요양급여적정성 평가자료를 이용한 예방적 항생제 사용과 수술부위 감염 발생의 관련성 연구

김경훈,박춘선,장진희,김남순,이진서,최보람,이병란,이규덕,김선민,염선아,Kim, Kyoung-Hoon,Park, Choon-Seon,Chang, Jin-Hee,Kim, Nam-Soon,Lee, Jin-Seo,Choi, Bo-Ram,Lee, Byung-Ran,Lee, Kyoo-Duck,Kim, Sun-Min,Yeom, Seon-A 대한예방의학회 2010 예방의학회지 Vol.43 No.3

Objectives: To examine the prophylactic antibiotic use in reducing surgical site infection. Methods: This was a retrospective study for patients aged 18 years and older who underwent gastrectomy, cholecystectomy, colectomy, cesarean section and hysterectomy. The data source was quality assessment data of the Health Insurance Review & Assessment Service gathered from medical records of 302 national hospitals. Prophylactic antibiotic use was defined as: timely antibiotic administration or inappropriate antibiotic selection. We performed hierarchical logistic regression to examine the association between prophylactic antibiotic use and surgical site infection with adjustment for covariates. Results: The study population consisted of 16 348 patients (1588 gastrectomies, 2327 cholecystectomies, 1,384 colectomies, 3977 hysterectomies and 7072 cesarean sections) and surgical site infection was identified in 351 (2.1%) patients. The rates of timely antibiotic administration and inappropriate antibiotic selection varied according to procedures. Cholecystectomy patients who received timely prophylactic antibiotic had a significantly reduced risk of surgical site infection compared with those who did not receive a timely prophylactic antibiotics (OR 0.64, 95% CI=0.50-0.83), but no significant reduction was observed for other procedures. When inappropriate prophylactic antibiotics were given, the risk of surgical site infection significantly increased: 8.26-fold (95% CI=4.34-15.7) for gastrectomy, 4.73-fold (95% CI=2.09-10.7) for colectomy, 2.34-fold (95% CI=1.14-4.80) for cesarean section, 4.03-fold (95% CI=1.93-8.42) for hysterectomy. Conclusions: This study examines the association among timely antibiotic administration, inappropriate antibiotic selection and surgical site infection. Patients who received timely and appropriate antibiotics had a decreased risk of surgical site infection. Efforts to improve the timing of antibiotic administration and use of appropriate antibiotic are needed to lower the risk of surgical site infection.

Charlson 동반질환의 ICD-10 알고리즘 예측력 비교연구

김경훈,Kim, Kyoung-Hoon 대한예방의학회 2010 예방의학회지 Vol.43 No.1

Objectives: To compare the performance of three International Statistical Classification of Diseases, 10th Revision translations of the Charlson comorbidities when predicting in-hospital among patients with myocardial infarction (MI). Methods: MI patients ${\geq}20$ years of age with the first admission during 2006 were identified(n=20,280). Charlson comorbidities were drawn from Heath Insurance Claims Data managed by Health Insurance Review and Assessment Service in Korea. Comparisions for various conditions included (a) three algorithms (Halfon, Sundararajan, and Quan algorithms), (b) lookback periods (1-, 3- and 5-years), (c) data range (admission data, admission and ambulatory data), and (d) diagnosis range (primary diagnosis and first secondary diagnoses, all diagnoses). The performance of each procedure was measured with the c-statistic derived from multiple logistic regression adjusted for age, sex, admission type and Charlson comorbidity index. A bootstrapping procedure was done to determine the approximate 95% confidence interval. Results: Among the 20,280 patients, the mean age was 63.3 years, 67.8% were men and 7.1% died while hospitalized. The Quan and Sundararajan algorithms produced higher prevalences than the Halfon algorithm. The c-statistic of the Quan algorithm was slightly higher, but not significantly different, than that of other two algorithms under all conditions. There was no evidence that on longer lookback periods, additional data, and diagnoses improved the predictive ability. Conclusions: In health services study of MI patients using Health Insurance Claims Data, the present results suggest that the Quan Algorithm using a 1-year lookback involving primary diagnosis and the first secondary diagnosis is adequate in predicting in-hospital mortality.

건강보험 청구자료에서 동반질환 보정방법과 관찰기관 비교 연구: 경피적 관상동맥 중재술을 받은 환자를 대상으로

김경훈,안이수,Kim, Kyoung-Hoon,Ahn, Lee-Su 대한예방의학회 2009 예방의학회지 Vol.42 No.4

Objectives : To compare the performance of three comorbidity measurements (Charlson comorbidity index, Elixhauser s comorbidity and comorbidity selection) with the effect of different comorbidity lookback periods when predicting in-hospital mortality for patients who underwent percutaneous coronary intervention. Methods : This was a retrospective study on patients aged 40 years and older who underwent percutaneous coronary intervention. To distinguish comorbidity from complications, the records of diagnosis were drawn from the National Health Insurance Database excluding diagnosis that admitted to the hospital. C-statistic values were used as measures for in comparing the predictability of comorbidity measures with lookback period, and a bootstrapping procedure with 1,000 replications was done to determine approximate 95% confidence interval. Results : Of the 61,815 patients included in this study, the mean age was 63.3 years (standard deviation: ${\pm}$10.2) and 64.8% of the population was male. Among them, 1,598 2.6%) had died in hospital. While the predictive ability of the Elixhauser's comorbidity and comorbidity selection was better than that of the Charlson comorbidity index, there was no significant difference among the three comorbidity measurements. Although the prevalence of comorbidity increased in 3 years of lookback periods, there was no significant improvement compared to 1 year of a lookback period. Conclusions : In a health outcome study for patients who underwent percutaneous coronary intervention using National Health Insurance Database, the Charlson comorbidity index was easy to apply without significant difference in predictability compared to the other methods. The one year of observation period was adequate to adjust the comorbidity. Further work to select adequate comorbidity measurements and lookback periods on other diseases and procedures are needed.

대학,프로 여자 농구선수들의 스포츠 손상 실태 조사

김경훈 ( Kyoung Hun Kim ),신성아 ( Sung Ah Shin ),김성훈 ( Sung Hoon Kim ) 한국스포츠정책과학원(구 한국스포츠개발원) 2012 체육과학연구 Vol.23 No.4

이 연구는 여자 농구 선수들의 스포츠 손상을 전체적으로 조사하고 분석함으로써 스포츠 손상 조사 체계와 예방의 기초 자료를 제공하는데 목적이 있다. 대학·프로 농구선수 120명의 자료를 수집하여 조사한 결과, 스포츠 손상시기에서는 두 집단 모두 시즌전이 높게 나타났으며, 스포츠 손상 발생순간의 경우 두 집단 모두 연습 경기 중에 손상이 높은 것으로 나타났다. 스포츠 손상 발생 장소의 경우 홈경기가 높으며, 3쿼터 때 많이 발생되는 것으로 나타났다. 스포츠 손상 시기는 오후에 가장 많이 발생하는 것으로 나타났으며 연습횟수에 대한 손상율은 하루 3회 연습 시 손상율이 더 높은 것으로 나타났다. 스포츠 손상의 원인의 경우 대학선수는 상대팀의 반칙행위 때문에 손상율이 많이 발생한다고 대답한 반면 프로선수의 경우에는 집중력의 부족 때문에 손상율이 발생하였다고 하였다. 치료기간의 경우 대학선수는 3-7일로 나타난 반면 프로선수의 경우 4주 이내로 나타났으며, 스포츠 손상 부위를 살펴보면 상지의 경우 손가락-손목-팔꿈치-어깨 순으로 나타났고, 몸통부분에서는 두 집단 모두 허리의 손상이 가장 높은 것으로 나타났다. 하지 손상은 두 집단 모두 발목 손상이 가장 높게 나타났다. 스포츠 손상 형태를 살펴보면 찰과상-타박-염좌 순으로 높게 나타났으며, 스포츠 손상 발생 원인으로는 다른 선수와의 접촉이 가장 많았고, 스포츠 손상 패턴의 경우 점핑 후 착지-리바운드 시 높게 나타났다. 스포츠 손상 발생 지역으로는 골밑에서 손상이 가장 많이 나타났다. 결과적으로 발목-허리-무릎-손가락의 손상이 높게 나타나는 것으로 조사 되어졌으며 이 결과는 발목-허리-무릎 순으로 정형 외과적 손상이 가장 빈번하게 일어나는 것으로 나타났다. 이러한 스포츠 손상율을 줄이기 위하여 정기적인 조사를 통해 연도별 추이와 데이터베이스 구축이 필요하다고 판단된다. 또한 추후 연구로는 개인별 심층면접을 통해 스포츠 손상을 입는 각 신체 부위에 대한 정확한 해부학적 구조물과 스포츠 손상 기전들에 대한 보다 심도 있는 조사를 통해 효과적인 스포츠 손상 예방법이 개발되어져야 할 것이다. The purpose of this study was to identify and analyze the sport injuries female basketball players (University; Professional) in order to provide foundational resources for the system and prevention of sports injuries. Questionnaires including injury characteristics and factor associated with sports injuries were collected from 120 players. The data from this study were analyzed using cross tabulation. These were the following results; The injury time was highest before the match for both groups. The injury occurrence was highest during the practice match for both groups. The place of injury occurrence was highes during the 3rd quarter of the home match. The injury time was highest in the afternoon, and the injury according to the number of practice was highest when practiced three times per day. Most of the University players considered the cause of injury due opponent`s foul play, whereas, professional players considered it due to lack of concentration. For the time of the injury treatment, the university players took 3-7 days, whereas, the professional players took within 4 week time. Looking at the frequent site of injury, it was ranked in the order of finger-wrist -elbow-shoulder for the part, and back for the mid part for both groups, and the ankle for the lower part of the body for both groups. For the most common type of injury, it was ranked in the oorder of abrasion-bruising-sprain. The most common cause of injury was due to collision with the other players. Most injuries occurred during landing and rebounding times, and the most frequent site of injury was at the basket region. The result showed that for the most frequent site of injury, it was ranked in the order of ankle-back-fingers. In order to reduce the percentage of injury, a progress and update of yearly records should be conducted via consistent research into this area. Also, further research into individual`s site of injury should be investigated via in -depth interviews for a more detailed investigation of the anatomical structure. Through the in depth research into the cause of injury, it is expected to develop a more effective approach to the prevention of sports injuries.

습식 압축을 채용한 재생 가스터빈 사이클의 엑서지 해석

김경훈(Kyoung Hoon Kim),김세웅(Se Woong Kim),고형종(Hyung-Jong Ko) 한국에너지학회 2009 에너지공학 Vol.18 No.2

Oilsands Bitumen의 용매 불용분 및 용해분의 물리ㆍ화학적 특성 연구

김경훈(Kyoung-Hoon Kim),전상구(Sang-Goo Jeon),노남선(Nam-Sun Nho),김광호(Kwang-Ho Kim),신대현(Dae-Hyun Shin),이기봉(Ki-Bong Lee),박효남(Hyo-Nam Park),한명완(Myung-Wan Han) 한국에너지학회 2008 에너지공학 Vol.17 No.1

LNG 냉열을 이용하는 유기랭킨사이클(ORC)의 열역학적 성능 특성

김경훈(Kyoung Hoon Kim),하종만(Jong Man Ha),김경천(Kyung Chun Kim) 한국가스학회 2014 한국가스학회지 Vol.18 No.2

본 논문에서는 유기랭킨사이클과 LNG 사이클로 구성된 복합사이클의 열역학적 성능 해석을 수행한다. 이 복합사이클에서는 현열 형태의 저등급 폐열을 사용하며 LNG 냉열은 열싱크 뿐 아니라 동력 생산에도 사용된다. 시스템의 성능에 대한 터빈입구압력, 응축온도, 열원온도 등 주 파라미터들의 영향을 상세하게 분석한다. 시뮬레이션 결과는 이 복합시스템은 LNG 냉에너지를 사용하지 않은 일반의 ORC에 비해 현저하게 성능이 개선될 수 있음을 보여준다. In this work a thermodynamic performance analysis is carried out for a combined cycle consisted of an organic Rankine cycle (ORC) and a LNG cycle. The combined system uses a low grade waste heat in the form of sensible energy and the LNG cold energy is used for power generation as well as for heat sink. The effects of the key parameters of th system such as turbine inlet pressure, condensation temperature and source temperature on the characteristics of system are throughly investigated. The simulation results show that the thermodynamic performance of the combined system can be significantly improved compared to the normal ORC which is not using the LNG cold energy.

단위가축영양 : Miniature Schnauzer에 있어서 현미 급여와 영양소 소화율 및 배설 분 특성

김경훈 ( Kyoung Hoon Kim ),장주송 ( Ju Song Chang ),오영균 ( Young Kyoon Oh ) 한국동물자원과학회(구 한국축산학회) 2011 한국축산학회지 Vol.53 No.5

The objectives of this research were to determine the effects of brown rice(BR) on food intake, digestion, energy value, and fecal characteristics. Three replacement levels which BR replaced 0, 15 and 30% of wheat flour were tested. Six female Miniature Schnauzer(8~9 month age, initial mean body weight 5.0±0.3kg) were assigned to treatments in replicated 3×3 Latin square design. Total tract digestibilities of DM, OM, acid hydrolyzed fat and gross energy except CP increased linearly(P<0.01), and observed digestible energy and metabolizable energy values also increased linearly(P=0.001 and P=0.006, respectively) with increasing BR replacement level. Wet and dry fecal output decreased linearly(P<0.001, P=0.004) with increasing BR inclusion to the diets and BR 30% treatment reduced wet fecal output up to 21% of that of control. Quadratic(P<0.01) effects was observed in fecal score for dog fed BR and fecal ammonia concentration tended to increase linearly(P=0.07) in response to increasing BR replacement level. It seems that the increase in fecal ammonia concentration may be partially related to the decrease in short-chain fatty acid concentration(P=0.001). This study clearly demonstrates that BR improves nutrients digestibility and fecal characteristics of dog.

외래 환자경험에 영향을 주는 요인

김경훈 ( Kyoung-hoon Kim ) 한국보건행정학회 2021 보건행정학회지 Vol.31 No.2

Background: Good patient experience is positively associated with adherence to treatment recommendations, better clinical effectiveness, and health outcomes. This study aims to find out the key factors affecting positive patient experience to improve the quality of care using nationally representative survey data. Methods: The data was collected from the 6th National Health Nutrition Survey in 2015. Four patient experience items were investigated for patients with visiting outpatient care over the past year. Positive patient experience was defined as a case of responding always or usually yes. The t-test, chi-square test, and multiple logistic regression were performed to determine the key factors affecting the outpatient experience. Results: More than 80% of the respondents reported their care experience as positive excluding doctor spending enough time during the consultation. Male, poor health status, and single/divorced, and the longer time interval between outpatient care visit and survey were found to be significantly correlated with negative care experiences in the multiple logistic regression. Patients who received outpatient care at the oriental medicine clinic had a positive experience compared to those received outpatient care at the general hospital. However, patient factors including age, income, job, and insurance type had no significant association with patient experience. Conclusion: Health care providers should prioritize patients who report negative patient experiences and implement management decisions to improve the patient experience.

캐쉬 효과를 고려한 확장된 이진 탐색 트리 알고리즘에 관한 연구

김경훈(Kyoung-Hoon Kim),정균락(Kyun-Rak Chong) 한국정보과학회 2000 한국정보과학회 학술발표논문집 Vol.27 No.2Ⅰ

VLSI 기술의 발전에 따라 프로세서의 속도는 빠르게 증가하고 있는 반면 메모리의 속도는 이를 뒷받침하지 못하여 속도의 차이를 줄이기 위해 캐쉬(cache) 메모리를 사용하고 있다. 캐쉬가 알고리즘의 실행시간에 미치는 영향이 점점 더 커지고 있으나 이제까지 개발된 대부분의 알고리즘들은 이러한 캐쉬의 중요성을 고려하지 않고 개발되었다. 본 논문에서는 캐쉬 효과를 고려한 확장된 이진 탐색 트리 알고리즘에 관해 연구하였고, 실험을 통하여 기존의 이진 탐색 트리와 제안된 알고리즘의 성능을 비교하였다.