여호와의 증인 환자에서 산과적 출혈 후 무수혈 치료 2예

김재령,여소진,이해혁,김정식,김태희,남계현,이권해,이임순,박진화,황경호 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Jehovah's Witness comprise a unique obstetric population. Their refusal of blood stems from an interpretation of a literal translation of the Bible, and it is this belief that puts them at an increased risk of morbidity and mortality if hemorrhage occurs. We report two cases of a Jehovah's Witness who bled massively due to obstetric hemorrhage, refused blood transfusion and had profound anemia. The patients were treated with recombinant human erythropoietin, parenteral iron and oxygen. And they were treated on an intensive care unit with intermittent positive pressure ventilation. We reviewed with literature considering the therapy for acutely anemic patients who refuse transfusion to decrease the duration of the most severe anemia.

임신 종결 후 발생한 자궁 동정맥 누공에서 자궁동맥색전술로 치료한 1예

김종민,이해혁,김태희,남계현,심일구,이권해,김형문,이임순,장종호 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Arteriovenous fistula of uterus is rarely reported disease. This vascular malformation is very dangerous condition because Dilatation & curettage can cause massive uterine bleeding without accurate diagnosis. The diagnosis is made by angiography, gray scale ultrasonography, color and duplex doppler ultrasonography, computed tomography, and magnetic resonance imaging is helpful. Especially color and duplex doppler ultrasonography is allows convincing detection and diagnosis of arteriovenous fistula. Recently transcatheter uterine artery embolization is treatment of choice. We have experienced a case of arteriovenous fistula of uterus. Which is presented with a brief review of literature.

위절제술 환자의 표준진료지침 개발 및 적용 효과

김은희,김철규,이순교,김순덕,이혜옥,권정순,이경미,이민미,심순미,유용만,신종식,강은희,이상일,김병식,오성태,육정환,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.2

Background : Gastric cancer is the most common malignant tumor in Korea. surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for recucing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and unplanned readmission rate between the pre-pathway group(n=67) and the post-pathway group(n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days(p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was of satistically significant(p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korea hospital settings.

Assessment of In Vitro Assay System for Thyroid HormoneDisruptors Using Rat Pituitary GH3 Cells

Hee Jin Kim1,Hae Young Park1,Jeonga Kim1,Il Hyun Kang2,Tae Sung Kim2,Soon Young Han2,Tae Seok Kang2,Kui Lea Park2,Hyung Sik Kim1 한국독성학회 2006 Toxicological Research Vol.22 No.4

The development of in vitro assays has been recommended to screening and test-ing the potential endocrine disruptors (EDs). These assay systems focus only on identifying thethe thyroid hormone (TH) disruptors. The aim of this study was to evaluate a test system to detectTH disruptors using rat pituitary tumor GH3 cells. The test system is based on the TH-dependentincrease in growth rate. As expected, L-3,5,3-triiodothyronine (T3) markedly induced a morphologicalchange in GH 3 cells from flattened fibroblastic types to rounded or spindle-shaped types. T3 stimu-lated GH3 cell growth in a dose-dependent manner with the maximum growth-stimulating effect9 M. In addition, T3 increased the release of growth hor-mone and prolactin into the medium of the GH3 cells culture. Using this assay system, the TH-dis-rupting activities of bisphenol A (BPA) and its related compounds were examined. BPA,dimethylbisphenol A (DMBPA), and TCI-EP significantly enhanced the growth of GH3 cells in therange of 1 × 10-5M to 1 × 10-6M concentrations. In conclusion, this in vitro assay system might bestandardization before it can be used as a broad-based screening tool.

Wheelchair사용 지체장애아의 기능적인 의복 연구 : 뇌성마비아동을 중심으로

김혜경,김순자,최정희 연세대학교 대학원 1986 延世論叢 Vol.22 No.1

본 연구의 목적은 휠체어를 사용하는 지체장애아의 기능적인 의복 구성에 있으며 구체적으로 진술하면 다음과 같다. 첫째, 휠체어 이동 동작시에 필요한 상지 동작을 선정하여 이에 따른 상지 형태를 석고형으로 제작하고 평면전개도를 작성하여 상지의 전체적인 형태변화를 파악한다. 둘째, 상지의 형태 변화에 따라 각 동작시 소매에 필요한 소매산의 높이와 진동둘레 여유분 치수를 설정한다. 세째, 설정된 여유분 치수로 상의에 대한 착의실험을 실시하여 적절한 소매산 높이와 진동둘레 여유분 치수의 타당도를 검증한다. 네째, 바지에 대한 착의실험을 실시하여 휠체어에 앉은 자세에서 필요한 바지의 전후차 및 앞밑위 길이를 결정한다.

석고법을 이용한 상지 견갑골부위의 체표변화에 따른 여유량 설정에 관한 연구

김혜경,서추연,박순지 연세대학교 생활과학연구소 1999 生活科學論集 Vol.13 No.-

This study was performed to determine the ease amount of upper arm and scapula whose motion range and capacity were highest in the upper body. Subjects were 10 women aged 23 to 25 and suing gypsum method, the body surface change according to the motion of upper arm were obtained. The results obtained from this study were as follows ; 1. In the upper arm area, increasing the motion, sleeve width increased but height of sleeve cap and armhole girth dcreased. In the scapula area, shoulder length showed the highest contraction ratio of 36.2%. 2. It was the sleeve width area including anterior and posterior armpit points that indicated the highest change ratio, demanding ease amount. 3. Overapping of body suface draft and sleeve pattern, the appropriate height of sleeve cap were A.H./4+3∼3.5㎝ in M1∼M3 and A.H./5 in M4. 4. Analyzing the shape of scapula according to the motion of upper arm by means of Moire´ Photography increasing to the motion, moire´contour line moved to the shoulder point.

신규간호사 배치후 교육시 프리셉터쉽 적용 사례연구

김창희,김혜숙,조혜성,이순옥,함형미,박미미 성인간호학회 2000 성인간호학회지 Vol.12 No.4

The purpose of this study was to examine the effect of preceptorship on On the Job Training of new nurses. The research design was a retrospective survey and one group pre-rost test design. The subjects were 49 entry nurses and 49 preceptors The data were collected from Feburary 1, 1998 to December 1, 1998. One questionnair applied in this study consisted of general characteristics, the responses of new entry nurses and their preceptors and their qualities. The other questionnair consisted of job satisfaction of new entry nurses and Preceptors and their competencies. The data were analyzed for frequencies, mean score, standard deviation, t-test, and ANOVA. The results of the study were as follows : 1) Preceptees's responses were that the nurses' affiliation of unit. cooperation of other nurses, and competencies of nursing skills improved after OJT applied preceptorship. 2) Preceptors's answers were that preceptorship had a positive effect on their continuing education. 3) While preceptees's job satisfaction scores were high in interaction, administration, and organization, they were low in autonomy and pay. 4) Pre-competency scores were the same as post-competency scores. 5) After preceptorship, preceptors responded that their nursing skill & communication competency increased, but their nursing administration competency decreased. 6) Finally, preceptorship's other effects were as follows: ① Checklists for preceptee education at the nursing unit were developed separately. ② It was proved that 'preceptor interview note' was effective on manage preceptorship. ③ We obtained duty orierlap periods, medical-surgical units-1 month. 5 ICU-2 months. operaction room-3 months ④ We prepared a preceptor program based on the study results.

문제발견 및 가설설정 능력 신장 과학영재교육프로그램 개발 : 멘델의 과학적 사고과정 적용

김순옥,김봉선,서혜애,김영민,박종석 韓國英才學會 2011 영재교육연구 Vol.21 No.4

본 연구는 역사적 발견을 이루어낸 과학자 가운데 멘델(Mendel, Gregor Johann, 1822-1884)의 과학적 사고과정을 활용하여 과학영재교육프로그램을 개발하고, 이 프로그램을 학습한 학생들의 문제발견 및 가설설정 능력의 변화를 측정하여, 프로그램의 효과성을 검증하는데 목적을 두었다. 이를 위해 먼저, 멘델이 유전법칙을 확립하는 과정에서 나타낸 과학적 사고과정을 분석하여 특징적 탐구요소를 추출하였다. 추출된 탐구요소 가운데 문제발견과 가설설정을 적용한 프로그램으로서 완두를 활용한 모의실험탐구중심의 과학영재교육프로그램을 개발하였다. 개발한 과학영재교육프로그램은 대학교 부설 과학영재교육원 소속 중학교 1, 2학년 학생 19명(남학생 11명, 여학생 8명)을 대상으로 적용되었다. 적용한 결과, 학생들은 문제발견 능력의 하위요소 융통성, 정교성, 독창성이 신장되었고, 가설설정 능력의 논리성도 신장되었다. 이에 개발된 과학영재교육프로그램은 중학교 과학영재로 선발된 학생들의 문제발견 및 가설 설정 능력을 향상시키는데 효과가 있는 것으로 고찰되었다. In the process of establishing the principle of genetics, Mendel discovered problems based on various observations. Mendel’s scientific thinking ability can be effective if this ability is embedded in gifted science education programs. The study aims to develop a science gifted education program utilizing Mendel’s scientific thinking ability shown in the principles of genetics and examine students’ changes in scientific thinking ability before and after the program implementation. For the program development, first, the characteristics of Mendel’s scientific thinking ability in the process of establishing the principle of genetics were investigated and extracted the major elements of inquiry. Second, the science gifted education programs was developed by applying the inquiry elements from the Mendel's Law. The program was implemented with 19 students of 7th, 8th graders who attend the science gifted education center affiliated with university during July 2011. The Mendel's scientific thinking ability was classified into induction, deduction, and integration. The elements of inquiry extracted from the Mendel’s scientific thinking include making observation, puzzling observation, proposing causal questions, generating hypothesis, drawing inference, designing experiment, gathering and analyzing data, drawing conclusions, and making generalization. With applying these elements, the program was developed with four phases: 1st - problem finding; 2nd - hypothesis generating; 3rd - hypothesis testing and 4th - problem solving. After implementation, students’ changes in scientific thinking ability were measured. The findings from the study are as follows: First, students’ abilities of problem finding is significantly (p<.05) increased. Second, students’ abilities of hypothesis generating is significantly (p<.05) increased.

감귤하우스 토양과 노지토양의 화학적 성질과 미생물상

김찬식,강순선,오명협,현해남 濟州大學校亞熱帶農業硏究所 1996 亞熱帶農業硏究 Vol.13 No.-

SummaryDistributions of actinomycetes, bacteria, and fungi were examined in citrus house and field soils sampled from volcanic ash soil area. pH, electrical conductivity, and exchangeable K, Ca, and Mg content in citrus house soil were higher than them in citrus field soil, however, total nitrogen content in citrus house soil is lower than that in citrus field soil.Number of total microorganisms in citrus house soil was about 3.1×105, which was 10 times lower than that in citrus field soil, and also that was remarkably lower than similar group of volcanic ash soil in cultivating and upland soil. Number of actinomycetes and bacteria in citrus house soil were similar to citrus field soil, however, that of fungi in citrus house soil was lower than that in citrus field soil.Electical conductivity and Bray No. 1 P in citrus field soil and pH and exchangeable Mg content in citrus house soil were positively correlated with distribution of actinomycetes in soils and Bray No. 1 P in citrus field soil and exchangeable Mg content in citrus house soil were negatively correlated with distribution of fungi in soils Keywords : volcanic ash citrus orchard soil, soil chemical property, actinomycetes, bacteria, fungi in soils

아크릴아마이드에 의한 신경병증 조기발견을 위한 선별검사의 평가

김성순,정해관,권용욱 大韓産業醫學會 2000 대한직업환경의학회지 Vol.12 No.3

목 적 : 아크릴아마이드에 직업적으로 노출되는 근로자들의 신경병증을 조기에 발견하기 위하여 사용될 수 있는 선별검사를 평가하기 위하여 본 연구를 진행하였다. 방 법 : 울산지역에서 아크릴아마이드 단량체를 제조하거나 취급하는 전체 근로자 52 명 중 아크릴 아마이드에 의한 신경병증 사례가 발생하고 작업환경노출이 많은 것으로 평가된 근로자 10명(평균연령 30.4세)을 고노출군으로, 나머지 근로자 42명(평균 연령 28.9세)을 저노출군으로 하였고, 의사 및 의대생 23명(평균 29.4세)을 대조군으로 선정하였다. 이들에 대하여 말초신경 증상설문지와 신경학적 진찰, 전기진단학적 검사, 진동감각역치검사 및 색도분별 검사를 시행하였다. 결 과 : 증상 설문지에서 고노출군은 말초신경에 특이한 증상을 저노출군 및 대조군에 비하여 더 많이 호소하였으며 신경학적 진찰소견상 이점분별력이 다른 집단에 비하여 유의하게 떨어져 있었다. 전기 진단학적 검사에서는 운동신경의 경우 정중신경 전도속도와 비골신경 잠시가, 감각신경의 경우 정중신경 진폭과 비복신경 잠시가 유의한 차이를 보였다.고노출군은 상지 및 하지의 진동감각역치가 저노출군 및 대조군에 비하여 유의하게 증가하였다. 색혼동지수로 측정한 색도분별력은 고노출군에서 대조군에 비하여 유의하게 떨어져 있었다. 이들 검사의 양성소견은 다른 변수를 제어하였을 때 아크릴아마이드 노출과 유의한 연관관계를 보였으며 각 검사의 양성 소견은 상호 중복이 많지 않고 이들 검사를 동시에 적용하였을 때 가장 많은 양성 소견을 보였다. 결 론 : 말초신경증상설문지, 진동감각역치검사 및 색도분별검사는 말초신경장해를 조기에 발견하는데 민감하였으며 이들 검사를 동시에 사용할 경우 말초신경장해의 조기 발견을 가장 효과적으로 수행할 수 있었다. Objectives : Acrylamide is a neurotoxin inducing central-peripheral distal axonopathy. The authors evaluated several neurologic tests to screen the early effect of occupational acrylamide exposure. Methods : Fifty-two males working either in the production of acrylamide monomer or in the handling of acrylamide in Ulsan, Korea, were selected and subcategorized into the hlgh-exposure group (n=10, mean age of 30.4 years) and the low-exposure group (n=42, mean age of 28.9 years). Twenty-three males (mean age 29.4 years) from medical professionals and students were chosen as a non-exposed reference group. Symptom questionnaire, neurologic examination, electrodiagnostic test, vibrotactile threshold test, and Lanthony desaturated 15 panel test (LD-l5D) were done. Results : The high-exposure group shewed more number of specific symptoms on questionnaire and more abnormal two point discrimination test. High-exposure group showed a significant difference in the median motor conduction velocity, peroneal nerve motor laten cy, sensory amplitude of median nerve action potential, and sensory latency of aural nerve. The vibrotactile threshold of the high-exposure group was significantly higher in both hands and feet than that of the low-exposure group and the reference group. Average color confusion index on the LD-l5D was significantly higher In the high-exposure group (median 22.7, range 0-135.7) than in the reference group (median 2.4, range 0-33.2) . Conclusions : The symptom questionnaire, vibrotactile threshold test, and color dis crimination test are sensitive in detection of the early acrylamide-induced neuropathy, and the combination of these tests would further facilitate the effectiveness of the screening.