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.

일개 도시주민의 품위 있는 죽음 태도에 대한 예측 요인

조계화,안경주,김균무,김연자,Jo, Kae Hwa,An, Gyeong Ju,Kim, Gyun Moo,Kim, Yeon Ja 한국호스피스완화의료학회 2012 한국호스피스.완화의료학회지 Vol.15 No.4

목적: 본 상관관계 연구는 품위 있는 죽음과 연명치료중단에 대한 일개도시 성인 남녀의 인식과 태도를 조사하는 한편, 품위 있는 죽음에 대한 그들의 태도를 예측할 수 있는 요인을 확인하기 위해 시도되었다. 방법: 일개 대도시 중 3개 마을의 성인남녀 총 291명을 편의 표출하였다. 구조화된 설문지 문항에는 연명치료중단에 대한 인식, 연명치료중단에 대한 태도, 품위 있는 죽음 척도에 대한 태도 등을 포함하였다. 자료는 기술통계, 피어슨 상관계수 및 다중회귀분석을 이용하여 분석하였다. 결과: 연명치료중단 및 품위 있는 죽음에 대한 태도는 통계학적으로 유의미한 양의 상관관계(r=0.49, P<0.001)를 보였다. 연명치료중단에 대한 태도, 연령, 종교, 연명치료중단의 적절한 프로세스 및 사전의료의향서(Advanced Medical Directives) 등은 품위 있는 죽음에 대한 태도의 중요한 예측 변수들로, 총 분산의 49.3%를 설명할 수 있었다. 결론: 본 연구 결과는 연명치료중단 및 사전의료의향서 프로세스 상에서 간호사의 적절한 역할 등 새로운 의학적 의사결정 시스템을 개발하는 데에 활용될 수 있다. Purpose: This correlation study was performed to examine Korean adults' perceptions and attitudes towards death with dignity and the withdrawal of life sustaining treatment and to identify factors that predict their attitude towards death with dignity. Methods: The study was conducted using convenience sampling of 291 adults from three towns of a metropolitan city in Korea. Data were collected using structured questionnaires which surveyed people's perception about and attitudes towards withdrawal of life sustaining treatment and scaled their attitude towards death with dignity. Data were analyzed by using descriptive statistics, Pearson correlation coefficients and multiple regression. Results: The attitude towards the withdrawal of life sustaining treatment and death with dignity showed a significant positive correlation (r=0.49, P<0.001). For attitudes towards death with dignity, significant predictors were attitudes towards the withdrawal of life sustaining treatment, age, religion, a proper withdrawal process and advanced medical directives, which explained 49.3% of total variance. Conclusion: The results of this study may contribute to development of a new medical decision-making system including nurses' appropriate roles in the process of withdrawing life sustaining treatment and advanced medical directives.

한국 성인이 인식하는 품위 있는 죽음의 이해 -Q방법론적 접근-

조계화 ( Kae Hwa Jo ),김균무 ( Gyun Moo Kim ) 한국의료윤리학회 2011 한국의료윤리학회지 Vol.14 No.1

Purpose: The purpose of this study was to analyze attitude that Korean adults have toward dignified dying. Method: The study employed a Q-methodology, which provides a method of analyzing the subjectivity of test items. Thirty-four selected Q-statements from each of the 34 subjects were arranged in a normal distribution using a 9-point scale. The collected data were then analyzed using a QUANL PC program. Result: Three types of attitudes toward dignified dying were identified. Type I is a positive self-recognition. These types of people thought positively and was said to be happy and thankful for the time of death. Type II is a rational comport-orientation. These type of people accepted death and want peaceful dying. Type III is emphasis on the supportive relationship. These types of people want to die peacefully in the bosom of family members. Conclusion: Understanding each type could be helpful that supporting and death education for Korean adult.

근위부 심부정맥 혈전증에서 유증상 폐색전증과 무증상 폐색전증의 비교

김동훈 ( Dong Hun Kim ),서영우 ( Young Woo Seo ),김균무 ( Gyun Moo Kim ),고승현 ( Seung Hyun Ko ),장재석 ( Jae Seok Jang ),장태창 ( Tae Chang Jang ) 영남대학교 의과대학 2017 Yeungnam University Journal of Medicine Vol.34 No.2

Background: Deep vein thrombosis (DVT) and pulmonary embolism (PE) are conditions with significant morbidity and mortality. Proximal DVT has a significant association with PE and possible fatal outcomes. Traditionally, PE is subdivided into symptomatic PE and asymptomatic PE, which have different treatments, preventions and prognoses. The growing utilization of computed tomography pulmonary angiography has led to increased detection of PE in DVT patients. This study examined the clinical characteristics and compared symptomatic PE and asymptomatic PE following proximal DVT. Methods: The medical records of 258 DVT inpatients from July, 2012 to June, 2015 were reviewed retrospectively. After excluding the patients who did not performed PE evaluation and were not diagnosed with PE, 95 patients diagnosed with PE following proximal DVT were enrolled in this study. They were divided into the symptomatic PE group and asymptomatic PE group. Results: The body weight, body mass index, thrombus size, thrombus length and location were similar in the two groups. The symptomatic PE following proximal DVT group showed an older age, higher incidence of emergency department access (85.0% vs. 38.7%, p<0.001) and preceding infection (25.0% vs. 1.3%, p< 0.001) as well as a higher incidence of immobilization (45.0% vs 13.3%, p=0.016). In the multivariate logistic regression study, preceding infection and emergency department access showed significant association with symptomatic PE. Conclusion: In proximal DVT inpatients, symptomatic PE was associated with emergency department access and preceding infection. The possibility of a symptomatic PE event should be considered in proximal DVT patients, especially those who were admitted through the emergency department and had preceding infection.

간호사와 의사의 임종치료선호도 점수에 영향을 미치는 예측요인

조계화 ( Kae Hwa Jo ),김균무 ( Gyun Moo Kim ) 한국의료윤리학회 2010 한국의료윤리학회지 Vol.13 No.4

Purpose: The purpose of this study was to identify the levels of the preferences for care near the end of life-korean version(PCEOL-K) and factors affecting the PCEOL-K among nurses and physicians. Methods: A descriptive study was conducted with 407 nurses and physicians working in general hospital and university hospital, Daegu and Busan. Data were collected through selfreported questionnaires from June to September, 2010. Data were analyzed using the Pearson`s Correlation Coefficient, t-test, ANOVA, Turkey`s HSD, and multiple regression with SPSS/WIN 15.0. Results: The mean score of PCEOL-K was 69.03±5.48 for nurses and 68.69±7.15 for physicians. Factors predicting subjects` PCEOL-K were clinical experience, fear of death, and the personal meaning of death. These factors explained 40.0% of the PCEOL-K (F=21.00, p<.001). Conclusion: The results of this study suggest that the construction of comprehensive framework for nurses and physicians in relation to end-of-life care may contribute to improved positive preferences for care near the end of life by encouraging their professional careers and spirituality.

연구논문 : 말기 환자에 대한 한국형 의료적 의사결정 체계 구축을 위한 델파이연구

조계화 ( Kae Hwa Jo ),안경주 ( Gyeong Ju An ),김균무 ( Gyun Moo Kim ) 한국의료윤리학회 2011 한국의료윤리학회지 Vol.14 No.2

Purpose: The purposes of this study were to identify future changes that may affect medical decision-making and to suggest future directions for the medical decision-making system in Korea. Methods: This study conducted Delphi surveys and in-depth group interviews with physicians and nurses working in two different university hospitals in Daegu and Busan. Results: The collected data suggest that the current medical decision-making system needs to be more clearly defined in accordance with clinical applications. The findings from professional group interviews suggest that the Korean government may need to regulate economic conditions in order to facilitate medical decision-making in the near future as hospital environments change and grow. Conclusion: The results of this study may help healthcare professionals working at various crisis settings to understand and apply decision-making systems in the context of end-of-life medical care. The future directions were proposed that national standard setting and financial support, hospital ethics committee constitution, nationwide information for social consensus, strengthening the education of health professionals.

의대생과 의사들의 골학 교육에 대한 인식 조사

박재희(Jae-Hee Park),이상훈(Sang-Hun Lee),전재천(Jae-Cheon Jeon),최우익(Woo-Ik Choi),김균무(Gyun-Moo Kim),이재호(Jae-Ho Lee) 대한체질인류학회 2021 해부·생물인류학 (Anat Biol Anthropol) Vol.34 No.1

기초의학 분야 중 하나인 해부학은 다양한 보건의료관련 직종에서 필수과목으로 배우고 있다. 해부학에서 골학은 단순히 뼈의 명칭만 배우는 것이 아니라 각 뼈의 세부구조 및 임상적 지식을 함께 배우는 학문이다. 따라서 각 뼈에 붙은 근육 및 신경, 혈관의 이름을 학습하기 위해서는 뼈에 대한 완벽한 이해가 필요하며, 보다 정확하게 인체의 기본 구조와 기능을 기억하는 데 도움이 된다. 본 연구는 맨눈해부학 경험이 있는 의과대학 학생과 의사를 대상으로 골학 학습에 대한 필요성에 대해 묻고, 골학 교육의 문제점을 파악하기 위해 설문조사하였다. 총 186명을 대상으로 설문조사 결과 골학 강의와 시험 및 성적반영에 대해 의과대학 학생보다 의사에서 긍정적인 의견이 높았으나 통계적으로 유의한 차이를 보이지 않았다. 골학 실습에 대해서도 의과대학 학생보다 의사에 있어 긍정적인 의견이 높았으며, 통계적으로 유의한 차이를 보였다 (p=0.037). 현재 골학 교육의 가장 큰 문제점으로 학생자체 골학(41.8%)을 선택하였으며, 다음으로는 강의시간 부족 및 모형 부족, 공부시간 부족, 시험문제 순으로 나타났다. 그리고 골학 공부에 있어 어려운 부분을 신체계통별로 파악하고 적정 수업시간 및 공부시간에 대해 알아본 결과 팔, 다리, 척추, 가슴의 경우 학습에 어려움은 적었으나 골반과 특히 머리의 경우는 학습에 어려우며 많은 학습시간이 필요함을 볼 수 있었다. 모든 계통에서 의과대학 학생보다 의사에 있어 더 많은 시간이 필요한 것으로 나타났으며 유의한 차이를 보였다. 본 연구를 통해 골학 교육에 대한 정규교육과정 필요성과 효과적인 골학 교육에 있어 이론 강의뿐만 아니라 실습을 병행한다면 해부학 학습효과를 높일 수 있음을 제언한다. Anatomy is being taught as a compulsory subject in various health care-related occupations. In anatomy, osteology is learning the names of bones and offers detailed structure of each bone and clinical knowledge. Therefore, understanding of bones is needed to learn the names of muscles, nerves, and blood vessels attached to each bone, and helps to remember the basic structure and function of human body. This study investigated the need for osteological learning and conducted a survey on medical students and doctors with experience in anatomy to identify the problems of osteological education. According to the result of conducting a survey on 186 people, doctors showed higher positive opinion on lectures, exams, and grades of osteology than medical students but did not show a statistically significant difference. Doctors showed higher positive opinions about osteological practice than medical students, and showed statistically significant difference (p=0.037). Senior teaching (41.8%) was selected as the biggest problem in osteological education today followed by a short lecture, lack model, lack of study hours, and examination. Also, students had little difficulty in learning chest, spine, and limbs but showed difficulty in learning pelvis especially the head and required a lot of learning time. It was identified that more time is needed for doctors than for medical students in every system and showed a significant difference. This study suggests the necessity of formal education for osteology education and that combining lecture on theory and practice can raise learning effect of anatomy in effective osteology education.

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.