정신장애인 치료에 중요 역할 담당자의 정신질환에 대한 태도조사

김병후,정선욱,강연화,김윤,김창엽,홍진표,한오수,조맹제,김용익 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.5

Objectives : Attitudes of families of mentally ill, health personnels and community leaders to the mentally ill after the development and utilization of the community mental health program and reintegration of the chronically ill patients into society. This study was designed to compare the attitudes toward the mentally ill patient of the persons who have important role in treating the mentally ill and to find the variables influencing the attitudes. Methods : We measured attitudes toward mental illness in psychotic patients' families(N=139), community leaders(N=180) and health personnels(N=324) including mental health personnels before the implementation of community mental health services in Yonchon county and Seodaemun district area. The instrument used to measure attitudes was Opinion about Mental Illness(O. M. I.) scale. Results : 1) Health personnel showed lower Authoritarianism(Factor A) and higher Benevolence(Factor B) scores on the average than community leaders and psychotic patients families. 2) Current residence affect the attitudes in psychotic patients' families, not in community leaders and health personnels. Families in urban area showed lower Authoritarianism(Factor A) and Social Restrictiveness(Factor D) and higher Benevolence(Factor B) scores than in the rural areas. 3) Many patient variables were correlated to the attitudes of families. Duration of illness, number of recurrence, number of admission, age of patient and family burden were positively correlated mainly to Social Restrictiveness(Factor D). 4) Sex and religion of respondents showed no or weak relationship with the factor scores. Conclusions : Education for community leaders and families is required to achieve successful community mental health services. Community support program should be developed for chronic, recurrent and burdensome psychiatric patients in the first place.

Prognostic Value of Serum Growth Differentiation Factor-15 in Patients with Chronic Obstructive Pulmonary Disease Exacerbation

Kim, Miyoung,Cha, Seung-Ick,Choi, Keum-Ju,Shin, Kyung-Min,Lim, Jae-Kwang,Yoo, Seung-Soo,Lee, Jaehee,Lee, Shin-Yup,Kim, Chang-Ho,Park, Jae-Yong,Yang, Dong Heon The Korean Academy of Tuberculosis and Respiratory 2014 Tuberculosis and Respiratory Diseases Vol.77 No.6

Background: Information regarding prognostic value of growth differentiation factor 15 (GDF-15) and heart-type fatty acid-binding protein (H-FABP) in patients with chronic obstructive pulmonary disease (COPD) exacerbation is limited. The aim of this study was to investigate whether serum levels of GDF-15 and H-FABP predict an adverse outcome for COPD exacerbation. Methods: Clinical variables, including serum GDF-15 and H-FABP levels were compared in prospectively enrolled patients with COPD exacerbation that did or did not experience an adverse outcome. An adverse outcome included 30-day mortality and need for endotracheal intubation or inotropic support. Results: Ninety-seven patients were included and allocated into an adverse outcome (n=10) or a control (n=87) group. Frequencies of mental change and $PaCO_2$>37 mm Hg were significantly higher in the adverse outcome group (mental change: 30% vs. 6%, p=0.034 and $PaCO_2$>37 mm Hg: 80% vs. 22%, p<0.001, respectively). Serum GDF-15 elevation (>1,600 pg/mL) was more common in the adverse outcome group (80% vs. 43%, p=0.041). However, serum H-FABP level and frequency of serum H-FABP elevation (>755 pg/mL) did not differ between the two groups. Multivariate analysis showed that an elevated serum GDF-15 and $PaCO_2$>37 mm Hg were significant predictors of an adverse outcome (odds ratio [OR], 25.8; 95% confidence interval [CI], 2.7-243.8; p=0.005 and OR, 11.8; 95% CI, 1.2-115.3; p=0.034, respectively). Conclusion: Elevated serum GDF-15 level and $PaCO_2$>37 mm Hg were found to predict an adverse outcome independently in patients with COPD exacerbation, suggesting the possibility that serum GDF-15 could be used as a prognostic biomarker of COPD exacerbation.

적절성 평가지침과 이유목록의 적용 가능성 평가

신영수,김용익,김창엽,김윤,김은경,송윤미,이영성 한국의료QA학회 1994 한국의료질향상학회지 Vol.1 No.1

Background: An appropriate use of hospital beds can improve productivity of hospital significanlly. The authors previous study revealed that approximately one third of Korean hospital bed days and one sixth of admissions were inappropritely used, when it was measured by Appropriateness Evaluation Protocol(AEP) and Delay Tool modified into Korean situation by the authors. This study aims to evaluate applicability of the instruments in a new hospital. More specifically the study aims to measure appropriateness of the instruments used by newly trained nurse reviewers at a new hospital setting. Methods: In order to evaluate applicability of these instruments, agreement rates of the scores recorded by newly trained nurse reviewers with by skilled nurse reviewer and also compared with the scores recorded by physician's implicit decision were assessed. Agreement rates were derived from concurrent application of AEP and Delay Tool to 52 admissions and 104 patient days from internal medicine, pediatrics, and general surgery of one university hospital. Oversall agreement rate, specific nonacute agreement rate, and kappa statistics were used to indicate level of agreement. Results: Overall agreement rates on appropriateness between newly trained nurse reviewers and skilled nurse reviewer were 100% in admission and 98% in bed days. Overall agreement rates on reason for inappropriateness between newly trained nurse reviewers and skilled nurse reviewer were 96% in admission and 91% in bed days. Overall agreement rates between newly trained nurse reviewers and physician reviewer were 86% in admission and 87% in bed days. Conclusion: Results indicated that AEP and Delay Tool were applicable to a new hospital in detecting inappropriate utilization of beds and reasoning of the inappropriateness. Thess instruments could contribute to enhance efficiency of hospital use, through continuous monitoring of level of inappropriate hospital use at national or individual hospital level.

Archer의 형태발생론을 활용한 2007년 의료급여정책변동 사례연구

정성식(Jeong, Seong-Sik),김창엽(Kim, Chang-Yup) 비판과 대안을 위한 사회복지학회 2016 비판사회정책 Vol.- No.53

본 연구는 2007년 의료급여정책 변동에 대한 사례연구로서, 당시 정부가 기존의 보장성 확대 정책기조에서 벗어나 재정안정화를 위하여 본인부담제와 선택병의원제와 같은 수급권자의 의료이용을 규제하는 정책들을 도입하게 된 원인과 기전을 규명하는 것을 목표로 하였다. 이를 위하여 Archer의 형태발생론을 연구모형으로 활용하여 정치ㆍ경제ㆍ사회문화의 구조적 요인과 정부체계적 요인 및 정책행위자 간의 상호작용 요인을 분석하였다. 분석 결과, 당시 복지예산 확대에 부정적인 정치권의 상황과 효율적 복지를 지향하는 참여정부의 질서자유주의적 경제정책이념 및 그에 따른 정책기조의 전환과 보건복지부 장관의 정책적 신념 등이 정책변동에 중요한 영향을 미쳤다. 정책행위자 간 상호작용 과정에서 정부는 시종일관 밀어붙이는 전략과 함께 수급권자 전체를 ‘도덕적 해이’ 집단으로 낙인찍는 언론프레이밍 전략을 활용하였고, 이에 맞서는 시민사회단체연합은 사회적 이슈화 전략과 도덕적 우위 전략을 통해 비판여론을 확산시켜 정부를 압박하고자 하였으나 결국 정책도입을 저지하는 데 실패하였다. As a case study of the Korea medical aid policy change in 2007, this study aimed to analyze the cause and mechanism that the government at that time introduced policies which restrict the medical use of the medical aid recipients like ‘co-payment system’ and ‘designated doctor system’ for out-patient services in order to stabilize the finances deviated from previous policy stance of the expansion of the medical aid coverage. For this, this study analyzed the political · economicㆍsociocultural structural conditions, government system · policy-decision maker factors and the interaction factors between policy actors using Archer’s morphogenetic social theory as a analysis model. The analysis results were as follows. The political conditions being negative about expanding the welfare budget, the government’s economic policy ideology of ‘Ordo-liberalism’ aiming efficient welfare, a change of the policy stance accordingly and the political belief of the Minister of Health and Welfare at that time had an effect on the policy change. While in the interactive process between policy actors, the government used ‘media framing strategy’ stigmatizing whole recipients as ‘moral hazard’ group with ‘pushing strategy’ consistently, whereas the civil society groups tried to put pressure on the government by spreading the critical opinions through ‘making social issue & moral superiority strategy’, but failed to stop the introduction of the policies eventually.

DRG 지불제도 도입에 따른 의료보험청구 행태 변화

강길원,박형근,김창엽,김용익,하범만,Kang, Gil-Won,Park, Hyoung-Keun,Kim, Chang-Yup,Kim, Yong-Ik,Ha, Beom-Man 대한예방의학회 2000 예방의학회지 Vol.33 No.4

Objectives : To evaluate the impacts of the DRG payment system on the behavior of medical insurance claimants. Specifically, we evaluated the case-mix index, the numbers of diagnosis and procedure codes utilized, and the corresponding rate of diagnosis codes before, during and after implementation of the DRG payment system. Methods : In order to evaluate the case-mix index, the number of diagnosis and procedure codes utilized, we used medical insurance claim data from all medical facilities that participated in the DRG-based Prospective Payment Demonstration Program. This medical insurance claim data consisted of both pre-demonstration program data (fee-for-service, from November, 1998 to January, 1999) and post-demonstration program data (DRG-based Prospective Payment, from February, 1999 to April, 1999). And in order to evaluate the corresponding rate of diagnosis codes utilized, we reviewed 820 medical records from 20 medical institutes that were selected by random sampling methods. Results : The case-mix index rate decreased after the DRG-based Prospective Payment Demonstration Program was introduced. The average numbers of different claim diagnosis codes used decreased (new DRGs from 2.22 to 1.24, and previous DRGs from 1.69 to 1.21), as did the average number of claim procedure codes used (new DRGs from 3.02 to 2.16, and previous DRGs from 2.97 to 2.43). With respect to the time of participation in the program, the change in number of claim procedure codes was significant, but the change in number of claim diagnosis codes was not. The corresponding rate of claim diagnosis codes increased (from 57.5% to 82.6%), as did the exclusion rate of claim diagnosis codes (from 16.5% to 25.1%). Conclusions : After the implementation of the DRG payment system, the corresponding rate of insurance claim codes and the corresponding exclusion rate of claim diagnosis codes both increased, because the inducement system for entering the codes for claim review was changed.

Interferon-γ Inhibits in vitro Mobilization of Eosinophils by Interleukin-5

Park, Choon-Sik,Choi, Eun Nam,Kim, Jung Sun,Choi, Yun Sung,Rhim, Tai Youn,Chang, Hun Soo,Chung, Il Yup S. Karger AG 2005 International archives of allergy and immunology Vol.136 No.3

<P><I>Background:</I> Th2 cytokines play pivotal roles in allergic inflammation, including eosinophilia, and their actions are antagonized by Th1 cytokines, conferring them therapeutic potential. <I>Methods:</I> In this study, we examined the ability of a number of cytokines to suppress the activation of eosinophils that function as effector cells for allergic airway diseases. <I>Results:</I> Interleukin (IL)-5, IL-6, and tumor necrosis factor (TNF) induced an eosinophil shape change, whereas interferon (IFN)-γ significantly inhibited the shape change. Other cytokines, including IL-1β, IL-4, IL-10 and IL-13, had little or only slightly enhancing or reducing effects on the shape change. We further analyzed the IFN-γ effect, showing that pretreatment with IFN-γ strongly suppressed IL-5-induced eosinophil shape change, and cycloheximide (CHX) abrogated the suppression by IFN-γ, suggesting that new protein synthesis is required for the inhibitory effect by this cytokine. In agreement with these results, IFN-γ blocked the eosinophil migration and ERK phophorylation induced by IL-5, and the addition of CHX restored eosinophil chemotaxis. <I>Conclusions:</I> Collectively, IFN-γ may attenuate eosinophilic inflammation by directly negating eosinophil mobilization.</P><P>Copyright © 2005 S. Karger AG, Basel</P>

병원표준화심사의 질 향상 관련 항목에 대한 평가와 개산방안

김창엽,이상일,이건세,신영수 한국의료QA학회 1995 한국의료질향상학회지 Vol.2 No.1

Background: Korean Hospital Standardization Program(KHSP), as a hospital accreditation program initiated and promoted by Korean Hospital Association since 1981, has played a key role in the hospital quality improvement in structural aspect particularly. Recently, however, KHSP has been critisized by hospitals and health personnels in that it is unpractical to be utilized as an initiative to improve hospital quality. In particular, the section of quality assurance in KHSP, strongly influenced by old version of Hospital accreditation of Joint Commission in U.S.A., has been required to be fundamentally sevised. For design of new criteria in quality assurance section, a survey for evaluation of existing program and collection of opinions for ideal one was conducted. Methods: For a month in 1994, structured questionnaires were administered by mailing to 470 hospital staffs from 200 hospitals, participated in the survey for the 1994 KHSP in each hospital. The total number of respondents was 116. Results: Less than half of the respondents(34.5%) value positively on the impact of current KHSP in general on the quality improvement of their hospitals. Moreover, most responses indicated that KHSP should be reorganized towards more practical and applicable one. Current KHSP criteria for quality activities in hospitals were regarded as a unpractical one which should be basically renewed. For new criteria and standards, most respondents emphasized the importance of applicability of those in real siuations. Conclusion: For the KHSP to be effective, new evaluation criteria for quality activities should be more practical and fully accommodated to hospital situations in reality.

'계획에 없던 재수술'의 분석

김은경,조성현,김창엽,오병희 한국의료QA학회 1995 한국의료질향상학회지 Vol.2 No.1

Background: clinical indicators are objective measures of process or outcome of patient care in quantitative terms. This study aims to review the medical records of patients who 'return to operating room during the same admission', which is one of the critical clinical outcomes, and describe the result by unplanned reoperation rate. Methods: Computerized patient registry was used for selecting subject conditions. For medical records retrieved, two nurse evaluators identified the presence of explicit reoperation planning in medical records. Results: Overall reoperation rate was 2.8% and unplanned reoperation rate 1.3%, The main category of reoperation cause was the postoperative bleeding. Duration of stay from previous operation to reoperation of the unplanned group, 12.7 days, was shorter than that of the planned(p<.05). The differences did not reach statistical significance in age, sex and length of stay. Conclusion: Results suggested that unplanned reoperation rate was lower than 'threshold' level other institutions had established. However, this result could become comparable only after management of medical records would be improved and risk adjusted.

의료기관 평가의 방법

김창엽 한국의료QA학회 1994 한국의료질향상학회지 Vol.1 No.2

평생교육 관점에서 본 시민교육 실천과제

김창엽 中央大學校 韓國敎育問題硏究所 2004 韓國敎育問題硏究所論文集 Vol.- No.19

시민사회단체의 시민교육은 시민사회단체의 특성과 활동방향에 연계되어 실행된다. 그러나 시민교육에 대한 논의가 부족하고 내용과 방법이 축적되지 못했다. 시민은 민주주의를 키워오고 완성하고자 하였던 사람들의 의지와 활동 속에서 만들어진 것이다. 시티즌쉽(citizenship)은 시민의 연대에 대한 강한 지향적 의미를 갖는다. 시티즌쉽을 가진 시민은 권리와 책임을 지는 주체인 것이다. 사회가 정상적으로 기능하기 위해서는 시민들의 적극적인 참여가 요구된다. 시민들 역시 적극적인 참여를 통해 자신의 가치를 발견하고 확대재생산해 나갈 수 있다. 이런 맥락에서 시민교육의 의의를 찾을 수 있다. 시민교육에 있어 중요한 역할을 담당하는 시민사회단체는 재정이 열악하고, 시민교육전문가를 담당할 교육전문가를 배치할 여력이 없다. 또한 강의식, 주입식 위주의 교육방법을 일반적으로 사용하고 있다. 시민교육은 생활세계에 바탕을 두고 진행되어야 하고, 청소년을 이해하고 함께 하도록 해야 하며, 문화부문에 주력해야 한다. 또한 시민교육 전문가 육성을 위해 다각적인 노력이 요구된다. Generally speaking, NGOs(Non-Governmental Organizations)try to provide civil education according to their characteristics and vision, but they have many barriers to do this because of their slight fabric. Citizens are made by the will and activities of people who had built and tried to complete democracy. Civic right has a strong inclinational meaning on the solidarity of the citizens. Citizens who have civic rights are the subject of the rights and responsibilities. In order for the society to function properly, citizens' active participation is required. Through this active participation, citizens' can find their own values, expand, and reproduce them. In this context, we can find the meaning of the civil education. The NGOs, which has an important role on the civil education, is in an inferior finance condition, and has no ability on locating a professional educator to take charge on civil education professional. In addition, they are generally using educationl methods, mostly lectures and cramming education. Civil education must be based on the living world, make adolescents understand and follow it and focus on the culture part. Moreover, multilateral effort is required for the upbringing of the civil education professionals.