위절제술 환자의 표준진료지침 개발 및 적용 효과

김은희,김철규,이순교,김순덕,이혜옥,권정순,이경미,이민미,심순미,유용만,신종식,강은희,이상일,김병식,오성태,육정환,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.2

Background : Gastric cancer is the most common malignant tumor in Korea. surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for recucing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and unplanned readmission rate between the pre-pathway group(n=67) and the post-pathway group(n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days(p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was of satistically significant(p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korea hospital settings.

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.

Graphene: Position‐ and Morphology‐Controlled ZnO Nanostructures Grown on Graphene Layers (Adv. Mater. 41/2012)

Kim, Yong‐,Jin,Yoo, Hyobin,Lee, Chul‐,Ho,Park, Jun Beom,Baek, Hyeonjun,Kim, Miyoung,Yi, Gyu‐,Chul WILEY‐VCH Verlag 2012 Advanced Materials Vol.24 No.41

<P>On page 5565, Gyu‐Chul Yi and co‐workers grow position‐ and morphology‐controlled ZnO nanowalls in prescribed positions on graphene layers. The nanowalls are grown to produce a variety of shapes from simple circles to text at the microscale. The selective growth of high quality ZnO nanowalls is investigated by electron microscopy and optical spectroscopy. The hybrid nanostructure can be exploited to fabricate various nanodevices including microarrays of nanotube LEDs. </P>

Flexible Optoelectronics: Flexible Inorganic Nanostructure Light‐Emitting Diodes Fabricated on Graphene Films (Adv. Mater. 40/2011)

Lee, Chul‐,Ho,Kim, Yong‐,Jin,Hong, Young Joon,Jeon, Seong‐,Ran,Bae, Sukang,Hong, Byung Hee,Yi, Gyu‐,Chul WILEY‐VCH Verlag 2011 ADVANCED MATERIALS Vol.23 No.40

<P>Inorganic‐based flexible light‐emitting diodes (LEDs) using single‐crystalline GaN/ZnO coaxial nanorod heterostructures grown directly on large graphene films are reported on page 4614 by Gyu‐Chul Yi and co‐workers. The LEDs demon‐strate reliable operation in a flexible form, with no significant degradation in their electroluminescent or electrical characteristics. This approach provides a general and rational route to develop many different inorganic optoelectronics in flexible or stretchable forms. </P>

관동맥질환에서 저밀도 지단백 입자 크기의 분포

임효영,김인숙,승기배,강동헌,전두수,장기육,박준철,이수영,홍순조,최규보 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.8

청주대학교 간호학과 교육과정 개발 연구

안경주 김철규 전해옥 김봉정 김혜숙 채명옥 윤현정 한달롱 김아린 청주대학교 보건의료과학연구소 2014 보건의료과학연구 Vol.3 No.1

Dynamics in the workplace and in society have contributed to the paradigm shift to outcome-based education. This study was performed to develop the curriculum based on assessment of existing program for the baccalaureate nursing program at Cheongju University. We used three steps-Analysis, Design, and Development-in ADDIE model for developing curriculum. The subjects were 18 graduate nurses, 41 nursing students, 38 parents, and 2 nursing team leaders for analysis of core competence. In conclusion, developing an outcome-based curriculum might be used to facilitate the students' development and evaluate the competence of the student during and on completion of the nursing baccalaureate program at Cheongju University.

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.

국내 지역사회 거주 노인의 우울중재프로그램에 대한 메타분석

김철규 청주대학교 보건의료과학연구소 2013 보건의료과학연구 Vol.2 No.1

The purpose of this study was to evaluate the effects of depression intervention programs in elderly living at home in Korea. Six studies for meta-analysis were extracted from electronic databases through KERIS, KISS, and DBpia. The selected studies were nonequivalent control group pretest-posttest design and reported statistical value to calculate the effect size(ES). The effect sizes for depression intervention programs was significant with ES=0.54 for flexibility, but were not significant with ES=-2.36 for depression, ES=-3.47 for quality of life and ES=0.44 for balance. The cumulative evidence suggests that the depression intervention programs has a minor effect on increasing the balance in elderly living at home in Korea.

입원환자 낙상 발생 실태와 원인에 관한 분석 연구

김철규,서문자 한국의료QA학회 2002 한국의료질향상학회지 Vol.9 No.2

Background : The purpose of this research was to examine the fall incidence rate and its related factors of fall in inpatients. Methods : The data were collected from the 138 fall incident reports in one tertiary hospital in Seoul from April 1st 1999 to September 30th 2001. The Fall Incident Report Form was originally developed based on that of Massachusetts General Hospital revised in 1995. And this was modified for this survey by the collaborating work of QI team including researcher and department of nursing service of this particular hospital. The contents of Fall Incident Form were general characteristics of patient, factors related to fall, types and places of fall, circumstances, nursing interventions, and outcome. Results : 1)the incidence rate of fall was 0.08% of total discharged patients and 0.081 per 1000 patient-day. This incidence rate is much lower than that of general hospitals in USA. This finding might result from the different incidence report system of each hospital. 2)The characteristics of fall-prone patient were found as follows. They were mostly over 60 years old, in alert mental status, ambulatory with some assistance, and dependent on ambulatory device. The types of diseases related high incidence rate were cerebrovascular disease(3.2), hypertension(1.6), cardiovascular disease(1.4), diabetes(1.3) and liver disease(0.6). 3)The majority of fall events usually occurred in bed, beside(walking or standing)and bathroom in patient room. Usually they were up on their own when they fell. And there were more falls of elderly occurred during night time than day or evening. 4)63.8% of fall events resulted in physical injuries such as fracture and usually the patients had diagnostic procedures and some treatment(ex.suture)which caused additional cost to the patients and their families. 5)The found risk factors of fall were drugs(antihypertensive drug, diuretics)and environmental factors like too high bed height, long distance of bedside table and lamp switch, and slippery tile of bathroom floor. Conclusion : Considering these results, every medical and nursing staff should be aware of the risk factors of patients in hospital, and should intervene more actively the preventive managements, specially for the elderly patients during night. Therefore, it is recommended that the development of Fall Prevention Programs based on these results.

국내 지역사회 거주 노인의 다면적 낙상예방프로그램에 대한 메타분석

김철규 청주대학교 보건의료과학연구소 2013 보건의료과학연구 Vol.2 No.1

The purpose of this study was to evaluate the effects of multifactorial fall intervention programs for elderly living at home in Korea. Four studies for meta-analysis were extracted from electronic databases through KERIS, KISS, and DBpia. The selected studies were nonequivalent control group pretest-posttest design and published peer reviewed articles. The effect sizes for multifactorial fall intervention programs were significant with ES=1.41 for balance, ES=0.72 for gait ability, and ES=-7.70 for fear of falling. The analysis of studies indicates that the multifactorial fall intervention programs is effective in improving balance, gait ability and fear of falling for elderly living at home in Korea.