위암수술 환자에서의 cp 개발과 cp적용에 따른 질 향상 활동에 관한 연구

임은주,황순휘,박도중,하광일,배현주,김형호 한국의료QA학회 2006 한국의료질향상학회지 Vol.13 No.2

Background : In an era of increasing medical costs, safe reduction in postoperative stay has become a major focus to optimize utilization of healthcare resources. The authors aimed to evaluate the clinical significance of the critical pathway(CP) for gastrectomy patients by implementing standardized postoperative management and electronic medical records. Method : From August 2006 to April 2007, critical pathways were introduced to inpatients and outpatients with gastric cancer. 60 consecutive patients undergoing distal gastrectomy were randomly divided into two groups; 30 CP group(A) and 30 non-CP group(B). Simultaneously, we also retrospectively reviewed the records of 438 patients(C:control group) who were able to be enrolled in CP program. We compared group(A) with (B), (C) in terms of hospital stay, complication rate, use of antibiotics and hospital costs. Patient satisfaction was surveyed by questionnaires. Result : There was no significant demographic difference between group(A) and (B). Of 30 patients in group(A), 5 drop-outs and 14 variances occurred. The mean postoperative hospital stays(Laparoscopy-assisted distal gastrectomy: LADG/Open distal gastrectomy: ODG) were 7.6/10.5 days for the group(A), 8.9/12.7 days for the group(B) and 12.6/14.5 days for the group(C) (p=0.02 in LADG). The total hospital cost of group(A) had a tendency to be less than that of group(B) and the amount of hospital cost per day in group(A) was significantly higher than that in group(B). The usage rates of the first generation antibiotics were 73.33%, 63.33%, and 59.2% in group(A), (B), and (C), respectively. Patients’ satisfaction had a tendency to be higher in the CP group than non-CP group. Conclusion : The mean hospital stay in LADG patients was shortened meaningfully and hospital cost per day was enlarged after introduction of clinical pathway. It is necessary to apply a number of patients to the critical pathway and to make an effort to reduce the variation and drop-out rates.

消音器의 音響減衰에 關한 硏究

윤화중,홍은숙,전관수 충남대학교 자연과학연구소 1989 忠南科學硏究誌 Vol.16 No.2

In order to investigate the acoustical attenuation effects from simple expansion chamber type muffler the following experiments were carried out ; the spectrum analyzer which has 25Hz analyzing frequency intervals was devised. The changing of acoustical attenuation frequency intervals was devised. The changing of acoustical attenuation effects were observed by varying the diameter and the length of the muffler. The diffuser was attached to the muffler in order to decrease the sound pressure levels more and then the acoustical attenuation effects were investigated. The phenomena on the sound wave surface was curvatured and visualized by the diffuser was confirmed in photographic developing of the attenuation wave.

환자진료결과연구에 대한 고찰 : 미국 PORT 연구를 중심으로

박은철,김한중,조우현,손명세 한국의료QA학회 1998 한국의료질향상학회지 Vol.5 No.1

Background : In this paper patient outcomes research is going to be reviewed and described, to be compared with relevant studies, and to consider the application in Korea. Methods : We compiled and reviewed the articles and materials related to patient outcomes research especially by PORT(Patient Outcomes Research Team) and rearranged them for seeking the main point and comparing with relevant studies. Results : Patient outcomes research emphasizes patient outcomes as well as conventional clinical outcomes. It is prospective study observing effectiveness in real situation instead of efficacy in ideal condition. Patient outcomes research comprises of 6 fields ; literature review and meta-analysis, use of claims data. decision modeling, outcomes assessment, cost of care, dissemination of research findings. SAA(small-area variations analysis), appropriateness study and clinical practice guideline are connected with patient outcomes research. Conclusion : In view of the fact that current medical policy in Korea is shifting its focus fromaccessibility to the improvement in quality and cost containment, and is stressing patient-based research, patient outcomes research is one direction for which the medicine is accountable and assessable. Considering that the number of patient receiving medical treatment in Korea is higher than the West, patient outcomes research has competitive power as against the West.

Cam-Follower 기구의 단순형상변형 설계에 의한 기구학적 성질의 변화에 관한 연구

최은순,신중호 國立 昌原大學校 産業技術硏究所 1992 産技硏論文集 Vol.6 No.-

As direct contact mechanisms, Cam-follower mechanisms are used commonly. Disk-typed cams have 4 different types due to the different type of followers, such as reciprocating roller type, reciprocating flat type, oscillating roller type, and oscillating flat type. In this paper, iterative contact method is used to design the cam shapes and analyze the kinematic properties of the cam and follower mechanisms. For the given displacements, the shapes of cam must be designed accurately with the given types of the follower. But Engineers in domestic industry modify the type of followers by simple shape synthesis without consideration of functional aspects. This paper presents that the simple shape modification as the reverse design makes big trouble in machines the mechanism operates incorrectly.

방광의 이행상피암에서 p53과 PCNA 분포에 관한 연구

최은정,강상균,양승하,김대중,김의한 순천향의학연구소 1996 Journal of Soonchunhyang Medical Science Vol.2 No.2

Immunohistochemical studies were carried out to observe the expression of p53 protein and PCNA in transitional cell carcinoma (TCC), then analyzed according to the tumor grade and progression. 38 cases of TCC consist of 13 cases grade Ⅰ, 12 cases grade Ⅱ and 13 cases grade Ⅲ respectively. Results obtained are as follows. 1. p53 protein expression was seen in 60% of cases(15 out of 38 cases) In the poorly differentiated area and infiltrated lesion, tumor cell showed more strong positive reaction of p53 protein compared with well differentiated area. 2. All of 38 cases of TCC showed PCNA positive expression. The more strong positivity was seen in the poorly differentiated area and the more intense positive reaction was noted in the basal layer of the tumor nests. 3. The above results showed that positivity of p53 protein and PCNA are closely related with tumor cell differentiation(grade) and progression. It is concluded that positive reaction of p53 protein and PCNA may contribute to detection of tumor growth and prognosis of patient.

내시경적 역행성 췌담관조영술중 췌선방 조영 후 발생한 중증 췌장염 1예

장세중,기승석,김훈일,신혜영,박장원,송은훈,태재웅 朝鮮大學校 附設 醫學硏究所 2008 The Medical Journal of Chosun University Vol.33 No.2

내시경적 역행성 담췌관조영술 후 발생한 급성췌장염의 발생인자로 여러 가지 인자들이 관여하지만 특히 담췌관조영술 시행 후 과도한 췌선방 조영화에 의한 중증의 췌장염 증례를 경험하였기에 보고하는 바이다 Endoscopic retrograde cholangiopancreatography (ERCP) has been considered as a valuable tool for the diagnosis and management of disease of the pancreas and biliary tree. Post-ERCP pancreatitis is the most frequent and clinically significant complication following ERCP. But a few complication associated with this procedure are unforeseeable. Specially, acinarization as a result of a careless cooperation between operator and assistant may be influenced in complications of ERCP. Severe post-ERCP pancreatitis is rare complication, and its prognosis will be poor. Therefore, careful process and good relationship between operator and assistant in ERCP may be prevented this complication, but is not clear. Neglect of acinarization may be resulted in more aggravation of pancreatitis. We have cared for one patient with severe post-ERCP pancreatitis with pseudocyst after water-soluble contrast media spreading into the acini (acinarization) via ERCP in resolving phase idiopathic pancreatitis.

유동층을 이용한 탈황제의 마모특성에 관한 연구

오광중,김형국,최은화,조기철 부산대학교 환경문제연구소 1999 環境硏究報 Vol.17 No.1

For the efficient energy use and the protection of environmental pollution, attrition characteristics, depending on the component and the condition of sorbent for the purification of fuel gas, were analyzed by a fluidized-bed tester. Results of these studies can be summarized follows. 1) When Mn-based sorbent(M, MT, MFT) prepared with varying addictives and induration conditions was compared in terms of particle size distribution and AI(Attrition Index), MT and MFT possessing TiO2 and Fe203 had much higher attrition resistance than M. Attrition resistance of M, MT and MFT increased as bentonite contents and induration temperature increased, when bentonite contents induration temperature were changed from 2 to 5% and from 1000 to 1100℃, respectively. Therefore when powdery catalysts are prepared, the attrition rate can be considerably affected by the controls of addictive, binder and induration temperature. 2) Attrition tests using MT1100-5 were performed under the conditions that particle size distribution was uniform and had much more over +270mesh and under -325mesh. AI due to attrition was 8.83, 21.54 and 1.67%, respectively. Thus, initial particle size distribution showed a great influence on both produced fines distribution and attrition loss. Therefore, the size distribution of particles injected initially and the particle size that carried over showed be considered to reduce the loss of particulate materials and the replacement cost due to attrition. 3) An experiment using MT1100-5 sorbent was also carried out to predict AI as a function of time and particle size distribution during 23hr. AI of prepared sorbent was 4.54, 7.73, 9.08, 11.35 and 12.48 after 1.5, 3, 5, 9 and 23hr. respectively. Thus, it was shown that the amount of produced fines during the same time was shorten with the increase of time. The operating condition of dust capturing equipment and the rate of powder exchange needs to be considered because most of the fines due to fluidization of particulate material was generated at initial operation.

수지상세포의 방사선 저항성에 대한 연구

김은실,김종순,이명호,범희승,민정준,정환정,김성민,허영준,송호천,이제중 대한핵의학회 2003 핵의학 분자영상 Vol.37 No.3

목적 : 림프구와 비교되는 수지상 세포의 방사선 민감성을 보기 위하여 본 연구를 시행하였다. 대상 및 방법 : 말초혈액에서 분리한 T 림프구에 0 Gy, 10 Gy, 30 Gy의 방사선을 조사하고 4시간 후에 유세포 분석기를 이용하여 선량별 세포고사 빈도를 관찰하였다. 또한 조혈모세포에서 미성숙 및 성숙 수지상 세포를 단계적으로 분리 배양하여 각각 0 Gy, 10 Gy, 30 Gy, 100 Gy의 방사선을 조사하고 4시간, 24시간 그리고 48 시간 후에 선량별 세포고사 빈도를 관찰하였다. 사이토스핀(cytospin)슬라이드에 림프구와 미성숙 및 성숙 수지상세포를 3×104개 씩 분주하고 May Grunwald-Giemsa 염색한 후, 광학 현미경 하에서 각각의 세포군 당 100개의 세포에서 세포 면적당 핵의 면적 비를 측정하였다. 결과 : 림프구에서는 방사선조사 선량별로 세포고사 빈도가 유의하게 증가하였으나, 수지상 세포에서는 그 분화정도나 방사선조사 선량에 따른 세포고사의 빈도차이가 없었다. 또한 수지상 세포는 방사선선량과 관계없이 용량에 의존적으로 강력한 T-세포 자극능을 보였다. 림프구의 세포에 대한 핵의 면적 비는 미성숙 및 성숙 수지상세포의 세포에 대한 핵의 면적 비보다 현저히 큰 반면, 두 가지 수지상세포간에 유의한 차이는 없었다. 결론 : 수지상세포는 그 분화도와 상관없이 림프구에 비하여 방사선 저항성을 나타내었고, 이는 세포의 형태적 차이에 따른 표적의 크기와 관련이 있을 것으로 생각되며, 향후 분자 생물학적인 연구의 기초 자료로 활용할 수 있을 것으로 생각된다. Purpose : To evaluate radiation sensitivity of dendritic cells in comparison with lymphocytes. Materials and methods : T lymphocytes captured from peripheral blood were irradiated by 0 Gy, 10 Gy, 30Gy. Apoptosis was measured by flowcytometry for staining of Annexin V 4 hours after irradiation. Immature and mature dendritic cells processed from blood hematopoietic stern cell were irradiated by 0 Gy, 10 Gy, 30 Gy, 100 Gy respectively and apoptosis was measured by flowcytometry with time difference as 4h, 24h and 48h after irradiation. Morphometric analysis by percent nucleus was measured in three cell groups, also. Results : Lymphocytes showed radiation sensitivity by increasing apoptotic fraction according to radiation dose. However, both mature and immature dendritic cells showed consistent fraction of apoptosis in spite of increasing radiation dose. Percent nucleus ratio is significantly higher in lymphocytes than that of mature or immature dendritic cells. Stimulation of T-cell by dendritic cells was not changed after irradiation. Conclusion : Dendritic cells showed radioresistance which was associated with small size of nucleus in comparison with lymphocytes and this result would be used as a basal data of radio-labelling for the cellular trafficking studies in nuclear medicine fields.

감마선 조사와 저장 기간에 따른 건멸치류의 품질 및 열발광 특성

노정은,변명우,권중호 한국식품저장유통학회(구 한국농산물저장유통학회) 2002 한국식품저장유통학회지 Vol.9 No.1

건멸치의 위생적 품질개선을 위한 감마선 조사가 품질에 미치는 영향을 조사하였으며, 아울러 감마선 조사 멸치에 대한 검지법으로서 열발광 특성을 분석하였다. 건멸치류의 미생물 오염도는 총세균이 10^4∼10^6 CFU/g 수준으로 건멸치의 종류에 따라 큰 차이를 보였으며, 대장균군은 모든 시료에서 음성으로 나타났다. 미생물학적 품질개선을 위한 3kGy 수준의 감마선 조사는 유통조건(식품포장용 PVC film, 0.06 ㎜, 500 g)으로 포장하여 6개월 저장(15±1℃) 후에도 검출한계이하(20 CFU/g)의 수준을 유지할 수 있었다. 저장 중 건멸치의 기계적색도(L, a, b, ΔE ), 갈색도, TBA가, VBN, TMA-N, 관능적 특성 등 건멸치의 품질에 관련된 여러 인자들은 3 kGy의 감마선 조사에 의해 거의 영향을 받지 않았다. 그러나 저장기간에 따른 영향은 매우 크게 나타났으며, 이는 저장온도와 포장조건의 중요성을 뒷받침해 주었다. 건멸치의 방사선 조사 여부 확인을 위한 열발광 특성을 분석해 본 결과, 비조사구는 280∼300℃ 부근에서 매우 낮은 peak를 나타내었고, 1 kGy 이상의 감마선 조사구는 200℃ 전후에서 조사선량에 의존적(R^2=0.9933)인 높은 glow curve를 나타내어 감마선 조사 건멸치의 판별이 가능하였고, - 20℃에서 6개월간 저장 후에도 검지가 가능하였다. The effect of gamma irradiation was investigated on the microbiological and physicochemical qualities of boiled-dried anchovies (large- and smallsized) packed in PVC film (0.06 ㎜) during storage at 15±1℃ for 6 months. On the other hand, thermoluminescence characteristics of minerals extracted from the sample were analyzed to evaluated its possibility in detecting the irradiated anchovies. The samples were contaminated by microbial levels of 104∼106 CFU/g in total aerobic bacterial counts and negative in coliforms, which were different depending on the sample sizes. Gamma irradiation at 3 kGy was effective for improving the hygienic quality of both samples for 6 months, keeping the microbial population less than 20 CFU/g. Besides it was not detrimental to the quality attributes, such as instrumental color parameters (L, a, b, ΔE ), browning, TBA value, volatile basic nitrogen, trimethylamine-N, and sensory properties(appearance, color, odor, taste, overall acceptability). However, storage conditions (time, temperature, packing) showed a critical factor influencing the quality changes of dried anchovies. Thermoluminscence analysis was prove to distinguish irradiated from non-irradiated anchovies by comparing both temperature at which glow curves appear and the curve intensity, that was possible even after 6 months at -20℃.

뇌동맥류성 지주막하 출혈 후 지연허혈신경결함에 대한 평가에 있어서의 Acetazolamide단일광자방출전산화 단층촬영술의 역할

김형중,김은영,하윤,윤승환,박형천,박현선 The Korean Neurosurgical Society 2004 Journal of Korean neurosurgical society Vol.35 No.2