병리검사 처방오류 개선 시스템 구축

이현임,최영진,구숙희,양승주,김병로,김묘정,신일근,신미옥,서임선 한국의료QA학회 2006 한국의료질향상학회지 Vol.13 No.2

문제: 조직병리검사의 처방이 복잡하고 전문화됨에 따라 오류처방이 빈번하게 발생되고 이를 해결하기위한 프로세스가 복잡하여 부서간의 갈등과 업무의 가중, 또한 병원 수입 감소가 초래되었다. 목적: 발생된 오류처방의 유형과 발생율, 오류처방을 해결하기 위한 프로세스를 파악하여 이에 대한 문제점을 개선하여 업무의 효율성과 관련부서간의 부가업무 감소와 갈등해소, 더불어 병원수익을 향상시키는 것에 목표를 두고 활동하였다. 의료기관: 서울시에 소재한 종합병원 질 향상 활동: 조직병리검사 처방의 오류처방 발생 원인과 유형, 발생율을 조사하여 원인을 파악하고 개선을 위한 프로세스를 구축하여 질 향상을 도모하였다. 개선효과: 수술실에서 의뢰한 외과 입원환자의 일반조직병리검사 오류율은 개선 전 7.8%에서 개선 후 3.5%, 동결절편조직검사 오류율은 개선 전 28.6%에서 개선 후 0%로 이전보다 모두 개선되었다. 또한 수술실 간호사의 업무 만족도는 일반조직병리검사의 처방시 95%, 동결절편조직검사 처방시 90%로 높은 만족도를 보였다. 단 병리과의 경우 업무가 증가됨에 따라 초과근무시간이 증가하였다.

고등어부시의 제조에 관한 연구 : 1. 제조중의 정미성분의 변화

고신효,임희유,고용구,하진환 濟州大學校 工科大學 産業技術硏究所 1993 産業技術硏究報告 Vol.4 No.-

Mackerel-bushi was manufactured as a natural flavoring substance and in each processing step the taste compounds including nucleotides and their related copmounds. free amino acids, non-volatile organic acids, trimethylamine oxide, trimethylamhe and betaine were determined. IMP and inosine were abundant in Mackerel-bushi which marked 465.3㎎/l00g and 465.7㎎/l00g on dry basis while ADP was trace in content. 17 species of free amino acids were isolated and identified from the extracts of raw material and its products. The abun-dant amino acids in the extracts were lysine, taurine, phenylalanine and alanine, and those were consisted of 65.8~80.7% of the total free amino acids while isoleucine, aspartic acid, tyrosine and leucine were poor, and glycine was trace in content. Citric and lactic acids were 95% of total nonvolatile organic acids, and malonic, oxalic and α-ketoglutaric acids were poor. The content of TMAO and TMA in the extract of Mackerel-bushi were 11.9㎎/l0g and 13.5㎎/100g on dry basis and that of betaine was 93.1㎎/100g. The major minerals were Ca. Na. K. and Mg.

VRE 감염증의 임상상, 미생물학적 특성 분석 및 유전적 관련성 비교 : 전국 6개 병원에서 분리된 VRE를 중심으로

정희진,박정원,엄중식,하경임,신종희,김정미,이혜수,박영희,김우주,박승철 대한감염학회 2002 감염 Vol.34 No.5

상악 제1 및 제2소구치의 발치공간 폐쇄기전에 대한 3차원 유한요소 해석의 비교 연구

고신애,임원희,박선형,전윤식 대한치과교정학회 2007 대한치과교정학회지 Vol.37 No.6

교정 치료에서 발치공간 폐쇄는 치열을 이루는 모든 치아의 연속적인 이동으로 이루어지므로 그 기전은 복잡하다. 특히 전치부 치축을 적절히 유지하면서 구치부 고정원을 조절하는 과정은 정교함을 요하기 때문에 입체적 분석을 통한 치아이동 양상에 대한 이해가 필요하다. 지금까지의 유한요소 분석은 초기 응력분포를 관찰하여 치아 이동 양상을 예측해 보는데 그쳤지만 이러한 양상만으로 정확한 치아이동 결과를 추정하는 데에는 한계가 있었다. 따라서 본 연구에서는 3차원 유한요소 모델을 이용하여 상악 제1소구치 및 제2소구치 발치공간 폐쇄 시 전치부와 구치부의 입체적인 이동 양상을 단계별로 비교하여 그 기전을 규명하고자 하였다. 자연치의 크기 및 형태를 갖는 상악 치아들과 브라켓, 교정용 호선 및 치조골부를 3차원 레이저 스캐너로 스캐닝한 후 사면체 요소의 유한요소모델을 제작하였다. 0.017" x 0.025" 스테인레스 강 호선에 제작된 bull 루프 후방에 10˚의 gable bend를 부여하고 한 번에 2mm씩 12회 활성화시켜 발치공간을 폐쇄시켰다. 그 결과 제1소구치를 발치한 경우 제2소구치 발치에 비해 전치부의 후방 이동량이 많았으며 구치부의 전방 이동량은 더 적게 나타났다. 전치부에서는 제1, 2소구치 발치 모두 비슷한 미약한 정출을 동반하였고 치축의 변화량은 제1소구치 발치에서 더 크게 나타났다. 또한 제2소구치 발치 시 고정원의 협측 이동량이 더 크게 나타났다. Objective: The aim of this study was to compare the differences in closing extraction spaces between maxillary first premolar and second premolar extractions using 3-dimensional finite element analysis (FEA). Methods: Maxillary artificial teeth were selected according to Wheeler's dental anatomy. The size and shape of each tooth, bracket and archwire were made from captured real images by a 3D laser scanner and FEA was performed with a 10-noded tetrahedron. A 10˚ gable bend was placed behind the bull loop on a 0.017" x 0.025" archwire. The extraction space was then closed through 12 repeated activating processes for each 2mm of space. Results and Conclusions: The study demonstrated that the retraction of anterior teeth was less for the second premolar extraction than for the first premolar extraction. The anterior teeth showed a controlled tipping movement with slight extrusion, and the posterior teeth showed a mesial-in rotational movement. For the second premolar extraction, buccal movement of posterior teeth was highly increased.

양로원과 요양원 간호사의 업무내용 비교 : 전국의 무료 양로 · 요양시설 중심으로

성기월,신임희,이경희,권경희 노인간호학회 2005 노인간호학회지 Vol.7 No.1

Purpose: The study was performed to compare the content of their jobs of the nurses working in the free elderly home with free nursing home in the whole country. Method: The subjects consisted of 138 nurses working in elderly home and nursing home. The data was collected from Jan. 1st to Feb. 22th 2005 using a structured questionnaire that included general characteristics, content of tasks which the nurse dose every day, health program, perceived job satisfaction and pay satisfaction scale. The collected data was analyzed by the SPSS(version 11.5) program including descriptive statistics, x^(2)-test. Result: On the nurses in the free elderly homes and nursing homes, there were many patient diagnosing hypertension, arthritis and dementia. Recently the death rate in elderly home and nursing home was highly increased. The mean period of nurses working in elderly home and nursing home were 3.75 years and 2.76 years. Experience of staying with the elderly was 70.9% on nurses working in elderly home. and 73.2% on nurses working in nursing home. Daily allotment of the nurses working in elderly home and nursing home were health assessment, medication care and eating care. The highest priority rank of nursing care of the nurse working in elderly home and nursing home was health assessment. Mean number of the patient in daily nursing care of the nurse residing in elderly home and nursing home was referral to hospital on 1-5persons/day and then transfer care on 1-6persons/day. The highest health care program was an exercise program. Conclusion: The resident nurses in the free elderly homes and nursing homes have had various types of tasks, and for their security a system for job satisfaction was needed.

반코마이신 내성 장내구균 분리 환자에서 황색포도알균의 내성

김동욱,신선혜,김혜진,류선,이선희,장철훈,김영대,곽임수 대한감염학회 2004 감염과 화학요법 Vol.36 No.1

목적 : Vancomycin-resistant enterococci (VRE)로부터 S. aureus로의 vacomycin 내성 유전자의 전파는 오래전부터 예견되어져 왔으며 큰 걱정거리로 남아있다. 최근에 vanA 유전자를 가지고 있는 vancomycin-resistant S. aureus 2주가 미국에서 분리되었다. 이 연구의 목적은 VRE를 보균하고 있는 환자들에서 S. aureus 보균양상과 항균제 내성을 알아보는데 그 목적이 있다. 재료 및 방법 : 2001년 1월부터 2001년 12월까지 부산대학교병원에 입원하였던 환자들 중 임상검체에서 VRE가 분리된 환자 7명과 2001년 9월부터 12월까지 외과 중 환자실에 입원하였던 환자들 중 VRE 감시배양을 시행하였던 20명의 환자들을 대상으로 하였다. 환자들은 전비공, 액와부, 회음부, 직장에서 매주 면봉으로 검체를 채취하였다. 선별배지에서 검체를 배양하여 S. aureus를 분리하였고 원판 확산법을 이용하여 methicillin 감수성을 측정하였다. Broth microdilution 법으로 vancomycin MIC를 측정하였다. 결과 : 총 27명에서 73회의 방문과 292회의 배양이 시행되었으며 총 67주의 S. aureus가 분리되었다. 이중 64주(95.5%)가 methicillin 내성이었다. 전비공 MRSA 보균율은 VRE를 보균하고 있었던 환자는 19명 중 11명(58%)에서, VRE를 보균하지 않았던 환자는 8명 중 3명(37.5%)으로 VRE 보균자에서 보균율이 더 높았다. 총 64주의 MRSA의 vancomycin MIC의 분포는 0.5-2㎍/mL였으며 2㎍/mL를 초과하는 균주는 발견되지 않았다. 64주 중 vancomycin MIC가 1㎍/mL인 균주가 54주(84.4%)로 가장 많았으며 2㎍/mL 6주(9.4%), 0.5㎍/mL 4주(6.3%)의 순이었다. 결론 : VRE 환자에서 S. aureus의 보균율은 비보균자 보다 높았으며 분리된 균주들은 대부분 MRSA였다. VRSA 균주는 발견되지 않았다. Background : The transfer of vancomycin resistance from vancomycin-resistant enterococci (VRE) to Staphylococcus aureus has been predicted. The purpose of this study is to determine the prevalence and antibiotics resistance of S. aureus among patients colonized with VRE. Methods : Between January 2001 and December 2001, a prospective study was performed at Pusan National University Hospital on 27 patients. Surveillance swabs from nasal cavity, axilla, perineum, and rectum were obtained at weekly intervals. Methicillin susceptability of S. aureus was determined by oxacillin disk diffusion test and minimum inhibitory concentration (MIC) for vancomycin by microdilution broth test. Results : Total of 292 swab cultures were performed and 67 S. aureus isolates were collected. 64 isolates (95.5%) were resistant to methicillin. The prevalence of nasal MRSA carrier in 19 patients colonized with VRE was higher than that in 8 patients not colonized with VRE (58% vs. 37.5%). In 64 MRSA isolates, MIC (㎍/mL) for vancomycin ranged from 0.5 to 2. No isolates with MIC >2 ㎍/mL were observed. MIC of 1 ㎍/mL was shown (observed) in 54 isolates, 2 ㎍/mL in 6 isolates, and 0.5 ㎍/mL in 4 isolates. Conclusion : The prevalence of S. aureus with colonization of VRE is higher than that without colonization of VRE. Most of S. aureus isolates were resistant to methicillin. VRSA isolates were not observed.

전공의와 전문의의 응급진료 형태에 대한 비교 연구 : 전공의 파업기간을 전후로

이정헌,신임희 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.1

Background : The doctors’ strike was not only a manmade disaster but also a chance to apply a new pattern of emergency medical service for patients. We hope to propose a new pattern of emergency medical service by comparing the patterns of emergency medical service given by resident and staff during the doctors’ strike. Methods : We reviewed the medical records of patients who received emergency medical service in the Emergency Department(ED) of Deagu Catholic University Hospital during 3 days q week prior to the residents’ strike(July 21-23, 2000) with those of patients receiving emergency medical service during the first 3 days of the residents’ strike(July 28-30, 2000). We evaluated the patient’s severity, the cause of the ED visit, the performance on the laboratory study, ECG, and radiological study, the disposition, and the length of ED stay. Also, we compared the collected data by presenting doctor and by patient’s severity. Results : The staff performed fewer tests admitted fewer emergent and non-emergent patients than the residents. Also, the length of ED stay was shorter in both the emergent(212.76 vs. 321.40 minutes) and the non-emergent groups(117.68 vs. 171.39 minutes) for patients presenting to staff. Conclusion : It is desirable that emergency medical service is given by staff, not by resident.

노인정신장애 평가척도(Psychogeriatric Assessment Scale)의 한국판 표준화 연구

조맹제,박임순,신영민,김무진,정희연,정은기,최용성,조성진,서국희,함봉진 大韓神經精神醫學會 2000 신경정신의학 Vol.39 No.1

연구목적 : 본 연구는 치매와 우울증을 다차원적으로 평가할 수 있는 도구인 Psychogeriatric Assessment Scale(PAS)의 한국판(PAS-K)을 개발하기 위한 것이다. 방 법 : 번역, 역번역, 그리고 세차례의 예비조사를 통하여 PAS-K를 제작하였다. 60세 이상의 노인 291명(임상환자군 : 58명, 지역사회노인군 : 168명, 수용시설 거주자 : 67명)과 그들의 정보제공자들을 대상으로 PAS-K, Geriatric Depression Scale(GDS), Korean version of Mini-Mental State Examination(MMSE-K), Hamilton Rating Scale for Depression(HRSD), 그리고 Hachinski Ischemic Score 를 적용하고, Diagnostic Interview chedule(DIS-Ⅲ-R)을 사용하여 치매와 우울증을 진단하였다. PAS-K의 신뢰도와 타당도를 평가하고, 예민도와 특이도, Kappa값, 그리고 ROC커브 분석법을 이용하여 PAS-K의 6개의 소척도들(피검자면접 : 인지기능 장애척도, 우울척도, 뇌졸중척도, 정보제공자면접 : 인지기능 저하척도, 행동변화척도, 뇌졸중척도)의 최적 절단점을 구하였다. 결 과 : PAS-K는 높은 내적 일관성을 보였고, 검사자간 신뢰도도 만족할 만한 수준이었다. PAS-K의 소척도들을 다른 표준화된 검사도구들과 비교하였을 때 인지기능 장애척도와 인지기능 저하척도는 MMSE-K와, 우울척도는 GDS 및 HRSD와 유의한 상관관계를 보였으며, 뇌졸중척도는 Hachinski Ischemic Score와 통계적으로 의미있는 상관관계를 보였다. 최적절단점은 인지기능 장애척도 10점, 인지기능 저하척도 3점, 우울척도 5점, 피검자면접과 정보제공자 뇌졸중척도 모두 1점, 그리고 행동변화척도 2점으로 추정하였다. 결 론 : 본 연구를 통해 PAS-K의 신뢰도와 타당도가 검증되었고, 노인정신의학 역학연구나 보건분야에서 치매와 우울증의 임상경과관찰 및 일차 선별도구로서 유용하게 사용될 수 있게 되었다. Objectives : This study was designed to develop the Korean version of the Psychogeriatric Assessment Scale(PAS-K), a multidimensional screening tool for the dementia and depression. Methods : Through three times preliminary trials, the authors translated PAS into Korean. The PAS-K, Geriatric Depression Scale, Hamilton Depression Rating Scale, Hachinski Ischemic Scale and Mini-Mental State Examination-Korean version were administered to 291 subjects over the age of 60 and the same number of their informants(67 subjects were institutionalized, 168 subjects were in community, 58 subjects were psychiatric hospital patients). And the Diagnostic Interview Schedule(DSM-Ⅲ-R) was independently administered to exactly diagnose dementia and depression. The reliability and validity test, optimal cut-off point estimation for six each scale and ROC curve analyses were done to investigate the diagnostic validity of PAS-K. Results : Internal consistency and interrater reliability of the PAS-K were high. Concurrent validity of each scales of PAS-K was good in being measured with other standardized scales. The optimal cut-off points of each scale of the PAS-K were estimated as follows : 1) Stroke Scale of subject interview : 1, 2) Cognitive Impairment Scale of subject interview: 10, 3) Depression Scale of subject interview : 5, 4) Stroke Scale of informant interview : 1, 5) Cognitive Decline Scale of informant interview : 3, and 6) Behavioral Change Scale of informant : 2. conclusions : The PAS-K was valid and reliable screening tools for detecting dementia and depression. Therefore the PAS-K could be widely and extensively used in psychogeriatric epidemiological research or clinical setting of primary screening for dementia and depression.

초등학교의 지역간 시력차이에 관한 연구 : 대구 및 영천지역을 중심으로

진미선,석귀덕,신임희 韓國學校保健學會 2001 韓國學校保健學會誌 Vol.14 No.2

The study was carried out to estimate the prevalence and possible causes of refractive errors in primary school children. At one primary school in urban Daegu, one in the medium-sized city of Yongcheon and 2 in rural areas, children wearing glasses and children with visual acuity of less than 0.7 were given our questions. 354 out of 378 children responded to our questions. The research was done from March 2000 to February 2001. The data were analyzed by percentage, χ2 test, t-test, ANOVA and Scheff method. Children with eyesight problems were more prevalent in urban areas than rural areas. The lack of luminosity during reading (p=0.015), length of reading time (p=0.08) and posture which watching TV (p=0.023) appeared leading causes of progressing myopias. The visual impairment caused by refractive errors may affect the mental and physical activity of primary school children and lead to social isolation, loneliness and depression. However, little attention may be paid by professionals engaged in providing health care to the children. Once we have recognized the impact of visual impairment, we may be in a better position to prevent progressing refractive errors.

Sesquiterpene Components from the Flower Buds of Magnolia fargesii

Jung, Keun-Young,Kim, Dong-Seon,Oh, Sei-Ryang,Lee, Im-Seon,Lee, Jung-Joon,Lee, Hyeong-Kyu,Shin, Dong-Hyuk,Kim, Eun-Hee,Cheong, Chae-Joon The Pharmaceutical Society of Korea 1997 Archives of Pharmacal Research Vol.20 No.4

From the Chinese crude drug shin-i, the flower buds of Magnolia fargesii, four sesquiterpene, oplopanoe (1), oplodiol (2), homalomenol A (3) and $1{\beta},4{\beta},7{\alpha}$-trihydroxyeudesmane (4) were isolated. These structures were elucidated and the ${13}^C-NMR$ chemical shifts of these compounds were revised by means of various 2D-NMR techniques.