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고령의 심방세동 환자의 Warfarin 치료 시, 출혈 발생률과 위험인자 분석
조현복,민경아,인용원,이영미,손기호 한국병원약사회 2011 병원약사회지 Vol.28 No.2
Atrial fibrillation is an independent risk factor for stroke, and oral anticoagulation therapy with warfarin is effective in the prevention of stroke in atrial fibrillation. It has been reported that the prevalence of atrial fibrillation increases with age, and numbers of elderly patients who take warfarin is also increasing. As a result, increasing rate of bleeding associated with warfarin in elderly patients has been reported in previous studies. This study was designed to evaluate the incidence rate of bleeding in relation to age, and the factor associated with bleeding. In this retrospective study, baseline characteristics, anticoagulant control (target INR of 2-3)and the incidence of bleeding were assessed in an elderly population (≥75 years) compared with a younger population (between 65 and 74 years). All patients were new warfarin users, attending anticoagulation service (ACS) at Samsung Medical Center from January 1, 2008 to August 31,2009. Each patient was followed up by 1 year after starting taking warfarin. A total of 155 patients were studied, and 100 patients in the younger group providing 83.1 person-years of follow-up and 55 patients in the elderly group providing 39.5 person-years of follow up. Between younger and elderly group, average of duration of INR within target range is 57.5% and 61.5% respectively, and there is no significant difference (p=0.269). No difference of incidence of minor bleedings was found between the elderly group and the elderly group(p=0.395). Major bleedings were developed 1 event in younger group and 2 events in the elderly group. Incidence rate of major bleeding in the elderly group was higher than the younger group in 4.21folds, but it was not statistically significant (95% CI, 0.38-46.4). 42.6% of all bleeding and 33.3%of major bleeding were developed in first 90 days after starting warfarin therapy. Male (p=0.031)was analyzed as a risk factor for bleeding associated with warfarin in the all 155 patient, and history of cancer was analyzed that had effect on the analyzing sex as a risk factor for bleeding. However, we couldn't find the risk factors of bleeding for the elderly group. These findings suggest that older age and early period of warfarin therapy were related to increasing of bleeding caused by warfarin, and needed much care for anticoagulation therapy. Further studies to analyse risk factors for bleeding and there results may be help provide better anticoagulation therapy to elderly atrial fibrillation patients for prevention of stroke.
조현복,박종서 晋州敎育大學校 科學敎育硏究所 2001 科學敎育硏究 Vol.27 No.-
This study is designed to plan and develop the titles of multimedia math learning with a view to providing students with interesting and exciting stories and games with the help of constructing a variety of methods for constructing learning contents, providing feedbacks based on learners' response, creating learner-centered programs and planning easy-to-handle programs. And this study is also aimed at helping teachers coping aggressively with educational multimedia maximizing the effects of math education with the help of producting teaching materials with multimedia-generating tools, motivating students and developing supplementary and individualized learning materials for the effective learning of part of mathematics based on the 7th curriculum.
DRG 지불제도 적용수술에 투입되는 재료비 산출 및 분석에 관한 연구
김광자,백순영,조현복,박두이,이양숙 병원간호사회 2005 임상간호연구 Vol.10 No.2
Purpose: This research analyzed the material cost of the operation adapted to DRG payment system. Method: This research was performed from April. 1, 2003 to Oct. 27, 2003 for 342 patients. We analyzed the output of operation material cost and the resulting factor of the difference by the research table about consumed materials. The 8 groups of operation that adapted in DRG system were divided into 12 lists and 3 factors ; disease-dependent factor, operator-dependent factor, and staff-dependent factor which induced the cost difference. Result: The most expensive operation was cataract surgery(\482,746) and the cheapest surgery was tonsillectomy(\7,217). Cesarean sections represented the greatest difference between the highest and the lowest cost, about \152,177, and tonsillectomy represented the smallest difference, about \3,128. The factors contributing to the difference were the operator-dependent factor(46.7%), the disease-dependent factor(37.5%), and the staff-dependent factor(15.8%). Conclusion: It is expected that the material cost of the operation can be reduced when all operator change their cognition about DRG payment system and voluntarily participate to reduce the cost of material.