권역심뇌혈관질환센터 사업의 비용-편익 분석

김병호 ( Byung Ho Kim ),감신 ( Sin Kam ),배상근 ( Sang Geun Bae ),김건엽 ( Keon-yeop Kim ),이원기 ( Won Kee Lee ),홍남수 ( Nam-soo Hong ),박형근 ( Hyeung-keun Park ),이혜진 ( Heyjean Lee ),조은정 ( Eun-jung Cho ),채성철 ( Shung C 한국보건정보통계학회(구 한국보건통계학회) 2017 보건정보통계학회지 Vol.42 No.1

Objectives: This study was conducted to investigate economic feasibility of operating Regional Cardiocerebrovascular Centers using cost-benefit analysis. Methods: The current study assessed cost and benefit data collected from nine hospitals which were designated as Regional Cardiocerebrovascular Centers between 2008 and 2010. Results: The operation of Regional Cardiocerebrovascular Centers reduced mortality rate and length of stay due to acute myocardial infarction and stroke and also decreased disability occurred after stroke. The total calculated cost of operating nine Regional Cardiocerebrovascular Centers was 19.85-22.30 billion won and the minimum benefit calculated was 23.98 billion won. Applying the maximum cost and the minimum benefit, the net benefit was 1.68 billion won, which is estimated to 190 million won per Regional Cardiocerebrovascular Center. Conclusions: The present study revealed that the operation of Regional Cardiocerebrovascular Centers was economically beneficial. The benefit would be larger if intangible benefit such as the long-term effects to community hospitals and enhancement of quality of life of patients and their families are considered.

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

청신경종의 크기에 따른 어지러움의 양상 및 전정기능 검사의 특징

정원호,홍성화,조양선,김성민,장병찬,최재연,이승진 대한이비인후과학회 2000 대한이비인후과학회지 두경부외과학 Vol.43 No.1

사지의 주요 동맥손상의 처치: 23증례에 대한 분석

원형섭,김상은,배성만,박철완,이 근,조상훈,김상일,우병완 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

Extremity vascular trauma is common in most emergency centers, and controversy remains about the optimal management of arterial injuries. Retrospectively we reviewed the records of 23 patients who had upper or lower extremity arterial trauma from July 1994 to December 1995. The purpose of this study was to evaluate our department`s management policy to major arterial injuries. The leading cause of major arterial injuries was penetrating trauma. We found that there were clinical findings such as absence of or decreased strength of pulsation(82.6%), cool ischemic extremity(69.6%), large expanding hematoma(43.5%), major bleeding(17.4%) and bruit or thill(8.7%). We gave the priority to management of life-threatening injuries and applied the pressure dressing to wounds as early as possible. There were 18 men(78.3%) and 5 women(21.7%); the mean age was 35(range 20-56 years old) years. There were 12 arterial injuries(52.2%) in the upper extremity and 11 arterial injuries(47.8%) in the lower exteremity. The most commonly injured artery was the brachial artery in the upper(34.8%) and the femoral artery in the lower(30.4%) extremity. The etiology included knife stabbing in 10 patients(43.5%), motor vehicle accidents in 6(26.1%), industrial accidents in 4(17.4%), falls in 2(8.7%) and a farm equipment accident in 1 patient(4.3%). The associated injuries were muscle injuries(78.3%), fracture(56.5%), nerve injuries(52.2%), vein injuries(43.5%), shock(17.4%) and dislocation(13.0%). All patients with arterial injuries were given a preoperative prophylactic antibiotic and TIG(tetanus immunoglobulin). We used Doppler technique as a means of detecting the blood flow. Fourteen patients(60.9%) underwent preoperative arteriography in the radiology department. We performed surgical exploration as soon as major arterial injuries were suspected. The most common methods of treating major arterial injuries were interposition vein graft(69.6%) and end to end anastomosis(21.7%). Systemic or locally infused heparin was used for all vascular repairs. In many of our patients(56.5%), fasciotomy was performed before the vascular repair, as a part of the exploration of the distal arteries. There were 2 amputations(8.7%) but no death. The reason for secondary amputation were wound infection in one and failure to achieve sufficient arterial flow to the involved extremity with resulting gangrene in the other. As the time factor is vitally important in the management of arterial injuries, we advocate prompt and early surgical treatment within 6 hours of the trauma. In conclusion, we believe that the crucial factorsin successful management of major arterial injuries of the extremities are early diagnosis, prompt treatment, complete debridement, fasciotomy when indicated, and simultaneous treatment of concomitant injuries.

부신질환의 마취관리

조희원,양홍석,최병권 중앙대부설한국의과학연구소 1991 한국의과학 Vol.23 No.2

만성 화농성 중이염의 세균학적 고찰

조남순,이영훈,강기훈,최제환,송태현,이병돈,장혁순,강주원,김연준 순천향의학연구소;Soonchunhyang Medical Research Institute 2000 Journal of Soonchunhyang Medical Science Vol.6 No.1

Background and Objectives : Chronic suppurative otitis media is one of the frequent diseases in otolaryngologic field. It is important to choose of antibiotics in the management of infectious disease. But the organisms in infections have been changed and resistance to antibiotics has been grown as the development of antibiotics has been achieved. And so it has been necessary to recognize the changes of organisms and resistance in antibiotics. Our study was performed to identify the pathogens isolated from discharges in chronic otitis media and evaluate the antibiotic agents, to recognize the change of to resistance to·antibiotic agents and to use the appropriate anitiotics. Materials and Methods : Retrospectively, authors reviewed the backeriologic study of 114 cases of chronic suppurative otitis media who visited the Department of Otolaryngology, Soonchunhyang University in Seoul from Nov. 1996 to Oct. 1999 and analyzed 101 strains and its sensitivity test to various antibiotics. Result : In 93 cases in which pathogenic organism was isolated, single infection was 85 cases(91.4%) and mixed infection was 8 cases(8.6%). The most frequent pathogenic organism was Staphylococcus aureus(59.4%), Pseudomonas aeruginosa(13.9%), Providencia(4.8%), Alcaligenes(3.0%) and Streptococcus pneumoniae(2.9%) were the next. Methicilline-Resistance Staphylococcus aureus was 34 cases(57.6%) of Staphylococcus aureus. Staphylococcus aureus was sensitive to Vancomycin(96.7%), Trimethoprim-Sulfamethoxazole (57.6%), Cefuroxime(42.4%) and Ciprofloxacin(40.7%) but resistant to Penicillin(94.9%). Pseudomonas aeruginosa was sentitive Amikacin(100%), Ciprofloxacin(100%) and Gentamicin(67%). Conclusion : As MRSA recently was wide spread in community accquired infection as well as nosocomial infection, we must consider strict control of MRSA.

뇌하수체경을 침범한 Histiocytosis X : 증례 보고 Case Report

조병규,왕규창,양세원,지제근,김인원,최길수 대한신경외과학회 1989 Journal of Korean neurosurgical society Vol.18 No.7-12

A case of histiocytosis X with the involvement of pituitary stalk in a 5 year old boy was described. He presented with diabetes insipidus and the endocrinological study showed growth hormone deficiency. On computerized tomography and magnetic resonance imaging, the pituitary stalk was abnormally thick. Overlooking of the skull lesion on plain X-ray film led to an erroneous diagnosis of 'germ cell tumor'. Gross total removal of the lesion and chemotherapy were performed. In the differential diagnosis of suprasellar masses, this disease entity should be included. The importance of histological diagnosis of the infundibular lesion in cases of central diabetes insipidus is also emphasized.

XML/RDF와 SMIL에 기반한 멀티미디어 교육 컨텐츠 검색

최병욱,류정우,조정원 한국컴퓨터교육학회 2002 컴퓨터교육학회 논문지 Vol.5 No.3

대량의 멀티미디어 교육 컨텐츠의 재사용과 그 효과적인 관리를 위해서는 원하는 컨텐츠를 빠르고 정확하게 검색하는 방법을 제공할 수 있어야 한다. 본 논문에서는 대량의 멀티미디어 교육 컨텐츠에 대한 새로운 검색 방법을 제안한다. 교육 컨텐츠의 호환성을 확보하기 위해, XML을 기반으로 한 멀티미디어 동기화 표준언어인 SMIL을 이용하여 교육 컨텐츠에 사용되는 멀티미디어 요소의 통합과 동기화를 표준화된 방법으로 구현하였다. 또한 SMIL 교육 컨텐츠에 교육용 메타데이터인 IEEE LOM을 XML 기반의 RDF 형태로 부여하였다. 본 논문에서는 2단계의 검색 방법을 통해 보다 정확한 검색 기법을 제시한다. 1단계에서는 메타데이터를 이용한 검색으로서 원하는 컨텐츠를 검색하고, 2단계에서는 1단계에서 찾은 컨텐츠에 대해 SMIL의 시간 정보를 이용하여 컨텐츠의 세부적인 내용을 검색하도록 설계하였다. 또한 사용자가 각각의 검색 결과들을 이용하여 새로운 교육 컨텐츠로 재구성하고, 이를 학습에 이용하도록 함으로써 사용자 주도적인 학습이 가능하도록 하였다. In this paper, we propose the new approach with which user is able to retrieve the massive volume of learning contents in the multimedia learning system. In order to secure the compatibility of learning contents, we apply the SMIL on the basis of XML, so that the integration and the synchronization of multimedia components can be available to realize in the mode of standardization. We also implement the multimedia learning contents represented by the RDF on the IEEE LOM. We present the two step-retrieval method to get precise results. In the first step, user can find with high speed and ease whatever contents user wants to take a look through metadata in the system. The second step is followed that by using the time information of SMIL, user can retrieve the interest synchronous parts in the result of the first step. This innovative retrieval approach applied in the multimedia learning system is highly expected to make a meaningful contribution to implement the principles of self-directed learning in the learning environments, where user can use and revise the retrieval results for their own learning purpose and make further the active knowledge-reconstruction.

Cylinder 內 交又噴射의 亂流混合流動에 對한 實驗的 考察

盧秉俊,趙元日 全北大學校 1984 論文集 Vol.26 No.-

A turbulent mixing flow of the constant 45˚ cross jet in the cylinder was experimentally exaimed. For the effectuation of the experiment, a cross jet kit with two circular nozzle(exit dia. ø20) manufactured and mounted at the subsonic wind tunnel. The cross point of the centerline of two nozzles was calculated as 120.7mm and the developing turbulent mixing region could be imagined to exist beyond the region of 120.7mm, where the experiments were effectuated. The mean velocities ??, ?? and ?? obtained in the cylinder were a little higher than those obtained from the free cross jet. The intensities of turbulence in the X and Z directions were largely distributed at 0≤Y/b≤1.0 and their distribution of the Y direction was different and they decrease according to the increasment of Y/b. But they keep constant values at 2.0≤Y/b. The turbulent shear stresses, correlation coefficients, were measured and their distribution was analyzed. From the turbulence data, turbulent kinetic energy was calculated and plotted. Every distribution profiles show that their most of the higher values exist at 0≤Y/b≤1.0 and they decrease at the region of 1.0≤Y≤2.1 and keep constant values beyond Y/b=2.1.

SCORM 기반의 XML 학습 컨텐츠 검색 시스템

최병욱,송미숙,조정원 한국컴퓨터교육학회 2003 컴퓨터교육학회 논문지 Vol.6 No.1

차세대 인터넷 표준 언어인 XML(eXtensible Markup Language)은 데이터(data)와 표현(presentation) 그리고 구조(Structure)가 구분되기 때문에 어느 환경에서나 재사용성이나 재구성이 용이한 장점을 보이고 있다. 본 논문에서는 XML 문서를 가상교육 시스템(Virtual Education System)의 멀티미디어 컨텐츠로 범위를 제한하여 사용자 위주의 효율적인 검색 시스템을 구현한다. 본 시스템에서는 가상교육 표준안으로 제안되고 있는 SCORM(Sharable Content Object Reference Model)에서 정치한 SCO(Sharable Content Object)단위의 메타데이터를 기반으로 컨텐츠를 설계하고 각 문서를 키워드, 엘리먼트, 애트리뷰트 단위로 색인한다. 또한 사용자 인터페이스에서 앨리먼트 검색화면을 구조적으로 구성해줌으로써 사용자가 DTD(Document Type Definition)fl 대한 사전지식 없이도 검색이 가능하며, XML-QL로 재구성된 XML 문서의 형태와 XSL(extensible markup language Stylesneet Language)을 이용한 HTML 형태의 두 가지 결과화면을 제시함으로써 사용자 선택의 폭을 넓혀준다. XML(eXtensible Markup Language), next generation internet standard language has the advantage of easy re-use and re-structure in other computing environment because it has the separate data, presentation and structure. In this paper, we implement the efficient retrieval system for the general user by limiting the XML documents on the multimedia learning contents for the virtual education system. The system design is based on SCO Metadata unit defined in SCORM as the proposed virtual education standard. Each XML documents has three indexes keyword, element and attribute. Also, it makes Possible to retrieve data without previous knowledge of the 078 by making the element retrieval screen structure for the user interface. And it gives the user various result screen formats such as XML and HTML by restructuring the retrieval result through XML-QL and XSL, respectively.