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.

복식 전자궁적출술후 절단부에 발생한 난관탈출증 1예

송은석,이해혁,김태희,김정식,남계현,이권해,고은석 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Prolapse of the fallopian tube into the vaginal vault after hysterectomy is a rare complication. Since most of cases may resolve before detection or remain undiagnosed, the exact incidence is still unknown. Though most common sign of tubal prolapse is tender friable tissue in vaginal cuff, with the simptoms of lower abdominal pain, dysparenunia, vaginal discharge, or postcoital spotting. The definitive diagnosis should be confirmed histologically Recently, we experienced a case of fallopian tube prolapse after abdominal hysterectomy in a 41-year-old woman and report with a brief review of the literature.

거대 난소 종양의 염전 1예

김미영,이해혁,유애리,박정희,이임순,정수호,고은석,레앙소팥,배동한,김태희,이권해 순천향의학연구소 2008 Journal of Soonchunhyang Medical Science Vol.14 No.1

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Sarcomatoid Carcinoma Arising from Mature Cystic Teratoma

Ho-Chang Lee1, Seung-Myoung Son, Yong-Moon Lee, Ji Hae Koo, Song-Yi Choi, Ok-Jun Lee, Eun-Hwan Jeong 충북대학교 동물의학연구소 2012 Journal of Biomedical and Translational Research Vol.13 No.2

Malignant transformation of mature cystic teratoma (MCT) is rare. Sarcomatoid carcinoma is a neoplasm comprising malignant mesenchymal cells and a conventional carcinomatous area. Here, we report on a case of sarcomatoid carcinoma arising from an MCT in the left ovary of a 45-year-old female. A unilocular cyst consistent with MCT was observed; however, a nodule within the cyst was confirmed from the resected ovary. Microscopically, the nodule showed both squamous cell carcinoma and pleomorphic sarcomatous components admixing with each other. Lining epithelial cells at the periphery of the main tumor showed squamous metaplasia. When a sarcomatous component is observed in the ovary tumor, it is important to find a squamous cell component, either benign or malignant.

노인 낮병원의 심리사회적 치료 프로그램이 노인의 신경인지기능과 우울 증상에 미치는 효과

유계준,송정은,오병훈,안석균,이홍식,오희철,구은형,황혜숙,이은철 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.5

노인에게 있어서 신경인지기능의 저하와 우울 증상은 가장 흔한 장애이며 신체적, 정신적인 면에 많은 영향을 미치고 있다. 또한 이러한 장애중 비임상군에서 심리사회적 치료개입의 효과가 보고되고 있다. 이러한 측면에서 지역사회에서 노인에게 제공되는 심리사회적 치료개입의 중요성이 높아지고 있다. 이전의 연구에서는 대상이 특정 집단이거나, 비교군이 없거나, 치료효과에 대한 추적 관찰이 이루어지지 않는 등의 제한점이 있었으며, 현재 국내의 노인 낮병원은 소수에 불과하고 이러한 낮병원의 치료효과에 대한 연구는 거의 없는 실정이다. 따라서 본 연구는 지역사회 정신보건센터에서 운영하는 노인 낮병원에 참가하는 노인들을 대상으로 낮병원의 심리사회적 프로그램이 노인들의 신경인지기능과 우울 증상에 미치는 효과와 이에 대한 유지 효과의 유무를 알아보고자 하였다. 경기도 광주군 정신보건센터의 노인 낮병원에 참여한 노인을 치료군으로, 치료를 거부하거나 치료 중 탈락한 노인을 비교군으로 하여 10주간의 낮병원 치료전후와 치료종결 후 10주에 신경인지기능은 한국형 간이 정신상태검사(이하 MMSE-K)로, 우울 증상은 단축형노인우울척도(이하 SGDS)로 평가하여 두 군을 비교하였고 치료군의 치료 직후와 치료종결 후 10주를 비교하였다. 연구결과 노인 낮병원의 심리사회적 치료가 시간에 따른 SGDS점수 변화에 통계학적으로 유의한 영향을 미쳤으며, MMSE-K점수 변화에는 통계학적으로 유의한 영향을 미치지 않았다. 또한 10주 추시가 가능했던 치료군 중 약 43%가 10주 후 SGDS가 증가하여 호전되었던 우울증상의 악화를 보였다. 본 연구 결과 노인 낮병원의 심리사회적 치료 프로그램 개입은 노인에게 있어서 우울 증상을 호전시키며 신경인지 기능에는 직접적인 영향을 미치지 않는 것을 알 수 있었다. 또한 상당수에서 심리사회적 치료 개입으로 인한 우울 증상의 호전이 유지되지 않음을 알 수 있었다. 이는 노인우울증상의 치료에 낮병원의 심리사회적 치료 프로그램이 효과적일 수 있음과 치료 후 이를 유지하기 위한 부가적인 치료개입의 필요성을 시사한다. Cognitive impairment and depression are the most common symptoms affecting the elderly on physical and mental states. Studies have shown that these symptoms in mild cases are improved by psychosocial intervention, emphasizing the importance of therapeutic intervention provided in the community. The purpose of this study was to investigate whether the psychosocial program at a geriatric day care service has any therapeutic effect on the cognitive function and depressive symptoms in the elderly and whether such effect can be maintained. The experimental group was composed of 37 elderly patients attending the day care service at the mental health center located in Kwangju county, Kyonggi province. The control group was composed of 22 elderly patients who either refused intervention or who dropped out of the program. Cognitive function was assessed with the Korean version of the Mini-Mental State Exam(MMSE-K), and depressive symptoms were assessed with the Short-form Geriatric Depression Scale(SGDS). The experimental group and the control group were compared on the score of on each test, which was administered before and after the program and 10 weeks after discontinuation of program. In the experimental group, the scores acquired immediately after the program and at 10 weeks of follow-up were also compared. The results showed that psychosocial intervention at a geriatric day care service was significantly associated with the change in SGDS scores dependent on time but not significantly associated with the change in MMSE-K scores. In the experimental group whose follow-up assessment was possible, it was further shown that 43% of patients had increased SGDS scores 10 weeks after the program ended, indicating that depressive symptoms had worsened. This study suggests that psychosocial therapeutic intervention in the geriatric day care service improve depressive symptoms but not cognitive functions in the elderly. In addition, for a considerable percentage of subjects in the experimental group, the improvements in depressive symptoms were not sustained after the intervention was withdrawn. These findings proposes a need of strengthening therapeutic intervention to maintain such effect.

서양복식에 나타난 복색규제에 관한 고찰

은영자,이해연 啓明大學校 生活科學硏究所 2005 科學論集 Vol.31 No.-

The costumes have been changed and developed with the development of the mankind. Also the color of the costume reflect the culture of the times and change. Furthermore the color of the costume has been used as symbol of social status. This study analysed the restrictions of color in the sumptuary of the western costume. The relations between the symbolic meaning of color and the sumptuary of the costume color were analysed through a literature survey. On the western costume sumptuary law, the major restriction colors were red, purple and violet. These were used only for governing class who have the Power and authority. Especially purple was used only for royal family. The symbolic meanings of color are given to costumes of specific social status. The color of the costume was related to the symbolic meanings of a specific color in the times and societies.

생쥐 뇌조직 체외배양법을 활용한 향산화제의 향독성효과에 관한 연구

이수현,박정은,김희옥,서혜원,조경혜 서울여자대학교 자연과학연구소 2000 자연과학연구논문집 Vol.12 No.-

In an effort to establish an in vitro model of Parkinson's disease (PD), we prepared slice cultures of midbrain from newborn mouse. The slice section containing substantia nigral region was cultured for 10days. The striatal culture was grown to preserve the distribution of interneurons with minimal contamination of any other brain tissue. Using this explant culture containing both glial cells and nitro-striatal dopamine neurons, the protective effect of antioxidant pineal hormone and melatonin on 1-methyl-4-phenyl-1, 2,3,6-tetrahydropyridine (MPTP) -induced loss of the dopamine neurons was investigated. MPTP selectively damaged dopaminergic neurons, as indicated by immunoblot and immunohistochemistry for glial fibrillary acidic protein (GFAP) and tyrosine hydroxylase, the marker enzymes for glial and dopaminergic neurons, respectively. Twenty-four-hour treatment of MPTP (50 μM) in the explant culture induced 37% loss of dopaminergic neurons while no apparent damage was observed in glial region. Type B monoamine oxidase (MAO-B) that resides in glial cells, produces free radicals during catecholamine metabolism and also oxidizes MPTP to its active form, MPP+, was activated by 2.2 times after MPTP treatment. Melatonin was able to recover both the dopaminergic neuronal loss and the elevated MAO-B activity level fully to the untreated control level. Similar observation was made bur the co-treatment of vitamin E with MPTP, suggesting the generation of oxygen radical species by MPTP. On behalf of pursuing molecular mechanisms of Parkinsonism, the data illustrate the proposed mechanism of MPTP-induced dopaminergic cell death ; namely, MPP+ that is processed by MAO-B in glial cells is taken up avidly by dopaminergic neurons and causes a toxic effect at least partly, if not mostly, through oxidative stress. The culture system, therefore, can serve as an experimental model of PD in which the putative neuroprotective effects of antioxidants can be investigated. This model is also useful for screening novel drugs and growth factors without a massive sacrifice of animals, and ultimately for developing neuroprotective therapies.

신체화장애 환자의 스트레스 대처방식 및 심리적 특성

이주연,이무석,윤진상,양종철,문지웅,정해원,은성종 大韓神經精神醫學會 2006 신경정신의학 Vol.45 No.6

Objectives : The purpose of this study was to investigate the stress coping strategies and psychological charactehstics, such as combined psychopathology and tendency of symptom interpretation, in patients with somatization disorder. Methods : Thirty patients meeting the criteria of DSM-IV somatization disorder were compared with thirty controls. We evaluated the subjects using Symptom Checklist-90-Revised (SCL-90-R), Somato-Sensory Amplification Scale (SSAS), Symptom Interpretation Questionnaire (SIQ), and The Ways of Stress Coping Questionnaire (SCQ). Independent t-test and Pearson correlation analysis were used. Results : From the results of SCL-90-R subscales, the scores of somatization, obsession-compulsion, depression, anxiety, and psychoticism were significantly higher in patients with somatization disorder than nonnal controls. Somatization disorder patients had greater amplification of physical sensation in SSAS and significantly higher score in physical interpretation of SIQ compared with psychological or environmental interpretation, In the SCQ of somatization disorder patients, we observed generallylower levels of total coping scores than the control group and significant positive correlation between passive coping style of SCQ and psychological interpretation of SIQ. Conclusion : These results show that patients with somatization disorder have various psychopathology, greater amplification of physical sensation, physical interpretation tendency of symptoms, and insufficient copying strategy.

어머니가 지각한 영아기질과 어머니 역할수행에 대한 자신감 및 만족도의 관계

이영은,강양희,박혜선,황은주,문미영 대한간호학회 아동간호학회 2003 Child Health Nursing Research Vol.9 No.2

브랜딩·스타일링·마케팅을 결합한 스페이스 디자인 프로세스 연구 - 작품‘Fill the Red, Feel the Red'를 중심으로 -

은다솜,장효실,최해원,홍지현,이진민,장미정,이성애 숙명여자대학교 디자인연구소 2018 숙명디자인학 연구 Vol.25 No.-

본 연구는 디자인 분야와 마케팅 분야의 전략을 종합하여 전략적 연결점을 찾아내 요소들 간 융합을 이루는 사례를 제시하여 브랜드·스페이스·마케팅에서 새로운 방향성과 아이디어를 제시하는데 목적을 둔다. 이에 본 연구는 2017년 9월~12월까지 ㈜애경과 산업 연계하여 진행된 숙명여대 환경디자인학과 ‘브 랜딩·스타일링·마케팅’ 교과목에서 도출된 ‘fill the red, feel the red’ 프로젝트를 마케팅 및 디자인 프로세스, 결과물을 도출하여 그 과정들을 밝힌다. 아울러 본 연구는 브랜드 스페이스 마케팅에 대한 이론적 고찰을 통해, 브랜드 스페이스(팝업스토어)를 개발 및 스타일링하며 ㈜애경의 화장품 브랜드 ‘LUNA’를 브 랜딩, 스타일, 마케팅적 측면에서 종합적으로 연계하여 도출되는 과정들을 제안함으로서 향후 브랜드 스페이스 디자인과 마케팅 분야에 체계적이고 창의적인 방법들로 결과물을 도출하는데 기초자료로 활용하는데 의의가 있다.