위절제술 환자의 표준진료지침 개발 및 적용 효과

김은희,김철규,이순교,김순덕,이혜옥,권정순,이경미,이민미,심순미,유용만,신종식,강은희,이상일,김병식,오성태,육정환,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.2

Background : Gastric cancer is the most common malignant tumor in Korea. surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for recucing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and unplanned readmission rate between the pre-pathway group(n=67) and the post-pathway group(n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days(p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was of satistically significant(p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korea hospital settings.

부산지역 수돗물과 지하수의 중금속 농도

김준연,손지언,김형수,김두희,원미숙,김인식,이혜령 동아대학교 산업의학연구소 2000 산업의학연구소 논총 Vol.- No.5

This study investigated mean airborne CO concention of 15 workplaces, suspected of CO exposure and conducted self-reported questionnaire completion and indirect COHb concentration measure using Micro II Smokerlyzer to healthy 702 adult subjects from 1999 May to 1999 September in order to find a relation of CO exposure and occupational factors, socioeconomic factors, and health related behaviors and confirm the related conditions in the screening test for CO exposure. The results of this study were summarized as follows : 1. In the CO exposed and non exposed group, COHb concentrations of the smokers were 2.55±0.96% and 2.21±0.97% and that got a statistically significant difference, There were not statistically significant differences in the age and total smoking index. Passed times after the last smoking, Working time/day, and working duration were statistically significant difference (p〈0.05). 2. In the CO exposed and non exposed group, COHb concentrations of non-smoking group were 0.94±0.35% and 0.68±0.47% and that got a statistically significant difference. There were not statistically significant differences in the age and working duration but Working time/day was a statistically significant difference(p〈0.05). 3. In the CO exposed group, r-square of multiple regression of the smokers was 38.5 % and passed time after the last smoking, working time/day, and job category were statistically significant differences (p〈0.05). And r-square in the CO non-exposed group was 38.3 % and age, passed time after the last smoking, and total smoking index were statistically significant difference. 4. In the CO exposed group, r-square of multiple repression of the non-smokers was 66.3% and job category and airborne CO concentration were statistically significant differences(p〈0.05). But r-square of non-smokers in the CO non-exposed group was 1.0% and there was not a statistically significant difference(p〈0.05). 5. In the smokers of CO exposed and non exposed groups, relation of COHb concentration and passed time after the last smoking was expressed as exponential function, Y = 2.9182e-0.0083x and r-square of this function was 37.4%. Therefore it was more than 150 minutes that passed time after the last smoking was when COHb concentrations were measured as less than 1%. In conclusion, variable, that was statistically significant to COHb concentraion in the both CO exposed and non-exposed smokers, was a passed time after the last smoking. We suggest that you have to restrict the smoking of smokers at least 150 minutes in the exposed and non exposed group before COHb concentration measure in order to exclude smoking effects

결혼이주여성과 한국여성의 양육 스트레스 비교

김혜경 ( Hae Kyeong Kim ),이은희 ( Eun Hee Lee ) 서울대학교 간호과학연구소 2014 간호학의 지평 Vol.11 No.2

Purpose: The purpose of this study was to compare parenting stress between married migrant women and Korean women. Methods: Subjects were 68 married migrant women and 70 Korean women raising children aged seven years or younger, living in three different cities in Gangwon Do. To measure parenting stress, we used Kim`s (1997) questionnaire that had been modified from Richard & Abidin`s (1990) Parenting Stress Index (PSI). Results: There were significant differences between the two groups in age, academic credentials, job, monthly income, and achievement of maternal role. No statistically significant differences were found for parenting stress scores (p<.355), but there was a significant difference in the child characteristics of parenting stress (p<.007) between the two groups. There were no differences in the demographic variables influencing parenting stress between the two groups. Conclusion: The development of multi-cultural parenting and family support programs should consider the nationality and marital satisfaction of the family.

개인적 특성과 교육서비스 품질이 교육 만족도에 미치는 영향 : ○○대학교 세무회계학과를 중심으로

김은혜(Kim Eun-Hae),마희영(Ma Hee-Young) 한국국제회계학회 2020 국제회계연구 Vol.0 No.92

본 연구는 특성화고졸 재직자 특별전형으로 입학한 ○○대학교 세무회계학과 학생들을 대상으로 교육서비스 품질의 변인과 교육 만족도 간의 관계가 재직자 특별전형 학생들의 개인적 특성인 근속연수, 전공과 현업의 관련성, 재학 중 퇴사여부에 영향을 받는지를 분석하였다. 교육서비스 품질을 유형성, 신뢰성, 반응성, 확신성 및 공감성으로 구분하고, 교육 만족도는 학교 교육, 교수, 교육과정, 학교의 환경 및 시설로 구분한다. 총 124개의 설문조사를 이용한 검증 결과는 다음과 같다. 첫째, 근속연수가 5년 미만인 경우 공감성, 신뢰성, 유형성 순으로, 근속연수가 5년 이상인 경우 확신성, 유형성 순으로 교육 만족도에 유의한 양(+)의 관계로 나타났다. 둘째, 전공과 현업이 일치하는 경우 공감성, 유형성 순으로, 전공과 현업이 불일치하는 경우 확신성만이 교육 만족도에 유의한 양(+)의 관계로 나타났다. 셋째, 재직을 유지하고 있는 경우 유형성, 반응성 순으로, 재학 중 퇴사한 경우 확신성, 공감성, 유형성 순으로 교육 만족도에 유의한 양(+)의 관계로 나타났다. 추가적으로 학업성취도가 높은 경우 유형성, 공감성, 확신성, 신뢰성 순으로, 학업성취도가 상대적으로 낮은 경우 반응성만 교육만족도에 통계적으로 유의한 양(+)의 관계로 나타났다. 본 연구의 결과는 재직자 특별전형 학생들의 개인적 특성에 따라 교육서비스 품질의 변인이 교육 만족도에 차별적으로 영향을 미치고 있음을 시사한다. This study analyzes how the quality of educational service affects educational satisfaction according to the personal characteristics of students in the tax accounting department of oo University who are admitted by special screening process for specialized high school graduates, the consistency of majors and field work, and whether they leave the company. The quality of educational services is divided into tangibility, reliability, responsiveness, assurance and empathy, and educational satisfaction is divided into school education, teaching, curriculum, environment and facilities of school. The results of the verification using a total of 124 surveys are as follows. First, if the working period is less than five years, empathy, reliability and tangibility affect educational satisfaction. If the period of service is more than five years, the reliability and tangibility affect the satisfaction of education. Second, if the major and the field work are matched, empathy and tangibility affect the satisfaction of education, and if the major and the field work are inconsistent, assurance affects the satisfaction of education. Third, when working, tangibility and responsiveness have an impact on educational satisfaction, and when leaving the company, reliability, empathy, and tangibility affect educational satisfaction. Additionally, if the academic achievement is high, tangibility, empathy, assurance, and reliability affect the educational satisfaction, and if the academic achievement is low, only the responsiveness affects the educational satisfaction. The results of this study suggest that the variables of educational service quality, depending on the personal characteristics of the students who were admitted through a special screening process for specialized high school graduates, have a different influence on educational satisfaction.

복식 전자궁적출술후 절단부에 발생한 난관탈출증 1예

송은석,이해혁,김태희,김정식,남계현,이권해,고은석 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Prolapse of the fallopian tube into the vaginal vault after hysterectomy is a rare complication. Since most of cases may resolve before detection or remain undiagnosed, the exact incidence is still unknown. Though most common sign of tubal prolapse is tender friable tissue in vaginal cuff, with the simptoms of lower abdominal pain, dysparenunia, vaginal discharge, or postcoital spotting. The definitive diagnosis should be confirmed histologically Recently, we experienced a case of fallopian tube prolapse after abdominal hysterectomy in a 41-year-old woman and report with a brief review of the literature.

우리나라 지역 직업성질환 감시체계의 현황과 전망

임종한,장성실,김성아,문재동,채창호,홍윤철,김수영,김진석,김영욱,한상환,이혜숙,원종욱,송동빈,하은희,강성규 대한산업의학회 2001 대한직업환경의학회지 Vol.13 No.2

기존의 특수건강진단과 작업환경측정을 통한 직업병 관리가 진폐증, 소음성난청 등의 소수 특정질환에 국한되고 실제 직업병 발생 규모 파악이나 신종 직업병의 발견에 한계를 보인다는 사실은 산업의학전문가들 사이에서도 공감을 이루고 있다. 미국과 영국 등에서의 직업성질환 감시체계에 대한 경험은 우리 나라의 직업성질환 감시체계 구축에도 새로운 자극제가 되면서, 1998년이후 인천, 대전, 여천, 구미, 부울경 지역에서 지역 직업성질환감시체계를 산업보건관리의 중요한 시스템으로 구축하려는 노력이 확산되고 있다. 새로이 구축되어지는 이들 지역 직업성질환 감시체계는 감시하고자 하는 대상질환, 활용 가능한 인적자원 및 자료원, 지역 의료체계의 특수성 등에 따라서 목적과 방법을 달리하면서 독특한 형태로 발전을 하고 있다. 각 지역단위 감시체계들이 그 상황에 맞게 독특한 목적과 전략들을 발전 시키면서도, 향후 발전할 국가적인 차원의 직업성질환 감시체계 구축을 위하여 직업성질환 감시의 기본 전략 등을 공유하는 등의 노력이 필요하다. 환례 정의 및 기본적인 등록 서식의 공유, 직업성질환 감시 자료원의 발굴, 공동의 정보 네트워크 및 직업성질환 감시 데이터베이스 구축 등 직업성질환 감시활동을 지원하기 위한 여러 기초 인프라 구축에 힘을 모아야 할 것이다. 우리 나라에서 직업성질환 감시체계를 성공적으로 구축하기 위해서는 수집된 자료의 질 관리를 위한 직업성질환 감시의 원칙 제정과 감시 전략의 공유 등이 필요하며, 전국적인 직업성질환 감시체계의 하부구조라고 할 수 있는 지역감시체계의 기초 토대 마련과 강화작업이 절실하게 필요하다.

여성암 환자의 영적건강과 우울의 관계

태영숙(Tae Young Sook),김미예(Kim Mi Yea),김혜나(Kim Hea Na),김혜은(Kim Hae Eun),김혜지(Kim Hea Ji),노영정(No Young Jeong) 고신대학교 전인간호과학연구소 2008 전인간호과학학술지 Vol.3 No.-

Purpose: This study was to identify the relationship between depression and spiritual health in patients suffering from women cancers. Methods: The research method was a cross-sectional descriptive study. Data was collected by questionnaires from 106 in woman patients who were diagnosed with women cancer at one university hospitals and one general hospital. The instruments used for this study included, the Depression Scale developed by Zung(1965) and Spirituality Health Inventory developed by Highfieid(1992) and amended by Lee & Kim. The collected data were analyzed using Frequency, Percentage, t-test, ANOVA, Pearson s correlation coefficients. Results: 1) Depression score was middle, Spiritual Health score was middle 2) The Spiritual Health in women cancer patients indicated a significant negative correlation between spiritual health and depression was perceived with over moderate level(r=-.647, p=.000) 3) There were significant difference in spiritual health according to the Monthly income (F=4.30, p= .016), the degree of pain(F= 2.848,p= .041), the degree of fatigue(F= 3.415,p=.020),the frequency of attendance at worship services(F=3.285, p=.014) the effect of religion on personal life(F= 9.413, p=.000). 4) There were significant difference in depression, according to the residence type(F= .748, p=.012), the cancer insurance(t=7.859, p=.006), the degree of pain(F= 2.775,p= .045). Conclusions: It is needed strategies for intervention of improving the spiritual health to reduce depression in women cancer patients. The significant several characteristics of related to depression and spiritual health should consider in sociopsychological nursing intervention of women cancer patients

만성 C형 간염 환자에서 페그인터페론 알파2a와 리바비린 병합 치료중 발생한 벨마비 1예

김일환,장제혁,유충헌,최규남,고정해,김윤정,서광원,김지현,박성재,박은택,이연재,이상혁,설상영 인제대학교 2008 仁濟醫學 Vol.29 No.-

페그인터페론과 리바비린 병합요법은 만성 C형 간염의 일차 치료법이다. 저자들은 만성 C형 간염 환자에서 페그인터페론 과 리바비린 병합 요법 중에 발생한 벨마비 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. 환자는 5년 전부터 만성 C형 간염을 앓아온 48세 남자이며, PEG-IFN α-2a 135μgm 피하주사 주1회와 하루 1200㎎의 리바비린을 투여하였다. 치료시작 후 9개월째 환자는 오른쪽 안면의 근력약화를 호소하였으며 벨마비로 진단되었다. 페그인터페론과 리바비린 병합요법을 지속하면서 관찰하였다. 환자의 벨마비는 페그인터페론 치료를 중단하지 않았음에도 3개월후 증상이 회복되고 이후 벨마비 재발 없이 현재 경과관찰 중이다. 만성 C형 간염에서 페그인터페론과 리바비린 병합 요법시 벨마비의 발생 가능성을 염두에 두어야 하겠다. A Case of Bell's Palsy Associated with Combination Therapy of Pegylated Interferon Alfa-2a (PEG-IFN) and Ribavirin for Chronic Hepatitis C Virus Infection Pegylated interferon alfa(PEG-IFN α) and ribavirin therapy is the first line treatment for chronic hepatitis C. Mild complications of the therapy are common, but more serious complications are rare. We report here a case of Bell's palsy that occurred in a patient with chronic hepatitis C virus infection during combination therapy of PEG-IFN α-2a and ribavirin. The patient was 49-year-old man with chronic hepatitis C (genotype 1b) for 8 years. He had compensated liver cirrhosis with splenomegaly. Therapy with PEG-IFN α- 2a 135mcg/week and ribavirin 1200mg/day was initiated. After 9 months of the therapy, the patient showed a loss of muscular tone on the right side of his face. A diagnosis of Bell's palsy was made. The Bell's palsy resolved over 3 months despite continuation of the combination therapy.

발아현미가루를 첨가한 머핀 제조조건의 최적화

김철재,이지해,이은혜,문혜진,주나미 숙명여자대학교 건강·생활과학연구소 2006 生活科學硏究誌 Vol.- No.22

In order to develop the functional muffin prepared with different levels of sprouted brown rice flour (SBRF), the mixing conditions of SBRF, butter and water were optimized by response surface methodology(RSM), using central composite design with 3 variables and 5 levels. The result of three-dimensional plot was showed that decrease of SBRF content increased the volume, maximum length, crumb grain, moistness and overall quality of muffin. The overall quality of the functional muffin was maximized under the preparing condition of 31.49 g SBRF(15% of flour used), 85.36 g butter, and 123.86 g water. Moreover, the optimum conditions for preparing muffin were as follow : 29.95 g, 81,24 g, 120.45 g for volume ; 23.67 g, 88.18 g, 118.24 g for maximum length ; 38.44 g, 63.38 g, 117.26 g for flavor ; 29.86 g, 93.04 g, 126.42 g for taste ; and 55.43 g, 94.40 g, 133.61 g for moistness. The range of optimum preparing conditions for the functional muffin in consideration of the physical and sensory characteristics were shown to the 30~40 g as SBRF, 80~90 g as butter, and 120~130 g as water.

노인인구에서 ApoE 유전자형에 따른 머리둘레와 인지기능간의 연관성

김경란,오병훈,이준영,김은아,정해관,이동우,홍창형 大韓神經精神醫學會 2007 신경정신의학 Vol.46 No.3

Objectives : The aim of this study is to find out the effect of ApoE genotype on correlation between head circumference and cognition of the elderly in the community. Methods : A total of 1,152 subjects (380 men and 772 women) aged 60-91 years were analyzed from preliminary data of GDEMCIS (Gwangju Dementia and MCI Study). The study questionnaire consisted of demographic characteristics, current and past illness history, drug history and K-MMSE (Korean version-Mini Mental State Examination). We also measured the head circumference and examined ApoE genotype. Results : On regression analysis, as head circumference becomes smaller, K-MMSE scores decreased adjusted by age, sex, educational level, ApoE ε4 allele, current smoking and alcohol drinking status (β=0.15, P=0.04). Only in the lowest qu-artile group, presence of ApoE ε4 allele reduced K-MMSE scores adjusted by age, sex, educational level, height, current alco-hol drinking and smoking status (β= -1.39, P= 0.008) Conclusion : These results suggest that head circumference may have an influence on K-MMSE scores, and presence of ApoE ε4 allele may be a medicating factor.