아미노글리코사이드 사용제한에 따른 병원성 균혈증 유발 그람음성간균의 내성변화 및 임상적 의의

오종택,김신우,손종원,도병훈,한승우,신병철,박지현,이종명,김능수 대한감염학회 2003 감염과 화학요법 Vol.35 No.4

목적 : 항균제 오남용으로 인한 내성균의 출현, 약물부작용의 발생 및 약제 비용의 증가는 환자 개인뿐만 아니라 사회적으로 문제가 되고 있다. 본 연구는 항생제의 오남용을 막기 위한 제도의 일환으로 시행한 아미노글리코사이드 사용 제한정책의 비용 효과적인 측면을 조사하고 그람음성간균에 의해 병원성 균혈증이 발생한 환자들을 대상으로 이 정책이 항생제 내성률과 환자 사망률에 미치는 영향을 연구하였다. 방법 : 930병상 규모의 3차 병원인 일개 대학병원에서 아미노글리코사이드 사용제한정책이 시행된 직후인 2002년 3월에서 9월 사이에 그람음성간균(Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae, Enterobacter aerogenes, Serratia marcescens, Stenotrophomonas maltophilia, Burkholderia cepacia)에 의해 발생한 병원성 균혈증 환자 60명(실험군)과, 이 정책이 시행되기 전에 입원한 환자들 중 균주별로 같은 수만큼 선별한 병원성 균혈증 환자 60명(대조군)의 의무기록을 후향적으로 조사하였다. 결과 : 아미노글리코사이드 사용제한정책이 시행된 시기인 2002년 3월에서 9월 사이에 처방된 아미노글리코사이드 사용량 및 비용을 이 정책이 시행되기 전인 2001년 3월에서 9월 사이와 비교한 결과, 아미노글리코사이드의 사용량(antimicrobial utilization density)은 사용제한 후 225.2에서 130.3으로 42% 감소하였고 약제 비용은 44% 감소하였다. 아미노글리코사이드 사용제한 후 병원성 균혈증을 유발한 그람 음성간균의 이 항생제에 대한 내성률은 유의한 변화를 보이지 않았으며 균혈증과 직접 연관된 사망률도 환자의 나이, 성별, 기저질환 및 원발병소 등을 보정할 경우 유의한 차이를 보이지 않았다(40.4% vs. 24.1%, P=0.11). 결론 : 아미노글리코사이드를 5일을 초과한 사용 시 감염전문가의 사전 승인을 필요로 하는 사용제한정책은 아미노글리코사이드의 사용량과 비용을 유의하게 감소시켰다. 또한 이 정책 시행 후 그람음성간균에 의한 균혈증 환자에서 균혈증으로 인한 사망률과 아미노글리코사이드에 대한 내성률은 유의한 차이가 없었다. Objective : To evaluate the effects of an aminoglycoside restriction policy on expenditures for aminoglycosides, antimicrobial resistance rates and clinical outcome of nosocomial bacteremia caused by Gram-negative bacilli (GNB). Methods : Starting in February, 2002, a prior consultation with an infectious disease specialist for using aminoglycoside antibiotics over 5 days was required in a 930-bed university hospital. In retrospective analysis of medical records 7 months after initiation of the aminoglycoside restriction policy, sixty cases of clinically relevant nosocomial bacteremia caused by GNB were found. These bacteremic patients were compared with sixty, species-matched, control patients with nosocomial Gramnegative bacteremia before the policy for total expenditures for aminoglycosides, susceptibility to antibiotics and clinical outcomes of bacteremia. Results : During the same period of 7 months before and after the restriction policy, total expenditures for aminoglycosides decreased by 44% in cost (from 465,030,841 Won to 259,618,337 Won) and the antimicrobial utilization density of aminoglycosides decreased by 42% (from 225,2 to 130.3). On the other hand, the patterns of antibiotic susceptibility and bacteremia-related in-hospital mortality rates after the policy did not show a significant change, compared with those before the policy. Conclusion : Antibiotic restrictions are among the most popular methods to diminish the practice of antibiotic overuse in hospitals. In this study, requirement for prior approval of aminoglycoside use over 5 days led to a significant decrease in the amount and cost of total aminoglycosides without a significant change in susceptibility patterns and bacteremia-related mortality rates.

보건관리대행 기관의 사업장내 진료에 대한 근로자 요구 및 실시 의향

원종욱,송재석,정선아,박화미,노재훈 大韓産業醫學會 2001 대한직업환경의학회지 Vol.13 No.1

목적 : 본 연구에서는 보건관리대행 사업에 있어 사업장내 진료에 대한 수요와 보건관리대행기관의 방문진료 제공에 대한 의향을 조사하여 사업장내 진료에 대한 욕구를 파악하고, 이를 토대로 사업장내 진료에 대한 기초적인 자료를 제공하는데 목적이 있다. 방법 : 근로자들의 의료이용 행태와 방문진료에 대한 요구도를 파악하기 위해 167개 보건관리대행 사업장의 사업주와 보건담당자, 그리고 1,350명의 근로자에게 설문 조사를 실시하였고, 사업주 121명(72.5%), 보건담당자 145명(86.8%), 근로자 816명(60.5%)이 응답하였다. 일차진료의 제공 가능성을 파악하기 위해서 전국의 66개 보건관리대행기관의 의사와 간호사 및 행정책임자에게 우편 설문조사를 실시하여 의사 31명 (47.0%), 간호사 38명(57.6%) 및 행정책임자 34명(51.5%)이 응답하였다. 결과 : 보건관리대행 사업을 수행하고 있는 의사의 87%와 간호사의 94%가 보건관리대행 업무를 담당하면서 많은 근로자들로부터 투약 등 진료를 요구받고 있었고, 100 %의 간호사와 행정책임자 94%, 의사의 76 %가 보건관리대행 사업에서 진료를 수행하는 것이 필요하다고 생각하고 있었다. 한편사업주의 85 %, 보건관리 담당자 86 %와 근로자81 %가 보건관리대행기관에서 사업장내 진료를 시행 할 때 이를 수용하겠다고 응답하였다.결론 대다수의 근로자와 사업주가 보건관리대행기관의 진료를 요구하고 있었고, 보건관리대행 기관의 의사와 간호사가 사업장에서의 진료를 수용할 의향이 있고, 직업성 뇌심혈 관계질환의 예방 등 필요성이 인정된다면 보건관리대행 의사의 사업장내 진료를 인정해야 한다고 생각된다. Objectives : This study was performed to survey worker's demands for worksite medical care and agency's intention for offering worksite medical care in Group Health Service Agency. Methods : One study subjects were employers, workers and office personnels in 167 factories. They were asked for medical care utilization behavior and worksite medical care demand. 121 employers(72.5%), 145 office personnels(86.8%) and 816 workers(60.5%) answered the questionnaire. The other subjects were doctors, nurses and administrators in 66 Group Health Service Agencies nationwide. They were asked for intention of offering worksite medical care in Group Health Service Agency through the mail survey. 31 doctors (47.0%), 38 nurses (57.6%) and 34 administrators answered the questionnaire. Results : 87 percentage of doctors and 94 percentage of nurses had experiences of being requested to prescribe and laboratory examination. All nurses, 94 percentage of administrators and 76 percentage of doctors thought that it was necessary to give medical treatment at worksite. Also in worksite 85 percentage of employers, 86 percentage of office personnels and 81 percentage of workers answered that they accepted the worksite medical care when it would be given. Conclusions : Worksite medical care should be permitted because almost of all workers and employers requested worksite medical care, and doctors and nurses in Group Health Service Agency were willing to give worksite medical care and there was necessity to prevent occupational cerebrovascular disease.

소음 특수건강진단 1차검사의 민감도와 특이도에 미치는 일과성 역치 상승과 주변환경 소음의 영향

원종욱,방문규,송중호,정선아,송재석,노재훈 대한산업의학회 2000 대한직업환경의학회지 Vol.12 No.2

Object : This study was performed to increase the sensitivity and specificity for screening the examinee of second hearing test. Methods : Study subjects were 219 workers who exposed more than average 80dB. They were taken the hearing test two times, before noose exposure and at 1 hour to 4 hours after worksite noise exposure. To investigate the ambient noise workers who were taken the hearing test in the test room which ambient noise was less than 45dB were classified Group I and the others were classified Group II . To calculate the sensitivity and specificity we made it gold standard whether worker had noise induced hearing loss. Results : Difference of hearing loss between before and after noise exposure for left and right ear was 11.4 dB and 11.7 dB respectively at 500 Hz, 8.7 dB and 9.6 dB at 1,000 Hz, 6.3 dB and 6.9 dB at 2,000 Hz and 6.9 dB and 7.4 dB at 4,000 Hz In Group I. That for left ear and right ear was 5.8 dB and 4.9 dB at 500 Hz respectively, 5.4 dB and 6.4 dB at 1,000 Hz, 6.3 dB and 5.3 dB at 2,000 Hz, and 5.5 dB and 5.8 dB at 4,000 Hz in Group II. The sensitivity was 100 in both Groups and the specificity was increased to 58.3 and 71.8 in Group I and Group II respectively until 10 dB was deducted from hearing level at 1,000 Hz and 4,000 Hz. Conclusion : When the screening hearing test was performed at worksite, we might deduct 10 dB from measured hearing level to increase the specificity without reduction of sensitivity.

플라즈마 처리에 의한 PET 보강사와 PP/NBR 블렌드계 열가소성탄성체와의 접착 물성 향상

원종훈,장영욱 한국공업화학회 2003 응용화학 Vol.7 No.2

PET fibers was treated by means of NH_3 plasma in order to improve the adhesion between PET fiber and PP/NBR TPE, which was compatibilized with GMA-PP. The adhesion between the surface modified PET fiber and PP/NBR TPE was markedly improved (∼60%), as measured by the pull-out test. Surface of plasma treated PET fiber was characterized by ATR-IR and XPS. The existence of any residue of matrix rubber on the PET fiber surface after pull-out test was examined by scanning electron microscope (SEM). The enhancement of the adhesion between PP/NBR matrix and plasma-treated PET fibers is due to the formation of functional groups on the fiber surface and the surface roughening of the fiber by sputtering effect.

신뢰성을 제공하는 효율적인 분산 파일 시스템

元裕憲,金鐘勳,安柔貞 弘益大學校 科學技術硏究所 1996 科學技術硏究論文集 Vol.7 No.2

Current network file system protocols rely heavily on a central server to coordinate file activity among client workstations. This central server can become a bottleneck that limits scalability for environments with large numbers of clients. In central server systems such as NFS and AFS, all client writes, cache misses, and coherence messages are handled by the server. To keep up with this workload, expensive server machines are needed, configured with high-performance CPUs, memory systems, and I/O channels. Since the server stores all data, it must be physically capable of connecting to many disks. This reliance on a central server also makes current systems inappropriate for wide area network use where the network bandwidth to the server may be limited. In this paper, we investigate the software RAID file system, writing data redundantly across an array of disks in each of the workstations on the network. By striping across enough disks, each workstation can appear to have disk bandwidth limited only by the network link bandwidth. Availability of a software RAID file system could be better than in other distributed file systems, because there is no central host to be a single point of failure. If one workstation crashes, any other can take its place in controlling the RAID. We present results from a trace-driven simulation study of the network file system protocol. We find that the software RAID file system improves the performance in the aspect of the av, age response time when compared with NFS protocol.

Nortriptyline 청소율과 Metoprolol 산화대사능과의 상관관계

정원석,장인진,이경훈,신상구,우종인,박찬웅 大韓臨床藥理學會 1993 臨床藥理學會誌 Vol.1 No.2

내시경적 절제로 진단된 폴립 형태의 심재성 낭종성 위염 2예

허종현,조영화,성용완,유재훈,구동영,김갑식,노지훈,문원 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.2

Gastritis cystica profunda (GCP) is a disease characterized by hyperplastic and significant extension of cystic dilatation of the gastric mucous glands, which results in a cystic lesion in gastric submucosa. It often occurs on the part of gastroenterostomy, but can be found in the stomach without any previous surgery. GCP has variable gross finding including solitary polyps, diffuse ones, submucosal tumors, and rare giant gastric mucosal fold. It is difficult to tell GCP from a cancerous lesion by gross finding that the disease demands a necessary tissue biopsy, though GCP is commonly showed as a benign in the progress. We report a case of GCP in polypoid types diagnosed by endoscopic polypectomy.

디스크 배열

元裕憲,金鍾勳,盧三赫 弘益大學校 科學技術硏究所 1995 科學技術硏究論文集 Vol.6 No.-

Disk arrays were proposed in the 1980`s as a way to allow parallelism between multiple disks to improve aggregate I/O performance. Today they appear in the product lines of most major computer manufactures. This paper gives a comprehensive overview of disk arrays and provides a framework in which to organize current and future work. First, this paper introduces disk arrays in general, and reviews the driving forces that have popularized disk arrays : performance and reliability. It discusses the two architectural techniques used in disk arrays, striping across multiple disks to improve performance and redundancy to improve reliability. Next, this paper describes 6 disk array architectures, namely RAID levels 0∼5. It goes on to discuss advanced research and implementation topics such as the way in which parity is distributed in a RAID, and the means of refining the basis RAID levels to improve performance. Finally, this paper describes software disk arrays which allow writing data redundantly across an array of disks in workstations distributed across the network.

멀티미디어 서버에서 효율적인 승인 제어 알고리즘 설계

元裕憲,朴勇,金鍾勳 弘益大學校 科學技術硏究所 1997 科學技術硏究論文集 Vol.8 No.-

A server of client-server environments has to not only minimum delay time, but also realtime processing of job. Specially, multimedia systems are need to an efficient admission control algorithm, because of clients of big-size data need to maximum processing and realtime processing. In this paper, we propose an admission control algorithm that considers both realtime requests and non-realtime requests. The proposed algorithm minimizes delay time about requests of client and efficiently uses resources of system. Using comparisons between a previously proposed algorithm and the proposed algorithm we show that the proposed algorithm improves performance in the aspect of the delay time and consumed buffer size.

한국산 잠자리과(잠자리목) 5종의 세포분류학적 연구

李鐘郁,愼鏞直,朴元學,金德勳 嶺南大學校附設 基礎科學硏究所 1988 基礎科學硏究 Vol.8 No.-

The chromosome study was performed in some species on the Korean Libellulidae by using squash techniques and lactopropionic orcein stain in order to define species relationship between them. The numerical and morphological differences were shown in the chromsome between the species of the stages of spermatocyte metaphase. The results obtained were summarized as follows: 1. The pattern of standard chromosome number in these species is divided into two groups; Orthetrum albistylum speciosum (UHLER), Orthetrum triangrlare melanina (SELYS), Rhyothemis fulignosa HAGEN are 13 in the haploid chromosome number. But, Crocothemis servilia servilia DRURY and Synoetrum eroticum (SELYS) are 12. 2. The shape of chromosome in these specie in divided into two groups; O. albistylum, S. eroticum eroticum, R. fulignosa, O. triangulare melania are bar or clover in shape at the spermatocyte metaphase. These species seem to be holocentric chromosome. On the other hand, C. servilia servilia is gloval and this species has monocentric chromosome. 3. The sex chromosome of five species ( O. albistylum speciosum, O. Triangulare melania, R. fulignosa, C. servilla servilia, S. eroticum eroticum ) are XO type. 4. Three species ( O. albistylum speciosum, O. Triangulare melania, S. eroticum eroticum ) shows the fragment chromosome in the spermatocyte metaphase. As the results, five species on the Korean Libellulidae (O. albistylum speciosum, O. triangulare melania, R. fulignosa, C. servilla servilia, S. eroticum eroticum ) is similar to each other in the external morphology, But, in the analysis of chromosome, these species is different to some degree.