자료포락분석(DEA)를 이용한 보건의료의 효율성 측정

김남송,박홍섭,김은진,김설화,김정숙,김현아,김경숙,신지혜,최은정,양은진,유선미,유수진 圓光大學校 醫科學硏究所 2007 圓光醫科學 Vol.22 No.1

난황낭종 환자에서 보존적 수술 및 항암 화학요법 후 성공적인 자연임신

정은환, 홍승화, 박연진, 지일운, 김학순 충북대학교 의과대학 충북대학교 의학연구소 2012 忠北醫大學術誌 Vol.22 No.1

침윤성 난소암의 경우 생식력의 보존이 중요한 도전이라고 할 수 있다. 20대 중반의 여성에서 거대 한 난황낭종이 발견되어 생식력의 보존을 위해 보존적 수술과 복합항암화학요법을 시행한 후 임신 및 출산에 성공한 증례를 경험하였기에 문헌고찰과 함께 보고한다.

일반 모델 덧씌우기 방식을 적용한 농촌지도공무원 역량모델 개발

김진모,주대진,이진화,길대환,주현미,이정은 한국농업교육학회 2007 농업교육과 인적자원개발 Vol.39 No.2

국내에서 파상풍의 연령별 면역혈청학적 역학연구

강진한,허재균,김종현,이경일,박수은,마상혁,이명숙,반상자,홍성화,조대현,이성호 대한감염학회 2001 감염 Vol.33 No.2

Background : The incidence of tetanus in adults and neonatal tetanus have been markedly reduced by world-wide use of DTP vaccines. But, tetanus is still one kind of major health problems in many developing countries, and several serosurvey stduies in developed ountries revealed that substantial proportions of adult opulation may lack immunity against tetanus and imunity level against tetanus is continuously decreasing by age. In Korea, tetanus outbreaks have been disappeared since the 1980s by high acceptant DTaP vaccination rates. Annually, few tetanus patient has been reported since 1990s. But, there knave been no seroepide-miological studies to tetanus, no trials to assess tetanuts immunizations. And we do not use Td vaccine in adults for maintaning tetanus immunity. In this aspect, we conducted age related survey of immunity to tetanus and indirectly assessed the immunogenecity of tetanus vaccines, used in Korea. Methods : For the evaluation of age related sero-survey of tetanus immunity in Korean population, study subjects were classified into 16 groups (A∼J group; below 10 years with one year interval, K∼O group; 11~60 yrs with 10 years interval, p group; over 60 yrs). The numbers of each group were 100, and sex distributions of each group were almostly equal. And far the indirect assessment of tetanus immunization in Korean children, children under 15 years old age were classified into 6 groups (I∼VI) according to the status of DTaP vaccination. The numbers of this each group were 50, and sex ratio was almostly equal. Specific IgG antibody to tetanus toxin were detected by ELISA. And the ANOVA repeated t-test was used to compare antibody levels in study groups. Results : In age related groups, the antibody levels to tetanus toxin were well maintained until 20 years old age group (L group), but thereafter the titers abruptly decreased below 0.1 IU/mL and over 75% populations among the groups over 30 years old age needed maintenance of protective immunity to tetanus. The antibody level of male was statistically higher than that of female in P group. In the groups related DTaP vaccination status, the antibody titer was very low in pre-vaccination group (I), but the titers after primary vaccinations were sharply increased and highly maintained until 15 years. Conclusion : The results of our study revealed that the immunity to tetanus was dramatically decreased in age groups over 30 years old. This result indicates that Td vaccination program in adults should be considered for maintenance of immunity to tetanus. And our study indicate that DtaP vaccination programs and vaccines, used in Korea, are effective for acquisition and maintenance of tetanus immunity in Korean children. (Korean J Infect 33:104~111, 2001)

농촌지도직 공무원의 역량 중심 계층교육과정 개발

김진모,이진화,주현미,이정은 한국농업교육학회 2007 농업교육과 인적자원개발 Vol.39 No.4

이 연구의 목적은 농촌지도직 공무원의 역량 중심 계층 교육과정을 개발하는 데 있었으며,이를 위하여 계층구조 및 특성 규명,역량 중심 계층교육과정 개발,학습개입 설계의 세 단계로 구성된 개발모형을 설정하였다. 먼저 계층구조 및 특성을 규명한 결과,3년 미만 일반지도사,3년 이상 7년 미만의 일반지도사,7년 이상 20년 미만의 일반지도사,20년 이상의 일반지도사,담당 계층,중간 관리자 계층,경영자 계층 동 7단계의 계층구조가 설정되었다. 계층별 역량 개발 우선순위를 파악한 결과,20년 이상의 일반지도사와 담당 계층은 거의 유사한 것으로 나타났으며,이에 따라 교육과정의 레벨을 설정함에 있어서 20년 이상 일반지도사와 담당 계층을 통합하였다. 이에 기반하여 역량 중심 계층교육과정을 개발한 결과,지도 입문프로그램,지도실무프로그램,지도전문프로그램,팀리더프로그램,변화리더프로그램,경영자 워크숍 등 6개의 교육 프로그램이 개발되었다. 다음으로 역량별 학습과제 분석을 실시하고,그 결과를 설정된 교육 프로그램에 반영하였다. 마지막으로 각 교육 프로그램별 모듈을 구성하고 설계하였으며,전문가협의회를 통하여 그 결과를 검증받음으로써 농촌지도직 공무원의 역량 중심 계층교육과정을 완성하였다. 또한 이상의 역량 중심 계충교육과정 개발 과정을 통해 나타난 논점을 중심으로 향후 역량 중심 교육과정 개발을 위한 시사점을 제공하였다. The purposes of this study are to develop competency-based management curriculums by position level for rural extension workers. 3step model was set up for developing curriculums as follow; ① identifying position levels and their characteristics, ② developing competency-based management curriculums by position level, ③ designing of learning intervention. Above all, as a result of identifying position levels and their characteristics, 7 positions were drafted. These included: general extension worker under 3 years, general extension worker over 3 years and under 7 years, general extension worker over 7 years and under 20 years, general extension worker over 20 years, extension worker in charge, middle management, executive. Then, it was performed to identify the priority order of competency developing by position. And the priority of general extension worker over 20 years and supervisor was mostly similar, so then these positions were integrated. Based on positions of rural extension workers, competency-based curriculum, by position level, was developed, Consequently, 6 curriculums were developed. Next, it was conducted to analyze learning task for each competencies and apply them to 6 level curriculums. finally, modules were organized and designed for each curriculums, and examined through professional workshop. In addition, there were implications for developing competency-based curriculum based on issues of our process for developing competency-based curriculums by position level.

항생제 내성 폐구균

최은화,박진영,이환종 대한감염학회 1997 감염 Vol.29 No.1

2003년 국내 중증급성호흡기증후군 진료 현황 및 문제점 분석

이진수,김은실,정문현,백제중,정선화,안주희,최영화,이선희,고철우,김성범,김민자,박승철,기현균,송재훈,최상호,김양수,이상오,조용균,박영훈,정숙인,김연숙,이흥범,손창희,장성희,정희진,김우주 대한감염학회 2004 감염과 화학요법 Vol.36 No.3

목적 : 2002년 말 중국에서 SARS가 발생한 이후 국내에서도 2003년 10월까지 총 3명의 추정환자, 17명의 의심환자가 보고되었다. 향후 추가적인 SARS의 유행이 우려되는 상황에서, 그간의 SARS 환자 진료에 있어서의 실질적인 준비사항, 진료 현황 등에 대한 조사를 통해 문제점을 파악하여, 향후 더 나은 대비가 될 수 있도록 개선점을 제시하고자 하였다. 재료 및 방법 : SARS로 의심되는 환자를 진료 경험이 있는 병원의료진을 대상으로 2003년 10월에 설문조사를 실시하였다. 설문에는 SARS 환자 진료 시의 실질적인 조치, 진료 현황, 병실, 응급실 및 외래에서의 격리 시설과 준비사항, 보건당국의 관리와 지원에 관한 사항을 포함하였다. 결과 : 대상이 되는 22개 병원 중 17개(17/22, 77.2%) 병원이 설문에 응하였다. SARS 환자를 위한 격리실은 응급실, 외래, 일반병실 및 중환자실에서 각각 9개(9/17, 52.9%), 5개(5/17, 29.4%), 15개(15/16, 93.7%), 4개(4/16, 25%) 병원에서 음압처리가 되어있지 않은 일인실 혹은 다인실이 사용되었고, 1개(1/16, 6.3%) 병원에서만 일반병실에서 음압격리실이 운영되었다. 입원환자의 진찰 시 개인보호구의 착용은 거의 모든 의료기관에서 이루어졌다. 보건당국에서 SARS지정병원의 시설 등을 사전에 확인한 곳은 1곳(1/12, 8.3%)이였고, 14개 병원(14/15, 93.3%)에서는 보건당국에 의뢰한 검사결과를 통하 받지 못하였다. 결론 : 의료기관에서 SARS 환자용 격리실뿐만 아니라 기존의 격리실 설비 등이 미흡하였으며, 특히 중환자실 및 외래의 준비가 더욱 부족하였다. 보건당국의 의료기관에 대한 종합적인 지원이 부족하였고, 병원과의 원활한 연계가 잘 이루어지지 않았다. SARS 만이 아닌 격리를 필요로 하는 질환의 적절한 진료를 위해 향후 병원 시설의 정비와 정부차원에서의 보다 구체적이고 실질적인 대책마련이 필요하다. Background : There was an worldwide outbreak of the Severe Acute Respiratory Syndrome (SARS) originated from China in late 2002. During that period three cases of suspected SARS and 17 cases of probable SARS were reported in Korea. With the concerns about the reemergence of SARS-coV transmission, it is important to be prepared for any possibility. So, this study is aimed to analysis the past measures in managing SARS and propose the amendatory plans to improve the preparedness. Materials & Methods : Questionnaires were collected among clinicians with any experience in managing the probable or suspected SARS cases in Oct. 2003. 17 out of 22 hospitals responded to the questionnaire. The contents in the questionnaire were practical activities, personal equipments, response plans, isolation facilities in emergency centers, outpatient clinics, general wards and intensive care units, and relationship with the public health department. Results : The dedicated isolation rooms in emergency centers, outpatient clinics, general wards, and intensive care units were prepared in 9 (9/17, 52.9%), 5 (5/17, 29.4%), 15 (15/16, 93.7%), and 4 (4/16, 25.0%) hospitals, respectively. Except for one hospital that newly made negative pressure room for SARS, single or multi-bed rooms without airborne infection control were used in all the other hospitals. The personal precaution principles were kept quite well in general wards. Before the designation of SARS hospital by the public health department prior evalution to see if the hospital was suitable for managing SARS was conducted in only 1 (1/12, 8.3%) hospital. The results of laboratory diagnosis were reported back in 1 (1/15, 6.6%) hospital. Conclusions : The isolation facilities which can control airborne infection were almost deficient not only for SARS but also for other respiratory transmissible diseases. For the infection control of transmissible diseases including SARS, more investment is needed on medical facilities and comprehensive support from the public health department required.

도시지역의 국지순환과 침적현상에 관한 수치모의

이화운,오은주,노순아,반수진 한국대기환경학회 2003 한국대기환경학회지 Vol.19 No.6

There are variations in the temperature field due to urban heat island and anthropogenic heating so that regional scale meteorological field is changed. Therefore we simulate and predict the regional climate change according to surface characteristics through regional meteorological model. This study investigates the regional meteorological field by urbanization that influences in local circulation system using CSU-RAMS and simulates dry deposition velocity (V_(d)) using PNU/DEM which includes surface characteristics (such as albedo, surface hydrology and roughness length etc.) with calculated meteorological field. During the summer, horizontal distributions of V_(d) were simulated using CSU-RAMS and PNU/DEM at Busan metropolitan area. The estimated values of V_(d) were larger in forest and agricultural areas than water areas since ozone with low water solubility is destroyed slowly at wet surface or water.

췌장 선방세포암 1예

이화정,지준호,박승찬,박정철,최은정,서혜진,이원식,이정림,배병조,손경락,이경희 영남대학교 의과대학 2008 Yeungnam University Journal of Medicine Vol.25 No.2

Acinar cell carcinoma is a rare tumor that represents 1~2% of al1 pancreatic cancers. Clinical and radiologic findings are inconclusive in this disease Acinar cell carcinoma is characterized by rapid progression and early metastasis, which lead to its poor prognosis. A 41-year-o1d man was admitted to our hospital for abdominal pain. Abdominal computed tomography (CT) and positron emission tomography-computed tomography (PET-CT) showed a splenic mass, which was being invaded by a pancreatic tail mass and which had increased ^(18)F-fluorodeoxyglucose (FDG) uptake Primary radical distal pancreatectomy and splenectomy were performed. Pathologic findings revealed an acinar cell carcinoma of the Pancreas The patient underwent a total gastrectomy three months later because of gastric recurrence Four months later, multiple hepatic metastases were discovered, and the patient underwent a left hepatectomy During treatment with capecitabine, there was no evidence of tumor progression for 14 months. We report a case of metastatic pancreatic acinar cell carcinoma, which did not progress for an extended period while the patient was being treated with capecitabme.

Chlorhexidine 처리가 상아질 접착제의 미세인장결합강도에 미치는 영향

오은화,최경규,김종률,박상진 大韓齒科保存學會 2008 Restorative Dentistry & Endodontics Vol.33 No.2

본 연구는 상아질 혼성층의 교원섬유를 가수분해하는 효소인 MMPs (Matrix metalloproteinses) 억제제로 알려진 chlorhexidine (CHX)을 적용 후 결합강도를 측정하였으며, 이를 각각 열순환 처리 후 결합강도를 측정하였다. 또한 주사전자현미경으로 접착계면메서의 파괴 양상을 비교 분석하였다. 우식이 없는 발거한 32 개의 제 3 대구치의 교합면 상아질을 노출시키고 GI그룹에서는 dentin conditioner를 처리 후 2% chlorhexidine을 적용시키고, 산부식 접착제 그룹에서는 인산 산부식을 시행하고 2 % chlorhexidine을 적용 후 3단계 산부식형 상아질 접착제 (Scotchbond Multipurpose, SM), 2단계 산부식형 상아질 접착제 (Single Bond, SB)를 도포하고, 자가부식 접착제 그룹에서는 2 % chlorhexidine 적용 후 자가부식 상아질 접착제 (Clearfil Tri-S, TS)를 도포한다. 이후 복합 레진 (Z-250)과 GI (Fuji-II LC)를 충전한 시편을 1 ㎟의 단면을 갖는 beam으로 제작하여 열순환 하지 않거나, 10,000 회 열순환 (5 ~ 55 ℃)하였다. Universal testing machine (EZ-test: Shimadzu, Japan)에서 cross head speed 1 mm/min로 인장력을 가하여 , 미세인장결합강도를 측정하였다. 실험 결과는 유의수준 0.05 1evel에서 two-way ANOVA를 이용하여 통계분석하였다. 그 후 파절된 시편의 파괴 양상을 현미경 (SEM)으로 관찰하여 다음과 같은 갈론을 얻었다; 1. 2 % CHX을 적용한 모든 실험군에서 상아질과의 미세인장결합강도가 증가하였고, 열순환은 상아질과의 미세인장 결합강도를 감소시켰다 (P>0.05). 2. CHX 적용 후 열순환 한 군은 CHX을 적용하지 않고 열순환한 군에 비하여, 상아질과의 미세인장결합강도가 높았으며 , 특히 GI와 TS군에서 유의한 차이를 나타내었다 (P<0.05). 3. 파괴 양상 분석 결과, 혼성층에서의 접착성 파괴를 보이며, CHX을 적용하면 혼성층 기저부에서 상부로 파괴 부위가 옮겨가는 양상을 나타내었다. 이상의 연구 결과를 토대로, MMPs 억제제인 2 % CHX은 글래스 아이오노머 시멘트와 상아질 접착제의 초기 미세인장결합강도에는 영향을 미치지 않으며 ,CHX 적용이 접착 내구성을 유지하는데 도움이 되었다. The purpose of this study was to evaluate the effect of chlorhexidine (CHX) on microtensile bond strength (μTBS) of dentin bonding systems. Dentin collagenolytic and gelatinolytic activities can be suppressed by protease inhibitors. indicating that MMPs (Matrix metalloproteinases) inhibition could be beneficial in the preservation of hybrid layers. Chlorhexidine (CHX) is known as an inhibitor of MMPs activity in vitro. The experiment was proceeded as follows : At first, flat occlusal surfaces were prepared on mid-coronal dentin of extracted third molars. GI(Glass lonomer) group was treated with dentin conditioner, and then, applied with 2 % CHX. Both SM (Scotchbond Multipurpose) and SB (Single Bond) group were applied with CHX after acid-etched with 37% phosphoric acid. TS (Clearfil Tri-S) group was applied with CHX, and then, with adhesives. Hybrid composite Z-250 and resin-modified glass ionomer Fuji-II LC was built up on experimental dentin surfaces. Half of them were subjected to 10,000 thermocycle, while the others were tested immediately. With the resulting data, statistically two-way ANOVA was performed to assess the μTBS before and after thermocycling and the effect of CHX. All statistical tests were carried out at the 95 % level of confidence. The failure mode of the testing samples was observed under a scanning electron microscopy (SEM). Within limited results, the results of this study were as follows; 1. In all experimental groups applied with 2 % chlorhexidine, the microtensile bond strength increased, and thermocycling decreased the microtensile bond strength (P > 0.05). 2. Compared to the thermocycling groups without chlorhexidine, those with both thermocycling and chlorhexidine showed higher microtensile bond strength, and there was significant difference especially in GI and TS groups.