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.

釜山 政治地理의 硏究 : 地域 政治地理學의 한 試圖 An Attempt at Formation of Regional Political Geography

任德淳 釜山敎育大學 1974 부산교육대학 논문집 Vol.10 No.1

The objective of this article is to scrutinize the structure and developmental process of the Busan's political geography. The author also wants this artical to be a pioneer in systematizing a regional political geography of state's sub-areas in this country. The conclusions on political geography of Busan are as follows: 1. The particular landforms and geographical locations, especially relative location, of Busan are very influencial foundations for forming structure and developmental process of today's political geography of this city, Busan. 2. The shape of Busan, generally speaking, is a trapezoid-type. But the degree (index) of elongatedness is relatively high (242). Therefore, the local government of Busan has difficulty in administrating (controlling) total area of this city. 3. The boundary structure of Busan is mainly consisted of mountains, hills, and rivers (including brooks). Therefore, the concept of "naturally marked boundaries" can be formated from Busan's boundaries. Especially Mt. Gowon Kyon (Ku boundaries), Mt. Kuem Jung (Do and Ku boundaries), and Busan Bay (Ku boundaries) are highly used for demarcating boundaries. 4. The political central place of Busan determined by the agglomeratedness of adiministrative organizations, press agencies, broadcasting stations, and political parties is the district of 4 Ka, Joong Ang Dong. 5. The political status of Busan is high because of developed industries, highly formated political consciousness of people, and administrational status of this city, central-goverment's city. 6. A representative symbol (a part of iconography) of Busan to be constructed for integrating people's feeling or emotion in this city is Tower of Busan locating at Suh Myon circle. The integrative force of the tower yet is relatively weak. 7. Early Busan as a modern habor was a "forward-point-of-growth" for young imperial Japan having had expansionalism. The character of this forward-point-of-growth or "a good door to wide East Asia" was a moment for Busan's development during the period (till 1945) under Japanese control. 8. The Busan's function and history of state's temporary capital during the Korean War (1950-1953) was a determinent moment for this city to be in today's status, central-government's city. 9. The fact that Busan even now is a capital city of Kyongsang Nam Do (province) is a important factor for this city to grow large (powerful) abnormally.

인견사제조업 근로자에서 발생한 이황화탄소중독증 8예 분석

김순덕,송동빈,염용태 大韓産業醫學會 1989 대한직업환경의학회지 Vol.1 No.2

The authors have experinced 8 cases of chronic carbon disulfide poisoning in workers engaged in the viscose rayon industry during the period between March 1987 and September 1988. Cases of carbon disulfide poisoning has been reported in Korea till then. Carbon disulfide is primarily a neurotoxic poison, therefore those symptoms indicating central and peripheral nervous damage are very important. And it has toxic effects on the various organs such as skin, eye, ear, and respiratory, cardiovascular, gastrointestinal, hepatic, genitourinary, hematological, and endocrine system. Occupational histories were obtained, and clinical findings and laboratory findings were analysed on all cases. 1. Seven (7) cases had been exposed to carbon disulfide for more than 10 years, and 1 case has been exposed for 6 years. 2. Most common symptoms were neurological symptoms such as disturbance, extremity weakness, paresthesia, and speech disturbance. 3. Involvement of central nervous system was noted in 7 cases through abnormal findings of electroencephalography, brain computerized tomography, neurological signs, and psychological test. Needle electromyography and nerve conduction study showed polyneuropathy in all cases. Ophthalmological abnormalities were found in 7 cases, mainly retinal microaneurysms and peripheral constriction of the visual field. Renal damage appeared in 4 cases, increase of serum cholesterol and/or triglyceride level appeared in 3 cases, and decrease of erythrocyte and hemoglobin appeared in 2 cases. And hypertension appeared in 2 cases, and diabetes appeared in 1 case. One(1) case who has been exposed to carbon disulfide for 6 years showed polyneuropathy and peripheral constriction of the visual field.

서울의 首都類型 硏究

任德淳 釜山敎育大學 1976 부산교육대학 논문집 Vol.12 No.1

The purpose of this study is to provide information on the capital types of Seoul, Capital city of Republic of Korea, by menas of multicriteria approach. Such six criteria as the genesis, historical evolution, function, population-culture, location of capital city of Seoul, and governmental system of Rupublic of Korea are selected. Under this criteria-frame, such thirteen concrete indicators as before-after status, capital period, number of Staatsforms located in this capital, and so on are analized. The reason for application of this approach is based on the fact that as c capital city is a complex or compound result of social, political, spatial, and historical phenomena: phenomenon-complex, if simple criterion analysis approach is adopted, the result is likely to be partial or biased. The conclusion of this study are as follows: 1. Seoul is, in genesis, a artificial capital, This capital type is proved from before-and after status of the time when Lee Dynasty choosed Seoul(Hanyang)as a capital. This status indicator was subdivided into such several sub-indicators as capital facilities, aristocrat's consciousness to new capital, settlement status or condition, and primacy of Seoul at that time and analized. 2. Being viewed from historical evolution, Seoul is a great historic capital. This city has 582-years long history of capital. And three Staatsforms(2 gone away, 1 present) took this city their capitals. 3. Seoul is a head capital as wellas symbolic capital in function. The character of head capital is proved from high degree of political-administrative centralization and great power given to president who presides at Seoul. These centralization and great power of president are based on the constitution of Republic of Korea. And character of symbolic capital is found out of many national symbols which are at many sports at this city and being used symbolically for consolidating Korean people. 4. Seoul has 19.8-percent population of Korea and 2.8-times-many people to second large city, Busan. And capital city of Seoul has many culture-art facilities and historical symbols. It is, therefore, said that Seoul has high primacy in population-culture status, and accordingly is a primate capital in Korea. 5. Short distance (35Km) from Seoul to armistice line, a de-facto boundary line, government's will to defend the capital city and land of the Republic against communist aggression, and defensive landscapes concerned in vicinities of Seoul make this city a defensive frontier capital. 6. Historically, Kerea has had a unitary system of government and been a unitary state and culturally snified one as well. From these Seoul is proved to be a unitary capital.

Cu, CuCl, CuCl_2·2H_2O 의 X-線 K 吸收 Spectrum 들과 Cu 의 X-線 K 放出 Spectrum 의 構造

李悳源,程順和 成均館大學校 1983 論文集 Vol.33 No.-

Cu, CuCl, CuCl_2·2H_2O의 X-線 K吸收端 微細構造와 같은 波長領域에서의 Cu의 放出構造를 50㎝인 曲率반경을 갖는 구부러진 SiO_2(石英)結晶과 함께 Cauchois type으로 배열된 single crystal Spectrameter에 의해 사진 건판위에 얻었으며 그 構造들은 recording microphotometer에 의해 eV의 간격에 따른 曲線으로 그려졌고 諸硏究者들에 의한 자료와 비교조사 했다. 그 結果 Cu에 대한 Cu화합물의 K吸收端 微細構造의 變位를 測定했으며 그 領域에서의 放出構造와의 비교에서 K吸收端의 energy 位置가 Kβ_2 line의 位置와 거의 一致함을 확인했고 諸硏究者들에 의한 實驗 및 理論値와 비교 검토하였다. The K-absorption spectra of Cu, CuCl, CuCl_2·2H_2O were photographed by the single bented crystal Spectrometer which was arranged to the cauchois type. The K-emission spectrum of Cu were photographed too. The extended finestructures of Cu were compared with the previously reported theoretical and experimental values. The diflerence of the Cu K-absorption fine Structures of Cu in the pure Cu metal and Cu compounds were measured. The shift was found on the short wavelength side from K-absorption edge of Cu (non Compound). The Kβ_2 emission line was compared with the K-absorption edge.

종합병원 간호사의 부서이동 양상 및 직무만족도

김순덕,이성수,이병국 순천향대학교 산업의학연구소 1998 순천향산업의학 Vol.4 No.1

In order to investigate the characteristics of job transfer and job satisfaction of general hospital nurses and provide the nurse department the basic materials neccesary for efficient manpower management, 400 nurses were selected from two university hospital in chunan Choognam. The study subject was nurses who came from special nursing care unit such as intensive care unit and emergency room and general nursing care unit such as general surgery ward, orthopedic surgery ward and neurosurgery ward. The priod of this study was from February 2 to 28, 1998. The results of the study were as follows. 1. While 252 nurses(63.0%) had transfer experience, 148 nurses(37.0%) didn't have. Two hundred sixty five nurses(67.7%) wanted over 15 days for the preparation period before job transfer and 57.7% wished the periodical change of assignment and 19.5% wanted job transfer in present nursing unit. 2. While the cause of wanting job transfer were "defict of accomplishment and worth in job(84.6%)", "to acquire experience of other nursing unit(83.3%)", "unsuitableness of own's aptitude in job(73.1%)" respectively, the cause of unwanting job tranfer were "possibility of transfer to undesired nursing unit(87.9%)", "satisfaction of present nursing unit(84.8%)", "anxiety of new nursing unit(73.0%)" respectively. 3. The mean score of opinion of job transfer effect was 3.1. Among these opinions the mean scores of professional development, employee' common desire, and management were 3.3, 3.0, and 3.0 respectively. 4. The mean score of opinion of job satisfaction was 3.0. Among these opinions the mean scores of interaction, professional status, autonomy, and task requirements revealed to be high, and were 3.6, 3.6, 3.1 and 3.0, respectively, and those of pay, administration, and doctor-nurse relationship showed to be low, and were 2.7, 2.7, and 2.5, respectively. 5. According to position. work duration. nursing unit, there were statistical difference among job satisfaction such as pay, professional status, doctor-nurse relationship, administration, autonomy, task requirements, and interaction. 6. The spearman correlation coefficients of professional development category on the effect of job transfer with job satisfaction were administration (rs=0.159, p=0.0014), autonomy(rs=0.142, p=0.0043), and task requirement(rs=0.139, p=0.053), respectively, The spearman correlation coefficients of administration-management category on the efffect of job transfer with job satisfaction were administration(rs=0.276, p=0.0001), autonomy(rs=0.246, p=0.0001), and task requirement(rs=0.236, p=0.0001), respectively. the spearman correlation coefficients of employee' common disire category on the effect of job transfer with job satisfaction were autonomy(rs=0.243, p=0.0001), administration(rs=0.227, p=0.0001), and task requirement(rs=0.213, p=0.0001), respectively.

가솔린 와류형 고압 분무의 증발 거동에 관한 연구

김덕줄,최동석,황순철 釜山大學校生産技術硏究所 1999 生産技術硏究所論文集 Vol.56 No.-

가솔린 와류형 고압 인젝터로부터 분사된 연료의 증발 거동을 exciplex 형광법을 사용하여 조사하였다. exciplex 형광법을 적용하기 위해 용매로 헥산, 참가제로 플루오로벤젠과 DEMA를 체적비로 각각 89%, 2%, 9% 혼합하였다. 결과로서 증발조건과 비증발조건에서 액상과증기상의 신호를 확인하였고, 분사후 경과시간에 따라 각각의 상의 공간분포의 변화를 측정하였다. 분무의 축방향으로의 증발보다는 분무반경방향으로의 증발이 더 활발히 진행되었다. 또한 순수한 증기상만이 차지하는 면적은 분사기간의 1/3지점에서 액상의 면적과 같아졌으며 그 이후는 급격히 증가하였다. This work was performed to provide qualitative information on the vaporization of fuel using exciplex fluorescence method in a spray from high-pressure swirl injector. Dopants used were 2% fluorobenzene and 9% DEMA(diethyl-methyl-amine) in 89% solution of hexane by volume respectively. As a result, liquid and vapor phases were compared under both evaporating and non-evaporating conditions, and each phase was illustrated with time after injection. Vaporization along the radial direction had larger activity than along the axial direction. The area of only vapor phase was approximated to that of liquid phase at about 1/3 of injection duration time, and after that time, it was greatly incrased.

光州市 家計의 課外敎育과 經濟的 負擔感에 대한 實態調査

황덕순,주문자 全南大學校家政科學硏究所 1994 生活科學硏究 Vol.4 No.-

This study aims to investigate the actual extracurricular education and economic strains of households. For these purposes, 372 households in Kwangju with students but collegians were surveyed through the questionnaire method. The frequency, percentile, One-way ANOVA in GLM and Chi-square test were used for the data analysis. The Results were as follows: 1. Most of households takes extracurricular lessons(334) and be willing to do (268). Many have concerns about it and need it. 2. The average lesson number is 2 subject and average cost per household is 177,000 won. 3. The average economic strains due to the extracurricular cost is 22 points. Economic strains differ according to the socio-economic variables (e. g. father's educational level, mother's educational level, average income level per month, and to the attitude variables, extracurricular will in future, parent concerns, and needs. Here we can conclude, many households have economic strains due to extracurricular fees. And the economic strains by extracurricular lessons are so undesirable to family growth and development that government have to reform the educational structure. So the social need to the extracurricular lesson will be taken away. But in reality, still extracurricular lessons are so needed that the households must have any strategies to face the economic strains.

도움닫기 거리가 멀리뛰기 기록에 미치는 영향 : 중학교 1학년 여학생을 중심으로 about the first-grade middle schoolgirls

宋順德,朴贊弘 公州大學校스포츠科學硏究所 1995 스포츠科學硏究所論文集 Vol.- No.9

To know the record affected by Approach-distance, 135 first-grade Schoolgirls of Y-middle school were sampled at random, and divided into three groups of Approach-distance 10m, 15m, and 20m. And then the experiment through the lesson for eight weeks was done and the effect was this : 1. In the first-grade middle schoolgirls case, the record of Long-jump was seldom affected by Approach-distance 10m. 2. But Approach-distance 15m and 20m were effective and, the most suitable approach-distance was 15m.

Periapical cemental dysplsia의 진단에 대한 치험례

이순영,이찬영,노병덕 大韓齒科保存學會 2005 Restorative Dentistry & Endodontics Vol.30 No.1

Periapical cemental dysplasia(PCD) is a condition most commonly seen in the mandibular incisor region. Radiographically it passes through the three phases(osteolytic stage, intermediate stage, and mature stage). At osteolytic stage, the lesion is similar to features associated with granuloma or cyst that arise following pulpal necrosis. So, it is important to confirm the vitality of the pulp to diagnosis. In this case, it is difficult to confirm the vitality of involved tooth because the tooth was covered with PFG bridge. And it is unusual that the PCD lesion at mandibular incisors has occurred at first and the lesion of mandibular canine and mandibular premolar were occurred afterward. 치근단 백악질 이형성증은 대부분 하악 전치부에서 발생하는 병소로 시간의 흐름에 따라 3단계의 독특한 방사선 사진상의 변화 양상을 보인다 (방사선 투과성기, 혼합기, 방사선 불투과성기). 특별히 1단계인 방사선 투과성기의 방사선 사진 상의 양상은 치수 괴사로 인해 발생하는 치근단 육종이나 치근단낭과 매우 유사하다. 따라서 이를 감별하기 위해서는 정기적인 방사선 사진 검사와 함께 치수의 생활력을 검사가 매우 중요하다고 할 수 있다. 하지만 본 증례에서는 해당 부위의 치아가 PFG bridge로 수복되어 있는 치수 생확력 검사를 정확하게 할 수 없었다. 또한 병소가 처음에는 하악 전치부에 발생하였으나 뒤이어 하악 견치와 소구치부에서도 연달아 발생한 특이한 소견을 보였다.