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.

당뇨병성 합병증을 가진 환자에서 혈증 Erythropoietin 농도

김동규,유기동,허광식,김상용,윤성호,조영신,권용은,김태원,김건영,정종훈,배학연 조선의대 1998 The Medical Journal of Chosun University Vol.23 No.1

Fluphenazine Decanoate의 治療經驗 第 3 篇 錐體外路症床과 經口用 抗精神病藥物의 治療經歷

金光日,金容植 大韓神經精神醫學會 1980 신경정신의학 Vol.19 No.4

The authors have tried to evaluate the incidence of extrapyramidal side reactions between acute schizophrenic and chronic schizophrenic groups in converting of oral antipsychotic medications into fluphenazine decanoate injection. The acute group consisted of 15 acute schizophrenics whose history of previous oral antipsychotic medication was less than 3 months. And the chronic group was 24 chronic schizophrenics whose history of, oral medication was more than one year. Ayd's method was applied to the all patients; in converting of oral antipsychotics into the depot form, the full estimated dose of fluphenazine decanoate was given for the initial shot after two days of clearance of oral medications. DiMascio's rating scale was used for evaluation of extrapyramidal symptoms. Extrapyramidal symptoms such as rigid facial expression, tremor, akinesia, rigidity, akathisia and dystonia were noticed to be 80 percent in the acute group and 45.8 percent in the chronic group. This difference was significant on the level of 0.02. It was proved that the patient group with a long-term history of previous oral antipsychotic medication revealed a lower incidence of extrapyramidal side reactions compared to the group with a shorter history of previous oral medication. For a safer dosage regimen even in the chronic patient group, however, it is recommended to start the regimen with very small test dose and to increase gradually up to 1cc as required, because this low-dose regimen manifested extrapyramidal symptoms in 10 or 19 percent from the previous trials(Kim-1979, Kim & Kim-1980).

Consumption Trends and Prospects of Fermented Soybean Products in Korea

Yong Sik Cho,Sang Lae Lee,So Young Kim1,Shin Young Park,Sun Hee Kim,Eun Suk Jung 한국식품영양과학회 2017 한국식품영양과학회 학술대회발표집 Vol.2016 No.10

가토에서 일측 요관 부분 및 완전폐색시 신장과 요관의 조직학적 변화

김상현,김용웅,육승모,한동석,노안식,임재성,김홍식,나용길,설종구 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

This study was designed to clarify histologic changes in the experimental rabbit kidney and ureter after unilateral partial or complete ureteral obstruction. A total of 20 adult white rabbits were divided into 4 subgroups in the partial obstruction followed by 2 weeks, the partial obstruction followed by 4 weeks, the complete obstruction followed by 2 weeks, and the complete obstruction followed by 4 weeks. The normal control group was consisted of 5 adult white rabbits. The kidneys and ureters for light microscopy were fixed in 10% neutral formalin, embedded in paraffin and stained with hematoxylin and eosin. Abnormal histologic fingings showed in ipsilateral kidney and ureter of all subgroups(such as dilatation of uriniferous tubule, focal necrosis and desquamation of epithelium, interstitial fibrosis, glomerular congestion, widening of Bowman's space, dilatation of ureter, epithelial cell atrophy or loss, interstitial fibrosis and interstitial inflammation). These findings were most severe in the group of the complete-obstructed ureter for 4 weeks. No significant changes showed in contralateral ureter of all subgroups. The degree of obstruction was severe and period of obstruction was long, the histological changes in ipsilateral side were severe. Despite of changes in ipsilateral side no abnormal findings showed in contralateral side. We suggest that long term experimental investigation of histologic changes in ipsilateral side and compensatory changes in contralateral side have to be studied.

생체분해성 망막압정을 이용한 망막고정에 대한 실험적 연구

김용백,민병무,김창식,박근성,김승영,길숙종,조항진,이성복,노승무,송규상,강대영,조준식,양준묵,정경수,최선웅,이진호,김학용,인현빈 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

Biodegradable retinal fixation devices obtain mechnical fixation of the retina with desirable chorioretinal scarring and with the potential for local, sustained release of antimetabolites and steroids to inhibit proliferative vitreoretinopathy. We manufactured a biodegradable retinal tack with barb that was designed in order to prevent intrusion from implantation of retinal tacks. This study was carried to evaluate the efficacy for retinal fixation and the capability for sustained release of drugs with a newly designed biodegradable retinal tack Biodegradable retinal tacks were made of polymers of glycolic acids and were designed with barbs in a shape to prevent the disinsertion. Biodegradale retinal tacks are divided into 3 parts, a conical portion that is inserted into the sclera, a cylinder portion that remains in the vitreous, and a neck portion between the pin and the cylinder. The tapered conical end was manufactured to allow easy insertion through the retina and choroid into the sclera. A cylinder portion was manufactured with a tapered angle that fixes firmly into the orifice of 19 gauge spinal needle. A neck portion, 0.4 mm in diameter, was designed to prevent disinsertion from following implantation of retinal tack. The applicator was a 19 gauge spinal needle and its orifice was prepared to 15°angle to accept the tapered cylinder portion of the retinal tack. The retinal tacks, secured in the needles, were passed through the formed vitreous and inserted into the retina, choroid, and sclera and were released by pushing the internal needle, usually within 2-3mm of the medullary ray of the posterior rabbit retina A retinal tack was placed in each of 8 pigmented rabbit eyes. Slit-lamp biomicroscopy, indirect ophthalmoscopy and fundus photography were performed periodically from 1 day to 8 weeks after surgery. Eight eyes were enucleated and studied by light microscopy at 8 weeks. Biomicroscopic evaluation of the animals revealed edemas adjacent to the retinal surfaces immediately after insertion of the biodegradable retinal tacks in all the animals. These edemas disappeared after 1 week. The first noticeable change in the size of retinal tacks was shown after 2weeks. The size of the retinal tacks gradually got smaller, decreasing to about one-half at 4 weeks and about one-third at 8 weeks. All retinal tacks remained in inserted places without any movement for an 8 week period. On light microscopy, epiretinal proliferations were seen to extend into the vitreous cavity. Cellular capsules that lined the inner aspect of the scleral defect caused by tack insertion were found. However the adjacent retina had a normal cytologic appearance and architecture in all specimens. We manufactured a biodegradable retinal tack that is designed to prevent intrusion from implantation of retinal tacks. All biodegradable retinal tacks reduce in size with time, but no retinal tacks extruded from the inserted place. The newly designed biodegradable retinal tack can be used for retinal fixation and may be used as a vehicle for the introduction of pharmacologic agents to prevent the cellular events that promote proliferative vitreoretinopathy.

항정신병약물 사용 중인 정신분열병 환자에서 올란자판으로의 교체 방법에 관한 연구(II) : Comparison of Safety 안전성 비교

안용민,권용실,권준수,민성호,박두병,양문정,소형석,송종호,신윤식,우행원,유범희,이홍석,정한용,한창환,김용식 大韓神經精神醫學會 2002 신경정신의학 Vol.41 No.5

연구목적: 이 다기관 공동임상연구는 사용 중인 항정신병약물을 ’직접 교체 방법’또는 ’시작-감량 교체 방법’중 한 가지 방법으로 올란자핀으로 교체한 후, 안정성 측면에서 두 교체 방법 간의 비교와 교체후의 변화를 관찰하기 위한 것이다. 방법: 국내 13개 병원의 입원 및 외래에 내원한 환자들 중 ICD-10 지단기준으로 정신분열병에 해당되며, 임상적으로 항정신병약물 교체가 필요한 환자를 대상으로 하였다. 두 가지 교체 방법 중 한 가지를 무작위로 피험자에 적용하였으며, ’직접 교체 방법’에 배정된 경우에는 사용중인 항정신병약물을 일시에 중단하고 10㎎의 올란자핀을 바로 투여하였고, ’시작-감량 교체 방법’에 배정된 경우는 10㎎의 올란자핀 투여하고 2주에 걸쳐서 기존 약물을 감량하여 중단하였다. 올란자핀 사용기간은 총 6주이며, 용량은 5∼20㎎ 범위로 제한하였다. 한정성 평가를 위해서 체중, 생명징후, 자발적인 이상반응 복, 실험실 검사 그리고 Simpson-Angus Scale(SAS), Barnes akathisia rating scale(BARS), Abnormal involuntary movement scale(AIMS). Liverpool University neuroleptic side effect rating scale(LUNSERS)등을 이용하였다. 결과: 총 103명의 정신분열병 환자를 대상으로 하였다. 사용한 올란자핀의 용량, 벤조디아제핀의 병용률, 탈락률과 탈락 사유, 자발적인 이상반응 보고, 생명징후, 실험실 검사 그리고 대부분의 부작용 척도 상에서 임상적으로 의미 있는 차이를 두 교체 방법간에 발견하지 못하였다. 다만 AIMS의 감소는 ’직접 교체 방법’군에서 보다 적었고, 항콜린제의 병용률은 ’시작-감량 교체 방법’군에서 보다 많았다. 기저 상태에서 전체 피험자의 SAS와 BARS 점수는 각각 3.5점과 1.8점이었으며 70% 이상의 피험자가 고프로락틴 혈증을 보였다. 올란자핀으로 교체한 후, SAS, BARS, AIMS 점수의 유의한 감소가 있었으며 고프로락틴 혈증을 보인 피험자 분율도 약 30%이하로 감소하였다. 그러나 교체 방법과 상관없이 올란자핀 교체 후 유의한 체중 증가가 있었다. 결론: 이 연구를 통해 교체 방법에 관계없이 비교적 안전하고 용이하게 올란자핀으로 교체 할 수 있음을 알 수 있었다. 그리고 기존 항정신병약물을 올란자핀으로 교체함으로써 일부 부작용들을 줄일 수 있음을 간접적으로 관찰할 수 있었다. 하지만 이 연구는 여러 제한점과 문제점을 지니고 있기 때문에 보다 체계적인 연구를 통해 검정이 필요하리라 생각된다. Objectives: This multicenter clinical trial involving 13 hospital sites compared the safely of switching to olanzapine between ’direct switching method’ and ’start-tapering switching method’. Method: This study included both inpatients and outpatients who fulfilled the criteria for schizophrenia as defined in the ICD-10, and were in need to be appropriate for switching antipsychotics. Subjects were randomly assigned to one of the two switching methods. For ’direct switching method’group, previous antipsychotics were abruptly discontinued and 10㎎ of olanzapine was administered, and previous antipsychotics was gradually tapered for 2 weeks. Olanzapine was used for 6 weeks and the dose was adjusted within the range of 5-20㎎. The safety of switching to olanzapine was measured with vital sings including body weight, adverse events reported spontaneously, laboratory tests, and various scales such as Simpson-Angus Scale(SAS), Barnes Akathisia Rating Scale(BARS). Abnormal Involuntary Movement Scale(AIMS), and Liverpool University Neuroleptic Side Effect Rating Scale(LUNSERS). Results: 103 patients were switched to olanzapine in this study. The comparison between two switching methods did not show any significant difference in the dosage of olanzapine used, the concomitant use of benzodiazepine, the rate and reasons of drop-out, the adverse events, vital signs, laboratory tests, and most scales for measuring side-effects. However, the decrease in AIMS scores was significantly lower in ’direct switching method’ group, and the concomitant use of anticholinergics was comparatively greater in ’start-tapering switching method’ group. At baseline, SAS and BARS scores were 3.5 and 1.8 points respectively, and more than 70% of the subjects showed hyperprolactinemia. After switching to olanzapine, SAS, BARS, and AIMS scores were significantly decreased and the proportion of the patients with hyperprolactinemia was also decreased to less than 30%. However significant weight gain after the treatment of olanzapine was observed regardless of switching method. Conclusion: This study may suggest that switching to olanzapine can be done with relatively high safety regardless of switching methods and olanzapine can significantly decrease some side-effects induced by other antipsychotics.

초음파검사자 기량검증 체제를 위한 다자비교시험

윤병식,양승한,김영호,김용식,양동순 한국비파괴검사학회 2004 한국비파괴검사학회지 Vol.24 No.4

국내 원자력발전소의 Class1과 Class2 배관검사에 적용할 수 있는 초음파탐상 검사자, 장비 그리고 절차서에 대한 한국형 기량검증(KPD) 시스템을 구축하였다. PD 방법을 적용한 검사결과와 전통적인 dB-drop 방법을 이용한 검사결과를 상호 비교하기 위하여 Round Robin Test(RRT)를 수행하였다. RRT 결과는 PD 방법의 신뢰성이 dB Drop 방법보다 우수한 것으로 나타났다. 이러한 결과로부터 원자력발전소 가동중검사에 PD 방법을 적용함으로써 초음파탐상검사 결과의 신뢰성이 더욱 향상될 것으로 기대된다. The Korean Performance Demonstration(KPD) System for the ultrasonic testing personnel, equipments and procedures applicable to the Class 1 and 2 piping examination for nuclear power plant in Korean has been established. A round robin test was conducted in order to compare the examination results by the method of Performance Demonstration(PD) with the traditional dB-drop method. As a result, adoption of the PD method to the in-service inspection of the nuclear power plants will improve the reliability of the ultrasonic test results.

공동주택 주동 형태와 주호 평면에 따른 자연환기량 분석 연구

김연정(Kim Yeon-Jung),김용식(Kim Yong-Sik) 대한건축학회 2007 대한건축학회 학술발표대회 논문집 - 계획계/구조계 Vol.27 No.1

Since 1991 as a part of the policy to solve housing problems and to narrow the gap between regions, the government enforced new town businesses starting with Bun-Dang including new regions like Pan-Gyo, Dong-Tan, Kim-Po, and Pa-Ju. As the supply of houses increased various arrangement forms are being planned to create better living environments. After the supply of apartments, many tower-type and linear-type buildings were built and the trend of a tower-type building is increasing as the understanding of a living environment is changing and also because of the consumer preference for apartments. However, unlike how cross ventilation is possible in a linear-type, the ventilation performance of a tower-type differs greatly in each position. Natural ventilation is formed by wind or the difference of temperature inside and outside a building. Especially, the shape of a building greatly effects the ventilation formed by wind. Natural ventilation not only improves the air quality inside a building by discharging polluted materials, but it also creates a pleasant heat-environment during summer without being dependent on other facilities. This study was focused on the analysis of the air flow from the exterior of buildings according to their shapes by using Computational Fluid Dynamic(CFD), and evaluation of the performance of natural ventilation from the plane of the standard floor. Then, the results are compared to find an efficient way of natural ventilation.

현훈 환자 Neuron Specific Enolase의 임상적 의의

김원주,김선곤,유철형,김원찬,김용덕,최영철,이명식 대한신경과학회 1998 대한신경과학회지 Vol.16 No.4