3개 대학병원의 주 진단 코딩사례 평가

서순원,김광환,부유경,서진숙,서정돈,윤석준,이영성,이무식,정희웅 한국의료QA학회 2002 한국의료질향상학회지 Vol.9 No.1

Background : Coding of principal diagnosis is essential component for producing reliable health statistics. We performed this study to evaluate the current practice of principal diagnoses determination and coding, and to give some basic data to improve coding of principal diagnosis. Method : Nineteen medical record administrators(MRAs) of 3 university hospitals participated in coding principal Dx. From August 1, 2001 to August 31, 2001. From each hospital, 10 medical records of patients with high frequency disease were selected randomly. Each 10 medical records were grouped into three(A,B,C). Then, these 30 medical records were given to each MRAs for coding. At the same time questionnaire was given to each of them. Questions were to prove how they decide and code the principal diagnosis among many current diagnoses ; how they decide and code the principal diagnosis when day see irrelevant diagnosis recorded as the principal diagnosis in medical record, when only tentative diagnoses were recorded without final diagnosis, and when different diagnoses were recorded in different sheets of same record. Agreement of coding among 3 hospitals were compared and survey results were analysed with SAS 6.12. Results : Agreement of coding was found in medical records 5-6 of each 10 medical records. Causes of disagreement were as follows. Difference of clinician’s opinion from each hospital; mixed use of guideline from KCD-3 and guideline from DRG; difference in 4th digit classification according to the absence of pathology report in the medical record; difference of abbreviations among hospitals. 57.9% of decided principal diagnosis after consulting to KCD-3 guideline. When there were difficulties in determining the principal diagnosis, 42.1% of MRAs decided principal diagnosis after discussion with the physician, 26.3% after discussion with fellow MRAs. Conclusion : There were differences in coding among hospitals. To minimize the difference, we suggest the development of disease-specific guidelines for coding in addition to the current general guideline such as KCD-3. To do this, Coding Clinic which can produce guidelines is needed.

심혈관계질환으로 사망한 성인형다낭신 3예 보고

양경무,권일훈,조갑래,서중석 大韓法醫學會 1999 대한법의학회지 Vol.23 No.1

Adult polycystic kidney disease is a genetic disease characterized by bilateral multiple renal cysts and is transmitted as an autosomal dominant traits. The disease usually manifests in the fourth decade of life. The affected patients usually die with end stage renal failure, cardiovascular assaults and infection etc. Cardiovascular assaults include ruptured berry aneurysm, spontaneous intracranial hemorrhage, acute myocardial infarction, dissecting aortic aneurysm and hypertensive heart failure. Fatal intracranial hemorrhage and hypertensive heart failure occur in 15% and 2% of patients, respectively. Genetically-dater-mined structural weakness in the arterial wall have been suggested as a possible factor in the genesis of berry aneurysm. We have experienced three autopsy cases with cardiovascular causes of sudden death. Two cases have intracranial hemorrahage (1 berry aneurysm and 1 intracerebral hemorrhage) and the remaining one is dead with hypertensive cardiomyopathy. All of them are aged over 40 years and associated with polycystic liver disease. Histologically, myriad cysts of enlarged bilateral kidney are lined by single layer of cuboidal cells with focal hyperplastic epithelial configuration. Diffusely scattered liver cysts are also lined by flat to cuboidal epithelium and often associated with portal fibrosis.

Ciprofloxacin의 돼지 호흡기 감염증 및 설사증에 대한 치료효과

전무형,김지영,채미경,서상희,김명철,박창식,김태용,윤효인 충남대학교 수의과대학 동물의과학연구소 2003 動物醫科學硏究誌 Vol.11 No.-

To evaluate the clinical efficacy of ciprofloxacin (CFX) on treatment of the pigs with respiratory diseases or diarrhea, CFX at various dosages were administered intramuscularly to the diseased pigs selected from the pig farms located in Chungnam province. One hundreds and fourteen heads of pigs with respiratory diseases were divided into five groups and CFX at 0.25, 0.5, 1.0 ( = 2.5mg CFX/Kg B.W.) and 2.0 doses were administered i.m. for 5 days. The recovery rates were found 31.8%, 73.9%, 91.3% and 92.0%, respectively, being higher than that of the untreated control group (19.0%). The mortality of the treated groups were 0%, that is lower than that of the control (9.5%). Seven kinds of bacteria were isolated from the respiratory organs of 86 pigs, and 34 (39.5%) of 86 pigs showed the complicated infection. In analyzing by the pigs infected with a single pathogen as P. multocida, A. pleuropneumonia, Staphylclcoccus spp. or Mycoplasma spp., the recovery rates were 0∼66.6% at 0.25 dose. 66.6∼100% at 0.5 dose and 100% in all of 4 pathogens at 1.0 to 2.0 doses. At 0.25 dosage the pigs infected with A. pleuropneumonia showed the lowest recovery rate. One hundreds and twenty two heads of pigs with diarrhea were divided into five groups and CFX at 0.25, 0.5, 1.0 ( = 2.5mg CFX/Kg B.W.) and 2.0 doses were administered i.m. for 5 days. The recovery rates were 29.1%, 40.0%, 80.0% and 88.0%, respectively. The mortality of the treated groups were 0-8.3%, being much lower than that of the control. Four kinds of bacteria were isolated from the fecal specimens of 94 pigs, and 84 (89.0%) of 94 pigs showed the complicated infection.

Ciprofloxacin의 돼지 호흡기 감염증 및 설사증에 대한 치료효과

전무형,김지영,채미경,서상희,김명철,박창식,김태용,윤효인 충남대학교 형질전환복제돼지연구센터 2004 논문집 Vol. No.8

To evaluate the clinical efficacy of ciprofloxacin (CFX) on treatment of the pigs with respiratory diseases or diarrhea. CFX at various dosages were administered intramuscularly to the diseased pigs selected from the pig farms located in Chungnam province. One hundreds and fourteen heads of pigs with respiratory diseases were divided into five groups and CFX at 0.25, 0.5, 1.0 (= 2.5mg CFX/Kg B.W.) and 2.0 doses were administered i.m. for 5 days. The recovery rates were found 31.8%, 73.9%, 91.3% and 92.0%, respectively, being higher than that of the untreated control group (19.0%). The mortality of the treated groups were 0%, that is lower than that of the control (9.5%). Seven kinds of bacteria were isolated from the respiratory organs of 86 pigs, and 34 (39.5%) of 86 pigs showed the complicated infection. In analyzing by the pigs infected with a single pathogen as P. multocida; A. pleuropneumonia. Staphyloccus spp. or Mymplasma spp., the recovery rates were 0∼66.6% at 0.25 dose, 66.6∼100% at 0.5 dose and 100% in all of 4 pathogens at 1.0 to 2.0 doses. At 0.25 dosage the pigs infected with A. pleuropneumonia showed the lowest recovery rate. One hundreds and twenty two heads of pigs with diarrhea were divided into five groups and CFX at 0.25, 0.5, 1.0 (= 2.5mg CFX/Kg B.W.) and 2.0 doses were administered i.m. for 5 days. The recovery rates were 29.1 %, 40.0%, 80.0% and 88.0%, respectively. The mortality of the treated groups were 0∼8.3%, being much lower than that of the control. Four kinds of bacteria were isolated from the fecal specimens of 94 pigs, and 84 (89.0%) of 94 pigs showed the complicated infection.

국가예방접종전산등록체계 개발을 위한 민간의료 기관 하부구조 및 환경 조사연구

이무식,김은영,이건세,이석구,홍지영,김건엽,김대경,신의철,이연경,기몽서,나백주,김영택 한국모자보건학회 2003 한국모자보건학회지 Vol.7 No.2

Roxythromycin-tylosin-furaltadone 합제의 닭 유래 세균에 대한 시험관내 항균효과

김지영,채미경,윤효인,서상희,박배근,김현수,전무형 충남대학교 수의과대학 동물의과학연구소 2003 動物醫科學硏究誌 Vol.11 No.-

In vitro antimicrobial susceptibility of roxythromycin (Rx), tylosin (Tyl), erythromycin (EM) and furaltadone (Fur) was studied, either by the single type or the combinated type of Rx-Tyl-Fur (RTF) against E. co1i (30 strains), Staph. aureus (20 strains) and Mycoplasma gallisepticum (5 strains) that are the major pathogens in poultry farm. The paper disk diffusion and MIC tests were applied. In screening test by paper disk diffusion method, the single types of antibiotics showed the sensitivity against 55 strains of bacteria in order of Fur, EM, Rx and Tyl. The combinated RTF showed the higher rate of sensitivity (80∼83.3% at 64㎍/disk, 60-75% at 32㎍/disk) and wider range of growth inhibiting zone (19.6±3.7-24.8±4.7mm) than those of the single drugs. In MIC test, the sensitivity against the 55 strains appeared in order of Fur. EM, Rx and Tyl as similar to those of paper disk diffusion method. The MIC ranges of RTF were 0.125∼16㎍/ml for E. coli, 0.25∼16㎍/ml for Staph. aureus and 1-8㎍/ml for Myco. gallisepticum, showing evidently lower than those of the single types. The MIC_(50) and MIC_(90) of RTF were estimated l∼4㎍/ml and 8∼16㎍/ml, respectively, and remarkably lower than those of the single drugs.

하악골 골절후의 골치유과정에 있어서 방사선학적 추적조사

최진영,김명호,허경희,서병무,이종호,정필훈,김명진 대한악안면성형재건외과학회 2000 Maxillofacial Plastic Reconstructive Surgery Vol.22 No.5

The results of radiographic study of healing of fractured mandible are often inconsistent with clinical evaluation of bone healing pattern of it. In addition, there is inconsistency between radiographic studies. We think if such inconsistency is resolved, clinical assessment combined with radiologic evidence can be used to guide to more accurate clinical management. The purpose of this study is to evaluate radiological healing pattern of mandible, and to apply its result to clinical use. Panoramic view was used to analyze the change of radiographic finding in 35 patients (27 male, 8 female, ranging 17 to 53 years old) treated for mandibular fracture at the department of oral & maxillofacial surgery, SNUH in the period 1991 to 1998, Patients are all treated by rigid internal fixation using monocortical miniplate. Within 9 weeks, no change is observed at fracture site. Osteogenic change is observed at various time interval (3 to 21 weeks). We have found radiographic change of healing is observed 4 to 6 weeks later to clinical healing, According to this result, we recommend radiographic follow-up at 4 week, 10 week, 10 month.

Postweaning Multisystemic Wasting Syndrome (PMWS)에 이환된 자돈에 대해 Porcine circovirus 2 Rep 유전자 검출에 관한 연구

이용훈,김지영,楚佳奇,서상희,장경수,김명철,박창식,전무형 충남대학교 형질전환복제돼지연구센터 2007 논문집 Vol. No.10

Postweaning multisystemic wasting syndrome (PMWS) is a new emerging disease in swine herds world wide, and porcine circovirus type 2 (PCV2) is known as a major cause of PMWS. In this study, the prevalence of PCV2 Rep gene was examined for the serum, nasal swabs and feces collected from 30 heads of piglets affected with PMWS and 10 heads of normal healthy piglets using polymerase chain reaction (PCR). The diagnostic efficiency of the PCR was evaluated for different types of samples. Rep gene of the isolate (PCV2 S1) was then sequenced. In the group of PMWS-affected piglets, the prevalence of PCR-positive were 70.0% in sera, 33.3% in nasal swabs and 0% in feces. In the normal healthy group, the PCR-positive rates of sera, nasal swabs and feces were 30%, 20% and 0%, respectively. Seven piglets (17.5%) out of 40 showed the simultaneously positive results in both of sera and nasal swabs. The nucleotide sequence homology of Rep gene of PCV2 S1 as compared with the reference strain of PCV2 (GenBank accesson no.AF027217) was 99.3%.

Postweaning Multisystemic Wasting Syndrome (PMWS)에 이환된 자돈에 대해 Porcine circovirus 2 Rep 유전자 검출에 관한 연구

이용훈,김지영,楚佳奇,서상희,장경수,김명철,박창식,전무형 충남대학교 수의과대학 동물의과학연구소 2004 動物醫科學硏究誌 Vol.12 No.-

Postweaning multisystemic wasting syndrome (PMWS) is a new emerging disease in swine herds world wide, and porcine circovirus type 2 (PCV2) is known as a major cause of PMWS. In this study, the prevalence of PCV2 Rep gene was examined for the serum, nasal swabs and feces collected from 30 heads of piglets affected with PMWS and 10 heads of normal healthy piglets using polymerase chain reaction (PCR). The diagnostic efficiency of the PCR was evaluated for different types of samples. Rep gene of the isolate (PCV2 S1) was then sequenced. In the group of PMWS-affected piglets, the prevalence of PCR-positive were 70.0% in sera, 33.3% in nasal swabs and 0% in feces. In the normal healthy group, the PCR-positive rates of sera, nasal swabs and feces were 30%, 20% and 0%, respectively. Seven piglets (17.5%) out of 40 showed the simultaneously positive results in both of sera and nasal swabs. The nucleotide sequence homology of Rep gene of PCV2 S1 as compared with the reference strain of PCV2 (GenBank accesson no.AF027217) was 99.3%.

사후분해 시체에 대한 법의학적 접근

최영식,이상용,김유훈,조갑래,이봉우,양경무,정낙은,서중석,이한영,이원태,강현욱 大韓法醫學會 2000 대한법의학회지 Vol.24 No.2

Disposal of a homicide victim by dismemberment is rare, but individual cases are on record in most major medicolegal departments. Recognition of postmortem mutilation may be of importance in the interpretation of certain murders committed by sexual perverts and other mentally deranged individuals and sometimes performed for the sole reason of easier disposal of the body. Postmortem dismemberment is usually readily recognizable as such; The edges of the injuries are dry and lack evidence of bleeding. The joints may be disarticulated without fracture, or the use of an axe or saw may be evident from examination of bones. Parallel horizontal or oblique furrows in the bone surface are caused by skipping of the saw prior to establishing depth. Such patterns on the bone may assist in identifying the particular saw involved. So we report 25 dismembered corpses that autopsied in National Institute of Scientific Investigation. This paper can help in attempting to establish not only the first criminal investigation steps but also the medicolegal approach methods in unidentified and dismembered deaths.