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.

신장이식 환자에서 HCMV 항원혈증 검사의 임상적 유용성

김탁,성흥섭,박관태,김송철,김성한,최상호,김양수,우준희,박수길,한덕종,이상오 대한감염학회 2009 감염과 화학요법 Vol.41 No.2

Background : This study was performed to determine the cut-off value and the predictability of symptomatic human cytomegalovirus (HCMV) infection according to the peak value of HCMV antigenemia assay in kidney transplant recipients. Materials and Methods : We reviewed the results of HCMV antigenemia assay (Chemicon, CA, USA) in patients who received kidney transplantation at our institution from May 2003 through May 2008, and investigated the existence and the type of HCMV infection by the medical record review. Patients who underwent the test only once during the episode or those who received ganciclovir for more than 48hrs before the test were excluded. The receiver-operator characteristic curve was drawn and the point showing maximum likelihood ratio (LR) was chosen as the cut-off value of symptomatic HCMV infection. Results : A total of 689 episodes were screened and 134 episodes were enrolled. Thirty-three (24.6%) episodes were symptomatic HCMV infection, 23 (17.2%) episodes were associated with HCMV syndrome, and 10 (7.5%) episodes were tissue-invasive diseases. The maximum LR was 7.5 (95% confidence interval, 4.014.2) and the cut-off value was 29.5 cells/200,000 WBC. The sensitivity, specificity, Positive predictive value, and negative predictive value were 66.7%, 91.1%, 71.0%, and 89.3%, respectively. Conclusions : The cut-off value of symptomatic HCMV infection by the peak value of HCMV antigenemia assay in our study was similar with previous results, although the sensitivity was relatively low.

소에서 盲腸擴張을 동반한 第4胃食滯 手術 1例

김명철,김덕환,신상태,임준호,김남중,김종만 충남대학교 수의과대학 동물의과학연구소 1998 動物醫科學硏究誌 Vol.6 No.-

Abomasal impaction with cecal dilatation was diagnosed in a 3 years old holstein cow. The clinical signs were loss of appetite, scant feces and moderate distension of the abdomen. Ping sound was revealed in the right 11th intercostal space by auscultation. Cecal dilatation and abomasal impaction were ascertained by right flank laparotomy and abdominal exploration, and intestinal content and gas were removed from the cecal apex incised. One day later, 2.5㎏ of sand was removed by ventral paramedian abomasotomy.

정재의 시대적 변천과 전승보급에 관한 연구

김상덕(Kim Sang Duck) 한국체육철학회 1997 움직임의철학 : 한국체육철학회지 Vol.5 No.1

Chong-Jae as a court dance is dedicated to the king. That means contributing talent. It originated grom the shape of court dance music under the control of professional department, and was named 「bang Ark and Hayng Ark」 and 「A-Ark Chong Jae」 has the genre as a dance. In the times of 「Korea」, the respect of Buddism made a present to the king customary, directed to inflew 「Sin Ark of the sung」 and 「Tae Song A-Ark」, and the sting contribute organized The department of court music of the tang, which modified to be in harmony with our people`s emoting, dance and music admired the great achievement of the founding country, prayed the national peace in the early of 「Cho-Sun」 era. So to speak, It developed to make a display of the kings authority. And the completing of 「Hoonmin Jong um」 dirceted Chang Sa, which use 「Korea and Chinese characters in combingation. Since, the early of the 「Cho-Sun」 dynasty, the golden age of the civilization, the dance and music declined, and not reached the level of the first stage. It caused by the much invasion of the Japanese and with the help of the political and economical peace of the king Sook Jong, the court music revived under the rale of the King 「Young Jong」. To the modes ages from the king 「Soon Jae」, there was np dance and music system, introduced 「Chong Jae」, as it is, and became extinct Since the annexation of the Korean and Japan. And, 「Lee Wang Jik」 court dance department renamed court dance department, opened the national classical music institute in 1951. With the designation as a 「Intagible cultural assets」, the modern full-dresses reappearance of 「Chong Jae」 accomplish by 「Kim Chon Heng」 as a 「Chong Jae」 reappearance choregrapher theagh the performance of the national classical music Institute. This work of the reapperarcne done by the national classical music institute must be estimatel affirmatively. As a researcher, I examined the inflow and conservation theroughout the times with the process of historcal changes of 「Chong Jae」, according to the creative Korean dance and the flood of the inflow of foreign culture, I made some conclusion on the pressevation and transmission of 「Chong Jae」. First, the recognition both school education and the institytional system in the national -public organization must direct the chance of various learning in view of the preservation and trancsmission of 「Chong Jae」. Second, the estrangement of court dance on the ceremony of dnace in the dance stage and students dance contest, a group of positive participation must be groped. Third, there is dnace which designation 「intangible cultural assents」 in 「Chong Jae」. Especially, Ovserng the dance of a group 「Chong Jae」, composition dance equipment, I feel sure that It will help the exploitation of various composition, dance, properties and device in the scope of the stage effection in the 「ceremony of the korean creative dance」. In the view of inheriting and tradition the reappearance, reviral, transmiting and spread of 「Chong Jae」 have the meaning as it is. The reappearance and revival must be developed top the arctic value which is in harmony with the present age, consider the internationalization and globalization and Institutional devices are essential to hand it down to poeterity as a research naterials and a concera to cultural art is indispensible.

단일공법 복강경하 질식자궁절제술 110예의 고찰 및 다공법과의 비교

박병준 ( Byung Joon Park ),김용욱 ( Yong Wook Kim ),노덕영 ( Duck Yeong Ro ),김태응 ( Tae Eung Kim ),류기성 ( Ki Sung Ryu ),김장흡 ( Jang Heup Kim ) 대한산부인과학회 2010 Obstetrics & Gynecology Science Vol.53 No.7

목적: 통상적인 복강경기구만을 사용한 단일공법 복강경하 질식자궁절제술을 다공법 복강경하 질식자궁절제술과 비교하여 안전성 및 유용성을 평가하고자 하였다. 연구 방법: 2007년 4월부터 2009년 11월까지 인천성모병원에서 자궁근종 또는 자궁샘근증의 질환으로 단일공법 복강경하 질식 자궁절제술을 시행받은 환자 110명과 다공법 복강경하 질식자궁절제술을 시행받은 환자 110명, 총 220명의 환자를 대상으로 하였다. 우리는 모든 수술에서 통상적으로 사용되는 구부러지지 않는 일직선의 복강경기구를 사용하였다. 또한 단일공법 및 다공법 복강경하 질식자궁절제술 둘 다에서 수술자 (Kim, YW)의 이름을 따서 명명한 새로운 질단부 봉합 방법인 김씨 질구개 현수법 (Kim`s Vaginal Vault Suspension Method)을 사용하였다. 결과: 환자 나이, 수술 시간, 자궁의 무게, 혈색소 수치의 변화, 수혈 빈도, 수술 후 발열에서 두 군 간에 유의한 차이를 보이지 않았다. 환자들의 평균 나이는 46.7±7.0세(단일공법)와 45.5±6.3세(다공법)이었다. 평균 수술 시간은 87.2±21.0분(단일공법)과 83.3±20.3분(다공법), 평균 자궁의 무게는 261.4±139.7 g(단일공법)과 257.8±132.9 g(다공법), 평균 혈색소 수치의 변화는 1.1±0.7 g/dL(단일공법)와 1.2±0.6 g/dL(다공법)이었다. 두 군 모두에서 수술 중 장 또는 요로의 손상은 없었다. 두 군 모두에서 각각 한 건의 개복수술로의 전환이 있었다. 단일공법을 시행한 군에서 입원 기간이 유의하게 짧았다(2.6±0.6일 [단일공법], 3.3±0.7일 [다공법], P<0.05). 결론: 통상적으로 사용하는 구부러지지 않는 일직선의 복강경기구를 이용한 단일공법 복강경하 질식자궁절제술은 다공법 복강경하 질식자궁절제술에 대한 안전하고 유용한 대체 수술이 될 수 있다. Objective: To evaluate the safety and feasibility of single-port access laparoscopically assisted vaginal hysterectomy (SPA-LAVH) using conventional laparoscopic instruments compared to multi-port access laparoscopically assisted vaginal hysterectomy (MPA-LAVH). Methods: We reviewed the medical records of 220 patients with uterine leiomyoma or adenomyosis who underwent 110 SPA-LAVH and 110 MPA-LAVH in Incheon St. Mary`s Hospital between April 2007 and November 2009. We performed SPA-LAVH with conventional rigid straight laparoscopic instruments in all cases. We also performed a new vaginal cuff closure method, Kim`s Vaginal Vault Suspension Method, named after the operator (Kim, YW) in both SPA-LAVH and MPA-LAVH. Results: There was no significant difference in patients` age, operating time, uterine weight, hemoglobin change, frequency of blood transfusion, and incidence of postoperative fever between the two groups. The patients` mean age was 46.1±7.0 years (SPA-LAVH) and 45.5±6.3 years (MPA-LAVH). The mean operating time was 87.2±21.0 minutes (SPA-LAVH) and 83.3±20.3 minutes (MPA-LAVH). The mean uterine weight was 261.4±139.7 g (SPA-LAVH) and 257.8±132.9 g (MPA-LAVH). The mean hemoglobin change was 1.1±0.7 g/dL (SPA-LAVH) and 1.2±0.6 g/dL (MPA-LAVH). Neither bowel injury nor urinary tract injury occurred during the operation in the two groups. One of the SPA-LAVH and one of the MPA-LAVH cases were converted to abdominal total hysterectomy. The mean hospital stay time was shorter with SPA-LAVH (2.6±0.6 days [SPA-LAVH] and 3.3±0.7 days [MPA-LAVH], P<0.05). Conclusion: SPA-LAVH using conventional rigid straight laparoscopic instruments can be offered as a safe and feasible alternative to MPA-LAVH.

허혈심근에서의 퓨린성 및 콜린성 작동제의 심근보호 작용

김재하,박상덕,주정민,국현,조정관,박옥규 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.7

참여주체간의 현장실습제도에 대한 인식차이 설문조사 연구

金相吉,李相鎬,趙德浩 한밭대학교 산업과학기술연구소 2001 논문집 Vol.5 No.-

The main purpose of this study is to investigate and analyze the perceptional differences between major participants for the Sandwich System. The participants of the study are students, faculty members for the Division of Advanced Materials Engineering in the Taejon National University of Technology(TNUT) and employers, taken part into the program for the second semester of 1999 school year. The study shows that students are not satisfied with the employers for their planning and preparation of the program, on the job program, their educational philosophy of the program, etc. But students are satisfied with the employer for their professional knowledge of the subject field, methodology of training, assessment for the students, and so on. Students are agreed on 7 out of 12 questions, but disagreed 5 items. Students are evaluated themselves in two ways. They said that they worked hard, kept time well, did assignments well. But they said that they did not have communication channels with their faculty members before the program, they were worried about accidents during the work, and others. This article pinpoints that faculty-members need to have good communications with their students in selecting the employer and placing the students. The paper also stresses the importance of administrative organization for the program in the university. The study suggests that the government has to amend the law and regulations for the betterment of the program.

레이저 계측에 의한 맞대기 용접부의 스트레인 측정

성백섭,차용훈,박창언,김일수,김덕중,이연신,손준식 한국공작기계학회 2001 한국공작기계학회 춘계학술대회논문집 Vol.2001 No.-

Currently knowledge of strain in welds has mainly been obtained from strain gaging method; that is directly attaching most of the material to the gage. The very few non-contact method are still in the early stage. One of the non-contact methods is by the use of the laser that has high-level of the accuracy for the measurement, and this laser also has excellent characteristics on which many studies for its applications are focused throughout the many fields. The dissertation is on the measurement of the strain caused by the characteristics and the temperature changes of the TIG welded zone which is used with 3D ESPI system that is functionally modified through the laser ESPI system. This system employed the aluminum sheet-metal which are mainly used for the steel plate such as for the electronics, chemistry, food instrument and electronic appliances.

2-[(4-Cyanophenyl)amino]-3-chloro-1,4-naphthalenedione (NQ-Y15)의 돌연변이원성

김봉희,정기화,유충규,창동신,이기선,전선덕,소동수,채상호,문창규 德成女子大學校 藥學硏究所 2001 藥學論文誌 Vol.12 No.1

2-[(4-Cyanophenyl)amino]-3-chloro-1, 4-naphthalenedione (NQ-Y15) was asssayed for its genotoxic potential by using Salmonella typhimurium reversion assay and in vitro chromosome aberration test on Chinese hamster lung cells. In the Ames test, NQ-Y15 induced his+revertants of Salmonella typhimurium TA 98 and TA 1537, reaching levels twice the negative control values. But, NQ-Y15 induced only his+revertants of Salmonella typhimurium TA 1537 more than twice the control values under the condition with metabolic activation system. In the cytogenetic test on chinese hamster lung cells. NQ-Y15 showed significant chromosomal aberrations, but the incidence was significantly reduced in the presence of metabolic activation.

ACSR 가공지선의 부식 특성(I) : 염수분무시험 Salt-Water Spray Test

김성덕,심재명,정재기 大田産業大學校 1996 한밭대학교 논문집 Vol.13 No.1

The corrosion and deterioration of ACSR(Aluminum Stranded Conductors Steel Reinforced) is mainly caused by atmospheric pollutants and contaminants, and then, the remaining life of the transmission components can be determined and analyzed through these chemical reactions. Especially, overhead ground wires which protect transmission system from ligthning strokes or abnormal current induced from the conductors, may be rapidly degraded with age by atmospheric environment. Some corrosion processes of ACSR overhead ground wires are disscused. To simulate the atmospheric and galvanic corrosion phenomena for ACSR located at a coastal area, salt-water spray test for new samples are performed in a laboratory. Several mechanical properties such as loss of tensile strength of galvanized steel and aluminum strands, torsional number and loss of zinc contents are analyzed. Furhermore, electrical characteristics for the samples are also presented. Such results of this study to verify the corrosion process for ACSR ground wires at a consul area may be provided a guideline for determining a correlation between chlorite corrosive environment and degree of corrosion.