아미노글리코사이드 사용제한에 따른 병원성 균혈증 유발 그람음성간균의 내성변화 및 임상적 의의

오종택,김신우,손종원,도병훈,한승우,신병철,박지현,이종명,김능수 대한감염학회 2003 감염과 화학요법 Vol.35 No.4

목적 : 항균제 오남용으로 인한 내성균의 출현, 약물부작용의 발생 및 약제 비용의 증가는 환자 개인뿐만 아니라 사회적으로 문제가 되고 있다. 본 연구는 항생제의 오남용을 막기 위한 제도의 일환으로 시행한 아미노글리코사이드 사용 제한정책의 비용 효과적인 측면을 조사하고 그람음성간균에 의해 병원성 균혈증이 발생한 환자들을 대상으로 이 정책이 항생제 내성률과 환자 사망률에 미치는 영향을 연구하였다. 방법 : 930병상 규모의 3차 병원인 일개 대학병원에서 아미노글리코사이드 사용제한정책이 시행된 직후인 2002년 3월에서 9월 사이에 그람음성간균(Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae, Enterobacter aerogenes, Serratia marcescens, Stenotrophomonas maltophilia, Burkholderia cepacia)에 의해 발생한 병원성 균혈증 환자 60명(실험군)과, 이 정책이 시행되기 전에 입원한 환자들 중 균주별로 같은 수만큼 선별한 병원성 균혈증 환자 60명(대조군)의 의무기록을 후향적으로 조사하였다. 결과 : 아미노글리코사이드 사용제한정책이 시행된 시기인 2002년 3월에서 9월 사이에 처방된 아미노글리코사이드 사용량 및 비용을 이 정책이 시행되기 전인 2001년 3월에서 9월 사이와 비교한 결과, 아미노글리코사이드의 사용량(antimicrobial utilization density)은 사용제한 후 225.2에서 130.3으로 42% 감소하였고 약제 비용은 44% 감소하였다. 아미노글리코사이드 사용제한 후 병원성 균혈증을 유발한 그람 음성간균의 이 항생제에 대한 내성률은 유의한 변화를 보이지 않았으며 균혈증과 직접 연관된 사망률도 환자의 나이, 성별, 기저질환 및 원발병소 등을 보정할 경우 유의한 차이를 보이지 않았다(40.4% vs. 24.1%, P=0.11). 결론 : 아미노글리코사이드를 5일을 초과한 사용 시 감염전문가의 사전 승인을 필요로 하는 사용제한정책은 아미노글리코사이드의 사용량과 비용을 유의하게 감소시켰다. 또한 이 정책 시행 후 그람음성간균에 의한 균혈증 환자에서 균혈증으로 인한 사망률과 아미노글리코사이드에 대한 내성률은 유의한 차이가 없었다. Objective : To evaluate the effects of an aminoglycoside restriction policy on expenditures for aminoglycosides, antimicrobial resistance rates and clinical outcome of nosocomial bacteremia caused by Gram-negative bacilli (GNB). Methods : Starting in February, 2002, a prior consultation with an infectious disease specialist for using aminoglycoside antibiotics over 5 days was required in a 930-bed university hospital. In retrospective analysis of medical records 7 months after initiation of the aminoglycoside restriction policy, sixty cases of clinically relevant nosocomial bacteremia caused by GNB were found. These bacteremic patients were compared with sixty, species-matched, control patients with nosocomial Gramnegative bacteremia before the policy for total expenditures for aminoglycosides, susceptibility to antibiotics and clinical outcomes of bacteremia. Results : During the same period of 7 months before and after the restriction policy, total expenditures for aminoglycosides decreased by 44% in cost (from 465,030,841 Won to 259,618,337 Won) and the antimicrobial utilization density of aminoglycosides decreased by 42% (from 225,2 to 130.3). On the other hand, the patterns of antibiotic susceptibility and bacteremia-related in-hospital mortality rates after the policy did not show a significant change, compared with those before the policy. Conclusion : Antibiotic restrictions are among the most popular methods to diminish the practice of antibiotic overuse in hospitals. In this study, requirement for prior approval of aminoglycoside use over 5 days led to a significant decrease in the amount and cost of total aminoglycosides without a significant change in susceptibility patterns and bacteremia-related mortality rates.

한의진단명과 진단요건의 표준화 연구 II (표준화 실례) : 2차년도 연구결과 중간 보고

양기상,최선미,최승훈,안규석,박경모,박종현,김성우,신승호,정우열,전병훈,고현,김정범,신상우,김성훈,김동희,권영규,엄현섭,장혜옥 한국한의학연구원 1996 한국한의학연구원논문집 Vol.2 No.1

The diagnostic requirements were suggested and explained regarding the systems of differentiation of symptoms and signs in the second year study of standardization and unification of the terms and conditions used for diagnosis in oriental medicine. The systems were as follows; - differential diagnosis according to condition of body fluid, differentiation of syndromes according to the state of qi and blood, differential diagnosis according to relative excessiveness or deficiency of yin and yang(氣血陰陽津液辨證) - differentiation of diseases according to pathological changes of the viscera and their interrelation - analyzing and differentiating of febrile diseases in accordance with the theory of the six channels(傷寒辨證) The individual diagnosis pattern was arranged by the diagnostic requirements in the following order : another name(異名), notion of diagnosis pattern, index of differentiation of symptoms and signs(辨證指標), the main point of diagnosis, analysis of diagnosis pattern(證候分析), discrimination of diagnosis pattern(證候鑑別), a way of curing a diseases(治法), prescription(處方), herb in common use(常用藥物), diseases appearing the diagnosis pattern(常見疾病), documents(文獻調査). This study was carried out on the basis of the Chinese documents and references.

Adamkiewicz 동맥의 폐색에 의한 척수경색 1례

이광훈,이종걸,이태연,신동익,이성현,이상수,한설희,차상훈 대한신경과학회 1998 대한신경과학회지 Vol.16 No.4

의무행정과 교과과정 개발을 위한 선행연구

신종연,윤병준,김영훈 서울保健大學 1993 論文集 Vol.13 No.1

This study was carried out to develope the educational program of medical administration department, Seoul Health Junior College. For this study, educational subjects were derived from the job division analysis of a hospital(1200 beds teaching hospital). Questionaires were sent to the 150 numbers of graduates who finished the course of the above department from 1983 to 1992, and who are now employed in hospitals. Also other questionairs were sent to the chiefs of medical record, medical insurance, and hospital affairs departments in 120 numbers of teaching hospitals accredited by Ministry of Health & Social Affairs. The answers from 109 graduates and 86 department chiefs have been actually surveyded. 1. General characteristics It was found that female respondents were 77%, the respondents under 30 years of age were 81.6%, and 67.9% of the 109 respondents were employed in hospitals with over 300 bed capacity. The largest number of respondent(34.9%) were employed in the hospitals run by educational foundations, the smallest numbers(10.1%) were in national & public hospitals. The classification by the working period showed that the workers under two years of period had the higest rate(40.4%) and the workers over 6 years of period had the second rate(27.5%) Their major working fields in the hospitals were the departments of medical record(32.1%), hospital affairs(27.5%), and medical insurance (21.1%), respectively. 2. Degree of job difficulty When the difficulties of the job performed by the respondents were categorized into difficulty, moderate, easy, the proportion of the moderate job in which more respondents were actually working was found to be much larger that of moderate job classified by job analysis. Job difficulties classified by working fields were not statistically significant. 3. The utilization of professional knowledge 68.8% of respondents think that their professional knowledge is practically utilized. The utilization of professional knowledge classified by difficulty of job, the more difficulty the job is, the more utilized the professional knowledge is. The utilization of professional knowledge by working period, it is statistically significant for the respondents of over 5 years of period compared with those of under 5 years of period. 4. The satisfaction with professional knowledge When the utilization of and the satisfaction with their professional knowledge were compared, their patterns(the percentage of respondent) appeared to be almost the same in bed capacity, working-fields, degree of job difficulty, the duration of work period, but the satisfaction was considered to be lower than utilization in all above variables. 5. Subjects of study needed in fields Professional knowledge in medical terminology, practicum of medical insurance, and ICD coding were necessary in carrying out their works. Also graduates wanted to study more about practicum of medical insurance, computer science, and clinical pharmacology respectively. The graduates in hospitals wanted to study more about the subjects such as hospital planning, hospital marketing, employer & labor relations, purchasing management, but these subjects are excluded from the curriculum of medical administration department as a single subject. 6. Training & QJT after graduation 60.6% of respondents had the intensive training to make themselves familiar with the professional work after graduation. Computer fields commomly required more training(40.9%) and the training period was usually 2~3 months(46.9%). 36.7% of the surveyed graduates were job-trained and the larger the bed capacity was, the more OJT was given. The subjects most frequently studied in OJT were firstly the reimbursement of medical insurance and secondly computer science. The effect of OJT is positive in recognition of facts and rules, in behavior changes, in cost reduction and improving job practice. 7. Continuing education Korea air and correspondence university was preferred in order to continue education but this educational experience was not much useful for their professional jobs in general. So the need of continuing education in connection with their practical jobs was very high(74.8%) and 76.2% of surveyed graduates intend to participate in program if the above continuing education program is provided in the junior college. 8. Evaluation of hospital practicum The effect of hospital practicum in college according to the graduates' opinion was moderate degree and the first negative reason against hospital practicum was the unfaithful behavior of the hospital personnels toward the students. 44.2% of department chiefs in hospitals think that practicum period(3~4weeks) was not adequate. 23.2% of chiefs think that the practicum season(summer vacation) was not adequate, because they are very busy due to the summer vacation of hospital personnels and the increase of hospital patients. So they don't have enough time to teach students in that season. 82.6% of chiefs gave job orientation to students and 71% of them trained the students according to systemic teaching schedule including all the aspects of works of departments and only 58.1% checked the reports submitted by students at the end of their practicum. 9. Extending of hospital practicum period The opinion about extension of hospital practicum period to 2∼3 months was recognized positively by 47.7% of departments chiefs. The reasons for the extension were that hospitals should have enough time for their educational responsibility and through their adequately long training course can choose the capable personnel. The preliminary requirement for the extension of hospital practicum period are the development of practicum programs and evaluation devices, the consideration of hospital top manager about the educational function of practicum, and the question of practicum fee. 10. The systems of promoting the efficiency of hospital practicum suggested by department chiefs were: 1) to change the 2 year course of the medical administration department into the 3 year course, and make the hospital practicum of the last term an obligation. 2) to give the credits of hospital practicum in current educational system. 3) to extend the current practicum period. 4) to consider the internship in the certain hospitals after graduation. As a result of the study, the educational program of medical administation department should be devised to promote the followings: 1. In order to meet the satisfaction of professional knowledge, quantitative & qualitative chance for studying the subjects necessary for practical job should be strengthened. 2. In the revision of the curriculum, the inclusion of the subjects the respondents want to study as a single subject should be considered. 3. In order to promote the efficient continuing education for the graduates, the chance of education program for further study should be provided in junior college. 4. The actual problems arising in the current hospital practicum should be recognized, the alternative improvement should be sought. 5. In stead of depending upon the partial changes of curriculum, the total educational program should be reformed to get rid of current problems and forecast the future need.

정상아 분만과 비정상아 분만 산모의 특성에 관한 비교연구

신종연,윤병준,김영훈 서울保健大學 1992 論文集 Vol.12 No.1

This study was carried out to find the characteristics of the women who delivered abnormal newborn infant. For this study, medical records of 511 abnormal cases along with those of 438 normal controls of the same ages who delivered from Jan. 1988 to Dec, 1990. at 6 general hospitals in Seoul were surveyed. The results obtained were as fallows : 1. Maternal age was most largely between the ages of 25 and 29 years. 2. The gestional period of under 36 weeks was found in 2.1% of the control group, and that of 37 to 42 weeks in 97.9%, while in the case group 22.7% had the period of under 36 weeks and 77.1 % the period of 37 to 42 weeks. The difference was statistically significant. 3. Of the types of delivery in the control group, NSVD was 93.6%, cesarean section 5.0%. In the case group, cesarean section was 41.9%, NSVD 40.5%, vacuum extraction 13.7%. breech extraction 0.8%. The difference was statistically significant. 4. As for medical history, 96.1% of the control group had their medical history, but in the case group only 88.8% had theirs. The difference was statistically significant. 5. The obstetric problems found during prenatal care in the case group were more frequent than in the control group. The problems were antepartum haemorrhage, abruptio placenta and placenta praevia, hyper tension complication pregnancy, childbirth and the puerperium, early or threatened labour, prolonged pregnancy, twin pregnancy. 6. Delivery complications were found in 10.5% of the control group, but they were found in 76.7% of the case group. The difference was statistically significant. 7. The body weight of 14.7% of the infants delivered by the control group was found to be less than or equal to 2.9kg and that of 59.0% was 30~34kg. Of the infants of the case group, 43.7% was less than or equal to 2.9kg and 37.5% were 3.0 to 3.4kg. The difference was statistically significant. 8. The congenital anomaly was the highest incidence in the musculoskeletal system. The musculoskeletal anomaly was found in 14.7%, bulbus cordis anomalies and anomalies of cardiac septal closure in 12.1%, other congenital anomaly of heart in 12.1%, the congenital anomalies of limbs in 9.0%.

강재 슬릿형 댐퍼를 부착한 철근콘크리트조 골조의 거동

신종익,이정한,송한범,강대언,오상훈,차승렬,이용재,김상대,이원호 대한건축학회 2004 대한건축학회 학술발표대회 논문집 - 계획계/구조계 Vol.24 No.1(구조계)

This study investigates the performance of the reinforced concrete frame with the steel plate slit damper. The test was carried out to investigate the structural behavior between the reinforced concrete bare frame and the reinforced concrete frame with the steel plate slit damper. The test results showed that the energy absorption capacity of the damped-frame was several times larger than that of the bare frame. For the damage by the input energy is concentrated on the steel plate slit damper, the ductilities of the former structure were increased and the damaged frame can be reused after exchange the steel plate slit damper.

응급실을 내원한 구강악안면외과 안면골 골절 환자의 변화에 대한 비교 연구

신상훈,성화식,강영훈,황대석,김용덕,김욱규,김종렬,정인교 부산대학교 병원 암연구소 2008 부산대병원학술지 Vol.- No.24

Although there have been many clinical studies about the facial trauma in the recent as well as in the past, severity and frequency of facial trauma are reported multifarious. It seemed to be because of variety of social, cultural, and environmental factors, and the view point of investigators. In this study, we investigated about the patients visiting emergency room during recent 4 years(2004-2007), and compared with retrospective study during former 10 years(1992-1996, 1999-2003) in Dept. OMS Pusan National University Hospital. We assessed the cause, type, demographic, etc, and analyzed alterations of facial bone fractures during past 3 periods. The results were as follows. The total number of patients was increased. 429 patients treated for maxillofacial fractures between January 1992 and December 1996, 466 patients treated between January 1992 and December 1996 and 764 patients treated between January 2004 and December 2007. The male-to-female ratio were 4.6:1, 3.9:1, and 4.16:1, respectively. Patient in the age groups of 10-19 years and 20-29 years increased in the latter two periods. Assaults and falls are decreased gradually, but slip down s are increased. Traffic accidents are still major cause of facial trauma. The mandibular fractures showed the highest incidence thorought three periods. Symphysis fractures of mandible was increased and condyle fractures of mandible was drecreased in the third period.

초고층건축물의 공공성 증진을 위한 계획방향에 관한 연구

신중진,임창복,류훈,박종현 대한건축학회 2004 대한건축학회논문집 Vol.20 No.10

The purpose of this study is to suggest the planning strategy of super tall building for publicness improvement in the points of urban, local and environmental level As a result is summarized with 8 theme, content is following as First, skyscrapers plan to consider urban grad and local character Second, urban landscape plan to promote city identity and image Third, context plan to consider local history and culture Fifth, pedestrian network plan to link near site and district Sixth, pedestrian environment plan to promote physical and sensibility Seventh, the security of residential environment and insurance of residential amenity In last, consideration to prevent corruption of surrounding local environment

가막사리(Bidens tripartita L.)와 미국가막사리(Bidens frondosa L.) 종자의 발아에 미치는 몇가지 요인

신혜정,신종섭,김지훈,김학윤,이인중,신동현,김길웅 경북대학교 농업과학기술연구소 1999 慶北大農學誌 Vol.17 No.-

The experiments were conducted to determine the factors such as light and darkness, phytohormone and seed coat, influencing on seed germination of Bidens tripartita L. and B. frondosa. The seeds of both species were germinated when seed coat was damaged and weakened GA3 and BA stimulated germination of both species but ABA and IAA had no effect on germination of them, which ranged 50.0% to 80.0%. In B. forndosa, when inner layer of seed coat was removed, germination was highly promoted up to 96.7% compared with 10.0% germination rate in another treatments.

경계층 난류박리의 제어에 관한 연구 : 제1보;매끄러운 2차원 디퓨저 벽면에서의 난류박리특성 First Report;Turbulent Separation Characteristic on the Smooth 2-Dimensional Diffuser Wall Surface

신정관,박종일,이한영,김경훈 경희대학교 산학협력기술연구원 1995 산학협력기술연구논문집 Vol.1 No.-

The structure of the turbulent wall layer developing into flow separation was studied. The experiments were performed to find out the formation of turbulent separation lead to diverging of the diffuser wall in a two-dimensional asymmetric diffuser which was attached to a downstream end of a long straight channel to provide a fully-developed turbulent inlet condition. First report, this is to estimate how to develop the region of the separation in the smooth diffuser wall with diverging condition and then is the reference on the characteristics of rough diffuser wall being under discussion at second report. As a result, static pressure profile of the fixed wall are in accord with the static pressure profire of the movable wall. Separation has broken out at the diffuser open angle θ=7o, while the diffuser openingangle is increasing, the region of the separation is advanced at the upstream and separation appears at the diffuser open angle θ=12o in the fixed wall too.