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.

The Proposal of a Verbal Interaction Framework for Elementary Science Teachers

Kim,Jong-young(Jong-young Kim),Shin,Myeong-kyeong(Myeong-kyeong Shin),Kim,Eun-jeong(Eun-jeong Kim) 경인교육대학교 교육연구원 2022 교육논총 Vol.42 No.-

This study is purposed to specifically present and suggest two of the five aspects of the existing framework using data recorded by science class teachers. Mortimer and Scott (2003) viewed teaching purposes, content, communicative approach, patterns of discourse, and teacher intervention as five aspects of classroom discourse analysis, analyzed for secondary science classes. In this study, four episodes were extracted from elementary science classes, the entire analysis was conducted, and the analysis frame developed in this study was applied. The results of the study showed that elementary science classes were analyzed differently according to class flow and the score of the Reformed Teaching Observation Protocol (RTOP). In addition, the analysis framework presented in this study and the score of the RTOP were slightly consistent.

군 간호 리더십 개념 개발

김은경 ( Eun Kyong Kim ),유명란 ( Myoung Ran Yoo ),박계화 ( Kye Hwa Park ),금경림 ( Kyeong Lim Keum ),정은영 ( Eun Young Jung ) 국군간호사관학교 군진간호연구소 2015 군진간호연구 Vol.33 No.2

Purpose: This study identifies the concept of `military nursing leadership’ based on a qualitative investigation. Methods: The study is based on Hybrid Model, proposed by Schwartz-Barcott and Kim. The study compromises of 3 steps : theory investigation, field study and final analysis. For theory investigation, we searched various literatures about ‘leadership’. Secondly, field study was conducted through interview and participatant observation of 14 participants (6 patients, 4 peer workers, and 4 nursing officers). Based on the above, we identified conceptual attributes of military nursing leadership. Results: Identified 9 attributes of military nursing leadership are achievement of group goal, respect, leading attitude, communication, educating how to be soldierly, specialty, persuasive power, judgment, and encouragement. Those attributes indicate that military nursing leadership is a process of achieving group goal through communication, educating soldierly manners based on encouragement and respect by nursing officers with specialty, persuasive power and judgement. Conclusion: In this study, we provide a way of understanding definition and 9 attributes of military nursing leadership to make military nursing officers have better apprehensibility. In addition, it can be helpful data in developing concept of military nursing leadership and related educational course.

결혼이주여성과 한국여성의 양육 스트레스 비교

김혜경 ( Hae Kyeong Kim ),이은희 ( Eun Hee Lee ) 서울대학교 간호과학연구소 2014 간호학의 지평 Vol.11 No.2

Purpose: The purpose of this study was to compare parenting stress between married migrant women and Korean women. Methods: Subjects were 68 married migrant women and 70 Korean women raising children aged seven years or younger, living in three different cities in Gangwon Do. To measure parenting stress, we used Kim`s (1997) questionnaire that had been modified from Richard & Abidin`s (1990) Parenting Stress Index (PSI). Results: There were significant differences between the two groups in age, academic credentials, job, monthly income, and achievement of maternal role. No statistically significant differences were found for parenting stress scores (p<.355), but there was a significant difference in the child characteristics of parenting stress (p<.007) between the two groups. There were no differences in the demographic variables influencing parenting stress between the two groups. Conclusion: The development of multi-cultural parenting and family support programs should consider the nationality and marital satisfaction of the family.

자원기준 상대가치(RBRVS : Resource-Based Relative Value Scale)를 이용한 다빈도 건강보험 요양급여항목의 간호서비스 상대가치 측정

김인숙,부은희,강경화,윤수진 병원간호사회 2006 임상간호연구 Vol.11 No.2

Purpose: This study was done to identify the workload of Registered Nurses for nursing service in a hospital by using the RBRVS (Resource-Based Relative Value Scale). Method: The methodology for this study of RBRVS is basically Hsiao's. First stage : identify nursing activities. Second stage: measure workload of nursing activities. Result & Conclusion: The results of the study indicate that the workload of Registered Nurses for nursing service was measured by considering time, physical effort, mental effort and judgement, and stress. The names and range of nursing activities were unclear. Therefore, in future studies naming of nursing activities and measurement of nursing activities should be done and relative values assess considering a balance of factors of relative value(time, physical effort, mental effort and judgement, and stress).

장기간 항갑상선제 투여 후 임의 중단 뒤 재복용시 발생한 무과립구증 1 예

김승만;김태영;박수영;배영환;서영경 정은주;김태균;권민정;박정현;이순희 인제대학교 2011 仁濟醫學 Vol.32 No.-

Agranulocytosis, one of the major side effects of antithyroid a gents, probably occurs in less than 0.25% of cases treated with antithyroid agents. It usually occurs within the first several weeks or months after the initiation of therapy, when drug dosage is higher. Most reported cases of agranulocytosis have occurred during the first 3 months of therapy. We describe here a rare case that did not experience the side effect for 6 years of antithyroid agent treatment but presented with agranulocytosis in one month after re-exposure. It suggests that the major side effect such as agranulocytosis can occur in patients who had undergone prior uneventful antithyroid drug therapy.

초등학교 고학년 학생의 구강보건에 관한 인식 및 행동

김영경,문혁수,정재연,한수진,이병진,김은경,정혜련 韓國學校保健學會 2001 韓國學校保健學會誌 Vol.14 No.1

The purpose of this study was to collect basic data for the development of effective oral health education program in elementary school. The subjects in this study were 604 fourth-year, fifth-year and sixth-year students of an elementary school in Seoul. Oral health awareness and behaviors were surveyed and analyzed. The findings of this study were as follows: 1. The most common time for toothbrushing was after dinner(62.0%) and before bedtime(62.3%). By school year, the largest number who brushed their teeth after dinner were fourth and fifth graders while the greatest number who did so after breakfast were sixth graders Seventy-four percent of respondents brushed the teeth twice or more a day. By school year, the fifth-year students brushed their teeth the least while girls outperformed the boys in daily toothbrushing frequency(p<0.05). Regarding the intake of cariogenic food, 62.1% took that kind of food once or more a day. By school year, the fifth graders took the most (p<0.05), and girls took more cariogenic food than the boys(p<0.05). 2. Ninety percent of the respondents had visited a dental clinic. By grade, the sixth-year students had visited a dental clinic more frequently and girls more frequently than boys. Eighty percent of the respondents visited a dental clinic to receive treatment but just 12.3% visited a dental clinic to prevent oral diseases. Concerning the fetor of dental treatment only 14.4% expressed fear. School year made no difference, yet the percentage of girls who experienced fear was higher than that of boys(P<0.05). Regarding preventive treatment, 39.7% experienced pit and fissure sealing and 24.2% experienced the application of fluorides. All the students hadn't much experience in preventive treatment regardless of school year -- gender didn't make a difference. 3. Fourty-six percent of respondents had a preference for the fluoride mouth rinsing program; 38.4% wanted that grogram to continue. As to the reason for preference, 38.2% preferred it because of the prevention of dental caries, 43.0%, the largest percentage, didn't favor it because they found it too much trouble to do(some of the respondents gave two different answers). 4. Despite an increase in the frequency of toothbrushing at the right time, they still took cariogenic food frequently Their visit to a dental clinics also aimed at treatment more than at prevention, and they had very narrow experience of preventive treatment. Furthermore, the fluoride mouth rinsing program failed to draw their interest. Therefore, it is recommended that a successful real health education program should be developed.

Ⅱ급 과개교합 환자의 측두근 박리 전 후의 근육활성도에 관한 연구

김은경,김정기,김오환 全北大學校 齒醫學硏究所 1992 전북치대논문집 Vol.10 No.1

The purpose of the present study was to investigate the differences of EMG activity of the masticatory muscles between before and after the temporal muscle detachment from coronoid process in the Class Ⅱ deep bite patients. 12 persons of Class Ⅱ deep bite malocclusion whose mean age 18.4 years served for this study. The EMG data from the anterior temporal and superficial masseter muscles in both sides as mandibular elevators were recorded with the Physiograph MK-Ⅲ electromyographic machine. The EMG recordings were analysed during mandibular rest position, maximal biting and swallowing of saliva. The following results were obtained. 1. There was no significant difference during mandibular rest position and swallowing between before and after temporal muscle detachment at anterior temporal and masseter muscle. 2. The activity of the anterior temporal and masseter muscle during maximal biting showed slightly increase at 8 weeks and 12-24 weeks after temporal muscle detachment, whereas showed significant decrease at 4 weeks after temporal muscle detachment. 3. In comparison of EMG activity during maximal biting between before and 12-24 weeks after temporal muscle detachment showed statistically nonsignificant difference in the anterior temporal muscle, however masseter muscle showed statistically difference(P<0.05).

지적장애 아동의 균형과 호흡 기능 향상을 위한 감각통합치료: 개별 실험 연구

김경미,홍은경 대한감각통합치료학회 2011 대한감각통합치료학회지 Vol.9 No.1

Objective : Sensory integration is the organization for sensation for use. The purpose of this study is to carry out the sensory integrative intervention for the mental retardation with child and to examine change of child's balance and breath abilities. Methods : The study performed from 25 May to 13 Autumn, 2009. The design is AB design(baseline 3sessions, intervention 21sessions) of single -subject research design. We carried out the sensory integrative intervention(3 sessions per week) for baseline period and the sensory integrative intervention(3 sessions per week) with sensory diet every day for intervention period. Results : The results of the sensory integrative intervention with sensory diet had positive effects for child's breathe and balance. Conclusion : The occupational therapists recognize the effects of the sensory integrative intervention with sensory diet and need to recommend for the family of child with disability. 목적 : 감각통합치료는 개별아동에 맞는 감각의 기회를 제공하고, 적절한 도전의 과제를 제공하여 적응반응을 이끌 어 내는 아동 중심의 접근법이다. 본 연구는 지적장애 아동에게 적합한 감각통합치료를 적용하여 아동의 균형과 호흡능력의 변화를 살펴보고자 하였다. 연구방법 : 연구 대상은 만 5세 3개월의 남아로 지적장애 진단을 받았다. 실험기간은 2009년 5월 25일부터 2009 년 8월 13일까지이었다. 실험설계는 개별실험연구(single-subject research design) 중 AB 설계를 사용하였고, 기초선 A(감각통합치료) 3회기와 중재 B(감각통합치료, 감각식이) 21회기이었다. 실험기간 동안 아동의 문제점 인 균형과 호흡의 변화를 측정하였다. 결과 : 첫째, 감각통합치료는 아동의 호흡능력에 긍정적인 영향을 미쳤다. 둘째, 감각통합치료는 아동의 균형에 긍 정적인 영향을 주었다. 결론 : 작업치료사는 지적장애아동의 균형과 호흡능력을 향상시키기 위해 감각통합치료를 지속적으로 적용, 확대 하는 것이 필요하다.

석청(Mad-honey) 복용 후 유발된 부정맥 1예

김용철,김남호,김승환,최준호,박은미,이상재,이은미,유남진,윤경호,오석규,정진원 圓光大學校 醫科學硏究所 2008 圓光醫科學 Vol.23 No.2

석청에 포함된 grayanotoxin에 의해 독성 작용이 나올 수 있으며, 이러한 독성 작용은 일반적으로 24시간 이내 저절로 회복된다. 최근에 본 저자들은 석청 복용 후 발생한 심실빈맥을 경험하였기에 보고하는 바이다. 49세 남자가 호흡곤란으로 내원하였으며, 내원당시 분당 40회 정도의 동성 서맥이 관찰되었고, 수액을 투여하던 중 심실 빈맥이 발생하였다. 항부정맥제를 투여 후 정상 동율동으로 전환되었으며, 특별한 이상 없이 4일 후 퇴원하였다. Mad-honey intoxication caused by the consumption of honey producted from the nectar of rhododendrons. The grayanotoxins cause the intoxication. The toxic effects of mad-honey poisoning are rarely fatal and generally last for no more than 24 hours. We experienced one case, a 49 years-old man who presented with dyspnea after ingestion of mad-honey. He showed marked sinus bradycardia with < 40 beats per minute on admission. The cardiac rhythm was changed to ventricular tachycardia immediately. These features resolved completely in 24 hours with continuous infusion of amiodarone(600 mg per day) and fluids. We report the case of intoxication of mad-honey as a presentation of fatal cardiac arrhythmia.