적혈구증다증 환자의 사혈술 효과 평가

공정희,공선영,이세나,엄현석,이혜원,한지연,유헌,심효은 대한수혈학회 2013 大韓輸血學會誌 Vol.24 No.3

Background:Polycythemia vera (PV) is a myeloproliferative neoplasm that can cause complications such as thrombosis and organ damage. To prevent complications of PV, therapy for maintenance of a hematocrit target of less than 45% has been recommended and phlebotomy is a simple therapy. However, the effects of phlebotomy have not been well evaluated in Korea. Therefore, we evaluated the effects of phlebotomy performed in patients with PV and secondary polycythemia. Methods:The clinical data and phlebotomy records of 15 patients diagnosed with PV and secondary polycythemia from May 2005 to March 2013 at the National Cancer Center were reviewed retrospectively. Results:Patients included 10 males and five females. The median age of patients was 63 years (range, 50∼72 years). There were six PV patients (40%) and nine secondary polycythemia patients (60%). The mean number of phlebotomy attempts per patient was 6 (range, 1∼22), with an interval between phlebotomy attempts of 16 weeks (range, 1∼96 weeks). The mean phlebotomy volume was 458 mL, which was 10.3% of the total blood volume. After phlebotomy, the mean hematocrit showed a decline, from 50.4 (±4.35)% to 46.5 (±4.85)%, and symptoms improved. After phlebotomies, 10 patients achieved a hematocrit of less than 45% and this hematocrit level was obtained after an average of six phlebotomies. Conclusion:Phlebotomy is an effective treatment modality for lowering the hematocrit value in patients with PV and secondary polycythemia. However, target hematocrit was not achieved after a single phlebotomy. Therefore, adjustment of visit intervals and changes in phlebotomy volume were needed. 배경: 진성 적혈구증다증은 골수증식성질환으로 혈전증과 이에 따른 경색, 장기 손상 등의 부작용이 발생할 수 있다. 이를 예방하기 위해 목표헤마토크릿 수치를 45% 미만으로 정하여 치료를시행하는 것이 권장되고 사혈술은 모든 진성 적혈구증다증 환자에게 권장되는 간단한 치료법이다. 하지만, 국내에서 사혈술의 효과에 대한 평가가 잘 이루어져 있지 않아 본 연구에서는 국립암센터에서 시행된 적혈구증다증 환자의 사혈술의효과를 평가해보고자 하였다. 방법: 2005년 5월부터 2013년 3월까지 국립암센터에서 진성과 이차성을 포함한 적혈구증다증으로 진단된 환자 15명에게 시행된 95건의 사혈술을 대상으로 환자의 임상기록 및 사혈술 기록지를 조사하여 후향적으로 분석하였다. 결과: 적혈구증다증 환자는 남자 10명, 여자 5 명으로 중앙 연령은 63세(50∼72)였다. 진성적혈구증다증 환자는 6명(40%), 이차성 적혈구증다증환자는 9명(60%)이었다. 평균 사혈 횟수는 6회(1 ∼22)이고 평균 사혈술 시행 간격은 16주(1∼96) 이었다. 평균 1회 제거 혈액량은 458 mL로 총 혈액량의 10.3%이었다. 시술 전, 후 헤마토크릿은50.4% (±4.35)에서 46.5% (±4.85)로 유의하게 감소하였으며 피로, 두통, 어지러움증, 가려움증 등의 증상이 개선되었다. 환자들의 치료 방법은 사혈술 단독치료 환자는 6명(40%), 아스피린과 사혈술 병행 치료환자는 4명(27%), 아스피린, 하이드록시유레아, 사혈술이 병행된 환자는 4명(27%), 인터페론알파, 사혈술이 병행된 환자는 1 명(6%)이었다. 10명에서 시술 후 헤마토크릿 목표치인 45%가 되었으며 목표치 헤마토크릿 45% 도달까지 평균 6회의 시술이 시행되었다. 결론: 사혈술은 적혈구증다증 환자에서 헤마토크릿을 낮추는 효과적인 치료 방법이었다. 하지만, 한 번의 시술로 45% 미만의 헤마토크릿 목표치에 도달하는 경우는 드물기 때문에 효과적인사혈술을 위한 방문 기간의 조정, 1회 사혈량의증가 등의 고려가 필요할 것으로 판단되었다.

행정기구변화에 따른 행정기능과 업무수행의 변화 연구

공정희(Kong Jung-hee),서재호(Seo Jae-ho) 서울행정학회 2010 한국사회와 행정연구 Vol.21 No.3

This study tried to find out three questions with the change between organizational units and its functions and tasks in the Busan Metropolitan City Office of Education: First, how does the organizational units' change affect the functional change? Second, if they have relations, how does the organizational units' change accompany the functional change? Third, how extend is the Kaufman's definition "the functions performed by the agencies were even more enduring than the organizations themselves," explained? Practical implication of this study is as fllows: First, the creation of organizational units strengthen the functions and the abolition of organizational units weaken the functions. Second, the functional changes on the organizational units' change appear on the change of workload, manpower, concern, and importance by the mediation of affair. Third, as to the Kaufman's definition that the functions performed by the agencies were even more enduring than the organizations themselves, the most of functions are maintained in spite of the organizational units' abolition.

농업교과 교수적 수정이 정신지체 학생의 수업참여도와 과제해결력에 미치는 영향

공정희 ( Jung Hee Kong ),강민채 ( Min Chae Kang ),곽승철 ( Seung Chul Kwak ) 한국특수교육문제연구소 2009 특수교육저널 : 이론과 실천 Vol.10 No.4

이 연구는 농업계 고등학교 ‘농업기초기술’과 ‘환경보전’교과목의 교수적 수정 적용을 통해 통합학급의 정신지체학생의 수업참여행동과 과제해결능력에 미치는 영향에 대해 알아보고자 단일대상연구의 반전설계 중 하나인 ABAB설계를 사용하였으며, 결과는 다음과 같다. 첫째, 교수적 수정이 특수학급 학생의 수업참여도에 미치는 영향은 대상 학생의 수업참여율을 측정한 결과 교과목의 교수적 수정 적용은 통합학급의 정신지체학생들의 수업참여행동 발생률의 증가를 가져왔다. 따라서 통합학급의 교수적 수정 적용이 정신지체학생의 수업참여율 향상에 효과적이라 할 수 있다. 둘째, 교수적 수정이 특수학급 학생의 과제해결능력에 미치는영향은 이루어진 교과목의 교수적 수정 적용은 통합학급의 정신지체학생들의 과제해결력 향상을 가져왔다. 따라서 통합학급의 교수적 수정 적용이 정신지체학생의 과제해결력 향상에 효과적이라 할 수 있다. This study set out to introduce instructional adaptation to the“Basic Agricultural Techniques”and “Conservation of the Environment”and investigateits effects on the class participating behavior and task solving abilities of students with mild mental retardation in an inclusive classroom. The effects of instructional adaptation were measured in the ABAB design form, which is one of the reversal designs for single subject research. Interventions were made during the theory, experiment and practice hours to examine the influences on their class participating behavior. Their class participating behavior that was operationally defined by the investigator was observed, recorded and quantified. As a result, the application of instructional adaptation had positive impacts on increasing the class participation rates of the students with mild mental retardation. As for task solving abilities, the level of performance assessment was revised according to the learning objectives that were altered after instructional adaptation. A series of performance assessment items were devised and provided. And the subjects’task solving abilities, which were operationally defined by the investigator, were measured. The results indicate that the application of instructional adaptation had positive effects on enhancing the task solving abilities of the students with mild mental retardation.

다발성골수종 환자의 임상적 특성과 국제간호실무분류체계(ICNP)를 이용한 전자간호기록의 분석: 말초혈액조혈모세포채집을 시행한 환자를 대상으로

공정희 ( Jung Hee Kong ),이광미 ( Kwang Mi Lee ),이세나 ( Se-na Lee ) 이화간호과학연구소 2018 Health & Nursing Vol.30 No.2

Purpose: This study was conducted to analyze the nursing records applied during the collection of peripheral blood stem cells collection (PBSCC) in multiple myeloma (MM) patients using International Classification for Nursing Practice (ICNP, version 1), and to utilize them as basic data for effective nursing process application and decision making. Methods: Forty - one patients with MM who underwent PBSCC from June 2010 to December 2013 were included. The ICNP was used to categorize electronic nursing records into 7 axes (FOCUS, JUDGMENT, TIME, LOCATION, MEANS, ACTION, CLIENT) according to the mobilization type of PBSCC. Results: The duration of hospitalization (p<.001) and the number of nursing diagnosis (p=.023) showed significant differences between the two groups according to the type of mobilization. As a result of cross analysis of the nursing statement, ‘secretory substance’ of FOCUS and ‘none’ of JUDGMENT were most commonly used terms for nursing assessment and statement for outcome, whereas ‘education’ of ACTION was most frequently used for the statement of nursing intervention. Conclusion: In the axis of ACTION for nursing intervention, ‘education’, ‘observing’, and ‘prevention’ were independent activities.

일개 종합병원 보건의료인의 헌혈경험 관련 요인

공정희(Kong, Jung-Hee),김미영(Kim, Mi-Young) 한국산학기술학회 2015 한국산학기술학회논문지 Vol.16 No.4

본 연구의 목적은 헌혈에 대한 지식과 태도, 이타성을 조사하고 헌혈경험과 관련한 요인을 조사하기 위함이다. 자료 는 311명의 보건의료인을 편의추출하여 설문지를 통해 조사하였다. 헌혈경험이 있는 대상자는 63.3%를 나타냈다. 간호사와 임상병리사 중 남자들의 헌혈 참여 비율이 여자보다 더 높게 나타났다. 보건의료인의 직업 유형에 따라 헌혈 지식에 차이가 있었고, 연령과 경력이 더 높은 군이 이타성 수준에 유의한 차이가 있는 것으로 나타났다. 본 연구의 결과는 헌혈에 참여하기 위해 더 실제적이고 구체적인 전략이 확인되어야 함을 시사한다. 추후에는 보건의료인들이 헌혈에 참여하는 가장 중요한 동기요인이 다른 사람을 돕기 위한 책임감이었으므로 책임감과 관련한 변인을 조사할 필요가 있다. The purpose of this study was to examine knowledge, attitude, and altruism on blood donation and influential factors in regard to its experience. Data were collected through questionnaires with a convenience sample of 311 healthcare providers. Subjects with blood donation experience accounted for 63.3%. In both nurses and laboratory technologist, the rate of blood donation in male group has higher than that of female group. There were differences in the knowledge of blood donation dependent upon the type of occupation of healthcare providers and the higher age and the longer period of career experience proved to be the significant factor for the level of altruism. The study suggests that more practical, concrete strategies should be identified to participate in blood donation. The further relevant variables need to be investigated since the most determinant motivator for blood donation among healthcare providers was the responsibility to help others.

백혈구증다증 환자에서 치료적 백혈구성분채집술의 임상적 효과 및 안전성

이세나,공선영,공정희,엄현석,이혜원,박현진,손지연 대한수혈학회 2014 大韓輸血學會誌 Vol.25 No.2

Background: Therapeutic leukapheresis is the cytoreduction procedure performed before chemotherapy in patientswith hyperleukocytosis for prevention of complication. However, there have been clinical concerns about bleedingtendency due to anticoagulant used during the procedure. The aim of our study was to compare the clinicalcharacteristics and hematological parameters before and after therapeutic leukapheresis in order to evaluate its effecton bleeding tendency and to provide a guideline for treatment strategy. Methods: The clinical data for 39 procedures of therapeutic leukapheresis performed on 17 patients withhyperleukocytosis from May 2005 to October 2013 at the National Cancer Center were reviewed retrospectively. Results: The patients consisted of 11 males and six females. The mean age was 41 years old (range, 8∼74). The mean number of therapeutic leukapheresis per patient was two (range, 1∼4). Clinical symptoms improvedin 14 patients (82%) after therapeutic leukapheresis and three patients (18%) were not yet to improve. The meanWBC count was significantly reduced by 32.6% (±17.4) after therapeutic leukapheresis, from 250,146/μL(±117,000) to 174,702/μL (±104,700) (P<0.001). The mean volume of single removal was 298 ml with4.25×1011/L (±1.54) WBCs. After therapeutic leukapheresis, the mean platelet count showed a decline from85×109/L (±43) to 71×109/L (±26). However, the prothrombin time (PT) and activated partial thromboplastin time(aPTT) did not show a significant increase (PT, P=0.637; aPTT, P=0.054). Conclusion: Therapeutic leukapheresis is demonstrated as an effective and safe treatment that can improvesymptoms and reduce leukocytes in hyperleukocytosis.

과립구 채집과 관련된 헌혈자 임상 지표 및 증상 평가

이세나,이혜원,엄현석,손지연,공정희,공선영 대한수혈학회 2015 大韓輸血學會誌 Vol.26 No.2

Background: Donor granulocyte transfusion has been used as a salvage treatment for neutropenic patients with severe infection who did not respond to antibiotics. Here we investigated hematological parameters of granulocyte collection to evaluate its efficacy and safety. Methods: The clinical data for 92 procedures of granulocyte collection performed on 82 healthy donors from April 2007 to July 2014 at National Cancer Center were reviewed retrospectively. Healthy donors were pre-medicated 12 hours before apheresis with subcutaneous injection of 600 mg of granulocyte-colony stimulating factor (G-CSF) with or without 8 mg of oral dexamethasone. Blood cell counts of donors at the time of pre- and post- granulocyte collection state of donors were investigated and any clinical symptoms and signs were monitored during the procedure. Results: he median age was 29 years old (range, 18∼52). The mean of collected granulocyte volume was 230 mL, and the granulocyte yield in apheresis products was 4.90×1010 (1.46∼7.86). Granulocyte yields showed significant correlation with volume of granulocyte collection, total processing volume, pre-WBC count, and pre-ANC. Granulocyte yields of dexamethasone and G-CSF administration were greater than with G-CSF administration alone. Pain (low back, hip, knee, and whole body), insomnia, fatigue, abdominal discomfort, and/or headache occurred in 21% of donors during mobilization. Conclusion: Granulocyte mobilization was safe and effective, and is well-tolerable in healthy donors because collection was possible in all donors without complications of G-CSF and dexamethasone administration and apheresis. 배경: 정상 헌혈자를 대상으로 한 과립구 채집은 항생제 치료에도 반응을 보이지 않는 호중구감소증과 연관된 중증 감염 환자의 수혈 치료이다. 본 연구는 헌혈자의 임상적 특성과 백혈구 채집술 전후의 혈액학적 지표들을 비교하여 과립구채집술의 효과와 시술 안전성을 평가하였다. 방법: 2007년 4월부터 2014년 7월까지 국립암센터에서 과립구 채집을 시행한 정상 헌혈자 82 명의 임상적 특성과 92건의 과립구 채집술의 시술기록을 조사하여, 시술 전후의 혈액학적 지표와 임상적 증상을 후향적으로 분석하였다. 과립구 가동화를 위하여 정상인 헌혈자는 시술 12시간 전에 과립구 집락촉진인자 600 g을 투여하였고 일부를 제외하고 경구 덱사메타손 8 mg을 추가로 투여하였다. 헌혈자에서 시술 직전, 시술 직후에 시행한 혈액검사 결과와 가동화와 시술과정중 발생한 임상증상 및 부작용을 조사하였다. 결과: 헌혈자 연령의 중앙값(범위)는 29세(18∼ 52세)이었고, 채집된 과립구 평균 용적은 230 mL, 채집된 평균 과립구수는 4.90×1010 (1.46∼7.86)이었다. 헌혈자의 채집된 과립구수와 과립구 채집용적, 총 순환혈액량, 시술 전 백혈구수, 절대호중구수치가 각각 유의한 상관관계가 있었으며, 과립구 집락촉진인자와 덱사메타손 병행 투여 헌혈자(72명, 88%)가 과립구 집락촉진인자만 투여한 헌혈자(10명, 12%)보다 채집 과립구수가 유의하게 높았으나(P=0.036), 병행 투여 헌혈자의 21%에서 통증(허리, 고관절, 전신), 수면장애, 피로, 복부 불편감, 또는 두통의 임상 증상을 보였다. 결론: 효율적인 백혈구 성분채집술을 위하여과립구 집락촉진인자 및 덱사메타손을 이용한 가동화 및 시술은 헌혈자의 경미한 임상 증상 외에치명적인 부작용 없이 안전한 시술임이 확인되었다.