의료보험 고액진료비 환자의 특성연구

문옥륜,강선희,이은표,좌용권,이현실 韓國保健行政學會 1993 보건행정학회지 Vol.3 No.1

A small number of high cost patients usually spend a larger proportion of scarce health resources. Korea is no exception. Under the national health insurance, 12% of the insured persons have consumed approximately half of the national health insurance expenditures. Therefore, it is necessary to identify the characteristics of the high cost patient group, if we would like to reduce them. This study has defined high cost patients as those who have spent one and half million won and over Per 6 months. The study reveals that high cost users are those who have a longer length of stays(LOS), 40 days of LOS in the 6 months, have multiple admissions, 2 to 3 admissions per 6 months and are the eiderly patients. They have Spent 814, 126won per day on the average, and commonly suffered from malignant neoplasms, circulatory diseases, fracture, diabetes mellitus, etc. Unlike the case of western developed countries, early readmissions are not the major causes of high cost spending in Korea. Undoubtedly, a lengthy admission is the main cause of large spending. Health policies should vigorously be explored to respond appropriately. There are evidences that hospital beds are often misused. As the Korean health care system is lacking in a mechanism of patient evaluation under the fee-for-service remuneration system, an idea of progressive patient care needs to be tested. The Government should set up health policy to diversify the role of long-term care facilities and encourage people to establish them. Further studies are needed to identify factors influencing large medical bills necessary for formulating the health policy on cost containment.

退溪의《禮安鄕約》에서 표현된 '孝'와 현대교육

김충실,최문식 단국대학교 퇴계학연구소 1990 退溪學硏究 Vol.4 No.-

Aspergillus flavus 와 Aspergillus parasiticus의 Aflatoxin 생산에 미치는 지실추출물의 효과

李文實,朴裁林 新羅大學校 1992 論文集 Vol.34 No.1

The study was carried out for the purpose of finding effects of Ponciri fructus extract on the growth of, aflatoxin production by, and protein patterns of Aspergillus flavus IFO 6343 and A.parasiticus NRRL 2999. The extract was extracted from Ponciri fructus. The crude extract was added in the enriched medium that is optimum for the growth of, and aflatoxin production by the mold. And ?? conidia of A.flavus of A.parasiticus was inoculated aseptically into the broth. Then the broth hold at 30℃ for 7 days in the dark field. Mycerial growth was measured by mycerial dry weight, aflatoxins were determined by the method of high performance liquid chromatography(HPLC) and protein patterns were tested by electrophoresis. Ponciri fructus extract used in this study delayed appearance of mycerial growth by 2 days and little change in pH occurred in the broth containing. The extract in all the levels of concentration used in this study activated accumulation of aflatoxin B₁ and G₁. However, the accummulation of aflatoxin B₁ by A. parasiticus was ingibited by the fructus extract. To be more specific, aflatoxin B₁ production come to 57% of the control when 0.6% of the extract was used, and 14% of aflatoxin B₁ produced when 3% of the extract was used. The protein patterns of the mold grown on the medium containing. The fructus extract showed little difference to the control group. However, there was no statistical significance of difference.

노인요양시설의 서비스 질 평가 지표 개발 및 적용: 구조-과정 측면의 질 평가

김문실,이승희 대한간호행정학회 2008 간호행정학회지 Vol.14 No.2

Purpose: The aim of this study was to develop service quality indicators to evaluate structure and process of the nursing home service. Method: On the basis of literature review and analysis of existing quality indicators, the researcher made a preliminary service quality indicators and verified content validity twice. The final service quality indicators were applied in 30 nursing homes. Results: Preliminarily, 3 domains, 24 sub-domains, and 156 indicators were generated. Through two content validity testings, the indicators scoring over .80 CVI for each testing were adopted and modified by discussion with a panel of experts. The final indicators consisted of 3 domains, 15 sub-domains, and 128 indicators. These indicators were applied in 30 nursing homes. The result showed that they were easily applicable and suitable for a evaluation of service quality in nursing home. Conclusion: This 'service quality indicators in nursing home' was verified by the content validity. This tool will be able to be used for evaluation and improvement of nursing home service quality. However, repeated researches are needed for further validity and reliability.

Al₂O₃ TiO₂ 담체종류별 Pt, PtRu 촉매의 산화특성

김문찬,신진실,이동구,최균 한국공업화학회 2005 응용화학 Vol.9 No.1

The volatile organic compounds (VOCs) have been recognized as major contributor to air pollution. The catalytic oxidation is one of the most important processes for VOCs destruction clue to getting high efficiency at low temperature. In this study, mono metallic Pt and bimetallic Pt-Ru were supported to TiO₂ and γ-Al₂O₃. In order to distribute metals uniformly, Xylene, toluene and MEK were used as reactants. The mono metallic or bimetallic catalysts were prepared by the excess wetness impregnation method and were characterized by XRD, XPS, TEM and BET analysis. As a result, Pt-Ru bimetallic catalysts were showed higher conversion than Pt mono metallic catalyst. Pt-Ru bimetallic catalyst was showed highest conversion on the γ-Al₂O₃support. In the VOCs oxidation, Pt-Ru bimetallic catalyst had multi point active sites, so it improved the range of Pt metal state. Therefore, bimetallic catalysts were higher conversion of VOCs than mono metallic ones.

Al₂O₃ 담체상에서 귀금속 담지 촉매의 Water Pretreatment 영향

김문찬,신진실 한국공업화학회 2005 응용화학 Vol.9 No.1

In this study, monometallic Pt and bimetallic Pt-Ru, Pt-Ir were supported to γ-Al₂O₃. In order to distribute metals uniformly, H₂O-H₂ treatment method was used. Xylene and MEK were used as reactants. The monometallic or bimetallic catalysts were prepared by the excess wetness impregnation method and were characterized by XRD, XPS, TEM analysis. As a result, Pt-Ru, Pt-Ir bimetallic catalysts were showed higher conversion than Pt monometallic catalyst. The catalysts which used H₂O-H₂ treatment had better VOC's conversion than that of nothing treatment on the γ-Al₂O₃ support. Pt-Ir bimetallic catalyst was showed highest conversion on the γ-Al₂O₃ support. The effect of H₂O-H₂ treatment was uniform distribution of Pt particles. The activation energy of H₂O-H₂ treatment catalysts were lower than that of nothing treatment ones on the γ-Al₂O₃ support. In this study, the use of small amount of Ru, Ir to Pt promoted oxidation conversion of VOCs. In addition to, H₂O-H₂ treatment promoted oxidation conversion of VOCs on the γ-Al₂O₃ support.

시스템 다이내믹스를 이용한 간호단위별 간호인력 산정에 관한 연구

김문실,성영희,권경자,김도형,김정아,신덕신,유인자,유재국,이현숙 병원간호사회 2006 임상간호연구 Vol.11 No.2

Purpose: The purpose of the study was to forecast manpower by building the nursing manpower-staffing model(surgical-medical nursing unite). Method: The system dynamics approach was adapted to build a simulation model for calculating medical-surgical nursing manpower-staffing. The model was built up on Venism 5.0b DSS. Result: The results in the basic circumstance are in following. The level of nursing service quality, patientsatisfaction, and nurse job satisfaction maintains higher at medical-surgical nursing unit of the tertiary hospitals with the ratio of bed to nurse 2.5:1-3.0:1 than at any other situations. The level of nursing service quality, patient satisfaction, and nurse job satisfaction maintains higher at madical nursing unit of the secontary hospotals with the ratio of bed to nurse 3.0:1 and at surgical nursing unit of the secondary hospitals with the ratio of bed to nurse 3.0:1-3.5:1 than at any other situations in the fundamental from. The results in the simulation circumstance are in following, As author raises the operating rate of bed into 95-100%, and cut skilled nursing staff down, the level of nursing-service quality, patient satisfaction, and nurse job satisfaction drops slightly. Conclusion: In terms of economic efficiency on tertiary hospotals, the ratio of bed to nurse for the best reasonable medical-surgical nursing manpower-staffing is 3.0:1. In terms of economic efficiency on secondary hospitals, the ratio of bed to nurse for the best reasonable medical nursing manpower-staffing is 3.0:1 and surgical nursing manpower-staffing is 3.5:1

變溫貯藏에 따른 白米의 褐變

全順實,姜文善,金武男 新羅大學校 1989 論文集 Vol.27 No.-

The browning development, occurring in the rice during storage, causes reduction of nutritional value. A kinetical approach for the non-enzymatic browning rection of the rice was studied in the present experiment. The reaction rates revealed the maxima at 0.65a??. The activation energies obtained from the Arrhenius plot ranted 13.2∼15.9 ㎉/mole. From these energies of activation, the θ?? values at 45℃ which is defined as an increase in reaction rate for a 10℃ increase in temperature can be calculated showing 1.89∼2.16. Shelf-lives, time to reach an optical density of 0.02 at which brown color change detect. In addition, a storage study under a square-wave fluctuating temperature condition was carried out. The rice smaple was maintained at 35℃ and 55℃ periodically with 7 days interval. In the fluctuating temperature storage study, the rate constants at all water activities used in the experimemts were higher than those at 45℃, the mean temperature of the cycle which affects other kinetic parameters including activation energies, θ?? value and finally the shelf-lives. The data obtained from fluctuating temperature storage study will be used in prediction of shelf-life. The shelf-lives assessed at 25℃ from the accelerated shelf-life tests ranged from 604 days at a?? 0.44,510 days at 0.52, 333 days at 0.65, 421 days at 0.75.

Orientia tsutsugamoshi에 대한 항균제 병용의 실험실 효과

김은실,김미경,이혜명,정문현,이진수,강재승 대한감염학회 2008 감염과 화학요법 Vol.40 No.6

Background : Occasionally, combinations of antibiotics are used for the treatment of scrub typhus. However, the effectiveness of such combined therapies has rarely been evaluated. To date, no experimental studies have been performed; only 1 clinical study has assessed the efficacy of combined doxycycline and rifampin therapy. To elucidate the efficacies of other antibiotic combinations, we performed an experiment to evaluate the in vitro efficacy of antibiotic combinations against Orientia tsutsugamushi. Materials and Methods : O. tsutsugamushi strain Boryong was inoculated into the ECV304 cell line. The infected cells were cultured in antibiotic-containing media for 3-5 days and stained with FS15, a monoclonal antibody reacting against the linear epitope on the 56-kDa major outer membrane protein of O. tsutsugamushi. Thereafter, antimicrobial susceptibility was measured by flow cytometry and expressed as a growth index (total mass of Orientia). The growth indices of doxycycline (0.1 ug/mL), azithromycin (0.1 ug/mL), rifampin (0.0125 ug/mL), cefotaxime (2 and 20 ug/mL), and their various combinations (doxycycline+cefotaxime, doxycycline+rifampin, azithromycin+cefotaxime, and rifampin+cefotaxime) were measured. The above mentioned antibiotic concentrations, except for that of cefotaxime, represent the minimal inhibitory concentrations of each antibiotic. Results : The growth indices of doxycycline (4.67% and 0.52%), rifampin (2.35% and 0.26%), and azithromycin (7.54%) were within the range of full suppression of O. tsutsugamushi', in contrast, cefotaxime (87.60%) was in effective. The growth indices of doxycycline + rifampin were 0.10% and 0.10% which were similar to those obtained with doxycycline or rifampin alone. The growth indices of doxycycline+cefotaxime were 3.99% and 3.65% in low-dose cefotaxime (2 ug/mL), and 3.69% and 4.40% in high-dose cefotaxime (20 ug/mL). The growth indices of rifampin +cefotaxime (2.19% and 2.19% at 2 ug/mL; 1.84% and 2.04% at 20 ug/mL cefotaxime) were similar to those obtained with rifampin alone (2.35% and 0.26%). Azithromycin+cefotaxime (11.06-14.63%) showed higher growth indices than azithromycin alone; this suggests that this combination may be antagonistic. Conclusions : The anti-Orientia efficacies of doxycycline+rifampin, doxycycline+cefotaxime, and rifampin+cefotaxime were not antagonistic. The efficacy of the azithromycin+cefotaxime combination needs to be confirmed by more sensitive methods to exclude the possibility of antagonistic interactions between the antibiotics.

Orientia tsutsugamushi 감염에서 doxycycline 용량과 투여기간에 대한 실험

김은실,김미경,이혜명,정문현,이진수,박재은,강재승 대한감염학회 2008 감염과 화학요법 Vol.40 No.5

Background : Doxycycline, azithromycin, and chloramphenicol have been used for the treatment of scrub typhus; however, the duration of treatment for this disease is still controversial. Most clinical studies on the treatment of scrub typhus focus on the effectiveness of antibiotics; few studies have focused on the duration of the treatment. There has been no in vitro evaluation of the optimal duration of treatment of scrub typhus. We performed an experiment to evaluate the regrowth of Orientia tsutsugamushi after exposure to doxycycline of various concentration and exposure time. Materials and Methods : O. tsutsugamushi strain Boryong was inoculated into the ECV304 cell line. The infected cells were stained with FS15, a monoclonal antibody reacting against a linear epitope on the 56-kDa major outer membrane protein of O. tsutsugamushi; thereafter, the antimicrobial susceptibilities were measured by flow cytometry and expressed as a growth index (total mass of Orientia). Incubation in media containing 0.1 (the minimal inhibitory concentration of doxycycline against O. tsutsugamushi strain Boryong), 0.2, and 2 ug/mL doxycycline for 1, 3, 5, and 7 day was followed by incubation in antibiotic-free media for 5 day. Two inocula sizes were employed; low inoculum (45.18% of cells were infected) and high inoculum (87.21% of cells). Results : The incubation with 0.1 ug/mL doxycycline resulted in O. tsutsugamushi regrowth irrespective of doxycycline treatment duration. When the concentration of doxycycline was increased to 0.2 or 2 ug/mL, regrowth was observed in short duration treatments (1-5 day at 0.2 ug/mL; 1 day at 2 ug/mL). Higher inoculum size of O. tsutsugamushi increased regrowth (1 day at the low inoculum; 1-5 day at the high inoculum). Conclusions : The regrowth of O. tsutsugamushi after doxycycline treatment depends on the doxycycline dose; the higher the dose, the lower the relapse rate. If this result is extrapolated to humans, higher dose of doxycycline might be preferred to lower the relapse rate. The inoculum effect in O. tsutsugamushi infection needs further investigations.