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.

소에서 盲腸擴張을 동반한 第4胃食滯 手術 1例

김명철,김덕환,신상태,임준호,김남중,김종만 충남대학교 수의과대학 동물의과학연구소 1998 動物醫科學硏究誌 Vol.6 No.-

Abomasal impaction with cecal dilatation was diagnosed in a 3 years old holstein cow. The clinical signs were loss of appetite, scant feces and moderate distension of the abdomen. Ping sound was revealed in the right 11th intercostal space by auscultation. Cecal dilatation and abomasal impaction were ascertained by right flank laparotomy and abdominal exploration, and intestinal content and gas were removed from the cecal apex incised. One day later, 2.5㎏ of sand was removed by ventral paramedian abomasotomy.

면양에서 개량된 제1위 누관 형성술 1례

김명철,김종만,김용국,김덕환,이영원 충남대학교 수의과대학 동물의과학연구소 1999 動物醫科學硏究誌 Vol.7 No.-

We performed rumen fistula operation in a sheep. In sheep, the procedure for a rumen fistula is quite successful, but choice of an appropriate cannula is of prime importance. The sheep was anesthetized by xylazine(0.1 ㎎/㎏ IM) administration 5 minutes after administration of atropine sulfate(0.1 ㎎/㎏ IM). We inserted rubber cannula in rumen incised and put rubber ring after employing purse-string suture in rumen. We marked the area for the puncture incision in the body wall through which the cannula is drawn. We drew the cannula as near the transverse process of the lumbar vertebrae as possible to minimize leakage. We isolated the cannula by fixing the stainless washer which has small holes. The sheep was given postoperative penicillin(20,000 IU/㎏ IM) to prevent secondary infection for 3 days. There were not observed the leakage of rumen contents, the entering of rubber cannula into abdominal cavity, and necrosis on incision site and skin, over months after surgery.

경찰관의 운동참여에 따른 직무 Stress와 직무만족에 관한 연구

김종달, 남덕현, 이한경, 반종진 용인대학교 체육과학연구소 2000 體育科學硏究論叢 Vol.10 No.1

This study is for the purpose of examining effects related to duty stress & duty satisfaction due to Police of officers' Physical exercise participation, helping more efficient duty Performance, and positive self-formation. Furthermore, providing basic data that can be helpful to the improvement of police duty. The objects of the study were police officers who were taking part in education program in Police Comprehensive Academy, and the number of police officers who answered the questionnaire is 356 police officers, but data used for real analyzation consist of 300 police officers. The tools for the study were based on Ivancevich's duty stress model in order to measure stress. And also questionnaire used on Kim yoon hee, Kim mae ja, Jo kyung soon, Lee hart kyung's study was used as a complementary tool. The instrument for measuring duty satisfaction rate was developed by Paula. And I used the instrument based on questionnaire that was used by Ko hee soon, Park ki hyung, Kim bum sik, Lee jong kil, Lim bun jang, Jo young chang, Hackeman, Lawlar and Oldham's study. Data analysis is Processed statistically with SPSS/PC+, I Performed T-verification, ANOVA-verification in accordance with the purpose of study after getting the percentage and the real number in case of general characteristics of the objects, and examine an average and standard variation in case of duty satisfaction and duty stress rate. And I set an err rate to 0.5. I verificated co-relation between stress and duty satisfaction with Pearson Correlation Coefficient. The result of the study is as follows, The first, among sociological characteristic and external factor of duty satisfaction, The married is more significant statistically(p< .01, p<.05) compared to the unmarried in terms of compensation system and working condition , which are subfactor of duty satisfaction . In terms of the length of one's service, the longer service term one has the higher significance level one shows in compensation system, working condition, safety, and external factor which are sub-factors of duty satisfaction In terms of an academic background, one who graduated from a high school shows significance statistically only in working condition which is a subfactor of duty satisfaction compared to other people (p<0.5) The second, among sociological characteristic and internal factor of duty satisfaction, the married is more significant statistically(P<.05) compared to the unmarried in terms of achievement which is a subfactor of duty satisfaction. In terms of age the older one shows higher significance level in stability which is a subfactor of duty satisfaction compared to younker one(p<.05) In terms of the length of one's service the longer service term one has ,the higher significance level one shows(p<.01, p<.05). The third, in terms of duty stress due to sociological variable, the married is more significant statistically(p<.05) in case of stress stems from police duty than the unmarried Interms of age, welfare and duty stress are significant statistically(P<.05) Interms of the length of one's service, police's work is significant statistically(P<.05). One who graduated from junior college is significant statistically in police's work, welfare, stress and gets a lot of stress in personal relations(p<.05). The forth, groups participating in exercise are more significant statistically in stability(p<.001), feeling of stability(P<.001), achievement(p<.001), internal factor(p<.01), external factor(p<.05) than croups not Participating in exercise. The fifth, groups participating in exercise are more significant statistically only in personal management than groups not participating in. The sixth co-relation between duty satisfaction and duty stress is r=-0.3814, (P<.001) ,which shows opposite co-relation. so, a result the more stress one has, the lower duty satisfaction he gets.

자기장 저속 냉동보관법을 이용한 쥐 치아 치주인대세포의 활성도 검사

안현정,김의성,김진,김덕원,김기열,이찬영,이승종 大韓齒科保存學會 2008 Restorative Dentistry & Endodontics Vol.33 No.4

본 연구의 목적은 흰쥐 상악 대구치를 발거하여 자기장 저속 냉동보관법을 이용하여 냉동 시 치주인대세포의 활성도 및 세포 사멸도를 MTT검색법과 TUNEL검사를 이용하여 측정하고자 하였다. 4주령의 암컷 Sprague-Dawley계 된 쥐의 상악 좌우 제1,2대 구치를 발거하여 각군 당 12개의 쥐 치아를MTT검색에 이용하였고 6개의 치아를 TUNEL 검사에 이용하였다. 실험군은 5개군으로 대조군은 즉시 발치군이며 4℃냉장고에서 1주일간 보관한 냉장군, 발치 후 동해방지제 처리과정을 거쳐 -196℃의 액화질소에 넣어 급속 냉동한 액화질소군, 21.7 ㎃, 60 ㎐, 1 G의 자기장을 이용하여 -0.3℃/min 의 속도로 -20℃까지 냉동 후 -196℃로 급속 냉동한 자기장군, -0.3℃/min의 속도로 -20℃까지 냉동 후 -196℃에 급속 냉동한 저속 냉동군으로 나누었다. 보존액은 F medium을 사용했으며 동해방지제로 10% dimethyl sulfoxide (DMSO)를 사용하였다. 치근면을 단위면적으로 표준화하기 위해 MTT측정값을 Eosin 염색 후 530 ㎜에서 측정한 흡광도 값으로 나누었다. TUNEL 검사 시 각 조직슬라이드에서 400배 크기의 현미경 시야에서 임의로 세 부분을 지정하여 정상 세포수와 양성 세포수를 세어 그 비율을 계산하여 각 실험군 당 평균치를 구하였다. 통계 분석을 위해 one way ANOVA를 시행하였으며 사후검정으로 Scheffe와 Tukey HSD방법을 썼으며 결과는 다음과 같다. MTT검색에 의한 흡광도를 Eosin염색 후 측정한 흡광도로 나눈 값에서는 자기장군은 즉시 발치군보다 낮은 세포활성을 보였고 (p < 0.05) 액화질소군, 저속 냉동군과는 통계적으로 유의성 있는 차이를 보이지 않았다. 그러나 자기장군은 액화질소군, 저속 냉동군과 함께 냉장군보다는 높은 세포 활성도를 보였다 (p<0.05).TUNEL검사 결과도 자기장군은 즉시 발치군보다 치주인대의 세포사멸도가 높았으나 (p < 0.05) 저속 냉동군과 액화 질소군과는 통계적으로 유의한 차이를 보이지 않았다. 자기장군은 냉장군보다 세포사멸도가 낮았으며 냉장군은 모든 군 중에서 세포 사멸도가 가장 높았다 (p<0.05). The purpose of this study was to evaluate the viability of periodontal ligament cell in rat teeth using slow cryopreservation method with magnetic field through MTT assay and TUNEL test. For each group, 12 teeth of 4 weeks old white female Sprague-Dawley rat were used for MTT assay, and 6 teeth in TUNEL test. The Maxillary left and right, first and second molars were extracted as atraumatically as possible under tiletamine anesthesia. The experimental groups were groupl (immediately extraction), group 2 (cold preservation at 4℃ for 1 week), group 3 (rapid Cryopreservation in liquid nitrogen), group 4 (slow cryopreservation with magnetic field of 1 G), and group 5 (slow cryopreservation). F medium was used as preservation medium and 10% DMSO as cryoprotectant. After preservation and thawing, the MTT assay and TUNEL test were processed. One way ANOVA and Scheffe method were performed at the 95 % level of confidence. The value of optical density obtained after MTT analysis was divided by the value of eosin staining for tissue volume standardization. In both MTT assay and TUNEL test, it had showed no significant difference among group 3,4, and 5. And group 3 had showed higher viability of periodontal ligament cell than group 2. From this study, slow cryopreservation method with magnetic field can be used as one of cryopreservation methods.

SOLUBILITY OF NITROGEN IN CLEAN EIRE EXTINGUISHING AGENTS AT HIGH PRESSURE

Kim,Jae-Duck,Lim,Jong-Sung,Lee,Youn-Woo,Lee,Youn-Yong 한국화재소방학회 1997 한국화재소방학회 학술대회 논문집 Vol.1997 No.-

Isothermal solubilities of nitrogen in clean fire extinguishing agents, such as bromotrifluoromethane (Halon-1301), bromochlorodifluoromethane (Halon-121 t), 1,1,1,2,3,3,3- heptafluoropropane (HFC-227ea), and trifluoroiodomethane (FIC-13I1) were measured in a circulation-type equilibrium apparatus. The temperature range was (293.2 to 313.2) K and the pressure range was (30 to 100) bar. The experimental data were well correlated with the Peng- Robinson equation of state using the Wong and Sandier mixing rules, and the relevant parameters are presented.

개의 흉추 및 요추에서 배측 추궁절제술 1례

김명철,이재일,이수진,김종만,황학균,서지민,이영원,김덕환,신상태 충남대학교 수의과대학 동물의과학연구소 2000 動物醫科學硏究誌 Vol.8 No.-

In dorsal laminectomy for the surgical treatment of thoracolumbar disc disease in dog, the bur could slip into the vertebral canal. For the decrease of this probability of danger, osteotome was used with instruments such as bur and rongeur in dorsal laminectomy. At thoracic vertebrae (T10-T11) and lumbar vertebrae (L5-L6) area, dorsal laminectomys were performed in a dog. In observation for 3 months after surgery, the dog revealed healthy physical condition. For the confirmation of healing condition at 3 months after dorsal laminectomy, two surgical sites were exposed by incision. Excellent healing response was observed with no adhesion and fibrosis in the vertebral canal.

일개 자동차 부품공장 근로자에서 초음파로 측정한 수근관 형태와 수근관증후군 위험도

김덕수,정해관,임현술,권용욱,이종민,조대현,최대섭 大韓産業醫學會 2002 대한직업환경의학회지 Vol.14 No.3

목적 : 일개 사업장의 생산직 근로자를 대상으로 손목 계측치 및 초음파를 이용한 수근관 계측치의 상관성 분석을 통하여 수근관증후군 발생에 관여하는 개인의 감수성 및 위험요인을 파악하여 생산직 근로자들의 수근관증후군 예방에 활용하고자 본 연구를 수행하였다. 방법 : 경주시에 위치한 자동차 방음재를 생산하는 사업장에 생산직 근로자 남자 24명, 여자 11명 등 총 35명을 대상으로 2000녀 4월과 2000년 10월 반드시 각 설문조사, 이학적검사, 전기진단검사를 실시하였으며, 2000년 10월에는 초음파를 이용한 수근관계측도 실시하였다. 결과 : 수근관증후군의 신체계측 요인에 따른 분석에서는 수근관 전치/폭 비가 0.17 미만인 군에 비하여 0.17 이상인 군에서 통계적으로 유의하게 높았다(p<0.05). 총 수근관 면적(두께×폭)은 300 ㎟이상인 군에 비하여 300㎟ 미만인 군에서 통계적으로 유의하게 높았다(p<0.05). 성별을 통제변수로 처리한 신체 계측치간 상간 분석에서는 수근관폭은 전기진단 검사와 음의 상관성을 보였으며, 수근관 두께는 전기진단 검사와 양의 상관성을 보였다. 수근관 두께/폭 비는 전기진단 검사와 양이 상관성을 보였으며, 수근관비 전치/두께 비는 전기진단 검사 결과와 음의 상관성을 보였다. 하부 수근관 면적[폭×(두께-전치)]은 전기진단 검사와 양의 상관성을 보였으며, 상부 수근관 면적(폭×전치)은 전기진단 검사와 음의 상관성을 보였다. 또한 수근관 전치의 상대적 비가 클수록 수근관증후군의 회복이 유의하게 좋았다. 결론 : 수근관증후군은 수근관 폭이 좁을수록, 수근관 두께가 두꺼울수록, 수근관 전치가 작을수록 수근관증후군 위험도가 증가한다. 저자들은 초음파를 이용한 수근관 형태의 측정은 수근관증후군의 발생의 내적 요인에 대한 중요한 정보를 제공하면 수근관증후군 발생 및 회복의 개별적 위험요인을 예측하는데 중요한 근거를 제공하는 것으로 판단하였다. Objectives: This study was conducted to evaluate individual susceptibility to carpal tunnel syndrome (CTS) by ultrasonographic measurement of the carpal tunnel configuration in workers doing repetitive work. Methods: The study subjects consisted of 24 male and 11 female workers in a soundproof material manufacturing company in Gyeongju. We conducted a self-reported questionnaire survey, a physical examination and an electrodiagnostic study (EDS) in April 2000. After the examination, jobs were rearranged for workers with CTS. A follow up physical examination. EDS, and measurement of the carpal tunnel by ultrasonography was done six monsths later. Results: Of those studied. prevalence or CTS was 63.6/100 persons among women and 29.2/100 persons among men. Mean depth and width of wrist was shorter in those with CTS compareal to the controls (p<0.05). The risk of CTS was higher in workers whose carpal tunnel ratio (displacement/width) was 0.17 or higher (OR 7.13, 95% confidence interval 1.18-43.1), and in workers whose carpal tunnel area was less than 300 ㎟ (OR 8.00, 95% confidence interval 1.18-68.5). Carpal tunnel depth and depth/width ratio had a positive correlation with motor latency of the median nerve and median-ulnar sensory latency difference (p<0.05). whereas the carpal tunnel width. displacement/depth ratio, and area (width×displacement) had a negative correlation with median nerve latencies after adjusting for gender. Workers who showed an improvement in the clinical stage of CTS after job rearrangement had a significantly lower carpal tunnel displacement/width ratio and displacement/depth ratio. They also had smaller upper carpal tunnel area (width×displacement) and larger upper carpal tunner\l area [(depth-displacement)×width] than the controls (p<0.05). Conclusions:Ultrasonographic measurement of the carpal tunnel is a good predictor of susceptibility and prognosis of CTS in workers doing repetivive work.

관광자원으로서의 자연휴양림의 관광환경분석과 문제점에 관한 연구 : 유명산, 대관령, 청태산 중심으로

김종은,양덕희 慶熙大學校 觀光産業情報硏究院 2000 觀光産業情報論集 Vol.2 No.-

Rapid growth in living standards and leisure time has increased the demand for leisure facilities, and concentration of cities and environmental pollution have created more demand for green space. Now people think of forestry more as the space for rest and leisure than as that for wood production, The demand for the forestry of the city people, who want to escape from the routine, has exploded and will continue to grow. Forestry Administration started to develop 'forest for recreation' in 1988. As of December 1999, it has designated about 176 places as forest for recreation, 83 of which have been already completed. The government mobilized the people in an unprecedented afforestation campaign to plant trees in the barren hills and mountains at the beginning of the national foundation. The successful campaign has brought dense woods back, Beautiful valleys and natural ecology have recovered its value as tourism resources. The natural forest for recreation has created variety of benefits for general public. It helps individuals to relax and thus increase productivity and living standard. It has helped to meet the demand for leisure not only as a place of out-door activity but as a place for nature exploration. It also helps to enhance the underdeveloped economy and cultural standard of remote isolated villages. Short history of recreation forest uncovered a lot of problems in the areas of development, management and operation, which requires urgent attention.

진공증착중합법에 의해 제조된 PMDA / 4,4'-DDE 폴리이미드의 내열 특성

김형권,이은학,우호환,김종석,이덕출 (사단법인)韓國火災 ·消防學會 1996 한국화재소방학회논문지 Vol.10 No.3

The Polyimide thin films based on PMDA and 4,4'-DDE were fabricated by VDPM, and their heat resistance characteristics were invastigated by TGA(Thermogaravimetry Analyzer). It was found that deposition rate decreased with increasing substrate temperature and the thin films were not fabricated over the substrate temperature of 70℃. T_TG of 5% weight loss temperature is 565℃, 397℃ and 210℃ at the substrate temperature of 20℃, 40℃ and 70℃, respectively. It is realized that the endurace temperature for 20,000 hour of thin films fabricated at 20℃ and 40℃ is 230℃ and 200℃, respectively.