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.

비장애 아동과 전반적 발달장애 아동에서 회전 후 안구진탕 기간의 비교

김진미,송지원,홍은경,김성희,김경미 대한감각통합치료학회 2005 대한감각통합치료학회지 Vol.3 No.1

Objective : The purpose of this study was to get the mean of duration of post-rotatory nystagmus test in normal children and to differentiate the duration of post-rotatory nystagmus test between normal children and children with pervasive developmental disorder. Method : 84 subjects were between 3 and 5 years of age and consisted of 64 normal children and 20 children with the pervasive developmental disorder. Analysis of the data was done by using t-test and ANOVA. Results : The results were as follows: 1. Range of duration of post-rotatory nyatagmus test in normal children was 5-22second on left and 7-21 second on right and the mean was 12.63 second on left and 12.59 second on right. 2. Range of duration of post-rotatory nystagmus test in children with the pervasive developmental disorder was 3-11 second on both and the mean was 5.65 second on left and 5.60 second on right. 3. There was no significant difference between males and females with normal children in duration of post-rotatory nystagmus test. However, there was a significant difference of the mean duration between 3 and 5 years old normal group. 4. Children with pervasive developmental disorder significantly have relatively lower duration than the duration of post-rotatory nystagmus test of normal children. Conclusions : The results of the study showed significant difference between normal children and children with pervasive developmental disorder in duration of post-rotatory nystagmus test and suggest that they could be applied to the baseline of clinical therapy.

Identification of a sensitive urinary biomarker, selenium-binding protein 1, for early detection of acute kidney injury

Kim, Kyeong Seok,Yang, Hun Yong,Song, Hosup,Kang, Ye Rim,Kwon, JiHoon,An, JiHye,Son, Ji Yeon,Kwack, Seung Jun,Kim, Young-Mi,Bae, Ok-Nam,Ahn, Mee-Young,Lee, Jaewon,Yoon, Sungpil,Lee, Byung μ,Kim, Hyung TAYLOR & FRANCIS 2017 Journal of Toxicology and Environmental Health Vol.80 No.9

<P>Acute kidney injury (AKI) is associated with increased mortality rate in patients but clinically available biomarkers for disease detection are currently not available. Recently, a new biomarker, selenium-binding protein 1 (SBP1), was identified for detection of nephrotoxicity using proteomic analysis. The aim of this study was to assess the sensitivity of urinary SBP1 levels as an early detection of AKI using animal models such as cisplatin or ischemia/reperfusion (I/R). Sprague-Dawley rats were injected with cisplatin (6 mg/kg, once i.p.) and sacrificed at 1, 3, or 5 days after treatment. Ischemia was achieved by bilaterally occluding both kidneys with a microvascular clamp for 45 min and verified visually by a change in tissue color. After post-reperfusion, urine samples were collected at 9, 24, and 48 hr intervals. Urinary excretion of protein-based biomarkers was measured by Western blot analysis. In cisplatin-treated rats, mild histopathologic alterations were noted at day 1 which became severe at day 3. Blood urea nitrogen (BUN) and serum creatinine (SCr) levels were significantly increased at day 3. Levels of urinary excretion of SBP1, neutrophil gelatinase-associated lipocalin (NGAL), and a tissue inhibitor of metalloproteinase-1 (TIMP-1) were markedly elevated at day 3 and 5 following drug treatment. In the vehicle-treated I/R group, serum levels of BUN and SCr and AST activity were significantly increased compared to sham. Urinary excretion of SBP1 and NGAL rose markedly following I/R. The urinary levels of SBP1, NGAL, TIMP-1, and KIM-1 proteins excreted by AKI patients and normal subjects were compared. Among these proteins, a marked rise in SBP1 was observed in urine of patients with AKI compared to normal subjects. Based upon receiver-operator curves (ROC), SBP1 displayed a higher area under the curve (AUC) scores than levels of SCr, BUN, total protein, and glucose. In particular, SBP1 protein was readily detected in small amounts of urine without purification. Data thus indicate that urinary excretion of SBP1 may be useful as a reliable biomarker for early diagnosis of AKI in patients.</P>

관상동맥 스텐트 삽입술을 시행한 환자에서 안지오텐신 전환효소 억제제와 안지오텐신 수용체 차단제가 재협착에 미치는 영향

김연경,정진원,윤경호,박은미,송미진,최준호,이은미,유남진,김남호,오석규 圓光大學校 醫科學硏究所 2006 圓光醫科學 Vol.21 No.1

민들레 잎과 뿌리 분말을 첨가한 설기떡의 품질 특성

유경미,김세희,장정화,황인경,김경임,김성수,김영찬 한국조리과학회 2005 한국식품조리과학회지 Vol.21 No.1

In order to develop a dandelion (Taraxacum officinale) with natural food applications, the effects of dandelion leaves and roots powder content on the physical, textural and sensory properties of sulggidduk were examined. Dandelion powders of leaves and roots at 0, 1, 2 and 3% were added to the dandelion sulgidduk. In the dandelion roots powder in sulgidduk, the color intensity of L values and the values and moisture content decreased however, the sensory color intensity, dandelion flavor and overall acceptability increased with increasing the dandelion powder content. The sensory overall acceptability indicated the dandelion roots powder content at 3% had the highest overall and flavor scores. As the dandelion leaves content was increased, the moisture contents, lightness, adhesiveness and cohesiveness of sulggidduk decreased, while the sensory color intensity, sensory hardness, hardness of texture properties and dandelion flavor increased. The addition at 1% of the dandelion leaves powder content with the dandelion sulggidduk and the addition at 3% of the dandelion roots powder content with the dandelion sulggidduk showed the highest overall acceptability.

급성 관동맥증후군 환자의 신기능 이상과 주요 심장사건과의 관계

이상재,윤경호,최준호,송미진,김연경,박은미,김현정,이은미,유남진,김남호,오석규,정진원 圓光大學校 醫科學硏究所 2006 圓光醫科學 Vol.21 No.1

항원 흡입에 의한 비특이적 기관지과민성: II. 화분

김미경,엄재호,이동호,조명찬,이상도,윤세진,궁성수,김승택,이복희 충북대학교 의과대학 충북대학교 의학연구소 1992 忠北醫大學術誌 Vol.2 No.1

피부단자검사, RAST 및 항원 기관지유발검사(allergen bronchial provocation test, ABPT)결과 쑥, 잔듸, 나무화분에 감작된 기관지 천식 환자 13명을 대상으로 이들 화분이 비특이적 기관지과민도(non-specific bronchial hyperresponsiveness, NSBR)에 미치는 영향을 알아보고, ABPT시의 조기 및 후기 천식반응(early, late asthmatic response, EAR, LAR)이 NSBR 생성에 관여하는지와 각각 화분의 항원성을 비교하고자, 감작된 화분으로 ABPT를 시행하고, 이를 전후하여 메타콜린 기관지유발검사(methacholine bronchial provocation test, MBPT)를 시행하여 아래와 같은 결과를 얻었다. 기저 폐기능상 기도 폐색을 보인 환자는 없었으며, 알레르기성 비염만을 호소하였던 환자 11명 중 4명(31%)은 MBPT에 양성반응을 나타내었으나, ABPT에는 11명 모두 양성반응을 보인 천식 환자였다. ABPT상 3명은 EAR, 2명은 ILAR, 8명은 LAR이였다. EAR만을 나타낸 경우는 ABPT 24시간 후 PC20이 감소하지 않고, 오히려 다소 증가하였으나, ILAR을 나타낸 환자들은 24시간 후 PC20가 감소하여 3일 후 기저치로 환원된 반면, LAR에서는 24시간 후 PC20가 현저히 감소하여, 2주 내지 6주 후에야 기저치로 환원되었다. LAR을 보인 환자들 중 쑥에 감작된 환자들이 목초 화분에 감작된 환자에 비해 Pc20의 감소기간이 유의하게 길었다. 이상의 결과를 종합해 보면 화분 흡입에 의한 LAR에 의해 NSBR이 악화되며 지속기간이 상당히 긴 것을 알 수 있다. 또한 화분 중 쑥의 항원성이 목초보다 상당히 강한 것도 알 수 있다. 더불어 화분에 감작된 알레르기성 비염 환자들의 대부분에서 천식이 잠재해 있음도 알 수 있다. 그러므로 향후 천식의 증상이 없는 화분에 감작된 비염환자라 할지라도 MBPT 및 ABPT를 시행하여 정확한 진단을 해야겠다. 본 연구에서 종래의 다른 연구 결과들과는 달리 쑥의 경우 ILAR의 경우도 NSBR을 악화시킴을 관찰하였는데, ILAR과 LAR의 차이가 단순한 기도폐색의 정도 차이인지, 기도 내에서 염증반응에 차이가 있는지는 향후 기관지 페포세척이나 조직 검사등을 통해 밝힘으로써, ABPT에 의한 NSBR의 발생 및 악화의 기전을 보다 확실히 규명할 수 있을 것으로 사료된다. Bronchial hyperresponsiveness is a fundamental characteristics in bronchial asthma. The pathogenesis of bronchial hyperreactivity has not been clearly understood, yet. We studied non-specific bronchial hyperresponsiveness with methacholine inhalation sequentially afterallergen provocation in pollen such as, alder, grass and mugwort-sensitzed allergic asthma and/or allergic rhinitis to investigate if there is any relation between allergen exposure and bronchial hyperreactivity, and compare the allergenicity of each pollen. 3 of 13 study subjects showed early asthmatic reaction, but 8 of them showed late(dual) asthmatic reaction, and the other 2 showed intermediate late asthmatic reaction. Non-specific bronchial hyperreactivity was not increased in early asthmatic responder, however, it was increased upto 45 days after allergen inhalation in all late asthmatic responder and in intermediate late reactor, upto 3 days. In mugwort-sensitized late asthmatic responder NSBR decreased much longer than any others. Taken together, pollen-induced late asthmatic reaction is one factor which contributes NSBR in pollinosis patients.

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.

가사노동의 에너지 대사에 관한 연구 : 작업대 높이를 중심으로 On the basis of the height of Work Surface

김미현,김영숙,신경원,이미선 효성여자대학교 가정대학 학도호국단 1986 家政大論集 Vol.5 No.-

본 연구의 목적은 동일 작업대에서 가사노동시 작업자의 신장과 에너지 대사와의 관계를 분석하는데 있다. 실험은 가사에 경험이 있는 자로서 신장별로 A(152㎝), B(159㎝), C(172㎝)를 피실험자로 하여 Respilyzer를 이용한 간접열량 측정법을 이용하였다. 실험 결과를 요약하면 다음과 같다. 1. 각 작업의 R. M. R. 평균은 설겆이 작업 0.64, 고구마 채썰기 0.77, 고구마 볶기는 0.42였다. 2. 개수대 작업에서 신장별에 따라 R. M. R.은 피실험자 C. A. B.의 순으로 키가 큰 사람이 (C) 1.16으로 에너지소모가 가장 많았다. 3. 준비대 작업에서 신장별에 따라 R. M. R.은 피실험자 A. B. C의 순으로 나타났으나 그 차이가 타작업에 비해 근소하였다. 이상의 결과를 볼 때 현재 시판되고 있는 작업대 높이에서 주부가 가사노동할 경우 표준신장에 가까운 사람에 비해 신장에 차이가 있는 사람은 개수대, 준비대에서의 작업시 에너지소모가 많다는 것을 알 수 있다. 생활수준의 향상과 더불어 신장도 증가하는 일로에 있으나 가사노동하는 주부의 체위는 다양하다. 이러한 점을 고려할 때 기업체에서는 시판 작업대 제작시 높이를 평균 키에 맞추어 단일화시킬 것이 아니라 작업자의 체위를 고려하여 적어도 상, 중, 하의 높이의 형으로라도 되어질 것이 요구된다고 하겠다. The purpose of present research is to analyze the relation of the height of homeworker and the Energy- Metabolism when welted on Sink Center, Mix Center andRange . Experiment was used indirection - calorimetry with Respilyzer and subjects wereclassified into A(152cm), B(158.6cm) and C(172cm) according to height. The results of this study were as follows ; 1. The average of R. M. R. in each homeworking was 0.64 in dishwashing (Sink Center), 0.77 in sweet potato slicing (Mix Center) and 0.42 in sweet potato Panbroiling (Range). 2. In dishwashing, R. H. R. according to height was the highest in the subject Cin order of C.A. B. 3. In sweet potato slicing, R. M. R. according to height was the hightest in thesubject A in order of A. C. B. 4. In sweet potato pan-broiling, R. M. R. according to height was high in orderof the subject A. B. C but the difference of R. M. R. among A. B. C was a few ascompared with dishwashing and sweet potato slicing.

미혼 남녀의 배우자 선택 조건 및 관련 요인 분석

김경신,김오남,이선미 全南大學校家政科學硏究所 1995 生活科學硏究 Vol.5 No.-

The purposes of this article are to find the general trends of unmarried men and women's mate selection conditions, to estimate the differences according to related variables and to analyze the effects of significant variables influencing on mate selection. The samples were selected from the unmarried 164 men and 235 women living in Kwang-ju. The major findings are as follows; 1. All scores of mate selection conditions were higher than medium. Especially in desirable spouse conditions, women's were higher than men's. Move valued spouse conditions were women's apperance, health, family background in men and all conditions in women. Women desired more similar and interactional conditions than men. 2. External and internal conditions were significantly different from age, work in men and age, father's and mother's age in women. Homogeneous and interactional conditions were significantly different from sex role attitude, premarital sexual experience in men and age, education, work, father's age, love necessity of marriage, sex role attitude, premarital sexual experience in women. 3. External and internal conditions were influenced by work in men and mother's and father's age in women. Homogeneous conditions were influenced by premarital sexual experience, necessity of marriage in men and age, premarital sexual experi-ence, necessity of marriage in women. Interactional conditions were influenced by sex role attitude, father's age in men and sex role attitude, education, work in women.