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병원 호스피스센터-보건소 연계를 통한 지역사회 재가암환자 관리 프로그램 평가
이해숙,박선희,정영순,이부경,권소희,Lee, Hae-Sook,Park, Sun-Hee,Chung, Young-Soon,Lee, Boo-Kyung,Kwon, So-Hi 한국호스피스완화의료학회 2010 한국호스피스.완화의료학회지 Vol.13 No.4
목적: 본 연구는 말기 재가암환자 관리를 위한 병원호스피스센터와 보건소 간의 연계 프로그램을 평가함으로써 보다 효율적이고 효과적인 재가암환자 관리체계를 구축하고자 시도되었다. 방법: 호스피스센터-보건소 재가암관리 연계 사업은 1) 협약체결, 2) 재가 말기암환자 발굴 및 등록, 3) 가정호스피스 방문 서비스 제공, 4) 만족도 조사의 단계로 전개되었다. 일 호스피스센터와 지역의 3개 보건소가 협약을 체결하였고, 2009년 2월 1일에서 12월 31일까지 11개월 동안 43명의 환자에게 605건의 가정호스피스 방문을 실시하였다. 방문기록지 분석을 통해 서비스 대상자의 특성과 제공된 서비스의 종류와 내용을 분석하였고, 이 중 20명에게 서비스 만족도 조사를 실시하였다. 결과: 대상자의 76.7%가 60세 이상이었고, ECOG 전신 수행상태 점수는 0점과 1점이 각각 37.2%, 39.5%이었다. 환자가 병식이 있는 경우는 90.7%, 호스피스 동의서에 서명한 경우는 62.8%였다. 초기방문 시 환자의 주 호소는 전신쇠약감(86.0%)과 식욕부진(72.1%)이 가장 많았다. 평균 총 서비스 기간은 144.42일이었고, 총 605건의 방문 중 간호사 방문이 371회로 가장 많았다. 각 방문중 정서적 지지와 건강상담이 가장 빈번하게 제공되었고, 서비스 전반에 대한 만족도는 5점 척도로 측정하였을 때 평균 4.45점이었다. 결론: 본 연구는 지역사회 내에서 실제적이고 체계적인 재가 말기암환자 관리 프로그램 구축을 위한 중간평가로서의 의미가 있다. 본 연구에서 의뢰된 대상자는 입원형 호스피스보다 기능 상태가 양호하고 서비스 제공기간이 길었으며, 서비스에 대한 만족도, 특히 정서적지지와 환자상태 설명에 대한 만족도가 높았다. 그러나 방문횟수와 빈도, 임종기 관리, 병원입원 재입원하는 환자관리에 대한 기준과 서비스 표준마련은 앞으로의 과제로 제시되었다. Purpose: The purpose of this study was to evaluate a community-based cancer patient management program (CBPCMP) which was collaborated between a hospice center and public health centers. Methods: The CBPCMP proceeded on four steps; 1) Signing agreements with three public health centers, 2) Enrolling the domiciliary terminal cancer patients, 3) Providing home hospice service, and 4) Inquiring patient's level of satisfaction. From February 1 to December 31 in 2009, 43 terminal cancer patients were referred and provided with home hospice service. The hospice team made a total of 605 visits. Medical records for each visit and data from satisfaction surveys were analyzed. Results: 76.7% of patients were older than 60 years, and 90.7% of the patients were alert. The level of functional status for 76.7% of patients rated as lower than ECOG grade 1. 62.8% of the patients or their caregivers signed hospice service agreements. On the initial evaluation, the most frequent reasons for referral were general weakness (86.0%), followed by anorexia (72.1%). Nurses visited the patients' most frequently (371 visits), followed by volunteers (216 visits). Nurses provided emotional support and health promotion counseling on 95.1% and 22.9% of visits, respectively. The mean satisfaction score rated by patients and their family was 4.45 out of 5. Conclusion: This study tested CBPCMP in collaboration with hospice centers and public health centers. CBPCMP showed a possibility to improve the quality of end of life care. To insure the quality care, however, the guidelines for home hospice service should be developed.
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Candida Albicans 와 Carcinogen 의 경구투여에 의한 Mouse 의 위점막 변화
정정명(Jung Myung Jung),김을수(Eul Soo Kim),오형석(Hyung Seok Oh),최경해(Kyung Hae Choi),이부경(Boo Kyung Lee),설상영(Sang Yung Sul),최하진(Ha Jin Choi) 대한내과학회 1988 대한내과학회지 Vol.34 No.4
N/A 1) In the group of the subject mice administered with candida albicans only, all of 6 mice had an inflammatory change both in stomach antrum and body at the 1 month-interval check. At the 3 month interval check, an inflammation in stomach antrum occurred in all of 6 mice; however, in stomach body 5 mice had an inflammation and 1 mice a mocosal atrophy, At the 6 month-interval check, all of 8 mice had an inflammatory change in stomach antrum, while 4 of them got a mucosal atrophy in stomach body. 2) In the group of the mice with a carcinogen alone administered, 2 of 4 mice in the 6 month-group, and 5 of 8 mice in the 9 month-group revealed a mucosal dysplasia with no appearance of cancer. But the degree of dysplasia was one mouse in grade A and another one mouse in grade B, respectively, at the 6 month-interval check, while 2 mice in grade B, and 3 mice in grade C, respectively, at the 9 month-interval check. 3) In the group of mice administered both with carcinogen and candida albicans, 2 of 4 mice showed no cancer but mucosal dysplasia of grade B at the 6 month-interval check, while at the 9 month-interval check, 6 of 8 mice had a squamous cell cancer (especially 3 having been grossly examined) and the other two had mucosal dysplasia of grade C. 4) The findings in the liver tissue of the mice adminstered with the carcinogen for more than 8 months revealed a severe liver cell dysplasia with no evidence of hepatoma. 5) The results from this experimental study suggested that in case of provoking a stomach cancer due to a carcinogen administered in the mice, gastrointestinal infection of pathogenic organism such as candida does play a promoting role. However, whether a suggestion from this experimental study will be applicable to human beings as well or not will have to await a lot of further researches thereafter in the field, There have been reported many experimental researches on the oncogenic effects of various nitroso-compounds since Barnes and Magee, in 1956, concluded the acute hepatotoxicity and oncogenic action of dimethylnitrosamine in a number of experimental animals. Thereafter these nitroso-compounds have been assumed to be an environmental carcinogen in human beings as well as a potent carcinogen in animals. Much attention has been paid particulary on the relation of stomach cancer and nitrosamine since the nitrosamine synthesis in human gastric juice was known to be available. However. at present, it seems so hard to confirm nitrosamine as a vital factor of human cancer that far more information is demanded to identify it accurately. Recent reports, including ours, show a high frequency of candida albicans infection in gastrointestinal tract by various environmental factors. But the influence of candida multiplication on gastric ulcer or stomach cancer has scarcely been known. In this research we made a study of possible effects of candida infection on the gastric mucosa injury as well as on stomach cancer.
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박경태,김을수,최영길,정정명,이부경,설상영,김기현 대한내과학회 1988 대한내과학회지 Vol.34 No.3
We had experienced a 34-year-old female patient with phlegmonous gastritis which was confirmed by radiologic studies and operation. Enterobacter aerogenes, E-Coli and Morganella morganii were cultured from the specimen of necrotic stomach tissue which was obtained by operation. The operation findings were revealed necrosis of total wall on the lower esophagus, stomach, duodenum and proximal portion of jejunum. The patient was rapidly deteriorated with downhill course and expired on 3rd hospital day.
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