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.

Variation in clinical usefulness of biomarkers of acute kidney injury in young children undergoing cardiac surgery

Baek, Hee Sun,Lee, Youngok,Jang, Hea Min,Cho, Joonyong,Hyun, Myung Chul,Kim, Yeo Hyang,Hwang, Su-Kyeong,Cho, Min Hyun The Korean Pediatric Society 2020 Clinical and Experimental Pediatrics (CEP) Vol.63 No.4

Background: Acute kidney injury (AKI) is one of the most significant postoperative complications of pediatric cardiac surgery. Because serum creatinine has limitations as a diagnostic marker of AKI, new biomarkers including neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and interleukin-18 (IL-18) are being evaluated to overcome these limitations and detect AKI at an early stage after cardiac surgery. Purpose: This study aimed to investigate the clinical usefulness of these biomarkers in young children. Methods: Thirty patients with congenital heart diseases who underwent cardiac surgery using cardiopulmonary bypass (CPB) were selected, and their urine and blood samples were collected at baseline and 6, 24, and 48 hours after surgery. Serum creatinine and blood urea nitrogen levels as well as NGAL, KIM-1, and IL-18 levels in urine samples were measured, and clinical parameters were evaluated. Results: Of the 30 patients, 12 developed AKI within 48 hours after cardiac surgery. In the AKI group, 8 of 12 (66.6%) met AKI criteria after 24 hours, and urine KIM-1/creatinine (Cr) level (with adjustment of urine creatinine) peaked at 24 hours with significant difference from baseline level. Additionally, urine KIM-1/Cr level in the AKI group was significantly higher than in the non-AKI group at 6 hours. However, urine NGAL/Cr and IL-18/Cr levels showed no specific trend with time for 48 hours after cardiac surgery. Conclusion: It is suggested that urine KIM-1/Cr concentration could be considered a good biomarker for early AKI prediction after open cardiac surgery using CPB in young children with congenital heart diseases.

얼굴 영상 생성을 위한 고유 공간 모델링

김경수,강오형,이양원 群山大學校 情報通信技術硏究所 1997 情報通信技術硏究論文集 Vol.1 No.-

In this paper, we suggests a novel approach which modifies facial images by utilizing eigenvectors without facial image analysis. Eigenvectors are often used in face recognition and expression understanding, since they exhibit good statistical characteristics of a given population. Especially we present how to employ eigenvectors to reconstruct novel facial images. For this purpose, weight vectors in an eigenspace are modeled to from weight vector database and weight vectors in this database are then applied to facial images to generate desired outputs.

장기간 항갑상선제 투여 후 임의 중단 뒤 재복용시 발생한 무과립구증 1 예

김승만;김태영;박수영;배영환;서영경 정은주;김태균;권민정;박정현;이순희 인제대학교 2011 仁濟醫學 Vol.32 No.-

Agranulocytosis, one of the major side effects of antithyroid a gents, probably occurs in less than 0.25% of cases treated with antithyroid agents. It usually occurs within the first several weeks or months after the initiation of therapy, when drug dosage is higher. Most reported cases of agranulocytosis have occurred during the first 3 months of therapy. We describe here a rare case that did not experience the side effect for 6 years of antithyroid agent treatment but presented with agranulocytosis in one month after re-exposure. It suggests that the major side effect such as agranulocytosis can occur in patients who had undergone prior uneventful antithyroid drug therapy.

초등학교 고학년 학생의 구강보건에 관한 인식 및 행동

김영경,문혁수,정재연,한수진,이병진,김은경,정혜련 韓國學校保健學會 2001 韓國學校保健學會誌 Vol.14 No.1

The purpose of this study was to collect basic data for the development of effective oral health education program in elementary school. The subjects in this study were 604 fourth-year, fifth-year and sixth-year students of an elementary school in Seoul. Oral health awareness and behaviors were surveyed and analyzed. The findings of this study were as follows: 1. The most common time for toothbrushing was after dinner(62.0%) and before bedtime(62.3%). By school year, the largest number who brushed their teeth after dinner were fourth and fifth graders while the greatest number who did so after breakfast were sixth graders Seventy-four percent of respondents brushed the teeth twice or more a day. By school year, the fifth-year students brushed their teeth the least while girls outperformed the boys in daily toothbrushing frequency(p<0.05). Regarding the intake of cariogenic food, 62.1% took that kind of food once or more a day. By school year, the fifth graders took the most (p<0.05), and girls took more cariogenic food than the boys(p<0.05). 2. Ninety percent of the respondents had visited a dental clinic. By grade, the sixth-year students had visited a dental clinic more frequently and girls more frequently than boys. Eighty percent of the respondents visited a dental clinic to receive treatment but just 12.3% visited a dental clinic to prevent oral diseases. Concerning the fetor of dental treatment only 14.4% expressed fear. School year made no difference, yet the percentage of girls who experienced fear was higher than that of boys(P<0.05). Regarding preventive treatment, 39.7% experienced pit and fissure sealing and 24.2% experienced the application of fluorides. All the students hadn't much experience in preventive treatment regardless of school year -- gender didn't make a difference. 3. Fourty-six percent of respondents had a preference for the fluoride mouth rinsing program; 38.4% wanted that grogram to continue. As to the reason for preference, 38.2% preferred it because of the prevention of dental caries, 43.0%, the largest percentage, didn't favor it because they found it too much trouble to do(some of the respondents gave two different answers). 4. Despite an increase in the frequency of toothbrushing at the right time, they still took cariogenic food frequently Their visit to a dental clinics also aimed at treatment more than at prevention, and they had very narrow experience of preventive treatment. Furthermore, the fluoride mouth rinsing program failed to draw their interest. Therefore, it is recommended that a successful real health education program should be developed.

[논문]병렬 유전 알고리즘을 이용한 발전기 기동정지계획

김형수,문경준,박준호 釜山大學校生産技術硏究所 2003 生産技術硏究所論文集 Vol.62 No.-

본 논문에서는 병렬 유전 알고리즘을 이용한 발전기 기동정지계획을 제안한다. 최소 기동 및 정지 시간 등과 같은 다양한 발전기의 제약조건을 만족시키면서 발전기 기동정지계획을 수립하는 문제는 비선형적이며 많은 국부해가 존재하므로 최적해를 탐색하는데 많은 시간이 소요된다. 이러한 문제점을 해결하기 위해 16개 의 프로세서를 가진 병렬 시스템과 이를 이용한 병렬 유전 알고리즘을 제안하였으며, 제안한 방법의 효용성을 검토하기위해 10기 및 26기의 전력계통에 적용하여 시율레이션을 시행하였다. 시율레이션 결과 기존의 방법에 비해 탐색속도를 개선하였고 우수한 해를 구할 수 있었다.

휴전선 인접 마을의 새마을운동 사례를 통해 본 1970년대 한국 농촌사회 정치·경제적 변화 : 강원도 철원군 사곡2리와 군탄1리를 중심으로

김수경,최은봉 이화여자대학교 2005 사회과학연구논총 Vol.14 No.-

이 논문은 1970년대 권위주의 유신체제 하에서 농촌근대화를 목적으로 추진되었던 새마을운동이 한국 농촌사회에 어떠한 정치적·경제적 변화를 초래하였는지 살펴보는 것을 목적으로 한다. 실증적인연구제시를 위해 강원도 철원군 근남면 사곡2리와 갈말면 군탄1리 두 마을의 새마을운동을 사례로 분석하였다. 이 사례연구는 한수이남에 집중되어 있던 기존 새마을운동 연구의 공간적 범위를 휴전선인접지역까지 확장시켰다. 1970년대 당시 두 마을 새마을지도자들과의 인터뷰 자료와 현재 마을회관에 남아 있는 새마을운동사업 기록을 토대로 마을간 사업추진 방식과 두 마을 주민들의 참여태도, 사업성과 둥을 분석하였다. 철원군 근남면 사곡2리와 갈말면 군탄1리의 새마을운동 전개양상은 마을의 입지조건 및 마을 구성원의 차이에 따라 상이한 결과로 나타났다. 사례연구의 케이스가 협소하긴 하지만, 이 연구를 통해서 새마을운동이 직 ·간접적으로 농촌사회에 가져온 변화를 찾을 수 있었다. 새마을운동은 마을 단위로 진행되었기 때문에 동일 지역에서도 마을구성의 상이한 조건적 차이로 인해 새마을운동의 결과도 다르게 나타났다. The objective of this thesis is to see political and economic changes in Korean rural society in 1970s when Saemaul Undong(Movement) was launched by authoritarian government for the modernization in an agricultural district. This paper focuses on Saemaul Undong in two villages of Cheorwon, Kangwon Province or Sagok2-ri and Cuntanl-ri in order to provide actual evidence. Based on the interviews of two towns' then Saemaul Leaders and the information on Saemaul Undong of those areas during the 1970s, this research analyzes people's attitudes, the way of the Movement and the achievement of the Movement. In addition, this paper emphasizes on some changes in political and economic areas of the two villages for about 8 years, comparing to before and after the movement being implemented. They have similarities as well as differences in the stages of Saemaul Undong. firstly, it led the dwellers to actvely participate in the process. Secondly, the residents could express their opinion to the government through the town meefngs. Thirdly, newly-elected leaders, called Saemaul Undong leaders were main actors who are at the center of the course. Although they took the helm just within the Saemaul Undong project, their capacities resulted in various consequences of the Movement under the autonomy of the town unit. Apart from other changes, it altered the appearances of the rural communities. It came to build new roads, convert old houses to modernized ones. It is difficult to say that Saemaul Undong has drawn the actual increase in the economic incomes. However, development in the repairing facilities in it played a key role in going up in the crop productivity, Therefore, it is fair to say that Saemaul Undong had a positive effect on the agricultural economy to some extent.

남자 대학생의 음주 형태 변화에 영향을 미치는 유전적, 심리사회적 요인

김시경,이수경,김민경,이상익 大韓神經精神醫學會 2007 신경정신의학 Vol.46 No.4

Objectives : This study aimed to determine the general predictive factors of change in drinking behavior and to provide materials for preventing drinking problems during early adulthood through examining genetic and psychosocial factors affecting the change of drinldng behavior in college students. Methods : The subjects were 101 male college students, apart of 534 students who had completed the previous study in 2000. In the present study as a 6-years follow up, we reassessed the drinking pattem and psychosocial variables and compared the results with previous data of the same subjects. To identify factors affecting the current drinking pattem, we used stepwise multiple regession and logistic regression analysis. Results : D allele (ALDH2) was found to reduce the degree of drinking and suppress problematic drinking, and C allele (TPH) had a suppression effect on problematic drinking. Drinking motive had a direct effect on the degree of drinking and Pro-blematic drinking. Negative cognitive expectancy had a direct effect on problematic drinking. Conelusion : Authors found some factors affecting the change of alcohol drinking behavior in college students and confirmed that there were hierarchies of significance among these factors. These may be applicable as variables for predicting drinking behavior in early adulthood.

부모의 양육태도가 고등학생의 자아존중감 및 자아탄력성에 미치는 영향

김경수,김화경 韓南大學校 敎育硏究所 2011 교육연구 Vol.19 No.2

본 연구는 고등학생이 지각한 부모 양육태도와 자아존중감 및 자아탄력성과의 관계를 알아보기 위한 연구이다. 이를 위해 충청남도에 소재한 인문계, 전문계 고등학교(4개교)의 1, 2학년 남학생과 여학생을 대상으로 490부의 설문 조사를 실시하였다. 설문 조사의 문항은 응답자 기초조사, 부모의 양육태도, 자아존중감, 자아탄력성 순으로 배치하였고 양육태도 척도, 자아탄력성 척도, 자아존중감 척도를 사용하였다. 수집된 자료 처리 및 분석은 SPSS/PC WIN 15.0 통계 프로그램을 사용하여 고등학생이 지각한 부모의 양육태도, 자아존중감 및 자아탄력성과의관계를 살펴보기 위해 상관분석과 회귀분석을 실시하였다. 연구결과를 요약하면 다음과 같다. 자녀들이 지각하는 부모의 양육태도는 자아존중감과 자아탄력성에 영향을 미치는 중요한 요인이 되며, 자아존중감과 자아탄력성의 관계는 자아존중감의 모든 하위 요인에 걸쳐 유익한 정적 상관을 보이는 것으로 나타났다. 이를 통해 청소년들의 건강한 성장발달을 돕는 부모의 바람직한 양육태도에 대한 중요성을 제시하고자 한다. This study aims to know of relation between perceived parental rearing attitude and self-esteem and ego-resilience. For this study, with male students and female students in the first and second grade, who go to general high school and vocational high school in Chungnam province, questionnaire was carried out. Questionnaire to know of parental rearing attitude, self-esteem scale and ego-resilience scale was carried out. And then, in order to analyze data collected, using SPSS/PC WIN 15.0 program, correlation analysis and regression analysis were carried out. The results of the study are as follows; In relation between parental rearing attitude and self-esteem and ego-resilience, when parental rearing attitude was affective, selfish and well-achieved, self-esteem and ego-resilience had both high correlation. And, self-esteem and ego-resilience showed meaningful correlation across all the subordinate variables of self-esteem. This study shows a foundation to perceive an importance of parental roles to help physical development of their children.

환자진료와 성과측정 중심의 의료기관 평가제도 : 미국, 캐나다 의료기관 신임제도의 최근 동향 The recent trends in Healthcare Organizations Accreditation in the United States and Canada

김수경 한국의료QA학회 1995 한국의료질향상학회지 Vol.2 No.1