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.

현훈 환자 Neuron Specific Enolase의 임상적 의의

김원주,김선곤,유철형,김원찬,김용덕,최영철,이명식 대한신경과학회 1998 대한신경과학회지 Vol.16 No.4

딤플을 적용한 평판에 대한 항력 감소 연구

백부근(Bu-Geun Paik),편영식(Young-Sik Pyun),김준형(Jun-Hyung Kim),김경열(Kyung-Youl Kim),김기섭(Kim1 ?Ki-Sup),정철민(Chul-Min Jung),김찬기(Chan-Ki Kim) 대한조선학회 2012 大韓造船學會 論文集 Vol.49 No.4

정신분열병 및 정신분열형 장애에 대한 올란자핀의 효과와 안전성

안용민,강대엽,권준수,김창윤,김철응,반건호,신영민,이기철,이동우,이중서,조현상,채정호,김용식 大韓神經精神醫學會 2001 신경정신의학 Vol.40 No.4

연구목적 : 본 다기관 공동임상연구는 국내 환자를 대상으로 새로운 항정신병약물인 올라자핀의 치료 효과와 안전성을 확인하고자 시행되었다. 방 법 : 1999년 7월부터 2000년 3월까지 국내 10개 병원에 방문한 정신분열병 및 정신분열형 장애 105명을 대상으로 비대조 개방 임상연구를 시행하였다. 중등도 이상의 정신병 증상을 지니거나, 부작용으로 약물교체가 필요한 경우 또는 기분장애 증상의 치료가 필요한 환자를 대상으로 하였다. 2∼7일간의 약물 배설기간 후에 1일 10mg의 올란자핀을 투여하였고, 이후로 3∼7일 간격으로 용량을 조절하여 총 8주간 투여하였다. 치료 효과는 PANSS(Positive and Negative Syndrome Scale), BPRS(Brief Psychiatric Rating Scale), CGI(Clinical Global Impression-Severity), MADRS(Montgomery-Asberg Depression Rating Scale), HAM-A(Hamilton Rating Scale for Anxiety)로 판정하였다. 안전성 평가는 자발적인 이상반응 보고, 활력징후와 혈액 검사 및 SAS(Simpson-Angus Scale), BARS(Barnes Akathisia Rating Scale), AIMS(Abnormal Involuntary Movement Scale)척도를 이용하였다. 결 과 : 105명중에서 85.7%인 90명이 8주간의 치료를 완료하였다. 평균 최빈 용량은 일일 16.1(±4.7)mg이었고, 종료시점에서의 BPRS전체 점수가 기저 상태에 비해 40%이상 감소된 반응군은 69.5%이었다. PANSS의 양성 증후군과 일반정신병리 뿐만 아니라 음성 증후군 소척도에서도 유의한 감소를 보였으며, 이 감소들은 치료 초기부터 나타나서 8주간 지속되었다. 43.8%의 피험자가 중등도 이상의 우울증상을 같이 지니고 있었으며, 올란자핀에 의해 MADRS와 HAM-A가 유의하게 감소하였다. 치료 기간 동안에 활력징후에는 뚜렷한 변화가 없었으나 체중은 8주간 지속적으로 증가하였다. SAS와 AIMS는 감소하였으며, 정좌불능증을 제외한 나머지 추체외로 증상의 발생비율도 낮았다. 임상적인 증상이나 징후를 동반하지 않는 ALT/SGPT의 상승을 보였지만 프로락틴을 포함하는 대부분의 혈액 검사상 뚜렷한 이상 변화는 없었다. 결 론 ; 비록 본 임상연구가 비대조 개방 임상연구로서 많은 제한점을 가지고 있지만, 올란자핀이 기존 약물에 내약성을 보이거나 기분증상을 동반하는 정신병에 치료 효과가 있었다. 그리고 기존 항정신병약물 치료시에 문제가 되었던 추체외로 증상과 고프르로락틴 혈증을 포함하는 대부분의 부작용면에서 안전성을 보여 주었다. Objective : This multicenter clinical trial was carried out to investigate the efficacy and the safety of olanzpine for the treatment of Korean patients. Mothod : 105 patients with schizophrenia and schizophreniform disorder, visited at 10 mental or university hospitals, had received an open and non-comparative treatment with olanzapine for 8 weeks. Patients had psychotic or depressive symptoms with the severity above moderate degree or intolerable side effects to previous antipsychotics. After a wash-out period of 2-7 days, 10mg olanzapine was prescribed initially to all the patients, and then the dosage could be adjusted within the range of 5-20mg/day of olanzapine by 3-7 days. Results : 90(85.7%) of 105 patients completed the 8-weeks trial and the mean modal dose of olanzapine was 16.1(±4.7%)mg/day. At the end of the trial, 73 patients(69.5%) were classified as responder, which was defined as 40% or more improvement in BPRS(Brief Psychiatric Rating Scale) score comparing to baseline. There was a significant reduction in the scores of PANSS(Positive and Negative Syndrome Scale)and subscales including negative symptom scores and CGI. Also weekly analysis showed that the reductions in scores were kept on for the whole period of the trial. 43.8% of all the patients had depressive symptoms at the baseline and total scores of MADRS(Montgomery-Asberg Depression Rating Scale) and HAM-A(Hamilton Rating Scale for Anxiety) were also reduced after the trials. Vital signs revealed no clinically significant changes but continuous weight gain was observed during the treatment with olanzapine. The scores of SAS(Simpson-Angus Scale) and AIMS(Abnormal Involuntary Movement Scale) for assessing the EPS(extrapyramidal symptoms)and tardive dyskinesia respectively were significantly decreased and only a few patients reported EPS as adverse events. Although mild and clinically non-significant of ALT/SGPT was observed, most laboratory parameters including plasma prolactin level showed to significant changes during the trial. Conclusions : Although this trial had many limitations because it was a non-comparative and open study, olanzapine showed high efficacy on the positive, negative and depressive symptoms in schizophrenia and schizophreniform disorder.In addition to that, olanzapine showed a substantially favorable safety profile, such as low incidence of EPS and hyperprolactinemia.

Proportion And Characteristics Of Transient Nodules In A Retrospective Analysis Of Pulmonary Nodules

( Jin Yeong Yu ),( Su Young Chi ),( Hee Jung Ban ),( Yong Soo Kwon ),( In Jae Oh ),( Kyu Sik Kim ),( Yu Il Kim1 ),( Sung Chul Lim ),( Song Choi ),( Yun Hyeon Kim ),( Young Chul Kim ) 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.-

반도체 교육용 집적회로의 개발

金鐵柱,金榮祚,金禧植 서울市立大學校 1991 論文集 Vol.25 No.-

For integrated circuit fabrication process compatible with education and R & D purpose, its period must be shortened and its yield must be satifactory, too. For this purpose, this study carried out minimized 4-film masks, hence the fabrication process period was shortened. 4-film mask I.C fabrication is processed during 40 hours, containing MOSFET of various W/L, resistors, diodes, ring-oscillator. The threshold voltage of p-n junction diode is about 0.7[V] and the resistivity of polysilicon for self-aligned gate electrode is less than 10-³[Ωcm]. This paper contains the diffusion profile, thin film growth condition using electrical furnace and CVD system, wet and dry etching condition of the growth thin film, I-V, and C-V characteristics of MOS Transistor fabricated in this process. In MOS Transistor, the leakage current of gate oxide and various charges in the interface between gate oxide and silicon substrate are proposed as the most important problem, but these problems are overcome by repeated experimentation. MOS Transistor using AEO as an example of research experimentation have characteristics prior to the case using general dry oxidation gate.

신경인성 방광 1례에 대한 임상고찰

김만호,이지영,이정원,조충식,김철중 대전대학교 한방병원 2002 惠和醫學 Vol.11 No.1

From January 10th 2002 to February 17th 2002, the clinical study was carried out I case of patient in trouble with voiding difficulty such as urinary incontinence, enuresis and urinary frequency after the L₄-L_(5) HN P operation, who had been hospitalised in the Dept. of Internal Medicin e, Cheon-An Oriental Medical Hospital, Daejeon University. The results were as following 1. For this case, we could get the better result using Bo-Joong-lk-Gi-Tang(補中益氣湯) in the treating period. 2. We could get the effective result that the case of voiding difficulty after HNP operation and cerebral infarction by conservative therapy of oriental medicine such as acupuncture, moxibustion and herb medicine.

전자선 증착장치 및 ITO 박막의 제작과 그 특성에 관한 연구

김수길,최범식,우정주,고년규,황정남,정원모,이철주 연세대학교 자연과학연구소 1982 學術論文集 Vol.9 No.-

태양 전지의 제작시 투명 전극막으로 쓰이는 ITO 박막을 제조하기 위하여 cathode 접지 방식의 전자총을 가진 정전 편향 집속형의 전자선 증착 장치를 제작하였다. 가속전압이 0∼15kV, 필라멘트 전류가 0∼28A, 두 전극판 사이의 간격이 11mm, anode와 deflector 사이의 간격이 30mm인 최적 실험조건하에서 생성된 전자선 spot의 크기는 길이가 20mm 폭이 1mm였으며, 전자선의 출력은 약 400W였다. 이 전자선 증착 장치를 이용하여 1600℃까지의 증발 온도를 가진 도체와 절연체 등을 쉽게 증착시킬 수 있었으며, 만드어진 ITO 박막은 약 5000Å의 두께에서 10^-1∼10^-2Ω·㎝의 비저항과 95%의 광투과율을 갖는다. An electron beam evaporator with a cathode grounded type electron gun was designed and constructed in order to deposit ITO thin films for photovoltaic applications. The optimum condition was observed with electode spacing of 11mm, 30mm between anode and deflector, a cathode inner diameter of 3mm and an anode inner diameter of 5mm. As the accelerating voltage varies from 0 to 15kV and ghe filament current from 0 to 28 A, the minimum electron beam spot has a 20mm length, and 1mm width and the output power ranges from 0 to 400W under the above optimum conditions. We can deposit materials whose evaporation temperature is over 1600℃ using this evaporator. And as a result ITO thin film showed a low resistivity of 10^-1∼10^-2Ω·㎝ and the transmittance of 95%.

확산강조 자기공명영상에서 양측 해마에 작은 고신호 강도 병변을 보인 일과성 전기억상실증 1예

김희철,김경식,손철호 大韓神經精神醫學會 2007 신경정신의학 Vol.46 No.5

We report on a patient with transient global amnesia (TGA) showing increased tiny signal intensities at the head of both hippocampi on diffusion-weighted image (DWI) performed on the second day after the onset of symptoms. The T1-weighted image using 3-tesla magnetic resonance imaging (MRl) showed no signal changes, but the T2-weighted image showed slight signal changes at the same portion of both hippocampi. Single photon emission computed tomography (SPECT) performcd on the 4th day after the onset of TGA showed no perfusion abnormalities. This patient experienced an extreme emotional stress before the onset of TGA, and the patient's TGA started by a simultaneous Valsava-like maneuver. We discuss the venous Congestion/ischemia hypothesis for TGA. This case confirms that DWI is a sensitive and useful tool for evaluating the early stage of TGA.

한국형 주정중독 선별검사 마련을 위한 예비적 연구(Ⅰ)

김자성,이철원,김용식 大韓神經精神醫學會 1989 신경정신의학 Vol.28 No.3

This study was done as a preliminary step for the development of Korean Alcoholism Screening Test. 4 Diagnostic criteria were applied to alcoholic in-patients and normal persons, and the difference between the diagnostic rates was studied. We differentiated the non-admitted alcoholic group and the alcoholic inpatient group from the normal sample, and compared these three groups. Non-admitted alcoholic group was assumed to be valid to be diagnosed alcoholics when they satisfied all four criteria. The number of non-admitted alcoholic group was about 12% of normal sample. The non-admitted alcoholic group(NA) was similar to alcoholic inpatient group(AA) in regard to the frequencies of drinking but the amount of drinking was estimated to locate between the AA group and NN group(Normal) but with no statistical significance. In applying the diagnostic criteria with the same original cut-off score, there were many false positives even with the most critical criteria. We could have detected some items to be meaningfully correlated with each group as the result of multiple regression analysis, and examined those items in relation to each group. The guilt factor which had been considered to be suggestive of alcoholics' response was found to be more related to normal peoples. We suspect this factor might contribute to guard the normal people from indulging in the problematic drinking habit. We could not conclude the NA group would develop into the AA group, but could estimate that NA group was transitional from NN to AA in regard to the alcohol amount and age. After having discussed some points about denial tendency or defenses of alcoholic group, we proposed some points for the development of Korean Alcoholim Diagnostic Criteria.