2003년 국내 중증급성호흡기증후군 진료 현황 및 문제점 분석

이진수,김은실,정문현,백제중,정선화,안주희,최영화,이선희,고철우,김성범,김민자,박승철,기현균,송재훈,최상호,김양수,이상오,조용균,박영훈,정숙인,김연숙,이흥범,손창희,장성희,정희진,김우주 대한감염학회 2004 감염과 화학요법 Vol.36 No.3

목적 : 2002년 말 중국에서 SARS가 발생한 이후 국내에서도 2003년 10월까지 총 3명의 추정환자, 17명의 의심환자가 보고되었다. 향후 추가적인 SARS의 유행이 우려되는 상황에서, 그간의 SARS 환자 진료에 있어서의 실질적인 준비사항, 진료 현황 등에 대한 조사를 통해 문제점을 파악하여, 향후 더 나은 대비가 될 수 있도록 개선점을 제시하고자 하였다. 재료 및 방법 : SARS로 의심되는 환자를 진료 경험이 있는 병원의료진을 대상으로 2003년 10월에 설문조사를 실시하였다. 설문에는 SARS 환자 진료 시의 실질적인 조치, 진료 현황, 병실, 응급실 및 외래에서의 격리 시설과 준비사항, 보건당국의 관리와 지원에 관한 사항을 포함하였다. 결과 : 대상이 되는 22개 병원 중 17개(17/22, 77.2%) 병원이 설문에 응하였다. SARS 환자를 위한 격리실은 응급실, 외래, 일반병실 및 중환자실에서 각각 9개(9/17, 52.9%), 5개(5/17, 29.4%), 15개(15/16, 93.7%), 4개(4/16, 25%) 병원에서 음압처리가 되어있지 않은 일인실 혹은 다인실이 사용되었고, 1개(1/16, 6.3%) 병원에서만 일반병실에서 음압격리실이 운영되었다. 입원환자의 진찰 시 개인보호구의 착용은 거의 모든 의료기관에서 이루어졌다. 보건당국에서 SARS지정병원의 시설 등을 사전에 확인한 곳은 1곳(1/12, 8.3%)이였고, 14개 병원(14/15, 93.3%)에서는 보건당국에 의뢰한 검사결과를 통하 받지 못하였다. 결론 : 의료기관에서 SARS 환자용 격리실뿐만 아니라 기존의 격리실 설비 등이 미흡하였으며, 특히 중환자실 및 외래의 준비가 더욱 부족하였다. 보건당국의 의료기관에 대한 종합적인 지원이 부족하였고, 병원과의 원활한 연계가 잘 이루어지지 않았다. SARS 만이 아닌 격리를 필요로 하는 질환의 적절한 진료를 위해 향후 병원 시설의 정비와 정부차원에서의 보다 구체적이고 실질적인 대책마련이 필요하다. Background : There was an worldwide outbreak of the Severe Acute Respiratory Syndrome (SARS) originated from China in late 2002. During that period three cases of suspected SARS and 17 cases of probable SARS were reported in Korea. With the concerns about the reemergence of SARS-coV transmission, it is important to be prepared for any possibility. So, this study is aimed to analysis the past measures in managing SARS and propose the amendatory plans to improve the preparedness. Materials & Methods : Questionnaires were collected among clinicians with any experience in managing the probable or suspected SARS cases in Oct. 2003. 17 out of 22 hospitals responded to the questionnaire. The contents in the questionnaire were practical activities, personal equipments, response plans, isolation facilities in emergency centers, outpatient clinics, general wards and intensive care units, and relationship with the public health department. Results : The dedicated isolation rooms in emergency centers, outpatient clinics, general wards, and intensive care units were prepared in 9 (9/17, 52.9%), 5 (5/17, 29.4%), 15 (15/16, 93.7%), and 4 (4/16, 25.0%) hospitals, respectively. Except for one hospital that newly made negative pressure room for SARS, single or multi-bed rooms without airborne infection control were used in all the other hospitals. The personal precaution principles were kept quite well in general wards. Before the designation of SARS hospital by the public health department prior evalution to see if the hospital was suitable for managing SARS was conducted in only 1 (1/12, 8.3%) hospital. The results of laboratory diagnosis were reported back in 1 (1/15, 6.6%) hospital. Conclusions : The isolation facilities which can control airborne infection were almost deficient not only for SARS but also for other respiratory transmissible diseases. For the infection control of transmissible diseases including SARS, more investment is needed on medical facilities and comprehensive support from the public health department required.

癩의 免疫에 關한 硏究 : 癩患者의 末梢血液 T 및 B 淋巴球 測定에 關한 硏究

殷熙哲,金原錫,金洪植,金道一 大韓癩學會 1981 癩學 會誌 Vol.14 No.1

대체의학 선택에 영향을 미치는 일반인들의 심리사회적 특성

유희정,노은여,이철,한오수 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.4

본 연구의 목적은 대체의학을 선택하는 사람들의 심리사회적 변인을 다차원상에서 분석해 봄으로써 이 요인들이 어떤 방식으로 선택 과정에 영향을 미치는가를 살펴보고, 대체의학을 선호하는 사람들의 특성을 탐색해 보는 것이다. 서울시에 거주하는 일반인 200명(남 92명, 여 108명)을 대상으로 인구 통계학적 특성, 대체의학에 대한 인지도, 정통의학 기법과 대체의학 기법의 특성, 경험한 대체의학 기법의 종류, 성격변인, 대처방식, 건강에 대한 통제감, 사회적 지지를 측정하였다. 본 연구결과, 연구대상 중 약 80%는 한약을 포함한 대체의학적 치료법을 경험해본 것으로 드러났다. 또한, 대체의학적 기법을 선호하는 사람들일수록 대체의학에 대한 인지도가 높고, 연령수준이 높으며, 적극적-행동적 대처방식을 지니고 있고, 건강에 대한 내적 통제감을 지닌 것으로 드러났다. 대체의학에 대한 관심이 급격히 증가하고, 정통의학 기법과는 달리 대체의학적 치료법의 선택에는 심리적인 요인의 영향이 크다는 점을 감안할 때 앞으로 이 분야에 대한 연구가 보다 폭넓게 진행되어야 하겠다. This study examined the characteristics of people who have preference for complementary medicine and also the psychosocial factors that are related to the selection of complementary medicine. Two-hundred subjects recruited from the community were included in this study. Demographic variables, medical service characteristics, health locus of control, social support, coping style, and personality characteristics such as self-esteem, neuroticism, and hypochon-driasis were measured. It turned out that nearly 80% of the subjects had already experienced at least one alternative therapy in the past. However, past experience was not significant in predicting future complementary medicine usage. People who were older in age, had more information about complementary medicine, used active-behavioural coping styles, and had internal locus of control were more likely to use complementary medicine in the future. Recommendations for furthur research is indicated.

도시 개발에 따른 기상장 변동의 3차원 수치해석에 관한 연구

이희철,이범주,이도훈,이은태 경희대학교 산학협력기술연구원 1999 산학협력기술연구논문집 Vol.5 No.-

학교구강보건실 운영 평가에 관한 연구

민희홍,신승철,서현석,김은주,김호선 대한구강보건학회 2003 大韓口腔保健學會誌 Vol.27 No.2

School dental clinic programs is the most active and effective programs to prevent the oral disease for school-children and it is one of the recommended programs by the advanced and welfare countries. In Korea, 15 primary schools have been established the school dental clinics in 1999 as one of the public oral health programs supported by the Ministry of Health and Welfares, and expanded more every year. 11 school dental clinics among 15 were participated for 2-years evaluation project. Such items as the structure, the process, the supply of dental services, the promotion of the health level and the community supports were evaluated through the standardization by governmental suggestions. Average score for 2-years evaluation was estimated as 81.35% as considerably good remark. In detail, score 4.74 for the structure, 22.10 for the process, 19.77 for supply of dental services, 26.22 for promotion of the oral health level and 8.53 for the community supports were calculated. In conclusion, school dental clinic programs in Korea were evaluated considerably good and they should be extended to all primary schools as possible.

우리 나라 보건관리대행서비스 평가 연구

하은희,조수헌,김선민,주영수,한상환,하미나,권호장,홍윤철,김창엽 大韓産業醫學會 1998 대한직업환경의학회지 Vol.10 No.1

Group occupational health service programme started in 1990 is one of the measures to cope with limited human and financial resources in occupational health. The programme has expanded rapidly to include 52 institutions, private as well as public, all over the country. In spite of its potential impact on health of employees and practice of occupational health in small and medium sized industries, comprehensive evaluation in terms of quality has not been tried. This study has aims to develop the criteria to assess the quality of newly developed group occupational health service programme, and to investigate the quality of institutions, and finally to develop policies for the quality improvement. 1) Criteria development : By defining occupational health services, in particular for small and medium sized industries, as one of the primary health care, followings are included as core elements of qualitative occupational health programme; accessibility, continuity, comprehensiveness, technical quality, intersectoral collaboration, emphasis on preventive services, community participation, and adequacy. Again each element is divided into five major components of national health system infrastructure developed by the World Health Organization; development of health resources, organized arrangement of resources, delivery of health care, economic support, and management. In turn, each component is categorized into three aspects of quality assessment, structure, process and outcome. Expert panel selected several criteria for each category to evaluate the programme. Criteria were modified according to each group of interviewees, to produce two sets of questionnaire, one for chief operating officer and another for nurses in the institutions, and the chief operating officer and workers in the workplace. 2) Subject : Of all 52 institutions, 25 voluntarily participated in the survey. At individual institution, chief operating officer and practicing nurses were interviewed in depth. After intensive education for interviewees, every interviewees, every interview was performed with standardized guideline and questionnaire. The quality of the 'Group occupational health service programme' was found to be lower than expected. Especially in continuity, comprehensiveness, technical quality, community participation and adequacy, lower quality in structural aspect was commonly identified throughout all the institutions,. Quality in terms of accessibility and continuity highly varied among institutions., To improve quality of the programme, more comprehensive and systematic programme such as accreditation has to be introduced. In addition, human resources, governmental fund and information systems for individual workers are to be developed. As a long range plan, integration of occupational health services into the national health systems and pooling of financial resources and planned allocation should be considered.

각주 콘크리트 공시체의 크기 효과에 관한 연구

강수철,은희창 제주대학교 산업기술연구소 2000 尖端技術硏究所論文集 Vol.11 No.1

The strength of concrete for design or core concrete for destructive test depends on several parameters including the size and type of specimen. The Korean and European Standard take φ15×30 cylindrical and 15cm cubic specimens for measuring the concrete strength, respectively. There have been rare attempts to decide the relationships according to the shape and size of squared specimens. Especially, it is incorrect to use the existing data due to the different material properties in Cheju from the others. Therefore, in this experimental study, we investigate the relationships and compare with the existing results. The experimental results will be utilized to grasp the material and mechanical characteristics of concrete in Cheju.

1999년도 전남 지역내 저소득층 주민암 검사 실시에 따른 암유병률 조사연구

선승철,박준영,장판기,이영춘,이은희 한국건강관리협회 2000 건협 Report Vol.3 No.-

사업장 근로자의 건강위험 평가도구 개발

홍윤철,임현술,하은희,정규철,조희숙,박혜숙,이용애 大韓産業醫學會 1998 대한직업환경의학회지 Vol.10 No.4

Health Risk Appraisal(HRA) is usually defined as a process by which we expect of individual's chances of death or acquiring specific diseases within a defined period of time. The concept of worksite as an area of health maintenance and promotion is newly developing. Our movement for health promotion of employees has been increasingly known in the worksite. The aim of this study is to develop health risk appraisal tools about health promotion at the worksite for employees. We performed this study by two steps; one step was to develop a HRA questionnaire of worksites in Korea, another was to evaluate the reliability of the questionnaire. For developing HRA questionnaire, we reviewed scientific examples at first, and then weighted the score by delphi. To evaluate the reliability of developed questionnaire, we carried out survey by test-retest method. A total of 131 employees completed HRA questionnaire on two times. The results are as follows. The total score of health risk in unhealthy workers was higher than that of healthy workers. The range of test-retest reliability of responses to the questionnaire was 0.57-0.94. Therefore it seems that this questionnaire was very suitable to assess the health behavior of workers. In conclusion, the developed HRA questionnaire can be used as a tool for evaluating health behavior and for providing health counseling materials.

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.