의과대학생들을 대상으로 한 웹기반 시뮬레이션 평가 적용을 위한 연구

이삼범(Sam Beom Lee),이영환(Young Hwan Lee),윤유상(Yoo Sang Yoon),방재범(Jae-Beum Bang) 한국의료시뮬레이션학회 2013 한국의료시뮬레이션학회지 Vol.2 No.1

흉부압박대 인공호흡 비율의 변화에 따른 소생술 방법의 정확도 비교: 마네킨을 이용한 연구

이성훈 ( Sung Hoon Lee ),이삼범 ( Sam Beom Lee ),도병수 ( Byung Soo Do ) 영남대학교 기초/임상의학연구소 2007 Yeungnam University Journal of Medicine Vol.24 No.2S

Background:Newly revised cardiopulmonary resuscitation (CPR) guideline in 2005 recommends 30 chest compressions and 2 rescue breaths during CPR for all rescuers to use for all adult victims. We would compare the accuracy of the CPR methods by revised CPR guideline in 2005 and previous guideline in 2000. Materials and Methods:Fifty medical students during the introduction to clinical medicine (ICM) were investigated after 30 minutes lecture and brief education of CPR methods. Each students performed twice both CPR methods, the one by guideline 2005 (method A), 4 cycles of 30 compressions every 2 breaths, and the other by guideline 2000 (method B), 10 cycles of 15 compressions every 2 breaths. Resci® Anne mannekin and Laerdal® skillmeter were used and paper reports were printed after each tests. After then, we compared the technical accuracy of the results between method A (30:2) and method B (15:2). 1) Results:Total fifty students (37 males, 13 females) were tested, their mean age was 25.1, mean body weight was 63.5 kg. The technical accuracy on chest compression was not different between two methods and also the technical accuracy on ventilation was not different between two methods except total ventilation number (p>0.05). Conclusion:We could not find significant differences of technical accuracy between both CPR methods. So we don`t think new guideline 2005 is superior to previous guideline 2000 by technical efforts although it`s hemodynamic responses and other clinical benefits is excluded in this study.

지역기상이 노인외상에 미치는 영향

김정호 ( Jung Ho Kim ),도병수 ( Byung Soo Do ),이삼범 ( Sam Beom Lee ),이성훈 ( Sung Hoon Lee ),시종원 ( Jong Won Si ),이재영 ( Jae Young Lee ),김오룡 ( Oh Lyong Kim ) 대한외상학회 2006 大韓外傷學會誌 Vol.19 No.2

Purpose: Many factors influence the occurrence and severity of geriatric trauma, and regional weather is regarded as one factor that influences geriatric trauma. In this study, to predict the type, severity, and incidence of geriatric trauma patient, we analyzed the influence of regional weather on geriatric trauma. Methods: The subjects of our investigation were trauma patients over sixty-five years of age who visited the Emergency Department (ED) of Yeungnam University Hospital during a one-year period. We retrospectively reviewed the medical charts of 436 geriatric trauma patients, and the data were analyzed by using SPSS 12.0 for Window. The weather was based on data from the Korea Meteorological Administration. Results: The average age was 72.8 years old, and the ratio of males to females was 1:1.1. The mean spell out ISS was 10.8, and no difference was found between males and females. Slips were the most common cause of trauma. The largest numbers of aged trauma patients, 46, visited the ED in May, and the smallest number of such patients, 24, visited the ED in December. In addition to, summer saw the largest number of aged trauma patients. The type of trauma, the Injury Severity Score, and the number of patients had no relationship with season. On sunny days, the ISS was larger in patients who had hypotension and who had tachycardia. On rainy day, the ISS was larger in male patients and cultivator accident patients. The number of patients was larger on partly cloudy days. Conclusion: In spring and summer and on partly cloudy days, we must be prepared to treat aged traumatized patients in the E.D. On rainy days, visual sensation, tactual sense, and acoustic sense must be closely examined. In addition,on rainy day, aged male traumatized patients or cultivator accident patients must to be closely observation. (J Korean Soc Traumatol 2006;19:97-104)

웹기반과 고충실도 시뮬레이션에서 의과대학생들의 팀 역할 수행과 임상수행능력 비교

방재범(Jae Beum Bang),윤유상(Yoo Sang Yoon),이영환(Young Hwan Lee),이삼범(Sam Beom Lee) 한국의학교육학회 2014 Korean journal of medical education Vol.26 No.4

Purpose: The importance of team dynamics with regard to clinical performance is being emphasized to improve patient safety and the quality of health care. The aim of this study was to examine the correlation and differences in team dynamics and team clinical performance in a web-based simulation (WS) and high-fidelity simulation (HS) in the medical students. Methods: The simulations were held for 15 teams of fourth year medical students (n=52). They were given two clinical cases, dyspnea (case 1) and chest pain (case 2) by WS and then HS. The scores on the team dynamics and the team’s clinical performance were analyzed by paired t-test and multiple regression using SPSS version 21.0 (IBM Corp.). Results: The teamwork scores on case 2 (22.67±6.58) were higher than for case 1 in the HS (20.47±7.22). Team clinical performance scores were the same the WS and HS. Team clinical performances were significantly associated with team dynamics in both cases by HS. Teamwork scores of team dynamics were each explanation on case 1 (74.9%), case 2 (63.4%) in the HS. Conclusion: The team dynamics and clinical performance can improve if undergraduate medical students have more opportunities. They should be trained in these endeavors to become future doctors for which scenario-based simulations could be valuable.

궤양성 대장염 31예에 대한 임상적 고찰

이삼범,정문관,이현우,이현주,장병익 대한소화기내시경학회 1991 Clinical Endoscopy Vol.11 No.2

Ulcerative colitis is diffuse inflammatory condition at mucosal lining of the colon & rectum and rare in Korea but there are no pathognomonic features or specific diagnostic tests. However, recently the diagnostic methods for ulcerative colitis are much developed and the incidence of ulcerative colitis is increased in Korea. Therefor, an analysis of 31 cases of ulcerative colitis which was diagnosed and treated in the department of the YeungNam University Hospital from May l983 to April 1991 was reviewed. The results were as following: 1) The sex distribution assumed a ratio of 1 to 2.1 and the age distribution was vqriable but the most prevalent age group was 5th decade(29.0%). 2) The most common clinical manifestations were abdominal pain & bloody diarrhea. 3) As to the extent of disease determined by the barium enema & endoscopy, rectum or rectosigmoid colon was involved in majority of the cases 22.6%, 41.9 (respectively). 4) Significant laboratory findings were elevated ESR, anemia, leukocytosis, hypoalbuminemia. 5) The endoscopic examination was performed in all 31 cases and showed sinificant findings such as hyperemia, mucosai edema, superficial ulceration & mucosal friability. 6) 23 of 26 cases treated by sulfasalazine medication showed improved, and 3 cases were improved by steriod medication and the surgical operation was indicated in 1 case.

상대정맥 증후군의 임상적 고찰

이충기,신세원,이현우,정진홍,이형우,현명수,김명세,강중순,이관호,이삼범 영남대학교 의과대학 1990 Yeungnam University Journal of Medicine Vol.7 No.2

We reviewed 30 cases of superior vena cava syndrome in adult patients who were seen at the Yeungnam University Hospital from January 1985 to June 1990. The results were as follows : 1. The male-to-female ratio was 6.5 : 1, and the most patients were in the age group between the sixth and seventh decades. 2. The most common symptoms were dyspnea (87%) and followed by cough (63%), facial swelling(63%) and chest pain (44%) and the physical signs were dilated neck vein (97%), facial edema(93%) and facial flushing (45%) in order of frequency. 3. The simple chest x-ray findings were superior mediastinal widening (90%), right hilar mass (77%) and pleural effusion (31%). 4. Diagnosis was made by history and physical examination(100%), chest C-T scan (100%), simple chest x-ray (97%), bronchoscopy with biopsy (40%) and so on. 5. 21 cases of patients were confirmed by histology : 14 cases (46%) of bronchogenic ca, 4 cases (14%) of lymphoma, 3 cases (10%) of metastic lung ca. Of bronchogenic ca, small cell ca was 7 cases (23%). squamous cell ca, 5 cases (17%), and unclassified ca was 2 cases (6%). 6. In response of treatment, the clinical improvement was achieved in 18 cases with radiotherapy alone, 1 case with chemotherapy only, and 6 cases with radio-chemotherapy.

대구 상인동 가스참사로 본 지역 응급의료체계에 대한 고찰

이삼범,도호석,도병수,이창현,심민철,권굉보 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

Disaster may be defined as a sudden calamitous event associated with great damage or destruction. A more common definition, among emergency-preparedness planners, is a medical occurrence that overwhelms medical care systems and facilities. Most regional disaster plans are formulated to respond to disasters of moderate size. At 07:50 A.M. on 28 April 1995, gas explosion was happened at Sangin-Dong where was going to be under construction of subway in Taegu, Korea. 102 victims had died and 178 victims had moderate or minor injuries. Problems in the organization at the scene, triage, field management, transport to the hospital, and the communication contributed to the confusion in the management of victims. An analysis of this disaster allows several lessons to be learn about perimeter control, command functions, crowd control, and transportation priorities. It will benefit disaster planners in other communities.

대구광역시 지역 응급의료체계의 현황분석을 통한 보완 및 개선책 제시

도병수,이삼범 대한응급의학회 2000 대한응급의학회지 Vol.11 No.2

Background: The EMSS can be defined as the complete chain of human and physical resources that provides patient care in cases of sudden illness and injury. To provide effective emergency care through the EMSS in a region, the organized EMSS should be periodically evaluated and improved in both aspects of quality and munber on the detected portions of defect. The EMSS in Taegu has been systematically developed since the gas explosion disaster happened at Sangin Dong, on 28th April, 1995. After then, many institutes have been organized, and various plans for improving Taegu regional EMSS have been suggested. The training of EMTs for operating the systems and various equipments which are needed for performing prehospital care and transporting the patient to hospital also has been undertaken. Method: We reviewed the effectiveness and problems of each EMSS elements established and operated during the past five years in Taegu by looking over the documents related to EMSS in the institutes concerned and accomplishing written survey from prehospital care providers belonged to Fire-Fight department. Result: Although the regional EMSS in Taegu has been well developed since 1995 in all its aspects, such as manpower, equipment and control system, but some ineffectiveness in the operation of EMSS and deficits of resources, especially manpower, are found. Conclusion: The emergency physicians should have to analyze the problems of their regional EMSS that involved in personally, and reestablish the long term plans for improving the regional EMSS at this point.

응급센터 입원환자의 통증처치에 대한 응급의학적 고찰

도병수,김현정,정준영,도호석,이창현,이삼범 대한응급의학회 1996 대한응급의학회지 Vol.7 No.2

Study objective: To recognize importance of pain management in ED and properly manage the ED patients complaining pain by analyzing the intervals between arrival time in ED and pain medicine starting time, the types and the administered routes of pain medicine. Design: Retrospective review of ED charts Setting: University teaching hospital Participants: The patients had admitted in ED of Yeungnam University Hospital with a chief complaint of acute abdominal pain or pain due to bone fracture between June 1, 1995 and December 31, 1995. Results: The study group consisted 256 patients, 161 of them female. ED administrations of analgesics were 103 cases, 17 of them administered more than two times. The average time interval between arrival time and medication time was 169.02±120.25 minutes. Each types of perceived analgesics were antispasmodics 55 cases(53.40%), NSAID 26 cases(25.24%) and opioid 19 cases(18.45%). Every analgesics were administered through intramuscular routes, except only 3 cases. Violences of patients or relatives due to delayed pain control were occured 32 cases, 5 cases of them self-discharged and looked for other hospitals. Conclusion: Emergency physicians including interns and residents delayed management so long and ordered inappropriate administration routes and types of analgesics. So we thought proper protocols about pain management in ED were established.

응급의료와 그 적용 법률에 대한 개요

도병수,이삼범 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.3

Background : The medicolegal problems can be occurred in all medical field. Especially ED can be more exposed to the legal claims due to the very nature of ED business and characteristics of ED patient (or their family member). All emergency physicians, as a ED manager, should be concerned about the law associated with emergency care for handling the medicolegal problem. So they can deal with and prevent the legally risky situations that may be occurred in ED practice. Ultimately we can reduce the risk of a malpractice lawsuit and provide good emergency care services Suggestion :The authors would like to suggest several items that we have thought the ED physicians and managers always have to remember to manage the medicolegally risky situations 1. Every member of ED health care team must be trained in understanding the patients' wants and desires. 2. The emergency physicians and nurses must realize that they are the best risk management tools in the hospital. 3. ED physician should have the knowledge of the law associated with emergency health care. 4. Develop the system that can share the informations about the medicolegal events which were experienced by each ED health care providers of every health care institutes. 5. We should never forget the time honored sentences, "Good medicine is good law".