국내 일개 2차 병원의 암환자 치료 실태

손명균,Son, Myoung Kyun 한국호스피스완화의료학회 2018 한국호스피스.완화의료학회지 Vol.21 No.3

목적: 본 연구는 국내 2차 병원의 암환자 치료 실태에 대해 알아보고자 하였다. 방법: 국내 한 2차종합병원에서 2009년 1월 1일부터 2017년 9월 31일까지 입원치료 받은 암환자를 대상으로 전자의무기록을 후향적으로 분석하였다. 결과: 연구 대상자는 총 223명이었다. 2차 병원 입원 이유로는 3차 병원에서의 수술, 항암화학요법, 방사선치료 후의 지지요법 위한 경우가 69명으로 가장 많았고, 다음으로 기타 지지치료 위한 입원(58명), 증상 조절 위한 입원(53명), 2차 병원 입원 중 암이 진단된 경우(27명), 적극적 항암치료를 하지 않기로 한 후 전원 된 경우(16명) 순이었다. 퇴원 시 타 기관으로 전원 된 환자 75명 중 3차 병원으로 전원 된 환자들이 50명으로 가장 많았고 다음으로 요양병원(10명), 호스피스병원(8명), 요양원(4명), 2차 병원(2명) 순이었다. 암 외 동반질환을 가진 환자가 120명(53.8%)이었다. 타 진료과로 협의진료 의뢰된 경우 암 관련 의뢰보다 암 외 다른 질환으로 의뢰된 경우가 더 많았다. 심폐소생술금지에 동의한 경우는 73명이었다. 결론: 암환자 치료를 위해 의료기관 간 협력체계 확립이 필요하며, 암 외 동반질환 치료 등 종합적인 관리가 필요하다. Purpose: This study aims to investigate treatment of cancer patients at a secondary hospital. Methods: A retrospective analysis was performed with electronic medical records of cancer patients admitted to a secondary hospital from January 1, 2009 through September 31, 2017. Results: A total of 223 patients were studied. Sixty-nine patients were hospitalized for supportive care after receiving a surgery, chemotherapy, and radiotherapy at a tertiary hospital, 58 patients for other supportive care, 53 patients for symptom control, 16 patients with a decision not to take active cancer treatment, and 27 patients for treatment of cancer that was diagnosed during their hospital stay. Among 75 patients who were discharged to other institutions, 50 were transferred to tertiary hospitals, 10 to long-term care hospitals, eight to hospice hospitals, four to nursing homes and two to secondary hospitals. Comorbidities were found in 120 patients (53.8%). For patients who consulted with more than one department, more consultations were for non-cancer diseases than cancer. Seventy-three patients had a do-not-resuscitate order. Conclusion: For treatment of cancer patients, it is needed to establish a cooperation system among medical institutions and provide comprehensive management including treatment of comorbidities.

Prognosis after Implantation of Cardioverter-Defibrillators in Korean Patients with Brugada Syndrome

손명균,온영근,변경민,박승정,김준수,남기병,최기준,김유호,박상원,김영훈,박형욱,조정관 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.1

Purpose: Our study aims to analyze prognosis after implantable cardioverter-defibrillator (ICD) implantation in Korean patients with Brugada syndrome (BrS). Materials and Methods: This was a retrospective study of BrS patients implanted with an ICD at one of four centers in Korea between January 1998 and April 2012. Sixty-nine patients (68 males, 1 female) were implanted with an ICD based on aborted cardiac arrest (n=38, 55%), history of syncope (n=17, 25%), or induced ventricular tachyarrhythmia on electrophysiologic study in asymptomatic patients (n=14, 20%). A family history of sudden cardiac death and a spontaneous type 1 electrocardiography (ECG) were noted in 13 patients (19%) and 44 patients (64%), respectively. Results: During a mean follow-up of 59±46 months, 4.6±5.5 appropriate shocks were delivered in 19 patients (28%). Fourteen patients (20%) experienced 5.2±8.0 inappropriate shocks caused by supraventricular arrhythmia, lead failure, or abnormal sensing. Six patients were admitted for cardiac causes during follow-up, but no cardiac deaths occurred. An episode of aborted cardiac arrest was a significant predictor of appropriate shock, and the composite of cardiac events in the Cox proportional hazard model [hazard ratio (95% confidence interval) was 11.34 (1.31-97.94) and 4.78 (1.41-16.22), respectively]. However, a spontaneous type 1 ECG was not a predictor of cardiac events. Conclusion: Appropriate shock (28%) and inappropriate shock (20%) were noted during a mean follow-up of 59±46 months in Korean BrS patients implanted with an ICD. An episode of aborted cardiac arrest was the most powerful predictor of cardiac events.

Efficacy and Safety of Regorafenib in Korean Patients with Advanced Gastrointestinal Stromal Tumor after Failure of Imatinib and Sunitinib: A Multicenter Study Based on the Management Access Program

손명균,류민희,박준오,임석아,김태용,이수진,류백렬,박숙련,강윤구 대한암학회 2017 Cancer Research and Treatment Vol.49 No.2

Purpose The aim of this study was to confirm the efficacy and safety of regorafenib for advanced gastrointestinal stromal tumors (GISTs) reported in the GRID phase III trial in Korean patients. Materials and Methods Fifty-seven Korean patients with advanced GIST who experienced both imatinib and sunitinib failure were enrolled in the management access program between December 2012 and November 2013 and treated with regorafenib (160 mg orally once daily in a 3 weeks on /1 week off). Results None of the patients achieved a complete or partial response while 25 patients (44%) showed stable disease for  12 weeks. With a median follow-up of 12.7 months (range, 0.2 to 27.6 months), the median progression-free survival and overall survival were 4.5 months (95% confidence interval [CI], 3.8 to 5.3) and 12.9 months (95% CI, 8.1 to 17.7), respectively. Interestingly, 15 patients (26%) experienced an exacerbation of their cancer-related symptoms (abdominal pain in eight and abdominal distension in five) during the rest period for regorafenib, but all were ameliorated upon the resumption of regorafenib. The most common grade 3 or 4 adverse event was a hand-foot skin reaction (25%). The regorafenib dose was reduced in 44 patients (77%) due to toxicity, which manifested mainly as a handfoot skin reaction (n=31). Conclusion This study confirmed the efficacy and safety of regorafenib for advanced GIST after imatinib and sunitinib failure in Korean patients. Considering the exacerbation of the cancer-related symptoms observed during the rest periods, further exploration of the continuous dosing schedule of regorafenib is warranted in future clinical trials.

탈북 아동・청소년에 관한국내 미술, 음악치료 연구 분석

손명균,이드보라 동의대학교 지방자치연구소 2019 공공정책연구 Vol.35 No.2

이 연구는 탈북 아동 청소년들에게 지원되고 있는 미술․음악치료 연구들을 살펴보고 향후의 연구들에 관한 방향을 제언한다. 이를 위해 2003년도부터 2017년도까지 국내의 학위논문과 학회지에 게재된 탈북 아동・청소년들을 대상으로 미술, 음악치료 프로그램의 효과를 살펴본 연구논문들중 16편(미술치료 11편, 음악치료 5편)을 선정하였다. 이 연구들을 대상으로 연구대상자, 연구방법, 평가도구와 사정, 치료 프로그램, 측정 및 결과를 비교 분석한다. 탈북아동․청소년 대상의 연구와 선행연구들의 수가 제한적인 것으로 나타났는데 이는 대상의 거주 지역 및 기관이 많지 않고 연구대상의 모집이쉽지 않기 때문이다. 선정된 연구들은 1편을 제외한 모든 연구에서 사전사후평가를 이용하였다. 평가도구는 16편의 연구에서 29개의 척도가 사용되었으며, 집나무사람검사(HTP)가 4개의 연구에서 측정된 것으로 나타났다. 프로그램의 변인영역은 크게 자아(37%), 스트레스(3%), 사회성(13%),학교적응문제(10%), 정서(6%), 우울과 불안(13%), 국가정체성(3%), 문화적응(10%), 공격성(6%)으로 나타났다. 그리고 16편의 연구논문에서 치료프로그램의 사전사후 검사의 결과에서 유의미한 향상이 나타났다.

Genetic Mutation in Korean Patients of Sudden Cardiac Arrest as a Surrogating Marker of Idiopathic Ventricular Arrhythmia

손명균,기창석,박승정,허준,김준수,온영근 대한의학회 2013 Journal of Korean medical science Vol.28 No.7

Mutation or common intronic variants in cardiac ion channel genes have been suggested to be associated with sudden cardiac death caused by idiopathic ventricular tachyarrhythmia. This study aimed to find mutations in cardiac ion channel genes of Korean sudden cardiac arrest patients with structurally normal heart and to verify association between common genetic variation in cardiac ion channel and sudden cardiac arrest by idiopathic ventricular tachyarrhythmia in Koreans. Study participants were Korean survivors of sudden cardiac arrest caused by idiopathic ventricular tachycardia or fibrillation. All coding exons of the SCN5A, KCNQ1, and KCNH2 genes were analyzed by Sanger sequencing. Fifteen survivors of sudden cardiac arrest were included. Three male patients had mutations in SCN5A gene and none in KCNQ1 and KCNH2 genes. Intronic variant (rs2283222) in KCNQ1 gene showed significant association with sudden cardiac arrest (OR 4.05). Four male sudden cardiac arrest survivors had intronic variant (rs11720524) in SCN5A gene. None of female survivors of sudden cardiac arrest had SCN5A gene mutations despite similar frequencies of intronic variants between males and females in 55 normal controls. Common intronic variant in KCNQ1 gene is associated with sudden cardiac arrest caused by idiopathic ventricular tachyarrhythmia in Koreans.

북한이탈 청소년의 문화적응에 따른 자아탄력성 향상 프로그램 개발

손명균(Son, Myung-Kyun) 세계태권도문화학회 2021 세계태권도문화학회지 Vol.12 No.3

The purpose of this study is to develop programs to improve self-elasticity of North Korean defectors who require cultural adaptation, and is based on music therapy techniques used in music therapy such as listening to music, songwriting, song discusstion, and improvisation. Programs in accordance with the four bottom of the ego resilience to constitute factors of classical music all time. The selected classical music was analyzed by three music professors, and five music therapist were also verified for the validity of the self-elastic music therapy program. The self-elasticity program consists of a total of 12 sessions, with goals and classical music presented according to four sub-factors. Music therapy techniques include listening to music, making lyrics, discussing lyrics, and improvising. Therefore, this study aims to provide support for self-identity, inner resilience, peer relations, social adaptation, emotional, optimistic, and psychological support through the development of music therapy programs that can improve self-elasticity for North Korean defectors.

약물유해반응의 인과관계 판정을 위한 Naranjo와 WHO-UMC 지표의 비교

손명균 ( Myoung Kyun Son ),이용원 ( Yong Won Lee ),정한영 ( Han Young Jung ),이승우 ( Seung Woo Yi ),이광훈 ( Kwang Hoon Lee ),김승업 ( Seung Up Kim ),정재헌 ( Jae Heon Jeong ),박재준 ( Jae Jun Park ),박중원 ( Jung Won Park ),홍 대한내과학회 2008 대한내과학회지 Vol.74 No.2

목적: 약물유해반응의 인과관계를 분석함에 있어 그 객관성, 신뢰성 및 타당성을 증대시키기 위해 평가의 기준이 되는 지표들이 개발되어 왔다. 가장 널리 사용되는 평가지표인 Naranjo 지표와 WHO-UMC 지표를 비교 평가하였다. 방법: 세브란스 병원에 입원했던 환자 및 외래 추적관찰하는 환자들 중, 약물유해반응으로 보고된 환자들 100명을 후향적으로 분석하였다. 의무기록들을 검토하여 Naranjo와 WHO-UMC 지표를 적용, 평가하였다. 결과: Naranjo 지표와 WHO-UMC 지표의 평가를 비교 검토한 결과, 동일한 증례에 대해서 평가범주가 다르게 나타나는 경우가 많았다. WHO-UMC 지표와 비교할 때, Naranjo 지표로 평가한 결과는 상당히 관련이 있음(probable)으로 수렴되는 경향이 관찰되었다. Naranjo 지표는 위약투여에 대한 반응, 약물농도, 객관적인 검사, 이전 투약시의 반응, 약물용량조절에 대한 반응을 평가하는 항목들을 포함하고 있는데 실제로 임상에서 이런 검사 및 평가가 가능하거나 시행된 경우는 거의 없었다. 결론: Naranjo 지표는 어느 정도 타당성을 보여주고 있으나 한국의 임상 환경에서 WHO-UMC 지표에 비해 유용성이 제한적임을 알 수 있었다. Background/Aims: Several criteria have been proposed to increase the objectivity, reliability and validity of causality assessment of adverse drug reactions (ADR). We compared the Naranjo probability scale and the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) causality categories to evaluate the validity and clinical usefulness of these criteria. Methods: We evaluated 100 ADR cases with the Naranjo probability scale and the WHO-UMC causality categories. The Spearman rank coefficient was used to determine the correlation of these criteria. The evaluation of the ADR was categorized into four groups for the Naranjo system: definite, probable, possible, and doubtful, and six groups for the WHO-UMC: certain, probable, possible, unlikely, conditional/unclassified, and unassessable. Results: The criteria used form these two systems showed some differences when compared with the same ADR cases. The Spearman rank coefficient was 0.519 (p<0.001) and the agreement was 55% between the Naranjo probability scale and the WHO-UMC causality categories. The Naranjo probability scale includes measurements for drug concentration, objective evidence of ADR, ADR to previous exposures, responses to placebo, and the dose adjustment of drugs. However, few cases were evaluated for all of these measures. Conclusions: The Naranjo probability scale may be helpful for assessing unexpected ADRs and useful for evaluators with little experience. However, some of the items are not utilized and there are discrepancies when compared with the WHO-UMC causality criteria.

터널 주변 폭발로 인해 발생된 버력의 처리시간 예측

유광호,손명균,You, Kwang-Ho,Son, Myung-Kyun 한국터널지하공간학회 2013 한국터널지하공간학회논문집 Vol.15 No.1

터널과 매우 인접해 폭발이 일어날 경우 터널의 기능을 회복하기 위해서는 발생된 버력을 신속히 외부로 처리하여야 한다. 본 연구에서는 폭발에 의해 발생된 버력량을 파악하여, 터널 외부로 처리하는 데 걸리는 시간을 예측하는 방법론을 제시하고자 하였다. 이를 위해 SolidWorks를 이용하여 3차원 요소망을 작성하고, AUTODYN을 이용하여 폭발해석을 수행하였다. 터널과 해석결과로부터 얻어지는 파쇄영역과의 관계에 근거하여 유입되는 버력량을 이론적으로 산정하는 방법을 제시하였다. 또한 건설장비의 선정에 따라 버력을 처리하는 데 걸리는 시간을 예측하고 결과들을 비교 분석하였다. 연구 결과, 터널 내부로 유입되는 버력량은 터널과 파쇄영역의 관계를 4가지로 분류하고, 구분구적법을 이용하여 효과적으로 산정될 수 있음을 확인하였다. 또한 폭발위치가 터널 갱구와 굴착면에 가까울수록, 또한 중심선으로부터 벗어날수록 버력량이 감소해 처리시간이 줄어드는 것을 확인하였다. When a bomb explodes near a tunnel, generated muck should be quickly moved outside for rehabilitation of the tunnel. In this study, the amount of muck generated by an explosion was estimated and a methodology was presented for the prediction of the muck hauling time. To this end, 3D-meshes were made by using SoildWorks and blasting analyses were performed by using AUTODYN. A method was suggested to calculate theoretically the amount of muck which inflows into a tunnel based on the relationship between the tunnel and the fragmentation zone obtained from the analysis results. Also, muck hauling times were predicted based on the selection of construction equipment and the results were compared and analyzed. As a result, it was convinced that the amount of muck flowing into the tunnel could be effectively calculated by classifying the relationship between a tunnel and the fragmentation zone into 4 cases and using the mensuration by parts. Also it was confirmed that the closer blasting location is to the portal and the excavation surface of a tunnel, and the more blasting location deviates from the center line of the tunnel, the lesser amount of muck occurs and thus the muck hauling time decreases as well.

자폐스펙트럼장애(ASD) 아동의 언어재활을 위한 국내 음악치료 연구 분석

정수량,손명균 동의대학교 지방자치연구소 2020 공공정책연구 Vol.37 No.1

본 연구는 자폐스펙트럼장애 아동을 대상으로 언어재활을 위해음악의 다양한 요소들을 사용한 국내 연구동향을 분석하여 향후관련 분야의 연구방향을 제시하기 위한 것이다. 분석연구의 초점중 연구대상은 2000년부터 2019년까지 자폐스펙트럼장애 아동의언어능력향상에 관한 16편의 논문이다. 선행연구 분석은 연구대상, 음악치료회기, 연구방법, 연구도구, 음악활동, 종속변인으로 6가지영역으로 분석하고 결과를 제시하였다. 분석결과는 대상자의 연령은 6세가 가장 많았다. 프로그램은 22, 30,32회기가 가장 많았으며연구방법은 단일사례연구 12편, 단일대상연구와 실험연구 각 2편이다. 평가도구는 아동기 자폐증 평정척도, 취학 전 아동의 수용언어 및 표현언어 발달 척도를 많이 사용하였다. 언어능력 향상을위해 사용된 음악활동은 노래 부르기, 노래듣기, 악기연주 등의 순이었다. 음악활동은 자폐스펙트럼장애 아동의 수용언어(이해력)와표현언어(발화) 능력을 향상시킬 수 있는 도구가 될 수 있다는 것을 증명해주었으며 악기활동 등 역동적 경험은 사회성이 부족한자폐스펙트럼장애 아동들의 언어재활에 흥미를 불러일으킬 수 있다는 것을 시사한다.

인공신경망 기법을 이용한 터널 주변에서 폭발에 따른 파쇄부피 및 반지름 평가

유광호,손명균 한국암반공학회 2013 한국암반공학회 학술대회 및 세미나 자료집 Vol.2013 No.3