병원에서의 질 향상(QI) 활동 - 필요성, 역사와 향후의 과제-

권영대,Kwon, Young-Dae 한국의료질향상학회 2006 한국의료질향상학회지 Vol.12 No.2

델파이법을 활용한 우리 나라 주요 암질환의 장애정도 가중치 추정

권영대,김병익,윤석준,Kwon, Young-Dae,Kim, Byoung-Yik,Yoon, Seok-Jun 대한예방의학회 2000 Journal of Preventive Medicine and Public Health Vol.33 No.4

Objectives : To estimate the weighting for the disability caused by major cancers in Korea using the Delphi method. Methods : We selected 19 panelists to estimate the disability weighting of major cancers in Korea by using the Delphi method. To select the relevant kinds of cancers, we used National Death Certificate Data produced by the National Statistical Office in 1996. Then the stability of each delphi round was calculated by using the coefficient of variance. Results : The disability weight of major cancers for males was pancreas cancer(0.36), liver cancer(0.35), esophageal cancer(0.30), stomach cancer(0.27), lung cancer(0.26), and colorectal cancer(0.30). The disability weight of major cancers fer females was pancreas cancer(0.36), liver cancer(0.34), esophageal cancer(0.29), stomach cancer(0.28), lung cancer(0.26), and colorecial cancer(0.28). Conclusion : The results of this study will provide baseline data useful for the measurement of the burden of disease caused by cancers in Korea.

중환자 중증도 평가도구의 타당도 평가 - APACHE III, SAPS II, MPM II

권영대,황정해,김은경,Kwon, Young-Dae,Hwang, Jeong-Hae,Kim, Eun-Kyung 대한예방의학회 2005 예방의학회지 Vol.38 No.3

Objectives : To evaluate the predictive validity of three scoring systems; the acute physiology and chronic health evaluation(APACHE) III, simplified acute physiology score(SAPS) II, and mortality probability model(MPM) II systems in critically ill patients. Methods : A concurrent and retrospective study conducted by collecting data on consecutive patients admitted to the intensive care unit(ICU) including surgical, medical and coronary care unit between January 1, 2004, and March 31, 2004. Data were collected on 348 patients consecutively admitted to the ICU(aged 16 years or older, no transfer, ICU stay at least 8 hours). Three models were analyzed using logistic regression. Discrimination was assessed using receiver operating characteristic(ROC) curves, sensitivity, specificity, and correct classification rate. Calibration was assessed using the Lemeshow-Hosmer goodness of fit H-statistic. Results : For the APACHE III, SAPS II and MPM II systems, the area under the receiver operating characterist ic(ROC) curves were 0.981, 0.978, and 0.941 respectively. With a predicted risk of 0.5, the sensitivities for the APACHE III, SAPS II, and MPM II systems were 81.1, 79.2 and 71.7%, the specificities 98.3, 98.6, and 98.3%, and the correct classification rates 95.7, 95.7, and 94.3%, respectively. The SAPS II and APACHE III systems showed good calibrations(chi-squared H=2.5838 p=0.9577 for SAPS II, and chi-squared H=4.3761 p=0.8217 for APACHE III). Conclusions : The APACHE III and SAPS II systems have excellent powers of mortality prediction, and calibration, and can be useful tools for the quality assessment of intensive care units(ICUs).

소아 요로 감염 원인균의 항생제 감수성 고찰(2003-2005)

권영대,김명진,김희운,송진영,고준태,강호석,오세호,Kwon, Young-Dae,Kim, Myung-Jin,Kim, Hee-Un,Song, Jin-Young,Ko, Joon-Tae,Kang, Ho-Seok,Oh, Sei-Ho 대한소아신장학회 2006 Childhood kidney diseases Vol.10 No.2

Purpose : We studied the degree of changes in antibiotic sensitivity toward causative organisms, prevalence and clinical manifestations of extended-spectrum $\beta$-lactamase(ESBL)-producers of urinary tract infection(UTI) for a period of three years. This serves to provide useful information in selecting adequate drugs for the treatment of UTI. Methods : We recruited 137 patients who grew more than $10^5$ CFU/mL in their urine culture among 250 patients who visited and were admitted to Handong University's Sunlin Hospital for UTI treatment from January 2003 to December 2005. We retrospectively analyzed the data from the medical records. Results : The common pathogenic organisms were Escherichia coli(65.0%), Klepsiella pneumoniae(14.0%), Enterococcus faecalis(5.8%) and Proteus vulgaris(2.9%) in consecutive order. The prevalence of ESBL-producers among isolated E. coli and K. pneumoniae was 4.5%(4 cases) and 14.3%(2 cases), respectively. The antibiotic sensitivity rates of E. coli were relatively high to amikacin(100%), imipenem(100%), ceftriaxone(95.5%) and tobramycin(91.4%) while relatively low to TMP/SMZ(55.4%), ampicillin/sulbactam(29.4%) and ampicillin(24.2%). Conclusion : The use of ampicillin, ampicillin/sulbactam and TMP/SMZ, which have been the first choices in the treatment of UTI, should be reconsidered due to the low sensitivity rates towards these antibiotics. Due to the high incidence and antibiotic tolerance of ESBL that might have risen from the development of new antibiotics and increased antibiotic use, it is necessary to consider changing the standard antibiotics that have been used in the treatment of UTI.

급성 뇌경색 환자의 증상 발현 후 응급실 도착까지의 시간이 치료 결과에 미치는 영향

권영대,윤성상,장혜정,Kwon, Young-Dae,Yoon, Sung-Sang,Chang, Hye-Jung 대한예방의학회 2007 예방의학회지 Vol.40 No.2

Objectives : Recent educational efforts have concentrated on patient's early hospital arrival after symptom onset. The purpose of this study was to evaluate the time interval between symptom onset and hospital arrival and to investigate its relation with clinical outcomes for patients with acute ischemic stroke. Methods : A prospective registry of patients with signs or symptoms of acute ischemic stroke, admitted to the OO Medical Center through emergency room, was established from September 2003 to December 2004. The interval between symptom onset and hospital arrival was recorded for each eligible patient and analyzed together with clinical characteristics, medication type, severity of neurologic deficits, and functional outcomes. Results : Based on the data of 256 patients, the median interval between symptom onset and hospital arrival was 13 hours, and 22% of patients were admitted to the hospital within 3 hours after symptom onset. Patients of not-mild initial severity and functional status showed significant differences between arrival hours of 0-3 and later than 3 in terms of their functional outcomes on discharge. Logistic regression models also showed that arrival within 3 hours was a significant factor influencing functional outcome (OR=5.6; 95% CI=2.1, 15.0), in addition to patient's initial severity, old age, cardioembolism subtype, and referral to another hospital. Conclusions : The time interval between symptom onset and hospital arrival significantly influenced treatment outcome for patients with acute ischemic stroke, even after controlling for other significant clinical characteristics. The findings provided initiatives for early hospital arrival of patients and improvement of emergency medical system.

쌍줄푸른밤나방 (Pseudoips fagana )의 생태학적 특성

권영대,박일권,Kwon, Young-Dae,Park, Il-Kwon 한국응용곤충학회 2011 한국응용곤충학회지 Vol.50 No.2

Pseudoips fagana Fabricius belongs to the subfamily Chloephorinae (Lepidoptera: Noctuidae). Eggs of Pseudoips fagana were white and oviposited on oak leaves. There were five P. fagana larval instars, which were light green in color with four white crosslines. The larval period was approx. 24.4 days ($25^{\circ}C$, 16L:8D). Pupae were covered with a light-green membrane and silk. The wingspan of adults was approx. 15 to 18 mm. The color of the forewings of both sexes was bright green. The color of the hindwings was yellow in males and and white in females. First emergence was from early May to late June, and the second emergence was from early July to late August. Pseudoips fagana over-wintered as pupae. 쌍줄푸른밤나방(Pseudoips fagana Fabricius)은 분류학적으로 밤나방과(Noctuidae), 푸른밤나방아과(Chloephorinae)에 속한다. 쌍줄푸른밤나방의 알은 백색이며 참나무잎에 무더기로 산란하였다. 유충은 총 5령기를 거치며, 몸전체에 걸쳐 연녹색을 띠며, 4개의 백색선이 복부의 끝까지 연결되어 있다. 유충기간은 약 24.4일이 소요되었다. 번데기는 연녹색의 단단한 막과 실크로 덮여져 있다. 성충의 날개를 편 길이는 15-18 mm 였으며, 앞날개의 바탕색은 연두색이다. 뒷날개의 경우 수컷은 황색이며 암컷은 백색을 띈다. 쌍줄푸른밤나방의 1화기는 5월 초순부터 6월 말까지이며, 2화기는 7월 초부터 8월 말까지 였으며, 번데기로 월동하였다.

대규모 염색체들을 위한 개선된 Probe 선택 알고리즘

권영대 ( Young-dae Kwon ),박경욱 ( Kyoung-wook Park ),임형석 ( Hyeong-seok Lim ) 한국정보처리학회 2005 한국정보처리학회 학술대회논문집 Vol.12 No.1

유전자 칩의 정확성은 각 유전자들의 식별자로 활용되는 probe들에 의해 결정된다. 일반적으로 칩을 구성하는 probe들은 반응 오류를 예측하기 위해 이중구조와 녹는점과 같은 요소들을 고려한다. 또한 다른 유전자들과의 교차반응을 최소화하기 위해 각 probe들의 specificity도 고려되어야 한다. probe가 specificity를 보장하는지 검증하는 것은 전체 유전자들을 탐색해야 하므로 대규모 인간염색체에 대해서는 많은 시간이 소요된다. 본 논문에서는 specificity를 만족하는 probe들을 선택하는 효율적인 알고리즘을 제시한다. 제시한 알고리즘은 해시 테이블을 활용하여 probe가 specificity를 만족하지 못하게 하는 유전자 시퀀스들만을 탐색하여 비교한다. 제시한 알고리즘이 기존 알고리즘보다 효율적임을 실험결과를 통해 보인다.

유전자 칩에서 Probe Specificity를 판별하기 위한 효율적인 알고리즘

권영대(Young-Dae Kwon),박경욱(Kyoung-Wook Park),임형석(Hyeong-Seok Lim) 한국정보과학회 2005 한국정보과학회 학술발표논문집 Vol.32 No.1

유전자 칩의 정확성은 각 유전자들의 식별자로 활용되는 probe들에 의해 결정된다. 칩에 삽입되는 probe들은 반응오류를 피하기 위해 이중구조, 녹는점, 그리고 CG구조와 같은 요소들을 고려한다. 또한 다른 유전자들과의 교차반응을 최소화하기 위해 specificity를 고려한다. probe의 specificity검증은 전체 유전자들에 대해 탐색해야 하므로 대규모 염색체에 대해서는 많은 계산이 요구된다. 본 논문에서는 specificity 검증을 위한 효율적인 알고리즘을 제시한다. 제시한 알고리즘은 해시테이블을 활용하여 probe가 specificity를 만족하지 못하게 하는 유전자 시퀀스들만을 탐색하여 비교한다. 제시한 알고리즘이 기존 알고리즘보다 효율적임을 실험결과를 통해 보인다.

진료협력간호사의 운영현황에 관한 연구

권영대 (Kwon, Young Dae),성영희 (Sung, Young Hee),권인각 (Kwon, In Gak),황문숙 (Hwang, Moon Sook) 병원간호사회 2008 임상간호연구 Vol.14 No.3

Purpose: The purpose for this study was to identify the present state of Clinical Nurses with Expanded Role (CNERs) and provide basic data to refine the roles of CNERs. In this study, CNREs refers to nurses who perform techniques traditionally done by doctors and use titles such as clinical nursing specialist, educator with consultation, research assistant, coordinator, physician assistant and special examiner. Method: This study was conducted from September 1 to November 12, 2007. Data from 684 nurses from 38 hospitals who responded to the questionnaire were analyzed with descriptive statistics using the SPSS 14.0 program. Results: The mean percentage of time spent was, for direct practice, 41.1%, for education and counseling, 22.8%, for consultation and coordination, 10.4%, for research, 6.8%, for administration, 8.9% and for other activities, 10.0%. The most frequently implemented CNERs, activities included consultation and education for patients and their families, counseling by telephone, history taking, physical examination, reading examination results, psychosocial assessment, managing treatment, input of prescriptions, and writing up patient records, Although not frequently performed, nurses in some fields carried out invasive procedures and prescribed medication and laboratory tests. Conclusion: Although the number of hospital CNERs are rapidly increasing, there is still confusion about the title and framework as well as standards. Furthermore, because some nurses are prescribing medication and laboratory tests as well as performing techniques not traditionally done by nurses, there is an absolute need for a legalized system and systematic education system for the safety of patients who are being cared by all CNERs.

군병원 ATT제도 개선에 관한 연구 - 의료기관 서비스 평가제도 도입을 중심으로 -

권영대 ( Young Dae Kwon ) 국군의무사령부 1996 대한군진의학학술지 Vol.27 No.1