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.

증기분사 재생 가스터빈 시스템의 성능 및 최적 운전조건에 관한 연구

김경훈(Kyoung Hoon Kim),김동주(Dong Joo Kim),박상희(Sang Hee Park),오만수(Man Soo Oh),김동명(Dong Myung Kim) 한국추진공학회 2010 한국추진공학회지 Vol.14 No.1

무선 LAN 환경에서 에너지효율 향상을 위한 스케쥴링

김경훈(Kyoung Hoon Kim),이지운(Ji Wun Lee),전화숙(Wha Sook Jeon) 한국통신학회 2005 한국통신학회 학술대회 및 강연회 Vol.2005 No.4

RFID 기반의 국방 공급사슬관리 시스템 모델링

김경훈 ( Kyoung Hoon Kim ),강경환 ( Kyung Hwan Kang ),김미이 ( Mi Yi Kim ),이영훈 ( Young Hoon Lee ) 국방대학교 안보문제연구소 2006 국방연구 Vol.49 No.2

엔트랜시 소산에 기반한 비가역 카르노 사이클의 최적 해석

김경훈(Kyoung Hoon Kim) 대한기계학회 2017 大韓機械學會論文集B Vol.41 No.2

최근 들어 열전달 포텐셜에 해당하는 엔트랜시 개념이 제안되었으며 이는 열-일 변환 시스템의 해석이나 최적화에 유용하게 사용될 수 있다. 본 논문에서는 비가역 카르노 사이클에 대해 엑서지 균형방정식 해석과 대응해서 체계적인 엔트랜시 손실, 일 엔트랜시, 엔트랜시 소산의 개념에 기반한 엔트랜시 해석을 수행한다. 또한 시스템의 최적 성능을 나타내기 위해서 엔트랜시에 기반한 몇 가지 형태의 시스템 효율을 도입한다. 한번 사용된 열원이 추가적으로 사용되는 경우와 그렇지 않은 경우, 즉 덤핑경우와 비덤핑인 경우에 대해 시스템 효율의 최적 조건에 대한 열원온도나 비가역 효율의 영향을 체계적으로 조사한다. 해석 결과는 엔트랜시에 의한 효율은 전통적인 에너지나 엑서지에 기반한 효율과는 다른 경향을 보여주며, 이는 열동력 시스템에서 또 다른 열원의 효과적인 사용 방법을 제시한다. The concept of entransy has been proposed recently as a potential heat transfer mechanism and could be useful in analyzing and optimizing the heat-work conversion systems. This work presents an entransy analysis for the irreversible Carnot cycle by systematic balance formulations of the entransy loss, work entransy, and entransy dissipations, which are consistent with exergy balances. Additionally, several forms of system efficiency are introduced based on entransy for the appreciation of the optimal system performance. The effects of the source temperature and irreversible efficiencies on the optimal conditions for system efficiencies are systematically investigated for both dumping and non-dumping cases of used source fluid. The results show different trends in entransy efficiencies when compared to the conventional efficiencies of energy and exergy, and represent another method to assess the effective use of heat source in power generation systems.

암모니아-물 작동유체의 부분증발유동을 적용한 재생 랭킨사이클에 관한 연구

김경훈(Kyoung Hoon Kim) 대한설비공학회 2011 설비공학 논문집 Vol.23 No.3

The power cycle using ammonia-water mixture as a working fluid is a possible way to improve efficiency of the system of low-temperature source. In this work thermodynamic performance of the ammonia-water regenerative Rankine cycle with partial-boiling flow is analyzed for purpose of extracting maximum power from the source. Effects of the system parameters such as mass fraction of ammonia, turbine inlet pressure or ratio of partial-boiling flow on the system are parametrically investigated. Results show that the power output increases with the mass fraction of ammonia but has a maximum value with respect to the turbine inlet pressure, and is able to reach 22 ㎾ per unit mass flow rate of source air at 180℃.

유가 철학에서의 선악 개념

김경훈 ( Kyoung Hoon Kim ) 전남대학교 인문학연구소 2012 용봉인문논총 Vol.40 No.-

기원전 4세기 전국시대(戰國時代)의 혼란상황은 인간의 본성(本性)에 대한 논의를 촉발시켰다. 당대의 혼란과 갈등을 원인이 인간의 본성에서 기인한 것으로 파악한 것이다. 인간의 본성이 선(善)하다면 당시의 정치 상황이 자국의 이익만을 추구하는 패권의 각축장이 되지는 않았을 것이며, 반대로 본성이 악(惡)하다면 도덕적 덕성이나 수양, 그리고 공동체의 윤리 등을 인식하고 발전시키지 못했을 것이다. 선진시대 인간의 본성에 대한 논의로는 맹자(孟子)가 주장한 인간의 본성이 선하다는 입장, 고자(告子)의 성이 선하지도 악하지도 않다는 관점, 그리고 인간의 본성은 악하다는 순자(荀子) 주장을 대표적인 것으로 볼 수 있다. 맹자는 인간의 마음속에 선천적으로 내재된 사단(四端)이라는 선의 가능성을 제기하며 왕도정치의 실현 가능성의 근거를 확보하고, 순자는 이익추구와 끊임없는 쟁탈에 매몰되어 있는 인간 본성을 악으로 규정하며 교육과 예(禮)를 통한 인위적인 교정을 중시한다. 이들 상호간에 펼쳐진 인간 본성의 선악에 대한 논쟁과 비판은 인간 이해의 단초를 제공한다. 그러나 인성론에서 선악 개념은 인간의 본성을 규정하는 술어적 개념으로 사용된 한계를 보인다. 이에 『주역』의 「계사전」에 제시된 도(道)와 연관한 선의 근거를 검토하고, 행위의 결과로서 주어지는 길흉(吉凶)이 선악 개념의 환치라는 것을 밝힌다. 또한 선악의 분기점을 기미(幾)로 보고 성(誠)에 근거한 선을 추구함으로써 인간의 윤리적 행위의 지향점을 제시하고자 한다. The chaos of Warring States Period (B.C. 4C) had triggered the discussion of Human Nature. That is because they recognized the confusion and conflict of the period as a result of Human Nature. The political situation at that time would not be arena of the struggle fo r supremacy if human being is good-natured. On the other hand, if human nature is evil, Humankind could not recognize or develop the moral virtue, moral culture, and community ethics. There are several discussions about Human nature during the Warring States Period: Mencius(孟子) regarded Human nature as good one; Gaozi(告子) insisted that Human Nature is neither good nor evi l; and Xunzi(荀子) considered Human Nature as evil. Those are the most representative theories about Human Nature. Mencius suggeste d the possibility of Four Beginnings(四端), the innately implicit good ness in Human mind. By suggesting this, he secured the possibility of Reign of the Justice. Xunzi defined Human Nature which is burie d under pursuit of profit and endless struggles as evil, therefore he l ayed stress on the artificial education and Li(禮). Those arguments and criticism between them provide clues to understand Human Nat ure. The concept of good and evil in the treatise of Human Nature i s, however, shows it``s limit because it is used as the predicate conc ept. Therefore the purpose of this paper is to examine the basis of goodness related Dao(道) suggested in the Book of Changes(周易), ‘t he Commentary on the Appended Remarks(繫辭傳)’ and to define ‘go od fortune and misfortune(吉凶)’ which is given by the result of so meone``s action is a hypallage of the concept of good and evil.

1-4분과 : 거시/금융 1 ; 무역 및 동아시아 지역에서의 금융시장 통합과 경기변동 동조성

김경훈 ( Kyoung Hoon Kim ),김성현 ( Sung Hyun Kim ) 한국국제경제학회 2015 한국국제경제학회 동계학술대회 Vol.2015 No.-

본 논문은 동아시아 국가들의 무역 및 금융시장 통합이 국가 간 경기변동성에 어떠한 영향을 미치는지를 패널 회귀분석을 통해 설증분석 하였다. 2004년 이후 10년간 자료를 삼펴본 결과 147~ 동아시아 국가 간 경기변동동조성이 2008년까지 는 감소하였으나, 그 이후 2011년까지 증가하였고 또한 무역시장 통합과 주식 및 채권시장 통합은 최근 10년간 강화된 것을 확인 할 수 있었다. 설증 분석 결과, 첫 째, 동아시아 9개 국가의 경우 국가 간 무역시장 통합 지표가 국가 간 경기변동동 조성에 양(+)의 영향을 미치는 것을 확인 할 수 있었다. 늘어난 무역거래로 인해 국 가 간 경기변동성동조성이 강화된다는 기존 연구결과와 일치하는 것이다. 두 번째, 주식시장 통합은 국가 간 경기변동동조성을 약화시키고 채권시장 통합은 국가 간 경기변동동조성을 강화시키는 것으로 나타났다. 주식거래는 소비위험분산을 통한 산엽구조의 이질화나 부의효과(wealth effect)를 일으켜 경기변동동조성을 약화시키 고, 주로 차익거래목적으로 거래되는 채권거래는 대차대조표 효과를 통해 경기변동 동조성을 강화시키는 것으로 해석 가능하다. 자본시장 통합이 경기변동 동조성에 미치는 영향이 자본유형에 따라 다르다는 결과는 자본시장 개방정책을 수립하는데 중요한 정책적 시사점을 줄 수 있다. This paper empirically studies the effects of trade and financial market integration on business cycle synchronization in East Asia. By examining the data of 14 East Asian countries during 2004-2013, we find that the degree of business cycle synchronization in the region had decreased until 2008, but increased from 2008 till 2011. Both trade and financial integration have been intensified for the past ten years. Empirical analysis for 9 East Asian countries shows that trade integration has positive effects on business cycle synchronization as shown in previous literature. Effects of financial integration differs according to its characteristics: equity market integration weakens business cycle synchronization due to wealth effects and industry diversification through consumption risk sharing, while debt market integration strengthens business cycle synchronization through balance sheet effects. These empirical results can provide important policy implications on financial market liberalization policies.