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.

초·중·고등학교 학생, 학부모, 일반교사의 보건교육 요구

윤순녕,김영임,최정명,조희순,김영희,박영남,오경순,이분옥,조선녀,조소영,한선희,하영미 韓國學校保健學會 2004 韓國學校保健學會誌 Vol.17 No.2

Purpose : The purpose of this study was to identify needs of health education of the students, parents, general teachers, and health teacher of the elementary, middle, and high schools. Method : 279 schools of elementary, middle, and high school were sampled nonproportionally during the period from June 28 to July 26, 2004 . The data were collected by the questionnaire from 1,888 students, 1,876 parents, 1,695 general teachers, 279 health teachers. A frequency, % and χ2-test were used to analysis by SAS program. Result : 1. It showed that 98.1% of elementary school students, 92.3% of middle school students, 89.6% of high school students answered that they need health education. The most of students, parents, and general teachers had high interests in health education. 2. In the case of students, main causes of needs of health education was 'to prevent diseases or accidents''. But parents answered that it was 'to build up a healthier behavior'. General teachers answered that it was 'more effective systematic and continuous health education'. 3. Over 80% of students, parents, and general teachers about the question of who qualified person is to teach health education as a regular class responded that health teacher is available. Especially 93% of elementary school students answered like that. 4. The most of students, parents, and general teachers answered that health education in the classroom is favorable 1 to 2 hours per week. Conclusion : As results of the study , the majority of students, parents, general teachers agreed needs of health education. Therefore, on the basis of this study, systematic and continuous health education is necessary. Additionally the establishment of independent health subject is required certainly.

초·중·고등학교 학생·학부모·일반교사의 보건교육 영역별 요구도와 보건교육

윤순녕,김영임,최정명,조희순,김영희,박영남,오경순,이분옥,조선녀,조소영,한선희,하영미 韓國學校保健學會 2005 韓國學校保健學會誌 Vol.18 No.1

Purpose: The purpose of this study was to identify the needs of health education in students, their parents and teachers in the elementary, middle and high schools and the current situation of health education class. Method: The subjects of this study were a total of 9450 persons including students, their parents and teachers from 279 schools throughout the country. They were selected through convenient sampling. Data were analyzed through x^(2)­test and ANOVA. Result: Students, their parents and teachers replied that 18 dimensions of health education class (DHEC) are necessary. The four DHEC - healthier life style, sex education, mental health and safety education - showed high educational needs in students, their parents, and teacher. High school students had higher educational need of 'symptom management for daily living' than elementary and middle school students. Students, their parents and teachers in elementary school had higher educational needs of 17 DHEC that those in middle and high school. The percentages of schools with health education class taught by health teachers were 99.2%, 75.5% and 66.0% respectively in elementary, middle and high schools. Health education was given mainly using physical education classes at elementary schools, and creative class hours at middle and high schools. In general, health education took 1-3 hours per week at elementary schools, and less than an hour at middle and high schools. Conclusion: Therefore, based on the results, systematic health education class should begin from elementary school to meet the need of health education in students, their parents and teachers, and further study should be made on the number of hours required and the amount of contents of 18 DHEC.

국내에서 유행하는 HIV의 전파 경로에 따른 Subtype 분포

이주실,남정구,김성순,강춘,최병선,김옥진,박미선,성봉모,서순덕,전수경,변승옥,신영오,조해월 대한감염학회 2001 감염 Vol.33 No.5

Background : Previous data have been reported that subtype B is prevalent in South Korea, but neither the extent nor the proportion of subtypes could be evaluated. This study was designed to analyze the distribution of HIV-1 subtypes, temporal instructions and transmission dynamics between epidemiological groups. Methods : 1,280 Koreans had been diagnosed as HIV seropositive during the period 1985 to 2000. Among them, 134 individuals were selected for this molecular epidemiological study. 134 DNAs were isolated from uncultured or cultured peripheral blood mononuclear cells. V3-V5 (0.7 kb) fragment of HIV-1 env gene was amplified by nested polymerase chain reaction and was sequenced. Results : HIV-1 isolates from thirty-seven homosexuals were all subtype B (100%). On the other hand, 66 isolates from 94 heterosexuals were subtype B (70%) and 28 were non B subtypes (30% : 13 A, 4 C, 2 D, 8 E , 1 G). Only subtype B strains were isolated from 73 males who were infected with HIV inside Korea while 16 B and 20 non B subtype strains were isolated from 36 males who were HIV infected outside of Korea. However, B and non B strains were isolated half and half from females who were infected inside Korea except one. Conclusion : The HIV-1 subtype B strains are prevalent in Korea from the early HIV infection until present in both homo and heterosexuals. Non B strains have been transmitted from men who were infected outside Korea to their spouses and casual partners. So, we need further study to monitor subtype B and non B HIV transmission in epidemiological groups of Korea, (Korean J Infect Dis 33:311∼318, 2001)

패류중 중금속함량에 관한 연구

신현수,허옥순,이진하,김세은,주인선,신동우,강석종,박만종,김지연,김근희,강숙경,정래석,허숙진,소유섭,최장덕,문병우,김진수 식품의약품안전청 2001 식품의약품안전청 연보 Vol.5 No.-

본 연구는 패류중 중금속함량 측정을 위한 분석효율이 높고 간편한 분해법을 찾아내어 그 방법에 의끓 유종중인 패류중 중금속함량을 파악하고자 수행하였다. 시료를 분해시키는 Microwave와 습식, 건식회법을 비교한 결과 변형습식회화르가 가장 적합하였다. 변형습식회차딘는 려린0,3+C104+H2SOf의 혼찰산을 쪼 · j 1 (v/v)의 비율로 혼합하여 사용하였 을 때 회수을 Pb린틴. Cd 97.8, Cu 94.2, Zn 92.8%를 나타내었근 분해시간은 2~2.5시간 소요되었다. 유통중인 패류중 중금속함량 」최소~최대(평균), mgAgl 은 Pb 0.028~o.528(0.153), Cd 0.OO7~1,832(0.587), Cu 0.360~37.375(4.6691, Zn 6.317~233.2iO(38.881), Hg 0.001 ~O.151(0.012)mg/ltg으로 나타났다. 또한 유통중인 5종의 패류중 중금속평균항량이 생산지 하재지역에서 구입한 패류에 비해 모든 중금속언써 약간 높은 함량을 보였으나 오염된 수준이 아닌 자연함유량수준이었다. This study was conducted to improve the digestion method for the determination of heavy metals in shellfishes and to estimate the contents of heavy metal in commercial shellfishes by their digestion method. This digestion method was compared microwave with wet and dry ash digestion for shellfish samples, obtained results showed that the modified wet ash Ⅱ digestion was convenient and easy to use. For the modified wet ash Ⅱ digestion, The mixed acid of HNO₃+HClO₄+H₂SO₄(25:5:1, v/v) was used. Under this condition, Recoveries were Pb 94.3, Cd 97.8, Cu 94.2 and Zn 92.8% and digestion time was ∼2.5 hours. The contents of heavy metal [minimum∼maximum (mean), mg/kg in commercial shellfishes were as follows ; Pb:0.028∼0.528(0.153), Cd:0.007∼1.832(0.587), Cu:0.360∼37.375(4.669), Zn:6.317∼233.250(38.881), Hg:0.001∼0.151(0.013). The contents of heavy metal in commercial shellfishes of five species were slightly greater than those of shellfishes purchased at Hajae. There was no great difference between the contents of heavy metal of Hajae and those of shellfishes purchased at Whole market.

수두백신의 역가시험법 표준화를 위한 연구

민경일,백선영,신진호,김재옥,류승렬,민복순,김병국,김도근,김훈,이석호,박순희 식품의약품안전청 2001 식품의약품안전청 연보 Vol.5 No.-

수두(chicltenpo즈) 및 대상포진(shingles)의 예방을 위해 사용되는 수두 생 바이러스 백근은 현재 국내 -외 제조사들이 정상사람 2배체 폐 태아 세포 주들을 이용하여 바이러스를 배양 · 증식시켜 생산하고 있으나, 품질관리를 쒸한 역가 시험에는 t·fRC튼 띤 LB딘EL 세포 주외에 제조사가 설정한 세포 주를 이용하고 있으며, 역파신험 방법인 fH Ui'rFO Plaque 3SSaIT에도 조사별로 다소 차이가 있는 시헌법을 사용하고 있다. 그러므로 일반적으로 세포 주간우 감수성 차이, 계대력(passa딩e level)간의 차이,varicelta-zoster virus(4'2V) diluent medium 등에 의한 차이에 의해 역가시힘 결과에 많은 차이를 나타낼 수 있다. 이에 본 연구에서는 역가 시험 결과꼭 편차를 촉소화 할 수 있는 시헌방법을 극힙하고자 Ok퍼 백신 주와 세로 주간 및 기타 요인에 따른 차이를 비교 분석하고 이를 표준확하여 일관겅있는 국가 및 제조사의 품질관리예 활용하고 나아가 수두 생 바이러스 백신 역가시헌 국가 표준품 거달에 활용하고자 하는데 목적이 운.다. 수두 생 바이러스 빅신의 역가 시험에 영향을 띠칠 수 꿀.는 모민으로 우선 바이러스 흡착에 사용되는 1#Z)·'diluent medium이 가장 큰 오인으로 확인되.고. 현개까기 최종적으로 if4 sucrose, 10% FBS, 0.1% sodiun) rrlonog)utamate in PBS(-), fIH 7.2가 가당 두수글 L'z).「 린luent medium 조성으로 확인되었단. 또한 '·:~l포 주별로 다소의 차이는 잇.으나 최대 바이러스 흡착시간은 90분으론:÷잰착인 되었다. 다른 negati)Fe effect를 보일 수 있는 요인으로 항생물질 및 항츤 제인 fuugiBone이 곡이러스의 역가에 영향을 미치는 것으로 확인되었다 따라서 이러한 항생물 띤 항균제를 standard solid agarose overla?·(5.tO) 시헌방법에는 사용하지 않는 것이 역가 시험의 편차를 줄일 수 있는 요인이라 판단된다. 최적의 조건하데서 Oka 수두 백신 주의 j 종의 세포 쭈에 대한 역가시험 수행 결과 각 세포 주의 감수성의 차이는 크지 않았으나, 반복시헌에 대한 표준편차는 다소 차이를 나타났다. Until now in Korea, the international and domestic vaccine maufacturers produce and sale live attenuated daricella vaccines, used to prevent chickenpox and shinglees, which are propagated in and done the potency test with various originated human diploid embryonic lung cells. Also manufacturers perform in vitro plaque assay with a little different methods to their quality control tests. Therefore, in general, there is slight or big difference among in vitro plaque assay results because of the difference in susceptibility of various originated human diploid embryonic lung cells and in assay methods. The purpose of this study is to confirm what factors occurring deviation to establish the standardized method which minimize deviation intracellularly and intercellularly. Eventually the standadized method will be used in consistent national and manufacturer's quality control and moreover intra and inter laboratory's validation assay of national standard for live varicella vaccine candidate. We confirmed VZV diluent medium was the biggest factor influencing in vitor plaque assay and the excellent composition of VZV diluent medium was final 5% sucrose, 10% FBS, 0.1% sodium monoglutamate in PBS(-), pH 7.2. We confirmed 90 minutes was maximum and optimum VZV adsorption time, but a little different among cells Also we recommended not use antibiotics and antimycotic, fungizone in standard solid agarose overlay assay in varicella potency test. Eventually 5 different originated human diploid embryonic lung cells showed little difference in susceptibility to Oka vaccine strain, but showed a lot of difference in reproducibility.

Cadmium投與 흰쥐간조직의 抗酸化系에 미치는 食餌 selenium의 영향

김성옥,이순재 대구효성가톨릭대학교 응용과학연구소 1993 응용과학연구논문집 Vol.2 No.-

본 연구는 식이 Selenim 급여기간에 따르는 카드뮴 중독된 흰쥐의 간장내의 항산화적 방어계에 미치는 영향을 연구하기 위하여 60±5g의 흰쥐 Sprague-Dawley종 수컷을 구입하여 식이중에 0.5ppm의 selenium을 첨가한 식이군과 비첨가식이군으로 나누어 2주간 및 4주간 자유섭식으로 사육한 후 다시 cadmium 투여군(CD, CDS group)과 비투여군(control, Cs group)등 각 4군으로 나누어 체중 kg당 2.5mg의 cadmium을 24시간 간격으로 4일동안 4회 투여하고 마지막 투여 24시간만에 쥐를 희생시켜 다음과 같은 실험을 행하였다. 적출한 간장조직으로 부터 free radical과 같은 항산화적 손상원으로부터 생체를 보호하는 체내 생리적 항산화계 효소인 superoxide dismutase(SOD), glutathione peroxidase(GPX), glutathine s-transferase(GST)를 측정함과 아울러 혈액 및 간조직중에서의 glutathione의 수준, 그리고 간조직중의 과산화지질량을 측정하였으며 그 결과는 다음과 같다. 식이섭취량, 체중증가량, 식이효율은 대조군에 비해 Cd 투여군이 유의적인 감소를 하였으며 Se 첨가로 인한 차이는 볼 수 없었다. SOD 활성은 대조군에 비해 CD군이 유의적으로 감소하였으며, 식이중에 Se를 첨가한 CDS식이군은 CD군에 비해서는 증가되었으나 대조군과는 차이가 없었다. GPX 및 GST 활성은 대조에 비해 CD군이 유의적인 감소를 하였으나 Se 첨가한 CDS 식이군에서는 현저한 증가를 하였다. 혈액과 간조직중의 환원형 glutathione(GSH) 함량은 대조군에 비해 CD군이 감소하고 산화형 glutathione(GSSG)은 증가하였으나 Se 첨가식이군에서는 GSH함량이 증가되고 GSSG는 낮아졌다. 과산화가는 대조군에 비해 CD군이 유의적으로 높았으나 식이중 Se을 첨가한 식이군에서는 유의적으로 낮았다. Se 급여기간별로 비교했을때 실험 2주에서 보다 실험 4주에서 CDS군이 GPX활성이 증가되고 POV 값이 감소되었다. To study effects of dietary selenium(Se) on antioxidative defense system in rats liver administered cadmium, Sprague-Dawley male rats(60±5g) were divided into two diet groups, depending on with(CDS groups) or without(CD groups) 0.5ppm Se supplementation and fed ad libitum for 2 and 4 weeks. And then each group was again subdivided into two groups, depending on with(CD, CDS) and without(control CS) cadmium injection. Level of cadmium was 2.5mg per kg of body weight and four injections was carried out with 24hr interval, the rats were sacrificed for examination on the next day after the last injection of cadmium. Superoxide dismutase(SOD) activity was decreased in CD group, but dietary selenium added groups(CDS) did not significantly different compared with control group. Glutathione peroxidase(GPX) glutathione S-transferase(GST) activities were remarkable decreased in CD group compared with control group. But CDS groups were higher than CD groups. Contents of reduced form of glutathione(GSH) in blood and liver of CD group were decreased whereas oxidized glutathione(GSSG) contents increased, but contents of GSH were higher and GSSG were lower in CDS group than CD group. Liver lipid peroxide values in CD group was significantly increased compaired with control group, but CDS group was significantly decreased, compared with CD group. Glutathione peroxidase activity oof CDS group in selenium feeding for 4 weeks was increased and peroxide value was decreased, compared with those of CDS group in selenium feeding for 2 weeks. But SOD, GST activities and glutathione contents were not different between 2 and 4 weeks groups.

Lidocaine과 Pentotal 전투여가 Propofol 정주 시 발생되는 혈관통에 미치는 영향

옥시영,김순임,김선종 순천향대학교 교수학습개발센터 2004 Journal of Soonchunhyang Medical Science Vol.10 No.3

Background: Propofol is a good induction agent. But it has a disadvantage of pain on intravenous injection. Pretreatment of lidocaine or pentothal have been reported to reduce pain on injection. Thus we have evaluated the quantity and quality of analgesic effect of lidocaine and pentothal. Methods: Ninety three patients scheduled for general anesthesia were randomly divided into three groups. Each patient received one of the pretreatment drugs via 18 G angiocatheter inserted in the antecubital fossa. Control group (n=31) received 2 ml normal saline and lidocaine group (n=31) received 40 mg (2%, 2ml) and petothal group (n=31) received 50 mg (2.5%, 2 ml) followed intravenous injection of 2 mg/kg of propofol at a rate of 1 ml/sec.After 50 mg of propofol were injected, patients were assessed for pain score. The severity of pain was classified as 0,1, 2, 3 (none, mild, moderate, severe) by one observer. Results: The severity and incidence of pain were significantly reduced in lidocaine group and pentothal group compared with control group for intravenous injection of propofol (P<0.05). And the incidence of pain in lidocaine group and pentothal group is similar but severity of pain is more reduced in lidocaine group Conclusions: Lidocaine 40 mg or pentohal 50 mg pretreatment to induction by propofol revealed a good analgesic effect for propofol injection pain. And lidocaine is more effective for iv propofol injection pain.

都市低所得階層의 醫療福祉模型定立을 爲한 基礎調査硏究

金正根,金貞順,鄭慶均,洪在雄,文玉綸,李詩伯 서울大學校 保健大學院 1983 보건학논집 Vol.20 No.1

가속된 공업화에 의한 경제발전은 인구의 도시집중을 초래하여 대도시의 변두리에는 새로 유입된 저소득집단거주지역을 형성하게 마련이다. 제한된 공간 기본 시설행정서비스등 생활수요에 과부족 상태에 있는 이들 지역은 많은 사회적문제를 안고 있을 뿐 아니라 건강관리면에서도 여러 가지 문제점을 내포하고 있다. 더구나 의료보험제도가 도입되면서 직장이 없는 대부분의 저소득주민은 의료보호 및 보험수가 때문에 불균형상태에 놓인 의료기관의 수지평형을 메꾸어주는 당착가지 낳게 하였다. 따라서 본연구는 종래의 보건의료체계에 의존하기보다 현실에 맞는 저소득층을 위한 보건의료복지모형을 모색하고자 기초조사를 실시하였다. 본연구의 대상지역은 종로구동숭동 낙산기슭에 위치한 11평형시민아파트, 전수와 근접한 5개통을 1982년 8월부터 11월까지 면접조사하였다. 그 주요결과를 요약하면 다음과 같다. 1) 조사비율은 가구단위로 아파트 지역 80%, 비아파트지역 60%였으며 인구별로는 전체인구의 64%였는데 65세 이상군의 조사율이 다른 년령군보다 낮았다. 2) 인구 및 사회경제적 특성 (1) 인구 및 가구의 특성 인구의 성별 및 년령별 구성은 서울 시인구의 구성과 아주 흡사하였으나 45세 이상의 인구비율이 약간높은 경향이었다. 혼인상태도 두드러진 특징은 없으며 25세 이상 성인인구의 교육수준도 다른 영세지역에 비해 높았다. 경제활동인구의 직업에 있어서 남자의 무직율은 13.6%였고 여자중 직업을 가진 비율은 36%나 되었다. 직종별로는 공원이 23%, 공무원 18%, 사회원 10%등이었다. 한편 현주소에 거주기간은 3년미만이 약 50%였고, 30%는 7년이상 살고 있는 사람들이어서 비교적 안정된 지역이었다. 또한 자가소득율도 62%였고 사용방수 2개가 50.6%, 1개는 8%에 불과하였다. 난방시설은 연탄온실이 대부분(84%)이었다. 변소는 공동수세식이 27.6%, 공동재래식이 18%였고 단독사용인 경우도 재래식 33%, 수세식 22%였다. (2) 가구단위의 경제상태 수입과 지출을 감안하여 생활형편이 충분하다는 가구는 19%, 빠듯하다는 가구가 68%였는데 이들 중 어떤 형태이건 저축을 하고 있는 가구가 48%였다. 월생활비가 40만원이하인 가구가 92%였다. 생활용품보유상태를 보면 흑백 TV가 72%, 칼라 TV 3.2%, 냉장고 75%, 세탁기 17%, 전화도 63%가지고 있어 이 지역의 경제상태를 종합해볼 때 우리나라 중류하층쯤이라 고려되어 지역의료보험을 실시하기에는 아주 적합한 지역이라고 생각되었다. (3) 주요사회문제 집안에 근심거리가 있다고 한 가구는 34%로 경제문제가 18%, 건강문제가 9%였다. 청소년문제를 간접적으로 엿보기 위하여 학교중단상황을 보았는데 학교를 중단한 학생이 2명이하 가진 가구는 98가구(2308가구중) 뿐이었으며 중고등학교중단이 가장 많았는데 그 이유로는 경제적사정이 가장 빈번하였다.

돼지 췌장 유래 엘라스타제의 항원성 시험

김순회,백남기,안병옥,이상득,이순복,김원배,양중익 A.R. Liss 1990 ENVIRONMENTAL MUTAGENS AND CARCINOGENS Vol.10 No.2