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.

자기 효능의 개념 분석

서순림,이은남,박송자,양영희,이동숙,최은옥,구미옥,김인자,이인숙,김성재,박영임,이은옥 서울대학교 간호대학 간호과학연구소 1997 간호학 논문집 Vol.11 No.1

Today human needs for health promotion and maintenance are increasing. The nursing progression has a great responsibility for helping clients to practice good health behavior. self efficacy was found to be potent predictor in initiating and maintaining the health-related behavior. Therefore, the concept is important in nursig intervention for change of health behavior. The purpose of this paper was to analyze and clarify the meaning of the concept, self efficacy. This study used Walder & Avant's process of concept analysis. Critical attributes of self efficacy were : 1) positive perception of his won capability; 2) intrapersonal strength; 3) possibility of being learned; 4) individuality; 5) specificity; 6) generalizability. Antecedents of self efficacy consist of those facts that 1) new situation occurs; 2) individuals have needs to change the new situation; 3) there are some required actions in new situation. Consequences occurring as a result of self efficacy consist of those facts that 1) individual initiates the of failure; 5) cope with the situation; 6) controls the situation; 7) the level of self efficacy is enhanced; 8) the level of self-esteem is enhanced.

우심방을 침범한 거대 비호지킨씨 림프종 1예

강상범,진승원,이은경,박용현,최용호,김용주,박준철,김재형,홍순조,최규보,권종범,원용순,박건,이은희 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.4

대량의 각혈로 사망한 장티푸스 1예

한상우,유진홍,권순석,김성훈,박지찬,홍은정,최경성,박용완,장준희,안지원,박유경,강지영,박상미,신완식 대한감염학회 2004 감염과 화학요법 Vol.36 No.5

We experienced a 25 year-old male patient with typhoid fever complicated with massive hemoptysis. Pulmonary complication in typhoid fever is very rare and to our knowledge, there has been no report of hemoptysis as a main cause of death with this disease. We herein report a rare case of typhoid fever.

서유구와 서화감상학과 『林園經濟志』

박은순 한양대학교 한국학연구소 2000 韓國學論集 Vol.34 No.-

밝은社會를 指向하는 指導者 Leadership에 關한 硏究 : 새마을 指導者를 중심으로 With Reference to the Saemaeul Leadership

朴淳永,申大淳,趙萬濟,金旭卿,金種垠 慶熙大學校 1980 論文集 Vol.10 No.-

The Saemaeul Undong was launched in 1972 on the basis of the experimental model or Saemaeul pilot projects of the previous year. The Saemaeul Undong is now a nation-wide movement which is based on the fundamental spirits of diligence, self-help and cooperation. Much of the success of the Saemaeul Undong depends on its leaders, who play a pivot role in implementing Saemaeul projects for their community. Popularly elected by the village assembly according to their leadership and faith, the leaders render their services without remuneration, working in the spirit of self-sacrifice. Now, the Saemacul Undong enters upon its tenth year in 1981. If the movement is to continue with renewed momentum, effective training projects for Saemaeul leaders must be worked out. For this purpose, it is then recommended that the research works on the leadership training projects of the Bright Society Movement be referred to. Initially started as a community movement for better life on the campus of Kyung Hee University in 1960's, the Bright Society Movement is now gaining widespread support from national as well as international club members. The goals of the Bright Society Movement are to promote mutual understanding and friendship among members and to construct on earth a truly sound and civilized welfare society that is spiritually beautiful, materially affluent, and humanely rewarding. The main objectives of this study is to propose effective training projects for Saemeaul leaders as well as the Bright Society leaders. 1) Educational courses of leadership training should be offered through the school as well as through the training institution of the community. 2) Educational contents of leadership training should place greater emphasis not only on the spiritual education but also on the technical and practical education related to the welfare of the Community. 3) Public relations education should be strengthened because leaders must work in close cooperation with the community residents for the effective movement. 4) Long-term integrated projects for the community or village unit should be established and the movement should be developed according to them. 5) A special system of regional itinerant education should be established for the effective management of selective leaders. 6) For the welfare of leaders themselves, special favors such as the authorization of leadership careers, scholarships for their sons and daughters, discounts on public charges and the priority on public employment must be offer according to their respective performance.

쇄골두개 이형성증 환아의 증례보고

박영옥,김은정,김현정,김영진,남순현 大韓小兒齒科學會 2004 大韓小兒齒科學會誌 Vol.31 No.3

쇄골두개 이형성증은 골격과 치아 이상을 동반하는 선천성 질환으로서 다수의 조직과 장기에 직접적인 영향을 주는 중배엽성 기능장애이다. 쇄골두개 이형성증에서 일반적인 골격 결함은 두개 봉합과 천문의 지연 폐쇄, wormian bone, clavicle aplasia가 나타날 수 있다. 또한 장골, 지골, 척추, 골반 등의 전체 골격 뿐 아니라 근육, 중앙 신경계 등에 영향을 줄 수 있다. 구강내 특징으로 유치의 만기잔존, 다수의 과잉치, 미맹출된 영구치, 낭 형성 등이 나타난다. 그러나 쇄골두개 이형성증 환아의 경우 정신적 및 신체적으로 특별한 이상을 나타내지 않아 스스로 질환을 인식하지 못하는 경우가 많으며 이의 결과 유치 탈락 후 영구치의 미맹출로 인하여 저작 및 심리적인 문제가 초래되는 경우가 많다. 따라서 쇄골두개 이형성증은 조기진단이 필요하며, 적절한 시기에 과잉치 제거 및 영구치 맹출을 유도하는 치료를 시행하여 저작기능의 회복 뿐 아니라 환자의 안모도 개선시킬 수 있어야 한다. Cleidocranial dysplasia(CCD) is a congenital disorder of skeletal and dental abnormality, which is mesodermal dysfunction influencing many tissues and organs. Skeletal abnormalities in CCD are delayed closure of cranial suture and fontanelle, presence of wormian bone and clavicle aplasia. And CCD has an effect on the long bones, phalanges, spine, pelvis, muscles, and central nervous system. Dental manifestations include retention of deciduous teeth, multiple supernumerary teeth and formation of cysts around nonerupted teeth. But as a result in common with a lack of medical and physical disability, patient may have no substantive complaint, there are many masticatory and psychological problem by absent eruption of permanent teeth after exfoliation of deciduous teeth. For this reason CCD is necessary fo early diagnosis and must be improvement of the patient's appearance as well as provision of a functioning masticatory mechanism by treatment of surgical removal of supernumerary teeth, followed orthodontically eruption of the natural permanent teeth at adequate time.

朝鮮初期 漢城의 繪畵 : 新都形勝·升平風流

박은순 한국불교미술사학회 ( 구 한국미술사연구소 ) 2002 강좌미술사 Vol.19 No.-

The numerous topographic landscape paintings of Seoul in the early Joseon dynasty exemplify a monumental phenomenon(p1.1,2,3). Scholar officials in this period favored the paintings of Seoul, the capital city where they lived and played an important role to found the dynasty. Seoul offered inexhaustible thematic and stylistic inspiration. Illustrations of this locale are exceeded in number only by paintings of Keumgang Mountain located by East Sea. Although literary evidence verifies the existence of images of Seoul as early as the fourteenth century, the earliest extant painting is dated early fifteenth century. Seoul, called Hanseong or Hangyang in the Joseon dynasty, was about as rich with historical and literary associations as a place could be. Most paintings depicting scholar officials' gatherings in this period offer compelling visual representations of Seoul. The artists enhance the illusion of depth and distance, which delivers the impression that the viewer is confronting the real scene. These paintings have shown the correlations of motifs with corresponding scenes of some scenic spots by Han river and in the capital. Much of the imagery in topographic paintings of Seoul owes to scholar officials' social connections and exposure to literary sources than standardized representations of ideal landscape paintings of the same period. Professional painters depicted some of the Eight or Ten views of Seoul, such as "Grand View of Palace Buildings", "Enjoying the Moon at the Jecheon Pavilion", "Snowy Walks at Yangwha" etc. According to thematic variations, different features of the natural and built environment of Seoul are included. The artists weaved together literary and cultural images of Seoul to create realistic pictures that escaped the conventional approaches of depictions in ideal landscapes. Why topographic landscapes of Seoul was favored as a subject for painting in the early Joseon dynasty? The Neo-Confucian philosophy influenced to the rule and social order was respected by scholar officials in this period. Their efforts to establish a world based on Confucian doctrine influenced every corner of the society including arts and paintings. Topographic paintings of Seoul recreates natural scenes selected from scenic spots of the capital. In that way, scholar officials provided pictures of utopian realm, idealized reality fulfilled by the new dynasty. They favored to have meetings on the selected spots where they could enjoy the peaceful moments created by the ideal rule. And as a kind of monumental record, topographic painting became a favorite menu for symbolizing the time and people to be remembered and advocated.

CTX-M형 ESBL 생성 비장티푸스성 살모넬라의 특성

박순호,서일혜,안정열,박필환,김경희,송영희,김정은 대한감염학회 2010 감염과 화학요법 Vol.42 No.1

Background: Extended-spectrum ß-lactamase (ESBL)-producing Salmonella have been increasingly reported worldwide. ESBL-producing Salmonella is of particular concern since children cannot be treated with quinolones. This study was conducted to determine the phenotypic and genetic characteristics of ESBL-producing Salmonella in a tertiary hospital. Materials and Methods: Four clinical ESBL-producing isolates of non-typhoidal Salmonella were collected during 2001 to 2009. Antimicrobial susceptibility was determined by disk diffusion test and VITEK-II system. ESBL production was tested by ESBL phenotypic confirmatory test. TEM, SHV, CTX-M1, CTX-M2, CTX-M8, and CTX-M9 type ESBL genes were detected by PCR amplification, and PCR products were subjected to direct sequencing Results: Phenotypic confirmatory test showed that 4 of the 300 non-typhoidal Salmonella isolates were ESBL-producing: 3 S. Enteritidis and 1 S. Typhimurium. All 4 isolates were recovered during the past 1 year period. All 3 S. Enteritidis harbored CTX-M-15, while the S. Typhimurium harbored CTX-M-14. All CTX-M-15-producing S. Enteritidis isolates showed resistance both to cefotaxime and ceftazidime, while the CTX-M-14-producing S. Enteritidis were resistant only to cefotaxime. Conclusions: ESBL-producing nontyphoidal Salmonella has emerged recently and the type of ESBL has switched from TEM and SHV to CTX-M.

光多變色 초파리 迷路集團의 性的 選擇利益에 관한 遺傳的 行動

朴殷圭,金在淳,崔五木 圓光大學校 1992 論文集 Vol.26 No.2

光多變色 迷路集團裝置를 사용하여 4가지 色光에 대한 초파리의 性的 選擇利益에 따른 光鮮好性 差異의 形質을 分析하고자 實驗하였다. 光多變色 迷路集團裝置 속에 野生型 초파리와 突然變異型 黃色體-小翅 초파리를 各各 50쌍씩 즉, 암·수 各各 25%씩을 混入하여 그후 異型接合體 野生型 암컷의 交叉에 의해서 出現된 突然變異型 黃色體 초파리와 小翅 초파리를 同時에 觀察하였던 바, 各 色光 房 초파리 集團마다 差異는 있었으나 모든 경우에서 野生型 초파리의 選擇利益率이 增加하고 突然變異型 초파리의 選擇利益率은 減少하는 傾向이었다. 各 色光 房 野生型 초파리의 +遺傳子를 운반한 染色體의 性的 選擇利益率은 25世代까지 全體 平均 頻度가 黃色光 房에서는 64.20%, 赤色光 房에서는 64.36%, 靑色光 房에서는 65.42%, 暗色光 房에서는 61.74%로 나타났다. 이러한 實驗結果는 陽性 走光性 步行行動을 나타낸 靑色光 房 초파리 集團의 性的 選擇利益率(65.42%)의 效率이 가장 강했음을 보여 주었고 반면에 陰城 走光性 步行行動을 나타낸 暗色光 房의 초파리 集團은 그 效率(61.74%)이 比較的 약한 것으로 觀察되었다. 한편 野生型과 突然變異型 모든 초파리가 各 色光 房의 光鮮好性에 따른 步行行動에 의한 發生率은 各各 25%로 시작했던 實驗이 25世代까지 全體平均 發生率은 黃色光 房, 30.41%; 赤色光 房, 23.24%; 靑色光 房, 41.96%; 暗色光 房과 4.38%로 算定되었다. 이런 實驗結果를 中立値 頻度 25%로 分析하여 보면 黃色光 房과 靑色光 房의 초파리 發生率은 各各 5.41%와 16.96%의 陽性 遺傳率을 보였고 赤色光 房과 暗色光 房에서는 各各 -1.76%와 -11.62%의 陰城 遺傳率로 觀察되었다. 이런 現象은 모든 초파리가 靑色光을 가장 鮮好하고 다음으로 黃色光, 赤色光, 暗色光 순으로 鮮好한다는 것을 보여준 것으로 思料된다. A study on the difference of photo-preference subjected to sexually selective advantage of Drosophila melanogaster in four light chambers was carried out. Each 25% of the wild type and the visible mutants(the yellow bodied-miniature winged) of male and female flies put into the photo-varicolored labyrinth population apparatus. The yellow bodied and the miniature winged mutants were observed by crossing over in the wild type heterozygous female flies. In all cases the selective advantage of the wild type increased and that of the mutants decreased. The sexually selective advantages of +gene bearing chromosome of the wild type in each light chamber were observed as 64. 20% in the yellow light chamber for the whole average frequency through initial to twenty-five generations. as 64.36% in the red light chamber, as 65.42% in the blue light chamber and as 61.74% in the dark light chamber respectively. These results showed that the efficiency of the sexually selective advantage(65.42%) of the blue chamber flies group was appeared high in the walking behavior of the positive phototaxis but to the contrary the flies group in the dark chamber showing negative phototaxis was observed as comparably weak (61.74%). On the other hand, the developmental ratio of all the wild type and the mutants by their walking behavior subjected to photo-preference of each chamber was computed to be of 30.41% in entire average through initial to twenty-five generations in the yellow chamber, 23.24% in the red chamber, 41.96% in the blue chamber, and 4.30% in the dark chamber respectively. As such results were analyzed by the neutral frequency (25%), the developmental ratio of files of the yellow and the blue chambers showed 5.41% and 16.96% respectively as positive realized heritability and in the red and the dark chamber it was observed as -1.76% and -11.62% respectively as negative realized heritability. All these results indicated that all the flies prefered the blue, yellow, red and dark light in order.