• 대한응급의학회지
• /
• 제29권5호
• /
• pp.465-473
• /
• 2018

Objective: We evaluated the clinical characteristics and prognoses of patients with septic shock who transferred to the emergency department (ED) in a tertiary referral center. Methods: This study was performed using a prospective, multi-center registry of septic shock, with the participation of 11 tertiary referral centers in the Korean Shock Society between October 2015 and February 2017. We classified the patients as a transferred group who transferred from other hospitals after meeting the inclusion criteria upon ED arrival and a non-transferred group who presented directly to the ED. Primary outcome was hospital mortality. We conducted multiple logistic regression analysis to assess variables related to in-hospital mortality. Results: A total of 2,098 patients were included, and we assigned 717 patients to the transferred group and 1,381 patients to the non-transferred group. The initial Sequential Organ Failure Assessment score was higher in the transferred group than the non-transferred group (6; interquartile range [IQR], 4-9 vs. 6; IQR, 4-8; P<0.001). Mechanical ventilator (29% vs. 21%, P<0.001) and renal replacement therapy (12% vs. 9%, P=0.034) within 24 hours after ED arrival were more frequently applied in the transferred group than the non-transferred group. Overall hospital mortality was 22% and there was no significant difference between transferred and non-transferred groups (23% vs. 22%, P=0.820). Multivariable analysis showed an odds ratio for in-hospital mortality of 1.00 (95% confidence interval, 0.78-1.28; P=0.999) for the transferred group compared with the non-transferred group. Conclusion: The transferred group showed higher severity and needed more organ support procedures than the non-transferred group. However, inter-hospital transfer did not affect in-hospital mortality.

• 기록학연구
• /
• 제41호
• /
• pp.175-212
• /
• 2014

성공회대 노동사연구소는 2001년 당시 전태일노동자료실의 소장 기록물이 성공회대에 기탁되는 것을 계기로 출범하게 되었다. 이후 문헌자료를 바탕으로 대규모 구술조사 연구사업을 진행하면서 노동아카이브와 노동연구의 바람직한 관계를 형성해 왔다. 하지만 노동기록이 축적되어감에 따라 새롭게 해결되어야 하는 문제들이 발생했다. 가장 중요한 것은 노동기록의 생산자(구술증언자)들의 불만족이었다. 기록의 이용자(연구자)들 측면에서도 연구자들이 기록을 고정된 해석의 프레임에 맞추거나, 자신의 해석에 따라 선별적으로 이용한다는 비판이 제기되어 왔다. 인천지역의 동일방직, 반도상사, 대한마이크로 등 노동조합 사례와 구로동맹파업의 사례 등을 통해 살펴보았을 때 기록의 생산과 활용 사이에서 발생하는 문제점은 분명하게 드러났다. 70년대 민주노조운동의 당사자들 사이에서도 역사적 기록에 '승리자'로 남는 그룹이 있는 반면에, 부당하게 '실패자'로 낙인찍히는 '중층적 주변화' 현상이 발생해 왔다. 연구자들의 적극적인 개입은 매우 제한적일 뿐이고, 시민과 노동자들 사이에서 이런 '기억투쟁'이 원활하게 해결되어 나갈 방법은 보이지 않는다. 이는 노동아카이브가 지역 속에 뿌리내리지 못하는 하나의 원인이 되고 있다. 본 논문은 참여형 노동아카이브의 구축을 통해서 기록 생산과 활용에 대한 대안적인 방법론을 제시하였다. 더 나아가 참여의 이론적인 부분을 보완하여 '로컬리티 기록화' 전략의 구체적 방향성을 모색하였다. 로컬과 로컬리티 연구는 비단 물리적 공간의 문제만이 아니다. 그것은 기억과 정체성, 그리고 사회적 관계를 구성해가는 과정에서 발생하는 '다중적 스케일'(multi-scalar) 접근 방법을 요청한다. 대안적인 '로컬리티 기록화' 전략은 기존의 노동아카이브가 해결해야 하는 기록 생산과 활용 사이의 문제점을 해소하는 데 기여할 것이다.

• Journal of Chest Surgery
• /
• 제52권4호
• /
• pp.248-329
• /
• 2019

Background: Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. Methods: This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors-primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. Results: CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Conclusion: Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.

• 대한영상의학회지
• /
• 제79권5호
• /
• pp.254-258
• /
• 2018

목적: 보건의료정보화를 위한 진료정보교류 기반 구축 및 활성화 과제의 일부인 의료영상정보교류의 효용성을 높이기 위한 영상 품질 기준 연구에서 유방 자기공명영상검사의 적절한 프로토콜을 정립한다. 대상과 방법: 문헌 및 참고자료를 통한 국내외 유방 자기공명영상검사의 권고 프로토콜과 판독문 형식을 조사하고, 책임연구자가 설문지를 작성한 후, 국내 9명의 유방영상의학 전문가를 섭외하여 패널을 구성하였다. 전문가 패널은 총 3차례의 델파이 합의를 진행하여 유방자기공명영상 프로토콜의 합의안을 도출하였다. 결과: 합의된 유방자기공명영상 권고 프로토콜은 1.5 테슬라 이상의 기기로 유방 전용 코일을 사용하여 복와위 자세에서 영상을 획득하며, T2 강조영상과 조영 전 T1 강조영상을 포함한다. 조영증강영상은 적어도 2차례 이상 획득하며, 60~120초 사이 영상과 4분 이후 영상을 포함한다. 또한 조영증강 T1 강조영상의 절편 두께는 3 mm 이하, 측면 해상력은 120초 이하, 공간 내 평면 해상도는 $1.5mm^2$ 이하여야 한다. 결론: 국내 유방영상전문가 집단의 3차례에 걸친 델파이 합의를 통하여 효율적인 유방 자기공명영상검사의 검사 프로토콜 권고안을 정립하였다.

• Journal of Rhinology
• /
• 제25권2호
• /
• pp.91-98
• /
• 2018

Background and Objectives: The present study evaluated the results of skin prick test using 55 allergens at 20 centers in the Republic of Korea in 2006, 2010, and 2014-2015. The aim was to assess changes in the positive rate of allergens according to temporal, regional, and environmental factors. Materials and Method: In total, 20 hospitals were selected based on the population distribution in the Republic of Korea. A skin prick test panel comprising 55 aeroallergens was distributed to 18 hospitals for this prospective study. The 2006 and 2010 skin prick test results were collected and analyzed retrospectively from 20 hospitals, while the 2014/2015 skin prick test results (from June 2014 to May 2015) were collected prospectively from 18 hospitals. Results: A total of 14,897 SPT test results were analyzed: 4,319 in 2006, 7,431 in 2010, and 1,852 in 2014/2015. The overall rate of skin prick test positivity to more than two allergens was significantly higher in males than females. The positive rates of alder pollens and birch, oak and ragweed pollen positivity were increased in older patients. Several positive rates were increased according to the temperature in spring. The positive rates for beech pollen, birch pollen, hazel pollen, oak pollen, Tyrophagus putrescentiae, mugwort, cat, Acarus siro, Lepidoglyphus destructor and Tyrophagus putrescentiae were significantly increased, while those of Cult rye pollen and dandelion were significantly decreased over the three test periods. The overall positive rate for allergens in Jeju province varied significantly from Seoul and other cities. Conclusion: Change in the positive rate of multiple aeroallergens was evaluated in the Republic of Korea over time. Our findings can be used to recommend aeroallergens suitable for inclusion in skin prick test panels in the Republic of Korea and will facilitate further investigation of changes in the patterns of allergic diseases.

• 벤처창업연구
• /
• 제16권3호
• /
• pp.13-29
• /
• 2021

이 연구는 서울시 세대별(청년층, 중년층) 창업의 공간적 분포와 영향 요인을 분석하는데 목적이 있었다. 이를 위해 창업가의 연령대 자료를 포함하고 있는 서울시 사업체조사(2018) 데이터를 활용하여 서울시 424개 행정동의 세대별 창업 분포를 분석했으며, 산업, 인구구조 및 창업지원 기관 관련 변인이 포함된 연구모형을 설정하여 세대별 창업의 영향 요인을 분석하였다. 분석 방법은 서울시 행정동의 세대별 창업과 주요 변인들의 빈도, 평균 및 표준편차를 확인하기 위해 기술통계를 활용했으며, 전역적, 국지적 공간자기상관 분석을 통해 세대별 창업의 공간적 분포를 분석하였다. 특히 세대별 전체 창업과 주요 산업별 창업을 구분하여 분석함으로써 서울시 창업의 공간 분포를 심층적으로 확인하였다. 이후 라그랑주 검정을 통해 공간회귀분석 모형을 선택하였으며, 이를 바탕으로 세대별 창업에 미치는 지역적 영향 요인을 분석하였다. 연구결과를 통해 도출한 주요 결과는 다음과 같다. 첫째, 청년층과 중년층 창업의 공간적 분포에 유의미한 차이가 있었다. 청년층은 서초·강남-용산-마포-강서구로 이어지는 벨트 지역에서 창업이 활발하게 이루어졌지만, 중년층은 서초·강남·송파·강동으로 대표되는 동남권 지역의 창업이 활발한 편이었다. 둘째, 서울시 세대별 창업은 업종에 따라 다양한 공간적 분포를 보였다. 지식첨단산업(정보통신, 전문서비스)은 세대 공통적으로 서초, 강남, 마포, 구로, 금천구가 중심지역이었으며, 제조업은 기존 집적지를 중심으로 창업이 집중되어 있었다. 반면 생활서비스업의 경우 청년층은 용산, 마포, 관악 등 대학과 문화 중심지역에서 창업이 활발했으며, 중년층은 신시가지 중심으로 창업이 집중되었다. 셋째, 서울시의 세대별 창업 입지에 대한 영향 요인에 차이가 있었다. 청년층은 첨단산업, 대학, 문화자본 및 인구 밀집이 창업에 유의미한 영향 요인이었으며, 중년층은 전문서비스 특화도, 낮은 평균연령, 창업지원 기관 밀집 수준이 창업에 유의미한 영향을 미쳤다. 또한 이러한 입지요인은 산업별로 차별적인 영향이 있었다. 연구를 통해 제시한 제언은 다음과 같다. 첫째, 서울시 지역, 산업 및 세대별 특성을 고려한 체계적인 창업지원이 필요하다. 세대별 창업 지역과 산업에 상당한 차이가 있는 만큼 지역 및 산업적 특성을 고려한 맞춤형 창업지원 체계를 강화할 필요가 있다. 둘째, 연구 방법적 측면에서 데이터 축적을 통해 자치구 단위에서 문화, 재정 등을 종합적으로 고려한 후속 연구가 필요하다.

• Tuberculosis and Respiratory Diseases
• /
• 제85권1호
• /
• pp.37-46
• /
• 2022

Background: Although respiratory tract infection is one of the most important factors triggering acute exacerbation of chronic obstructive pulmonary disease (AE-COPD), limited data are available to suggest an epidemiologic pattern of microbiology in South Korea. Methods: A multicenter observational study was conducted between January 2015 and December 2018 across 28 hospitals in South Korea. Adult patients with moderate-to-severe acute exacerbations of COPD were eligible to participate in the present study. The participants underwent all conventional tests to identify etiology of microbial pathogenesis. The primary outcome was the percentage of different microbiological pathogens causing AE-COPD. A comparative microbiological analysis of the patients with overlapping asthma-COPD (ACO) and pure COPD was performed. Results: We included 1,186 patients with AE-COPD. Patients with pure COPD constituted 87.9% and those with ACO accounted for 12.1%. Nearly half of the patients used an inhaled corticosteroid-containing regimen and one-fifth used systemic corticosteroids. Respiratory pathogens were found in 55.3% of all such patients. Bacteria and viruses were detected in 33% and 33.2%, respectively. Bacterial and viral coinfections were found in 10.9%. The most frequently detected bacteria were Pseudomonas aeruginosa (9.8%), and the most frequently detected virus was influenza A (10.4%). Multiple bacterial infections were more likely to appear in ACO than in pure COPD (8.3% vs. 3.6%, p=0.016). Conclusion: Distinct microbiological patterns were identified in patients with moderate-to-severe AE-COPD in South Korea. These findings may improve evidence-based management of patients with AE-COPD and represent the basis for further studies investigating infectious pathogens in patients with COPD.

• Tuberculosis and Respiratory Diseases
• /
• 제85권1호
• /
• pp.56-66
• /
• 2022

Background: Because the etiologies of bronchiectasis and related diseases vary significantly among different regions and ethnicities, this study aimed to develop a diagnostic bundle for bronchiectasis in South Korea. Methods: A modified Delphi method was used to develop expert consensus statements on a diagnostic bundle for bronchiectasis in South Korea. Initial statements proposed by a core panel, based on international bronchiectasis guidelines, were discussed in an online meeting and two email surveys by a panel of experts (≥70% agreement). Results: The study involved 21 expert participants, and 30 statements regarding a diagnostic bundle for bronchiectasis were classified as recommended, conditional, or not recommended. The consensus statements of the expert panel were as follows: A standardized diagnostic bundle is useful in clinical practice; diagnostic tests for specific diseases, including immunodeficiency and allergic bronchopulmonary aspergillosis, are necessary when clinically suspected; initial diagnostic tests, including sputum microbiology and spirometry, are essential in all patients with bronchiectasis, and patients suspected with rare causes such as primary ciliary dyskinesia should be referred to specialized centers. Conclusion: Based on this Delphi survey, expert consensus statements were generated including specific diagnostic, laboratory, microbiological, and pulmonary function tests required to manage patients with bronchiectasis in South Korea.

• Journal of Gastric Cancer
• /
• 제23권1호
• /
• pp.3-106
• /
• 2023

Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.

• 대한영상의학회지
• /
• 제83권2호
• /
• pp.254-264
• /
• 2022

대한영상의학회 진료지침위원회는 기존의 2016년 진료지침을 개정하여 '주사용 요오드화 조영제 및 MRI용 가돌리늄 조영제 유해 반응에 대한 한국 임상진료지침: 개정된 임상적 합의 및 권고안(2022년 제3판)'을 제작하였다. 대한영상의학회와 대한천식알레르기학회, 대한신장학회에세 추천 및 승인된 전문가 위원들이 함께 참여하였고, 전문가 합의 또는 체계적 문헌 고찰을 기반으로, 조영제를 사용 시 감염관리를 위한 자동주입기 및 연결선에 대한 기술과 요요드화 조영제에 대한 급성 유해반응 및 신장 유해반응에 대한 내용들을 수정 및 추가하였다. 이에 개정된 내용을 소개하고자 한다.