급성심근경색증 환자을 대상으로 한 중증도 보정 방법의 평가

박형근 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.2

Objectives : to evaluate the performance of models to predict AMI patients death using serverity adjustment measures in Korea. Methods : Medical records of 861 patients treated by AMI in 7 general hospitals during 1996 and 1997 were reviewed by trained nurses. We measured the severity of patients by APACHE Ⅲ, MedisGroups, CSI and DS. Using each severity method a predictive mortality for each patient was calculated from a logistic regression model including the severity score. The statistical performance of each severity method model was evaluated by using c-statistics and R2. For each hospital, z scores compared actual and expected mortality rates. Results : The overall in-hospital mortality was 14.5%, ranged from 10.0% to 22.2%. The distributions of severity scores for each method was significantly different by hospitals. The four severity-adjusted models to predict AMI patients death varied in their statistical performance for discrimination power of patients death. Order of Severity-adjusted mortality rates and z scores by four severity measure was different. Conclusion : Severity-adjusted mortality rates of AMI patients might be applied as an indicator for hospital performance evaluation in Korea. Because different severity methods frequently produce different impressions about relative hospital performance, more studies has to be done to use it as quality indicator and more attention should be paid to select appropriate severity measures.

國民學校 敎師 自然 및 算數科 再敎育의 分析的 硏究 : Based on the Choong Buk Province

黃秉德,梁仁煥,崔炳文,趙璇衡,朴根生 淸州大學校 科學敎育硏究所 1977 淸州大學校 科學敎育硏究所 Vol.1 No.-

Our college has retrained many primary school teachers during 5 years is science, and during 4 years in case of mathematics. Many problems are found out in the process of retraining them in our school. This study is aimed to research the actual condition of the retraining and to find out the way to improvement from the problems. However, Our study will have some limitation as follows: (1) For our study, only 300 teachers are chosen from the total 1,869 attended at our college(Cheong Ju Teachers College) in 1976. (2) The administrational and financial affairs are analyzed only according to the Ministry of Education with UNICEF funds from 1972 to 1976, and (3) We didn't take any consideration of Ministry of Education Project in Suggesting the way of improvement. Following are some problems found in our study: 1) Throughout the nation, only 23% of primary school teachers were taught in science and mathematice reservice work during the 5 years, and it can be said that it takes about 20 years to retrained all the teachers without consideration of natural increase of teachers. 2) The proportion of selecting primary school teachers in all the country for this reservice training is extreme, for example, Jeju Province is 57.9%, Seoul 17.7%. 3) The proportion of woman teachers selected in Choong Buk primary school is only 3.5% of total woman teachers, who takes 32% of total Choong Buk primary teachers during 5 years. Therefore, it is said that the number is very little. 4) Some teachers have been reselected in the reservice training. In case of the Choong Buk Board of Education. the 6% of teachers selected once were reselected for 5 years. 5) When the test are enforced on attendants to get data before the reservice training. We could find that they didn't understand the basic concept of science except a grade under their charge. 6) In the process of inquiry study, they didn't know even the scientific terms of expectation and reasoning. 7) After 60 hours of reservice training course. We tested them about understanding of the contents of text, and their marks are from 10 to 100. the marks show large individual difference among them. 8) Some teachers may have neither teaching ability nor knowledge of the basic concept, that is 11.3% of total attendants are less than 30 marks in mathematics test. 9) It is too very large work to study reservice text during the 60 hours. 10) There are many difficult signs in the mathematics reservice text having no connection with the actual primary school mathematics text book. 11) In the reservice text of science, there are omitted the method of teaching materials production, the model of inquiry learning, and the evaluation method. 12) From the analysis of questionary response for finding the actual condition of administration of teaching materials, We could find out 15% of primary schools in Choong Buk Province do almost not prepare teaching materials, and 15% of its never put them to practical use. Therefore, We could say that total 30% of them have been teaching without teaching materials. 13) The 42% of attendants in mathematics class answer that they do not understand the new mathematical signs, and 42% of them answer the shortage of hours (60 hours) to understand their reservice text book. 14) The 25% of them answer that they teach children with cramming education, and almost of them want good teachers guide books. As mentioned above, there are found many problems to be solved for reservice training of science education in our country. Some of them will be solved in our study. So We find out its and We suggest the ways solving the problems as follows: A. On the administration of reservice training. 1) The reservice training work for primary school teachers is very significant and will have to be continued. 2) It will be done in not only summer vacation but also winter one for finishing immediatly all over the country. 3) The 60 hours of science reservice training course work are very short, and the classmember of attendants will be regulated. 4) The funds for reservice operation and travelling expenses for attendants will be realized. B. On selecting the attendants 1) When the attendants are selected, there will be consideration of age, rank, term of their service, sex and academic background. 2) as far as possible, it will be selected as homogeous groups, and it will be effective to teach them with division between class teacher and nonclass teacher. 3) When select attendants are it will be taken consideration of balance between city and province for the diffusion effect and parallel development in reservice training work. 4) It must give a chance to woman as same as to man teacher according to a rule of equal select chance. 5) The principal, instructor and school inspector will be reeducated for fixing of science curriculum. C. On reservice training text book 1) The text book must reedit moderatly for 60 hours, or the time of retraining for the text book finished will be extented. In our opinion, it is to be desired that the time have to be added. 2) The difficult signs must be omitted, taking into account for the mathematics knowledge and time of education period. 3) In the science reservice training text book, it must supplement the tack for framming of inquiry teaching plan, the method for making teaching materials, and the skill for replacing of teaching materials. D. For the curriculum management of science. 1) The Governmental Company must settle the shortage of science teaching materials in primary school. 2) For the charge of the old state of teaching method, the teachers must devote themselves to teach children without miscellaneous duties. 3) The authorities concerned (for example, Ministry of Education, Teachers College, etc.) must make guide books for science teachers, and supply them to primary school teachers. 4) It must be given the chance of long period reeducation to the incompetent primary school teachers, and problem will have to be studied under the situation of educational administration.

캘리포니아주의 관상동맥 우회술 위험도보정 결과평가 사례 연구

윤석준,서현주,박형근 한국의료QA학회 2004 한국의료질향상학회지 Vol.11 No.1

치과위생사의 감염관리 실태에 관한 연구

조윤정,윤석준,안형식,김순덕,박형근 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.2

Background : Dental hygienists are at risk of acquiring infections through exposure to infectious agents. This study explores the frequency of exposure to infectious agents and infection control practices among dental hygienists. Methods : We undertook a cross-sectional survey to examine the exposure to infectious agents and infection control practices among dental hygienists through questionnaire. Data were obtained from 124 dental hygienists attending educational conferences. A multiple logistic regression analysis was conducted to determine the factors that effect infection control practices in to age, completion of infection control education, recognition of their own serum hepatitis Ag/Ab status, the number of one day patients, location of clinics, type of clinics, and career years. Results : Of the 124 dental hygienists, 91.7% were exposed to at least one accident such as needle strike injuries during their practices periods. The health screening coverage rate in dental hygienists was 16.5%. The number of one day patients and career years were important in relation to infection control practices among dental hygienists. The adjusted odds ratio estimates for career years were 5.049 times greater(95% CI 1.238-20.597)for groups with 4 career years than under 2 career years. That for the number of one day patients were 0.261(95% CI 0.071-0.0955)lower for through 20 up to 30 patients, 0.531(95% CI 0.102-2.78)lower for through 30 up to 40 patients and 0.498(95% CI 0.123-2.017)lower for more than 40 patients than under 20 patients. Conclusion : From these results, prevalence of infection control practices among dental hygienists is related to the number of one day patients and career years. Prevention of cross infection and reduction of future transmission should be a priority to dental hygienists for promotion of infection control and further efforts to educate newcomers on infection prevention should be made.

사체간이식 환자와 생체간이식 환자들의 삶의 질 비교 연구

김금희,윤석준,안형식,이준영,박형근,서경석 한국의료QA학회 2004 한국의료질향상학회지 Vol.11 No.1

Objective : The aim of this study were to measure quality of life(QOL) in liver transplant recipicnts, to ocmpare QOL between living donor liver transplant recipicnts and cadavcric live transplant recipients and to investgatre whether SF-36 may be used as a disease-specific instrument in liver transplant recipients. Methods : We conducted a single-center cross-sectional study of 133 LT recipients ages 13 to 65 years, all of whom had had Liver Transplantion(LT) at least 1 months previously. QOL was assessed using a self-completion questionnaire consisting of the Bang Whal Ran(1991) instruments and the 36-Item Short-Firm Health Survey(SF-36) health status profile measure. We investigated whether the SF-36 instrument may be used as a disease-specific instrument in LT recipients. Individual scale scores range from 0 to 100 , with higher score reflecting better health. Data on demograpics, clinical status at pre transplantation 1 day, post transplantation clinical statns, and graft gunction were collected to identify predictors of post transplantation QOL. Results : Standard measures for test-rtest reliability, internal consistency, and discriminant and concurrent validity were examined. The reliability of the SF-36, as measured by test-retest correlation(Pearson coeffocoents: 0.729, p=0.002) and by internal consistency (Cronbach's alpha: 0.9431) exceeded conbentional acceptability criteria. The correlation between domain scores of SF-36 and the Bang Whal Ran(1991) was clear and logical in that the clinical characteristics of SF-36 strongly correlated with the clinical component summary score of the Bang Whal Ran(1991)(r = 0.8155, P<01). SF-36 scale scores were compared between Cadaveric Liver Transplant recipients and Living Donor Liver Transplant recipients. Donor types of post LT did not influence HRQOL(P >0.05). 87% of the liver transplant recipients were safisfied to get LT. Satisfaction of post LT showed significantly greater HRQOL(p<0.001). Conclusion : SF-36 is found reliable and valid. This study indicates thet Donor Type did not influence HRQOL after LT. The information gained from this study will help us to better define expectations and the colinical course after liver transplantation to patients and their families.

시뮬레이션을 이용한 금융 ATM기 유지보수의 효율적 운영에 관한 연구

유형근(Hyeung Keun Yu),이강원(Kang Won Lee) 한국경영과학회 2011 經營 科學 Vol.28 No.1

The automated teller machine (ATM) is developed as a system to provide customers with an easy deposit and withdrawal of their money without time restriction and be served for 24 hours. Today, ATM is come up to the level of an unmanned branch. The automatic financing system is developed as an essential one for dealing with the rationalization of management and the globalization of financing in order to improve the efficiency of financial management work and increase the customer service quality. With reducing the operational cost of financial organizations through the efficient maintenance operation of ATM and increasing the service quality through the maximization of its processing efficiency, this study is to draw the scheme to ensure the competitiveness among the finance companies. The importance of ATM is highly recognized as the utilization of ATM is increased and the processing function is extended, but ATM is quite vulnerable to the malfunction occurred during the nighttime after banking hours. The ATM maintenance is done through consignment to the specialized maintenance company. The efficient operation of ATM maintenance work is important to the satisfaction of customer using ATM in the nighttime.

1990년대 중반 이후 병상 공급 및 환자들의 병원이용 양상 변화에 관한 분석

박형근 ( Hyeung Keun Park ),박연서 ( Youn Seo Park ) 한국보건경제정책학회(구 한국보건경제학회) 2011 보건경제와 정책연구 Vol.17 No.1

이 연구에서는 1990년대 초에 진행된 일련의 병상 공급 규제 완화 이후 진행된 병상 공급의 변화와 환자들의 의료기관 이용 양상의 변화 추이를 평가하였다. 1996년부터 2005년까지 진행된 4차례 환자조사 자료를 이용하여, 급성기 병원에서 1개월 동안 퇴원한 환자 전수자료를 병원현황 자료와 연계해 병원 특성별 병상구성비, 병원 특성별 총 환자점유율, 개별병원별 병상회전율과 환자점유율을 산출하여 분석하였다. 서울로의 환자집중 여부를 평가하기 위해 서울소재 병원들의 입원 환자점유율 추이도 분석하였다. 병원급 기관 중심의 병상 증가와 환자점유율 비중 증가, 종합병원의 대형화 및 대형 종합병원의 환자점유율 증가, 서울병원의 지방 거주 환자점유율 증가 등이 확인되었다. 병상점유율과 병상회전율이 높은 일부 대형병원들의 병상 증축이 지속되고 있어 향후 이들 병원으로 환자집중이 보다 심화될 전망이다. 향후 보다 세밀한 평가를 위한 자료체계 구축과 이에 기초한 연구가 지속되어야 할 것이다. The aim of this study is to evaluate the trends of acute hospital beds supply and acute hospital utilization after deregulation of hospital beds in 1990s. This study calculate hospital bed proportions and hospital market shares by hospital characteristics, each hospital`s market shares and turnover rates for 1996-2005 using ``Patient Survey Data`` which has been gathered by the Ministry of Health and Welfare every three years. The concentration of patients into Seoul is examined, too. The results show the constant increase of acute hospital beds by ``hospitals``, hospital bed expansion of general hospitals and decrease of hospital bed proportions where has been in Seoul in the bed supply side. In the hospital utilization side, it appear that total ``hospitals`` market share has been continuously increased but less than it`s growth of bed composition, small-scale general hospital market share has been decreased and the market share of big4 hospitals in Seoul. It is confirmed that the growth rate of patients that turn to hospitals in Seoul to get best outcomes has been faster than on the average rate.

요막관 낭종성 종물로 오인된 폐흉충증 이소기생 1례

김형남,권동득,오봉렬,류수방,박양일,정용연,강형근 大韓泌尿器科學會 1998 Korean Journal of Urology Vol.39 No.4

2개의 금속판을 이용한 감염된 장관골 불유합의 치료

김근우(Keun Woo Kim),김용훈(Yong Hoon Kim),민학진(Hak Jin Min),윤의성(Ui Seoung Yoon),조국형(Kook Hyeung Cho),김호석(Ho Seok Kim),김일명(Il Myung Kim) 대한정형외과학회 1997 대한정형외과학회지 Vol.32 No.7

척추증 및 척수증에서 경추전후경의 임상적 의의

김형근,김남규 中央醫學社 1977 中央醫學 Vol.33 No.1

It is well known that subjects with all the radiological features of cervical spondylosis may be symptom-free. On the other hand, manifest cervical myelopathy may occur in the presence of modest radiological changes. This discrepancy between symptoms and radiological findings seems to be attributable mainly to differences in the initial size of the cervical spinal canal In order to determine the minimal diameter of the cervical spinal canal, the canal, diameter was measured in radiographs taken in the neutral portion in 361 cases (male; 198, female; 163) and patients were classified into four groups as following. 1) Control group (male; 62, female; 56) : There were no cervical myelopathy and cervical spondylosis. 2) Group II (male; 60, female; 49): Significant cervical myelopathy without cervical spondylosis. 3) Group III (male; 31, female; 27): Cervical spondylos with cervical myelopathy 4) Group IV (male; 45, female; 31) : Cervical spondylosis without cervical myelopathy. It was found that; 1) In the myelopathic group the average canal diameter was, significantly smaller than in the control group. 2) In cervical spondylosis without cervical myelopathy the initial sagittal diameter of the cervical spinal canal was larger than control group and more than 17mm. 3) In the cases of cervical myelopathy without cervical spondylosis, the sagittal diameter of the cervical spinal canal) was smaller than 13.5mm usually.