An Evaluation of Nutrition Support for Terminal Cancer Patients at Teaching Hospitals in Korea

Do Yeun Kim,Sang Min Lee,Kyoung Eun Lee,Hye Ran Lee,김지현,Keun-Wook Lee,Jong Seok Lee,Soon Nam Lee 대한암학회 2006 Cancer Research and Treatment Vol.38 No.4

Purpose: We wanted to analyze the use of nutrition support for terminal cancer patients, the effect of discussing withdrawal of nutrition support and do-not- resuscitate (DNR) consent on the use of intravenous nutrition during the patient’s last week of life and at the time of death.Materials and Methods: The study involved 362 patients with terminal cancer from four teaching hospitals, and they all died between January 1 2003 and December 31 2005. The basic demographic data, the use of intravenous nutrition during the patient’s last week of life and at death, discussion of terminal nutrition withdrawal and DNR consent were evaluated.Results:In the week before death, the patients received artificial nutrition such as total parenteral nutrition (31%), intravenous albumin infusion (25%), and feeding tube placements (9%). A discussion concerning withdrawal of nutrition support was limited to 25 (7%) patients. DNR consent was obtained from 294 (81%) patients. None of the patients were directly involved in any of these decisions. The discussion about withdrawal of terminal nutrition and DNR consent with the patient’s surrogates did not have any effect on reducing the use of parenteral nutrition.Conclusion: The majority of patients dying of terminal cancer were still given potentially futile nutritional support. Modern clinical guidelines and ethical education about nutritional support at the end of life care is urgently needed in Korean medical practice to provide proper administration of terminal nutrition for end of life care. (Cancer Res Treat. 2006;38:214-217)

Do-Not-Resuscitate Orders for Terminal Patients with Cancer in Teaching Hospitals of Korea

Kim, Do Yeun,Lee, Kyoung Eun,Nam, Eun Mi,Lee, Hye Ran,Lee, Keun-Wook,Kim, Jee Hyun,Lee, Jong Seok,Lee, Soon Nam Mary Ann Liebert 2007 Journal of palliative medicine Vol.10 No.5

<P>OBJECTIVES: To examine the current practices relating to do-not-resuscitate (DNR) orders for terminal patients with cancer at teaching hospitals in Korea. METHODS: The records of 387 deaths from January 1 to December 31, 2005 at four cancer centers were identified and reviewed to assess the DNR delineation. Basic demographics, circumstances surrounding the establishment of the DNR directive, the percentage of orders for identified populations, and the time interval between DNR consent and death were evaluated. RESULTS: An order of DNR consent was obtained from 296 patients (76%) of a total of 387 patients. All DNR consents were made between the physician and family, without involving the patient. Written preprinted DNR consent forms were used in 169 (57%) cases and 127 patients (43%) had verbal DNR permission. DNR consent was interpreted in two ways: one forbade resuscitation in two hospitals and the other implied limited care in two other hospitals. A unilateral physician decision to withhold cardiopulmonary resuscitation (CPR) was decided for 62 (16%) patients. Terminal CPR was performed on 29 (7%) patients. DNR discussion was made within 7 days of the day of death on 228 (77%) patient among the 296 DNR consenting patients. CONCLUSION: From our teaching-hospital-based analysis of terminal cancer patients in Korea, consent for a DNR order was common. However, DNR order forms were not standardized and lacked room to document patient involvement in the decision. Usually the DNR decision was made within last days of the patient's life. Our results reflect the need for the improvement of end-of-life care decisions in Korea.</P>

도시 내 복개하천 복원계획에 관한 연구 : 도림천을 중심으로

김도경,손석범 경희대학교 디자인연구원 2003 예술· 디자인학연구 Vol.6 No.1

As the urbanization continues, rivers are covered for roads and parking lots. In addition, people thought that if rivers are covered, this will improve the appearance of the street and remove terrible stench, and actively started to cover rivers. But urban rivers, which are covered for short-term benefits, ended up with urban drains and destroyed urban ecosystem. These days, other problems are continuously caused by construction of covering rivers. As public attention is being directed to the environment recently, people pay more attention to the need for the restoration of rivers. In this study, I conducted field research and took pictures while walking along Do-rim river, and studied related literature. I found out that there were many schools and reservoirs around Do-rim river. This study is intended to find out ways to secure water, which is essential to the restoration of rivers, and to suggest various methods for securing water by using the existing infrastructure such as schools and reservoirs.

In Vitro에서 골 형성과 흡수에 대한 Endothelin-1의 영향

사석진,안도환 고신대학교 의과대학 2010 고신대학교 의과대학 학술지 Vol.25 No.2

Background: Balanced regulation of the receptor activator of nuclear factor-kB (RANK) ligand (RANKL) and osteoprotegerin (OPG) by osteoblasts is important for osteoclastogenesis. Sex hormones, glucocorticoids, and prostaglandin E2 (PGE2) are known to modulate osteoblast proliferation and osteoclast formation. Endothelin (ET)-1 is a mitogen as well as a strong vasoconstrictor.It stimulates proliferation of osteoblasts, but its effects on differentiation are controversial. In addition, little is known about ET-1 regulation of osteoclast formation. Thus, the present study was undertaken to investigate whether ET-1 canregulate the expression of RANKL and OPG genes in osteoblasts and affect RANKL-induced osteoclastogenesis. Methods: Osteoblasts were derived from neonatal calvariae and monocytic preosteoclasts from the bone marrow of adult mice, respectively. Cells were cultured in a-minimum essential medium containing 10 nM ET-1. The gene expressions of RANKL and OPG in osteoblasts and RANK in preosteoclasts were measured by real-time RT-PCR. Mineralization by osteoblasts was determined by Alizarin-red staining. Osteoclastogenesis was examined using tartrate-resistant acid phosphatase (TRAP) staining and resorption pit assay. Results: Osteoblasts expressed both ETA and ETB receptors (ETAR and ETBR). ET-1 (10 nM) increased osteoblast proliferation 1.6-fold compared with the control after 3 days in culture and stimulated differentiation, which was indicated by increased formation of mineralized matrix. Proliferation and differentiation of osteoblasts was blocked by 1 uM BQ123, an ETAR antagonist. ET-1 suppressed RANKL gene expression by 50% but did not affect OPG gene expression, and thus reduced the ratio of RANKL to OPG mRNA. PGE2 production by osteoblasts was increased by ET-1. In preosteoclast cultures, ET-1 had little effect on RANK mRNA expression and suppressed RANKL-induced osteoclastogenesis by decreasing the number of TRAP-positive osteoclasts and the resorbed areas. Conclusions: These findings demonstrate that ET-1 can increase bone formation by stimulating proliferation and differentiation of osteoblasts and decrease bone resorption by suppressing RANKL-induced osteoclastogenesis as well as suppressing RANKL mRNA expression In vitro에서 골 형성과 흡수에 대한 endothelin-1의 영향 배경: 조골세포에서 생성되는 receptor activator of nuclear factor-kB ligand (RANKL)과 osteoprotegerin (OPG) 사이의 균형은 파골세포 형성에 매우 중요하다. Enodothelin-1(ET-1)은 강력한 혈관수축제일뿐만 아니라 다양한 세포에서 세포 증식을 촉진시키는 물질이다. 그러나 ET-1의 조골세포의 분화에 대한 영향은 상반될 뿐만 아니라 ET-1이 조골세포의 RANKL과 OPG의 생성을 변화시켜 간접적으로 파골세포 형성에 영향을 주는지 혹은 파골세포의 분화에 직접적으로 영향을 주는지에 대해서는 연구된 바 없다. 따라서 본 연구에서는 ET-1에 의한 조골세포의 분화와 RANKL 및 OPG 유전자 발현이 파골세포 형성에 미치는 영향을 조사하였다. 재료와 방법: 조골세포는 생쥐의 두개골로부터 그리고 파골전구세포는 골수로부터 각각 분리하였다. 이들 세포들을 10 nM ET-1이 포함된 α-MEM 배지에서 배양하였다. 유전자의 발현은 real-time RT-PCR을 통해 정량적으로 측정하였다. 조골세포의 분화는 alizarin-red 염색으로, 파골세포의 형성과 활성은 tartrate-resistant acid phosphatase 염색과 골 흡수와(resorption pit)의 크기로 평가하였다. 결과: ET-1은 조골세포의 증식과 분화를 촉진시켰으며, 이는 ETA 수용체를 통해 이루어졌다. 조골세포에서 ET-1은 PGE2 생성을 크게 증가시켰을 뿐만 아니라 RANKL 유전자 발현을 대조군에 비해 50% 감소시켰다. 그러나 OPG 유전자의 발현에 영향을 주지 않았다. 파골 전구세포에서 ET-1은 RANK 유전자의 발현에 영향을 주지 않았지만 RANKL에 의해 유도된 파골세포 형성과 활성은 억제시켰다. 결론: ET-1은 조골세포의 증식과 분화를 촉진시키고 RANKL mRNA 발현을 감소시켜 파골세포 형성을 간접적으로 억제한다. 또한 RANKL에 의해 유도되는 파골세포 형성과 활성을 직접적으로 억제한다. 이러한 결과로 미루어 ET-1은 골형성은 촉진하고 골흡수는 억제할 것으로 사료된다.

고객만족의 결정변수에 관한 연구

안운석,강도원 남서울대학교 1999 남서울대학교 논문집 Vol.5 No.-

The purpose of this study is a conceptualization of consumer satisfaction, introduction of a predictive variables to determine consumer satisfaction and testimony of predictive variables. For achievement the purpose of study, theoretical and empirical survey performed. Specially, hypothesis and hypothesis testimony referenced <table 2 to 9>. And in conclusion, strategical suggestions and limitations of this study presented.

초등학생들의 물질 개념에 관한 연구

김석중,남철우,김정길,송판섭,한광래,최도성,김숙희 光州敎育大學校 初等敎育硏究所 2002 初等敎育硏究 Vol.17 No.-

Over the past 20 years, research on students' conceptual development of science concepts has begun to inform educators about the roles that prior knowledge and experiences play in the development of conceptual understandings. Whereas many initial studies focused on identifying and cataloging naive of misconceptions, more recent research has focused on how student concept development research can inform teaching practice and curriculum design. In this study, we investigated children's (ages 11∼12) spontaneously constructed or naive understanding of the particulate nature of matter prior to any formal instruction in the domain. Thirty students were interviewed concerning their understanding of the macroscopic and microscopic properties of the states of matter(solid, liquid, and gas), as well as their macro/microscopic understanding of phase changes and dissolving. Children expressed ideas about states of matter which were categorized as macrocontinuous, macroparticulate, or microparticulate. Furthermore, a substantial number of the children provided explanations of properties and processes which were consistent with those beliefs. These children's beliefs about matter were not fully and consistently developed across the spectrum of substances from continuous solids to particulate solids to liquids to gases. We speculate that children first develop local frameworks particular to different classes of substances and then slowly expand these frameworks to include a wide range of substances and their properties as well as such processes as melting and freezing.

Some Properties of β-irresolute Maps on Nearly Open Sets

송석준,김도현 제주대학교 1984 논문집 Vol.17 No.-

In this paper, we define a &irresolute map and obtain its characterizations and some properties of the maps on nearly open sets. Moreover, we define a β-Hausdorff space and have its some topological pro-perties and its characterizations.

강구조 복앵글 전단 접합부의 구조적 거동에 관한 실험적 연구

이도형,김석중 江原大學校 産業技術硏究所 1997 産業技術硏究 Vol.17 No.-

Shear connection in steel structures should satisfy dual criteria of shear strength and retational flexibility and ductility. The connection should be strong enough to transfer the shear reaction of the beam, and should have sufficient rotational flexibility and ductility to rotate easily and supply the end rotation demand of the beam. This paper is concerned with the behavior of double-angle shear connections where the parameters are numbers of high strength bolt pitch, the length of angle leg, and connection method. An experimental investigation of shear connection was conducted by testing 12 beam-to-column joint specimens. Based on experimental and analytical study, the failure modes are developed and proposed design formulas.

여성요도구협착의 수술적 교정

오범석,김도완,오철규,노안식,박석산 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Objective: We describe various clinical presentations of female urethral meatal stricture, which may mimic other pelvic floor disorders and result in diagnostic delay. Diagnosis, management, and outcome results are reported Materials and Methods: We reviewed retrospectively 26 consecutive cases of female urethral meatal stricture. Patient characteristics, history, clinical presentation, symptom score, maximal flow rate, residual urine, diagnosis, management and short-term follow up are reported. Results: Mean patient age plus or minus standard deviation was 54 years. Most 21 (81%) cases were referred as diagnostic dilemmas with symptoms present for 1 month to 30 years. Mean interval between onset of symptoms to diagnosis was 5.8 years. The most common symptoms were residual urine sensation (77% of cases), frequency (54%), pelvic pain (46%), dysuria (46%), weak stream urine (27%), urgency (15%) and 17 patients (65%) have combined symptoms. 16 patients (62%) had been treated with oral and/or vaginal medication and/or psychotherapy. The female urethral meatal stricture was visible on physical examination in 21 patients (81%) and cystoscopy in 5 patients (19%). Of these visible urethral meatal stricture, 11 patients (45%) contained recurrent urinary tract infection, 9 patients (35%) contained urethral mucosal prolapse, 7 patients (27%) contained urethral diverticulum, and 3 patients (12%) contained stress urinary incontinence. 18 patients (69%) who has been treated with oral and/or vaginal medication or psychotherapy was not successfully improved. Treatment consist of urethral meatal excision and/or everted urethral mucosal excision and/or urethral diverticulum excision and/or anti-incontinence surgery when indicated. Subsequently 24 patients (92%) had improved symptom score, but 2 patient was not changed. In 9 patients new symptom developed. Conclusions: Female urethral meatal stricture have several urinary symptoms and may mimic other pelvic floor disorders. This condition should be considered in women with frequency, residual urine sensation, pelvic pain, dysuria and etc. Medical treatment is not sufficient but surgical treatment is usually simple, safe and effective in alleviation associated symptoms.

응급실에서 급성 췌장염 환자의 선별을 위한 actim pancreatitisR검사의 유용성

송석훈,도병수,이삼범 대한응급의학회 2001 대한응급의학회지 Vol.12 No.4

Background: Acute pancreatitis is a fairly common abdominal disorder that can be easily confronted in the emergency department(ED) and is one of the most complex and clinically challenging of all abdominal disorders. Currently, there is no gold standard for the diagnosis of acute pancreatitis. We evaluated the usefulness of the actim Pancreatitis□ rapid test, which has been recently developed in Europe, as a screening test of acute pancreatitis in our emergency department. Methods: We prospectively studied the urinary trypsinogen-2 dipstick tests(actim Pancreatitis□, Medix Biochemica, Kauniainen, Finland) of 200 patients with acute abdominal pain who were treated at our ED. All urine samples were collected from the patients within 12 hours of arrival at ED. We also measured serum amylase assay in the laboratory and compared the sensitivities and the specificities of the two test. Acute pancreatitis was diagnosed by authors according to standardized criteria. Abdominal USG or CT was performed when a patient with a normal serum amylase level had a typical clinical presentation. Results: The actim Pancreatitis□ rapid test was positive in 22 of the 25 patients with acute pancreatitis(sensitivity, 88.0 percent). The test was also positive in 6 of 175 patients without pancreatitis(specificity, 96.6 percent). The serum amylase assay had a sensitivity of 68.0 percent(with a cutoff value of 300 U per liter for the upper reference limit) and a specificity of 90.9 percent. But there were no statistical differences between the correlation coefficients of the two tests as diagnostic tool Conclusion: In patients with acute abdominal pain who are seen in the emergency department, the actim Pancreatitis□ urinary dipstick test has a high degree of probability as a screening test for acute pancreatitis. Also it can easily and rapidly be use at the bedside.