2003년 국내 중증급성호흡기증후군 진료 현황 및 문제점 분석

이진수,김은실,정문현,백제중,정선화,안주희,최영화,이선희,고철우,김성범,김민자,박승철,기현균,송재훈,최상호,김양수,이상오,조용균,박영훈,정숙인,김연숙,이흥범,손창희,장성희,정희진,김우주 대한감염학회 2004 감염과 화학요법 Vol.36 No.3

목적 : 2002년 말 중국에서 SARS가 발생한 이후 국내에서도 2003년 10월까지 총 3명의 추정환자, 17명의 의심환자가 보고되었다. 향후 추가적인 SARS의 유행이 우려되는 상황에서, 그간의 SARS 환자 진료에 있어서의 실질적인 준비사항, 진료 현황 등에 대한 조사를 통해 문제점을 파악하여, 향후 더 나은 대비가 될 수 있도록 개선점을 제시하고자 하였다. 재료 및 방법 : SARS로 의심되는 환자를 진료 경험이 있는 병원의료진을 대상으로 2003년 10월에 설문조사를 실시하였다. 설문에는 SARS 환자 진료 시의 실질적인 조치, 진료 현황, 병실, 응급실 및 외래에서의 격리 시설과 준비사항, 보건당국의 관리와 지원에 관한 사항을 포함하였다. 결과 : 대상이 되는 22개 병원 중 17개(17/22, 77.2%) 병원이 설문에 응하였다. SARS 환자를 위한 격리실은 응급실, 외래, 일반병실 및 중환자실에서 각각 9개(9/17, 52.9%), 5개(5/17, 29.4%), 15개(15/16, 93.7%), 4개(4/16, 25%) 병원에서 음압처리가 되어있지 않은 일인실 혹은 다인실이 사용되었고, 1개(1/16, 6.3%) 병원에서만 일반병실에서 음압격리실이 운영되었다. 입원환자의 진찰 시 개인보호구의 착용은 거의 모든 의료기관에서 이루어졌다. 보건당국에서 SARS지정병원의 시설 등을 사전에 확인한 곳은 1곳(1/12, 8.3%)이였고, 14개 병원(14/15, 93.3%)에서는 보건당국에 의뢰한 검사결과를 통하 받지 못하였다. 결론 : 의료기관에서 SARS 환자용 격리실뿐만 아니라 기존의 격리실 설비 등이 미흡하였으며, 특히 중환자실 및 외래의 준비가 더욱 부족하였다. 보건당국의 의료기관에 대한 종합적인 지원이 부족하였고, 병원과의 원활한 연계가 잘 이루어지지 않았다. SARS 만이 아닌 격리를 필요로 하는 질환의 적절한 진료를 위해 향후 병원 시설의 정비와 정부차원에서의 보다 구체적이고 실질적인 대책마련이 필요하다. Background : There was an worldwide outbreak of the Severe Acute Respiratory Syndrome (SARS) originated from China in late 2002. During that period three cases of suspected SARS and 17 cases of probable SARS were reported in Korea. With the concerns about the reemergence of SARS-coV transmission, it is important to be prepared for any possibility. So, this study is aimed to analysis the past measures in managing SARS and propose the amendatory plans to improve the preparedness. Materials & Methods : Questionnaires were collected among clinicians with any experience in managing the probable or suspected SARS cases in Oct. 2003. 17 out of 22 hospitals responded to the questionnaire. The contents in the questionnaire were practical activities, personal equipments, response plans, isolation facilities in emergency centers, outpatient clinics, general wards and intensive care units, and relationship with the public health department. Results : The dedicated isolation rooms in emergency centers, outpatient clinics, general wards, and intensive care units were prepared in 9 (9/17, 52.9%), 5 (5/17, 29.4%), 15 (15/16, 93.7%), and 4 (4/16, 25.0%) hospitals, respectively. Except for one hospital that newly made negative pressure room for SARS, single or multi-bed rooms without airborne infection control were used in all the other hospitals. The personal precaution principles were kept quite well in general wards. Before the designation of SARS hospital by the public health department prior evalution to see if the hospital was suitable for managing SARS was conducted in only 1 (1/12, 8.3%) hospital. The results of laboratory diagnosis were reported back in 1 (1/15, 6.6%) hospital. Conclusions : The isolation facilities which can control airborne infection were almost deficient not only for SARS but also for other respiratory transmissible diseases. For the infection control of transmissible diseases including SARS, more investment is needed on medical facilities and comprehensive support from the public health department required.

대동맥 판막 치환술 후 반복되는 Acinetobacter baumannii 균혈증의 원인이 된 대동맥염 1예

정용필,김성철,송은희,장은영,김은경,김윤지,성흥섭,김미나,최상호,우준희,김양수 대한감염학회 2007 감염과 화학요법 Vol.39 No.3

감염성 대동맥염은 흔하지 않지만 매우 위중한 질병으로 Salmonella so.와 S. aureus가 주된 원인균이다. 아직까지 병원내 감염의 주요 원인균인 Acinetobacter baumannii에 의한 감염성 대동맥염은 보고된 바가 없었다. 저자들은 대동맥 판막 치환술을 시행받은 76세 남자 환자에서 적절한 항생제 투여에도 반복되는 A. baumannii 균혈증의 원인이 감염성 대동맥염으로 진단되었던 1예를 경험하였기에 보고하는 바이다. Infectious aortitis is an uncommon yet, life threatening disease. Early surgical treatment and prolonged antibiotic therapy is crucial to survival. Salmonella sp. and Staphylococcus aureus are the most common organisms isolated. There is no case report of infectious aortitis caused by Acinetobacter baumannii, which has recently emerged as a major cause of health care-associated infections. Here, we describe a 76-year-old male with infectious aortitis who experienced recurrent bacteremia due to A. baumannii in spite of adequate antimicrobial therapy after aortic valve replacement.

뇌하수체 종양 제거술 시행 후 뒤늦게 발생한 횡문근 융해증과 동반된 중추성 열

장제혁,최규남,김일환,노은지,김윤정,유충헌,고정해,박봉수,김태균,권민정,이순희,박정현 인제대학교 2008 仁濟醫學 Vol.29 No.-

Body temperature is controlled by thermoregulatory center of the hypothalamus. We report a case of 24 years old man with central fever. He was subjected to a partial excision of pituitary tumor compressing optic chiasm four years ago. He has received hormonal therapy for panhypothyroidism after removal of pituitary tumor. And He received gamma knife operation for partially contrast-enhancing masses in suprasellar and both hypothalamic areas that is probably postoperatively remnant or recurrent tumor of pituitary adenoma. One year after gamma knife operation, he presented with a febrile syndrome of unknown origin including rhabdomyolysis. All usual investigations proved negative. We diagnosed him as central fever with rhabdomyolysis. He received medical ICU care with cooling bed, ice pack. And his symptom improved. Postoperative hyperthermia may result following resection of the pituitary tumor. When central fever is suspected taking note of past history, a quick recognition of course of fever can help reduce the using of unnecessary antibiotics and hospital stay.

독거노인과 가족동거노인의 신체적 건강상태와 건강행위에 관한 연구

장은희,김후자,권경남,정귀애,김연화,이인혜 영남이공대학 2004 論文集 Vol.33 No.-

Purpose : The purpose of this study was to identify the physical health status and health behavior practice of in-home elderly in order to provide basic data for effective nursing intervention to promote health and quality of life. Method : The subjects for this study were 299 elderly persons in the D city. Data were collected by interview with questionnaires. Result : The ratio of chronic disease was higher for the elderly who live alone than the elderly who live with family. Arthritis was the most common chronic disease of the elderly in spite of the fact that either they live alone or live with family. The physical health status score of the elderly who live with family was statistically higher than the elderly who live alone. The health behavior score of the elderly who live with family was statistically higher than the elderly who live alone. Conclusion : To promote health behavior of the elderly, it is necessary to develop nursing intervention that considers sociocultural tradition and demographic character.

항암요법을 받은 폐암환자의 삶의 질

장군자,박점희,류은경,김현미 慶北大學校 醫科大學 1996 慶北醫大誌 Vol.37 No.3

목적 : 항암요법을 받은 폐암환자의 삶의 질 정도를 파악하여 효과적인 암환자 간호를 하기 위한 기초자료를 제공하기 위해 본 연구를 시도하였다. 대상 및 방법 : 1995년 10월 1일부터 1996년 3월 31일까지 대구시내 소재 1개 대학교 병원에 입원하여 폐암을 진단받은 후 항암요법을 받은 환자 97명을 대상으로 하여 구조화된 질문지를 이용하여 자료를 수집하였으며, 자료의 분석은 SAS program을 이용하여 실수, 백분율, 최소값, 최대값, 평균, 표준편차, t-test 및 ANOVA, 단계적 중회귀분석을 하였고, 도구의 신뢰도는 Cronbach's α값을 구하였다. 결과 : 항암요법을 받은 폐암환자의 삶의 질 평균은 4.67이었고, 영역별로는 신체적 영역 3.90, 정신적 영역 4.23, 사회경제적 영역 5.65였다. 인구학적 특성에 따른 삶의 질은 연령과 교육수준에서, 질환특성에 따른 삶의 질은 신체적 활동정도에서 유의한 차이가 있었고, 항암제 종류와 항암치료횟수에 따른 삶의 질은 유의한 차이가 없었다. 결론 : 항암요법을 받은 폐암환자의 삶의 질 정도는 4.67로 다른 암진단을 받은 환자들에 비해 낮은 편으로 폐암에 대한 간호학적인 지식의 축적과 효과적인 간호중재에 대한 계속적인 연구, 항암요법이 폐암환자의 삶의 질에 미치는 영향에 대해서 더 많은 연구가 필요하다고 생각된다. This study was designed to investigate the quality of life in lung cancer patients with chemotherapy. Ninety seven patients with chemotherapy were sampled from one university hospital located in Taegu. The data were analyzed by percentage, mean, t-test. ANOVA. and stepwise multiple regression analysis, using the SAS program. The results were as follows; The mean score of quality of life was 4.67/10. The mean score of psychological dimension was 4.23/10. The mean score of socio-economic dimension was 5.65/10. The general characteristics related to quality of life were age. education level. A cancer characteristics related to quality of life was performance state. There was no statistically significant difference between chemoagents, chemotherapy frequency and quality of life.

간호사들의 건강개념 의미에 관한 연구

장은희 영남이공대학 산업기술연구소 1990 産業技術硏究 Vol.4 No.-

This study aims at identifying the nurse's cognition of health concept and to provide basic data of nursing theory and practice. For this research, the data were gathered by self-administered questionaries from 241 nurses who were selected of 3 General Hospital and 4 Community Health Center. The instruments used for the study were health conception scale which was developed by Smith, Laffrey's revised and tested its reliability. The data was analyzed by SPSS program and the resulted were as follows; 1. The results of the reliability test for content of health concept was α=.90. 2. The nurse's cognition of health meaning were inclined to emphasize well-being dimension rather than clinical dimension. 3. The cognitive level of health concept in clinical dimension was proved to be significantly by the variable; age, marital status, education level, hospitalization and clinical career.

에스떼틱 살롱을 위한 Relax-Zone 경영에 관한 고찰

장경자,한은희 경복대학 2001 京福論叢 Vol.5 No.-

국내 피부미용계는 그 동안 많은 전문인력의 배출과 에스테티션의 노력으로 발전되어 왔다. 그러나 에스테틱 살롱이 보다 높은 경쟁력을 갖추기 위한 전문적이고 현장 적응이 용이한 경영 이론서가 적은 것이 우리 피부미용계의 현실이다. 본 논문은 이러한 사업 현장에서 적용 가능한 경영기법의 노하우와 새로운 시대에 걸맞는 경영기법을 제시하는데 연구의 목적이 있다. 이러한 상황에서 에스테티션에게 가장 적합한 대안으로 선택한 경영이론이 Relax-Zone 경영기법으로 연구 내용은 다음과 같다. - Esthetic salon의 실태 - 마켓팅의 원론과 현대 마켓팅론 - Esthetic salon의 경영환경과 사고의 전환 - Relax-Zone의 정의 - Realx-Zone 경영의 구성요소 본 연구는 다음과 같은 결론을 내릴 수 있다. 에스테티션에 의한 에스테틱 살롱의 경영에 경쟁력을 높일 수 있는 방법으로 설정 할 수 있는 것은 Relax-Zone 경영 기법이다. 이는 에스테티션의 노력과 연구로 충분히 성취할 수 있는 기법이며 자연 친화적 (Natural Friendly) 사유를 말하는 것이다. 특히 Relax-Zone 경영은 에스테티션에게 테라피스트 로서의 독창적인 경영의 노하우를 터득하게 하고 높은 경쟁력과 이익을 가져다 줄 것이다. The field of domestic skin & beauty has been developed by appearance of many professionalist and esthetician's effort. It is our reality that there are few technical management theoretic books which is easy to the field for higher competitve power of esthetic salon. The purpose of this study is to suggest know-how of management techique applicable in these business area and suitable for new age. In these environment, it is Relax Zone management esthetician technique that management theory chosen for the most adequate alternative plan to estheticians is. The study of this Relax Zone management technique is following : - Actual condition of esthetic salon - Marketing principles and modern marketing theory - Managing environment of esthetic salon and conversion of thought - The definition of Relax Zone - Constitutional elements of Relax Zone The results of this study are following ; It is Relax Zone management technique that can be set up as a technique raise competitive power in esthetic salon management by esthetician. It is the technique which can be accomplished with esthetician's effort and research and natural friendly speculation. Especially the management of Relax Zone will let esthetician acquire know-how of management and have high competitive power.

Mycobacterium intracellulare에 의한 요추부 척추염 1예

장은영,김미영,김정욱,송은희,백관미,정용필,성흥섭,김미나,김양수,우준희,이상호 대한감염학회 2007 감염과 화학요법 Vol.39 No.3

비결핵성 미코박테리아에 의한 척추염에 대한 증례 보고가 국내에서는 아직 없었다. 저자들은 기저질환이 없는 환자에서 M. intracellulare에 의한 척추염을 rpoB 유전자에 대한 PCR-RFLP 방법을 통해 진단하였고 수술적 치료와 3제 병합 항균 요법으로 성공적인 임상 경과를 보인 1예를 경험하였기에 보고하는 바이다. We report a case of vertebral osteomyelitis due to Mycobacterium intracellulare in a 60-year-old man without predisposing conditions. He was successfully treated with surgical excision of the inflamed tissue and combined antimycobacterial therapy consisting of clarithromycin, ethambutol, and rifampin. In this case, polymerase chain reaction-restriction fragment length polymorphism analysis (PCR-RFLP) based on the rpo B gene of cultured isolates allowed rapid identification of M. intracellulare. Although very rare, nontuberculous mycobacteria (NTM) should be suspected as a causative pathogen of vertebral osteomyelitis. To the best of our knowledge, this is the first case of vertebral osteomyelitis caused by NTM reported in the Korean literature.

보의 전단 내력에 관한 실험적 연구

장원영,고봉수,은희창,서일교 제주대학교 공과대학 첨단기술연구소 2001 尖端技術硏究所論文集 Vol.12 No.2

The objective of this study is to describe the shear behavior of reinforced concrete beams. Twenty-four specimens were tested with the variables of concrete strength, the strength and spacing of shear bars, and support conditions. The specimens without the shear reinforcement bars showed the shear failure with the abrupt deterioration of shear capacity. The ones with the shear bars exhibited the enhanced capacity with the yielding of longitudinal bars or crushing of compressive concrete. It was observed that the specimens had an flexural effect. Also, the specimens with the continued support condition showed more flexural and shear capacity than the ones with the simple supports, and it was shown that the results satisfied the ACI code.

보완대체요법에 대한 간호사와 의사의 태도 비교 연구

장은희,박경숙 성인간호학회 2003 성인간호학회지 Vol.15 No.3

Purpose : The purpose of this study was to develop a fundamental reference for the clinical implementation of Complementary and Alternative Therapy (CAT) by surveying and analyzing different perception and attitude between nurses and physicians. Method : A total of 167 nurses and 103 physicians from two C university health science centers participated in this survey, and SPSS program with version 10.0 was used to analyze the result of survey. Result : As results, 72.7% nurses and 57.1% physicians showed positive attitude for the concept of CAT, 606% nurses and 36.7% physicians responded positively while 2.6% nurses and 25.9% physicians responded negatively for the application of CAT to the clinical practice. There was a meaningful difference between two groups in the belief of therapeutic effectiveness of CAT. 67.7^ nurses believed the therapeutic effectiveness of CAT while 38.8% physicians did. For attitudes of nurses and physicians toward CAT showed meaningful difference according to general characteristics : age, gender, marital status, a level of education, position in the organization, religion, and duration of health care service other than inpatient units. Conclusion : In this study, the attitudes of nurses and physicians about CAT showed meaningful difference that nurses were more positive than physicians in application.