말기암환자에서 통증 외 증상의 관리: 최신 NCCN(National Comprehensive Cancer Netweork) 권고안을 중심으로

이혜란,Lee, Hye Ran 한국호스피스완화의료학회 2013 한국호스피스.완화의료학회지 Vol.16 No.4

말기암환자들은 암의 진행으로 인한 여러 가지 육체적, 정신적 증상들로 고통 받고 있으며, 통증뿐만 아니라 피로감, 쇠약감, 식욕부진, 오심 구토, 호흡곤란 등은 말기암환자의 삶의 질 감소에 큰 영향을 미친다. 피로감은 여러 기전 및 원인에 의하여 발생하는데, 치료 가능한 원인으로는 약물부작용, 빈혈, 심한 통증, 수면장애, 우울증 또는 불안감, 영양부족, 내과적 동반질환 등이다. 피로감의 주 기전으로는 사이토카인의 조절이상 및 시상하부-뇌하수체-부신축의 기능부전, serotonin의 조절이상 생체리듬의 파괴, ATP에서의 변화 등이다. 치료는 치료 가능한 원인을 제거하고 환자의 에너지를 보존할 수 있게 하는 방향으로 활동을 계획하고, 교육해야 하며, 약물 치료로는 corticosteroid와 psychostimulants를 사용할 수 있다. 식욕부진과 악액질도 여러 가지 치료 가능한 원인이 있을 수 있는데, 구내염, 구강 캔디다증, 구강 herpes, 구강건조, 변비, 통증과 호흡곤란같이 조절이 안 되는 증상, 섬망, 오심 구토, 우울증, 위장관 운동기능 장애, 역류성 식도염, 내분비 장애가 포함 된다. 식욕부전의 기전은 음식섭취를 조절하는 뇌의 생리적 기전의 이상과 관련, serotonin 분비 증가, IL-$1{\alpha}$, IL-1, IL-6, IL-8 TNF-${\alpha}$와 관련이 있다. 악액질의 기전은 에너지와 기질(substrate metabolism)에서의 변화, 종양에서 생산된 지질분해요소와 단백질 분해요소, 호르몬 이상, 암세포로부터 세포성장에 필요한 영양분을 빼앗기는 것, 에너지 섭취의 감소 등이다. 치료는 정신과 상담 및 환자와 가족의 교육인데, 교육할 때는 환자와 그 가족에게 식욕부진과 악액질이 암으로 인한 임종과정 중 일어나는 자연적인 현상이라는 것을 알리며, 다른 행동으로 환자를 돌보는 방법 등을 교육한다. 약물치료로는 megestrol acetate와 dronabinol, steroid를 사용할 수 있다. 오심 구토의 원인 중 치료가 가능할 수도 있는 것으로는 약물, 요독증, 감염, 불안증, 변비, 상부위장관 폐쇄, 고칼슘혈증, 저나트륨증이 있고, 치료는 metoclopramide, haloperidol, olanzapine 또는 ondansetron 등을 사용해 볼 수 있다. 말기 암에서 호흡곤란의 증상은 폐의 특별한 병변이 없이도 환자가 호소할 수 있는데, 이 경우 opioids가 효과적이다. 말기 암환자에서 환자의 증상을 경감시켜주기 위한 완화치료는 매우 중요하며, 환자의 증상을 잘 평가하고 적절한 치료 및 관리를 해 줌으로써 환자의 삶의 질을 향상시킬 수 있다. 따라서 이들 환자의 증상 호소에 더욱 관심을 갖고 적극적으로 치료하고 관리하여야 할 것이다. Most terminally ill cancer patients experience various physical and psychological symptoms during their illness. In addition to pain, they commonly suffer from fatigue, anorexia-cachexia syndrome, nausea, vomiting and dyspnea. In this paper, I reviewed some of the common non-pain symptoms in terminally ill cancer patients, based on the National Comprehensive Cancer Network (NCCN) guidelines to better understand and treat cancer patients. Cancer-related fatigue (CRF) is a common symptom in terminally ill cancer patients. There are reversible causes of fatigue, which include anemia, sleep disturbance, malnutrition, pain, depression and anxiety, medical comorbidities, hyperthyroidism and hypogonadism. Energy conservation and education are recommended as central management for CRF. Corticosteroid and psychostimulants can be used as well. The anorexia and cachexia syndrome has reversible causes and should be managed. It includes stomatitis, constipation and uncontrolled severe symptoms such as pain or dyspnea, delirium, nausea/vomiting, depression and gastroparesis. To manage the syndrome, it is important to provide emotional support and inform the patient and family of the natural history of the disease. Megesteol acetate, dronabinol and corticosteroid can be helpful. Nausea and vomiting will occur by potentially reversible causes including drug consumption, uremia, infection, anxiety, constipation, gastric irritation and proximal gastrointestinal obstruction. Metoclopramide, haloperidol, olanzapine and ondansetron can be used to manage nausea and vomiting. Dyspnea is common even in terminally ill cancer patients without lung disease. Opioids are effective for symptomatic management of dyspnea. To improve the quality of life for terminally ill cancer patients, we should try to ameliorate these symptoms by paying more attention to patients and understanding of management principles.

한우태자의 축추골 몸통과 첫째 척추사이 원반의 발달

이혜란,안동춘,김인식,양홍현,백영기,Lee, Hye-ran,Ahn, Dong-choon,Kim, In-shik,Yang, Hong-hyun,Paik, Young-ki 대한수의학회 1997 大韓獸醫學會誌 Vol.37 No.1

The histological and histochemical study of the body of axis and 1st intervertebral disc in the Korean native cattle fetus was attempted to early developmental process. The experimental animals used in this study were collected from fetus of the Korean native cattle ranging from 50mm to 180mm in Crown-Rump length(CR-length). The results were summerized as follows: 1. The ossification centers appeared centrum 1 and centrum 2 of the axis in 110mm CR-length fetus of the Korean native cattle. The centrum 2 was formed little earlier than the centrum 1. 2. The histochemical reactions for collagenous fibers in the axis revealed negative in 50mm CR-length, mild positive in 90mm CR-length, and strong positive in 110mm CR-length, respectively. 3. Dense collagenous fibers were observed in the notochord through the centrum 2, and intervertebral disc developed into cuneiform dorsoventrally, It's contour looks like an annual ring. These fiber bundle arranged lamellar formation. 4. The intervertabral disc of 50mm CR-length fetus was composed mainly mesenchymal cells, and these cell showed aggregation in the central portion. The intervertebral disc of 110mm CR-length fetus was consisted of pricipally fibroblast, and notochordal sheath formed with two layers in the center.

영어영문학21제26권 2호 : 포스트아파르트헤이트 시대의 "탈정체화"-나딘 고디머의 『줄라이의 사람들』

이혜란 ( Hye Ran Lee ) 21세기영어영문학회 2013 영어영문학21 Vol.26 No.2

In July`s People, Nadine Gordimer considers post-apartheid as a revolutionary ‘interregnum’ in the history of South Africa, and pays attention to a great diversity of ‘morbid symptoms’ in the post-apartheid era. The novel traces to the inner changes of Maureen and Bam, a liberal white couple who are shipwrecked in ‘homeland,’ which is one of black people`s reservations and their servant July`s hometown. In July`s People, Gordimer examines the possibility of whites` coexistence with blacks in the post-apartheid era when the black power establishes a new social, political order. The purpose of this paper is to analyse the moments of rupture of Maureen`s and Bam`s identities in the perspective of ‘de-identification,’ which is one of main notions of Jacques Ranciere. In Ranciere`s definition, an identity is something given by ‘police community,’ and ‘political subjectivation’ can be achieved by the process of dismantling the identity distributed by this ‘police community.’ From this perspective, this paper interprets Maureen`s choice in the end of the novel as a step of becoming a ‘political subjectivation’ which the new political order demands South African whites in the post-apartheid era. Maureen`s action can be interpreted as a kind of initiation in which she tries to throw herself into ‘July`s people’ in ‘the age of July.’

영국 헤리티지 산업에 대한 문화적 개입과 수정-V.S. 나이폴의 『당혹스러운 도착』

이혜란 ( Hye Ran Lee ) 한국현대영미소설학회 2015 현대영미소설 Vol.22 No.2

This paper explores the way Naipaul critically engages in the cultural politics of 1980s in England which is represented by the Heritage Industry through analysing how The Enigma of Arrival describes the English country house and the rural landscape. The Heritage Industry, supported strategically by Thatcher government, encouraged the English people to search “Englishness” through consuming cultural goods concerning “national heritages.” As a response to the post-imperial decline and the rush of immigrants from the former British colonies, the Heritage Industry reveals the conservative defensive psychology of the English society. The narrator of the novel, an Indian immigrant from the Caribbean, settles in the Edwardian manor, the ancient heart of England, and observes the English landlord to find out that he is still living in the imperial past. Naipaul``s narrator realizes the morbid aspects of his landlord who is hypnotized by the images of the past and lost the capacity for creative changes. Naipaul suggests the English society confront the post-imperial realities from the perspective of “change” and “flux” instead of being obsessed by the idealized past. Through The Enigma of Arrival, Naipaul criticizes the cultural stream of the Heritage Industry and claims his own territory as an immigrant in the post-imperial English society.

중년층 라인댄스 참여자의 동기가 정서와 심리적 안녕감에 미치는 영향

이혜란(Lee, Hye-Ran),윤인애(Yoon, In-Ae),윤용진(Yoon, Yong-Jin) 한국체육과학회 2013 한국체육과학회지 Vol.22 No.5

The purpose of this research is to know the relation of psychological well-being through participative motivation of line dance in the middle-aged, and also how to apply emotional experience psychological well-being. This research represents the dancers participating in line dance competition and uses judgment sampling method. 300 questionnaire was distributed, and got rid of four questionnaire which are unreliable response. Finally, 296 questionnaire was used in data collected. for analysis, frequency analysis, exploratory factor analysis, Cronbach’s a, reliability analysis, hierarchical regression and path analysis were used by computer using the statistical program SPPSS Version 15.0 and Amos. The result of research is as follows. First, participative motivation of line dance participants has an impact on emotional experience. Second, participative motivation of line dance participants has an impact on psychological well-being. Third, emotional experience of line dance participants has not an impact on psychological well-being Finally, getting technical development, a sense of achievement, health, strength, pleasure, external show off and sociability by participating line dance made the psychological well-being to the line dance participants Therefore, it is important to let the middle-aged enjoy participating line dance rather than controlling their emotional experience.

라인댄스 참여자의 참여동기가 몰입경험, 심리적 안녕감에 미치는 영향

이혜란(Lee, Hye-Ran),윤인애(Yoon, In-Ae),윤용진(Yoon, Yong-Jin) 한국체육과학회 2013 한국체육과학회지 Vol.22 No.4

The purpose of this study was to investigate how related participation motivation, flow experience and psychological well-being in participated Line-dance. The data collected from 254 people who participating on Line-dance in Seoul. For analysis, frequency analysis, exploratory factor analysis, Cronbach’s α, correlation and covariance structures analysis were used by the computer using the statistics program SPSS 15.0 and Amos 7.0. The results of this study can be acquired as follows; First, participation motivation had influence on the flow experience in participating Line-dance. Second, participation motivation had not influence on the psychological well-being in participating Line-dance. Third, the flow experience had influence on the psychological well-being in participating Line-dance.

골프퍼팅 학습에 적용된 결과지식과 맥락간섭 효과

이혜란(Lee, Hye-Ran),윤인애(Yoon, In-Ae),박금숙(Park, Keum-Sook),윤용진(Yoon, Yong-Jin) 한국체육과학회 2012 한국체육과학회지 Vol.21 No.6

The purpose of this study is to analyze the effects of contextual interference effect according to frequency of providing knowledge of results(KR) on golf putting. The subjects were 40 female students and have physical capacity for performing exercise tests, but have no experience in golf putting. Selected subject groups were divided into 4 groups; group1 (block practice group, 100% of KR, 10 people), group2 (block practice group, 50% of KR, 10 people), group3 (random practice group, 100% of KR, 10 people) and group4 (random practice group, 50% of KR, 10 people), total 40 people participated in this study. Based on collected data, average, standard deviation and two-way variable of each group in acquisition phase were analyzed, and average, standard deviation and one-way variable of each group in retention test and transfer test were calculated. The results of this study process are as follows: First, in acquisition phase, the group that were provided 100% of KR and performed block practice generally showed the best performing result compared with other groups. Second, in retention phase, the group that were provided 50% of KR and performed random practice showed better performing result compared with other groups. Third, in transfer phase, the group that were provided 50% of KR and performed random practice showed better performing result than groups that were provided 100% of KR.

실시간 시선 추적과 거리 측정 기법을 활용한 눈 보호 앱 개발

이혜란(Hye-Ran Lee),이준표(Jun Pyo Lee) 한국컴퓨터정보학회 2019 한국컴퓨터정보학회 학술발표논문집 Vol.27 No.2

한식상차림의 색채분석 연구

이혜란 ( Hye Ran Lee ),김혜원 ( Hye Won Kim ),조우균 ( Woo Kyoun Cho ) 한국식생활문화학회 2013 韓國食生活文化學會誌 Vol.28 No.1

교내 매점 유무에 따른 고등학생의 간식섭취행동

이혜란(Hye Ran Lee),김민지(Min Ji Kim),현태선(Taisun Hyun) 충북대학교 생활과학연구소 2013 생활과학연구논총 Vol.17 No.2

This study was carried out to investigate snacking behaviors among high school students according to the presence of a school snack shop and gender. Questionnaires were distributed to 280 students in two schools with snack shop and two schools without snack shop. The data of 257 students were analyzed using SPSS program (version 17.0). Students in schools with snack shop had meals significantly less frequently as well as breakfast, and snack more frequently than those in schools without snack shop. While 47.4% of the students in schools with snack shop had snack in the morning, 58.4% of the students in schools without snack shop had snack after 6 in the evening. When snack intake behavior outside the school was compared according to the presence of snack shop, frequency of snack purchase outside the school was significantly higher in schools without snack shop. When frequency and kind of snack intake in schools with or without snack shop were compared, frozen dessert showed the highest intake frequency inside and outside the schools in schools with snack shop, while milk and dairy products showed the highest frequency outside the schools in schools without snack shop. The results show that eating behavior including meals and snack were different between the students in schools with and without snack shop. Healthy eating habits should be guided through nutrition education about proper snack selection and moderate intake of snack.