요양급여적정성 평가자료를 이용한 예방적 항생제 사용과 수술부위 감염 발생의 관련성 연구

김경훈,박춘선,장진희,김남순,이진서,최보람,이병란,이규덕,김선민,염선아,Kim, Kyoung-Hoon,Park, Choon-Seon,Chang, Jin-Hee,Kim, Nam-Soon,Lee, Jin-Seo,Choi, Bo-Ram,Lee, Byung-Ran,Lee, Kyoo-Duck,Kim, Sun-Min,Yeom, Seon-A 대한예방의학회 2010 예방의학회지 Vol.43 No.3

Objectives: To examine the prophylactic antibiotic use in reducing surgical site infection. Methods: This was a retrospective study for patients aged 18 years and older who underwent gastrectomy, cholecystectomy, colectomy, cesarean section and hysterectomy. The data source was quality assessment data of the Health Insurance Review & Assessment Service gathered from medical records of 302 national hospitals. Prophylactic antibiotic use was defined as: timely antibiotic administration or inappropriate antibiotic selection. We performed hierarchical logistic regression to examine the association between prophylactic antibiotic use and surgical site infection with adjustment for covariates. Results: The study population consisted of 16 348 patients (1588 gastrectomies, 2327 cholecystectomies, 1,384 colectomies, 3977 hysterectomies and 7072 cesarean sections) and surgical site infection was identified in 351 (2.1%) patients. The rates of timely antibiotic administration and inappropriate antibiotic selection varied according to procedures. Cholecystectomy patients who received timely prophylactic antibiotic had a significantly reduced risk of surgical site infection compared with those who did not receive a timely prophylactic antibiotics (OR 0.64, 95% CI=0.50-0.83), but no significant reduction was observed for other procedures. When inappropriate prophylactic antibiotics were given, the risk of surgical site infection significantly increased: 8.26-fold (95% CI=4.34-15.7) for gastrectomy, 4.73-fold (95% CI=2.09-10.7) for colectomy, 2.34-fold (95% CI=1.14-4.80) for cesarean section, 4.03-fold (95% CI=1.93-8.42) for hysterectomy. Conclusions: This study examines the association among timely antibiotic administration, inappropriate antibiotic selection and surgical site infection. Patients who received timely and appropriate antibiotics had a decreased risk of surgical site infection. Efforts to improve the timing of antibiotic administration and use of appropriate antibiotic are needed to lower the risk of surgical site infection.

건강보험 청구자료에서 동반질환 보정방법과 관찰기관 비교 연구: 경피적 관상동맥 중재술을 받은 환자를 대상으로

김경훈,안이수,Kim, Kyoung-Hoon,Ahn, Lee-Su 대한예방의학회 2009 예방의학회지 Vol.42 No.4

Objectives : To compare the performance of three comorbidity measurements (Charlson comorbidity index, Elixhauser s comorbidity and comorbidity selection) with the effect of different comorbidity lookback periods when predicting in-hospital mortality for patients who underwent percutaneous coronary intervention. Methods : This was a retrospective study on patients aged 40 years and older who underwent percutaneous coronary intervention. To distinguish comorbidity from complications, the records of diagnosis were drawn from the National Health Insurance Database excluding diagnosis that admitted to the hospital. C-statistic values were used as measures for in comparing the predictability of comorbidity measures with lookback period, and a bootstrapping procedure with 1,000 replications was done to determine approximate 95% confidence interval. Results : Of the 61,815 patients included in this study, the mean age was 63.3 years (standard deviation: ${\pm}$10.2) and 64.8% of the population was male. Among them, 1,598 2.6%) had died in hospital. While the predictive ability of the Elixhauser's comorbidity and comorbidity selection was better than that of the Charlson comorbidity index, there was no significant difference among the three comorbidity measurements. Although the prevalence of comorbidity increased in 3 years of lookback periods, there was no significant improvement compared to 1 year of a lookback period. Conclusions : In a health outcome study for patients who underwent percutaneous coronary intervention using National Health Insurance Database, the Charlson comorbidity index was easy to apply without significant difference in predictability compared to the other methods. The one year of observation period was adequate to adjust the comorbidity. Further work to select adequate comorbidity measurements and lookback periods on other diseases and procedures are needed.

Charlson 동반질환의 ICD-10 알고리즘 예측력 비교연구

김경훈,Kim, Kyoung-Hoon 대한예방의학회 2010 예방의학회지 Vol.43 No.1

Objectives: To compare the performance of three International Statistical Classification of Diseases, 10th Revision translations of the Charlson comorbidities when predicting in-hospital among patients with myocardial infarction (MI). Methods: MI patients ${\geq}20$ years of age with the first admission during 2006 were identified(n=20,280). Charlson comorbidities were drawn from Heath Insurance Claims Data managed by Health Insurance Review and Assessment Service in Korea. Comparisions for various conditions included (a) three algorithms (Halfon, Sundararajan, and Quan algorithms), (b) lookback periods (1-, 3- and 5-years), (c) data range (admission data, admission and ambulatory data), and (d) diagnosis range (primary diagnosis and first secondary diagnoses, all diagnoses). The performance of each procedure was measured with the c-statistic derived from multiple logistic regression adjusted for age, sex, admission type and Charlson comorbidity index. A bootstrapping procedure was done to determine the approximate 95% confidence interval. Results: Among the 20,280 patients, the mean age was 63.3 years, 67.8% were men and 7.1% died while hospitalized. The Quan and Sundararajan algorithms produced higher prevalences than the Halfon algorithm. The c-statistic of the Quan algorithm was slightly higher, but not significantly different, than that of other two algorithms under all conditions. There was no evidence that on longer lookback periods, additional data, and diagnoses improved the predictive ability. Conclusions: In health services study of MI patients using Health Insurance Claims Data, the present results suggest that the Quan Algorithm using a 1-year lookback involving primary diagnosis and the first secondary diagnosis is adequate in predicting in-hospital mortality.

암모니아-물 작동유체의 부분증발유동을 적용한 재생 랭킨사이클에 관한 연구

김경훈(Kyoung Hoon Kim) 대한설비공학회 2011 설비공학 논문집 Vol.23 No.3

The power cycle using ammonia-water mixture as a working fluid is a possible way to improve efficiency of the system of low-temperature source. In this work thermodynamic performance of the ammonia-water regenerative Rankine cycle with partial-boiling flow is analyzed for purpose of extracting maximum power from the source. Effects of the system parameters such as mass fraction of ammonia, turbine inlet pressure or ratio of partial-boiling flow on the system are parametrically investigated. Results show that the power output increases with the mass fraction of ammonia but has a maximum value with respect to the turbine inlet pressure, and is able to reach 22 ㎾ per unit mass flow rate of source air at 180℃.

기밀성 차단제를 이용한 탄산화 억제대책

김경훈 ( Kyoung Hoon Kim ),어량량 ( Liang Liang Lu ),허영선 ( Young Sun Heo ),한민철 ( Min Cheol Han ),한천구 ( Cheon Goo Han ) 한국건축시공학회 2013 한국건축시공학회 학술발표대회 논문집 Vol.13 No.1

This study investigates the effect of a protective layer on the level of carbonation resistance of concrete. For the protective layer, a PE film, bubble sheets, double layered bubble sheets and styroform were placed in a mold before placing the concrete. In addition, PE film was retrofitted by attaching on the surface of the substrate concrete with a glue. Results showed that the carbonation depths of the control concrete were 4.6 mm and 5.2 mm at one week and two weeks exposure in an accelerated carbonation chamber, whereas the concrete with all types of protective layer except PE flim did not allow the ingress of carbon dioxide during the same period.

단위가축영양 : Miniature Schnauzer에 있어서 현미 급여와 영양소 소화율 및 배설 분 특성

김경훈 ( Kyoung Hoon Kim ),장주송 ( Ju Song Chang ),오영균 ( Young Kyoon Oh ) 한국동물자원과학회(구 한국축산학회) 2011 한국축산학회지 Vol.53 No.5

The objectives of this research were to determine the effects of brown rice(BR) on food intake, digestion, energy value, and fecal characteristics. Three replacement levels which BR replaced 0, 15 and 30% of wheat flour were tested. Six female Miniature Schnauzer(8~9 month age, initial mean body weight 5.0±0.3kg) were assigned to treatments in replicated 3×3 Latin square design. Total tract digestibilities of DM, OM, acid hydrolyzed fat and gross energy except CP increased linearly(P<0.01), and observed digestible energy and metabolizable energy values also increased linearly(P=0.001 and P=0.006, respectively) with increasing BR replacement level. Wet and dry fecal output decreased linearly(P<0.001, P=0.004) with increasing BR inclusion to the diets and BR 30% treatment reduced wet fecal output up to 21% of that of control. Quadratic(P<0.01) effects was observed in fecal score for dog fed BR and fecal ammonia concentration tended to increase linearly(P=0.07) in response to increasing BR replacement level. It seems that the increase in fecal ammonia concentration may be partially related to the decrease in short-chain fatty acid concentration(P=0.001). This study clearly demonstrates that BR improves nutrients digestibility and fecal characteristics of dog.

발사대기 중인 액체추진 로켓의 극저온 산화제 탱크 내 비정상 열해석

김경훈(Kyoung Hoon Kim),고형종(Hyung-Jong Ko),김경진(Kyoungjin Kim),조기주(Kie-Joo Cho),오승협(Seung-Hyub Oh) 한국추진공학회 2008 한국추진공학회지 Vol.12 No.4

The prelaunch thermal transients in the cryogenic oxidizer tank of liquid propulsion rocket subjected to uniform heat flux from outside are numerically analyzed through thermodynamic equations and heat and mass transfer relations. The prelaunch stage is assumed to be composed of five idealized sub-stages including pressurization process by helium gas injection. The Peng-Robinson equation of state is utilized in the lumped analysis of ullage gas. The liquid region is divided into a number of horizontal layers of uniform properties to account for the thermal stratification. The computational result for the typical case shows that the temperature rise of liquid oxidizer is less than 1K and the adsorbed helium into the liquid is approximately 10g.

증기분사 재생 가스터빈 시스템의 엑서지 해석

김경훈(Kyoung Hoon Kim),정영관(Young Guan Jung),한철호(Chul Ho Han) 한국추진공학회 2009 한국추진공학회지 Vol.13 No.4

An exergy analysis is carried out for the regenerative steam-injection gas turbine systems which has a potential of enhanced thermal efficiency and specific power. Using the analysis model in the view of the second law of thermodynamics, the effects of pressure ratio, steam injection ratio, ambient temperature and turbine inlet temperature are investigated on the performance of the system such as exergetic efficiency, heat recovery ratio of heat exchangers, exergy destruction, loss ratios, and on the optimal conditions for maximum exergy efficiency. The results of computation show that the regenerative steam-injection gas turbine system can make a notable enhancement of exergy efficiency and reduce irreversibilities of the system.

증기분사 재생 가스터빈 시스템의 성능 및 최적 운전조건에 관한 연구

김경훈(Kyoung Hoon Kim),김동주(Dong Joo Kim),박상희(Sang Hee Park),오만수(Man Soo Oh),김동명(Dong Myung Kim) 한국추진공학회 2010 한국추진공학회지 Vol.14 No.1

The system performance of the regenerative gas-turbine cycle with the steam injection into the combustor has been studied through the thermodynamic cyclic analysis. The effects of the pressure ratio, the steam injection ratio, the ambient temperature, and the turbine inlet temperature are investigated on the thermal efficiency, the fuel consumption, and the specific power as well as the operating conditions for the maximum thermal efficiency of the system. The results of the present analysis find that the use of steam injection in the regenerative gas-turbine system can greatly enhance the thermal efficiency and the specific power of the system.

1-4분과 : 거시/금융 1 ; 무역 및 동아시아 지역에서의 금융시장 통합과 경기변동 동조성

김경훈 ( Kyoung Hoon Kim ),김성현 ( Sung Hyun Kim ) 한국국제경제학회 2015 한국국제경제학회 동계학술대회 Vol.2015 No.-

본 논문은 동아시아 국가들의 무역 및 금융시장 통합이 국가 간 경기변동성에 어떠한 영향을 미치는지를 패널 회귀분석을 통해 설증분석 하였다. 2004년 이후 10년간 자료를 삼펴본 결과 147~ 동아시아 국가 간 경기변동동조성이 2008년까지 는 감소하였으나, 그 이후 2011년까지 증가하였고 또한 무역시장 통합과 주식 및 채권시장 통합은 최근 10년간 강화된 것을 확인 할 수 있었다. 설증 분석 결과, 첫 째, 동아시아 9개 국가의 경우 국가 간 무역시장 통합 지표가 국가 간 경기변동동 조성에 양(+)의 영향을 미치는 것을 확인 할 수 있었다. 늘어난 무역거래로 인해 국 가 간 경기변동성동조성이 강화된다는 기존 연구결과와 일치하는 것이다. 두 번째, 주식시장 통합은 국가 간 경기변동동조성을 약화시키고 채권시장 통합은 국가 간 경기변동동조성을 강화시키는 것으로 나타났다. 주식거래는 소비위험분산을 통한 산엽구조의 이질화나 부의효과(wealth effect)를 일으켜 경기변동동조성을 약화시키 고, 주로 차익거래목적으로 거래되는 채권거래는 대차대조표 효과를 통해 경기변동 동조성을 강화시키는 것으로 해석 가능하다. 자본시장 통합이 경기변동 동조성에 미치는 영향이 자본유형에 따라 다르다는 결과는 자본시장 개방정책을 수립하는데 중요한 정책적 시사점을 줄 수 있다. This paper empirically studies the effects of trade and financial market integration on business cycle synchronization in East Asia. By examining the data of 14 East Asian countries during 2004-2013, we find that the degree of business cycle synchronization in the region had decreased until 2008, but increased from 2008 till 2011. Both trade and financial integration have been intensified for the past ten years. Empirical analysis for 9 East Asian countries shows that trade integration has positive effects on business cycle synchronization as shown in previous literature. Effects of financial integration differs according to its characteristics: equity market integration weakens business cycle synchronization due to wealth effects and industry diversification through consumption risk sharing, while debt market integration strengthens business cycle synchronization through balance sheet effects. These empirical results can provide important policy implications on financial market liberalization policies.