which reflects capacity to manage patients and general level of medical services has been known for one of the causes of medical expenditure due to inefficient service. Compared to disease-specific readmission, hospital wide readmission (HWR) is relatively easy to understand, and has merit to get over limitation of collateral medical services assessment; therefore, a growing interest in development and usage of readmission indicator as quality of care indicator focusing on all-disease is detected. In this study, we investigate current state of risk standardized readmission rate indicator used in the United States, the United Kingdom, and Canada, and examine the considerations when using readmission rate as quality indicator in Korea. Differences in risk-adjustment methods were showed among countries. The United States do not control race not to hide socio-demographic factors on readmission. Canada shows differentiation compared to other countries about reflecting community factors. All three-countries utilize readmission rate as monitoring quality of care rather than incentives or penalty due to the fact that readmission rate could not represent the whole quality of hospital and has a limitation at controlling socio-economic factors. Therefore, for usage readmission rate as quality indicator in Korea, preparing readmission classification standard for Korean medical environment and additional methods for acquiring information by using discharge summary is need. Moreover, continued discussion with clinical specialists is needed for obtain clinical reliability and validity.

외상성 뇌손상 후두통과 기억장애가 발생한 환자에 서각지황탕가감방(犀角地黃湯加減方)을 투여한 1례 보고

이상아,권태욱,김명호,손한범,안립,장명웅,최동준,Lee, Sang-Ah,Kwon, Tae-Wook,Kim, Myung-Ho,Son, Han-Beom,Ahn, Lib,Jang, Myung-Woong,Choi, Dong-Jun 대한한방내과학회 2013 大韓韓方內科學會誌 Vol.34 No.4

The purpose of this study is to report the clinical effects of modified Seogakjihwang-tang on a patient who had headache and memory disorder after traumatic brain injury, which were considered as the result of blood stasis. The patient had headache and memory disorder after traumatic brain injury and treated with modified Seogakjihwang-tang three times a day for 60days. As a result, the numerical rating scale and pain rating score of headache decreased and the scores of mini-mental state examination-Korea, the Korean version of Montreal cognitive assessment and the mini-memory test increased during treatment with modified Seogakjihwang-tang. Therefore, this case supports a possibility that modified Seogakjihwang-tang might be an effective treatment to patients with headache and memory disorder after traumatic brain injury.

나비굴경유 수술을 통해 완치된 뇌하수체 거대선종에 동반된 쿠싱병 1예

이상아,문재철,Lee, Sang Ah,Moon, Jae Cheol 제주대학교 의과학연구소 2021 The Journal of Medicine and Life Science Vol.18 No.1

Cushing's disease (CD) is a rare illness characterized by chronic hypercortisolism secondary to the overproduction of adrenocorticotropic hormone by a pituitary adenoma, which is associated with a high risk of developing serious complications, such as diabetes mellitus, cardiovascular disease, and emotional disorders. Endoscopic transsphenoidal surgery is performed for the treatment of CD, and was initially preferred over other types of treatments. However, the recurrence after pituitary surgery for CD is a common problem after an initial successful surgery. In microadenomas, the remission rates were higher than those of macroadenoma. This patient had a giant tumor that was greater than 4 cm in length on sella magnetic resonance imaging, and panhypopituitarism was detected using a combined pituitary stimulation test. After transsphenoidal surgery, the patient required temporary hormone replacement for a short period of time. After 1 year, he showed a normal cortisol response on the overnight dexamethasone suppression test and low morning cortisol levels. Therefore, we indicated that the patient was cured of giant macroadenoma with panhypopituitarism before surgery, and thus, reported this case.

비타민 D 고용량 주사로 인한 심한 고칼슘혈증 발생 1예

이상아,문재철,Lee, Sang Ah,Moon, Jae Cheol 제주대학교 의과학연구소 2019 The Journal of Medicine and Life Science Vol.16 No.1

Hypercalcemia is often seen in patients, but most of them showed mild to moderate hypercalcemia. The severe hypercalcemia with a blood calcium level of 14.0 mg/dL or more is known to be associated mainly with malignant tumors. Because this is emergency status, most clinicians tried to decrease serum calcium level to near normal range to improve symptoms related to hypercalcemia. A 71-year-old female patient visited the emergency room with dizziness and general weakness. Her serum calcium level was very high (15.6 mg/dL), but serum PTH, 25-OH vitamin D, and PTH related peptide were normal. We can exclude hyperparathyroidism, familial hypocalciuric hypercalcemia, other connective tissue diseases, and hypercalcemia due to malignant tumors as a cause of severe hypercalcemia. Conclusively, we diagnosed as severe hypercalcemia due to high-dose vitamin D injections treated one week ago. High dose vitamin D injections have recently been shown to increase the frequency of prescription as the various causes and the clinicians needed to carefully monitor the serum calcium levels in the patients after treating with high dose vitamin D.

특용자원 닥나무를 활용한 영월 향토음식 개발 연구

이상아(Lee, Sang-Ah) 아시아강원민속학회 2021 아시아강원민속 Vol.36 No.-

예로부터 한지의 원료로 사용되어왔던 닥나무는 경제적 가치를 높게 평가 받아 조선시대 말기 전국적으로 널리 재배를 장려했다.『세종실록』153권 지리지 강원도 원주목 영월군에 기록에 따르면 “토의(土宣)는 기장 · 피 · 조 · 콩 · 보리 · 뽕나무 · 삼 · 배 · 밤 · 칠 · 대추 · 닥나무이다”라는 기록이 있고, 영월읍 거운리의 딱밭굴이라는 지역은 거운리 남쪽 강가에 닥나무 밭이 있어서 붙여진 지명이다. 이런 역사성을 바탕으로 본 연구에서는 특용 자원으로 닥나무를 선택하여 닥나무를 활용한 다양한 지역대표 음식을 개발하여 지역문화콘텐츠로 제시하였다. 이에 본 연구에서는 경제성장으로 소득 수준이 증대된 현 시점에서 무병장수를 원하는 사람들이 많아지는데 외적인 건강과 내적인 건강 모두에 대 한 관심은 바로 웰빙으로 이어지고 있다. 예로부터 한약재로 사용할 정도로 효능이 좋았던 닥나무를 건강보조식품으로 식용화 할 수 있는 방법을 제시하였다. 닥나무는 미백, 항산화, 항암 활성 등에 효과가 있고, 닥나무 열매에 사포닌, 비타민B 및 유지가 다량 함유되어 있다. 잎에는 플라보노이드, 글리코사이드, 페놀류, 유기산, 탄닌, 아미노산의 일종인 GABA(gamma amino butyric acid)가 함유되어 있다. 이런 닥나무의 효능을 바탕으로 닥나무를 첨가한 상품화를 유도한 다양한 향토음식을 개발하였다. 닥나무 식빵, 닥나무 두부, 닥나무 혼합 밀가루를 비롯하여 닥나무 주먹밥, 닥나무 감자수제비, 닥나무 제육 쌈 김밥, 닥나무 닭백숙, 닥나무 돼지고기 수육, 닥나무 코다리찜, 닥나무 황태찹쌀구이, 닥나무 돼지고기 김치볶음 등이다. 본 연구를 통해 개발된 닥나무 상품을 영월지역 특용자원으로 생산될 닥나무와 연계하여 상용화한다면 농산물 생산농가의 부가가치 창출 및 타지 역과의 차별화된 품질의 음식문화를 개발할 수 있다. The mulberry tree, which has been used as a raw material for Korean paper since ancient times, was highly valued for its economic value and was widely promoted nationwide at the end of the Joseon Dynasty. According to the record in Yeongwol-gun, Wonju-mok, Gangwon-do, in Volume 153 of the Annals of King Sejong, “The discussion of discussion is millet, pea, millet, soybean, barley, mulberry, hemp, pear, chestnut, chil, jujube, and mulberry.” There is this area, and the area called Dakbatgul in Geoun-ri, Yeongwol-eup was given the name because there was a field of mulberry trees along the river south of Geoun-ri. Based on this historicity, in this study, mulberry was selected as a special resource, and various regional representative foods using mulberry were developed and presented as regional cultural contents. Therefore, in this study, more and more people want a disease-free long life at this point in time when income levels have increased due to economic growth, and interest in both external and internal health is directly leading to well-being. A method for making mulberry tree, which has been effective enough to be used as a herbal medicine since ancient times, into an edible health supplement was presented. The mulberry tree is effective in whitening, antioxidant, and anticancer activity, and the mulberry fruit contains a large amount of saponin, vitamin B and oil. The leaves contain flavonoids, glycosides, phenols, organic acids, tannins, and gamma amino butyric acid (GABA), an amino acid. Based on the efficacy of this mulberry tree, various local foods were developed that led to the commercialization of the mulberry tree. Paper mulberry bread, mulberry tofu, mulberry noodles, mulberry mixed flour, mulberry rice ball, mulberry potato sujebi, mulberry pork ssam gimbap, mulberry chicken stew, mulberry pork broth, mulberry braised pork belly, mulberry yellow glutinous rice roast, mulberry pork kimchi stir-fry, etc. am. If the mulberry product developed through this study is commercialized in connection with the mulberry tree to be produced as a special resource in the Yeongwol region, it is possible to create added value for agricultural producers and develop a food culture of differentiated quality from other regions.

반성적 시 읽기의 실현을 위한 교수‧학습의 방향 - 아이러니를 중심으로 -

이상아(Lee, Sang-ah) 우리말글학회 2022 우리말 글 Vol.92 No.-

본 연구는 시를 뜻을 이해하고 의미를 해석하는 능동적 시 읽기의 실현을 위해 반성적 시 읽기의 교육적 실현 방안을 모색하였다. 반성적 시 읽기는 시를 읽으며 독자가 마주하게 되는 인지적 부조화로 인한 의미적 공백을 채워가는 과정을 의미한다. 특히 아이러니 시와 같이 표면과 이면의 의미가 다른 경우 시 읽기 과정에의 적극적인 참여는 필수적으로 요구된다. 본고는 그동안 반어와 역설을 변별하는 활동으로 학습되어 온 아이러니 개념을 능동적 시 읽기의 기제로 정의하고 시 읽기와 관련한 교수학습 방안을 활동과 평가 측면에서 살펴보았다. The purpose of this study is to find an educational methods for reflective poetry reading in order to realize active poetry reading that understands the meaning of poetry and interprets the significance. Reflection in poetry reading refers to the process of filling the gaps in meaning caused by cognitive dissonance faced by the reader while reading the poem. In particular, active participation in the poetry reading process is essential when the meaning of the surface and the back is different, such as irony poetry. This paper defined the concept of irony, which has been learned as an activity to discriminate between irony and paradox, as an active poetry reading mechanism, and examined teaching-learning plan related to a poetry reading in terms of activity and evaluation.

문학과 음악에 대한 범교과적 접근

이상아 ( Sang Ah Lee ),김창원 ( Chang Won Kim ) 한국문학교육학회 2016 문학교육학 Vol.0 No.50

본고는 학습자의 사고와 정서 발달에서 필수 불가결한 문화 양식인 문학과 음악에 대하여 범교과적 접근의 가능성을 살피고 연계 방향을 논의하였다. 이들은 매재 및 구성과 소통 방식, 특히 추상적 상징 체계인 언어의 개입 여부에 따라 차이를 지니게 되었지만, 형상적 사유와 상상력을 바탕으로 정서를 자극한다는 점에서 미적인 속성을 공유한다. 문학과 음악을 통한 미적 체험은 인간으로 하여금 잃어버렸던 총체성을 회복하게 한다는 점에서 주관적인 만족에 그치지 않고 사회를 긍정적으로 변화시킬 수 있는 주체를 형성하는 데 기여한다. 이러한 전인적 인간으로의 성장은 교육의 궁극적인 목표이기도 하다. 본고는 위와 같은 목표의 실현에 문학과 음악의 범교과적 접근이 기여할 수 있다는 전제 아래 교육과정 및 교과서의 분석을 통해 그 방향을 가늠해 보았다. 문학과 음악은 본질적으로 시간적 경험의 특성을 지니기 때문에 감상의 진행 과정에서 상호작용하며 미적 체험을 형성할 수 있다. 이는 문학을 음성으로 구현하는 과정에서 음악성을 발견함으로써 일어날 수 있다. 이러한 방향 아래 본고는 학습자가 문학의 언어로부터 발견할 수 있는 음악성에 대해 살피고 문학과 음악의 융합이 학습자 내부에서 총체적인 미적 체험으로 정착될 수 있을 가능성에 대해 논의하였다. Literature and music are the essential components of students` way of thinking and emotional development process. In this study, possibilities of approaching interdisciplinarity and the connection between literature and music will be discussed. These two subjects are different from their own medium, structure, and a way of interacting. However, there also exists a common property that stimulates students` aesthetics based on inspiration and imaginal thinking. Aesthetic experience via literature and music are not only to restore one`s forgotten totality, but also to contribute developing a subject that can change our society in a positive direction. These characteristics related to train mature people correspond to the ultimate goal of education. In this paper, a feasible way which associated with cross-curricular approaches of literature and music education to achieve the goal will be discussed by evaluating a National Curriculum and textbooks. Literature and music are able to interact each other during an appreciation process and form aesthetic experience because two subjects essentially have features of time-based experience. This process of formation can be observed by discovering musicality in the process of reading literature. Under this assumption, in this research, musicality discovered in literature and possibilities of aesthetic experience caused by consolidation of literature and music will be investigated.

운율 교육에서 현대시 읽기 방법의 모색

이상아 ( Lee Sang-ah ) 한국독서학회 2017 독서연구 Vol.0 No.42

본고의 목표는 현대시의 운율을 시 교육에서 활용하기 위한 읽기 방법을 모색하는 데 있다. 운율은 개념 자체가 지닌 혼란에 더불어 국내로 수용되면서 서구의 언어 및 시사(詩史)와의 차이로 인해 명확한 합의가 어려운 용어가 되었다. 본고는 운율 교육의 목표가 지식을 `아는 것`이라기보다 이를 활용하여 시를 읽고 해석할 수 있는 능력 함양에 있다는 데 주목하였다. 따라서 운율을 느끼기 위해 학습자의 시 읽기는 음독 상황을 뜻하는 것이어야 하며, 이러한 음독의 과정에서 시의 전체적 의미와 운율 간의 관계를 찾을 수 있어야 한다는 조건 아래 연구를 진행하였다. 길이와 형태 측면에서 자유로운 확대를 꾀한 현대시 텍스트를 음독하며 학습자들은 의도된 호흡의 패턴을 느낌으로써 시의 의미를 추론해 나갈 수 있다. 이러한 경험은 이후 시의 다양한 운율에 대한 주체적 발견과 해석을 하는 데 유용한 도움을 줄 수 있을 것이다. The aim of this paper is to find a reading method to utilize the rhythm of modern poetry in poetry education. The rhythm has become a difficult term to be defined due to the confusion of the concept itself and the difference between western languages and history of poetry. This paper focuses on the fact that the purpose of rhythm education is not to `know` knowledge but rather to develop a set of abilities to read and interpret poetry. Therefore, in order to sense the rhythm, the learner `s poetry reading should be performed by reading aloud. This research was carried out under the condition that the relationship between the poem` s whole meaning and rhythm should be found in the process of reading aloud. Deducing the meaning of poetry could be achieved by reading aloud modern poetry texts that are free to expand in terms of length and form. By doing this activity, learners are able to taste the intended breathing pattern in the poem. This experience should be useful in helping to identify and interpret the various rhythms of poetry later on.

2015 개정 국어과 교육과정 적용 현황 분석 연구: 초등학교 1~2학년 한글 교육을 중심으로

이상아(Lee Sang Ah),이인화(Lee In Wha) 학습자중심교과교육학회 2019 학습자중심교과교육연구 Vol.19 No.12

이 연구의 목적은 2015 개정 국어과 교육과정이 가장 먼저 적용되고 있는 초등학교 1~2학년의 현황을 파악하여 개정 교육과정의 현장 안착 방안을 마련하는 것이다. 초등학교 1~2학년의 적용 현황을 분석하기 위하여, 확대된 한글교육 시수 운영과 한글 교육 실태라는 두 가지 측면에 주목하고 이에 대해 교사, 학생, 학부모의 의견을 다각적으로 수렴하였다. 의견 수렴은 개정 교육과정에 대한 교사들의 인식 및 실행 실태를 설문조사하고, 다양한 교육적 현상과 그 원인에 대한 질적 분석을 면담을 통해 수행하는 방식으로 이루어졌다. 그 결과, 교사, 학생, 학부모는 한글 교육 시수 확대의 적절성에 공감하고 학년별 교과서 수준도 적절하다고 판단하였으나, 국어과의 한글 사용 수준이 수학이나 통합교과에 비해 낮다고 인식하고 있었다. 또한 교과서에 구현된 한글 교육 방향에 대해서는 긍정적으로 평가하였으나 학생간 한글 학습 수준 차이가 문제로 인식되고 있었다. 의견 수렴에서 제시된 문제점의 해소 방안으로는 창의적 체험활동에 포함되어 있는 학기 초 적응활동 시간을 활용한 한글 교육의 시행과 한글 학습 지원을 위한 다양한 수업 운영 자료의 개발및 보급을 들 수 있다. The purpose of this study is to identify the current status of the 2015 revised Korean language curriculum applied to elementary school 1st and 2nd graders and to prepare a way for the revised curriculum to settle in the field. In this study, attention was paid to expansion of Hangeul education and Korean language education in order to analyze the application status of elementary school 1st and 2nd graders. In order to understand whether the Hangeul education is smoothly performed in these two aspects, opinions of teachers, students, and parents were collected variously. The questionnaire survey was conducted on teachers perception and implementation of the revised curriculum, and the qualitative analysis of various educational phenomena and their causes was conducted through interviews. As a result, teachers, students, and parents agreed with the appropriateness of expanding Hangeul education hours and judged that the grade level textbooks were appropriate. However, it was recognized that the use level of Hangeul in Korean language was lower than that of mathematics or integrated subject. In addition, although the direction of the Hangeul education implemented in the responding textbook was evaluated positively, it was recognized that the difference of the level of the Hangeul learning was a problem. In order to solve the problems of unequal distribution of the achievement criteria and hierarchy setting, the following alternatives can be sought. First, it concentrates on Hangeul education using the adaptation activity time included in the creative experiential activities. Hangeul learning can enhance learning efficiency because it is the foundation of other subject learning. Second, it is necessary to develop and disseminate a variety of instructional materials for Hangeul education.

생태시의 융합적 성격과 창의성

이상아(Lee, Sang-Ah),윤여탁(Yoon, Yeo-Tak) 문학과환경학회 2014 문학과 환경 Vol.13 No.2

This study aims to reveal convergent characteristics and creativity of Eco-poetry. Existing studies on convergence of science and art understand nature as a subject which has an objective truth understandable through scientific methodology. It has been identified that this point of view is opposed to the world-view of art which focused on aesthetic judgement and figuration of nature. There have been some attempts recently to blur such conflictual distinction and communicate across the borderline, but there was a limit to that convergence as it was based on the existing way of thinking of science. This study is about ecological literature as science being integrative, which believes that ecology is an alternative to an inflexible definition of existing science and accordingly has been influenced by ecology. This study gives an example of the convergence of science and art, in particular, mainly with Eco-poetry. Along with that, it gives shape to meaning of convergent aspect of Eco-poetry by deriving creativity of that characteristics.