의료인력(醫療人力)의 수급정책(需給定策) 개선방안(改善方案)에 관한 연구(硏究) - 치과기공사(齒科技工士) 분야(分野)를 중심(中心)으로 -

노재경,Roh, Jae-Kyung 대한치과기공학회 1995 대한치과기공학회지 Vol.17 No.1

인력은 한 사회에 있어서 자본을 축적하며 자연자원을 개발하고 사회 경제 정치적 조직을 성장시키는 변화요인으로, 인간을 중심으로 하는 사회경제적 자원을 종합적으로 지칭하는 말이다. 이렇게 국가 사회가 필요로 하는 인력을 정부가 적절히 계획하여, 형성시키며, 배분 및 활용하는 문제를 논리적이고 일관성 있게 다루는 것을 인력정책이라 한다. 이러한 거시적이고 대 사회적인 정부의 인력정책은 국민의 건강과 생명을 보호하기 위한 보건의료 서비스를 제공해야 하는 의료인력을 대상으로 하는 경우 그 중요성이 더욱 특별하다 할 것이다. 국민에 대한 보건의료 서비스는 훈련된 보건 인력에 의해서 제공되며, 국가의 인력정책의 결과로 나타나는 보건의료인력 공급의 적합성은 인력의 불균형이라는 개념들을 통해서 검토될 수 있다. 의료인력의 불균형이라 함은 의료인력의 수, 종류, 기능, 분포, 질 등과 의료서비스에 대한 국민의 전체적 요구에 대응하여 정부가 생산하여 채용, 지원, 유시할 수 있는 정부 능력의 한계를 의미한다. 다시 말해서 국민에 대한 의료서비스의 적정화는 잘 훈련된(well qualified) 의료인력이 충분히 공급되어야(adequately supplied) 하고, 또한 적절히 분포되어야(well distributed) 한다는 양적, 질적, 그리고 분포의 세 가지 측면에서 살펴볼 수 있다. 질적, 양적, 그리고 분포의 불균형이라는 범주를 통하여 살펴본 치과기공사 분야의 인력정책에 대한 연구 결과와 개선방안은 다음과 같다. 첫째, 수적 불균형의 면에서 치과기공사의 인력은 1970년대 중반이래 계속 과잉 공급되어 왔으며, 이에 대해 정부는 그동안 소극적으로 대처하므로 과잉공급을 가속시켜왔다. 따라서 이러한 과잉공급을 최소하기 위해서는 치과이용에 대한 수요의 확장, 무면허자의 취업규제단속 및 대학의 치과기공학과 정원 축소 등을 생각해 볼 수 있다. 이러한 외형상의 과잉공급에도 불구하고 현업에 종사하는 실제인력은 수용에 비해 부족한 과소 공급현상을 빚고 있다는 점이 문제이다. 이러한 역설적인 현상을 타파하기 위하여 무면허자의 적발을 위시한 제도적 장치가 마련되어야 한다. 둘째, 질적 불균형은 수적 과잉공급에 의한 취업률 저하로 인한 실력 있는 전문인력 확보의 어려움과 전문 교육인력 및 교육시설의 열악한 조건이 원인으로 지적될 수 있으며, 이에 대한 해결방안으로 적절한 인력수요의 조절과 교육인력 및 시설 여건의 향상이 요망된다. 예컨대 3년제로 되어있는 학제를 4년제로 상향조정하는 방안을 고려할 수 있다. 세째, 치과기공사 분야의 인력분포 불균형은 그다지 심각하지는 않은 것으로 나타난다. 그러나 변화하는 소득수준과 사회환경은 의료인력과 균등한 지역적 분포에 대해 지속적인 관심을 가질것을 요청한다고 할 것이다. 이를 위하여 현재의 공중보건의 제도처럼 치기공 분야의 인력을 무의촌지역에 배치하여 공익요원으로 봉사케 하는 제도를 생각해 볼 수 있다.

치과기공사 인력 수급 정책

노재경(Jae Kyung Roh) 고려대학교 보건과학연구소 1996 보건과학논집 Vol.5 No.1

두경부 상피세포암의 화학요법

노재경(Jae Kyung Roh) 대한두경부종양학회 1990 대한두경부 종양학회지 Vol.6 No.1

Systemic chemotherapy is usually regarded as the standard treatment for palliation in patients with recurrent or metastatic cancer who have failed the definite local treatment with surgery and/or radiotherapy. Recently, with the introduction of more active chemotherapeutic agents and combinations, systemic chemotherapy is being increasingly used before or after local therapy in patients with previously untreated locally advanced head and neck cancer. The most active agents for the head and neck caner are methotrexate, 5-fluorouracil (5-FU), cisplatin and bleomycin. The overall response rates to each of these four drugs are 15-30% expecially when used as first line therapy. But most of these responses are partial with a mean duration of 3-5 months. Various combinations with methotrexate, 5-FU, cisplatin, and bleomycin have been tried with overall response rates of 50-90%, and 10-20% of complete responses. The introduction of chemotherapy prior to local therapy, induction chemotherapy, has been investigated with improved survivals in patients with complete response, especially pathologic, though improvement in overall survival has not been proved yet after the induction chemotherapy. Other therapeutic modalities, such as 'Sandwich' chemotherapy between surgery and radiotherapy, concomittent chemo-radiotherapy and post local treatment adjuvant chemotherapy have been pursued with some hopeful results but these trials should be compared with prospective randomized Phase III trials. To increase the response rates and enhance the survival, important work still remains; 1. Identification of better prognostic factors, 2. Improvement in staging, 3. Development of more active and safter chemotherapeutic agents, 4. Identification of the proper sequence for the addition of chemotherapy to multimodality treatment, and 5. Testing the value of such chemotherapy in locally advanced cancer patients.

진행암에서 Recombinant Human Interferon Alpha ( Rifn α ) 의 Phase 1 임상 및 약물동태에 관한 연구

노재경(Jae Kyung Roh),정현철(Hyun Cheol Chung),박용준(Yong Jun Park),김주항(Joo Hang Kim),김병수(Byung Soo Kim),현형환(Hyung Hwan Hyun) 대한내과학회 1989 대한내과학회지 Vol.37 No.1

N/A Fifteen patients with advanced cancers wre treated with recombinant interferon alpha (Alphaferon, Cheil Sugar Co.) by IM routes daily 5 times a week with the dose of either 3, 5, or 7´106 IU/m2 without intrapatient escalation in order to determine the tolerance and pharmacokinetics of IFN. Of the enrolled 15 patients, 12 patients were evaluable for toxicities and responses. Enrolled diseases were malignant melanoma (3), renal cell carcinoma (3), cutaneous T-cell lymphoma (3), non-small cell lung cancer (2), CML (1), breast cancer (1), stomach cancer (1), and fibrosarcoma (1). The median duration of treatment was 2 months. Of the evaluable 4 patients with the 3´105IU/m2 dose, a mild degree of flu-like syndrome in all, nausea and vomiting (severe; 1) in 3 and a mild degree of reversible elevation of hepatic transaminases was observed in 1 patient. Of the evaluable 6 patients with 5´106 IU/m2 dose, mild to moderate degree of flu-like syndrome in all, mild degree of reversible elevation of hepatic transaminases in 1, and mild degree of leukopenia in one patient was observed. Of the evaluable 3 patients with 7´108 IU/m2, severe flu-like syndrome in all, and moderate degree of leukopenia was observed in 2 patients which required dose modification. One patient with malignant melanoma showed partial response of the metastatic lymph nodes more than 12 months. Serum peak concentration of IFN was reached 4-8 hours after the IM treatment and the serum concentration was declined slowly to less than 10% of the peak concentration by 24 hours. The 24-hour urinary excretion of IFN was less than 1% of administered dose. Alphaferon was tolerable to the patients without life threatening toxicities, and the suggested MTD was 6×106 IU/m2/D with this dose schedule.

증례 : 조기위악성종양을 의심하였던 위가성임파종 2 예 보고

노재경 ( Jae Kyung Roh ),이상훈 ( Sang Hoon Lee ) 대한내과학회 1983 대한내과학회지 Vol.26 No.8

증례 : Gilbert 증후군 1 예

강진경 ( Jin Kyung Kang ),박인서 ( In Suh Park ),최흥재 ( Heung Jai Choi ),이우형 ( Woo Hyung Lee ),노재경 ( Jae Kyung Roh ),전재연 ( Jai Yoon Chun ) 대한내과학회 1977 대한내과학회지 Vol.20 No.12

간장 ( 肝腸 ) 및 담도 ( 膽道 ) : I - 131 - Lipiodol의 간동맥주입과 간동맥 색전술에 의한 원발성 간암 치료 효과

강진경(Jin Kyung Kang),최흥재(Heung Jai Choi),박인서(In Suh Park),이상인(Sang In Lee),한광협(Kwang Hyub Han),전재윤(Chae Yoon Chon),이종태(Jong Tae lee),유형식(Hyung Sik Yoo),한승희(Seung Hee Han),노재경(Jae Kyung Roh) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.3

N/A Lipiodol (iodized oil) is known to be selectively retained for an extended duration in hepatocellular carcinoma (HCC), so a number of therapeutic trials using Lipiodol in patients with HCC have been performed. Hepatic arterial infusion of radiolabelled iodized oil (I-131-Lipiodol) has potential as a radiotherapeutic agent in patiens with HCC. This study was undertaken to assess the therapeutic efficacy of hepatic arterial infusion of I-131-Lipiodol alone or I-131-Lipiodol combined with transcath- eter arterial embolization (TAE) in comparison with conventional TAE in patients with HCC. From March 1985 to December 1988, 136 patients with HCC were given eithep an hepatic arterial infusion of I-131-Lipiodol alone (Group 1, n=83), TAE with Ivalon or GelfoaO (Group 2, n=23) or infusion of I-131-Lipiodol combined with TAE (Group 3, n=30). There was no significant difference in sex, age, tumor size and type, biochemical tests, and Child classification among the 3 groups. We analyzed the response rate and survival rate according to the therapeutic modality and tumor size. 1) The response rates were 32.5, 43.5, and 73.3% in groups 1,2, and 3 respectively and the response rate in group 3 was significantly higher than group 1 (p<0.05). (response was defined as a decrease more than 2.5% in tumor size 3 months after treatment). 2) There was no significant difference in response rate among the 3 groups in tumors smaller than 5 cm, but the response rate of group 3 (71.4%) was significantly higher than group 1 (27.9%) in tumors larger than 5 cm (p<0.05). 3) The survival rate among tumors smaller than 5 cm was significantly highter than among tumors larger than 5 cm (p<0.05).

High dose Methotrexate 의 Pharmacokinetics 와 진행된 High dose Methotrexate , 5 - Fluorouracil 및 Adriamycin 복합화학요법

이흥재(Hoong Jai Lee),노재경(Jae Kyung Roh),고은희(Eun Hee Koh),김주항(Joo Hang Kim),김기호(Ki Ho Kim),김병수(Byung Soo Kim),안영수(Young Soo Ahn),임창현(Chang Hyun Lim),권오헌(Oh Hun Kwon) 대한내과학회 1989 대한내과학회지 Vol.36 No.3

N/A The folic acid antagonist, methotrexate (MTX), was shown to have antitumor activity due to inhibition of the enzyme dihydrofolate reductase. In the last two decades, the drug has been administered in conventional doses of 30 ㎎/㎡, however, during the last 10 years, very high doses of methotrexate in the range of 1-10 g/㎡, coupled with citrovorum factor rescue have been found to be strikingly more effective for chemotherapy of osteogenic sarcoma, malighant lymphoma, and squamous carcinoma of the head and neck. Klein (1983) reported a high response rate (63%) by MTX and 5-fluorouracil (5-FU) combination chemotherapy in cases with advanced stomach cancer. In Korea, the incidence of stomach cancer is higher than other tumors, and the usual chemotherapy program for advanced stomach cancer is a 5-fluorouracil, adriamycin and mitomycin-C combination regimen (FAM); but there has been no pharmacokinetic study or clinical application of MTX. This paper presents a pharmacokinetic and clinical study of 18 cases with advanced stomach cancer, admitted from January 1986 to December 1986. The results were as follows: 1) After intravenous infusion of MTX 1.5 ㎎/㎡, the plasma MTX levels were recorded as follows: At 30 min after discontinuation of MTX infusion, the plasma MTX level was 7.17×10-5±3.63×10-5 M, At 6 hours, it was 1.38×10-5±0.75×10-5 M; at 12 hours, 3.71×10-6±2.23×10-6 M; at 24 hours, 9.30×10-7±1.02±10-7 M; at 48 hours, 1.99×10-7±1.70×10-7 M; and at 72 hours, 1.27×10-7±1.25±10-7 M. Forty-eight hours after discontinuing the drug, the plasma level of MTX fell below 1×10-7 M in half of the cases. After 72 hours, 66.6% of the cases fell below the 1×10-7 M level. 2) The response rate for the HDMTX, 5-FU and ADR combination chemotherapy was 11.2% in all cases. One case (9.1%) out of 11 cases with previous chemotherapy, showed a partial response; also out of 7 case without previous chemotherapy, one case (14.2%) showed a partial response. 3) Toxicities with high dose MTX were: pancytopenia (1 case), nausea and vomiting (14 cases), stomatitis (8 cases), skin rash (2 cases) and diarrhea (2 cases). In our study the patient with pancytopenia died due to sepsis. There was only one case with an elevated creatinine level. In summary, the results of this study for pharmacokinetic changes of that MTX were similar to other reports. However, over 72 hours after discontinuation of high dose MTX and 5-FU combination chemotherapy, the risk of toxicity is reduced by the administration of CF. The response rates of HDMTX, 5-FU and ADR combination chemotherapy were low; therefore further studies should be done to elucidate a more exact response rate.

간암세포주를 대상으로 한 체외 복합 항암제 감수성 검사

박인서(In Suh Park),정재복(Jae Bock Chung),김병수(Byung Soo Kim),김주항(Joo Hang Kim),노재경(Jae Kyung Roh),유내춘(Nae Chun Yoo),조재용(Jae Yong Cho),최진혁(Jin Hyuk Choi),임호영(Ho Yeong Lim) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.2

N/A Primary hepatocellular carcinoma(HCC) is one of the most common malignancies in Korea due mainly to high incidence of chronic hepatitis B virus infection. Most of the HCC are inoperable even at first presentation. So chemotherapy could be one of the major therapeutic modalities, but HCC is seldom chemosensitive. This type of chemoresistance is explainesd by high level of expression of multidrug resistance(MDR) gene and p-glycoprotein. We initiated this study to establish the in vitro model of drug selection and combination for HCC. Three human HCC cell lines and five cytotoxic drugs were used. MTT assays for cytotoxicity test were performed with single chemotherapeutic agent and various two drug combinations. Slot blot analysis for measuring the expression levels or MDR1 RNA was performed and demon strated that 2 HCC lines show moderate to high degree of MDRI expression, The ranges of drug concetration which causes 50% inhibition of the cell lines(IC50) are in the clinically achievable concentrations for the 5-fluorouracil in two HCC lines, and adriamycin in one cell line. Two cell lines which showed positive MDRI exression were resistant to adriamycin. But all three cell lines were sensitive to etoposide irrespective of MDR1 expression. In thelinically achievable concentration ranges those we tested, singnificantly improved cytotoxic effects are demonstrated in combinations of etoposide plus cisplatin, and etoposide plus mitomycin-C out of 10 possible two drug combinations. These data indicate the need for in vivo trials with the combination chemotherapy of etoposide plus cisplatin or etoposide plus mitomycin-C for HCC.

에스자결장암에서 근치적 절졔술 후 방사선 치료의 역할

박원,성진실,금기창,서창옥,이상욱,임지훈,민진식,노재경,김주항,정현철,이강규,김귀언,Park, Won,Seong, Jin-Sil,Keum, Ki-Chang,Suh, Chang-Ok,Lee, Sang-Wook,Lim, Ji-Hoon,Min, Jin-Sik,Roh, Jae-Kyung,Kim, Joo-Hang,Chung, Hyun-Cheol,Lee, Kang-K 대한방사선종양학회 1997 Radiation Oncology Journal Vol.15 No.4

목적 : 에스자결장암으로 진단 받고 근치적 절제술이 시행된 환자를 대상으로 수술후 보조 요법으로서 방사선 치료의 역할을 평가하고자 하며, 방사선 치료를 받은 군과 받지 않은 군의 재발 양상과 생존율을 비교하고, 방사선 치료를 추가함으로써 국소 제어율이나 생존율의 향상을 기대 할 수 있는 요인을 분석해 보고자 하였다. 대상 및 방법 : 1988년 1월부터 1993년 12월까지 연세 의료원에서 에스자결장암이라고 진단 받고 근치적 절제술을 시행받은 93례를 대상으로 하였다. 근치적 수술후 방사선 추가 여부에 따라 두 군으로 분류하였다. 에스자결장암으로 근치적 수술만 시행된 43례는 수술 단독군이라 하였고 수술후 보조 요법으로 방사선 치료가 추가된 50례는 방사선 치료군으로 분류하였다. 방사선 치료군에서 방사선 치료는 수술 후 1-2개월후부터 시작하였는데 원발 병소가 있었던 부위에 적어도 5cm의 여유를 두고 4 MV나 10 MV 선형 가속기를 이용하여 하루에 1.8Gy씩 50.4Gy-61Gy까지 조사하였다. 항암화학요법은 5-Fluorouracil을 이용하여 32례에서 시행하였는데 항암화학요법을 받은 예가 두 군간 의의있는 차이는 없었다. 결과 : 5년 국소 제어율과 무병 생존율이 각각 $85.1\%,\;68.5\%$였다. 수술 단독군과 방사선 치료군의 국소 제어율은 각각 $75.2\%$와 $91.7\%$였다. MAC Stage C3에서 방사선 치료군이 수술 단독군보다 국소 제어율과 무병 생존율이 높았다(P=0.01, p=0.06). MAC Stage B3에서 방사선 치료군이 수술 단독군보다 국소 제어율이 더 높았으나 통계적 의의는 없었다. 특히, 조직학적으로 원발 병소가 결장 주위를 넘어 다른 조직에 침윤이 있는 경우(Stage T4), 수술 단독군보다 방사선 치료군의 국소 제어율이 더 높았다. 결론 : 에스자결장암에서 근치적 절제술후 MAC Stgae B3, C3 -특히, 주위 조직에 조직학적으로 침윤이 있는 경우-에서 방사선 치료를 추가함으로써 국소 제어율을 높이고, 생존율의 향상을 기대해 볼 수 있겠다. 그리고 에스자결장암에서 근치적 수술후 방사선 치료의 역할을 보다 명확하게 규명하기 위해서는 향후 전향적 연구가 필요하리라 생각된다. Purpose : To evaluate the role of postoperative radiation therapy after curative resection of sigmoid colon cancer Materials and Methods : From 1988 to 1993, a total of 93 Patients with curative resectable sigmoid colon cancer of modified Astler-Coiler (MAC) stage B2, B3, C2, C3 was divided into two groups on the basis of those who received radiation treatment and those who did not. Forty-three patients who treated by surgery alone were classified as postop RT (-) group The remaining 50 patients who underwent postoperative radiotherapy were classified as postop RT (+) group. In all patients in Postop RT (+) group. radiation therapy was delivered using 4 or 10 MV linear accelerators to treat the tumor bed with approximately 5cm margin to a total dose 50.4-61Gy(median 54Gy) in 1.8Gy per fraction. Thirty-two patients were treated. with 5-Fluorouracil based adjuvant chemotherapy at least 3 cycles. but these was no significant difference between two groups. Treatment failure Pattern, 5-year local failure-free survival rates (LFFS), and 5-year disease-free survival rates (DFS) were compared between two groups. Result : Five year LFFS and DFS were $85.1\%,\;68.5\%$, respectively, In Postop RT (-) group, LFFS was $76.2\%$ compared with $91.7\%$ in Postop RT (+) group. Improved LFFS and DFS were seen for patients with stage C3 sigmoid colon carcinoma with postoperative radiation therapy compared with postop RT (-) group (P=0.01, p=0.06 respectively), in stage B3, LFFS washigher in postop RT (+) group than that in Postop RT (-) group. although itwas not significant. Especially, local control was higher in stage 74 inpostop RT (+) group than that in postop RT (-) group, Conclusion : This studv showed significantly improved LFFS and DFS in MAC Stage C3 and improved tendency of LFFS and DFS in MAC Stage B3 disease. Large scale prospective study is required to verify the role of adjuvant radiation therapy in resectable sigmoid colon cancer.