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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.
임신 종결 후 발생한 자궁 동정맥 누공에서 자궁동맥색전술로 치료한 1예
김종민,이해혁,김태희,남계현,심일구,이권해,김형문,이임순,장종호 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2
Arteriovenous fistula of uterus is rarely reported disease. This vascular malformation is very dangerous condition because Dilatation & curettage can cause massive uterine bleeding without accurate diagnosis. The diagnosis is made by angiography, gray scale ultrasonography, color and duplex doppler ultrasonography, computed tomography, and magnetic resonance imaging is helpful. Especially color and duplex doppler ultrasonography is allows convincing detection and diagnosis of arteriovenous fistula. Recently transcatheter uterine artery embolization is treatment of choice. We have experienced a case of arteriovenous fistula of uterus. Which is presented with a brief review of literature.
여호와의 증인 환자에서 산과적 출혈 후 무수혈 치료 2예
김재령,여소진,이해혁,김정식,김태희,남계현,이권해,이임순,박진화,황경호 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2
Jehovah's Witness comprise a unique obstetric population. Their refusal of blood stems from an interpretation of a literal translation of the Bible, and it is this belief that puts them at an increased risk of morbidity and mortality if hemorrhage occurs. We report two cases of a Jehovah's Witness who bled massively due to obstetric hemorrhage, refused blood transfusion and had profound anemia. The patients were treated with recombinant human erythropoietin, parenteral iron and oxygen. And they were treated on an intensive care unit with intermittent positive pressure ventilation. We reviewed with literature considering the therapy for acutely anemic patients who refuse transfusion to decrease the duration of the most severe anemia.
Assessment of In Vitro Assay System for Thyroid HormoneDisruptors Using Rat Pituitary GH3 Cells
Hee Jin Kim1,Hae Young Park1,Jeonga Kim1,Il Hyun Kang2,Tae Sung Kim2,Soon Young Han2,Tae Seok Kang2,Kui Lea Park2,Hyung Sik Kim1 한국독성학회 2006 Toxicological Research Vol.22 No.4
The development of in vitro assays has been recommended to screening and test-ing the potential endocrine disruptors (EDs). These assay systems focus only on identifying thethe thyroid hormone (TH) disruptors. The aim of this study was to evaluate a test system to detectTH disruptors using rat pituitary tumor GH3 cells. The test system is based on the TH-dependentincrease in growth rate. As expected, L-3,5,3-triiodothyronine (T3) markedly induced a morphologicalchange in GH 3 cells from flattened fibroblastic types to rounded or spindle-shaped types. T3 stimu-lated GH3 cell growth in a dose-dependent manner with the maximum growth-stimulating effect9 M. In addition, T3 increased the release of growth hor-mone and prolactin into the medium of the GH3 cells culture. Using this assay system, the TH-dis-rupting activities of bisphenol A (BPA) and its related compounds were examined. BPA,dimethylbisphenol A (DMBPA), and TCI-EP significantly enhanced the growth of GH3 cells in therange of 1 × 10-5M to 1 × 10-6M concentrations. In conclusion, this in vitro assay system might bestandardization before it can be used as a broad-based screening tool.
충전용 글라스 아이오노머 시멘트의 시간경과에 따른 불소용출
김해규,김현정,남순현,김영진 慶北大學校 齒科大學 1990 慶北齒大論文集 Vol.7 No.1
The purpose of this study was to evaluate the pattern and quantity of fluoride release from four commercial glass ionomer filling cements and silicate cement. 10 specimens was made from each group, and the fluoride ion concentration was estimated by fluoride electrode during each 2days over a 30 day period. The results were as follows : The glass ionomer cements released considerable more fluoride during each of the first 12 days than during each of the subsequent 18 days. The continued release did not decrease very much with time. The fluoride release of Ketac-Fil cement was higher than that from silicate, but the fluoride release of other experimental groups was similar to or lower than that of silicate cement. The average amount of fluoride released during the 2 day to 30 day periods was somewhat different among the same type of ionomer cements. J. Kyungpook Univ. Sch. Dent. Vol. 7, No. 1, 61∼59, 1990
김찬식,강순선,오명협,현해남 濟州大學校亞熱帶農業硏究所 1996 亞熱帶農業硏究 Vol.13 No.-
SummaryDistributions of actinomycetes, bacteria, and fungi were examined in citrus house and field soils sampled from volcanic ash soil area. pH, electrical conductivity, and exchangeable K, Ca, and Mg content in citrus house soil were higher than them in citrus field soil, however, total nitrogen content in citrus house soil is lower than that in citrus field soil.Number of total microorganisms in citrus house soil was about 3.1×105, which was 10 times lower than that in citrus field soil, and also that was remarkably lower than similar group of volcanic ash soil in cultivating and upland soil. Number of actinomycetes and bacteria in citrus house soil were similar to citrus field soil, however, that of fungi in citrus house soil was lower than that in citrus field soil.Electical conductivity and Bray No. 1 P in citrus field soil and pH and exchangeable Mg content in citrus house soil were positively correlated with distribution of actinomycetes in soils and Bray No. 1 P in citrus field soil and exchangeable Mg content in citrus house soil were negatively correlated with distribution of fungi in soils Keywords : volcanic ash citrus orchard soil, soil chemical property, actinomycetes, bacteria, fungi in soils
김용진,이충일,이해혁,남계현,이임순,이권해 순천향의학연구소 1996 Journal of Soonchunhyang Medical Science Vol.2 No.2
Ovarian pregnancy is an uncommon form of the ectopic pregnancies. The ovarian vascularity results in maternal hemorrhage early in the first trimester, which disrupts the pregnancy and usually ruptures the ovary with sufficient hemoperitoneum to require emergency operation. This report presents 10 cases of ovarian pregnancy by retrospective review between January 1986 and December 1995 at the Department of Obstetrics and Gynecology, Soonchunhyang University Hospital. There was 19,849 deliveries and 637 ectopic pregnancies during same period. It showed that the incidence of ovarian pregnancy was 3.21 % of all ectopic pregnancies. The clinical features of ovarian pregnancy revealed that abdominal pain was the major symptom, and history of amenorrhea was obscure. Because of life-threatening course, the early diagnosis and treatment of ovarian pregnancy is important. The clinical diagnosis of ovarian pregnancy was more difficult than that of tubal pregnancy.
골반 초음파 감시 하에 16 Gauge Angioneedle™을 사용하여 치료적 더글라스와 천자를 시행하여 치유된 복강 내 출혈 1예
김미영,이해혁,유애리,박정희,이임순,정수호,레앙소팔,배동한,김태희,이권해 순천향의학연구소 2008 Journal of Soonchunhyang Medical Science Vol.14 No.1
Culdocentesis is a procedure that checks for abnormal Quid in the space just behind the vagina (cul-de-sac). First, a pelvic examination is done. Then, after exposing the postehor vaginal fonix with a bivalve vaginal speculum the posterior lip of the cervix is grasped with a tenaculum. The cul-de-sac is then entered through the postehor vaginal wall with an 18-20 gauge needle with a syringe inserted. As the cul-de-sac is entered, suction is applied, and the intraperitoneal contents are aspirated. In the recent past, culdocentesis was commonly used in the evaluation of a vahety of common intraperitoneal conditions, principally, the hemorrhage associated with ectopic gestations and ruptured ovarian cysts the presence and/or drainage of purulent associated with pelvic inGammatory disease, and as a screening procedure to facilitate early diagnosis of ovarian neoplasms. Usually 16-18 gauge needle with a syhnge attached was used for culdocentesis. But we have experienced a case of therapeutic culdocentesis with 16 gauge angioneedle in patient of hemoperitoneum. So, report it with a bhef review of literature.
문제중심학습(Problem Based Learning; PBL) 패키지 개발 : 지각·조정장애상황을 중심으로
김애리,김영경,송영선,신경림,안혜정,이지순,조계화 성인간호학회 2001 성인간호학회지 Vol.13 No.3
The Purpose of this study is to present an actual example for procedures for developing a PBL package based on philosophical backgrounds derived from Problem-based learning. To perform a systemic study on the operations of an intergrated curricula under multi-disciplines, a research team made up of several professors with different academic backgrounds was formed. Among the four situations for the patients with perception-adjustment disorder, especially a procedure for the development of PBL package which can be used in the emergency room situation has been proposed. The little(2000)'s PBL package model has been applied for this study. Tha package includes course objectives, learning objectives, concept map, situation scenario. tutor guide, and evaluation method. It is believed that learning objectives achievement procedures designed as a part of a problem-based learning package development procedures for the nursing of patients with perception-adjustment can be achieved at the same level as the learning objectives for the science of nursing founded by the Korean Nurses Association.