전략적 인적자원개발 활동수준 진단준거 개발

이찬,최영준,박혜선,정보영,전동원,박연정 한국기업교육학회 2012 기업교육과인재연구 Vol.14 No.2

The purpose of this study was to develop the validated criteria to evaluate the quality of strategic human resource development activities and to identify the relative importance of each diagnostic criterion. To this end, the previous researches were reviewed and the Delphi technique was employed. the primary diagnostic criteria were developed based on the result of analyzing the previous researches. Then, the Delphi technique was used to verify the validity of diagnostic criteria and analyze the relative importance of each diagnostic criterion finally developed. To develop diagnostic criteria for strategic human resource development activities, the interviews were conducted with 13 HRD practitioners engaged in large corporation in Korea. Based on the result of the interviews, the primary diagnostic criteria consisted of 9 diagnostic domains, 27 diagnostic items, and 71 diagnostic indicators. In order to verify the validity, the Delphi survey was carried out five times with 11 expert panelists including 6 HRD researchers such as professors and 5 HRD experts working in large corporations in Korea. The diagnostic criteria with relatively low degree of consensus between experts were modified and the set of evaluation criteria were revised repeatedly through the Delphi survey. Finally, the diagnostic criteria of strategic human resource development activities were developed and its validity was ensured. The confirmed diagnostic criteria for the strategic human resource development activities consisted of 9 diagnostic domains (such as 1. Business partnership 2. HRD strategy 3. HRD infrastructure, 4. Learning climate, 5. HRD research, 6. Needs analysis, 7. Implementation of learning activities, 8. Evaluation, 9. Feedback and revision), 27 diagnostic items, and 69 diagnostic indicators. In the final Delphi survey, the Analytic Hierarchy Process (AHP) was implemented to identify the relative importance of the diagnostic criteria developed. Based on the results of the study, recommendations were proposed. 이 연구의 목적은 전략적 인적자원개발 활동을 진단하기 위한 타당한 준거를 개발하고, 개발된 진단준거의 상대적 중요도를 산정하는데 있었다. 이러한 연구의 목적을 달성하기 위해 선행연구 고찰 및 기업 HRD 담당자 인터뷰를 통해 진단준거 초안을 구안하고, 델파이 조사를 통해 진단준거에 대한 타당화를 거쳐 최종적으로 확정된 진단준거의 상대적 중요도를 분석하였다. 전략적 인적자원 개발 활동에 대한 진단준거를 개발하기 위하여 선행연구를 고찰하고, 국내 기업의 HRD 담당자 13명을 대상으로 인터뷰를 실시하여 9개의 진단영역, 27개의 진단항목, 71개의 진단지표로 구성된 진단준거 초안을 구안하였다. 구안된 진단준거 초안에 대한 타당성을 확보하고, 진단준거간의 상대적 중요도를 분석하기 위해 HRD 학계 전문가 및 기업 전문가 11명을 대상으로 델파이 조사를 실시하였다. 상대적으로 낮은 타당도를 보인 진단영역 및 항목, 지표의 명칭 및 개념 정의 등을 수정하고, 전문가 패널들의 의견을 종합하는 과정을 거쳐 전략적 인적자원개발 활동수준의 진단준거를 확정하였다. 최종 확정된 전략적 인적자원개발 활동수준의 진단준거는 비즈니스 파트너십, HRD 전략, HRD 인프라, 학습풍토, HRD 연구, 요구분석, 학습활동의 제공 및 관리, 평가, 피드백 및 개선 등의 9개 영역, 27개 항목, 69개의 지표로 구성되었다. 델파이 조사를 통해 타당성을 확보한 전략적 인적자원개발 활동 진단준거의 상대적 중요도를 분석하기 위해 마지막 델파이 조사에서 계층화 분석을 실시하였다. 델파이 조사와 상대적 중요도를 분석한 결과를 바탕으로 결론 및 후속 연구를 위한 제언을 하였다.

진단기준에 따른 아토피피부염 유병률의 차이: Hanifin-Rajka, 일본인 및 한국인 진단기준에 따른 유병률의 차이 및 특징

김준영 ( Jun Young Kim ),임현정 ( Hyun Jung Lim ),김호연 ( Ho Youn Kim ),이원기 ( Won Kee Lee ),김병수 ( Byung Soo Kim ),이원주 ( Weon Ju Lee ),이석종 ( Seok Jong Lee ),김도원 ( Do Won Kim ) 대한피부과학회 2010 대한피부과학회지 Vol.48 No.8

Background: Although surveys on the prevalence of atopic dermatitis (AD) have been carried out worldwide, the results vary widely. The differences were probably due to the use of different diagnostic criteria. Objective: To evaluate the differences in prevalence and characteristics of AD according to various diagnostic criteria. Methods: The criteria of Hanifin and Rajka, Japanese Dermatological Association (JDA) and Korean AD diagnostic criteria were applied and compared in 733 children, aged from 3 to 6 years. Survey using questionnaires was conducted on their parents. Using these data, more precise analysis was performed about the differences in prevalence and their leading factors. Results: The prevalence rates of AD (number of the patients) were 7.9% (58/733), 8.0% (59/733), 11.2% (82/733) from Korean AD, JDA, Hanifin and Rajka diagnostic criteria, respectively. The number of children simultaneously diagnosed with AD in all three criteria was 45. According to our study, the lowest prevalence rate recorded by the Korean AD diagnostic criteria may be due to absence of the major features of chronic relapsing dermatitis (Youden`s J index: 0.80) and the minor features of onset of early age (Youden`s J index: 0.60). Conclusion: Through careful analysis of various AD diagnostic features, we demonstrated some diagnostically significant clinical features of AD that determine difference in prevalence. These results may be applicable in the revision of Korean AD diagnostic criteria to enable more accurate and practical diagnosis of AD in the near future. (Korean J Dermatol 2010;48(8):649~656)

아토피피부염 학회보고서: 한국인 아토피피부염의 진단기준에 대한 연구

박영립 ( Young Lip Park ),김형동 ( Hyung Dong Kim ),김규한 ( Kyu Han Kim ),김명남 ( Myeung Nam Kim ),김진우 ( Jin Wou Kim ),노영석 ( Young Suck Ro ),박천욱 ( Chun Wook Park ),이광훈 ( Kwang Hoon Lee ),이애영 ( Ai Young Lee ),조상 대한피부과학회 2006 대한피부과학회지 Vol.44 No.6

Background: Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease with genetic and environmental background. The diagnosis of AD depends on the clinical presentation and history because there are no objective laboratory tests. The criteria established by Hanifin and Rajka have become the standard for the clinical diagnosis of AD (Until now, we used conventional Hanifin and Rajka`s diagnostic guidelines). But diagnostic criteria for Korean have not been studied yet. Objective: The purpose of the present study was to establish the diagnostic criteria of Korean AD. Methods: We made out a draft for diagnostic criteria for Korean on the basis of the Hanifin and Rajka`s guidelines and published Korean journals. And we established the diagnostic criteria for Korean after collecting extensive opinions from dermatologic specialists in many university hospitals. Results: The major criteria of AD is similar to conventional diagnosic criteria, but three additional minor features(periauricular eczema, scalp scale, skin prick test reactivity) were significant for the diagnosis of AD in Korean patients. The other eleven minor features of the conventional minor diagnostic features were also significant. Conclusion: We established Korean diagnostic criteria for AD. Our result suggest that ethnic backgrounds influence the phenotype of AD and that additional three features need to be included in the Korean diagnostic criteria. Continued refinement of these guidelines will facilitate diagnosis in specific ethnic populations and in specific subgroups of patients. (Korean J Dermatol 2006;44(6):659~663)

진단기준 차이가 폭주부족의 빈도에 미치는 영향

유동식,조현국,문병연 한국안광학회 2016 한국안광학회지 Vol.21 No.3

Purpose: This study was to investigate whether the application of different diagnostic criteria affected the frequency of convergence insufficiency (CI). Methods: Eighty one subjects with mean age of 22.54 years (20 to 27 years) were evaluated. Binocularity tests after refraction were performed as the following tests: near point of convergence (NPC) with an accommodative target, phoria using von Graefe method, positive fusional vergence (PFV) with a phoropter. Subjects with CI were diagnosed when exophoria (exo) was greater at near than at distance (exo≥4 Δ, or >6 Δ), fusional vergence was PFV≤11 Δ for blur, PFV≤15 Δ for break, Sheard’s or Percival’s criterion, and NPC was NPC≥6 cm, ≥7.5 cm or >10 cm. Results: Frequency of CI with one diagnostic criterion was ranged from 6.2% to 77.8%, and was overestimated or underestimated according to criteria. It was reduced to the range of 6.2% to 43.2% with diagnostic criteria more than two, especially to the range of 24.7% to 28.4% with lower variability in diagnostic criteria including phoria and Sheard’s criterion. There were high relationship between total score of signs and phoria score (r = 0.772, p<0.001), and measured phoria and Sheard’s criterion (r = –0.654, p<0.001), but NPC had a high variability and a weak or no significant relationship with other diagnostic criteria. Results suggested exo≥4 Δ, Sheard’s criterion and NPC≥7.5 cm for diagnostic criteria of signs and sequence for CI. Conclusions: Frequency of CI is likely to be over- and underestimated with diagnostic criteria. Cutoff values and procedures for phoria, Sheard’s criterion and NPC as clinical signs should be suggested definitely in diagnosis associated with CI. 목적: 다른 진단기준의 적용이 폭주부족의 빈도에 미치는 영향을 알아보고자 하였다. 방법: 평균 나이 22.54세(20~27세)의 81명을 대상으로 평가하였다. 굴절검사 후 조절성 시표에 의한 폭주근점(NPC)검사, 폰 그래페에 의한사위검사, 포롭터에 의한 양성융합이향운동(PFV)검사를 실시하였다. 근거리 외사위가 원거리 사위보다 큰 기준(exo≥4 Δ, >6 Δ), 융합이향운동 기준(PFV의 흐린점 ≤11 Δ, PFV의 분리점 ≤15 Δ, 쉐어드기준, 퍼시발 기준), 폭주근점 기준(NPC≥6 cm, ≥7.5 cm, >10 cm)을 이용하여 폭주부족을 진단하였다. 결과: 하나의 진단기준에 의한 폭주부족 빈도는 6.2%~77.8%의 범위로 분포하였고, 기준에 따라 과대평가되거나 과소평가되었다. 두 가지 이상의 진단기준에 의한 폭주부족 빈도는 6.2%~43.2%로 변동성이 줄어들었으며, 특히 사위 기준과 쉐어드를 포함하는 진단기준일 때 폭주부족의 빈도는 24.7%~28.4%로 줄어들어 낮은 변동성을 보였다. 점수 척도의 전체 징후와 사위, 측정값의 사위와 쉐어드 기준의 상관관계가 각각 0.772와 –0.654로 유의하게 높았다(p<0.001). 폭주근점 기준은 변동성이 컸으며, 다른 진단기준과의 상관관계는 낮거나 유의하지 않았다. 징후에 따른 폭주부족의 진단기준과 적용순서로 exo≥4 Δ, 쉐어드 기준, 폭주근점≥7.5 cm로 제시한다. 결론: 폭주부족의 빈도는 진단기준에 따라 과대, 과소평가될 가능성이 있다. 임상징후로서 사위, 쉐어드 기준과 폭주근점의 절단값과 절차는 폭주부족과 관련된 진단에서 명확하게 제시되어야 한다.

복부 둔사에 의한 장 천공 의심시 진단적 복강세척술의 새로운 양성기준의 의의

민용일,허탁,소정일 대한응급의학회 2000 대한응급의학회지 Vol.11 No.1

Background. Although diagnostic peritoneal lavage (DPL) is a well-established, reliably objective method of diagnosis of intraperitoneal injury, it is too sensitive to be used as a absolute indicator for emergency laparotomy. Recently, Otomo et al, have devised a new DPL criteria specifically designed and modified the classic criteria to aid in the diagnosis of intestinal injury. So the author studied the difference of diagnostic sensitivity, specificity, and accuracy between the new and classic criteria for intestinal injury. Methods. The author reviewed retrospectively one hundred fifteen patients underwent DPL from January 1993 to August 1999. The author adopted the classic criteria positive for intestinal injury when the lavage fluid was white blood cell(WBC) ≥ 500/㎣ and newly developed supplementary criteria positive when RBC ≥ 100,000/㎣, the positive-negative borderline was adjusted to WBC ≥ RBC/150, and when RBC < 100,000/㎣, to WBC ≥500/㎣. And analyzed the diference of sensitivity, specificity, and accuracy each other. Results. Among 115 patients, the sensitivity, specificity, and accuracy for intestinal injury were 96.4%, 87.4%, and 89.6% for the new criteria, and 100%, 42.5%, and 56.5% for the classic criteria. After exclusion of 10 patients in whom DPL was performed within 3 hours or after 18 hours from the time of injury, the sensitivity, specificity, and accuracy for intestinal injury were 96.4%, 97.4%, and 97.1% for the new criteria, and 100%, 46.8%, and 61% for the classic criteria. When analyzed the time interval from injury to DPL in the new criteria, 105 patients that DPL was performed between 3 to 18 hours had 2 false-positive, while 115 patiens regardless of DPL time 11 false-positive. Conclusions. The author concluded that the new criteria of DPL effluent performed between 3 to 18 hours from abdominal blunt trauma would be more specific and accurate indicator of intestinal perforation than the classic criteria. And this new criteria will be used as a reliable indicator for emergency laparotomy for that patients

감염성 심내막염 진단기준(Duke Criteria: Von Reyn Criteria)의 비교 및 경식도심초음파의 유용성

김양수,김백남 대한감염학회 1997 감염 Vol.29 No.1

목적: 감염성 심내막염의 진단을 위하여 사용되는 Duke criteria의 민감도와 특이도를 알아보고 경식도 심초음파의 유용성을 검토하고자 한다. 방법: 감염성 심내막염으로 치료를 받은 99례의 임상적, 미생물학적, 그리고 심초음파 소견, 병리학적 소견을 종합하여 각각을 Duke criteria와 von Reyn criteria로 재분류하였다. 결과: 병리학적으로 증명된 27례에서 Duke criteria로 definite case는 22례(81.5%)였으며, von Reyn criteria로는 possible case가 6례(22.6%)이어, Duke criteria의 민감도가 von Reyn criteria에 비해 더 높았다(p<0.05). Duke criteria의 possible case까지 포함하면 민감도는 100%로 von Reyn criteria로 possible case까지 포함한 70.4% 보다 더 높았다(p<0.05). 병리학적으로 증명된 심내막염에서는 경식도초음파를 시행함으로써 Duke criteria의 진단적 민감도가 유의하게 증가하지는 않았다. 조직학적으로 심내막염이 아닌 7례에서 Duke criteria로 definite case는 없었지만 possible case는 6례로 85.7%의 위양성율을 보였으나 von Reyn criteria로는 모두 rejected case이어 통계적으로 유의하게 Duke criteria의 특이도가 떨어졌다. 특히 Duke criteria를 적용할 때, 경식도초음파 소견은(85.7%) 경흉부초음파에 비하여(33.3%) 위양성율이 높아 심내막염을 진단하는데 경식도초음파의 특이도는 떨어짐을 알수 있었다. Viridans streptococci 심내막염이나 S. aureus 심내막염에서도 Duke criteria가 von Reyn criteria보다 진단적 민감도 더 높았다(p<0.05). 결론: Duke criteria는 von Reyn criteria보다 진단적인 민감도는 더 높다고 할 수는 있으나 특이도는 떨어지므로 특이도를 높일수 있는 보완이 있어야 할 것으로 생각된다. 경식도초음파는 특이성이 떨어질 수 있으므로, 심내막염을 진단하는 경우에는 반드시 임상적인 증거들을 고려하여 판단하여야 한다. Background: We compared the sensitivity and specificity of the newly developed Duke criteria(D) with those of the von Reyn criteria(R), and also evaluated the usefulness of transesophageal echocardiography(TEE) for the diagnosis of infective endocarditis(IE). Methods: We retrospectively reclassified 99 cases of infective endocarditis either by the Duke criteria or by the von Reyn criteria, according to clinical, microbiologic, and echocardiographic findings. Results: Of 27 histologically-confirmed cases, the sensitivity of D(22 definite + 5 possible) was 100%, and that of R(6 probable + 13 possible) was 70.4%(p<0.05). Of 7 histologically-rejected cases, there were 6 possible cases falsely accepted as IE by D, but none were accepted by R(p<0.05). For the histologically-confirmed cases, the sensitivity of D was not improved by TEE(23/23, 100%) compared with TTE(23/23, 100%). For 7 histologically rejected cases, the false-positive rate of TEE(5/7, 85.7%) was higher than that of TTE(2/7, 33.3%). There were 2 rejected cases by R compared with 0 by D among 34 cases of IE caused by viridans streptococci(p<0.05). And there were 5 rejected cases by R compared with 0 by D among 11 cases caused by S. aureus. Conclusion: The Duke criteria was more sensitive, but less specific than the von Reyn criteria for the diagnosis of IE. TEE may be helpful, but are not specific. The usefulness of TEE should be further evaluated.

Clinical Implications of Various Criteria for the Biochemical Diagnosis of Insulinoma

안창호,김이경,이지은,중찬현,민세희,박경수,김승연,조영민 대한내분비학회 2014 Endocrinology and metabolism Vol.29 No.4

Background: Among the various diagnostic criteria for insulinoma, the ratio criteria have been controversial. However, the amended insulin-glucose ratio exhibited excellent diagnostic performance in a recent retrospective cohort study, although it has not yet been validated in other patient cohorts. We examined the diagnostic performance of the current criteria of the Endocrine Society, insulin-glucose ratio, C-peptide-glucose ratio, and amended ratios in terms of differentiating insulinomas. Methods: We reviewed the medical records of patients who underwent evaluation for hypoglycemia from 2000 to 2013. Fourteen patients with histopathologically confirmed insulinoma and 18 patients without clinical evidence of insulinoma were included. The results of a prolonged fast test were analyzed according to the abovementioned criteria. Results: Fulfilling all three Endocrine Society criteria—plasma levels of glucose (<3.0 mmol/L), insulin (≥18 pmol/L), and C-peptide (≥0.2 nmol/L)—exhibited 100% sensitivity and 89% specificity. Fulfilling the glucose and C-peptide criteria showed 100% sensitivity and 83% specificity, while fulfilling the glucose and insulin criteria showed 100% sensitivity and 72% specificity. Among the ratio criteria, the insulin-glucose ratio [>24.0 (pmol/L)/(mmol/L)] gave the highest area under the receiver operating characteristic curve, with 93% sensitivity and 94% specificity. Conclusion: Fulfilling the glucose, insulin, and C-peptide criteria of the Endocrine Society guidelines exhibited the best diagnostic performance for insulinoma. Nonetheless, the insulin-glucose ratio may still have a role in the biochemical diagnosis of insulinoma.

Original Articles : Comparison of usefulness of clinical diagnostic criteria for hepatocellular carcinoma in a hepatitis B endemic area

( So Young Bae ),( Moon Seok Choi ),( Geum Youn Gwak ),( Yong Han Paik ),( Joon Hyoek Lee ),( Kwang Cheol Koh ),( Seung Woon Paik ),( Byung Chul Yoo ) 대한간학회 2012 Clinical and Molecular Hepatology(대한간학회지) Vol.18 No.2

Background/Aims: We compared the accuracy and usefulness of clinical diagnostic criteria for hepatocellular carcinoma in a hepatitis B virus (HBV)-endemic area. Methods: We reviewed the medical records of 355 patients who had undergone liver resection or biopsy at our institution between January 2008 and December 2009. These patients were reevaluated using four noninvasive diagnostic criteria for hepatocellular carcinoma proposed by the European Association for the Study of the Liver (EASL), the American Association for the Study of Liver Diseases (AASLD), the Korean Liver Cancer Study Group and the National Cancer Center (KLCSG/NCC), and National Comprehensive Cancer Network (NCCN) guidelines. Results: The overall sensitivity was highest using the KLCSG/NCC criteria (79.8%), followed by the AASLD (51.5%), EASL (38.4%), and NCCN (10.1%; P<0.001) criteria, whereas the specificity (84.5-98.3%) and positive predictive value (96.2- 98.3%) were similar for all of the criteria. The KLCSG/NCC criteria had an acceptable false-positive rate and the highest sensitivity among all of the patients, including those positive for HBsAg, those without liver cancer, and those with a tumor of at least 2 cm. Conclusions: The KLCSG/NCC and AASLD criteria exhibited the highest sensitivity, and all four guidelines had a high specifi city among all of the patients. Based on the sensitivity and false-positive rate, the KLCSG/NCC criteria was the most useful in the majority of patients. Inclusion of HBV infection in the clinical diagnostic criteria for hepatocellular carcinoma would be reasonable and may lead to an improvement in the sensitivity, with acceptable false-positive rates, in HBVendemic areas. (Clin Mol Hepatol 2012;18:185-194)

Classification and Diagnostic Criteria for IgG4-Related Sclerosing Cholangitis

( Itaru Naitoh ),( Takahiro Nakazawa ) 대한소화기학회 2022 Gut and Liver Vol.16 No.1

IgG4-related sclerosing cholangitis (IgG4-SC) can be classified into four types based on cholangiographic findings and regions of biliary stricture. This cholangiographic classification is useful to differentiate IgG4-SC from mimickers including cholangiocarcinoma, primary sclerosing cholangitis, and pancreatic cancer. Autoimmune pancreatitis (AIP) is a valuable clue for the diagnosis of IgG4-SC because the two are frequently found in association with each other. Two sets of diagnostic criteria for IgG4-SC have been proposed. In Japan, the clinical diagnostic criteria 2020 were recently developed. These clinical diagnostic criteria include narrowing of the intrahepatic and/or extrahepatic bile duct, thickening of the bile duct wall, serological findings, pathological findings, other organ involvement, and effectiveness of steroid therapy. When these criteria are applied, IgG4-SC is initially classified as associated or not associated with AIP, and cholangiographic classification is used for differential diagnosis. In most instances, IgG4-SC can be diagnosed on the basis of clinical diagnostic criteria. However, it is challenging to diagnose isolated IgG4-SC or IgG4-SC not associated with AIP. Here, we review the classification and diagnostic criteria for IgG4-SC, specifically focusing on the clinical diagnostic criteria 2020 and a large IgG4-SC case series from a nationwide survey in Japan. (Gut Liver 2022;16:28-36)

원저: 한국인에서 다양한 진단기준에 따른 대사증후군의 유병률과 인슐린 저항성 반영의 차이

지재환,성지동,최윤호,정재훈,민용기,이명식,김광원,이문규 한국지질동맥경화학회 2006 韓國脂質學會誌 Vol.16 No.2

Objective: NCEP ATP III criteria, recent IDF and AHA/NHLBI criteria of metabolic syndrome (MetS) are useful to diagnose briefly MetS clinically, but exclude concept of insulin resistance in definition of MetS unlikely WHO criteria. We compared prevalence of MetS using various diagnostic criteria and evaluated if recent definitions of MetS reflect insulin resistance better than earlier criteria. Methods: Among 1,708 subjects aged 23~85 years (1,088 men; 620 women) who underwent medical checkup at health promotion center, we evaluated components of MetS with the basis of modified ATP III criteria using BMI≥25 kg/m2 instead of waist circumference (WC), classic ATP III criteria, IDF criteria, modified IDF criteria of Korea (IDF-K) using WC≥85 cm for women and AHA/NHLBI criteria, and calculated HOMA-IR in 708 subjects. Results: The prevalence of MetS according to AHA criteria was 25.3%, significantly higher than the other criteria (P<0.05) and that in IDF-K was 16.8%, significantly lower than the others, especially in women (P<0.001). In all criteria, prevalence of MetS increased significantly with aging in women (P<0.001) but decreased in 8th decade in men. Diagnosis of MetS showed positive relationships with HOMA-IR, and risk of HOMA-IR was higher in modified ATP III (OR 2.54, 95% CI 2.04~3.17) and AHA criteria (2.52, 2.03~3.14) in men, then high in classic ATP III (2.51, 1.64~3.85) and IDF criteria (2.65, 1.70~4.11) but lowest in modified ATP III criteria (1.88, 1.31~2.69) in women. Conclusion: In Koreans, according to AHA/NHLBI criteria, prevalence of MetS was higher than to the other criteria, and diagnosis of MetS reflected insulin resistance better than other criteria only in men.