계획에 없던 중환자실 재입실 실태 및 원인

송동현,이순교,김철규,최동주,이상일,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.1

Background : Because unplanned readmissions to intensive care unit(ICU)might be related with undesirable patient outcomes, we investigated the pattern of and reason for unplanned ICU readmission to provide baseline data for reducing unplanned returns to ICU. Methods : The subjects included all patients who readmitted to ICU during the same hospitalization at a tertiary referral hospital between January 1st and June 30th 2002. Quality improvement(QI) nurse collected the data through medical records and a medical director reviewed the data collected. Results : 1)The average unplanned ICU readmission rate was 5.6%(gastroenterology 14.6%, pediatrics 12.7%, pulmonology 11.9%, neurosurgery 6.3%, general surgery 5.3%, chest surgery 3.9%, and cardiology 3.3%). 2)Among the unplanned readmissions, more than 50% of cases were from patients older than 60 years, and the main categories of diagnose at hospital admission were neurologic disease(29.9%) and cardiovascular disease(27.6%). 3)Of unplanned ICU readmissions, 41.8% had recurrence of the initial problems, 44.8% had occurrence of new problems. And 9.7% required post-operative care after unplanned operations. 4)The most common cause responsible for unplanned ICU readmission were respiratory problem(38.3%) and cardiovascular problem(14.3%). 5)About 40% of unplanned ICU readmission occurred within 3 days after ICU discharge. 6)Average length of stay of the readmitted patients to ICUs were much longer than that of non-readmitted patients. 7)Hospital mortality rate was much higher for unplanned ICU readmitted patients(23.6%) than for non-readmitted patients(1.5%)(P<0.001). Conclusions : This study showed that the unplanned ICU readmitted patients had poor outcomes(high morality and increased length of stay). In addition study results suggest that more attention should be paid to patients in ICU with poor respiratory function or elderly patients, and careful clinical decisions are required at discharged from ICU to general ward.

항갑상선제로 치료한 그레이브스병 환자의 관해예측인자

남일송,윤여일,김선규,김용현,이주영,목지오,윤석기,김철희,김영선,변동원,서교일,유명희 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.2

Background: Most cases of Graves' disease have been treated by antithyroid drugs in Korea. The major drawbacks of antithyroid drugs are the relative high rate of relapse and the inconvinience of long term therapy. Measurement of TBII and TRH stimulation test have been considered as the most reliable tests predicting relapse, but the predictive power is not high enough to use in clinical situation. This study was performed to find good prognostic indicators in Graves' disease patients after the discontinuation of antithyroid drug therapy. Subjects and methods : We restrospectively evaluated 96 patients with Graves' disease who showed normal TRH test at the end of antithyroid drug therapy and were followed for more than one year. Serum T3, T4, T3/T4 ratio, TBII, Anti-TPO Ab and TGAb levels were measured at the time of diagnosis and at the end of therapy. Two to three months after withdrawal of antithyroid medication, serum TSH and free T3 responses to TRH were examined. These parameters were compared between the relapse group and the remission group. Results : Among the 96 patients, 22 patients(22.9%) relapsed(Group Ⅱ) and 74 patients(77.1%) remained in remmision(Group Ⅰ). No significant difference was observed between the relapse and the remission group in clinical parameters, serum T3, T4, TSH, T3/T4 ratio, TBⅡ and Anti-TPO Ab determined before and after treatment. Serum TSH and free T3 levels measured after TRH stimulation were also similar in both groups. Serum TGAb levels determined at the end of treatment were significantly higher in the remission group(p<0.05). Relapse following the discontinuation of therapy occured within 24 months in 72.7% of the relapsed cases. After 24 months, relapse rate was reduced significantly. Conclusion : These results suggest that high serum TGAb levels could be a favorable prognostic indicator for the long term remission of Graves' disease treated with antithyroid drugs, and may suggest that Hashimoto's thyroiditis is combined with Graves' disease in those patients.

건설현장 근로자들의 안저예방실태와 사고예방과의 개선요인 조사연구

심규범,남철현,최상복,이송권,이정희,이순자,문기내,김문환 慶山大學校 保健福祉硏究所 2003 保健福祉硏究 Vol.8 No.-

This study was conducted to examine aspects of health and safety education and demand level of safety education in construction job sites in order to provide direction of safety education development. The subjects of this study were 566 workers who were working in construction job sites located in Daegu City and Kyungbuk Province. Data were collected from June 1, 2002 to August 30, 2002. The results of this study can be summarized as follows. 1. According to safety education by experience methods, the proportion of education by lecture was highest (90.6%). The proportion of education by field practice was 13.1%. 2. Among the education methods which they thought as the most desirable method, the proportion of audio-visual education was 39.4% and the proportion of education by experience was 37.5%. Those who had more monthly income and higher education level preferred audio-visual education, while those who were younger and less educated preferred education by experience. 3. In the case of the contents of the safety education which they thought as the most important one, the proportion of enhancement of safety awareness and education of risk factors was highest (24.7%). The groups of older workers, having longer working period, and belonging to higher education level preferred these contents. 4. According to the factors which were most important to increase effectiveness of the safety education were workers' voluntary participation (27.7%), 40 to 49 years old (27.7%), and monthly income of one million, five hundred thousand won to one million, nine hundred ninety thousand won (32.0%). The proportions of lower educated workers and working as daily workers were also high. 5. The variable which most influenced the safety education was age. The safety awareness of construction job sites was the second highest influential variable. From above results, it is clear that the workers' participation in the safety education was low since most of the safety educations were formal education by lecture. Although they participated in the education, the education was also not effective because they compulsorily participated in it. Therefore, it can be concluded that effective alternative policies must be formulated.

폐허탈 및 농흉을 유발한 기관지 지방종 1예

이규진,이송주,옥철호,장태원,정만홍,김영옥,박성달 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.4

저자들은 객혈을 주소로 내원한 75세 남자 환자에서 기관지내시경 육안 소견상 양성 종양이 의심 되었으나 조직 검사상 지방종을 확진하지 못하였고 악성종양을 배제할 수 없는 상황에서 종괴에 의한 왼쪽 폐의 허탈과 농흉 때문에 수술적 치료를 시행 하였으며, 수술 결과 기관지 지방종에 의한 폐허탈, 농흉 및 기관지 확장증, 이로 인한 객혈이 발생한 예가 있어 보고하는 바이다. Lipoma is a common neoplasm on soft tissues. However, bronchial lipoma is rare benign tumor. Patients with bronchial lipoma might have a malignant potential, and there were case reports of lung cancer accompanied with lipoma. Therefore, it should initially be treated by fibrotic bronchoscopy or surgery. We encountered a 75 year-old male patients with bronchial lipoma, causing hemoptysis.

정신과 입원환자의 서비스 만족척도의 개발

김철권,이지연,송영선,김규호,김경률,김제원,이동기,최병무 大韓神經精神醫學會 2006 신경정신의학 Vol.45 No.3

목적 본 연구의 목적은 국내 정신의료기관(정신병원, 종합병원 정신과)에서 간편하게 사용할 수 있는 신뢰도와 타당도가 검증된 입원환자의 서비스 만족척도를 개발하기 위한 것이다. 방법 여러 단계를 거쳐 국내 실정에 맞는 문항을 개발하였고,정신병원, 종합병원, 대학병원 정신과 병동에서 퇴원하는 348명의 환자들을 대상으로 신뢰도와 타당도를 조사하였다. 요인분석 결과 5개의 요인이 추출되었으며 전체 변량의 63.04%를 설명하였다. 내적 일관성에 대한 신뢰도 계수 (Crohnbach's α)는 0.95로 상당히 높은 수준이었고, 수정된 개별문항-총점 상관계수는 0.50부터 0.72까지의 범위에 속하였다. 요인분석을 통해 추출된 서비스 만족척도의 각 하위척도 점수와 서비스 만족척도에 첨부된 각 영역에 대해 전반적인 만족도를 묻는 세 개의 문항 점수 간의 상관성 역시 유의하게 높았다. 결과 진단명에 따른 서비스 만족척도의 전체 점수에서는 불안/신체형/강박장애 환자군과 기분장애 환자군이 각각 정신분열병 및 기타 정신병 환자군과 알코올중독 장애 환자군에 비하여 유의하게 높은 점수를 보였으며, 입원형태에 있어서는 자발적 입원군이 강제 입원군에 비하여 전체 만족점수가 유의하게 높았다. 그러나 성별, 월수입, 학력, 직업, 종교, 결혼상태 등의 변수에서는 서비스 만족척도의 전체 점수에서 유의한 차이가 발견되지 않았으며, 마찬가지로 연령, 입원일수, 입원횟수, 첫 발병나이, 유병기간 등의 임상적 변수에서도 서비스 만족척도의 전체 점수와 유의한 관계를 보이지 않았다. 서비스 만족척도의 전체점수에서 대학병원 환자군이 정신병원 환자군과 종합병원 환자군에 비하여 각각 유의하게 높았다. 결론 결론적으로 국내 정신의료기관에 입원한 환자들의 서비스 만족을 평가하기 위한 목적으로 개발된 본 척도는 높은 수준의 신뢰도와 타당도를 보였으며, 또 국내 정신의료 환경에 맞는 요인구조를 보였다. 따라서 정신의료 서비스에 대한 정신과 환자의 만족도에 대한 연구가 거의 없는 실정에서 본 척도의 개발은 향후 국내 정신의료의 질과 치료결과를 높이는 도구로 활용될 수 있을 것으로 기대된다. Objectives : To develop and test the validity and reliability of a brief self-completed questionnaire (Service Satisfaction Scale : SSS) for routinely assessing the quality of service in psychiatric ward inpatients. Methods : A 30-item multidimensional questionnaire was developed by several steps of face validity and content validity. The questionnaire was administered to inpatients (n=348) discharged from psychiatric hospitals, general hospitals, and University hospitals. Construct validity was supported by performing principal component analysis. Reliability was estimated by calculating internal consistency of Cronbach's alpha. Results : Factor analysis yielded five factors comprising staff attitude, treatment quality, ward environment, access/cost, and ward rule, which account for 63.04% of the common variance. The internal consistency of the scale was high (Cronbach's alpha=0.95). The concurrent validity was supported by the significant correlation of each of five factors with item that measured overall satisfaction of SSS. Patients with neurosis (anxiety disorder, somatoform disorder, obsessive compulsive disorder) and mood disorders were significantly satisfied than those with psychosis and alcoholic disorders. Patients who admitted voluntarily were more significantly satisfied than those who admitted involuntarily. Sociodemographic variables such as age, gender, marital status, monthly income, education level, employment status and religion were not significantly different at the total scores of SSS. Similarly, clinical characteristics such as age of onset, duration of illness, lengths of hospital stay and number of previous hospitalization did not associate significantly with the total scores of SSS. Patients discharged from university hospitals were significantly more satisfied than those of the general and psychiatric hospitals. Conclusion : SSS performed well in the validity and reliability, indicating that it can be a useful tool for measuring Satisfaction of psychiatric inpatients in Korea.

임피던스 방법을 이용한 뇌혈류량 측정기기의 개발(Ⅰ)

김덕원,김정래,송철규,김정열,남문현 대한의용생체공학회 1989 의공학회지 Vol.10 No.1

In this study, Rheoencephalography(REG) was designed and constructed. Using the constructed instrument cerebral blood flow(CBF) of left and right brain, CBF change by posture, and reproducibility were studied. Followings are important results. Relative CBF could be measured noninvasively and continuously. Since reproducibility of the constructed REG was found to be quite high (4 %), the accuracy of the instrument itself was proved. REG can be easily applied for testing the effect of drugs for the patients with cerebral vessel diseases since it is quite sensitive to the relative changes of CBF. Various cerebral diseases can be diagnosed by analyzing the REG waveforms. The area of restricted cerebral blood vessels can be located by arranging the electrode configuration. Comparative studies with the standard techniques of measuring CBF are needed to verify the accuracy of REG. Further studies on optimal electrode configuration and various artifacts are also necessary.

A Performance Evaluation and Development of 3D Endoscopic Imaging System

Chul Gyu Song,Kyeong Seop Kim,Nam Gyun Kim,Myoung Ho Lee 대한전기학회 2000 Journal of Korean Institute of Electrical Engineer Vol.10 No.1

의료용 광음향 단층촬영 원리와 의학적 응용

송철규(Chul Gyu Song),유상훈(Sang Hun Ryu),김도훈(Do Hyun Kim) 대한전기학회 2011 전기학회논문지 Vol.60 No.6

Photoacoustics has been broadly studied in biomedicine, for both human and small animal tissues. Photoacoustics uniquely combines the absorption contrast of light or radio frequency waves with ultrasound resolution. Moreover, it is non-ionizing and non-invasive, and is the fastest growing new biomedical method, with clinical applications on the way. This paper provides a brief recap of recent developments in photoacoustics in biomedicine, from basic principles to applications. The emphasized areas include the new imaging modalities as well as translational research topics. A primary PA application in biomedicine is photoacoustic tomography (PAT). The past decade has seen fast developments in both theoretical reconstruction algorithms and innovative imaging techniques, and PAT has been implemented in imaging different tissues, from centimeter-large breast tumors to several micrometer-large single red blood cels (RBC). PAT now provides structural, functional and molecular imaging. Overall, PA techniques for biomedicine are maturing. They have been widely used to study both animal and human tissues. Recently, more and more research focuses on clinical applications. Commercialized PA systems are expected to be available in the near future, and wide clinical PA applications are foreseen.

생체 임피던스를 이용한 인체 하지운동출을 위한 최적 전극위치 선정

宋哲奎(Chul-Gyu Song),尹大榮(Dae-Young Youn),李東憲(Dong-Heon Lee),金守贊(Soo Chan Kim),金德源(Deok Won Kim) 대한전기학회 2003 전기학회논문지 D Vol.52 No.8

중추신경계 손상에 의한 경직의 이동형 측정 시스템

송철규(Chul-Gyu Song),서정환(Jeong-Hwan Seo),한상형(Sang-Hyung Han),김거식(Keo-Sik Kim),안양수(Yang-Su An) 대한전기학회 2009 전기학회논문지 Vol.58 No.6

Spasticity is a velocity-dependent stretch reflex disorder of the body motor system developing after the injury of the central nervous system, in which certain muscles are continuously contracted involuntarily. Conventional methods such as the modified Ashworth scale, Spasm frequency scale, pendulum test and isokinetic dynamometer had some disadvantages: limitation in discriminating the increase of resistance, immovable and expensive device, not enough study parameters. Therefore, it is necessary to introduce clinically more useful instrument, which can produce objective data and are more convenient on spasticity measurement. Spasticity measuring methods were reviewed and a new measuring instrument was designed and introduced. The new measuring system is a portable spasticity-measurement system, which encompass various scopes of spasticity-related human signals such as electrophysiologic, kinematic and biomechanical data. Our device was designed in order to measure the joint angle, angular velocity, electromyographic signals and force. We suggest that this new system can diagnose the spasticity of the muscles, objectively.