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.

소화성궤양 환자에 대한 Omeprazole(Losec^(�))의 임상 효과

이종선,이기천,허승식,안정기,윤세진,정현용,이헌영,김영건 최신의학사 1990 最新醫學 Vol.33 No.9

소화성 궤양에 대한 Nizatidine의 임상효과

안정기,이기천,허승식,이종선,정현용,이헌영,김영건 충남대학교 의과대학 지역사회의학연구소 1990 충남의대잡지 Vol.17 No.1

Nizatidine is a newly introduced potent H2-receptor antagonist of acid secretion with long duration of action. For evaluation of clinical efficancy and safety, twenty one patients with endoscopically proved thirteen gastric ulcers and eight duodenal ulcers were treated with nizatidine 300mg at bed time via per os for 6 weeks. The results were as follows 1. The rate of complete endoscopic healing of duodenal ulcer 92.3% and 87.5% after 6 weeks. The overall healing rate of peptic ulcer was achieved in 89.9% at 6 weeks. 2. Clinical symptoms disappeared in 84.6%, 92.3% and 100% of patients with duodenal ulcer and 75.0%, 87.5% and 87.5% patients with gastric ulcer at 2, 4 and 6 weeks respectively. 3. There were not developed any symptoms and signs suggesting side effect of drug. In conclusion, data from this study suggest that nizatidine 300mg p.o. at sleeping time is effective and safe in treatment of peptic ulcer disease, and is well tolerated on a short-term basis.

보존적 치료로 회복된 망경색에 의한 급성복증 1예

김정념,이숭환,김정식,김진호,배윤오,박성규,윤상정,한현영,이헌영 충남대학교 의과대학 의학연구소 2003 충남의대잡지 Vol.30 No.1

Omental infarction, the end result of impaired perfusion to the greater omentum, is a rare benign self-limiting clinical entity. The main clinical symptom is non-specific localized abdominal pain with a moderately raised white blood cell and erythrocyte sedimentation rate. These findings often mimic an abdominal surgical emergency. This condition is often misdiagnosed as acute appendicitis or cholecystitis. The characteristic feature of CT scan and ultrasonography provide non-invasive diagnosis in most patients with omental infarction. We report a case of patient whose CT scan showed the characteristic finding of omental infarction. The patient was improved spontaneously only with conservative care.

내시경으로 확인된 상부소화관 용종의 임상적 고찰

김영건,김병호,성자원,이기천,허승식,이종선,정현용,이헌영 충남대학교 의과대학 지역사회의학연구소 1991 충남의대잡지 Vol.18 No.2

From January 1987 to October 1991, we performed 14,333 cases of upper gastrointestinal endoscopy and diagnosed 527 cases with U.G.I polyp. We assesed these 527 cases and obtained following results: 1) The overall incidence of U.G.I. polyps was 3.6%, and there was no sexual difference. The peak incidence was in 6th decades(32.4%). 2) The U.G.I. polyps were located chiefly at stomach(415 cases, 78.7%), among which antrum occupied antrum 43.5%, body 24.0% and funds 5.1%. And the others were esophagus(6.5%) and duodenum(12.3%). 3) The size of U.G.I. polyp was below 1cm in 72.3%, from 1cm to 1.9cm in 20.7% and above 2cm in 7.0%. According to Yamada' classification, type Ⅰ, Ⅱ, Ⅲ and Ⅳ was 31.9%, 51.3%, 13.7% and 3.0%. 4) Histological nature of U.I.G. polyp were hyperplastic polyp(85.8%), adenomatous polyps(9.3%), carcinomatous polyps(3.3%) and etc. The size of neoplastic polyp such as adenomatous polyps(mean 1.0±0.7cm) and carcinomatous polyps(niean 2.0±1.8) were larger man hyperplastic polyp(mean 0.6±0.4) (p<0.05) 5) The gastric polyps were associated with peptic ulcer(7.5%), gastric cancer(3.2%), other malignancy(3.5%), hepatobiliary disease(5.5%), post subtotal gastrectomy(5.5%). And others(75%) werenot associated with specific disease.

고빌리루빈혈증을 동반한 자가면역성 간염 1례

서영범,김성욱,장재식,강혁주,이중현,윤병구,김욱년,이광헌,이구,유석동,양창헌,이정호,이영현,이창우,서정일 동국대학교 의학연구소 2000 東國醫學 Vol.7 No.-

자가면역성 간염은 대개 만성 경과를 가지며, 혈중 자가면역항체와 혈청 글로불린치의 상승, 그리고 조직학적으로 괴사 염증성 변화를 특징으로 하는 질환으로 아직 정확한 병인이 밝혀져 있지 않은 상태이다. 발병연령은 대개 젊은 영자(15-25세)에서 호발한다. 이 질환은 급성 간염의 임상경과를 보일 수 있으나, 심한 급성 간염이나 전격성 간염으로도 나타날 수 있는데, 이 경우 아주 나쁜 예후를 보인다고 한다. 치료는 자가면역성 간염 임상 경과의 다양성이나 병인, 병리기전의 불확실성에도 불구하고 대개 steroid 치료에 반응하는 것으로 알려져 있으며 대개 80%의 관해율을 나타내며 궁극적으로 간경변으로의 진행을 막을 수 있는 것으로 보인다. 저자들은 58세 남자에서 발생한 급성의 경과를 가지고 심한 황달을 동반한 자가면역성 간염을 경험하였기에 문헌고찰과 함께 보고하는 바이다. Autoimmune hepatitis (AIH) is a chronic necroinflammatory liver disorder of unknown cause associated with circulating autoantibodies and a high serum globulin level. The age of onset of AIH show a peak between the age of 15 and 25 years. AIH can develop and be manifested as acute hepatitis, but severe form of acute hepatitis or fulminant hepatic failure has a poor prognosis. Although AIH is likely to progress from chronic active hepatitis to cirrhosis, steroid therapy can control the disease activity, prolong survival, improve the quality of life , and defer liver transplantation. In the present report we describe a 58-year-old man who admitted because of progressive jaundice and fatigue. He was diagnosed with AIH from laboratory test result showing positivity for antinuclear antibodies, anti-smooth muscle antibodies, and negativity for hepatitis viral markers and from liver biopsy. Steroid therapy, oral administration of prednisolone, was effective in improving the liver function test. Following liver biopsy 6 months after onset shows markedly improved necroinflammatory activity.

원예작물 수출경쟁력 비교분석

이정식,김양희 한국화훼연구회 1995 화훼연구 Vol.4 No.1

Twenty horticultural crops(5 fruit crops, 4 vegetable crops, 3 flower crops, 4 horticultural seed crops, 2 flowers grafted) were studied comparatively for exports by 14 parameters. The results are summarized as fellows : From the aspeet of necessity for freshness and storability, seed crops and grafted plants (group 3) were preferable. And in terms of product quality requirement and transport ability, the survey showed that seeds and dried red pepper were preferable in international trade. Considering per kilogram prices and transport ability, horticultural seed crops and red pepper were the most preferable. Whereas transportation and per 1000 won in bulk, seeds, reses, and grafted cactus were most preferable. If we compare the labor cost at wholesale level per 10,000 won, seeds, carnatons, grafted rose, chrysanthemum, and roses are more profitable, while radish, cabbage, and grapes required the most labor. Comparing labor requirement per 1ton and per ha output, the products in groups 1 and 2 were most preferable. In terms of production technology and cultivation periods, the products in upper parts of group 1(Fig. 6) were preferable. In conclusion, if we were to determine by considering 14 parameters studied, apples, seeds, and grafts rank high. Research and development such high rank crops should be encouraged and the government primary support is required.

韓·中·日의 전통연극에 사용되는 五色을 중심으로 한 색채문화연구 : 白色을 例로 들어 Based on White Color

이정식 중한인문과학연구회 2003 국제학술대회 Vol.- No.11

색이란 무엇보다도 사회적인 현상이라고 할 수 있다. 문화를 초월한 색의 진실이란 것은 존재하지 않는다. 같은 맥락에서 한국과 중국은 고대부터 현재에 이르기까지 오랜 기간 동안 상호 문화적인 교류를 지속해왔다. 본고는 이러한 배경을 바탕으로 오랜 시간동안 한자와 젓가락을 공유하며 동일한 유교문화권속에서 한국의 색채관념에 지대한 영향을 끼쳐온 고대중국인들의 색상관, 또 그것을 절대적으로 지배해온 음양 오행설중의 오색설, 그리고 오색설의 보급과 영향으로 고대 중국사회 속에 자연스레 자리잡게 되었던 색채의 관습이나 혹은 현재까지도 지켜지고 있는 색채의 습속 등의 영향을 받아온 전통극속의 백색 의미와 이를 둘러싼 색채에 대해서 고찰 해보기로 한다.

산재지정병원 이용 후 산재요양환자에 대한 만족도 조사

이화평,임형준,주영수,권영준,강희태,김정민,조성식,이태경,윤종완 대한산업의학회 2007 대한직업환경의학회지 Vol.19 No.3

산화제 NaOH의 첨가량에 따른 NixFe₃-xO₄박막의 특성

이정식 慶星大學校 1998 論文集 Vol.19 No.2

The magnetic thin films can be prepared without vacuum process and under the low temperature(<100℃) by ferrite plating. We have performed ferrite plating of Ni?Fe?(x=0.162∼0.138) films on cover glass at the substrate temperature 80℃ and pH range of the oxidizing solution, 7.1∼8.8. The crystal structure of the samples has been identified as a single phase of polycrystal spinel structure by x-ray diffraction technique. The deposition rate and the grain size of the film increased with the pH of oxidizing solution. The coercive force(Hc) decreased with the pH of oxidizing solution.