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.

I-Muscone의 심혈관계에 관한 약리연구

조태순,김낙두,허인회,권광일,박석기,심상호,신대희,박대규 충남대학교 약학대학 의약품개발연구소 1997 藥學論文集 Vol.13 No.-

In order to investigate the pharmacological properties of l-muscone, effects of l-muscone and musk were studied on the cardiovascular system with various experimental models. In isolated rat aorta, l-muscone and musk made the relaxation of blood vessels in maximum contractile response to phenylephrin (10^-6M) in endothelium-containing rings of the rat aorta, but not in endothelium-denuded rings. However, l-muscone and musk in the presence of the inhibitor of NO synthase and guanylate cyclase did not make the relaxation of blood vessel. In spontaneously hypertensive rats (SHRs), l-muscone and musk slightly reduced blood pressure but significantly decreased heart rate. In the isolated perfused rat hearts. l-muscone and musk did not affect significantly on LVDP, contractile force, coronary flow and (-dp/dt)/(+dp/dt). These results suggest that l-muscone and musk have weak cardiovascular effects with relaxation of blood vessel and decrease of heart rate, but without significant cardiac functions.

태생 및 신생 흰쥐의 위유문부 gastrin 세포에 대한 면역세포화학적 연구

金淳會,李熙來,李惠星 梨花女子大學校 韓國生活科學硏究院 1988 韓國生活科學硏究院 論叢 Vol.41 No.-

The structure and distribution of gastrin cells in the gastrointestinal tract of albino rats, Sprague-Dawley strain, have been clarified, but little have been studied on the ontogeny of the gastrin cells. The present study was attempted to examine the gastrin-immunoreactive cells in the pyloric antrum of the fetal and neonatal rats. In the 19-day-old fetuses the gastrin cells were identified in the epithelium of the pyloric antrum with the glands. In the early period of neonate the gastrin cells were gradually increased and most of the cells were located in the base of the pyloric gland. It imply that the gastrin cell may influence the gastric mucosal cellular proliferative activity during various stages of late fetal and early neonatal development.

배추와 무우의 屬間變異體 誘起에 關한 硏究 : 未成熱胚와 外1來 DNA와의 co-cultivation 및 屬間交雜胚의 培養 Co-cultivation of Immature Embryos with Exogenous DNA and Culture of Intergeneric Hybrid Embryos

嚴聖均,陳旬馥,朴贊熙,朴重春 慶尙大學校 1990 論文集 Vol.29 No.1

배추 및 무우의 未成熟?에 外來 DNA를 co-cultivation시킴으로서 變異體 誘起를 試圖하였으며 屬間交雜을 통하여 雜種體를 生産함으로서 遺傳的 多樣性을 넓히고 genetic barrier를 克服하고자 本實驗을 試圖하였다. 1.핵배추 및 궁중무우의 未成熟?와 相互 外來 DNA와의 co-cultivation ?培養에서 完全한 植物體의 獲得은 핵배추 ?와 궁중무우 DNA와의 co-cultivation 에서는 ?粉後 20日 以上 發育한 ?를, 궁중무우 ?와 핵배추 DNA와의 co-cultivation 에서는 ?粉後 25日 이상 發育한 ?를 置床했을때 效果的이었다. 이들의 分化率은 ?粉後 日數가 經過할수록 또한 外部 DNA 存在下에서 높았으며 특히 10㎍의 DNA 存在下에서 가장 效果的이었다. 器內에서 分化된 個體는 hypocotyl의 發育이 억제되거나 지나치게 伸張될 뿐만아니라 cotyledon이 swelling 되는 등의 非正常的인 個體가 대부분이었으며 이들 個體는 계속 發育되지 못했다. 外來 DNA 와 co-cultivation 시킨 後分化된 個體중 正常的으로 發育된 個體의 表現型과 및 ?白질 isozyme 分析 結果 control區와 差異가 없었지만 10㎍의 DNA濃度下에서 非正常的으로 發育된 個體는 ?白質 및 isozyme banding pattern 상에서 control 區와는 큰 差異를 보였다. 2.배추 및 궁중무우 間의 屬間交雜 ?의培養 궁중무우를 種子親으로 한 것보다 핵배추를 種子親으로 했을 경우 受精率이 높아 ?의獲得이 많았다.雜種?培養時 ?粉後 日數가 經過할수록 分化 個體數가 많았으며 分化된 個體의 葉型은 배추와 무우의 中間型을 , 花色은무우와같ㅇ느 白色을 나타냈다. 雜種體의 葉 ?白質과 isozyme 分析 結果 ?白質과 AcP의 banding pattern은 무우가 種子親일 경우에는 무우와 같은 banding pattern이 관찰되었지만 배추가 種子親일 때에는 배추와 같거나 배추와 무우의 混合形이 觀察되었다.MDH의 banding patterndms 4개의 雜種體中 배추와 같은 것이 1個體였고 나머지 3個體는 兩親에서 觀察되지 않은 새로운 banding pattern을 나타냈다. This experiment was conducted to produce genetic transformants through co-cultivation of immature embryos with foreign DNA.and to produce intergeneric hybrids between radish and Chinese cabbage. It was designed to help broaden the genetic diversity of crop plants and to overcome the genetic barrier. 1. Co-cultivation The later the embryos were removed from the mother plants.and the higher the concentration of exogenous DNA up to 10 ㎍/embryo.the better the differentiation of the explants. However, most of the differentiated plants were developed abnormally;leaving only a few plants with a mother-type morphology were obtained . Electrophoretic banding patterns of totalproteins and the isozymes of acid phosphatase of norma; plants obtained by co-cultivating Kungzung embryos with Haekbaechu DNA revealed that there was no significant difference in any of them . Only those plants developed abnormally exhibited different banding patterns of the isozymes and total ptoteins as well. 2. Intergneric hybridization With embryo culture techniques, intergeneric hybrids have been obtained between Chinese csabbage and radish. The fertilizxation rate was higher when Chinese cabage served as a female than radish served as female. The later the embryos were removed from the mother plants. the better the differentiation of explants. The embryos have developed into mature plants with the characteristics of the intermediate type of two plants kabnd resembled radish in flower color . Majority of the tetrad stage adn pollen grain of prent species are oraml. whereas those of intergeneric hybirds are abonormal. The banding patterns of total ptoteins revealed that a Chinese cabbage type or a mixed type of radish and Chinese cabbage was served as a female. The total proteins banding patterns of radish type wer observed only when radish served as a female. One Chinese cabbage type were MDH banding patterns were observed in the tybrids, 3 out of 4 hybrids exhibited new banding patterns which were not observed in the hybirds, 3 out of 4 hybirds exhibited new banding patterns which were not observed in the patterns. With the exception of minor band , the isozyme banding patterns of AcP were similar to the banding patterns of total proteins.

만성 정신장애자 가족의 경험과 주간 재활프로그램 만족도에 관한 연구

김상남,신순희,김미영 東國專門大學 2002 金龜論叢 Vol.9 No.1

본 연구는 C군의 만성 정신장애자 회원과 가족들을 대상으로, 정신보건센터에서 운영하고 있는 "주간 재활 프로그램"에 대한 만족도를 평가하고 일상생활에서의 변화를 파악하여 향후 C군 지역의 특성에 맞는 정신보건 사업 프로그램을 개발 수행하는데 필요한 기초자료로 활용하고자 시도되었다. 연구방법은 양적·질적 동시 연구방법인 Triangulation 방법을 이용하였다. 연구결과, 회원들은 '주간재활 프로그램 참여'에 대하여 대인관계 증진의 기회로 여기고 있었으며, 가족들은 회원의 상태변화에 대한 만족보다는 정신보건센터운영에 대한 만족을 더 높게 나타냄으로써, 정신보건센터 활용을 환자에 대한 돌봄 부담감 감소의 기회로 여기고 있었다. 또한 가족의 경험을 파악하는 질적 연구에서는 가족들이 고통과 소망 두 가지 영역에서 감정을 노출함과 동시에 추후 관리에 대한 요구를 나타내었다. 만성 정신질환자 가족은, 회원들이 정신보건센터 활용하는 것에 대해서 긍정적인 사고를 가지고 있는 반면에 사회 지지망에 의존하고자 하는 강한 욕구도 가지고 있었다. 제언에서 향후 정신보건센터의 주간 재활 프로그램 개발과 수행에 대한 정책적, 방법적 내용을 제시하고 있다.

자두와인에 대한 마케팅 전략 연구

이수원 ; 윤옥현 ; 김순희 김천대학교 2003 김천대학교 논문집 Vol.24 No.-

Marketing strategy is marketing logic by which the business unit expects to achieve its marketing objectives. Marketing strategy consists of making decisions on the business's marketing expenditures, marketing mix, and marketing allocations in relation to expected environmental and competitive conditions. On the other hand, this study was taken on develop the marketing strategies for plum wine by the research institute of indigenous food at Gimcheon College. Accordingly, this study examines for the analysis, planning and con-trol of market involved plum wine through SWOT analysis and 4Ps. It is expected to provide the marketing managers of plum wine with some knowledge and insight in this area. Furthermore, this study can contribute to the establishment of the marketing strategies for plum wine.

Mossbauer 분광법을 이용한 제주 화산암의 미시적 연구와 그 응용

홍성락,고정대,김순희 濟州大學校 基礎科學硏究所 1994 基礎科學硏究 Vol.7 No.1

제주도 전 지역의 특정위치를 선정하여 그 위치에 따라 지하 60m, 61m, 87m, 99.5m, 220m까지 깊이별로 화산암 시료를 채취하여, 이 시료에 대한 SIMS, XPS와 Mossbauer spectroscopy의 실험결과를 보고한다. UHV chamber에서 분리 이온화에 의해 생겨 난 parent 이온들로부터 cracking pattern들에 대해 연구하였고, 그 parent 이온들은 Si??, Al??, Ca??, Mg??, Fe??, Fe??, Na?, k?등으로 나타났다. 이 시료들에 대한 XPS 실험에서 wide scan analysis를 통하여 시료 표면에서 Al, Si, Ca, O, Fe, Na 등의 원소가 존재하고 있음을 알 수 있었으며, narrow scan analysis를 통하여 이들 대부분이 single compound state를 나타내고 있음을 발견할 수 있었다. 화산암에 대한 Mossbauer spectrum으로부터 olivine, pyroxene, ilmenite에 의한 세쌍의 quadrupole splitting을 얻었으며, 각 광물에 함유된 Fe는 약간의 Fe??를 제외하고는 거의 모두 Fe??상태임을 확인하였다. We are reporting the results of measurements of the SIMS, XPS, and ??Fe Mossbauer spectrum for powder samples of volcanic rock which has been distributed throughout different areas on Cheju island, each in different depth beginning at 60m then 61m than 61m, 87m, 99.5m, and 220m. We have studied the cracking patterns from parent ions which are created by dissociative ionization in the UHV chamber. The parent ions were Si??, Al??, Ca??, Mg??, Fe??, Fe??, Na??, and k??. In the XPS results for these samples, we find the existence of elements Al, Si, Ca, O, Fe, Na on their surfaces through the wide scan analysis. Also, the single compound state has appeared in a greater percentage of the them through the narrow scan analysis. The Mossbauer spectrum consists of well defined quadrupole doublets having a dominant 2+ charge state with a small percent having a 3+ charge state. These indicate the presense of olivine, pyroxene, and ilmenite.

農家所得을 위한 감의 효율적 이용을 위한 젖산발효

김순동,서정식,상채규,구경희 효성여자대학교 새마을연구소 1984 새마을硏究論文集 Vol.4 No.-

This study was carried out to improve the utility of persimmon fruit by lactic acid fermentation and drying. A strain of Streptococcus lactis was used in the fermentation. The changes in acidity, pH, number of microorganism, and the content of sugar, lycopene and tannin were determined during fermentation. Color of the fermented persimmon was checked by using a colorimeter, while quality of persimmon was evaluated by sensory test. The optimum temperature for lactate fermentation was at 25℃ showing on acidity of 50mg lactate per 100g fresh weight, when 10^7 cells per ml(1% inoclum)of Streptococcus lactis was added as the starter. By sterilization at 1kg/cm^2 for 15 minutes, the fruit was coagulated and colored reddish. The loss of brix degree was 2.3%. The content of fructose was increased while sucrose and glucose 23%, respectively. The rate of tannin and lycopene loss were 32% and 23%, respectively. Tannin slightly inhibited growth of the microorganism. Optimum temperature for drying of fermented fruit was at 60℃ with little variation in color. The fermented and dried persimmon was better in texture and taste than the raisin. From above results, it was clear that quality of persimmon fruit such as texture, and storage characteristics can be improved by lactate fermentation and drying.

철골 기둥-보 접합부의 모멘트 전달효율과 변형도 집중과의 관계에 관한 해석적 연구

김순희,김영주,오상훈,문태섭 대한건축학회 2004 대한건축학회 학술발표대회 논문집 - 계획계/구조계 Vol.24 No.1(구조계)

In this paper, the results of monotonic loading analysis with 4 full-scale specimen were shown. The effect that moment transfer efficiency of a web and strain concentration at a steel beam-to-column connections was investigated. Analysis results showed that the moment transfer efficiency of the specimen with box-column was poor when comparing to specimen with H-column due to out-of-plane deformation of the box-column flange. The presence of scallop and thin plate of box column was also a reason of the decrease of moment transfer efficiency, which would result in a potential fracture of the steel beam-to-column connections. As a result, the deformation capacity of connections with box-column may decrease due to the poor moment transfer efficiency and the strain concentration

신규간호사 배치후 교육시 프리셉터쉽 적용 사례연구

김창희,김혜숙,조혜성,이순옥,함형미,박미미 성인간호학회 2000 성인간호학회지 Vol.12 No.4

The purpose of this study was to examine the effect of preceptorship on On the Job Training of new nurses. The research design was a retrospective survey and one group pre-rost test design. The subjects were 49 entry nurses and 49 preceptors The data were collected from Feburary 1, 1998 to December 1, 1998. One questionnair applied in this study consisted of general characteristics, the responses of new entry nurses and their preceptors and their qualities. The other questionnair consisted of job satisfaction of new entry nurses and Preceptors and their competencies. The data were analyzed for frequencies, mean score, standard deviation, t-test, and ANOVA. The results of the study were as follows : 1) Preceptees's responses were that the nurses' affiliation of unit. cooperation of other nurses, and competencies of nursing skills improved after OJT applied preceptorship. 2) Preceptors's answers were that preceptorship had a positive effect on their continuing education. 3) While preceptees's job satisfaction scores were high in interaction, administration, and organization, they were low in autonomy and pay. 4) Pre-competency scores were the same as post-competency scores. 5) After preceptorship, preceptors responded that their nursing skill & communication competency increased, but their nursing administration competency decreased. 6) Finally, preceptorship's other effects were as follows: ① Checklists for preceptee education at the nursing unit were developed separately. ② It was proved that 'preceptor interview note' was effective on manage preceptorship. ③ We obtained duty orierlap periods, medical-surgical units-1 month. 5 ICU-2 months. operaction room-3 months ④ We prepared a preceptor program based on the study results.