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.

중학교 과학 수업에서 교사와 학생의 언어적 상호작용 분석

최경희,박종윤,최병순,남정희,최경순,이기순 한국과학교육학회 2004 한국과학교육학회지 Vol.24 No.6

이 연구의 목적은 중학교 과학 수업에서 교사와 학생간의 언어적 상호작용이 실제로 어떻게 이루어지고 있는지를 관찰ㆍ분석하여 이에 대한 특징을 추출함으로써 과학 수업에서 교사와 학생간의 언어적 상호작용에 대한 기초 자료를 제공하는데 있다. 이를 위해 수업 분석 준거를 개발하였으며, 8명의 과학 교사의 수업 12차시를 관찰 및 녹화하였으며, 교사와의 면담을 실시하였다. 수업 분석 결과, 관찰한 과학 수업에서 교사와 학생간의 언어적 상호작용은 주로 교사의 단순 확인/기억 질문, 학생의 단답형 응답, 교사의 즉각적 피드백이 주를 이루었다. 교사가 사고 질문을 하고 지연 피드백을 부여 하는 경우 학생들이 자신의 생각을 드러내고 이를 기반으로 사고를 진전시켜 나갈 수 있었으나 이러한 사례는 그 수가 상당히 적었다. 교사들은 학생들의 사고를 유발하고 이를 진전시키기 위한 노력보다는 수업 내용을 논리적 흐름에 맞추어 체계적으로 제시하는 것에 더 큰 중점을 두는 경향이 있었다. 또한 관찰한 수업에서 교사가 시범 실험, 모형 혹은 실물 수업자료 등을 활용할 때 보다 많은 수의 학생들이 적극적으로 수업에 참여하여 자신의 생각을 드러내었으나 교사가 학생들의 생각을 바탕으로 학생들의 사고과정을 진전시켜 나가는 과정을 도모하지 않음으로써 학생들의 사고과정을 단절시키는 경우가 많았다. 따라서 수업 활동과 수업 자료 활용이 효과를 거두기 위해서는 각각의 활용에 있어서 학생들과 구체적으로 어떠한 상호 작용을 형성해야 하는지에 대해 연구가 이루어져야하며, 또한 교사는 교사의 질문이나 피드백이 학생들의 학습에 중요한 역할을 함을 인식해야 한다. The purpose of this study is to analyze verbal interaction between teachers and students in order to collect qualitative data on the characteristics of the interaction to enhance teaching efficacy. Total of 12 classes of eight science teachers were observed and were interviewed. The classes were video taped and all the verbal interactions were transcribed. The transcribed content and interviews were further analyzed to draw any conclusions on the verbal interaction between teachers and students. Analysis criteria for the data on the class and interview were developed based on the literature review and applied to analyze the collected content. The analyzed data showed that verbal interactions composed of confirmation questions for memorization, students' short responses and teacher's immediate feedbacks. The results of the study also suggested that there needs to be further studies on the interactional techniques for teacher in utilizing the class materials and activities. The teachers should acknowledge the importance of the questions and feedbacks of teachers for students to stimulate their sound learning through literatures.

지방정부 재가노인복지사업의 적실성 제고방안 : 대구광역시의 일부 사례를 중심으로

김순양, 박병일, 고수정 영남대학교 사회과학연구소 2001 社會科學硏究 Vol.20 No.2

본 논문은 지방정부 단위의 재가노인복지사업의 현황과 문제점을 대구광역시의 사례를 중심으로 실증적으로 분석하고, 이를 통해서 아직 초기단계에 불과한 지방정부에서의 재가 노인복지사업의 적실성 제고방안을 제시하려는 것이다. 이를 위해서 이론적 논의로서 재가 노인복지의 의의, 필요성, 그리고 한국에서의 재가노인복지의 전개과정을 살펴보았다. 그리고 이러한 이론적 논의를 토대로 실증적 연구를 수행하기 위한 분석 틀을 Gilbert와 Terrell의 네 가지 분석차원을 중심으로 구성하였다. 다음에는 이러한 분석 틀에 입각하여 대구광역시의 재가노인복지사업의 현황과 문제점들을 적용범위, 전달체계, 급여내용, 재정의 네 가지 분석차원을 중심으로 고찰하였으며, 이를 토대로 재가노인복지사업의 적실성물 제고할 수 있는 구체적인 방안들을 제시하였다. 그리고 여기서 재가노인복지사업의 범위에는 가정봉사원 파견사업, 주간보호사업, 단기보호사업의 세 가지를 포함하였다.

대학생의 노인복지에 대한 인식도

차병준,김무룡,김기열,차경미,김귀희,김현실,서인선,임상규,이순자,위광복,남철현 慶山大學校 保健福祉硏究所 1999 保健福祉硏究 Vol.2 No.-

The purpose of this study is to grasp the change of consciousness of young people in order to seek new approach of policy for aged era. 1,200 students attending collages and universities in three small or medium sized cities were inquired for 2 months, from October 1 to November 30, 1996. The result is as follows. 1. The characteristic of the respondents of this survey is that they include 72.1% of women, 40.4% of people aged between 20 to 21, and 49.1% of people who do not have any religion. Those who are from big cities and those who are form farming villages or fishing village occupy equally 40.2%, those who reside in that cities for a long period 49.0%, and those who live with their family 60.9%. 2. The family feature of the subject is that 31.5% of them are those whose father is the age of 55 and more than 55, 10% of them are those whose mothers age is so, 33.1% of them have 5 family members, 29.5% of them have the family income of 1,000,000 to 1,490,000 won, 83.9% of them are from middle class, 47.7% of them are the people whose grand parents have passed away, 70.4% of them live apart from their grand parents, and 60.9% of them are second child. 3. 64.0% of males, 70% of respondents who are aged over 24, 58.1% of respondents who are from rural communities, 62.4% of respondents who live in rural area, and 58.3% of respondents who live alone, prefer to live with grand parents, marked higher rate than other groups. The groups whose father and mother are the age of more than 55 marked higher rate of 55.9% and 58% each than any other groups(p<0.05). The groups whose family member is less than three, whose grand parents both have passed away in middle class, who live with their grand parents, and who are second children, give more positive answers than any other groups. 4. Those who are older, who are buddhists, who are from rural area or live in rural area, whose family is small, whose family income is small, who are from lower class and whose grand parents are still alive, shows preference to support their parents after marriage. 5. Females(89.4%), those who are from small or medium sized cities(89%), who live with their family(85.6%), whose father is the age of 55 and more than 55, whose mother is the age of 54 and less than 54, whose family member is 6, who are from middle class, whose grandparents are still alive and who are the eldest child in their family, give more response that they prefer to live apart from their children in their old age than any other groups. 6. What elderly people need most right now is past time(42.3%), and the respondents whose age is 20 to 21, who are buddhists, who are from middle sized cities and live alone, whose parents are the age of more than 55, who have small family income, who live with their grand parents and who are second children show higher level than any other groups. 7. 76.8% of respondents answer that they do not need their parent's fortune, marked still higher rate than the opposite answer. Those who are older, who are buddhists, who are from big cities, who reside in rural area, who live alone and have smaller family, who are in bad family economic conditions and who live with grand parents present higher rate of positive response. 8. 59.3% of respondents reply that they think about death from time to time, and those who are female, who are in the age of 20 to 21, who are christian, who live with their family, whose siblings or other family members offer their education expenses show higher rate than any other groups. 9. 92.3% of respondents answer that the budget for welfare facility for elderly people is very small. The younger the respondents are and the worse economic condition they have among those who live in big cities, the more answered that. 10. 50% of respondents think social security should provide for their old age, and 42.8% of them believe they themselves provide against it. The respondence that social security ought provide for it appeared more among those whose age are over 24, who are female, who reside in rural area, who are christian, who are in bad economic condition, and who ever used medical institutions in recent one month, marked higher level than other groups. 11. The adequate time of retirement is 59.97±5.60 for public officers, the highest and 59.28±6.35 for teachers, the next. 12. 35.2% of respondents reply that the adequate budget for the old age after their retirement at the age of 60 is 220 million won, showed the highest level of respondence. 13. The factors which affect on the old people in the charged welfare facilities are sex(p<0.01), the type of housing(p<0.05) and whole family income(p<0.05). 14. The factors which affect on remarriage are sex(p<0.05) and religion(p<0.05). For varying old population and expanded welfare service for them, government and relevant authority should give more attention to secure the budget, establish effective plans to expand various program and the facilities for elderly people in order that elderly people spend the rest of life time more happily and more fruitfully. To do that, each college and university should open Health courses, and educate and inform about health and welfare.

방사선의 단회조사와 분할조사가 백서 전치에 미치는 영향

閔丙淳 慶熙大學校 1987 論文集 Vol.16 No.-

The purpose of this study is to compare the effects on the fractionated irradiation with single irradiation, which make an isoeffect of the tissues. Upper anterior teeth of the rat were used as experimental materials, and made 4 gruops; single irradiated 1650R and 1800R groups and fractionated 1950R and 2100R by dividing 2 times. Experimental animals were sacrificed 6 hours, 12 hours. 1 day, 3 days, 7 days after irradiation, and observed through the light microscope. Microscopic findings led to the following conclusions: 1. Tissue recover was more rapid in the fractionated groups than the single irradiation groups. 2. Necrotic cells were observed in the papillary pulpal tissues at the early experimental stage. 3. With the increase of the irradiation dosage, the increase of the cell degeneration and the decrease of the cellularity were occurred markedly. 4. The osteodentin was appeared at 3 days after irradiation in all groups, and in the fractionated 1950R group, it was the marked at 7 days after irradiation.

도서형피판(Island Pedicle Flap)에 대한 임상적 고찰

양순재,박종섭,박병일 大韓成形外科學會 1987 Archives of Plastic Surgery Vol.14 No.1

Following its introduction as island flap by Dunham in 1893 for the reconstruction of a cheek defect with a flap based on the anterior temporal vessels has been popularized in the field of plastic and reconstructive surgery. And investigators are continually searching for new donor area for use of it. In clinical application of the island flap, a given flap must be met certain criteria in order to given widespread acceptance. Among these are applicability in a wide range of situations, presence of indentifiable blood vessels, easy dissection, and minimal donor-site morbidity. Island pedicle flap is a very useful method of treatment for such situations in which cannot to be using a local flap because of scar tissues or irradiated tissues around the wound, and in which inapplicable to be using a free because of inadequacy of the recipient vessels. It has many distinctive advantages over the conventional local flaps. They are as follows; 1. It has good blood supply and less risk of infection, so it is be one of the safest. 2. It provides well vascularized flap with a one-stage operation. 3. It has no necessity of delay, and far fewer limitations of flap-size. 4. It improves the comfort of the patients, and allows early ambulation. And compare to free flap, advantages of the island flap are the technical ease of the transferring it, the simplest method with a single operation, short hospitalization, and lower cost. During the past 5 years (from Feb., 1982 to July, 1986) authors experienced 18 cases of island pedicle flaps. In this paper, we would like to report our cases with brief of the related references.

증발과 응결에 대한 국민 학생들의 개념 조사

최병순,김효남,강순희,신인철 한국교원대학교 과학교육연구소 1993 청람과학교육연구논총 Vol.3 No.1

The purpose of this study was to investigate and analyze the conception of elementary school students on evaporation and condensation, and then to verify the types of the conception. Forty-eight children from six elementary schools were sampled by stratified random sampling in Seoul and other provinces. They responded to the questionaire and the interview. This study was carried out according to the process of the basic study, the preliminary study, and the main study. The materials collected were classified and analyzed according to the types of children's ideas. The findings of this study were as follows: 1. The vocabulary used to describe the evaporation phenomena varied according to the situations, and the scientific term "evaporation" was more frequently used by the older groups. 2. Most children answered that the last location of water were air/sky/cloud. Air/cloud which represents the scientific conception of the location of water were mentioned by children of all ages. The higher the grade of the children were, the more scientific conception the children mentioned, however. 3. Most children referred to the heat as the factor of evaporation. Wind, on the other hand was mentioned by less than 10% of lower graders, and by about 30% of higher graders. 4. The result of asking children whether they thought it was possible to get the evaporated water back showed that about 70% of lower graders denied the possibility of the water being reversible. About 60% of higher graders, however, recognized that the water will be returned as rain or condensation. This increase may be associated with formal teaching of water cycle. 5. In the ideas of evaporation and condensation, some of the children have supernatural ideas and animism, which are most younger chilren's characteristics.

초음파검사자 기량검증 체제를 위한 다자비교시험

윤병식,양승한,김영호,김용식,양동순 한국비파괴검사학회 2004 한국비파괴검사학회지 Vol.24 No.4

국내 원자력발전소의 Class1과 Class2 배관검사에 적용할 수 있는 초음파탐상 검사자, 장비 그리고 절차서에 대한 한국형 기량검증(KPD) 시스템을 구축하였다. PD 방법을 적용한 검사결과와 전통적인 dB-drop 방법을 이용한 검사결과를 상호 비교하기 위하여 Round Robin Test(RRT)를 수행하였다. RRT 결과는 PD 방법의 신뢰성이 dB Drop 방법보다 우수한 것으로 나타났다. 이러한 결과로부터 원자력발전소 가동중검사에 PD 방법을 적용함으로써 초음파탐상검사 결과의 신뢰성이 더욱 향상될 것으로 기대된다. The Korean Performance Demonstration(KPD) System for the ultrasonic testing personnel, equipments and procedures applicable to the Class 1 and 2 piping examination for nuclear power plant in Korean has been established. A round robin test was conducted in order to compare the examination results by the method of Performance Demonstration(PD) with the traditional dB-drop method. As a result, adoption of the PD method to the in-service inspection of the nuclear power plants will improve the reliability of the ultrasonic test results.

지반-3차원 골조구조물 상호작용계의 동적 해석

장병순,서상근 釜山大學校生産技術硏究所` 1998 生産技術硏究所論文集 Vol.54 No.-

지반상에 존재하는 3차원 골조구조물에 진동을 유발시키는 기계하중, 풍하중, 지진과 같은 동적 하중이 작용한다면, 동적 거동을 고려하여 구조물을 해석해야 할 뿐만 아니라, 지반의 동적 거동도 고려하여야 한다. 따라서, 본 연구에서는 3차원 구조물 모델로 정식화된 유한요소법을 사용하여 지반-3차원 골조구조물 상호작용계의 동적 거동을 해석하고자 한다. 실제 구조물에 근접한 기하학적 형상으로 이상화시키기 위해, 지반-구조물 상호작용계를 판은 유연성을 갖는 4-절점 판요소, 보·기둥은 2-절점 보요소, 탄성지반은 8-절점 입체요소로 분할하였다. 본 연구의 목적은 지반-3차원 골조구조물 상호작용계의 동적 거동을 해석하기 위해, 동적 운동 방정식을 정리한 후 유한요소 프로그램으로 상호작용계의 동적 거동을 해석하는 것이다. When a dynamic loads such as a mechanical load, a wind load, and a seismic load causing a vibration, act on the body of the 3-D framework resting on soil foundation, it is required to consider the dynamic behavior of the soil foundation as well as that of the 3-D structure in the structural analysis. Thus, this study presents the analysis for the dynamic behavior of soil-space framework interaction system obtained from the finite element method which is formulated by modelling the 3-D structure. Since an actual structure is idealized as the geometric shape, the plate, the beam-column, and the soil foundation will be subdivided into 4-node plate elements with flexibility, 2-node beam elements, and 8-node brick elements respectively. The aim of this study is analysis of dynamic behavior of soil-space framework interaction system by finite element program.

화학문제의 요구주의력과 학습자의 기능적 정신용량과의 관계

崔秉舜,金都旭 한국교원대학교 과학교육연구소 1998 청람과학교육연구논총 Vol.8 No.1

이 연구에서는 100명의 인문계 고등학생을 대상으로 화학양론과 관련된 문제의 해결에서, 과제의 요구주의력 결정 방법과 학습자의 덩이지식화 정도가 화학문제의 요구주의력과 학습자의 기능적 정신용량과의 관계에 미치는 영향을 분석하였다. 연구결과에 의하면, 과제에 포함된 조작스키머 종류의 수를 그 과제의 요구주의력으로 보는 것이 가장 타당함을 알 수 있었다. 또한, 학습자의 덩이지식화 정도가 과제의 요구주의력과 학습자의 기능적 정신용량과의 관계에 영향을 미치는 중요한 변인이며, Pascual-Leone의 이론으로부터 가정할 수 있는 임계상황이 나타나지 않는 중요한 이유임을 알 수 있었다. The puprpose of this study was to investigate the influence of the way determining mental demand of the problem and the extent of chunking of the learner on the relations between the mental demand of the problem and mental capacity of the students in solving chemical stoichiometry problems of 11th grade students. It was found that the number of types of operative scheme included in the problem was considered the mental demand of the problem. It was also found that the extent of chunking of the learner was one of the important factors influencing on the relations between the mental demand of the problem and mental capacity of the students in solving chemical stoichiometry problems.