위절제술 환자의 표준진료지침 개발 및 적용 효과

김은희,김철규,이순교,김순덕,이혜옥,권정순,이경미,이민미,심순미,유용만,신종식,강은희,이상일,김병식,오성태,육정환,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.2

Background : Gastric cancer is the most common malignant tumor in Korea. surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for recucing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and unplanned readmission rate between the pre-pathway group(n=67) and the post-pathway group(n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days(p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was of satistically significant(p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korea hospital settings.

Fault Detection in Linear Descriptor Systems Via Unknown Input PI Observer

Hwan?Seong KIM,Tae?Kyeong YEU,Shigeyasu KAWAJI 제어로봇시스템학회 2000 제어로봇시스템학회 국내학술대회 논문집 Vol.2 No.10

석청(Mad-honey) 복용 후 유발된 부정맥 1예

김용철,김남호,김승환,최준호,박은미,이상재,이은미,유남진,윤경호,오석규,정진원 圓光大學校 醫科學硏究所 2008 圓光醫科學 Vol.23 No.2

석청에 포함된 grayanotoxin에 의해 독성 작용이 나올 수 있으며, 이러한 독성 작용은 일반적으로 24시간 이내 저절로 회복된다. 최근에 본 저자들은 석청 복용 후 발생한 심실빈맥을 경험하였기에 보고하는 바이다. 49세 남자가 호흡곤란으로 내원하였으며, 내원당시 분당 40회 정도의 동성 서맥이 관찰되었고, 수액을 투여하던 중 심실 빈맥이 발생하였다. 항부정맥제를 투여 후 정상 동율동으로 전환되었으며, 특별한 이상 없이 4일 후 퇴원하였다. Mad-honey intoxication caused by the consumption of honey producted from the nectar of rhododendrons. The grayanotoxins cause the intoxication. The toxic effects of mad-honey poisoning are rarely fatal and generally last for no more than 24 hours. We experienced one case, a 49 years-old man who presented with dyspnea after ingestion of mad-honey. He showed marked sinus bradycardia with < 40 beats per minute on admission. The cardiac rhythm was changed to ventricular tachycardia immediately. These features resolved completely in 24 hours with continuous infusion of amiodarone(600 mg per day) and fluids. We report the case of intoxication of mad-honey as a presentation of fatal cardiac arrhythmia.

콘크리트 引拔附着强度 試驗法의 提案

金敬鎭,金聖煥 충주대 2003 産業科學論文集 Vol.11 No.-

The development and maintenance of a sound bond are an essential requirements of concrete repair and replacement. The bond property of a bonded overlay to its substrate concrete during the lifetime is one of the most important performance requirements which should be quantified. A standard or a verified bond strength measurement method is required at field for screening, selecting materials and quality control for overlay or repair materials, but no test method have been adopted as a standard. In this dissertation, a concrete pull off bond strength measurement method for field application is proposed and evaluated. This dissertation compares the splitting tensile test, slant shear test, nipple pipe direct tensile test, flexure adhesion test, briquette tensile test, jumbo nael pull-out test and core pull-off test with their test procedures. From these comparison and investigation, core pull-off test is selected ad a main topic of this study because of it's suitability for in situtesting, simplicities in field application and clearness at interface boundary condition. The stress concentration, which is one of non-uniform stress distribution and arises from specimen geometry, should be minimized in order to measure the bond strength correctly. This study discusses the main relevant issues effecting to core pull-off test, namely, core drilling depth, stiffness of steel disk, modulus ratio, overlay thickness and length of between cores and edges. Finite element analysis is carried out in order to investigate the effects of those above into the stress concentration at concrete interface. From a series of finite element analysis, a fine concrete pull-off bond strength test method is proposed for field application.

광중합 구치부용 레진에서 광조사 후 이차 가열시 가열시간이 간접인장강도에 미치는 영향

박경준,김경남,황동환 大韓齒科器材學會 1993 대한치과재료학회지 Vol.20 No.1

The visible light-curing posterior composite materials are used extensively due to their esthetic characteristics. Many disadvantages of marginal leakage, wear and poor strength should be overcome through improvement of mechanical properties. It has been proved that most of materials could be improved by additional heat curing after light curing. The objectives of this study was to estimate the effects of additional heat curing on the five different commercial posterior light curing resins, P-50, Herculite XR, Heliomolar, Prisma AP. H, Clearfil Photoposterior. Additional heat(CRC system, Kuraray Co., Japan) of 100℃ was applied for 0, 5, 15 and 25 minutes after light curing with Visilux Ⅱ (3M Co., U.S.A.). The diametral tensile strength was measured by using UTM (Instron 6022, U.S.A.) of cross head speed of 1cm/min after storing in 37℃, 100% humidity for 10minutes and 24 hours. The following conclusions may be drawn from this study. 1) When heat was applied on tested specimens, diametral tensile strength was increased in proportion to period of heat applying in early stage. However, there were differences of diametral tensile strength in each tested materials. 2) The highest diametral tensile strength was shown after 5 and 15 minutes of heat application. 3) When it was compared between 24 hours and 10 minutes group, former showed higher values. Heat application after light curing on VLC posterior composite resins showed increase of diametral tensile strength on this study. Not only the temperature applied but period of heat application seemed affect the strength of this materials. The further investigation of proper temperature and period of heat application for each materials was recommended.

동진강의 식물상과 식생

이경보,김창환,이덕배,김종구,박찬원 한국환경농학회 2004 한국환경농학회지 Vol.23 No.1

동진강 일대의 인위적인 교란에 의한 하천식생의 복원 및 복구를 위한 기초적인 자료를 제공하고자 2001년 6월부터 2002년 3월까지 하천식생의 종 구성, 하천형태에 따른 군락의 구조, 현존식생의 분포 등을 종합적으로 분석한 결과는 다음과 같다.동진강 유역에서 조사된 하천식생은 73과 188속 238종 33변종 1품종으로 총 272종류가 조사되었다. 또한 관속식물의 생활형에 따라 분류하면 침수식물이 23종, 부엽식물이 7종, 부유식물이 2종, 정수식물이 18종, 습생식물이 53종, 수변식물이 168종이었으며, 수생식물과 습생식물은 각각 50종과 53종류로 전체 조사된 272종류 중 37.9%를 차지하였다. 식물생활형의 분포비율은 휴면형 1년생 식물이 97종 35.7%, 수생식물이 78종 28.7%, 반지중식물이 41종 15.1%, 지중식물이 22종 8.1%, 지표식물이 12종 4.4%가 관찰되었다.동진강 상류유역의 식물군락은 검정말군락, 검정말-실말군락, 붕어마름군락, 달뿌리풀군락, 고마리군락, 큰황새냉이군락, 여뀌군락 등 총 8개의 식물군락이 분포하였다. 동진강 중류유역은 수생식물인 줄과 갈대군락, 그리고 수변식물군락으로 고마리군락, 교란지식생인 환삼덩굴군락 등 총4개 군락이 분포하였고, 동진강 하류 유역은 자라풀군락, 붕어마름군락, 마름군락, 줄군락, 갈대군락의 5개 습생식물군락과 털물참새피군락, 고마리군락의 2개 습생식물군락, 새콩 등의 나대지 식물군락 등 총 8개 식물군락이 관찰되었다 This study was conducted to get some vegetation information and to find out a way to conserve the ecosystem in the Dongjin River. The riparian vegetation was investigted by Zurich-Montpellier school's method from June 2001 to March 2002. The number of riparian plants were 73 families, 188 genera, 238 species, 33 varietles or 272 Taxa in Dongjin River. The characteristics of life form spectra were 97 therophytes(35.7%), 78 hydrophytes (28.7%), 41 hemicryptophytes (15.1%) 22 geophytes (8.1%), and 12 chamaephytes (4.4%). The riparian vegetaton was identified 8 plant communities (Potamogeton brechtoldii, Hydrill verticillata, Ceratophyllum demersum, Potamogeton malaianus, Phragnites japonica, Persicaria thunbergii, Cardamine scutata, Persicaria hydropiper) in upstream, 4 plant communities(Zizania latifoliar, Phragmites communis, Persicaria thunbergii, Hunmulus japonicus) in midstream and 8 plant communities(Hydrocharis dubia, Ceratophyllum demersum, Trapa japonica, Zizania Iatifolia, Paspalum distichum, Phragmites communis, Persicaria thunbergii, Amphicarpaea edgeworthii) in downstream of the Dongjin River.

만경강 본류의 자연정화능 향상을 위한 식생학적 진단

이경보,김창환,김종구,이덕배,박찬원,나승용 한국환경농학회 2003 한국환경농학회지 Vol.22 No.2

만경강 본류를 대상으로 수질을 개선하기 위한 일환으로 하천식생의 종구성, 하천형태에 따른 군락의 구조, 단면분석을 통한 현존식생의 분포 등을 종합적으로 분석하여 하천 생태계에 대한 종합적 해석과 식생에 의한 자연정화능 활용방안을 평가하고자 2001년 6월부터 2002년 3월까지 수질 및 식생에 관한 자연정화능을 조사, 평가하였다. 만경강 본류 수질중 T-N의 농도는 갈수기인 겨울철이 17.23 mg/L로 가장 높았으며, 여름철이 8.59 mg/L로 낮았고, 상류보다는 하류에서 그 농도가 높았다. 또한 평균 T-P의 농도는 여름철과 가을철에 각각 0.45, 0.47 mg/L로 비슷하였으나 겨울철에 1.79 mg/L로 농도가 높아졌다. BOD의 농도는 상류유역에서 0.95~2.57 mg/L로 Ⅰ~Ⅱ급수 수질을 나타내었으나 하류유역에서는 6.87~9.72 mg/L로 Ⅴ급수에 가까운 수질이었다. 만경강 상류의 식물상은 73과 134속 218종 33변종으로 총 251종류가 조사되었으며, 중류 일대에서 조사된 식물은 33과 69속 82종 16변종으로 총 98종류가 조사되었다. 그리고 만경강 하류 일대에서 관찰된 식물은 27과 58속 71종 14변종으로 총 85종류가 조사되었다. 만경강 유역에서 자연정화능에 의한 수질개선을 도모하기 위해 식물 생활형별로 하천 정화능이 뛰어난 식물을 조사 분석한 결과 침수식물은 붕어마름, 검정말, 부엽식물은 어리연꽃, 왜개연꽃, 추수식물은 갈대, 줄, 부들, 습생식물은 큰황새 냉이, 고마리 등이 질소, 인 흡수능이 우수한 식물이었다. This study was conducted to get some information on plants abilities to enhance water purification and to find out away to conserve the ecosystem in Mankyeong river. Vegetation were surveyed at 4 sites pointing by 1:5,000 topographical map, from June 2001 through March 2002. T-N content in water were high in all sites of Mankyeong river, the average T-N levels were 8.59 and 17.23 ㎎/L summer and winter, respectively. The average T-P level during summer was 0.47 ㎎/L, but that was 1.79 ㎎/L during winter. The BOD level in Mankyeong upstream ranged from 0.95 to 2.57 ㎎/L which would be in Ⅰ or Ⅱ grade according to water quality criteria by Ministry of Environment, but BOD level in Mankyeong downstream ranged from 6.87 to 9.72 ㎎/L. The plant species of river flora were found 251, 98 and 85, upstream, midstream and down stream, respectively. Among the surveyed plants, Ceratophyllum demersum, submerged plant and Nuphar subinteperrimum took up higher contents of phosphate and nitrogen than other plants. The Phragmites communis and Zizania latifolia having much biomass were thought to be suitable plants for enhancement of the natural water purification.

광장공포증 유무에 따른 공황장애 환자의 특이적인 대처전략 비교

류경환,김정범 대한생물치료정신의학회 1999 생물치료정신의학 Vol.5 No.2

요 약본 연구는 공황장애 환자에서 공황발작을 조절하기 위해 흔히 사용되는 대처전략을 조사하고, 광장공포증의 유무에 따른 대처전략 사용을 비교하여 공황장애와 광장공포증 사이의 일부 관련성을 밝히고자 한다. DSM-Ⅳ 진단기준에 의거하여 공황장애로 진단된 환자 51명을 대상으로 하였으며, 그 중 광장공포증을 가진 환자(광장공포증군)는 30명(58.8%), 광장공포증을 가지지 않은 환자(비광장공포증군)는 21명(41.2%)이었다. 대처전략 조사를 위해 Cox 등(1992)의 연구에서 사용된 14가지 대처전략 항목들을 이용하였고, 각 대처전략의 사용 유무와 그 효과 정도를 평가하였다. 연구 결과 공황발작동안 대처전략 중 '안심시킴'이 가장 흔히 사용되었으며, '약물복용'이 가장 효과가 있었다. 두 군 모두 '약물복용'이 가장 효과가 있었으나, 광장공포증군에서 '가까운 사람을 찾음'의 대처전략 사용이 비광장공포증군과 비교하여 유의하게 효과가 있었다. 전체 대상환자 중 여성군보다 남성군에서 '약물복용'이 유의하게 효과가 있었다. 본 연구의 결과는 공황장애 환자들이 향후 공황발작동안 '약물복용'에 더 의존할 가능성이 높고, 광장공포증을 가진 환자에서 '가까운 사람을 찾음'을 안전신호로 사용하는 대처전략이 광장공포증적 회피의 발생이나 유지에 하나의 중요한 역할을 할 수 있음을 시사한다. 향후 치료적인 면에서 바람직한 대처전략의 사용과 안전신호 사용으로 초래되는 부정적인 결과에 대한 환자 교육이 필요할 것으로 생각된다.Objectives : To clarify some aspects of the relationship between panic disorder and agoraphobia, this study compared specific coping strategies employed to control panic attacks between patients with panic disorder without agoraphobia(PD) and with panic disorder with agoraphobia(PDA).Methods : Fifty one patients were diagnosed with PD(N=21) and PDA(N=30) by DSM-IV. All subjects were given the 14 specific coping strategies administered in the Cox et al's study(1992), then indicated which of 14 coping strategies they used together with the efficacy of a particular strategy of reducing the severity of a panic attack where 1 = totally ineffectively and 5 = completely effectively.Results : The most commonly used coping strategies for all subjects was 'reassure self over soon' and the highest efficacy ratings was for 'take medication'. Subjects with PDA reported significantly higher efficacy ratings than did subjects with PA for 'be with friend', but there were no significant differences in both groups for other coping strategies. Male subjects reported significantly higher efficacy ratings than did female subjects for 'take medication'. Female subjects reported significantly higher efficacy ratings than did male subjects for 'smoke cigarette'.Conclusions : The results suggest that the coping strategy 'be with friend' may play an important role in the development and maintenance of agoraphobic avoidance among panic patients. Treatment program for panic patients should include emphasizing the use of positive coping strategies during panic attacks and increasing awareness of the negative consequences resulting from using safety signals.

病院勤務者의 後天性免疫缺乏症에 關한 認識度 調査硏究

林國煥,金榮煥,金順德,柳樂姬,洪景蘭 高麗大學校 倂設 保健大學 保健科學硏究所 1991 保健科學論集 Vol.17 No.1

Recently HIV infection has been increasing in Korea and recognized as one of the serious social problems. In the current situation in which any effective treatment or preventive vaccine for AIDS has not yet been invented, the most important method of control to reduce the chances of HIV infection is through the continuous education about AIDS. Hospital workers are one type of group which are at a high risk for HIV infection and to some degree resposible for the transmission of AIDS. This study was carried out to provide data to help educate hospital workers prevent the AIDS transmission. For this study, 409 workers from 18 hospitals in the Seoul area were asked to answer the questionaire. The results obtained are as follows : 1. Most respondents (97.8%) knew that AIDS is Acquired Immune Deficiency Syndrome. And 85.6% of respondents knew exactly (71.4%) or roughly (14.2%) about the general characteristics of AIDS. 2 . 68.6% of the respondents knew the route of HIV infection. A lot of people thought that one could be infected by AIDS through utensils, foods, coughing or sneezing. 3. Respondents with high education knew relatively well about the causes of AIDS, compared with those with low education. Males generally understood the characteristics about AIDS better than females. As for the age group, the people in their thirties knew more than those in any other age group. Whereas average income amount, marrige status, or overseas travel experience showed no correlationship with the knowledge about AIDS. 4 . It was observed that males(36.5%) had more experience wity blood donation than females (8.8%) . 83.8% of females thought that they need not take the blood test to be examined for HIV infection, which was higher compared to the 62.3% of males. 5. Mass communication was the main source to provide the information about AIDS for the respondents. Most of the respondents hoped that the hospital where they worked or any other clinic would provide them with more detailed information about AIDS. 92.8% of the respondents insisted that AIDS patients should be isolated to prevent the AIDS transmission.

만경강 상류 수질 및 식생분포와 토양환경에 따른 하천식생의 종 다양성

이경보,김창환,이덕배,김종구,박찬원,나승용 한국환경농학회 2003 한국환경농학회지 Vol.22 No.2

만경강 상류유역 수질 및 하천식생 군락 변화를 조사 분석하여 수질에 따른 하천식생의 종 다양성 및 토양요인에 따른 종 다양성의 변화를 평가하기 위하여 2001년 6월부터 2002년 9월까지 만경강 상류유역 5개 조사지점을 선정한 후 조사를 실시하였다. 수질중 T-N의 농도는 전주천과 삼천에서 높았으며, 겨울철에 전주천에서 7.45 mg/L로 가장 높았다. 무기태 질소 성분벽 함량은 NH₄-N 경우 고산천과 소양천 유역은 0.01~0.06 mg/L 범위로 계절별 커다란 차이가 없는 낮은 농도를 나타냈으나, 생활하수가 유입되는 전주천과 삼천에서는 0.77~3.01 mg/L로 계절별로 큰 차이를 보였다. T-P의 농도는 계절별로 비슷하였으나 전주천에서 겨울천에 0.89 mg/L로 가장 높았다. 계절별 BOD의 농도는 고산천과 소양천 유역에서 0.92~2.14 mg/L를 나타내었으나 생활하수가 유입되는 유역에서는 2.01~7.65 mg/L범위를 보였다. SO₄²^(-)의 농도는 농업용수 수질기준인 50 mg/L를 초과하는 지역은 없었으며 소양천에서 다소 높았다. 만경강 지류인 고산천에서 조사된 식물은 59과 과 129속 165종 20변종으로 총 185종류가 조사되었으며, 소양천에서 조사된 식물은 53과 111속 141종 19변종으로 총 160종이었고, 전주천 하류에서 조사된 식물은 37과 68속 86종 15변종으로 총 103종이었다. 그리고 삼천에서 조사된 식물은 32과 92속 110종 18변종으로 총 128종류 조사되었으며, 만경강 본류인 하리유역에서 조사된 식물은 73과 134속 218종 33변종으로 총 251종류가 조사되었는데 식물의 생활형에 따라 분류하면 침수식물이 13종, 부엽식물이 5종, 부유식물이 2종, 추수식물이 26종, 수생식물이 46종, 습생식물이 47종으로 조사지점중 이 지역의 식생이 가장 다양하였다. 식물사회학적 방법에 따라 분류된 하천식생의 식물군락은 10개의 수생식물 군락과 2개의 습생 및 수변식물 군락으로 대별되어졌다. 이들 군락들에 대한 4종류(종수, 종의 풍부도지수, 종의 이질성지수, 종의 균등도지수)의 종 다양성과 토양요인(pH, EC, 유기물 함량, 전질소, 인삭)과의 관계를 분석한 결과 pH가 높을수록 4종류의 종 다양성 지수는 높아 졌으며, EC는 값이 높을수록 종수(SN), 종의 풍부도지수(SR), 종의 이질성지수(H'), 종의 균등도지수(J')가 낮아 졌다. 또한 유기물 함량(OM)과 전질소(T-N)의 경우도 4종류의 다양성지수와는 부의 상관관계를 나타내었다. 인산(P₂O_(5))은 4종류의 다양성 지수의 변화에 영향을 미치지 않았다. This study was conducted to evaluate influence of chemical properties in the riparian on the species diversity and to get plant information for enhancement of natural purification in Mankyeong River. The concentration of total nitrogen was high in Jeonju and Sam stream, while that of total nitrogen showed the highest peak in Winter. Concentrations of NH₄-N was 0.01-0.06 ㎎/L in Gosan and Soyang stream. The water quality of upstream along with Mankyeong River was suitable for the imgation source. The riparian vegetation was investigated by Zurich-Montpellier school's method from June, 2001 to September, 2002. The number of riparian plants were 59 families, 129 genera, 165 species, 20 varieties in Gosancheon, on the while 53 families, 111 genera, 141 species, 19 varieties in Soyangcheon The number of riparian plants in Hari basin was higher than that of other sites namely, 73 families, 134 genera, 218 species, 33 varieties. Riparian vegetation was consisted of 12 plant communities. The contents of organic matter, total nitrogen and electrical conductivity had negative relationship with species diversity (Species richness index, Heterogeneity index, Species evenness index, Species number). On the while, species diversity had positive relationship with soil pH. Species diversity of the plant communities were affected by topography and disturbance.