병원내 재난 : 한국의 현실과 재난대비 계획 제안 Status of Korea and proposal of countermeasures

김준식,김행재,김철,유인술,조준필 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

CALS에 있어 STEP/SGML표준과 응용방안

임준식,손달호,차영한 啓明大學校 産業經營硏究所 1997 會計情報리뷰 Vol.- No.3

CALS(Commerce At Light Speed)는 제품생산과 관련된 설계, 생산과정, 보급 및 조달과 관련된 일련의 과정을 통합시키고, 이들 과정에서 사용되는 문자와 그래픽정보의 표준과 D/B를 통하여 설계, 제조 및 운용지원 자료와 정보를 통합하여 자동화시키는 개념이다. 이상적인 CALS시스템을 구축하려면 로지스틱스와 비지니스의 물류를 잘 조화시켜서 접목한 물류의 기능(Function), 절차(Procedure), 양식(Form), 자료(Data Dictionary)를 어떠한 방법으로 국제적 표준에 가깝게 하느냐가 중요한 부분이다. CALS시스템의 구축에 이용되는 표준에서는 여러 종류가 있다. 그와 같은 표준들 중에서 STEP/SGML과 관련된 표준들은 CALS시스템의 구축에 핵심적인 역할을 하고 있다. 본 연구는 이러한 CALS시스템의 구축에서 표준화의 중요성에 비춰 CALS시스템의 구축에 이용되는 표준 중에서 중요한 역할을 하는 STEP/SGML표준 및 그의 응용방법을 살펴보았다. 현재 구미에서는 SGML에 관한 연구가 활발하여 문서의 공유와 교환을 위해서 문서구조에 대한 표준화가 급속히 진행되고 있다. 우리 나라도 모든 특허출원을 SGML을 통하여 시도하는 사업이 진행되고 있으며, 학술논문의 전자화에 관해 SGML에 의한 논문의 데이타베이스화의 검토가 시작되는 등 SGML에 의한 응용의 움직임이 일어나고 있다. 따라서 우리 나라에서도 SGML의 중요성을 인식하여 SGML을 표준화하여 공표 하려는 움직임이 있고 추후 이에 대한 연구가 급속히 증가하리라 생각되며 보다 많은 추후 연구가 필요하리라 본다.

진달래 꽃에 의한 Grayanotoxin 중독 3 례

김아진,김준식,신동운,백광제,한승백,이용주 대한응급의학회 2000 대한응급의학회지 Vol.11 No.3

Traditionally, the Rhododendron species has been used in gastrointestinal disorder or hypertension. Grayanotoxin exists in honey, flowers, pollen, and the nectar of the Rhododenron species. We experienced 3 cases of Grayanotoxin intoxication. The symptoms of intoxication were nausea, vomiting, hypotension, bradycardia, diplopia, dizziness, and chest discomfort. Generally, the treatment for Grayanotoxin intoxication is fluid resuscitation and injection of atropine sulfate. The patients who were intoxicated with Grayanotoxin were discharged without complication after supportive care.

중환자에서 APACHE Ⅲ score와 사망율과의 관계

조준필,김준식,이영주 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

To evaluate the relationship between APACHE Ⅲ score and mortality in critically ill adult ICU patient, we studied the 548 patients who were admitted to the ICU from June 1, 1994 to January 31, 1995. We did not include patients with burn injuries, patients aged less than 15 years, or chest pain patients, in order to rule out myocardial infarction and unsatisfactory data files. There were 120 multiple trauma patients, 68 sepsis patients, 62 hemorrhagic shock patients, 20 multiple organ failure patients, and 120 patients with, among other conditions, durg intoxi-cation, diabetic ketoacidosis, renal failure, hepatic encephalopathy, and cerebral hemorrhage or infarction. The APACHE Ⅲ scores of survivors and non-survivors were analyzed with Chi-square test and compared. The number of nonsurvivors was 168 patients, and the overall mortality rate was 30.7%. there was a positive correlation between a high APACHE Ⅲ score and mortality ; all patients with more than 90 points expired. The average points of the survivors was 34.52 ±15.48 and of nonsurvivors was 77.74 ±31.37. The difference between each group is significant statistically. The average APACHE Ⅲ points was 47.8. The APACHE Ⅲ score is a good prognostic tool to predict the mortality rate in ICU adult patients, and can be used for selection of patients and for ICU admission/discharge. It can also be used to compare the efficacy of intensive care in different hospitals.

응급의료센터로 내원한 급성심근경색증 환자

정윤석,김준식,유인술,조준필 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

Early reperfusion can prevent myocardial necrosis, and clinical trials with reperfusion therapy demonstrating a significant reduction in acute myocardial infarction(AMT) mortality have dramatically changed the treatment paradigm for AMI. All patients with symptoms and ECG findings suggestive of AMI should be considered for treatment with thrombolytic agents. However, only a minority of AMI patients actually receive a thrombolytic therapy. Many patients are often excluded from treatment because they do not meet the criteria for age, duration of the chest pain, and a qualifying ECG. And late arrival at the hospital is a frequently cited reason for not giving a thrombolytic agent. To confirm the reason for not receiving an early reperfusion therapy, we obtained the data for the clinical characteristics, the time intervals between the symptom onset and the start of a thrombolytic agent infusion, the method of reperfusion therapy, the reason for not giving a thrombolytic agent and overall outcomes by retrograde chart review. During the 12-month study period between July 1994 and June 1995, 113 patients were finally diagnosed to AMI, who presented to Emergency Center of Ajou University Hospital in total 30,819 patients. The results were followings: 1. The average age was 59±12 years old, the ratio of male to female was 3.2:1. The direct visited patients to our hospital were 31 and the transfered were 82. 2. The chief complaints were chest pain(86.7%), dyspnea, dyspnea, and mental change. The common preceding diseases were angina pectoris(10 cases), old myocardial infarction(9 cases), congestive heart failure(2 cases) and typical chest pain but not diagnosed(23 cases). The risk factors were smoking(81 cases), hypertension (46 cases) and DM (22 cases). 3. 75 patients had arrived within 12 hours from symptom onset and 38 patients after 12 hours. 45cases (54.7%) were performed the reperfusion therapy ; 31 patients were taken the thrombolytic therapy by tissue-type Plasminogen Activator. 4. The most common reason for not receiving a reperfusion therapy was the time delay and the main was the patient/bystander factor. 5. 75.2%(85 cases) of the patients discharged with or without complications, 7.1% (8 cases) died, 10.6% (12 cases) discharged moribundly, and 7.1% (8 cases) discharged against advise. In conclusion, the time delay was the first reason for not receiving a reperfusion therapy in AMI patients. And the education for the AMI symptom and BLS (Basic Life Support) to the people, good EMS(Emergency Medical Service) system, early definite diagnosis and aggresive therapy may decline the mortality rate.

입원치료를 요하는 소아의 급성복증

배택환,김준식,유인술,조준필,이철주,민영기 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

The acute abdomen defined as an acute abdominal condition which needs immediate decision for treatment is one of the most common cause for emergency care. One thound six hundreds nine patients were visited to pediatric emergency center due to acute abdomen. To aid in early diagnosis and proper treatment, a clinical review was made on 278 cases of acute abdomen under 15 yrs old which admitted to Pediatrics and General surgery via emergency center from June of 1994 to May of 1995. The results as follows: It was 17.3% of total visiting to pediatric emergency center due to gastrointestinal sysmptoms. The sex ratio(Male: Female) was 2.35:1. Acute gastroenteristis was the most common acute abdominal condition(54%) and followed by acute appendicitis(17.9%), and intussusception(13.9%). The most common chief commplaint was vomiting(58%) and followed by abdominal pain(39.4%), diarrhea(35.8%), and fever(42.1%). One hundred fifty-five patients were visited to pediatric emergency center via local clinic and thirty patients via OPDs. The operations were done in 75 patients. Among them, immediate operation were done in 60 patients and delayed operations were done in 15 patients, but there is no difference in complication.

응급실을 내원한 요로결석 환자

김성중,김준식,조준필 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

A clinical study was made on 139 cases of urolithiasis among the total number of 14798 who visited in the emergency center during 7 months from June 1994 to December 1994.The 186 patients was suspected the urolithiasis, then the 150 patients was followed through out-patient department of Urology and performed Intravenous pyelogram. Among the 150 cases, the urolithiasis was confirmed in 139 cases. The results are summarized as follows: 1. The ration of the male to female is approximately 2.97:1. 2. The age of the patients ranged from 20 to 50 in approximately 80.6%. 3. Among 52 patient who were not revealed stone in KUB, 45 patients were shown micro-scopic hematuria. The 22 patients were revealed urolithiasis in IVP.The 6 patients found the urolithiasis spontaneously delivered.The 17 patients were diagnosed through out-patient department of urology. 4. The 7 patients, who not hematuria and no stones in KUB, were revealed urolithiasis in IVP performed at other hospital. 5. The major clinical symptoms and signs were flank pain(117 cases),abdominal pain and suprapublic discomfort(35 cases),fever(7 cases),low back pain(7 cases),nausea and vomiting(6 cases),painful urination(1 case),and urinary frequency(1 case). 6. The specific location of the stones showed 98 cases in ureter, 7 cases in kidney,bilaterality(3 cases),and multiple stones(8 cases). The ureteral stones located most frequently in the lower 1/3 of the ureter with 55 cases.

질소-프로판-암모니아 가스분위기에서 침탄질화시 공기첨가량이 침탄질화특성에 미치는 영향

조효석,이준범,노용식,이상윤 동아대학교 공과대학 부설 한국자원개발연구소 1993 硏究報告 Vol.17 No.1

This study has been performed to find out some effects of air and ammonia addition to a given quantity of nitrogen and propane gas mixture on the carbonitriding characteristics of low carbon steel after carbonitriding for one hour and two hours at 870℃. Carbon potential analysis has shown that the carbon potential decreases with increasing air addition at a given amount of ammonia and also with increasing ammonia addition at a given amount of air. Microscopical observation has revealed that the depth of internal oxidation increases with increasing air addition to a given gas atmosphere and the formation of surface abnormal layer considerably occurs in the gas mixture of more than 2.5% ammonia addition. If has been found by hardness measurements that the effective case depth increases with increasing air addition to a given gas mixture, whereas in more or less decreases with ammonia addition.

응급 의료 센터내 사망 환자의 분석

유인술,김준식,진재우,이철주,민영기,조준필 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

We need the constitute of Emergency medical system that connect prehospital care of inhospital care effectively for optimal treatment of emergency patient. The analysis of actual condition of our emergency medical system, through study of mortality case in emergency medical center will be a aid to the constitute. The authors performed a review on the records of 60 cases who died in Ajou university Emergency medical center during management, since June 1994 to september 1995. Among the 60 patient, 72% were male and 28% were female. In nontrauma patient, 6th decade was many, in trauma patients, 3rd and 5th decade was many. Among the 60 patient, 33% were traumatic cases, 66% were nontraumatic cases. Among the traumatic patients, more than half of the cases were due to motor vehicle accidents. The most frequent time interval from onset of emergent situation to arreving at emergency center was more than 2 hours. The most common transfer method was by 119 ambulance. In most cases, prehospital treatments were not taken. In most cases, initial mental status was comatose, and systolic blood pressure was less than 60 mmHg. Most cardiovascular resuscitation was done in 30 min. to an hour. In cases as traffic accident of ischemic heart disease, where rapid transportation of the patient is critical for the patient's survival, however, in most cases it took more than two hours to bring such patients to hospital, and first aid treatment before arrival to hospital was rare. No prehospital treatment was done to nearly all patient. In many cases the patient was already in under coma or shock state. The inhospital care at emergency center was made relatively quickly and adequately. The mean duration of cardiopulmonary resustation was 30min to one hour. From this study, we could notice the poor quality of prehospital care in the region ,near Ajou university hospital, and we came to know that the improvement of quality of prehospital care was the most important factor to reduce the motality of emergency department patient. that is, in the treatment of emergency patients, weak points has been revealed in the pre-hospital treatment, the improvement of which is important factor for the survival of emergency patients.

전략적 정보제휴의 결정요인에 관한 연구

손달호,임준식 한국경영과학회 1999 經營 科學 Vol.16 No.2

There seems to be a renewed interest in interorganizational relationship to search for strategic information partnerships it is particularly noteworthy that no study has yet reported configurations at the level of interorganizational relationships nor compared such configurations across different types of IOS(Interorganizational Information System) This paper seeks to uncover dominant configurations of interorganizational relationships across the various types of IOS We integrate relevant theoretical concepts from transaction cost economics, organization theory and political economy to develop a conceptual model of interorganizational relationships based on the fit between information processing needs and information processing capabilities We empirically uncover a set of hypothesis toward the patterns of interorganizational relationships Moreover the implications for further research pertaining to the logic and development of configurations were proposed