말기암환자에서 임박사건 간 48시간 임종예측도 비교

황인철,최충현,김경곤,이경식,서희선,심재용,Hwang, In-Cheol,Choi, Chung-Hyun,Kim, Kyoung-Kon,Lee, Kyoung-Shik,Suh, Heuy-Sun,Shim, Jae-Yong 한국호스피스완화의료학회 2011 한국호스피스.완화의료학회지 Vol.14 No.1

목적: 임박사건(impending event)에 대한 인지는 보호자와의 보다 효과적인 의사소통을 위해 필요할 뿐 아니라, 임종실로 옮기는 시점을 결정하는데 있어서 매우 중요하다. 이 주제에 대한 지금까지의 연구는 대부분 임종 48시간을 전후한 시점에서 이미 '발생되어 있는' 증상의 나열에 불과하였다. 이에 '변화'의 시점에서 사망까지의 시간을 기준으로 하여 임박사건 간 48시간 이내 임종예측도를 비교하였다. 방법: 인천소재 완화의료병동에서 임종을 맞이한 160명의 환자 중 임종 전 일주일 동안의 의무기록이 있는 80명을 대상으로 하였다. 환자 및 보호자가 호소하는 주관적 증상 9가지와 의료인에 의해 관찰되는 객관적 징후 8가지를 선정하고 각 항목에 대한 '의미 있는 변화'의 기준을 사전에 정하였다. 결과: 증상에서는 수면량의 증가(53.8%), 징후에서는 혈압의 감소(87.5%)가 가장 높은 발생빈도를 보였다. 임종까지의 평균시간은 증상의 경우 안정 시 호흡곤란(46.8시간)이, 징후의 경우 산소포화도의 감소(13.6시간)와 혈압의 감소(36.9시간)가 48시간 이내였다. 48시간 임박사건으로서의 예측도는 증상의 경우, 양성예측도는 안정 시 호흡곤란이 가장 높았고(83%) 음성예측도는 안정 시 호흡곤란과 의식혼탁/섬망의 조합이 가장 높았으며(86%), 징후의 경우 양성 예측도는 모두 95% 이상이었고 음성예측도는 혈압의 감소와 산소포화도 감소의 조합에서 가장 높았다(60%). 증상과 징후의 발생양상은 유의한 차이를 보였다. 결론: 증상에서는 안정 시 호흡곤란과 의식혼탁/섬망이, 징후에서는 산소포화도나 혈압의 감소가 임종임박을 예측하는데 가장 유용한 임상지표로 생각된다. Purpose: Recognition of impending death is crucial not only for efficient communication with the caregiver of the patient, but also determination of the time to refer to a separate room. Current studies simply list the events 'that have already occurred' around 48 hours before the death. This study is to analyze the predictability of each event by comparing the time length from 'change' to death. Methods: Subjects included 160 patients who passed away in a palliative care unit in Incheon. The analysis was limited to 80 patients who had medical records for the last week of their lives. We determined 9 symptoms and 8 signs, and established the standard of 'significant change' of each event before death. Results: The most common symptom was increased sleeping (53.8%) and the most common sign was decreased blood pressure (BP) (87.5%). The mean time to death within 48 hours was 46.8% in the case of resting dyspnea, 13.6% in the ease of low oxygen saturation, and 36.9% in the case of decreased BP. The symptom(s) which had the highest positive predictive value (PV) for death within 48 hours was shown to be resting dyspnea (83%), whereas the combination of resting dyspnea and confusion/delirium (65%) had the highest negative PV. As for the most common signs before death within 48 hours, the positive PVs were more than 95%, and the negative PV was the highest when decreased BP and low oxygen saturation were combined. The difference in survival patterns between symptoms and signs was significant. Conclusion: The most reliable symptoms to predict the impending death are resting dyspnea and confusion/delirium, and decline of oxygen saturation and BP are the reliable signs to predict the event.

한국청소년에서 자가비만인식도와 정신건강과의 관련성

황인철(In Cheol Hwang),이경식(Kyoung Shik Lee),박동균(Dong Kyun Park),정은영(Eun-Young Jung),최충현(Chung-Hyun Choi),조성진(Seong-Jin Cho),배승민(Seung-Min Bae) 대한소아청소년정신의학회 2011 소아청소년정신의학 Vol.22 No.2

Objectives:Obesity has been linked to various psychological problems as well as medical complications, especially among adolescents. Previous studies have suggested an association between body weight and depression or self-esteem ; however, there has been little evidence on self-perception of weight and mental health. The aim of this study was to examine the association of perceptional weight status with mental health in Korean adolescents. Methods:This study was based on data obtained from the third Korean National Health and Nutritional Examination Survey (2005). The study sample consisted of 583 adolescents (268 boys, 315 girls) aged 12-18 years, who had completed the health survey, the health examination, and the nutritional survey. Participants were divided into two groups based on the actual or perceptional weight status: non-obese and obese. Questionnaires for stress, depressive mood, and suicidal thoughts were utilized as mental health indicators. Results:The agreement between actual and perceptional weight status was moderate (κ value, 0.585 ; p<0.01). The influencing factors for the discrepancy between actual and perceptional weight status were body mass index of subjects and their parents’ education. The obese group was likely to have higher stress levels and more experience of depressive mood or suicidal ideation in regard to both actual and perceptional weight status. A multiple logistic regression analysis revealed that girls who had perceived themselves as obese were more likely to have an experience of depressive mood than other girls (unadjusted OR, 4.98 ; adjusted OR, 5.15). Conclusion:An experience of depressive mood was significantly associated with the perception of weight status and not actual weight status in Korean female adolescents.

E-서비스의 서비스 특성에 대한 고찰

김은희(Eun-hee Kim),이경식(Kyoung-shik Lee) 한국컴퓨터정보학회 2014 한국컴퓨터정보학회 학술발표논문집 Vol.22 No.1

최근 E-Service의 기술 촉진이나 적용 범위는 점차 확대되어가고 있으나, 이에 반해 E-Service의 이론과 실행은 여전히 초기 단계이고, E-Service상의 서비스나 서비스 경험에 대한 정의가 부재인 것으로 확인되고 있다. 따라서 본 논문에서는 전통적 서비스와 E-Service의 차이점을 도출하여 E-Service만의 특화점을 학문적으로 확인하여 보고자 한다. 이를 위하여 E-Service의 정의를 우선 설명하고, 전통적인 서비스의 주요 특성 5가지를 활용하여 E-Service와의 특성을 비교한 후, 5가지 특성에서 각각 전통적인 서비스와 E-Service간에 어떤 차이점이 있는지를 밝혀보고자 한다. 마지막으로 E-Service의 가장 큰 특징인 기술과 정보의 만남을 통해 가치의 창조가 포함되는 점을 추가하여 E-Service가 기존 상품이나 오프라인 서비스에 대한 보완재나 대체제가 아닌 E-Service 만의 고유 핵심 가치를 보유하고 있다는 점을 이용하여 명백한 E-Service만의 우위 요소를 정의한 후 학문적으로 명확한 차이점을 밝혀내 보고자 한다.

구두발표 : 환경분석 ; 맛있는 물,건강한 물 평가지표에 관한 연구

방석배 ( Seok Bae Bang ),나운철 ( Oun Chul Na ),현준호 ( Joon Ho Hyun ),백경희 ( Kyoung Hee Baik ),이경식 ( Kyeong Shik Lee ) 대한상하수도학회 2005 공동춘계 학술발표회 논문집 Vol.2005 No.-

맛있는 물,건강한 물 평가지표에 관한 연구

방석배 ( Seok Bae Bang ),나운철 ( Oun Chul Na ),현준호 ( Joon Ho Hyun ),백경희 ( Kyoung Hee Baik ),이경식 ( Kyeong Shik Lee ) 한국물환경학회 2005 한국물환경학회·대한상하수도학회 공동 춘계학술발표회 Vol.2005 No.-

A Study of Robert Frost

李景植 東亞大學校 1964 東亞論叢 Vol.2 No.1

It is generally acknowledged that American literature had thrown off the restraint of ‘colonial complex' at the beginning of twentieth century, and that in modern American literature poetry takes precedence over novel from an artistic standpoint. The actual moment of maturity of American poetry might be set at 1912. With this year as a turning-point, American poetry seemed almost ready to throw off connection with the past and with the old tradition. And we cannot think of what is called 'poetic renaissance' with disregard for 'POETRY', the poetical magazine, which was published by Harriet Monroe in Chicago in 1912. So that, it is no exaggeration that there is no poet who is not placed under an obligation of 'POETRY' in modern American poets. Here, we must call your attention to this remarkable fact that The American poetical magazine, 'POETRY' and 'LITTLE REVIEW' which was a turning-point in modern American poetry, came out from Chicago. and that we must note the reason why 'New poetry' and novel famous in 1920th American realism came out from the new cultural background of Middle-west. In brief, New culture of America had fit rather to wild, complicated but passionate modern big city of Chicago in Middle-west than to the warmest and conservative traditions of North-west country. That is to say, Modern American literature was slightly savage and harsh in each voices, but as I said just little before, it did not stick to the past and the traditions. In a rapid current of 'New Poetry' so called 'CHICAGO GROUP' was first appeared. They are Carl Sandberg, Vachel Lindsay, and E. L. Masters. Their voices was also harsh, wild and dynamic just as the sound of hammer in a factory of Chicago, but was fresh, passionate and modern. And continually, in the broad new frontier of American poetry, there arose Imagism movement, modernism movement and surrealism Movement and so on. In this treatise, I studied the poetic spirit of Robert Frost who tooks pride in isolation in the farm of Vermont through all his life and he was also identified with New England soil, and I considered the essence of poetry seeking the characteristics of his poetry. In the first place, the first and second poetical works of Frost, 'A Boy's will and North of Boston', appeared in England ironically. Then he had stayed in suburban town of Beaconsfield in England keeping his company with so called Georgian Poets. With these two poetical works, Frost was recognized at once as one of the authentic voices of Modern poetry in England and in America especially. The world of his early works is lyrical and pastoral. He insisted upon love and belief for the nature and the man. However, in his poems nature and man are always conflicting. Frost had dramatized the nature and the man with New England for the background using New England slang and various rhythm. In short, his qualities of early days was that of love-poet and was nature poet. Secondly, when we came out into the world of his middle phase, we find that he had written continually about the nature and the man in New England using metaphor and allegory more skillfully than ever. And that definitely his thought and philosophy has deepened into his poems, and his view point of the nature and the man has become skeptic. Although his standpoint in life was skeptic and his philosophy was dualistic, he is still a humanitarian as he was before, because we can find his love poems in his middle phase as ever. Finally, we can see a slightly changed portrait of poet in his last poems. But he has never given up pastoralism. Become deepened into his skepticism, he found a star in his heaven and in his poetry. It was a religion of Robert Frost. In other words, he searched a star something like eternity or God, into his mind as a spiritual reliance. thus he changed his themes of pastoralism into cosmic themes such as star or moon in his later poems. In a sense, he recognized the limitatation of Man's existence in the infinite cosmos. And he accepted tragic interpretion for the world and for humanity. Finally, I can conclude that although he was a skeptic, and his philosophy was dualism, he had emphasized the dignity of humanity and the immortality of human spirit from beginning to end, that even if he had held on to the traditions, the underlying tones of his poetry was modern. It seems to me that there will never appears again such a poet as Robert Frost in the history of American poetry. He was a love poet. He was a poet of belief.

다발성 골수종 환자에서 병발한 급성신부전의 혈장반출법 치료 1예

박경선,김호연,박은영,문한림,김훈교,이경식,김동집 大韓血液學會 1987 大韓血液學會誌 Vol.22 No.2

巨大輸尿管을 同伴한 先天性 二重尿管 1例

曺昌周,金俊泰,金明淑,李琦寧,陣東植,李景植,鄭承和 中央醫學社 1972 中央醫學 Vol.22 No.1

A congenital double ureter with megaureter is of interest because of its rarity and difficulty in diagnosis. This one year old female was admitted with the chief problems of high fever, marked 'abdominal distension and vomiting for five days duration. After confirming the diagnosis by exploratory laparotomy, a nephroureterectomy of the left side was performed. The pathological findings showed a chronic nonspecific inflammation with marked congestion and cystic dilatation of the left kidney and megaureter. We presented a case of congenital double ureter with megaureter and. reviewed the literatures.