임상 지도의사 제도에 의한 임상교육의 내용과 교육태도에 대한 평가

송윤미(Yoon Mi Song),김창엽(Chang Yup Kim),유태우(Tai Woo You),허봉렬(Bong Yul Huh) 한국의학교육학회 1993 Korean journal of medical education Vol.5 No.1

In an effort to evaluate the usage of preceptorship in a department of family medicine, we analyzed the data which gathered during 10 months, from July 1990 to April 1991. The analyzed results were as follows ; 1. The number of precepting per preceptor was 3.5 during one day. 2. In the clinical learning, the residents needed instruction most frequently in the process for diagnosing the problems of their patients. 3. For the purpose of evaluating the teaching behavior of preceptors, we asked to 21 residents and 8 preceptors of the department who experienced the preceptorship for responding a questionnaire, which contained 30 questions. Residents perceived that the most contributable teaching behavior was deals with students in a friendly, outgoing manner . Preceptors answered that behavior as emphasizes problem solving approaches rather than solution per se . About the least contributable teaching behavior, residents and preceptors agreed that it was emphasis on his/her personal research . For further improvement in clinical instruction and its evaluation, it would be necessary to develop a collaborative methodology for clinical instruction and to organize an ongoing professional communication.

의료기관 임상영양사 요구도에 미치는 영향

엄미향(Um, Mi Hyang),박유경(Park, Yoo Kyoung),송윤미(Song, Yoon Mi),이송미(Lee, Song Mi),류은순(Lyu, Eun Soon) 한국영양학회 2017 Journal of Nutrition and Health Vol.50 No.5

임상영양서비스에 대한 의사의 인식과 임상영양사 요구도에 대한 의사의 인식에 대한 인과관계를 명확하게 파악하기 위해 매개효과를 분석하고 부트스트래핑으로 매개효과를 검증한 이 연구의 결과물을 요약하면 다음과 같다. 연구목적을 달성하기 위해 5가지 가설을 다음과 같이 세웠다. 가설 1. ‘의사가 인식하는 임상영양서비스의 실행에 대한 의사의 인식’은 ‘임상영양서비스의 중요도에 대한 의사의 인식’에 정(+)의 영향을 줄 것이다. 가설 2. 의사가 인식하는 ‘임상영양서비스의 질병 치료 효과에 대한 의사의 인식’은 ‘임상영양서비스 중요도에 대한 의사의 인식’에 정(+)의 영향을 줄 것이다. 가설 3. ‘임상영양서비스의 중요도에 대한 의사의 인식’은 ‘임상영양사 요구도에 대한 의사의 인식’에 정(+)의 영향을 줄 것이다. 가설 4. ‘임상영양서비스 중요도에 대한 의사의 인식’은 ‘임상영양서비스 실행에 대한 의사의 인식’과 ‘임상영양사 요구도에 대한 의사의 인식’ 사이에서 매개역할을 할 것이다. 가설 5. ‘임상영양서비스 중요도에 대한 의사의 인식’은 ‘임상영양서비스의 질병 치료 효과에 대한 의사의 인식’과 ‘임상영양사 요구도에 대한 의사의 인식’ 사이에서 매개역할을 할 것 이다. 가설검증 결과와 매개효과 분석 결과 가설 1~5까지의 가설이 모두 지지되었다. 결론적으로 1) ‘임상영양서비스의 중요도에 대한 의사의 인식’이 완전 매개로 작용한 경우는 임상영양서비스 실행횟수에 상관없이 의사가 임상영양서비스의 중요도를 인식해야만 임상영양사 요구도를 인식한다는 것이며, 2) 임상영양서비스의 중요도에 대한 의사의 인식이 불완전 매개로 작용한 경우는 임상영양서비스의 질병 치료 효과에 대한 의사의 인식과 임상영양서비스 요구도에 대한 의사의 인식 사이에서 프로세스 역할을 수행하지만, 임상영양서비스의 질병 치료 효과에 대한 의사의 인식이 임상영양서비스 요구도에 대한 의사의 인식에 더 큰 영향을 준다는 것이다. 따라서 임상영양서비스에 대한 의사들의 긍정적인 인식은 임상영양사 요구도에 대한 의사의 인식을 높이지만, 단순히 임상영양서비스의 양적 횟수 즉 임상영양서비스의 실행에 대한 의사의 인식이 아니라 환자 치료에 있어서 도움이 되는 질적 효과 즉 임상영양서비스의 질병 치료효과에 대한 의사의 인식과 임상영양서비스의 중요도에 대한 의사의 인식이 의사들에게서 임상영양서비스에 대한 긍정적인 인식을 이끌어 낼 수 있다. 이러한 의료진의 긍정적인 인식을 높이기 위해서는 추가적으로 임상영양서비스를 수행하는 임상영양사의 전문성이 요구된다. 이상의 결과를 근거로 임상영양서비스에 대한 의사의 인식이 임상영양사 요구도에 영향을 준다고 여겨진다. 더불어 영양학 분야의 유사연구에서 사회과학 분야 통계기법을 활용하여 명확한 인과관계를 규명하는데 본 연구가 발판이 되어 질 것으로 기대하는 바이다. Purpose: The purpose of this study was to explore whether or not there is a relationship between doctor`s awareness of clinical nutrition service and needs for a clinical dietitian. Methods: A cross-sectional survey design was used. The research was carried out by using questionnaires that had been specifically designed for the study. The research was conducted from September to October, 2013 for 311 doctors at 43 hospitals (with over 400 beds). Frequency analysis, factor analysis, reliability analysis, confirmatory factor analysis, and bootstrapping analysis were conducted using SPSS 21.0. Results: ‘Implementation of clinical nutritional service’ (p < 0.001) and ‘usefulness on clinical nutrition service’ (p < 0.001) were found to be correlated with ‘importance of clinical nutrition service’ as an independent variable. The correlation between ‘importance of clinical nutrition service’ as a mediating variable and ‘needs for clinical dietitian’ as a dependent variable was also confirmed (p < 0.001). The results of the bootstrapping test showed that the mediating effect of ‘importance of clinical nutrition service’ was significant. The indirect effect value between ‘implementation of clinical nutrition service’ and ‘needs for clinical dietitian’ was 0.040, indirect effect value between ‘usefulness on clinical nutrition service’ and ‘needs for clinical dietitian’ was 0.095. Conclusion: The frequency of providing clinical nutritional services, the quality of clinical nutritional services, and the degree of implementation of clinical nutritional services were found to be important for positive perception of clinical nutrition services by doctors. Therefore, proper provision of clinical nutrition services and effective therapeutic effects will be continuously highlighted, which will increase the awareness of the physician and ultimately increase the demand for clinical nutrition service.

상, 하악골 유래 조골세포의 골형성 능: 일차 연구

양훈주,송윤미,김리연,오지혜,조태형,김인숙,황순정,Yang, Hoon Joo,Song, Yoon Mi,Kim, Ri Youn,Oh, Ji Hye,Cho, Tae Hyung,Kim, In Sook,Hwang, Soon Jung 대한악안면성형재건외과학회 2013 Maxillofacial Plastic Reconstructive Surgery Vol.35 No.1

Purpose: Maxilla and mandible have different patterns of cortical and trabecular bone and different bone mineral densities, even though both are components of the jaw bone. However, cellular differences between maxilla- and mandible derived osteoblasts (OBs) have rarely been studied. We hypothesize that maxilla- and mandible-derived OBs show different responses to $17{\beta}$-estradiol (E2), which is one of the critical factors for bone formation. This study compares skeletal site-specific cell responses between maxilla- and mandible-derived human OBs to E2. Methods: Maxilla- and mandible-derived OBs derived from an identical donor were separately isolated from a total of five normal healthy subjects aged 18~44 years old, cultured with a treatment of 100 nM estrogen. The responses between maxilla- and mandible-derived OBs to E2 were evaluated and compared using cell proliferation, alkaline phosphatase (ALP) activity and gene expression of osteoprotegerin (OPG), ALP, insulin-like growth factor-1 (IGF-1), and estrogen receptor ${\alpha}$ ($ER{\alpha}$). Results: E2 did not have any distinct effects on the proliferation of both types of OBs. Mandible-derived OBs exhibited higher ALP activity than maxilla-derived OBs in the non-treated condition, which was common in all tested individuals. ALP activities of both types of OBs showed a minor increasing tendency with the treatment of E2, even though there was no statistical significance in some specimens. The gene expression of OB by E2 was diverse, depending on the individuals. There was increased expression of OPG, IGF-1, or $ER{\alpha}$ gene in the part of subjects, which was more repeated in maxilla-derived OBs. In particular, OPG or ALP induction by E appeared less frequently in mandible-derived OBs. Conclusion: Current results revealed that E2 affects maxilla- and mandible-derived OBs into facilitating the osteogenic process despite individual differences. Mandible-derived OBs are less sensitive to bone-forming gene expression by E2.

성인여성에서 열량공급원과 비만도의 관련성 -4회 실시한 3일간의 식이기록 평균을 토대로-

신명희,윤미옥,남석진,송윤미,Shin, Myung-Hee,Yoon, Mi-Ock,Nam, Seok-Jin,Song, Yun-Mi 대한예방의학회 2007 예방의학회지 Vol.40 No.1

Objectives : The aim of this study was to investigate the relationship between the contributions of macronutrients to the total energy intakes and Body Mass Indices (BMI, $kg/m^2$) of Korean women. Methods : We used dietary records data from 115 healthy Korean women, ages 20 and over, who completed four 3-day dietary records between February 2003 and March 2004. For the calculation of nutrients we used a dietary assessment program developed by the Korean Nutritional Society. Macronutrient intakes were estimated by averaging individual total daily intakes in four 3-day dietary records. Subjects were categorized into three Body Mass Index (BMI) groups : underweight (BMI < 20), normal (20 $\leq$ BMI < 25), and overweight (BMI $\geq$ 25) group. Results : The total energy intakes were not different among the three BMI groups. Similarly, other macronutrient intakes such as protein, fat, carbohydrate, vegetable protein, animal protein, saturated fatty acids, monounsaturated fatty acids, and polyunsaturated fatty acids were not different. From the multivariate nutrient density model, substituting polyunsaturated fatty acid for carbohydrate was positively associated with BMI in women aged 20 to 49 ($\beta=2.31$, p<0.01). In women aged 50 and over, substituting animal protein for carbohydrate was positively associated with BMI ($\beta=0.549$, p=0.04). Conclusions : No single macronutrient was associated with BMI when all subjects were combined. However, when stratified by age, polyunsaturated fatty acid intake in younger women, and animal protein intake in older women, were positively associated with BMI. In the future, we recommend a larger study to confirm these results.

암환자의 영양상태 평가와 재원일수 및 사망률과의 관계

윤기영(Ki Young Yoon),안수미(Su Mi Ahn),신연명(Yeon Myeong Shin),최경현(Kyung Hyun Choi),장문경(Moon Kyung Jang),공은진(Eun Jin Kong),송윤미(Yun Mi Song) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.72 No.6

Purpose: The length of a patient’s stay in a hospital is an indication of the patient’s recovery rate. The length of the hospital stay has an important economic factor for hospitals. This study was conducted to determine the relationship of the nutritional status at the time of admission to mortality and the length of the hospital stay (LOHS). Methods: The study subjects were 1,619 patients who suffered with cancer, were admitted to Kosin University Gospel Hospital during 2005 and they met the study criteria. The patients were classified to the not at risk group, the patients having one risk factor for malnutrition were the Ⅰ group, the patients having two risk factors for malnutrition were the Ⅱ group, the patients having three risk factors for malnutrition were the Ⅲ group and the patients having 4 risk factors for malnutrition were the Ⅳ group, based on the established criteria of serum albumin <3.0 g/㎗, a total lympocyte count of <1,500 cells/㎣, a cholesterol level of ≥240 ㎎/㎗ or ≤130 ㎎/㎗, weight for height ≥120% or <90% ideal body weight. Results: 24.3% of the patients were classified into the not at risk group, 37.6% were classified into the at risk group Ⅰ, 24.2% were classified into the at risk group Ⅱ, 10.3% were classified into the at risk group Ⅲ and 3.6% were classified into the at risk group Ⅳ. The at risk group (at risk Ⅲ, at risk Ⅳ) had a significantly higher prevalence of liver disease. The relationship between liver disease and low serum albumin albumin levels may have confounded the data. Although the estimated LOHS was similar in all the groups, the average length of stay was 14.4±16.38 days in the malnourished group (at risk group Ⅳ) compared to approximately 2.8 days in the not at risk group. The more nutritional risk factors the patients had, the longer was the LOHS and the mortality rates were higher. Correlation was not observed between the risk factors and the length of the hospital stay, as well as the lack of correlation with the mortality rate. Conclusion: These results suggest that a patient’s nutritional status upon admission has an effect on the length of the hospital stay for patients with carcinoma.

컴퓨터 통신을 이용한 건강 상담 내용의 분석

송윤미,김창엽,황인홍 대한가정의학회 1992 Korean Journal of Family Medicine Vol.13 No.4

공중보건의의 고혈압 진단 및 치료과정 평가

송윤미,김윤,조홍준,정희숙,김용익 한국의료QA학회 1996 한국의료질향상학회지 Vol.3 No.1

Background : Little work has been carried out regarding quality assessment research in a primary care setting, comparing with that of hospitals. This study aims to evaluate the process of diagnosis and management of hypertension by public health doctors on the basis of pre-established clinical guideline, and to identify several modifying factors associated with them. Methods : Hypertension was selected as the target disease, because it is a chronic disease which is of great public health importance. Self-administered questionnaires were mailed to public health doctors practicing at health centers and health subcenters across the nation. The response rate was 20.9%. The questionnaire included the diagnosis and management process such as measuring blood pressure, history taking, physical examinations, and treatment approches and potentially modifying factors such as level of training, duration of practice as a public health doctor, and education on management of hypertension. Results : Public health doctors pay little attention in measuring BP, hypertension related history taking, performing physical examination and laboratory examination. But they devoted much effort in diagnosing hypertension exactly and giving nonpharmacological treatment. Among various antihypertensive drugs, calcium-channel blockers were the most preferred agent(50.8%). Level of training, duration of practice as a public health doctor, and education on management of hypertension made no difference on quality of care(p>0.05). Conclusion : These public health doctors showed poor compliance with the preestablished clinical guidelines, which leaves much to be desired in diagnosion and managing hypertensive patients by public health doctors. This study might be able to contribute to develop some strategies, such as educational programs, which would be able to improve the process of care in hypertensives.

입원 환자 영양검색 전산 프로그램 개발

안수미,윤기영,신연명,최경현,임근승,장문경,송윤미,공은희 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.2

Background : About 30% of patients in the hospital are under nourishment. A large portion of people are undernourished when they are admitted to the hospital and in the majority of these, undernutrition develops further while in hospital. Patient-Generated subjective global assessment(PG-SGA), a method of nutritional assessment based on clinical judgment, has been widely used to assess the nutritional status of adults for both clinical and research purposes. Modified PG-SGA can be used as a nutrition screening tool, and a comprehensive nutrition assessment is desirable for those who are malnourished. The purpose of this study is to develop a simple, reliable and valid nutrition screening program(NSP). Methods : We applied the nutrition screening program(NSP) to adult inpatients who are at risk of malnutrition using the Modified Patient-Generated subjective global assessment(PG-SGA) and objective assessment(electrical medical record data). Results : Therefore simple and beneficial NSP is developed for patients with severe malnutrition. Using NSP. nutritional information of the severe malnutrition patient should be shared with the physicians and they should be taken care of by clinical dietitians to improve their nutritional status. Conclusion : The Modified PG-SGA and nutrition screening tool are simple, reliable and valid nutrition screening program(NSP).

단식이 인체에 미치는 영향에 관한 연구

조성일,송윤미,김철환,서홍관,최지호,신보문 대한가정의학회 1994 Korean Journal of Family Medicine Vol.15 No.12

새로운 예방접종 스케줄의 문제점과 대안

김영식,송윤미,김철환,김경수 대한가정의학회 1996 Korean Journal of Family Medicine Vol.17 No.11