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        • KCI등재

          연명의료결정법과 자기결정권 강화의 실제 : 의료현장을 중심으로

          홍지형(Hong, Ji Hyung) 가톨릭생명윤리연구소 2020 인격주의 생명윤리 Vol.10 No.1

          '스콜라' 이용 시 소속기관이 구독 중이 아닌 경우, 오후 4시부터 익일 오전 7시까지 원문보기가 가능합니다.

          이 논문은 실제 의료 현장에서 생애 말기 시점에서 환자의 자기결정권 강화를 위해 제정된 연명의료결정법 제정 10개월 시점에서의 연명의료결정법의 수행에 대해 분석하였다. 연명계획서상 환자 본인의 의사반영 비율, 연명의료계획의 내용, 연명의료계획서 작성에 미치는 환자의 임상적, 사회경제적 요인을 분석하였다. 2018년 2월 4일부터 2018년 12월 31일까지 3차 대학병원에서 연명의료결정법 관련 서식을 작성한 환자는 총 669 명이었다. 이 중 35%의 환자가 연명의료계획서를 작성하였고, 환자 본인이 연명계획서를 작성하지는 않았지만, 연명의료에 관한 환자의 의사를 반영한 연명의료결정을 한 환자는 25%에 해당하여, 59%의 환자에게서 본인의 의사가 연명의료계획에 반영되었다. 연명의계획에 환자의 의사가 반영된 환자와 그렇지 않은 환자군 간 환자의 직업의 유무, 동반거주자의 유무, 고학력자, 주거형태 등에 차이가 있었다. 90% 이상의 환자들은 말기상태에서 심폐소생술, 인공호흡, 혈액투석, 항암치료 등의 적극적 치료에 동의하지 않았다. 연명의료계획서 작성에 영향을 미치는 인자로는 단변량 분석에서 직업, 동반거주자, 학력, 주거형태, 사보험 여부, 주진단, 주진료과 등이 영향을 주었으나, 다변량 분석에서 주거형태, 주진료과, 주진단만이 영향력을 유지하였다. 본 연구는 향후 연명의료결정법의 취지에 부합하는 의료현장에서의 연명의료계획의 수립과 수행에 자료제시 및 자기결정권 강화의 역할을 촉진할 수 있는 제반연구로서의 의미를 갖는다. The purpose of this paper is to investigate the effect of the Act on Life-Sustaining Treatment Determination on the patient s self-determination and autonomy about the end-of-life treatment at the 10-month time point of enactment of the Act on Life-Sustaining Treatment Determination in Korea. The percentage of reflection of the patient's own opinion on end-of-life treatment, the contents of POLST, the clinical and socioeconomic factors affecting the completion of POLST were analyzed with retrospective manner. From February 4, 2018, to December 31, 2018, a total of 669 patients were enrolled at the tertiary university hospitals. Of these, 35% of the patients completed POLST and 25% of the patients did not write POLST, but their family members decided the end-of-life care treatment according to patients wish. Therefore, the wish of 59% of patients was reflected in the end-of-life decision. More than 90% of patients did not agree to active treatment, such as CPR, artificial respiration, hemodialysis, and chemotherapy, in the terminal period. In the univariate analysis, factors influencing the completion of POLST included employment states, educated degree, residential status, private insurance, department the patients were involved and diagnosis. However, only employment states, department the patients and patient's diagnosis remained independency of influencing the completion of POLST in the multivariate analysis. This study is meaningful as a study of how to strengthen self-determination and autonomy in end-of-life care decisions.

        • KCI등재

          연구보문 : 환경환경 ; 취나물의 재배기간 중 살충제 Chlrofenapyr와 살균제 Fenarimol의 생산단계 농약잔류허용기준의 설정

          홍지형 ( Ji Hyung Hong ), 이규승 ( Kyu Seung Lee ), 임종성 ( Jong Sung Lim ), 이유리 ( Yu Ri Lee ), 한국탁 ( Kook Tak Han ), 이초롱 ( Cho Rong Lee ) 한국환경농학회 2011 한국환경농학회지 Vol.30 No.1

          BACKGROUND: This study was performed to investigate pre-harvest residue limit (PHRL) in Chwinamul, to estimate biological half-life for residue of each pesticide. Chwinamul was sprayed with pesticides of standard and double application rate. Chlorfenapyr and fenarimol were sprayed once on Chwinamul at 10 days before harvest, and it was sampled 7 times and analysed the residual change of two pesticides. METHODS AND RESULTS: Chwinamul sample was extracted with acetonitrile and partitioned with dichloromethane, and pesticide residues were determined with GCECD. Method quantitation limit (MQL) of chlorfenapyr was 0.10mg/kg and that of fenarimol was 0.02mg/kg. Recoveries of chlorfenapyr at two fortification levels of 1.0 and 5.0mg/kg were 94.2±1.70 and 99.0±1.61%, respectively. Recoveries of fenarimol at two fortification levels of 0.2 and 1.0mg/kg were 92.1±2.14 and 83.1±1.98%, respectively. CONCLUSION(s): The biological half-lives of chlorfenapyr were about 3.5 days at standard application rate, and 3.4 days at double application rate. The biological half-lives of fenarimol were about 6.0 days at standard application rate, and 5.9 days at double application rate. The PHRLs of chlorfenapyr were recommended as 13.02 and 6.25mg/kg for 10 and 5 days before harvest, respectively. And the PHRLs of fenarimol were recommended as 2.80 and 1.67mg/kg for 10 and 5 days before harvest, respectively.

        • KCI등재
        • 퇴비화 암모니아 가스의 톱밥 바이오 필터 매체에 의한 생물학적 탈취

          홍지형 ( Hong Ji Hyung ), 박금주 ( Park Keum Joo ) 한국농공학회 2003 韓國農工學會誌 : 전원과 자원 Vol.45 No.2

          Dairy manure amended with crop and forest residues (moisture 69% wet basis, C/N 22) was composted in a 605 L pilot-scale vessel using continuous air flow (56 L/min) for 19 days. Three pilot-scale sawdust biofilters (moisture 63%, pH 5.0) were built to clean biological waste gas from the composting process. For each methods, two replicated experiments were monitored over a period of three weeks. The system was evaluated to determine the biofilter media depth that would be adequate for compost odour reduction. The compost air cleaning was measured based on ammonia gas concentration before and after passing through the biofilter. Ammonia gas removal efficiency over 3 weeks was 42, 75 and 87% at sawdust biofilter media depth levels of 202, 400 and 600 mm, respectively. Each sawdust biofilter was operated at a moisture content in the range of 60~62% (wb), a temperature from 15 to 25℃, an average pressure drop from 240 to 340 Pa and a detention time from 60 to 180 seconds during the biofiltration process.

        • 시설채소(施設菜蔬) 생산(生産)시스템의 순(純) 에너지 분석(分析)

          홍지형 ( Hong Ji Hyung ) 한국농공학회 1995 韓國農工學會誌 : 전원과 자원 Vol.37 No.1

          This paper presents analytic results of energy sequestered for the forcing cultural Cu- cumber and the others production system with the input-output tables method in the suthern parts of Korea. In this study an attempt is made to evaluate input of direct and indirect energy, output of yield energy and net energy in order to achieve increased energy productivity under P E greenhouse. Cultural practices were grouped soil and soilless with perlite for vegetable production. The results from this study are summarized as follows : 1. Total energy inputs in cucumber production were calculated to be 510 GJ/10a(di-rect energy : 480 GJ/10a, indirect energy : 30 GJ/10a) from soil culture and 440 GJ/ 10a(direct energy : 420 GJ/10a, indirect energy : 20 GJ/10a) from soilless culture in perlite hydroponics. 2. Energy outputs from cucumber and biomass were 7 GJ/10a and 120 GJ/10a at a uniform rate respectively. 3. Heating fuel as diesel is a major energy inputs approaching 90% of the total energy requirements for cucumber production. 4. Net energy in cucumber production was calculated to be 503 GJ/10a from soil cul- ture and 431 GJ/10a from soilless culture. Net energy productivity was maintained costantly as 0.98. 5. Energy productivity in cucumber was calculated to be 0.029 kg/MJ from soil culture and 0.043kg/MJ from soilless culture, while energy efficiency was 0.012 and 0.015 respectively. It is expected that a soilless cultural production system seems to be reduc-tive in seguestered energy input by 13%.

        • KCI등재
        • 우리나라 농업(農業)의 대체(代替)에너지 활용(活用) 실태(實態)에 관한 연구(硏究)

          홍지형 ( Hong Ji Hyung ) 한국농공학회 1993 韓國農工學會誌 : 전원과 자원 Vol.35 No.3

          Groundwater and animal wastes are typical example which are underutilized resources than their value in agriculture. This paper was to investigate the actual patterns of utilization of water curtain for greenhouses and methane gas utilization from swine wastes in a view point of promoting more efficient use of alternative energy. The results from measurements can be summarized as follows : 1. It was estimated that the maximum heating load per 10a was around 23, 280kJ/hr and the heating load at January showed 3.93×10<sup>6</sup>kJ respectively for strawberry greenhouses with insulation by the water curtain. 2. The average heating cost of the greenhouse with water curtain system amounted to about 75.000 Won per 10a. This result suggested that the greater cultivated area provides less heating cost. 3. The operating volume was about 73 percent of the optimum size of the digester. The net available methane gas rates of the produced gas remained close to 62 percent, But the conventional and small size of the digester was maintained at a lower level of around 20 to 29 percent. 4. It appeared that major problems of biogas production system were required to maintain the temperature of the fermentation above ambient temperature and the optimum volume of digester.

        • 부자재 비용 저감을 위한 순환 퇴비화 시스템의 예비 연구

          홍지형 ( Hong Ji Hyung ), 최명환 ( Choi Myung Hwan ), 박금주 ( Park Keum Joo ) 한국농공학회 1999 한국농공학회 학술대회초록집 Vol.1999 No.-

          This study was performed to find the recycling performance and to provide design data during recycled solid composting system to reduce bulking agent cost. Dairy manure amended with rice hulls and recycled compost was composted in a laboratory-scale vessel by continuous aeration for 10 days. The temperature and ammonia emission variations according to the r:'ltios of bulking agents during the primary aeration stage were surveyed. Also, the influence of fresh compost quality on the recycling performance were analyzed. While recycled composting system were operated, The temperature in compost was maintained in the range of 40~60℃ needed for biodegradation and death of pathogenic organisms, but the ammonia emission was different by the ratios of recycled compost. The ammonia emission increased due' to the low C/N ratio(17.6), high pH value(8.1) of the recycled compost.

        • KCI등재

          증례 : 호흡기 ; 유방암 환자에서 방사선 조사 후 발생한 폐쇄성 세기관지 기질화 폐렴 1예

          홍지형 ( Ji Hyung Hong ), 강지영 ( Ji Young Kang ), 김태정 ( Tae Jung Kim ), 이재호 ( Jae Ho Lee ), 김대원 ( Dae Won Kim ), 윤형규 ( Hyoung Kyu Yoon ), 송정섭 ( Jeong Sup Song ) 대한내과학회 2011 대한내과학회지 Vol.80 No.4

          폐쇄성 세기관지 기질화 폐렴은 방사선 치료 후에 드물지만 발생할 수 있는 합병증이다. 종양으로 흉부 방사선 조사의 기왕력이 있는 환자에서 다발성 경결성 폐병변이 있는 경우, 특히 방사선에 노출되지 않은 부위라 하더라도 감염성폐렴이나 방사선 폐렴, 종양의 재발 뿐만 아니라 본 증례와 같이 방사선 유도 BOOP의 가능성이 발생할 수 있음을 염두에 두고 접근하는 것이 필요하겠다. Pulmonary toxicity can develop following radiation therapy during breast cancer treatment. Of the pulmonary toxicities that can develop, radiation-induced bronchiolitis obliterans organizing pneumonia (BOOP) is relatively rare. A 43-year-old woman who had previously undergone radiation therapy for right breast cancer presented with fever and cough for 4 days. Chest radiology findings demonstrated consolidations in the right middle and lower lobe. Initially, we assumed that her findings were consistent with pneumonia and started empirical antibiotics. However, even after 10 days of antibiotic treatment, the fever persisted, and the consolidations showed progression. A transbronchial lung biopsy of the right middle lobe via bronchoscopy revealed organizing pneumonia. We strongly suspected radiation-induced BOOP and began steroid treatment. The symptoms and consolidations rapidly disappeared. We tapered the steroids, and no relapse has occurred since then. Considering the clinical, radiological, and pathological findings, we diagnosed the patient with radiation-induced BOOP. To our knowledge, this is the first case of radiation-induced BOOP in Korea. (Korean J Med 2011;80:458-463)

        • 농업 부산물을 이용한 돼지 사체 퇴비화

          홍지형 ( Hong Ji Hyung ), 최병민 ( Choi Byoung Min ) 한국농공학회 1998 한국농공학회 학술대회초록집 Vol.1998 No.-

          Dead animals amended with agricultural rersidues are utilized ai a compost to promote soil fertility and reduce environmental pollution by traditional methods of livestock mortalities. The full-scale bin composting swine mortality in roofed system with three amendments was very successful in reaching sufficient temperature above 55℃ long enough for pathogen kill. The average temperature of tile compost material in dead swine amended with corn stover increased rapidly to 64℃ on the 2nd day after primary composting and dropped to near ambient temperature on the 140th day of composting. The composting temperature of corn stover and wheat straw is more efficient for swine carcass composting than that of sawdust.

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