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장복순,고유상,정병호,홍구현,임소연,이경종,전경만,고원중,서지영,정만표,김호중,권오정,박혜윤 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-
Object: To evaluate the usefulness of the lung volume measurement to diagnose the obstructive disease in patients with restrictive ventilatory impairment, postbronchodilator FEV1/FVC was compared with the flow of lung function interpretation. Methods: A retrospective study was conducted in 2,570 subjects with lung function tests including spirometry, lung volume measurement and postbronchodilator spirometry on the same date between April 2008 and December 2010 at Samsung Medical Center, Seoul, Korea. Postbronchodilator criteria was defined as postbronchodilator FEV1/FVC <0.7, and TLC criteria as TLC ≥80% predicted. Results: Seventy patients with normal FEV1/FVC and low FVC showed restrictive ventilator impairment. The flow of lung function interpretation indicated that 36 patients belonged to obstructive pattern more through TLC criteria. Of the 36 patients with an obstructive pattern, 18 (50%) patients were obstructive disease by postbronchodilator criteria. Of the 34 patients with a restrictive pattern, 15 (44%) patients were obstructive disease by postbronchodilator criteria. The agreement between the postbronchodilator criteria and TLC criteria was low, with concordance in 37/70 (53%) (κ=0.059, 95% CI: 0.494-3.245, p=0.622). Conclusion: Lung volume measurement might not be useful to diagnose the obstructive disease in patients with restrictive ventilatory impairment. If patients with restrictive pattern have risk factors and clinical symptoms, they might get a benefit from postbronchodilator spirometry to confirm the obstructive disease.
장복순,고유상,정병호,홍구현,박혜윤,전경만,이남용,고원중 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-
Background: Nontuberculous mycobacteria (NTM) are frequently isolated from environmental sources and can cause contamination of respiratory specimens. This study was performed to evaluate the clinical significance of a single isolation of pathogenic NTM from sputum specimens. Methods: We identified single NTM isolates from sputum specimens at the Samsung Medical Center (Seoul, South Korea) obtained from January 2002 to December 2003. If the patients had compatible clinical and radiographic findings and the same pathogenic NTM species were isolated from subsequent sputum examinations, the patients were diagnosed with NTM lung disease. Results: We identified 190 patients with a single sputum culture of pathogenic NTM: 120 patients had MAC (67 with M. avium and 53 with M. intracellulare), 62 had M. abscessus, and 8 had M. kansasii. During the follow-up period, 26 patients (14%) had an additional positive culture of the same NTM species and met the ATS diagnostic criteria. Sixteen patients (13%) with a single isolate of MAC, 10 patients (16%) with a single isolate of M. abscessus and none patients with a single isolate of M. kansasii were diagnosed with NTM lung disease. The median duration from the first sputum culture to the second was 30 months (IQR, 15-46 months). The common CT findings were bronchiectasis (26/26; 100%) and bronchiolitis (20/26; 77%). Conclusion: Patients with a single sputum culture positive for pathogenic NTM, particularly those with underlying bronchiectasis, might benefit from long-term follow-up to confirm or exclude NTM lung disease.
Recovery Rate of Mycobacteria Over a 12-year Period in a Tertiary Hospital in Korea
장복순,정병호,전경만,권오정,이남용,기창석,고원중 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-
Background: The incidence of nontuberculous mycobacteria (NTM) infection in Korea is increasing. The aim of this study was to evaluate trends of the recovery rate of Mycobacterium tuberculosis or NTM from positive result either by acid fast bacilli (AFB) staining or culture over a 12-year period in a tertiary hospital in Korea. Methods: We identified all respiratory specimens with positive result from culture regardless of AFB staining results at the Samsung Medical Center (Seoul, South Korea) obtained from January 2000 to December 2011.Results: During the study period, 33,792 isolates from 11,058 patients were positive for mycobacterial culture. The proportion of the NTM isolates from specimens with positive result of mycobacterial culture was increasing from 22.8% (217/951) in 2000 to 69.6% (3,341/4,800) in 2011 (p<0.001, test for trend). Among the AFB smear-positive specimens, recovery rate of the NTM isolates was also increasing from 6.1% (20/330) in 2000 to 64.3% (1,284/1,997) in 2011 (p<0.001, test for trend). The most frequently isolated organisms in NTM isolates were Mycobacterium avium complex (n=6,000, 53%) and Mycobacterium abscessus (n=2,864, 25%). Conclusion: We found that the rate of NTM isolation from respiratory specimens has increased over a 12-year period in a tertiary hospital in Korea, and half of the patients with AFB smear-positive respiratory specimens have NTM infection rather than pulmonary tuberculosis.
증례 : 호흡기 ; GM-CSF 흡입치료로 호전된 폐포단백증 1예
장복순 ( Bok Soon Chang ),노정원 ( Jung Won Noh ),옥창수 ( Chang Soo Ok ),이가연 ( Ga Yeon Lee ),손서영 ( Seo Young Sohn ),방선하 ( Sun Ha Bahng ),정만표 ( Man Pyo Chung ) 대한내과학회 2011 대한내과학회지 Vol.80 No.5
표준치료법인 전 폐하세척술에서 효과를 보지 못했던 폐포단백증 환자에서 GM-CSF 흡입법을 이용하여 임상적으로 증상, 폐기능, 흉부단층촬영에서 호전을 보인 증례를 보고하고자 한다. Pulmonary alveolar proteinosis (PAP) is a rare condition that is treated using whole lung lavage. A recent study suggested that granulocyte-macrophage colony stimulating factor (GM-CSF) plays roles in both the pathogenesis and treatment of PAP. We present a 69-year-old man with PAP who deteriorated despite bilateral whole lung lavage; that said, his symptoms, chest X-ray findings, and pulmonary function test improved after GM-CSF inhalation therapy over 12 months. GM-CSF therapy is an effective treatment modality for PAP.
국가 간호·간병통합서비스에 대한 의료서비스 고객만족도와 충성도의 상관관계
장복순 ( Jang Bok-sun ),전나미 ( Chun Na-mi ) 한국경영공학회 2017 한국경영공학회지 Vol.22 No.3
The purpose of study was to identify correlations between customer satisfaction and loyalty in health care service focused on the comprehensive nursing care medical service. 152 subjects who were admitted in the comprehensive inpatient nursing care unit answered the questionnaire on customer expectation, satisfaction and loyalty. Customer expectation were 3.88 and satisfaction were 4.11 on the 5-point likert scale. Discrepancies were noted between customer expectation and satisfaction. The highest discrepancies between customer expectation and satisfaction were service responsiveness with 3.86 points of expectation and 4.25 points of satisfaction. Customer loyalty showed 4.23 points on 5-point likert scale. Significant correlations were noted among customer satisfaction and all categories of loyalty, intention to reuse despite unfavorable hours, distance, cost to use and intention to recommend hospital. Results indicate that the comprehensive inpatient nursing care services were effective health care system on customer satisfaction and loyalty.