제2형 당뇨병 환자에서 적극적 환자 교육이 혈당조절에 미치는 효과

이윤욱,황원선,최선정,이동훈,김도현,이은희,홍은경,노혜림,정윤석,이관우,김현만 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.1

연구배경: 현재까지의 당뇨병 교육에 대한 노력은 제한되었으며, 연구 결과를 보면 식사 조절 교육과 체중 조절 프로그램을 수행한 환자들 중 적극적이고 기간이 긴 교육을 받은 경우, 성공적 결과가 나타남을 알 수 있었다. 자가관리나 체중감량 등의 당뇨병 치료의 중요한 목표는 적극적이고 긴 기간의 교육 없이는 시행되기 어렵다. 본 연구에서는 외래에서 당뇨병 환자를 대상으로 시행할 수 있는 행동 및 식사 교육 등의 적극적 교육 프로그램을 개발하여 제2형 당뇨병 환자들을 대상으로 이들에게 식사 조절 방법에 대한 목표설정과 문제에 직면하였을 때의 해결 방법 등을 교육해서 궁극적으로는 적극적 자아관리에 연결될 수 있도록 도와주는 것을 목적으로 기존의 통상적 교육과 보다 적극적인 교육이 당뇨병 환자의 혈당 조절에 어떠한 영향을 미치는지에 대해 알아보기 위해 다음과 같은 연구를 시행하였다. 방법: 본 연구는 아주대학교 병원 내분비 대사 내과를 처음으로 방문하여 치료받았던 58명의 제2형 당뇨병 환자를 대상으로 하였다. 내원 환자들을 무작위하게 추출하여 진찰권 번호 끝자리에 따라 홀수는 통상적 교육군(conventional education group, CE)과 짝수는 적극적 교육군(intensive education group, IE)으로 나누어 교육하고, 3개월후에 교육의 효과를 평가하였다. 결과: 1) 연구 대상자들의 교육 전과 후의 공복혈당, 식후2시간 혈당 및 HbA_lc 치는 IE군과 CE군 모두 각 그룹 내에서, 유의적으로 감소하였다(p<0.05). IE군에서는 공복혈당이 12.4nmol/L에서 7.7nmol/L로, 식후2시간 혈당이 20.3nmol/L에서 10.9nmol/L으로, HbA_lc치가 9.4%에서 7.0%로 모두 교육 전에 비하여, 교육 후에 감소(p<0.05)하였고, CE군도 공복혈당은 10.9nmol/L에서 9.4nmol/L로, 식후2시간 혈당은 17.1nmol/L에서 14.6nmol/L으로 HbA_lc가 8.5%에서 7.3%으로 모두 교육 후에 감소하였다(p<0.05). 또한, 교육 전에 비하여 교육 후에 공복 혈당 및 HbA_lc치가 감소하는 정도는 IE군에서의 감소가 CE군에 비해 더 현저하였다Op<0.05). 2) 식사에 대한 태도는 3부분으로 나누어 식사에 대한 규칙성, 식사 내용의 균형성, 식사에 대한 태도 등으로 나누어 각각의 점수 및 총점을 비교하였으며 교육 전에 비해 교육 후에 연구 대상자들의 식태도가 향상되었음을 알 수 있었다. 두 그룹간의 차이를 분석한 결과 식사의 균형성 항목에서와 총점에서 유의적으로 두 그룹의 차이를 보여서 IE군에 CE군에 비해 식사의 균형성 측면이 향상되었고, 전체적인 식태도가 좋아졌음을 알 수 있었다(p<0.05). 결론: 비교적 긴 기간은 아니지만 적극적 교육을 받은 당뇨병 환자들이 통상적 교육을 받은 군보다 혈당 및 HbA_lc, 식태도 점수등의 수치의 호전뿐만 아니라 당뇨병 환자의 삶에서 중요한 부분을 차지하는 식사요법 관리 부분에 있어 향상됨을 알 수 있었다. Background: To this date, efforts to develop effective methods for the education of diabetic patients have been limited. The important goal of self-management and weight control for diabetic treatment can not be attained without long and intensive period of education. This study was undertaken to assess the effectiveness of an intensive educational program, of behavior and diet control, which was carried out on subjects with type 2 diabetes, on and out-patient basis. we compared the effectiveness of an intensive education programme with that of a conventional education programme for the self-management of type 2 diabetic patients. Methods: Subjects with type 2 diabetes were randomly selected, and allocated to one of two groups. One group received a conventional education programme of self-management(the CE group), and the second group received an intensive education progammes for three months, after which the effectiveness of the programmes were evaluate. Results: 1) The levels of fasting blood sugar(FBS), postprandial 2 hour blood sugar(PP2h) and HbA1c were significantly lowered in both groups following the intervention(p<0.05). In the IE group, the FBS declined from 12.4nmol/L to 7.7nmol/L, PP2h declined from 20.3nmol/L to 10.9nmol/L, and the HbA_lc showed a similar decline from 9.4 to 7.0% after intervention(p<0.05). In the Ce group, the FBS declined from 10.9 to 9.4nmol/l, the PP2h decreased from 17.1 to 14.6nmol/l, and the HbA_lc also decreased from 8.5 to 7.3% after intervention(p<0.05). The decrease in the FBS and HbA_lc following the educational intervention was more pronounced in the IE group than the CE group(p<0.05). 2) The effectiveness of the education programmes in promoting appropriate dietary behavior in the diabetic subjects was assessed by a scoring system in three parts: a regularity score, a balance score and an attitude score. From a comparative study of the three scores, the patients attitudes were observed to be much improved in both the groups following the intervention compared to before the programmes, but the balance and total scores were significantly higher in the IE group than the CE group(p<0.05). Conclusion: We can conclude that the intensive diabetic education programme is more effective than a conventional programme, not only in improving the patients' levels of glucose, HbA_lc, and dietary score, but also the diabetic patients self-control abilities, promoting behavioral change, and prompting problem solving capabilities in respect to the everyday problems that they have to face throughout their lives(J Kor Soc Endocrinol 18:63∼72, 2003).

췌장 선방세포암 1예

이화정,지준호,박승찬,박정철,최은정,서혜진,이원식,이정림,배병조,손경락,이경희 영남대학교 의과대학 2008 Yeungnam University Journal of Medicine Vol.25 No.2

Acinar cell carcinoma is a rare tumor that represents 1~2% of al1 pancreatic cancers. Clinical and radiologic findings are inconclusive in this disease Acinar cell carcinoma is characterized by rapid progression and early metastasis, which lead to its poor prognosis. A 41-year-o1d man was admitted to our hospital for abdominal pain. Abdominal computed tomography (CT) and positron emission tomography-computed tomography (PET-CT) showed a splenic mass, which was being invaded by a pancreatic tail mass and which had increased ^(18)F-fluorodeoxyglucose (FDG) uptake Primary radical distal pancreatectomy and splenectomy were performed. Pathologic findings revealed an acinar cell carcinoma of the Pancreas The patient underwent a total gastrectomy three months later because of gastric recurrence Four months later, multiple hepatic metastases were discovered, and the patient underwent a left hepatectomy During treatment with capecitabine, there was no evidence of tumor progression for 14 months. We report a case of metastatic pancreatic acinar cell carcinoma, which did not progress for an extended period while the patient was being treated with capecitabme.

치차로스의 <시적인 순간> 중 ‘철새’, ‘블루스 왈츠’, ‘나비 래그타임’, ‘서부기차’ 분석 및 교수법적 제안

신은혜 ( Shin¸ Eun-hyeㆍlee¸ Joo-hye ),이주혜 한국피아노교수법학회 2021 음악교수법연구 Vol.22 No.1

치차로스(Christos Tsitsaros, b. 1961)는 미국 일리노이 대학교의 피아노 교수학과 교수이며, 피아노 교육용 작품을 많이 작곡하였다. 본 논문은 국내에 잘 알려지지 않은 그의 작품에 대한 정보를 제공하고 한정된 레퍼토리의 선택지를 넓히는데 기여하고자 그의 교육용 피아노 작품인 <시적인 순간>에 나타난 음악적 특징을 살펴보았으며, 중급 학생들에게 효과적인 교수방법을 제시하였다. <시적인 순간>은 총 8곡으로 구성되어있으며 이 중 ‘철새’, ‘블루스 왈츠’, ‘나비 래그타임’, ‘서부기차’를 살펴보았다. ‘철새’는 편안하고 서정적이며 아르페지오와 당김음 페달 교육에 효과적이다. ‘블루스 왈츠’는 불분명한 조성감으로 몽환적 분위기를 자아내며 리듬적 유연함을 배울 수 있다. ‘나비 래그타임’은 스윙 리듬과 다양한 아티큘레이션의 표현을 공부할 수 있다. ‘서부기차’는 빠르고 긴장감을 유발하는 곡으로 다양한 페달의 사용을 습득할 수 있다. 이 곡들은 길이가 짧고 단순하며, 다양한 음악양식과 재즈적인 요소를 지니고 있어 중급 학생들이 흥미롭게 학습할 수 있다. 본 논문을 통해 더 많은 교육용 레퍼토리가 확대되고 그의 교육용 피아노 작품들에 대한 관심과 연구가 이어지길 기대한다. Christos Tsitsaros(b. 1961) is a Professor of Piano Pedagogy at the University of Illinois in Urbana-Champaign, IL in the United States, and has composed many educational piano pieces. On the purpose of providing information on his compositions, which are not well known in Korea, and contributing to expand educational piano repertoire, this article examines the musical features of his < Poetic Moments > and suggests effective teaching methods for intermediate level students. < Poetic Moment > consists of a total of 8 character pieces: ‘Migrating Birds’, ‘Blues Valsette’, ‘Butterfly Rag’, and ‘Westbound Train’ among them were investigated. ‘Migrating Birds’ is easy to listen, lyrical and effective for polishing arpeggio skills and syncopated pedaling. ‘Blues Valsette’ creates a dreamy atmosphere with complex harmonies and students may learn rhythmic flexibility. ‘Butterfly Rag’ employs swing rhythm and diverse articulations. ‘Westbound Train’ has fast running tempo increasing tension and good for learning various pedaling. Each piece is short and simple attracting intermediate level students’ interest by conveying various musical styles and jazz elements. Through this article, I hope that more educational repertoire will be expanded and interest and research on Tsitsaros’ educational piano compositions will continue.

원발성 후복막 점액낭샘암종 1예

지준호,이화정,박승찬,박정철,최은정,서혜진,이원식,이정림,배병조,손경락,이경희 영남대학교 의과대학 2008 Yeungnam University Journal of Medicine Vol.25 No.2

Primary retroperitoneal mucinous cystadenocarcinoma is a very rare malignancy, and little is known concerning its Pathogenesis, optimal treatment, and prognosis. A 29-year-o1d pregnant woman (21 weeks) Presented with abdominal discomfort CA 19-9, CA 125, and CEA were normal Abdominal CT scanning revealed a 19x15x13 cm retropentoneal tumor Exploratory laparotomy and tumor excision were performed. Mucinous retropentoneal implants were removed as completely as possible Histologically, the tumor showed focal areas of capsular invasion, but free resection margins The uterus and both ovaries were normal in appearance No adjuvant therapy was pursued. Six months later, Peritoneal and bilateral ovarian metastases were discovered. Hence, we report the details of this case of primary retroperitoneal mucinous Cystadeno-carcinoma and present a review of the literature.

억제대 적용지침 개발을 통한 불필요한 억제대 적용율 감소활동

곽경선,김성은,배은경,이은숙,이은혜,최윤정,이윤경 한국의료QA학회 2009 한국의료질향상학회지 Vol.15 No.2

문제: 억제대 적용에 대한구체적 적용지침 없이 의례적으로 억제대를사용함으로 인해 환자들의 신체적 또는 정신적 안전을 위협할 수 있다. 목적: 완전 진정상태 이거나 근력이 약하여 발관능력이 없는 환자에 대한 예방적 적용, 바빠서 환자를볼수 없 는경우, 간호사본인의 판단이 없이 타인의 요구에 따르는등의 불필요한 억제대 적용이 증가하는 원인을 파악하여 중환자실의 특수성에 맞는 억제대 적용및 제거 지침을 마련하고자 한다. 의료기관: 인천광역시에 소재한 의과대학 소속병원의 집중치료실 개선효과: 억제대 적용에 대한중환자실 간호사에게 미치는 영향을 보면 태도 정도 p=0.09(p<0.1), 올바른 수행 능력은 p= 0.005 (p <0.0히로통계적으로유의한것으로 나타났다. 지식 정도 p=0.172(p<0.05) 통계적으로 유의 하지는 않지만 모든항목이 개선 활동전 에 비해 2,3차 개선 활동후에 향상한 것으로 나타났다. 개선활동전에 8.1%였던 간호 기록, 0.7%였던 간호중재, 0%였던 의사처방율이 3차 개선 활동 후 3가지 모두 100% 달성되었다. 이는 억제대 적용율 갑소 및 부적절한 억제대 적용율은 유의하게 감소하였다. 교훈: 중환자실 간호사의 억제대 적용에 대한태도, 지식, 올바른 간호 수행 능력은 지속적으로 재평가 되어지고, 교육내용은좀더 나은 간호제공을 위하여 개발 되어져야 할 것이다. 억제대 적용 기준과 제거 기준을 Check List 하여 객관성의 유지를 위한 개선 활동은계속적으로 Feedback 되어야 할 것이다.

식품 기준·규격의 합리적 관리 ·운영에 관한 연구(Ⅰ) : 두부,식용유지, 전분의 분말상 원료에 관하여 Powdered marerials of Tofu, Edible oil, Starch

김희연,홍진환,박혜경,한상배,박종석,이은주,이정성,송경희,최은희,최영준,소경아,성영제,이주엽 식품의약품안전청 2000 식품의약품안전청 연보 Vol.4 No.-

본 연구는 분말상 원료(전분, 대두분)의 저장유통시 품질변화를 건전성과 안전성 측면에서 검토하여 식품의 기준 ·규격 설정f.」 합지적으로 반영하고자 하였다. 전분과 패두분의 이물을 검사하고, 2종 대두분(중국산, 미국산)을 ?0일간 IS'c와 30t에 저장하면서 성상, 수분, 산가, 과산화물가, 지방산 조성,아플라톡신 BB의 생성여부를 분석하였다. 중국산 대두분 30'』 저장군에서 50일 이후 곰팡이가 발생한 것 이외에 모든 시료에서 양호한 성상을 나타내었고, 전분과 대두닥 모든 시료에서 이물은 검출되지 않았다. 산가는 중국산과 미국산 시료간에 편차를 보여 증국산 30"C, 50일 저장시료에서 약 10배끙도 증가하였고, 과산화물가는 저장 90일후 15'E 저장군은 약 2.3배, 30'c 저장군은 3배정도 증가하였다. 대두분의 주요 지방산은 linoleic acidf18. 2), oleic acid(18 : 1), palmitic acid(16 : 0)이었으며, 3개월 저장에 따른 지방산 함량의 변화는 미미하였다. 아플라톡신 B₁은 모든 시료에서 검출되지 않았다. The objective of this study was to investigate auality changes of type raw materials(starch, soy flour) during various storage conditions. Starchflour(source of China, U.S.A) were slfred under two temperature(15'C, 30'c) forSensory evaluation, (o.reign material test, moisture content, acid value, peroxide ualue,composition, aflatorin Bi were analyzed. China soy flour(stor·ed 30'f) was contaminated by fungj on 50 days. Except for soy flour contardnated by fungi, sensory characteristics were not changed and foreign mater;als were notdetected. Acid value of China soy flour(stored at 30'C, 90 days) was about 10 times higherlevel before storage and acid value was more influenced by source(China, USA). Peroxide valuewas in proportion with the storage period slightly. The major fatty acid of soy flour waslinoleic acid(18 . 2), an(3 the change of fatty acid composition was not observed. Aflatoxlrl Blwas not detected.

피부 적용 겔제제의 첨가제에 의한 수분 보유력 평가

이은미,박종희,경기열,전일순,조혜정,지웅길 충남대학교 약학대학 의약품개발연구소 2004 藥學論文集 Vol.19 No.-

The aim of this study was to improve the moisturizing and water retaining effects of a gel containing poloxamer 407, glycerin, sod hyaluronate, sorbo(sorbitol 70%). Topical preparations were formulated as a gel containing different concentration poloxamer 407, glycerin, sod. hyaluronate, sorbo(sorbito1 70%), lipid(ceramide. sphingosine ratio 1:l). We tested a various combination of different additives for the moisturizing effect The water holding capacity of the mixture was measured using a moisture analyzer. In vivo test was carried out on human skin using Skicon-200 and water retaining effect was increased by addition of lipid. Water evaporation test was performed by various concentration of additives and water evaporation characteristics of the preparations were determined using the moisture analyzer. Moisturizing and water retaining effects was increased by adequate combination of various additives with topical gel formulations.

정련 및 세리신 정착처리 견직물의 물리적 성질과 염색성

이은미,이혜자,유혜자 한국의류학회 2003 한국의류학회지 Vol.27 No.5

We studied the physical properties of silk fabrics after degumming, the dyeability and the color fastness of silk fabrics after degumming and sericin fixing. As the sericin was removed form silk fabrics, the rate of weight loss increased and both the abrasion resistance and the drape coefficient decreased. This means that the amount of the sericin remained in silk fabrics significantly affects the physical properties of silk fabrics. On the surface and the cross-section of silk fabrics, the silk fibers enclosed by the sericin seemed to be in a lump shape. Each fibroin strand, however, got scattered, ad the process of degumming went through. The dyeability of silk fabrics degummed decreased at between 20℃~80℃ the dyeing temperature, on the other hand, it significantly increased over 80℃. The dyeability of the sericin-fixed silk fabrics was lower than that of the non-serin-fixed silk fabrics, to a little extent. The colorfastness of crocking in the dyed-silk fabrics was a little low and that of the sweat was much lower in a basic sweat. Especially, the colorfastness of the partially degummed silk fabrics was low, because the sericin was not stable in the condition of sweat. Therefore, the process of sericin fixing is essentially required, for the partially degummed silk fabrics and the process of degumming itself.

교원의 교원능력개발평가 결과, 인구학적 특성과 전문성 인식의 관계

박지혜,이경란,문은주 이화여자대학교 교육과학연구소 2015 교육과학연구 Vol.46 No.4

This study aimed to provide useful information by investigating the relationships between the results of teacher evaluation for professional development, teachers’ demographic characteristics, and their perception of expertise. Among those who participated in the survey asking teachers’ perception of the 2014 teacher evaluation for professional development, the data from 1,622 teachers in the upper and lower limits of one standard deviation of teacher peer evaluation and student satisfaction were used. Study findings were as follows. First, statistically significant and positive correlations existed between teacher evaluation results and teachers’perception of expertise. Second, female teachers, those whose career spanned 5-15 years, elementary teachers perceived their expertise higher than those of male teachers, those whose careers did not span 5-15 years, and middle and high school teachers. Third, mean scores of expertise perception of teachers who had high scores on peer evaluation and student satisfaction were higher than those of other groups. Last, providing information to parents and appropriate evaluation were the key factors distinguishing those who had high scores on teacher evaluation and student satisfaction from those had high scores on teacher evaluation and low scores on student satisfaction. In addition, providing information to parents was the key factor differentiating those who had high scores on teacher evaluation and student satisfaction from those who had low scores on both teacher evaluation and student satisfaction. The significance of these study results was discussed along with limitations and suggestions for future research studies.

고등학생의 인터넷 사용정도와 학교적응, 친구관계에 대한 연구

이현주,김미연,이희재,권소영,김민정,김민주,방은혜,이경희,김수지,이자형 이화여자대학교 간호과학대학 2004 이화간호학회지 Vol.- No.38

Today, almost all families are quipped with computers. At the same time, we can find lots of side-effects because of computers. If young students, who tend to be unable to control their impulses once they are immersed in internet, the problem will be more serious. It could be happened that the young students can't distinguish the real from the image. Therefore, it is important to grasp the actual condition of juvenile Internet addicts and their practical life, and to come up with basic materials necessary for working out countermeasures. This study surveyed 339 high school students from three high schools in the area of Seoul. Data collection were collected from 22nd of December, 2003 to 27th of December 2003. The collected data were analyzed by SPSS program using T-test, ANAVA and Pearson correlation coefficient. The results were as follows: First, of the 333 respondents 9.61% of them were high-risk internet using group, 15.02% of them were potential-risk internet using group. 25% of then were identified as addicted group. Second, the more addicted the subjects are, the lower their level of school adjustment becomes. For the addicted group, it is difficult to adjust their school and to have a good relationship with friend. Third, the more addicted the subjects are, the lower their level of friendship becomes. The subordinate areas of friendship have same results as the level of Internet addiction and the extent of friendship. If students are addicted to Internet, it is difficult to find friends who can give them encouragement in practical life. Firth, there was a negative relationship between Internet addiction and school adjustment, and, there was a negative relationship between Internet addiction and friendship. Through this study we have seized the relationship between Internet addiction and school adjustment and friendship. As a result, the more addicted, the more difficult to adjust to school. And for the students who were addicted, it is difficult to make a friend.