의과대학생의 행복에 관한 인식: Q방법론적 접근

김균무,조계화 한국의료윤리학회 2013 한국의료윤리학회지 Vol.16 No.3

Happiness is one of the most important values or goals in life. Stress is one of the factors that can negatively affect levels of happiness, and medical students can experience high levels of stress during their studies. The purpose of this study was to analyze the perception of happiness among medical students. The study used Q-methodology, which provides a method of analyzing the subjectivity of each item. Thirty-four selected Q-statements from each of 34 subjects were classified into a normal distribution using a 9-point scale. The collected data were analyzed using a PC-QUANL program. Three types of perception of happiness were identified in the subjects: ‘comfort’ (15 persons), ‘self-satisfaction’ (10 persons), and ‘accomplishment’ (13 persons). When there are programsoffering opportunities for leisure activities, such as rest and travel, medical students’levels of satisfaction go up. On the basis of these findings we suggest that the concept of happiness should perhaps be included in the medical curriculum.

응급 내시경역행췌담관조영술 시행 급성 담관염 환자 분석; 급성 담관염 환자에서 응급 내시경역행췌담관조영술 시행을 예측하게 하는 요인은 무엇인가?

김균무,이경원 대한응급의학회 2009 대한응급의학회지 Vol.20 No.4

Purpose: Acute cholangitis is a life-threatening biliary complication. Medical treatment is the first-line therapy in patients with acute cholangitis, but those who fail to respond to antibiotic treatment require urgent biliary decompression. This study was undertaken in order to determine predictive factors for emergency endoscopic retrograde cholangiopancreatography (ERCP). Methods: This was a retrospective observation study with data from Daegu Catholic University Hospital, Emergency Department (ED). Between Jan 2005 and Dec 2007, 317 patients were enrolled into this study. Inclusion criteria for patients were a final diagnosis: acute cholangitis, and an ERCP from ED visit. We defined emergency ERCP, as ERCP done within 24 hours of an ED visit. We analyzed the medical data by using SPSS 14.0 and compared the Emergency ERCP group to the Elective (Non emergency) ERCP group with regard to age, sex, vital signs on ED, symptom onset time, mortality, and various laboratory tests. Results: Access to ED and laboratory tests (such as aspartate transaminase (AST) and alanine transaminase (ALT) were factors that showed statistically significant differences between the ERCP group (n=289) and Elective ERCP group (n=28) by the Chi-square test and the t-test by each. There were no statistical differences in other factors by independent t test or Chi-square test. Multiple logistic regression showed access to ED; a laboratory test such as AST were predictive factors for emergency ERCP. Conclusion: The result of this study indicates that the EP (Emergency physician) should pay attention to the acute cholangitis patients who visit the ED with an abnormal laboratory test. In the timely consultation to the endoscopist, EP plays a key role in the treatment of acute cholangitis.

대장내시경검사 후 발생한 의인혈액복강

김균무,장태창 대한응급의학회 2013 大韓應急醫學會誌 Vol.24 No.3

Colonoscopy is a routinely performed diagnostic and therapeutic procedure for colorectal diseases. Abdominal pain after colonoscopy is a relatively common complication;however, hemoperitoneum is a very rare complication. We report a case of a 51-year-old male patient who suffered from a left upper quadrant pain after diagnostic colonoscopy at a healthcare promotion center. He had a routine screening test, including computed tomography (CT), and the follow-up CT showed an iatrogenic hemoperitoneum without a definite spleen injury. That is complication is rare, but potentially life-threatening. We recommend a high suspicion for this complication for its early diagnosis and proper treatment.

응급 수술을 시행한 복부 외상 환자의 예후 인자는 무엇인가?

김균무 고신대학교 의과대학 2011 고신대학교 의과대학 학술지 Vol.26 No.1

OBJECTIVES: To study epidemiologic characteristics and prognostic factors of emergency laparotomy patients due to abdominal trauma. METHODS: From Jan 2006 to Dec 2008, 116 patients enrolled in this study. Inclusion criteria for patients were abdominal trauma patients with emergency laparotomy. Age, sex, ED access, transportation, previous history, time, injured organ, combined injury, initial mental status, revised trauma score, laboratory finding, mortality ware reviewed. RESULTS: Trauma was most common at 40s and at night. Men has three time more common than women. Trauma etiology was traffic accident (64 cases, 55.2%), stab injuries (31 cases, 26.7%), violence (11 cases, 9.5%). Most commonly injured organs were the small intestine, the mesentery was a following. Combined injuries were extremities fractures, head and neck injuries, chest trauma, pelvis trauma, respectively. The average time of prehospital interval was 186.49 +/- 233.29 minutes and Emergency department stay time was 270.50 +/- 180.08 minutes. The average hospitalization was 22.84 +/- 38.02 days. In a univariate logistic regression study, age (odds ratio [OR]: 1.364), systolic blood pressure below 90mmHg (OR 4.460), Hemoglobin (OR 2.380), Revised trauma score (OR 0.902), initial mental status (OR 3.394) were significant prognostic factor. CONCLUSIONS: The result of this study indicated that age, systolic blood pressure below 90mmHg, hemoglobin, revised trauma score, initial mental status were prognostic factor of emergency laparotomy patients due to abdominal trauma. When treating patients with abdominal trauma, we could be considered these prognostic factors. In addition, to establish therapeutic plan will be helpful.

심인성 원인에 의한 병원외 심정지 후 소생된 병원전 하트세이버 환자의 임상적 분석

박경인,김균무,장태창 대한응급의학회 2014 大韓應急醫學會誌 Vol.25 No.6

Purpose: Sudden cardiac death is still a major cause ofdeath and a burden to national public health. Out-of-hospitalcardiac arrest (OHCA) patients achieving field Return ofspontaneous circulation (ROSC) have better survival ratesand good neurological outcomes. The study was designedfor analysis of prehospital and hospital clinical characteristicsof Heartsaver patients surviving OHCA of cardiac origin. Methods: A retrospective study was conducted on 31Heartsaver patients surviving OHCA by EmergencyMedical Service (EMS) from March, 2011 to May, 2014; 24cardiogenic-Heartsaver patients were enrolled in this study. They were divided into the myocardial infarction group (MIgroup) and the non-myocardial infarction group (Non-MIgroup) by final diagnosis for comparison of prehospital andin-hospital characteristics. Results: The etiology of cardiac arrest cause of cardiogenic-Heartsaver was categorized according to five groups,including myocardial infarction (29.2%), Brugada syndrome(25.0%), idiopathic ventricular fibrillation (25.0%), idiopathicventricular tachycardia (8.3%), and coronary spasm(12.5%). Most patients had good neurological outcomes,Cerebral Performance Categories scale (CPC) median was1.0(1.0-1.0). The MI group showed higher average age(57.1±6.49 vs 52.3±13.0, p=0.036), high incidence of STsegmentelevation (42.9%), and nonspecific-ST or T-wavechange (24.9%) in electrocardiogram (ECG) after ROSC,higher incidence of regional wall motion abnormality inEchocardiography (85.7% vs 23.5%, p=0.009), and higherpeak level of CK-MB, troponin I within 12 hours (p=0.005,p=0.014). Some Non-MI patients had undergone an electrophysiologicstudy and received an implantable cardioverterdefibrillator. Conclusion: Cardiogenic OHCA patients should be examinedby cardiac enzyme, ECG, echocardiography, andcoronary angiography in order to differentiate etiology. Besides, to prevent sudden cardiac death from fatalarrhythmia, electrophysiologic study and implantable cardioverterdefibrillator insertion therapy must be considered.

말기 환자의 공유 의료적 의사결정에 관한 의료인의 인식 유형

조계화,김균무,Jo, Kae Hwa,Kim, Gyun Moo 한국호스피스완화의료학회 2014 한국호스피스.완화의료학회지 Vol.17 No.4

목적: 의료가 복잡하고 전문화된 최근에는 의료학문간 소통과 융합이 강조되고 있다. 병원업무는 환자를 중심으로 여러 분야의 협동 체계를 통한 의사결정의 효율성이 요구된다. 이 논문은 말기 환자에 대한 의사와 간호사의 공유 의료적 의사결정에 대한 인식을 알아보고자 한다. 방법: Q 방법론을 적용하여 35개의 Q 진술문을 9점 척도의 정규분포로 39명에게 작성하도록 하였다. 수집된 자료는 QUANL PC 프로그램으로 분석하였다. 결과: 환자결정형, 의사결정형, 의료인 공유결정형, 환자 가족 결정형의 네 가지 유형으로 나타났다. 공통적으로 동의한 항목은 충분한 설명과 치료과정의 공유, 교육 등으로 나타났고, 부정적으로 생각한 항목은 치료에 법적 측면을 고려에 대한 내용이었다. 제1유형은 환자의 요구와 가치관을 존중하는 환자중심의 의사결정 방식을, 제2유형은 의사가 결정을 내리고 환자가 이를 따르는 방식을, 제3유형은 의료인 상호간의 협력적인 의사 공유를, 제4유형은 의료인뿐 아니라 가족 참여의 의사결정을 중요하게 생각하였다. 결론: 의료인 간의 생각이 다양하다는 것을 보여주며, 일반인과도 의견의 차이를 보여준다. 의사결정에 대한 의견의 공유와 추가적인 연구가 필요할 것으로 생각된다. Purpose: The purpose of this study is to analyze types of shared medical decision making by health professionals in a decision making position. Methods: The Q-methodology was used. Q sample was constructed with a total of 35 Q-statements that were offered with a 9-point rating scale. The statements were structured to generate answers that would form a shape of a normal distribution. Answers to Q sample were analyzed using a QUANL PC program. Results: Four types of shared medical decision making were identified. Type I is patient-centered decision making, Type II is physician-centered, Type III is health professional-centered and Type IV is patient-family-centered. Conclusion: Study results indicate that it is recommended to develop an education program based on the four types of shared medical decision making so that health professionals can be provided with different approaches according to their decision making style.

병원 임상 실습이 응급구조과 학생들의 심폐소생술 수행능력과인식에 미치는 영향: 전후 연구

오예진,김균무,서영우,고승현,김동훈,장태창 대한응급의학회 2018 대한응급의학회지 Vol.29 No.3

Objective: Various educational programs have been implemented to achieve skill, willingness and self-confidence in performing cardiopulmonary resuscitation (CPR). Paramedic students usually participate in clinical practice in emergency department as one of their educational courses. We investigated the effects of hospital based clinical practice and participation in real cardiac arrest situation on paramedic students’ CPR performance and recognition. Methods: Eighty-one paramedic students from 10 different universities who received hospital based clinical practice for 3 or 4 weeks in a regional emergency medical center from December 2016 to August 2017 were enrolled in our study. Subjects were asked, using a questionnaire, about their confidence and willingness to perform CPR before and after clinical practice. We also objectively measured two minute-CPR performance using the Laerdal skill reporter before and after clinical practice. During clinical practice, students participated in real CPR situations and took several theoretical examinations; however, additional CPR practical training was not included. Results: This study included 48.1% male volunteers and 70.4% respondents who had Basic Life Support provider certification. The average number of real CPR situations participated in was 8.35 times. Scores in confidence of CPR increased significantly (3.80 vs. 4.36, P<0.001) after clinical practice; however, scores in willingness to conduct CPR were high in both groups (4.46 vs. 4.48, P=0.787). Average chest compression depth also increased significantly (51.3 mm vs. 55.5 mm, P<0.001) after clinical practice, but average compression rate showed no difference (111 vs. 111, P=0.694). Correct hand positioning and chest recoil also showed no difference between groups. Conclusion: Hospital based clinical practice of paramedic students could provide extra confidence in student’s ability to perform CPR and lead to adequate chest compression depth.

급성 담관염 환자에서 응급 역행 내시경 췌담관 조영술의 적절한 시간은?

이지현,김균무,장태창,서영우,고승현,이숙희 대한응급의학회 2021 대한응급의학회지 Vol.32 No.5

Objective: Acute cholangitis is a clinical condition caused by infection of an obstructed biliary system, which is normally managed with intravenous fluids, antibiotics, and biliary drainage. Although endoscopic retrograde cholangiopancreatography (ERCP) is the preferred method of biliary drainage, guidelines for biliary drainage time remain unclear. Methods: The current research is a retrospective study of patients with acute cholangitis who had undergone ERCP between January 2016 and December 2019. We investigated the effect of the time taken from visit to the emergency department and commencement of the ERCP, on hospital length of stay. Results: A total of 441 patients were included in this study. No association was observed between the severity of acute cholangitis and ERCP time. However, the length of hospital stay was significantly shorter for patients who underwent ERCP less than 12 hours after arrival at the emergency department. Conclusion: Conducting ERCP within 12 hours of arrival is associated with reduced hospital stays, regardless of the severity of acute cholangitis.

SCIWORA 환자에서 발생한 외상성 심정지 1례

서영우,김균무,장태창 대한응급의학회 2015 大韓應急醫學會誌 Vol.26 No.4

Spinal cord injury without radiographic abnormality (SCIWORA) is a rare injury and reported less frequently in adults than children. The symptoms and prognosis of SCIWORA are associated with injury level of the spinal cord, neurologic impairment, resolution rate, etc. High level injury of the spinal cord can lead to development of quadriplegia, paraplegia, spinal shock, cardiac dysfunction, and respiratory arrest. However initial presenting cardiac arrest is extremely rare in SCIWORA. Therefore we report on a cardiac arrest patient due to SCIWORA after a motorcycle accident. A 50-year-old male was an out of hospital cardiac arrest in a transferred hospital. At the time of local hospital arrival, he was in cardiac arrest state. Therefore he received endotracheal intubation and cardiopulmonary resuscitation for 5 minutes, and spontaneous circulation returned. In our hospital, he underwent whole body computed tomography and echocardiography. He had a fibular fracture and simple multiple rib fractures without pneumothorax and hemothorax. Magnetic resonance imaging showed spinal cord edema from the cervicomedullary junction to C3 level and ossification of the posterior longitudinal ligament at C2-3 level without bony abnormality. In unknown cause of traumatic cardiac arrest, high level spinal cord injury and further evaluation of the cervical spine may be needed.

의료인이 인식하는 말기의 적절한 의료적 의사결정 저해요인 분석

조계화,안경주,김균무 한국의료윤리학회 2011 한국의료윤리학회지 Vol.14 No.4

Purpose: This study was designed to identify the impediment factors for end-stage medical decisionmaking as perceived by nurses and physicians in Korea. Method: The subjects in this descriptive exploratory study were 82 nurses and 61 physicians working in university hospitals in the Korean cities of Daegu and Busan. Principal component analysis was implemented in the exploratory factor analysis study, where the eigen value 1 was used for the basis of factor extractor and Varimax rotation was used to divide the factors. The data were analyzed by a SPSS/WIN 15.0 program. Result: The analysis of the impediment factors for end-stage medical decision-making revealed 15 statements and 5 categorized factors: legal compliance, prescriptive health professionals, interpersonal preparation, hospital systems, and ethical belief. These factors explained 66.84% of the total variance. Legal compliance was requested excessive roles and responsibilities of healthcare providers. Prescriptive health professionals were indicated reflection of paternalistic decision making type. Interpersonal preparation was claimed for readiness toward appropriate medical decision making issues among patient,families and healthcare providers. Hospital systems were showed inappropriate management of hospice palliative wards. Ethical belief was determined as an impediment factors for end stage medical decision making. Conclusion: We divided impediment factors for appropriate end stage medical decision-making into 5 separate categories. There is a need for a formation of a decision making system that includes the patient - health professional - family which is based on promoting the free choice of the patient while providing an atmosphere of open communication between health professionals which will facilitate the decision making process. The results of this study may contribute to the development of a new endstage decision-making system that is appropriate for medical care in Korea. Purpose: This study was designed to identify the impediment factors for end-stage medical decisionmaking as perceived by nurses and physicians in Korea. Method: The subjects in this descriptive exploratory study were 82 nurses and 61 physicians working in university hospitals in the Korean cities of Daegu and Busan. Principal component analysis was implemented in the exploratory factor analysis study, where the eigen value 1 was used for the basis of factor extractor and Varimax rotation was used to divide the factors. The data were analyzed by a SPSS/WIN 15.0 program. Result: The analysis of the impediment factors for end-stage medical decision-making revealed 15 statements and 5 categorized factors: legal compliance, prescriptive health professionals, interpersonal preparation, hospital systems, and ethical belief. These factors explained 66.84% of the total variance. Legal compliance was requested excessive roles and responsibilities of healthcare providers. Prescriptive health professionals were indicated reflection of paternalistic decision making type. Interpersonal preparation was claimed for readiness toward appropriate medical decision making issues among patient,families and healthcare providers. Hospital systems were showed inappropriate management of hospice palliative wards. Ethical belief was determined as an impediment factors for end stage medical decision making. Conclusion: We divided impediment factors for appropriate end stage medical decision-making into 5 separate categories. There is a need for a formation of a decision making system that includes the patient - health professional - family which is based on promoting the free choice of the patient while providing an atmosphere of open communication between health professionals which will facilitate the decision making process. The results of this study may contribute to the development of a new endstage decision-making system that is appropriate for medical care in Korea.