계획에 없던 중환자실 재입실 실태 및 원인

송동현,이순교,김철규,최동주,이상일,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.1

Background : Because unplanned readmissions to intensive care unit(ICU)might be related with undesirable patient outcomes, we investigated the pattern of and reason for unplanned ICU readmission to provide baseline data for reducing unplanned returns to ICU. Methods : The subjects included all patients who readmitted to ICU during the same hospitalization at a tertiary referral hospital between January 1st and June 30th 2002. Quality improvement(QI) nurse collected the data through medical records and a medical director reviewed the data collected. Results : 1)The average unplanned ICU readmission rate was 5.6%(gastroenterology 14.6%, pediatrics 12.7%, pulmonology 11.9%, neurosurgery 6.3%, general surgery 5.3%, chest surgery 3.9%, and cardiology 3.3%). 2)Among the unplanned readmissions, more than 50% of cases were from patients older than 60 years, and the main categories of diagnose at hospital admission were neurologic disease(29.9%) and cardiovascular disease(27.6%). 3)Of unplanned ICU readmissions, 41.8% had recurrence of the initial problems, 44.8% had occurrence of new problems. And 9.7% required post-operative care after unplanned operations. 4)The most common cause responsible for unplanned ICU readmission were respiratory problem(38.3%) and cardiovascular problem(14.3%). 5)About 40% of unplanned ICU readmission occurred within 3 days after ICU discharge. 6)Average length of stay of the readmitted patients to ICUs were much longer than that of non-readmitted patients. 7)Hospital mortality rate was much higher for unplanned ICU readmitted patients(23.6%) than for non-readmitted patients(1.5%)(P<0.001). Conclusions : This study showed that the unplanned ICU readmitted patients had poor outcomes(high morality and increased length of stay). In addition study results suggest that more attention should be paid to patients in ICU with poor respiratory function or elderly patients, and careful clinical decisions are required at discharged from ICU to general ward.

건설현장 근로자들의 안저예방실태와 사고예방과의 개선요인 조사연구

심규범,남철현,최상복,이송권,이정희,이순자,문기내,김문환 慶山大學校 保健福祉硏究所 2003 保健福祉硏究 Vol.8 No.-

This study was conducted to examine aspects of health and safety education and demand level of safety education in construction job sites in order to provide direction of safety education development. The subjects of this study were 566 workers who were working in construction job sites located in Daegu City and Kyungbuk Province. Data were collected from June 1, 2002 to August 30, 2002. The results of this study can be summarized as follows. 1. According to safety education by experience methods, the proportion of education by lecture was highest (90.6%). The proportion of education by field practice was 13.1%. 2. Among the education methods which they thought as the most desirable method, the proportion of audio-visual education was 39.4% and the proportion of education by experience was 37.5%. Those who had more monthly income and higher education level preferred audio-visual education, while those who were younger and less educated preferred education by experience. 3. In the case of the contents of the safety education which they thought as the most important one, the proportion of enhancement of safety awareness and education of risk factors was highest (24.7%). The groups of older workers, having longer working period, and belonging to higher education level preferred these contents. 4. According to the factors which were most important to increase effectiveness of the safety education were workers' voluntary participation (27.7%), 40 to 49 years old (27.7%), and monthly income of one million, five hundred thousand won to one million, nine hundred ninety thousand won (32.0%). The proportions of lower educated workers and working as daily workers were also high. 5. The variable which most influenced the safety education was age. The safety awareness of construction job sites was the second highest influential variable. From above results, it is clear that the workers' participation in the safety education was low since most of the safety educations were formal education by lecture. Although they participated in the education, the education was also not effective because they compulsorily participated in it. Therefore, it can be concluded that effective alternative policies must be formulated.

정신과 입원환자의 서비스 만족척도의 개발

김철권,이지연,송영선,김규호,김경률,김제원,이동기,최병무 大韓神經精神醫學會 2006 신경정신의학 Vol.45 No.3

목적 본 연구의 목적은 국내 정신의료기관(정신병원, 종합병원 정신과)에서 간편하게 사용할 수 있는 신뢰도와 타당도가 검증된 입원환자의 서비스 만족척도를 개발하기 위한 것이다. 방법 여러 단계를 거쳐 국내 실정에 맞는 문항을 개발하였고,정신병원, 종합병원, 대학병원 정신과 병동에서 퇴원하는 348명의 환자들을 대상으로 신뢰도와 타당도를 조사하였다. 요인분석 결과 5개의 요인이 추출되었으며 전체 변량의 63.04%를 설명하였다. 내적 일관성에 대한 신뢰도 계수 (Crohnbach's α)는 0.95로 상당히 높은 수준이었고, 수정된 개별문항-총점 상관계수는 0.50부터 0.72까지의 범위에 속하였다. 요인분석을 통해 추출된 서비스 만족척도의 각 하위척도 점수와 서비스 만족척도에 첨부된 각 영역에 대해 전반적인 만족도를 묻는 세 개의 문항 점수 간의 상관성 역시 유의하게 높았다. 결과 진단명에 따른 서비스 만족척도의 전체 점수에서는 불안/신체형/강박장애 환자군과 기분장애 환자군이 각각 정신분열병 및 기타 정신병 환자군과 알코올중독 장애 환자군에 비하여 유의하게 높은 점수를 보였으며, 입원형태에 있어서는 자발적 입원군이 강제 입원군에 비하여 전체 만족점수가 유의하게 높았다. 그러나 성별, 월수입, 학력, 직업, 종교, 결혼상태 등의 변수에서는 서비스 만족척도의 전체 점수에서 유의한 차이가 발견되지 않았으며, 마찬가지로 연령, 입원일수, 입원횟수, 첫 발병나이, 유병기간 등의 임상적 변수에서도 서비스 만족척도의 전체 점수와 유의한 관계를 보이지 않았다. 서비스 만족척도의 전체점수에서 대학병원 환자군이 정신병원 환자군과 종합병원 환자군에 비하여 각각 유의하게 높았다. 결론 결론적으로 국내 정신의료기관에 입원한 환자들의 서비스 만족을 평가하기 위한 목적으로 개발된 본 척도는 높은 수준의 신뢰도와 타당도를 보였으며, 또 국내 정신의료 환경에 맞는 요인구조를 보였다. 따라서 정신의료 서비스에 대한 정신과 환자의 만족도에 대한 연구가 거의 없는 실정에서 본 척도의 개발은 향후 국내 정신의료의 질과 치료결과를 높이는 도구로 활용될 수 있을 것으로 기대된다. Objectives : To develop and test the validity and reliability of a brief self-completed questionnaire (Service Satisfaction Scale : SSS) for routinely assessing the quality of service in psychiatric ward inpatients. Methods : A 30-item multidimensional questionnaire was developed by several steps of face validity and content validity. The questionnaire was administered to inpatients (n=348) discharged from psychiatric hospitals, general hospitals, and University hospitals. Construct validity was supported by performing principal component analysis. Reliability was estimated by calculating internal consistency of Cronbach's alpha. Results : Factor analysis yielded five factors comprising staff attitude, treatment quality, ward environment, access/cost, and ward rule, which account for 63.04% of the common variance. The internal consistency of the scale was high (Cronbach's alpha=0.95). The concurrent validity was supported by the significant correlation of each of five factors with item that measured overall satisfaction of SSS. Patients with neurosis (anxiety disorder, somatoform disorder, obsessive compulsive disorder) and mood disorders were significantly satisfied than those with psychosis and alcoholic disorders. Patients who admitted voluntarily were more significantly satisfied than those who admitted involuntarily. Sociodemographic variables such as age, gender, marital status, monthly income, education level, employment status and religion were not significantly different at the total scores of SSS. Similarly, clinical characteristics such as age of onset, duration of illness, lengths of hospital stay and number of previous hospitalization did not associate significantly with the total scores of SSS. Patients discharged from university hospitals were significantly more satisfied than those of the general and psychiatric hospitals. Conclusion : SSS performed well in the validity and reliability, indicating that it can be a useful tool for measuring Satisfaction of psychiatric inpatients in Korea.

항갑상선제로 치료한 그레이브스병 환자의 관해예측인자

남일송,윤여일,김선규,김용현,이주영,목지오,윤석기,김철희,김영선,변동원,서교일,유명희 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.2

Background: Most cases of Graves' disease have been treated by antithyroid drugs in Korea. The major drawbacks of antithyroid drugs are the relative high rate of relapse and the inconvinience of long term therapy. Measurement of TBII and TRH stimulation test have been considered as the most reliable tests predicting relapse, but the predictive power is not high enough to use in clinical situation. This study was performed to find good prognostic indicators in Graves' disease patients after the discontinuation of antithyroid drug therapy. Subjects and methods : We restrospectively evaluated 96 patients with Graves' disease who showed normal TRH test at the end of antithyroid drug therapy and were followed for more than one year. Serum T3, T4, T3/T4 ratio, TBII, Anti-TPO Ab and TGAb levels were measured at the time of diagnosis and at the end of therapy. Two to three months after withdrawal of antithyroid medication, serum TSH and free T3 responses to TRH were examined. These parameters were compared between the relapse group and the remission group. Results : Among the 96 patients, 22 patients(22.9%) relapsed(Group Ⅱ) and 74 patients(77.1%) remained in remmision(Group Ⅰ). No significant difference was observed between the relapse and the remission group in clinical parameters, serum T3, T4, TSH, T3/T4 ratio, TBⅡ and Anti-TPO Ab determined before and after treatment. Serum TSH and free T3 levels measured after TRH stimulation were also similar in both groups. Serum TGAb levels determined at the end of treatment were significantly higher in the remission group(p<0.05). Relapse following the discontinuation of therapy occured within 24 months in 72.7% of the relapsed cases. After 24 months, relapse rate was reduced significantly. Conclusion : These results suggest that high serum TGAb levels could be a favorable prognostic indicator for the long term remission of Graves' disease treated with antithyroid drugs, and may suggest that Hashimoto's thyroiditis is combined with Graves' disease in those patients.

폐허탈 및 농흉을 유발한 기관지 지방종 1예

이규진,이송주,옥철호,장태원,정만홍,김영옥,박성달 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.4

저자들은 객혈을 주소로 내원한 75세 남자 환자에서 기관지내시경 육안 소견상 양성 종양이 의심 되었으나 조직 검사상 지방종을 확진하지 못하였고 악성종양을 배제할 수 없는 상황에서 종괴에 의한 왼쪽 폐의 허탈과 농흉 때문에 수술적 치료를 시행 하였으며, 수술 결과 기관지 지방종에 의한 폐허탈, 농흉 및 기관지 확장증, 이로 인한 객혈이 발생한 예가 있어 보고하는 바이다. Lipoma is a common neoplasm on soft tissues. However, bronchial lipoma is rare benign tumor. Patients with bronchial lipoma might have a malignant potential, and there were case reports of lung cancer accompanied with lipoma. Therefore, it should initially be treated by fibrotic bronchoscopy or surgery. We encountered a 75 year-old male patients with bronchial lipoma, causing hemoptysis.

임피던스 방법을 이용한 뇌혈류량 측정기기의 개발(Ⅰ)

김덕원,김정래,송철규,김정열,남문현 대한의용생체공학회 1989 의공학회지 Vol.10 No.1

In this study, Rheoencephalography(REG) was designed and constructed. Using the constructed instrument cerebral blood flow(CBF) of left and right brain, CBF change by posture, and reproducibility were studied. Followings are important results. Relative CBF could be measured noninvasively and continuously. Since reproducibility of the constructed REG was found to be quite high (4 %), the accuracy of the instrument itself was proved. REG can be easily applied for testing the effect of drugs for the patients with cerebral vessel diseases since it is quite sensitive to the relative changes of CBF. Various cerebral diseases can be diagnosed by analyzing the REG waveforms. The area of restricted cerebral blood vessels can be located by arranging the electrode configuration. Comparative studies with the standard techniques of measuring CBF are needed to verify the accuracy of REG. Further studies on optimal electrode configuration and various artifacts are also necessary.

A Performance Evaluation and Development of 3D Endoscopic Imaging System

Chul Gyu Song,Kyeong Seop Kim,Nam Gyun Kim,Myoung Ho Lee 대한전기학회 2000 Journal of Korean Institute of Electrical Engineer Vol.10 No.1

생체 임피던스를 이용한 인체 하지운동출을 위한 최적 전극위치 선정

宋哲奎(Chul-Gyu Song),尹大榮(Dae-Young Youn),李東憲(Dong-Heon Lee),金守贊(Soo Chan Kim),金德源(Deok Won Kim) 대한전기학회 2003 전기학회논문지 D Vol.52 No.8

인천, 경기 지역 무인도서의 식물상에 관한 연구

송세규 ( Song Se-gyu ),최승세 ( Choi Seung-se ),신현철 ( Shin Hyun-chul ),서형수 ( Seo Hyung-soo ),박진영 ( Park Jin-young ),차진열 ( Cha Jin-yeol ),김철환 ( Kim Chul-hwan ) 한국도서(섬)학회 2021 韓國島嶼硏究 Vol.33 No.4

전국 무인도서 자연환경조사와 특정도서 정밀조사를 통해 인천, 경기 지역 무인도서에서 확인된 관속식물은 115과 401속 691종 7아종 76변종 7품종의 총 781분류군으로 확인되었다. 이는 최근에 유입된 귀화식물을 포함한 한반도 전체의 4,596종의 약 17%에 해당된다. 양치식물 29분류군, 나자식물 6분류군, 피자식물의 쌍자엽식물 582분류군, 단자엽식물 164분류군으로 집계되어 한반도 전체 비율에 비해 양치식물과 나자식물의 종 다양성이 다소 낮은 것으로 분석되었다. 식물상은 나도밤나무, 합다리나무, 동백나무를 비롯하여 다수의 남방계식물이 분포하는 특성을 갖는 점에서 식물구계학적으로 남부아구에 가깝다. 식물상의 종다양성은 대체로 도서의 면적에 비례하고, 인위적인 간섭이 많은 도서일수록 귀화식물의 수는 증가하였다. 환경부 지정 멸종위기 야생생물은 발견되지 않았으며, 전체적으로 고유종은 병꽃나무를 비롯하여 외대으아리, 은꿩의다리, 새끼노루귀, 태안원추리, 털중나리 등 16분류군, 식물구계학적 특정식물은 Ⅴ등급은 개정향풀을 비롯하여 두메대극, 민솜방망이 3분류군, Ⅳ등급은 회리바람꽃, 산마늘 등 11분류군, Ⅲ등급은 멀꿀, 감탕나무, 곽향 등 36분류군, Ⅱ등급은 세뿔석위, 해당화, 초종용 등 38분류군, Ⅰ등급은 소사나무, 선괭이눈, 쥐방울덩굴 등 79분류군 등 총 167분류군, 그리고 귀화식물은 소리쟁이, 아까시나무, 좀명아주, 닭의덩굴 등 53분류군이 생육하는 것으로 나타났다. 또한 각 무인도서의 귀화율을 분석하였으며 황산도엣 가장 높은 14.4%로 확인되었다. 생태계교란 생물에 해당되는 식물로는 돼지풀, 애기수영, 가시박, 미국쓱부쟁이, 가시상추, 환삼덩굴 등 6종이 확인되었다. 특히 황산도에는 돼지풀, 환산덩굴, 미국쑥부쟁이, 가시상추 등 4종의 생태계교란 식물이 발견되어 인접 무인도의 확산 방지를 위하여 각각의 생육특성 및 생리학적 특성 파악을 통하여 종자산포 이전에 적극적인 방제 조치를 취해야 할 것으로 판단되었다. 학술적으로 중요하거나 특기할 만한 식물로는 개정향풀, 앵도나무, 큰천남성, 두루미천남성 등이었다. 식물의 생존과 번성을 위협하는 가장 중요한 요인으로 방목된 염소로 조사되었으며, 이에 대한 관리대책이 필요할 것으로 예상되었다. 한편, 개석송과 산오이풀을 비롯하여 일부 식물들은 종 분포적 특성을 감안할 때 오동정된 것으로 판단되어, 향후 조사시 주의 깊게 관찰할 필요가 있는 것으로 판단되었다. Through a National survey of the natural environment of Uninhabited islands and a detailed survey of the Specific islands, vascular plants of uninhabited islands in Incheon and Gyeonggi-do provinces were identified as a total of 781 taxa of 115 families, 401 genera, 691 species, 7 subspecies, and 76 varieties. This taxa accounts for about 17% of the 4,596 species on the entire Korean Peninsula, including recently introduced naturalized plants. The flora was counted as 29 taxa of pteridophytes, 6 taxa of gymnosperms, 582 taxa of dicotyledon of angiosperms, and 164 taxa of monocotyledon plants, while it was analyzed that the species diversity of pteridophytes and gymnosperms, was somewhat lower than the total ratio of the Korean Peninsula as a whole. The flora is close to the southern subgroup phytologically in that it has the characteristics of distribution of a number of southern plants, including Meliosma oldhamii, Carpinus erosa and Camellia japonica. The diversity of flora is generally proportional to the area of the islands, and the number of naturalized plants increased in islands with more anthropogenic interference. No endangered wildlife designated by the Ministry of Environment were found, and 16 taxa (Weigela subsessilis, Clematis brachyura, Thalictrum actaefolium var. brevistylum, Hemerocallis taeanensis, etc.) were found for endemic species , 167 taxa (Ⅴ level 3 taxa, Ⅳ level 11 taxa, Ⅲ level 36taxa, Ⅱ level 38 taxa, Ⅰlevel 79 taxa) for floristic target species, and 53 taxa (Rumex crispus, Robinia pseudoacacia, Chenopodium ficifolium, Fallopia dumetorum etc.) for naturalized plants. The ecosystem of Disturbed Plants were identified as 6 taxa (Ambrosia artemisiifolia, Rumex acetosella, Sicyos angulatus, Aster pilosus, Lactuca scariola, Humulus japonicus). The vascular plants that were academically important or noteworthy were Apocynum lancifolium, Prunus tomentosa, Arisaema ringens and Arisaema heterophyllum. Grazing goats were investigated as the most important factor threatening the survival and prosperity of plants, and management measures were expected to be necessary. On the other hand, it was judged that some plants, including Lycopodium annotinum and Sanguisorba hakusanensis, were misidentified in consideration of the species distribution characteristics, and needed to be carefully observed during future investigations.

중추신경계 손상에 의한 경직의 이동형 측정 시스템

송철규(Chul-Gyu Song),서정환(Jeong-Hwan Seo),한상형(Sang-Hyung Han),김거식(Keo-Sik Kim),안양수(Yang-Su An) 대한전기학회 2009 전기학회논문지 Vol.58 No.6

Spasticity is a velocity-dependent stretch reflex disorder of the body motor system developing after the injury of the central nervous system, in which certain muscles are continuously contracted involuntarily. Conventional methods such as the modified Ashworth scale, Spasm frequency scale, pendulum test and isokinetic dynamometer had some disadvantages: limitation in discriminating the increase of resistance, immovable and expensive device, not enough study parameters. Therefore, it is necessary to introduce clinically more useful instrument, which can produce objective data and are more convenient on spasticity measurement. Spasticity measuring methods were reviewed and a new measuring instrument was designed and introduced. The new measuring system is a portable spasticity-measurement system, which encompass various scopes of spasticity-related human signals such as electrophysiologic, kinematic and biomechanical data. Our device was designed in order to measure the joint angle, angular velocity, electromyographic signals and force. We suggest that this new system can diagnose the spasticity of the muscles, objectively.