중환자실의 입실과 퇴실 기준 개발

장연수 성인간호학회 2001 성인간호학회지 Vol.13 No.2

The purpose of this study was to develop Intensive Care Unit (ICU) admission and discharge criteria that would lead to the appropriate utilization of ICU resources and nursing services. For this study, a conceptual framework was developed through a review of the literature. Then in order to identify the overall health condition of patients in the ICU, and to draw up preliminary criteria, the medical records of 58 patients who were admitted to the ICU of Y Medical Center in Seoul between March, 1999 to February 2000 of were analyzed. Two expert validity tests were done for the preliminary criteria for admission and discharge with 21 patients over 18 years of age who were admitted patients and for 12 patients who were discharged between May 30, 2000 and June 5, 2000 a clinical validity test was also done. After criteria were developed. The results of this study are summarized as follows: 1.After a review of the literature, there were 9 categories for admission criteria cardiologic, gastrointestinal, neurologic, endocrine, post-op care of major surgery, vital signs, laboratory values, and a category of miscellaneous items. Discharge criteria had 3 categories which were vital signs, laboratory values, and a category of miscellaneous items. 2. From the medical records of the 58 patients who were admitted to the ICU, 45 items for preliminary criteria for admission and 17 for discharge were identified. 3.The two export validity tests showed that of over 75 percent agreement. The 16 admission items which received less than 75 percent agreement were revised or deleted from the admission criteria. Of the 17 discharge items, 11 had over 75 percent agreement and 6 less then 75 percent agreement. These were revised or deleted from the discharge criteria. 4.In the clinical validity test, 14 admission items showed more than 75 percent agreement and 11 discharge items more than 83 percent agreement. 5. The final criteria consisted of 29 items for admission and 11 items for discharge. Since patients being considered for admission to the ICU have complex problems, there is a need to make the decision based on more than a nursing care and treatment resources are appropriately used by allowing a multi-professional health team to make admission and discharge decisions.

수치해석프로그램을 이용한 연직배수재의 깊이에 따른 압밀효과 분석

장연수,김영우 동국대학교 산업기술연구원 1998 산업기술논문집 Vol.11 No.-

본 논문에서는 천연마섬유배수재와 PD재의 실내통수능시험과 원통형 압밀시험을 통하여 구한 결과값을 토대로 수치해석프로그램을 이용하여 실내시험을 모델링하였고 현장 타설시 길이 증가에 의한 웰 레지스턴스의 영향을 고려하여 배수재의 재료에 따른 압밀효과를 분석해 보았다. 금번 해석에는 수평토압에 의한 배수재의 통수능 감소에 대한 영향은 포함되지 않았으며 해석결과 판형마섬유배수재는 PD재에 비하여 웰 레지스턴스의 영향이 크게 나타났으나 원형마섬유배수재는 MD88과 같은 우수한 연약지반 개량효과를 나타내었다. In this paper, the duration of consolidation of clay foundation improved by the plastic board drain and the natural jute drain is analyzed using the numerical flow program, MODFLOW. The numerical flow behavior in the clay foundation is first validated by the laboratory consolidation test and then the well resistance effects with respect to the increase of drain length is compared for both drain types. The results show that the natural jute drain of plate shape is more influenced by the well resistance than the plastic board drain, while the improvement effects of the natural jute drain of circular shape is similar to that of the MD88 in case that the lateral pressure on the discharge capacity of the drains is not included.

비균질성을 고려한 김포매립장의 수리전도도 추정

장연수,정상용 동국대학교 산업기술연구원 1995 산업기술논문집 Vol.6 No.-

본 논문에서는 지구통계학적 방법을 이용하여 오염물 이동에 큰 영향을 미치는 김포 쓰레기 매립지의 수리전도도의 비균질성에 대해서 분석하였다. 수리전도도는 가압 실내투수 실험 자료와 현장 투수실험 자료를 이용하였고 지구 통계학적 방법으로는 일반 크리깅과 조건부 시뮬레이션 방법을 이용하였다. 그 결과 실내수리전도도의 범위는 1.2×10 exp (-7) - 9.6×10 exp (-7)cm/sec, 1.1×10 exp (-8) - 7.17×10 exp (-6)cm/sec, 그리고 현장 수리전도도는 4.27×10 exp (-9) - 2.02×10 exp (-6)cm/sec, 3.34×10 exp (-9) - 1.43×10 exp (-5)cm/sec가 일반 크리깅과 조건부 시뮬레이션 방법에서 각각 구해졌다. 대체로 현장 수리전도도는 실내 수리전도도 자료에 비하여 10에서 100배 정도 컸으며 일반 크리깅 해석보다 조건부 시뮬레이션에 의한 수리전도도의 비균질성이 크게 나타났다. In this paper, the heterogeneity of hydraulic conductivity of Kimpo Waste Landfill which has large influence on the migration of contaminant transport is analized using Geostatistical methods. The hydraulic conductivity data are obtained from laboratory pressurized permeability test and in-situ slug test. The Geostatistical methods used in this analysis are Ordinary Kriging and Conditional simulation. The results show that the range of laboratory hydraulic conductivity data was 1.2×10 exp (-7) - 9.6×10 exp (-7)cm/sec obtained from Kriging analysis and 1.1×10 exp (-8) - 7.17×10 exp (-6)cm/sec from Conditional simulation. The in-situ hydraulic conductivity data have the range of 4.27×10 exp (-9) - 2.02×10 exp (-6)cm/sec from Kriging analysis and 3.34×10 exp (-9) - 1.43×10 exp (-5)cm/sec from Conditional simulation. It can be recognized that in-situ hydraulic conductivity data have magnitude 10 to 100 times higher than the laboratory hydraulic conductivity data and the heterogeneities of hydraulic conductivity obtained from Conditional simulation are greater than those obtained from Ordinary Kriging analysis.

서울시민의 수돗물 불소화에 대한 인식

장재연,조수남,윤제용 대한상하수도학회 2003 상하수도학회지 Vol.17 No.2

Public perception concerning water fluoridation and influencing factors were assessed. A mailing survey was conducted in 1999 with a representative sample of the general Seoul citizen (response rate=40.1%), who consisted of 1108 adults aged between 20 and 78. The data were analyzed using the chi-square test and structural equation modeling. 48.3% favored and 11.4% opposed water fluoridation while 40.5% were not certain. The contact on information about water fluoridation was the most significantly influencing factor on the perception concerning water fluoridation while experience of marriage, income and the perception of tap water were also significant. 52.8% expect governmental health authorities to take the decisions about water fluoridation.

2003년 국내 중증급성호흡기증후군 진료 현황 및 문제점 분석

이진수,김은실,정문현,백제중,정선화,안주희,최영화,이선희,고철우,김성범,김민자,박승철,기현균,송재훈,최상호,김양수,이상오,조용균,박영훈,정숙인,김연숙,이흥범,손창희,장성희,정희진,김우주 대한감염학회 2004 감염과 화학요법 Vol.36 No.3

목적 : 2002년 말 중국에서 SARS가 발생한 이후 국내에서도 2003년 10월까지 총 3명의 추정환자, 17명의 의심환자가 보고되었다. 향후 추가적인 SARS의 유행이 우려되는 상황에서, 그간의 SARS 환자 진료에 있어서의 실질적인 준비사항, 진료 현황 등에 대한 조사를 통해 문제점을 파악하여, 향후 더 나은 대비가 될 수 있도록 개선점을 제시하고자 하였다. 재료 및 방법 : SARS로 의심되는 환자를 진료 경험이 있는 병원의료진을 대상으로 2003년 10월에 설문조사를 실시하였다. 설문에는 SARS 환자 진료 시의 실질적인 조치, 진료 현황, 병실, 응급실 및 외래에서의 격리 시설과 준비사항, 보건당국의 관리와 지원에 관한 사항을 포함하였다. 결과 : 대상이 되는 22개 병원 중 17개(17/22, 77.2%) 병원이 설문에 응하였다. SARS 환자를 위한 격리실은 응급실, 외래, 일반병실 및 중환자실에서 각각 9개(9/17, 52.9%), 5개(5/17, 29.4%), 15개(15/16, 93.7%), 4개(4/16, 25%) 병원에서 음압처리가 되어있지 않은 일인실 혹은 다인실이 사용되었고, 1개(1/16, 6.3%) 병원에서만 일반병실에서 음압격리실이 운영되었다. 입원환자의 진찰 시 개인보호구의 착용은 거의 모든 의료기관에서 이루어졌다. 보건당국에서 SARS지정병원의 시설 등을 사전에 확인한 곳은 1곳(1/12, 8.3%)이였고, 14개 병원(14/15, 93.3%)에서는 보건당국에 의뢰한 검사결과를 통하 받지 못하였다. 결론 : 의료기관에서 SARS 환자용 격리실뿐만 아니라 기존의 격리실 설비 등이 미흡하였으며, 특히 중환자실 및 외래의 준비가 더욱 부족하였다. 보건당국의 의료기관에 대한 종합적인 지원이 부족하였고, 병원과의 원활한 연계가 잘 이루어지지 않았다. SARS 만이 아닌 격리를 필요로 하는 질환의 적절한 진료를 위해 향후 병원 시설의 정비와 정부차원에서의 보다 구체적이고 실질적인 대책마련이 필요하다. Background : There was an worldwide outbreak of the Severe Acute Respiratory Syndrome (SARS) originated from China in late 2002. During that period three cases of suspected SARS and 17 cases of probable SARS were reported in Korea. With the concerns about the reemergence of SARS-coV transmission, it is important to be prepared for any possibility. So, this study is aimed to analysis the past measures in managing SARS and propose the amendatory plans to improve the preparedness. Materials & Methods : Questionnaires were collected among clinicians with any experience in managing the probable or suspected SARS cases in Oct. 2003. 17 out of 22 hospitals responded to the questionnaire. The contents in the questionnaire were practical activities, personal equipments, response plans, isolation facilities in emergency centers, outpatient clinics, general wards and intensive care units, and relationship with the public health department. Results : The dedicated isolation rooms in emergency centers, outpatient clinics, general wards, and intensive care units were prepared in 9 (9/17, 52.9%), 5 (5/17, 29.4%), 15 (15/16, 93.7%), and 4 (4/16, 25.0%) hospitals, respectively. Except for one hospital that newly made negative pressure room for SARS, single or multi-bed rooms without airborne infection control were used in all the other hospitals. The personal precaution principles were kept quite well in general wards. Before the designation of SARS hospital by the public health department prior evalution to see if the hospital was suitable for managing SARS was conducted in only 1 (1/12, 8.3%) hospital. The results of laboratory diagnosis were reported back in 1 (1/15, 6.6%) hospital. Conclusions : The isolation facilities which can control airborne infection were almost deficient not only for SARS but also for other respiratory transmissible diseases. For the infection control of transmissible diseases including SARS, more investment is needed on medical facilities and comprehensive support from the public health department required.

인체 자궁암 세포에서 천연 성분이 P-당단백질의 활성에 미치는 영향

정수연,고은정,김나형,성민경,장정옥,이화정 이화여자대학교 약학연구소 2005 藥學硏究論文集 Vol.- No.15

Multidrug resistance (MDR) of cancer cells is, at least in part, associated with the overexpression of P-gly-coprotein (P-gp). Many studies hve demonstrated that natural compounds obtained from fruits, vegetables, teas and medicinal plants may modulate P-gp activity. The objective of the present investigation was to examine the effect of seven natural compounds on the P-gp activity in human uterine sarcoma cell line, MES-SA/DX5. Daunomycin uptake was significantly increased by biochanin A and silymarin (p<0.0001) whereas it was reduced by morin (p<0.01). The efflux of daunomycin from the cells was significantly inhibited by biochanin A, morin, cephalotaxine, berberine (p<0.05) and silymarin (p<0.0001). Biochanin A, berberine and silymarin significantly decreased IC_(50) value of daunomycin (p<0.05) while morin increased it (p<0.05). These results suggest that some natural compounds such as biochanin A and silymarin may inhibit P-gp funciton and can by developed as MDR reversing agents to improve the efficacy of chemotherapeutic drugs when administered concomitantly.

용인 안성지구 산사태와 파괴 형상에 관한 연구

신승목,김상규,장연수 동국대학교 대학원 1993 大學院硏究論集-東國大學校 大學院 Vol.23 No.-

본 논문에는 1991년 7월의 집중호우로 인해 많은 산사태가 발생한 용인·안성지역의 산사태 현장을 방문 조사를 실시한 결과를 토대로 우리나라의 산사태 발생요인과 파괴형상을 규명하였다. 표본지구의 지질암은 풍화된 편마암 및 편암이 주종을 이루고 주요 사면파괴형태는 평행활동파괴 및 토석류이었다. 평행활동파괴는 표토층이 1m내로 얕고 경사가 30˚이상인 사면의 산복부에서 발생한 반면 토석류는 대체로 길이가 길고 경사가 40˚~50˚로 급경사를 이루는 계곡부에서 발생하였는데 토석류발생이 시작된 산정상부에서는 소규모의 평행 또는 회전활동의 흔적이 발견되었다. 본 지역 식생의 뿌리 깊이는 표토의 두께와 거의 일치하고 파괴면도 표토와 기반암의 경계에서 발생하여 집중호우시 나무하중도 국내 지형 지질에서는 무시못할 요소이며 또한 큰 균열도 유수의 침투로를 제공하여 산사태 발생을 촉진시킨 것으로 판단되었다. This paper investigates the causes of the generation of domestic landslides and their representative failure shapes, based on the results of the reconnaissance of Youngin-Ansung region where enormous number of landslides occurred due to downpour in July, 1991. The geology of the site is mainly weathered schist and gneiss, and the representative failure patterns of the landslides are translational sliding and debris flow. The translational sliding failure is generated at the abdominal region of the mountain, of which the thickness of cover soil is less than 1m and its slope is greater than 30 degrees. On the other hand debris flow is generated in the valleys where their slopes are steep in between 40˚ and 55˚ and the travel distance of debris is quite long. At the summit area where debris flows were initiated, small sized translation or rotational failures were found. The thickness of the vegetation roots in the landslide area consists almost with that of the soil covers, and most failure planes are located at the boundary of cover soil and base rock. Hence, it can be recognized that the surcharge load due to vegetation accompanied with severe downpour can be a significant cause of domestic landslides. The macropores formed at these boundaries can also accelerate the initiation of landslides by accumulating the pore pressure in the pores.

흉추의 병적골절을 보인 심한 신성 골이영양증 1례 : 증례 보고

이송주,이은미,임학,정연순,장재호 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.4

A 33-year-old woman presented with tingling sensation and weakness in the both hands and feet. She had a diagnosis of secondary hyperparathyroidism caused by renal failure. Her height was shortened due to severe kyphosis. On plain radiograph, there were fractures on both femoral necks and pathologic fracture on thoracic vertebra. An MRI scan of the spine demonstrated a expansile, heterogeneous hypointense lesion of the 2nd thoracic spine, which remained hypointense on T2 images. Following total parathyroidectomy the patient underwent a thoracic decompression and spinal stabilization from the back. Hyperparathyroidism may cause brown tumor and tumor associated pathologic fracture in the spine. Involvement of the spine with neural compression is extremely rare. An early spinal decompression with parathyroidectomy leads to remission of symptoms.

HBsAg양성 원발성간암에 있어서 HBV-DNA표지자의 PCR성적

이원길,김재식,김정철,서장수,강은자,이중원,김기연,송경은,양정선 慶北大學校 醫科大學 1997 慶北醫大誌 Vol.38 No.2

목적 : HBV-DNA를 정성적 그리고 정량적으로 검출함으로써 강한 전염성과 높은 유병율로 인해 사회적으로 문제가 되는 B형 간염과 원발성간암의 연관성을 알아보고자 하였다. 대상 및 방법 : B형 간염 표면항원(HBsAg)이 양성을 보이는 원발성간암 환자 38명을 대상으로 하였으며 HBV-DNA 중합효소연쇄반응법을 이용하여 정성적 검출 그리고 luminometry법을 이용하여 정량적 검출을 하였다. 결과 : HBV-DNA 중합효소연쇄반응법과 luminometry법의 양성율은 각각 57.9%, 39.5%를 보였다. 그리고 HBsAg과 HBeAg가 동시에 양성을 보인 11명에서는 HBV-DNA 양성율이 81.8%를 보였다. 결론: HBV-DNA 중합효소연쇄반응법의 양성율이 luminometry법에 의한 양성율보다 높은 결과를 보였고 HBV-DNA 검사는 B형 간염을 조기 발견하고 치료하여 만성간질환으로의 진행을 예방하고 특히 원발성간암의 병율을 낮추는데 많이 기여할 것으로 사료되었다. Background : Primary hepatocellular carcinoma(PHCC) is the most common malignant neoplasm in most countries of Asia and Africa. Hepatitis B virus is known to be strongly related to the pathogenesis of PHCC. HBV-DNA PCR and HBV-DNA quantitation assay were attempted to apply to 38 cases of HBsAg positive PHCC. Methods : The ordinary HBV markers(HBsAg, anti-HBs, anti-HBc(Ig-G and -M), HBeAg and anti-HBe) were examined with ELISA. Qualitative screening of HBV-DNA PCR and HBV-DNA quantitation-luminometric measurement were performed. Results : Among 38 cases of HBsAg positive PHCC, positive rates for HBV DNA-PCR and HBV DNA-quantitation were 57.9% and 39.5%, respectively. And 11 cases which were positive for both HBsAg and HBeAg showed 81.8% positive rate in HBV-DNA PCR. Conclusion : For 38 cases of HBsAg positive PHCC, the positive rate for HBV DNA-PCR was higher than HBV-DNA quantitation-luminometry. In HBV-DNA PCR, both HBsAg and HBeAg positive cases showed high positive rate.

정신보건법의 주요 쟁점 조항에 대한 선진국과의 사례 비교

홍진표,황순찬,박수빈,서동우,정은기,김진학,박종익,안주연,김수정,장홍석 大韓神經精神醫學會 2009 신경정신의학 Vol.48 No.2

Objectives The Mental Health Act is an initiative aimed at changing and shaping mental health services and protecting human rights of persons with mental disorders. Since the Mental Health Act was legislated in 1995, four amendments have been made according to the issues that arose from public concerns. However, there are still many debates about the human rights protection of the mentally iII. This study aimed to provide information regarding major aspects of the Mental Health Act by comparing them among several developed countries. Methods Current Mental Health Acts of the state of Michigan in the United States, Scotland in England, the state of Victoria in Australia, and Japan were reviewed. Issues regarding the Korean Mental Health Act were collected from seminar materials, news media contents, and mental health professionals Results The definition of subjects in Korean Mental Health Act was more inclusive than other countries and was derived from a medical classification of mental illness. Family members or guardians were granted important responsibilities for deciding the involuntary admission of mentally ill patients in Korea and Japan. In Western countries, Mental Health Review Tribunals or courts have the primary responsibility for important decisions about mentally ill patients. The regulation of immediate dis- charge after request by voluntarily admitted patients was not enacted in all countries except Korea. The mandatory procedure for involuntary admission in Western countries includes an individual case review with personal interview by a Mental Health Review Tribunal or court. Conclusion The Korean Mental Health Act appears to meet the basic standards of Guidelines from international organizations. Our traditional culture and inherent health systems seem to influence the legal regulation of mental health service and might be related to the problems of human rights protection of mentally ill patients in Korea.