• 한국산학기술학회논문지
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• 제13권6호
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• pp.2672-2679
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• 2012

본 연구는 급성심근경색증 환자의 사망률 측정을 위한 중증도 보정 모형을 개발하여 의료의 질 평가에 필요한 기초자료를 제공하고자 수행되었다. 이를 위해서 질병관리본부의 2005-2008년 퇴원손상환자 699,701건의 자료를 분석하였다. Charlson Comorbidity Index 보정 방법을 이용한 경우와 새롭게 개발된 중증도 보정 모형의 예측력 및 적합도를 비교하기 위해 로지스틱 회귀분석을 실시하였다. 새롭게 개발된 모형에는 연령, 성, 입원경로, PCI 유무, CABG 유무, 동반질환 12가지 변수가 포함되었다. 분석결과 CCI를 이용한 중증도 보정 모형보다 새롭게 개발된 중증도 보정 사망 모형의 C 통계량 값이 0.796(95%CI=0.771-0.821)으로 더 높아 모형의 예측력이 더 우수한 것으로 나타났다. 본 연구를 통하여 중증도 보정 방법에 따라 사망률, 유병률, 예측력에도 차이가 있음을 확인하였다. 향후에 이모형은 의료의 질 평가에 이용하고, 질환별로 임상적 의미와 특성, 모형의 통계적 적합성 등을 고려한 중증도 보정모형이 계속해서 개발되어야 할 것이다.

• 한국유기농업학회지
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• 제25권2호
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• pp.489-498
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• 2017

본 연구는 양돈농장에 HACCP 제도 도입이 폐사두수에 미치는 영향과 HACCP 제도 적용 목적 및 장 단점을 분석하기 위한 목적으로 실시하였다. HACCP 제도 적용 전 후에 따른 돼지의 폐사두수 변화는 HACCP 제도 적용 전 호흡기와 설사로 인한 폐사두수가 각각 288.30두와 122.90두로 나타났으나 HACCP 적용 후에는 각각 261.60두와 101.10두로 감소하는 것으로 나타났다. 또한 유 사산, 사고사 및 기타 폐사두수는 HACCP 적용 전에 각각 91.08두, 18.22두, 108.10두로 나타났으나 HACCP 적용 후에는 85.91두, 16.37두, 108.60두로 조사되었다. 따라서 총 폐사두수는 HACCP 적용 전 628.70두에서 HACCP 적용 후 573.60두로 감소하였다. 양돈농장의 HACCP 적용 목적 중 1순위와 2순위는 각각 농장의 경쟁력 향상(26.92%)와 위생적이고 안전한 돼지생산(23.43%)인 것으로 나타났다. 또한 HACCP 적용에 따른 가장 큰 장점으로는 농장의 위생관리 수준 향상(20.90%)이었으며, 단점은 HACCP 기록(23.10%)으로 조사되었다.

• Journal of Chest Surgery
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• 제52권2호
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• pp.78-84
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• 2019

Background: Pulmonary thromboembolism (PTE) is a life-threatening disease with high mortality. This study aimed to assess the outcomes of surgical embolectomy and to clarify the sustained long-term effects of surgery by comparing preoperative, postoperative, and long-term follow-up echocardiography outcomes. Of 22 survivors, 21 were followed up for a mean (median) period of $6.8{\pm}5.4years$ (4.2 years). Methods: We retrospectively reviewed 27 surgical embolectomy cases for massive or submassive acute PTE from 2003 to 2016. Immediate and long-term follow-up outcomes of surgical embolectomy were assessed on the basis of 30-day mortality, long-term mortality, postoperative complications, right ventricular systolic pressure, and tricuspid regurgitation grade. Results: The 30-day and long-term mortality rates were 14.8% (4 of 27) and 4.3% (1 of 23), respectively. Three patients had major postoperative complications, including hypoxic brain damage, acute kidney injury, and endobronchial b leeding, respectively (3.7% each). Right ventricular systolic pressure (median [range], mm Hg) decreased from 62.0 (45.5-78.5) to 31.0 (25.7-37.0, p<0.001). The tricuspid valve regurgitation grade (median [range]) decreased from 1.5 (0.63-2.00) to 0.50 (0.50-1.00, p<0.05). The improvement lasted until the last echocardiographic follow-up. Conclusion: Surgical embolectomy revealed favorable mortality and morbidity rates in patients with acute massive or submassive PTE, with sustained long-term improvements in cardiac function.

• Acute and Critical Care
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• 제33권4호
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• pp.222-229
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• 2018

Background: The diagnosis of pediatric acute respiratory distress syndrome (PARDS) is a pragmatic decision based on the degree of hypoxia at the time of onset. We aimed to determine whether reclassification using oxygenation metrics 24 hours after diagnosis could provide prognostic ability for outcomes in PARDS. Methods: Two hundred and eighty-eight pediatric patients admitted between January 1, 2010 and January 30, 2017, who met the inclusion criteria for PARDS were retrospectively analyzed. Reclassification based on data measured 24 hours after diagnosis was compared with the initial classification, and changes in pressure parameters and oxygenation were investigated for their prognostic value with respect to mortality. Results: PARDS severity varied widely in the first 24 hours; 52.4% of patients showed an improvement, 35.4% showed no change, and 12.2% either showed progression of PARDS or died. Multivariate analysis revealed that mortality risk significantly increased for the severe group, based on classification using metrics collected 24 hours after diagnosis (adjusted odds ratio, 26.84; 95% confidence interval [CI], 3.43 to 209.89; P=0.002). Compared to changes in pressure variables (peak inspiratory pressure and driving pressure), changes in oxygenation (arterial partial pressure of oxygen to fraction of inspired oxygen) over the first 24 hours showed statistically better discriminative power for mortality (area under the receiver operating characteristic curve, 0.701; 95% CI, 0.636 to 0.766; P<0.001). Conclusions: Implementation of reclassification based on oxygenation metrics 24 hours after diagnosis effectively stratified outcomes in PARDS. Progress within the first 24 hours was significantly associated with outcomes in PARDS, and oxygenation response was the most discernable surrogate metric for mortality.

• Journal of Chest Surgery
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• 제24권10호
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• pp.960-966
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• 1991

From February 1984 through July 1991, 104 infants less than 1 year of age with congenital heart defects underwent open heart repair with conventional cardiopulmonary bypass which occupied 10.7% of all patients with congenital heart defects operated on during same period. There were 66 boys and 38 girls 7 days to 12 months [mean age, 8.2 months]. Four patients were neonates, 8 were 1 to 3 months, 23 were 4 to 6 months, and 69 were 7 to 12 months of age. Mean body weight at repair was 6.9kg and mean BSA, 0.36m2 Indications for operation were intractable congestive heart failure and severe pulmonary hypertension in patients with VSD and severe cyanosis and anoxic spells in patients with TOF. Conditions corrected were VSD[79], TOF[8], AVSD[4], PS[2], PA+IVS[2], TAPVC [2], MR[2], DOLV[l], Truncus arteriosus[1], D-TGA[1], and PA-VSD[1]. Twenty-three of 79 patients with VSD had associated cardiovascular anomalies which included PDA in 16 patients, PS in 9 patients, ASD in 5 patients, LSVC in 2 patients, MR in 1 patient, dextrocardia in 1 patient, and single coronary artery in 1 patient. The hospital mortality rate was 24.0% which was much higher than that of 6% in patients over 1 year of age. The greatest mortality occurred in babies of low weight under 6 months of age, There was no late death. Surviving infants showed marked symptomatic improvement and change in growth patterns. These surgical results were to be overcome with proper pre- and post-operative management and improvement of surgical technique

• BMB Reports
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• 제55권1호
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• pp.30-38
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• 2022

Cardiovascular disease, especially ischemic heart disease, is a major cause of mortality worldwide. Cardiac repair is one of the most promising strategies to address advanced cardiovascular diseases. Despite moderate improvement in heart function via stem cell therapy, there is no evidence of significant improvement in mortality and morbidity beyond standard therapy. The most salutary effect of stem cell therapy are attributed to the paracrine effects and the stem cell-derived exosomes are known as a major contributor. Hence, exosomes are emerging as a promising therapeutic agent and potent biomarkers of cardiovascular disease. Furthermore, they play a role as cellular cargo and facilitate intercellular communication. However, the clinical use of exosomes is hindered by the absence of a standard operating procedures for exosome isolation and characterization, problems related to yield, and heterogeneity. In addition, the successful clinical application of exosomes requires strategies to optimize cargo, improve targeted delivery, and reduce the elimination of exosomes. In this review, we discuss the basic concept of exosomes and stem cell-derived exosomes in cardiovascular disease, and introduce current efforts to overcome the limitations and maximize the benefit of exosomes including engineered biomimetic exosomes.

• Healthcare Informatics Research
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• 제24권4호
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• pp.346-358
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• 2018

Objectives: The association between obstructive sleep apnea (OSA) and mortality or serious cardiovascular events over a long period of time is not clearly understood. The aim of this observational study was to estimate the clinical effectiveness of continuous positive airway pressure (CPAP) treatment on an outcome variable combining mortality, acute myocardial infarction (AMI), and cerebrovascular insult (CVI) during a follow-up period of 15.5 years ($186{\pm}58$ months). Methods: The data set consisted of 978 patients with an apnea-hypopnea index (AHI) ${\geq}5.0$. One-third had used CPAP treatment. For the first time, a data-driven causal Bayesian network (DDBN) and a hypothesis-driven causal Bayesian network (HDBN) were used to investigate the effectiveness of CPAP. Results: In the DDBN, coronary heart disease (CHD), congestive heart failure (CHF), and diuretic use were directly associated with the outcome variable. Sleep apnea parameters and CPAP treatment had no direct association with the outcome variable. In the HDBN, CPAP treatment showed an average improvement of 5.3 percentage points in the outcome. The greatest improvement was seen in patients aged ${\leq}55$ years. The effect of CPAP treatment was weaker in older patients (>55 years) and in patients with CHD. In CHF patients, CPAP treatment was associated with an increased risk of mortality, AMI, or CVI. Conclusions: The effectiveness of CPAP is modest in younger patients. Long-term effectiveness is limited in older patients and in patients with heart disease (CHD or CHF).

• 응용통계연구
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• 제31권5호
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• pp.637-653
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• 2018

빠른 고령화로 고령층의 증가는 인구구조 변화와 인구고령화에 영향을 미친다. 예전부터 선진국은 인구고령화를 주요현안으로 간주하여 고령화로 인한 연금 재정건전성, 건강 및 노인 복지 시스템의 지속 가능성에 집중하고 있다. 이처럼 고령층의 증가로 인구구조 변화와 인구고령화에 미치는 사망률 예측은 어느 때보다도 중요하다. 본 논문은 통계청 1970-2016년 각세별 생명표 자료를 활용하여 사망률 모형 6가지를 비교하였다. 이들 모형은 Lee-Carter(LC) 모형 (Lee and Carter, Journal of the American Statistical Association, 87, 659-671, 1992)에 근원을 두고 있으며, LC 의 가정을 수정하고 개선한 것이다. 이들 개선과정과 가정검토를 모형별로 살펴보고 우리나라에 적합한 사망률 모형을 모색했다. 분석결과 빠른 고령화와 연령별 사망률의 개선 효과를 보이는 우리나라의 경우 기대수명에 큰 변화를 주지 않고 이들 현상을 반영하고 연령별 사망률 패턴을 수정하는 LC-ER 모형 (Li 등, Demography, 50, 2037-2051, 2013)과 Li-Lee 모형과 LC-ER모형을 조합한 LL&LC-ER 모형으로 사망률을 예측하는 것이 바람직하다.

• 보건행정학회지
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• 제27권2호
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• pp.114-120
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• 2017

The hospital standardized mortality ratio (HSMR) is a widely used generic measure for assessing quality of hospital care in many countries. However, the validity of HSMR as a quality indicator is still controversial. We critically reviewed characteristics of HSMR and suggested how to use HSMR as a quality indicator in the Korean setting. The association between HSMR and other quality measures of hospital care is inconclusive. In addition current HSMR model has shortcomings in risk adjustment because of the lack of clinical data, accuracy of disease coding, coding variation among hospitals, end-of-life care issues, and so on. Therefore, HSMR should be used as an indicator for improvement, not for judgement such as public reporting and pay-for-performance. More efforts will be needed to tackle practical and methodological weaknesses of HSMR in the Korean setting.

• Journal of Chest Surgery
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• 제21권5호
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• pp.816-827
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• 1988

Since 1978, We have experienced 87 cases of Fontan operations and the candidates of that increased in numbers recently with the improvement of the diagnostic and operative technique. We studied the prerequisite factors and hemodynamics of 22 cases of Fontan operations, done during the last one year period, which were 3 tricuspid atresia, 16 functional single ventricle and 3 anatomic single ventricle. The mean age was 68 months and the mortality rate 24%, and 9 patients of under 4 years of age were operated with 22.2% mortality rate, but the youngest, 16 months of age, patient survived well without problems. The preoperative pulmonary artery pressure[PAP], pulmonary vascular resistance[PVR] and postoperative right atrial pressure[RAP], left atrial pressure[LAP] value influenced the mortality, but age, preoperative Hb, preoperative PaO2 and pulmonary artery index[PAI] did not. There were favorable survival tendency in under 15mmHg of preop. PAP, 2a of preop. PVR and under 25cmHyO of postop. RAP, under 15cmHyO of postop LAP. The younger, the more pleural effusion and the longer postoperative admission days. The higher preop. Hb related to the higher postop. transpulmonary pressure gradient and the lower preop. PaO2 and PAI. The higher preop. PaO2, the less pleural effusion and postop. admission days. Preop. PAP closely related to preop. PVR and postop. LAP and high PVR increased the pleural effusion and postop. admission days. The larger PAI, the larger CI. We concluded that there were so many factors influencing the postoperative condition, but preop. PAP, PVR, Hb, postop. RAP and LAP were the most ones.