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김장한(Jang Han Kim) 한국역학회 2007 Epidemiology and Health Vol.29 No.1
Unlike the classical genetic study which dealt with the mendelian inheritances of relatively small number of patients, the genetic epidemiology study needs the large scaled genetic data base. The main ethical and legal problems of these kinds of studies are research design, informed consent, long term follow-up of research subjects, data sharing and benefit sharing. Classically, the informed consent was an important right but if these kinds of large scaled and long period studies were involved, the newly developing rights should be more stressed. The bioethics and biosafety act and governmental regulations for the genetic study and gene bank also shows those considerations. In EU, the general consent is considered acceptable if the approval of all future projects is fulfilled by a research ethics committee and the participants" right to withdraw samples at any times. In U.S.A., strict restriction is required for future experiments, but if the research involves no more than minimal risk to the subject, the waiver or alternation will not affect adversely the rights and welfare of subjects and the research could not be practicably carried out without the waiver or alteration, the specific future consents could be exempted. Long term follow up of research patients is needed to provide the newly developed information which would be helpful for the patients. Data sharing is needed to prevent the exclusive possession of genetic information. Benefit sharing is the newly coming up debates on how to manage the conflicts of interests between tissue-donors and scientific researchers. The context and inventory of human rights for the research is changing and still under construction.
견관절경 수술시 초음파를 이용한 팔신경얼기차단에서 저용량의 Levobupivacaine의 통증조절 효과
김장재 ( Jang Jae Kim ),김치효 ( Chi Hyo Kim ),김윤진 ( Youn Jin Kim ),김동연 ( Dong Yeon Kim ),한종인 ( Jong In Han ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.3
Background: Ultrasound guided-interscalene brachial plexus block (US-ISBPB) becomes more popular and has higher success rate. The aim of this study was to assess the analgesic effectiveness of US-ISBPB with low dose levobupivacaine for arthroscopic shoulder surgery. Methods: The thirty patients undergoing elective arthroscopic shoulder surgery were randomly assigned to two groups: Group B0.5, and Group B0.25 received ultrasound-guided ISBPB using same volume 10 ml of 0.5% levobupivacaine and 0.25% levobupivacaine, respectively. General anesthesia was standardized. All patients received continuous intra-articular infusion of a local anesthetic. Remifentanil consumption during operation, verbal numerical rating scales (VNRS) after operation were assessed. The need for rescue analgesics in post-anesthesia care unit (PACU), sleep quality, and complications were documented. Results: There were no significant differences in VNRS at 20 min, 30 min, 60 min, 120 min, 8 h, 24 h after surgery, remifentanil consumption during operation, the number of patients required rescue analgesics in the PACU, sleep quality, and complication up to 24 h after surgery. Conclusions: Ultrasound-guided interscalene brachial plexus block with levobupivacaine, 10 ml of 0.5% and 0.25%, provides effective analgesia after arthroscopic shoulder surgery. (Korean J Anesthesiol 2009;57:302∼7)
김장한(Jang Han Kim) 한국생명윤리학회 2004 생명윤리 Vol.5 No.1
"Bioethics and Biosafety Act" was enacted in 2004.1.29. and will be in effect from 2005.1.1. except the inhibition of human cloning (article 11), the inhibition of implementation of different species (article 12) and its punishment clauses which were in effect immediately after enactment. This act is composed 9 chapters and 55 articles. In general rules (chapter 1), the aim, definitions, obligations and the principle of self determination are described. In ethical committee (chapter 2), the national and institutional review board have a ground to be founded. In embryonal research (chapter 3), human reproductive cloning is prohibited but the research on residual human embryo and therapeutic cloning using somatic cell nuclear transfer (SCNT) is permitted. Severe ethical debates were raised against this legislation. In genetic examination(chapter 4), the protection of genetic privacy, informed consent and withdrawal, access to and call for research records, request to abolish the genetic material is well equipped. But discrimination in favor of public sector is considered to violate the equal protection (article 24). In protection and use of genetic information (chapter 5), the discrimination due to the genetic difference is prohibited. The gene banking is permitted and the genetic information offer is allowed under the permission of institutional review board and should be noticed to the ministry of Health and Welfare. Personal information should be excluded from the genetic information offer. If medical documents are issued other than patient, genetic information should not be included. In gene therapy (chapter 6), for the treatment of life threatening disease or if the benefit of gene therapy overwhelms that of other therapy or officially determined disease for treatment or prevention, gene therapy is allowed. But the sperm, egg, embryo and fetus could not be objects of gene therapy (article 36). This act will function as general principles of biomedical researches. But ethical debates are still on going and spread widely. The main debates are the allowance of human embryonal research and SCNT therapeutic cloning. Along with that, stem cell research including the use of fetal tissue, maternal protection will be the next themes to be discussed. Still we don't have any regulations. The genetic information as a common property of all mankind, we have to find a way to use it in a fair. Gene therapy could have effect beyond the generations, so the safety and quality of therapeutics is to be guaranteed. The proportions and authority of national and institutional ethical board should be adjusted for well¬functioning. We take a first step to regulate the bioethical and biosafety problems. More efforts will be needed to solve these problems.
김장한(Kim.Jang-Han),정만석(Chung.Man-Seok),석호태(Seok.Ho-Tae) 대한건축학회 2004 대한건축학회 학술발표대회 논문집 - 계획계/구조계 Vol.24 No.1
The environment pollution is very important problem. Even at the field of architecture, a study about method of saving energy and constructing environment friendly building will have performed with activity. But trends of Korea housing market are changed that the height of building become more higher and the level of comfort going up. Therefore, these requirements force to increase the energy usage for indoor environmental controls.<br/> Thus, the purpose of this study is to reduce the heating and cooling energy requirements of High-rise Residential Buildings by the analysis of Energy Performance. From now on, we search improvement plan for the most efficient Energy Saving at present High-rise Residential Buildings.
의료전문가주의-역사적 관점에서 본 사회적 책무에 관하여
김장한 ( Jang Han Kim ) 대한소화기학회 2015 대한소화기학회지 Vol.65 No.3
What is medical professionalism and does it matter to the patients? Medical professionals take responsibility for their judgements and the consequences that ensue. Traditionally medical professionalism is defined as a set of values, behaviors, and relationships which support the trust the public has in doctors. The public is well aware that absence of professionalism is harmful to their interests. However, the exercise of medical professionalism is endangered by the political and cultural environment. The values of professionalism have been changed throughout the medical history and the meaning of it was also changed according to social theories. Traditional medical professionalism was based on the virtue of autonomy, self-regulation and competency etc. However, in the new millenium era, the meaning of professionalism has changed under the concept of responsibility which includes the classical virtues. The meaning of professionalism nowadays is only based on the structure and conflicting theories which cannot solve all the issues surrounding professionalism in medical practice. The conditions of medical practice are critical determinants for the future of professionalism. The interaction between doctor and patient is central to the medical care, and medical professionalism has roots in almost every aspect of medical care. I argue that doctors have responsibility to act according to the values which have been determined by the medical profession, history and surrounding society. The new millennium medical professionalism which based on the responsibility could initiate a public dialogue about the role of the doctor in creating a fairer society. (Korean J Gastroenterol 2015;65:165-172)