항암화학요법 관련 오심과 구토 완화를 위한 비약물요법에 관한 연구동향

소향숙,최자윤,조인숙,김영재,김지영,김애숙,김옥미,김춘심,김현오,설영애,안정옥,이애리,이영자 성인간호학회 2003 성인간호학회지 Vol.15 No.3

Purpose: Purposes of this study were to understand the current trends on complementary therapy in relieving chemotherapy-induced nausea and vomiting and to suggest the future research direction. Method: Subjects were selected on CINAHL, MEDLINE, Korean Academy Data Base from 1980 to 2001 which used nausea, vomiting, chemotherapy and complementary therapy as key words in experimental studies. Eight korean articles and twenty-one international articles were analyzed in terms of general characteristics, research methods, and types of complementary therapy. Data were analyzed by using descriptive statistical methods. Result: Since 2000, researchers have more actively used complementary therapy. In subject characteristics, mean age was 35.5 years old, 45% of the researchers were performed with high level of incidence of chemotherapy induced vomiting, 14% of them set limit of consecutive cycle during research, and 65% of them did not comment the selecting criteria of sample. About 60% of them were designed post-test only control group: 35% used INV by Rhodes, 31% used Likert scale, and 24% used VAS for dependent variable. Muscle relaxation therapy was mostly applied for relief of nausea and vomiting. Conclusion: Further studies will be needed to control extrinsic variables affecting nausea and vomiting in research design and to accumulate evidence with studies applying various complementary therapies.

신규간호사와 프리셉터가 인지하는 프리셉터의 교수효율성 비교

김지양,김영선,김춘실,박현숙,신미영,윤연숙,조유숙,박미미,유문숙 한국간호과학회 간호행정학회 2009 간호행정학회지 Vol.15 No.2

Objective: The purpose of this study was to compare preceptors and new graduate nurses on their perception of preceptor teaching effectiveness. Methods: The participants were 90 new nurses and 90 preceptors who worked in A medical center. The data were collected from July 1 to September 30, 2008. A cross-sectional descriptive survey was done using a structured questionnaire. Results: New nurses' perception (4.07±.44) of the preceptor teaching effectiveness was significantly higher than perception of the preceptors (3.57±.37). Fifty five percent of new graduate nurses reported a lack of coherence in the preceptor's practice guidelines. For 5 causal factors classified on the teaching effectiveness, the factor of 'Professional knowledge and ability' showed the highest score, but 'Interpersonal and communication skill' got lowest score for both group. Preceptors responded that they did not have enough time to teach well because of their heavy workloads. Conclusions: These results suggest that the preceptors need appropriate compensation and education opportunities, and new graduate nurses need consistent education by the teaching professionals. Therefore, it is important to give preceptors full charge of the preceptorship. Also, it will be necessary to develop education programs to enhance interpersonal and communication skill for preceptors and new nurses.

제왕절개술 환자에서 수술전 투여한 ketamine의 혈청 interleukin-6 및 수술후 통증에 대한 효과

김진수,김유재,안기량,김천숙,김일호,한찬수 순천향의학연구소 1997 Journal of Soonchunhyang Medical Science Vol.3 No.2

The inflammatory reaction to tissue damage during surgery may induce central sensitization followed by hyperalgesia. Previous studies suggest that central sensitization is related to N-methyl-D-aspartate (NMDA) receptor activation, which can be blocked with NMDA antagonist, ketamine. Thus, we compared the effect of preoperative intravenous and epidural low doses of ketamine with placebo on serum interleukin-6 (IL-6) level and postoperative pain. ASA class I and II women scheduled for C-sections received intravenous ketamine 0.15mg/kg(group 2) or placebo(group 1), or epidural ketamine(0.15 mg/kg) before the operation. IL-6 levels were measured before and during the operation, and 8, 24, and 48 hrs after the operation. Visual Analogue Scales(VAS) and Verbal Ration Scales(VRS) were measured at 8, 24, and 48 hrs after the operation. Serum IL-6 levels at 8, 24, and 48 hrs after the operation were significantly lower in the intravenous ketamine and epidural ketamine groups than in the control group. VAS at 8 hrs and 48 hrs after the operation were significantly lower in the epidural ketamine group. VAS at 8 hrs and 48 hrs after the operation were significantly lower in the epidural ketamine group than in the control and intravenous ketamine groups. In conclusion, in the preoperative intravenous and epidural administration of low doses(0.15mg/kg) of ketamine, both are effective in reducing postoperative IL-6 levels. Epidural Ketamine is more effective than intravenous ketamine in postoperative pain control.

항암화학요법 중 호중구감소증이 발생한 저위험군 발열 환자들을 대상으로 한 경구 항균제 요법의 임상적 유용성 및 안정성에 대한 연구

김연숙,이혁,기현균,김춘관,김신우,김성민,백경란,김원석,윤성수,이홍기,강원기,박찬형,박근칠,송재훈 대한화학요법학회 2000 대한화학요법학회지 Vol.18 No.1

목적 : 항암화학요법 중 호중구감소증을 동반한 발열이 발생하는 암환자들을 치료하기 위한 다양한 항균제와 여러 가지 방법들이 시도되고 있는 가운데, 합병증과 사망률의 발생가능성이 적은 저위험군 환자들을 대상으로 초기 72시간동안 정주 항균제를 투여한 이후 경구 항균제로 전환하는 요법의 유용성과 안정성을 평가해보고자 본 연구를 시행하였다. 방법 : 1998년 2월부터 1999년 9월까지 본원에서 항암화학요법 중 호중구감소증과 발열이 발생한 환자들 가운데 기저 암질환이 고형암이거나 림프종이고, 입원당시 패혈증의 증후가 없으며 입원 72시간이내에 해열되고 백혈구수치가 증가 추세인 환자들을 대상으로 하여 72시간 동안 정주 항균제를 투여한 이후 경우 ciprofloxacin 750㎎을 하루 2회씩 투여하여 총 4일간 투여하였다. 모든 환자들은 열이 떨어지고 호중구감소증이 회복될 때까지 입원하도록 하였다. 결과 : 총 38명 환자의 40예가 등록이 되었고, 환자들의 기저암 질환은 고형함이 72.5%, 림프종이 27.5%였다. 입원당시 평균 호중구치수는 156/㎕였고, 호중구수치가 100/㎕미만인 경우는 65%였으며, 호중구감소증이 지속된 기간의 평균은 2.4일이었다. 40예 중 39예가 항균제의 변형이나 추가 없이 호중구감소증과 발열로부터 회복이 되어 97.5%의 성공율(95% 신뢰구간: 86.8-99.9%)을 보였다. 부작용으로 피부발진이 있었던 경우가 한 예 있었는데, 증상이 경하여 경구 항균제를 지속할 수 있었다. 심와부의 동통으로 복용을 지속할 수 없어서 대상에서 제외된 예가 또 한 예 있었다. 결론 : 항암요법 중 호중구감소증과 발열을 동반한 환자들 가운데 저위험군 환자들에서 항균제 72시간정주 이후 경구 항균제로의 전환요법은 효과적이고도 안전한 치료방법이라고 할 수 있다. Background : Oral antibiotic therapy following empirical intravenous antibiotics may be effective and safe for febrile neutropenic patients with lowrisk for complications. Methods : We conducted a prospective clinical trial of oral antibiotic therapy in the patients with neutropenia and fever during chemotherapy for cancer. Underlying malignancies were solid tumor or lymphoma with short duration of neurtropenia and the patients had no evidence of clinically or microbiologically documented infections. Oral ciprofloxacin was given to the patients who lacked signs of sepsis on admission, had a rising tendency of neutrophil count (ANC >100 /㎕ ) at 72 hours, and were afebrile at 72 hours. All patients were hospitalized until neutropenia and fever resolved. Results : A total of 40 episodes of 38 patients were enrolled from February 1998 to September 1999. The mean neutrophil counts on admission were 156/㎕ and the mean duration of neutropenia was 2.4 days. The episodes which had neutrophil count below 100 /㎕ were 26 (65%). Treatment was successful in 39 of 40 episodes (97.5% : 95 % confidence interval, 86.8% to 99.9%). Adverse reactions of oral ciprofloxacin were skin rash and epigastric soreness in two cases, respectively. There were no deaths during the study. Conclusions : For low-risk febrile patients with neutropenia during cancer chemotherapy, switch therapy to oral ciprofloxacin at 72 hours following intravenous broad-spectrum antibiotics is effective and safe,

기도이물에 관한 임상적 고찰

한찬수,김태정,김일호,김유재,김천숙,안기량 순천향의학연구소 1996 Journal of Soonchunhyang Medical Science Vol.2 No.2

Aspiration of a foreign body in the airway is common cause of sudden obstructive breathing, crouping cough, hoarseness, and wheezing. Especially that caused serious problem in case of the young children. A past history of foreign body aspiration is itself an indication for bronchoscopic examination of the airway, because some children with aspirated foreign bodies are without symptoms and chest X-ray films may not show abnormalities. So the anesthesiologist should take a notice of removing foreign body in the anesthetic procedure. The author have experienced 36 cases removal of foreign bodies in the airway under general anesthesia from July, 1982 to January, 1996 in Chunan Hospital, College of Medicine, Soonchunhyang University. The results were as follows 1) Among the 36 cases, 25 cases(69.7%) were under the age of 5. The ratio of male and female was 1.8 : 1. 2) In duration of lodgement, there was most frequent within one day in 15 cases(41.7%) and the longest duration was 20 days. 3) The most common symptom, sign and auscultation finding were cough 19 cases(52.8%). chest retractions 7 cases(19.4%) and decreased breathing sound 20 cases(55.6%) 4) Abnormalities in the chest X-ray were found in 15 cases(41.7%) among 36 cases. 5) Vegetable foreign bodies, expecially peanut were the most common airway foreign body(28.7%), followed by plastic foreign body(14.4%) and mucous plug(11.3%). 6) The foreign body involved the right bronchus 16 cases(45.7), left bronchus 10 cases(28.6%), trachea 5 cases(14.3%), and larynx 4 cases(11.4%). 7) Foreign body induced complications occurred in 9 cases(25.0%); pneumonia 8 cases and pneumomediastinum 1 case, and all of postoperative complication was pneumonia(25.0%). 8) 34 foreign objects(94.4%) were removed by endoscopy but tracheostomy was required in two patients.

Original Article : Geographic difference of epidemiological features of HCV infection in Korea

( Kyung Ah Kim ),( Sook Hyang Jeong ),( Eun Sun Jang ),( Young Seok Kim3 ),( Youn Jae Lee ),( Eun Uk Jung ),( In Hee Kim ),( Sung Bum Cho ),( Mee Kyung Kee ),( Chun Kang ) 대한간학회 2014 Clinical and Molecular Hepatology(대한간학회지) Vol.20 No.4

Background/Aims: The prevalence of hepatitis C virus (HCV) infection in Korea exhibits significant geographic variation, with it being higher in Busan and Jeonam than in other areas. The reason for this intranational geographic difference was investigated in this study by conducting a comparative analysis of the risk factors related to HCV infection among three geographic areas: the capital (Seoul), Busan, and the province of Jeolla. Methods: In total, 990 patients with chronic HCV infection were prospectively enrolled at 5 university hospitals located in Seoul (n=374), Busan (n=264), and Jeolla (n=352). A standardized questionnaire survey on the risk factors for HCV infection was administered to these three groups of patients, and a comparative analysis of the findings was performed. Results: The analysis revealed significant regional differences in exposure to the risk factors of HCV infection. By comparison with patients in Seoul as a control group in the multivariate analysis, patients in Busan had significantly more experience of invasive medical procedures, acupuncture, cosmetic procedures, and multiple sex partners. In contrast, patients in Jeolla were significantly older, and they had a higher prevalence of hepatocellular carcinoma, a lower prevalence of multiple sex partners, and had experienced fewer invasive procedures. Conclusions: There was a significant geographic difference in the exposure to potential risk factors of HCV infection between patients from the three studied regions. This may explain the regional variation of the prevalence of HCV infection in Korea, and should be taken into account when planning strategies for the prevention and management of HCV infection. (Clin Mol Hepatol 2014;20:361-367)

강원도 원주지역 초·중·고등학생의 식습관 및 섭식행동에 관한 단면연구

허혜경,박소미,김기연,김춘배,안정숙,송희영,김기경 韓國保健敎育.健康增進學會 2003 보건교육건강증진학회지 Vol.20 No.1

Purpose : The purpose of this study was to investigate the dietary habits of students in order to identify risk groups according to their Body Mass Index (BMI), and to compare the eating behavior of students in the normal range (19<I≤24) and those in risk groups (BMI≤19, 24<I≤27, BMI>). Method : 1176 elementary school students, 850 middle school students and 672 high school City, were the participants The instrument for this study was a structured questionnaire that included demographic data as well as dietary habits, and the eating behavior instrument developed by Stunkard &essick(1985) and revised by Kim &im (1997). Result : 1) As students moved up in grade level their dietary habits became more irregular and the degree that students chewed food was reduced 2) As students moved up in grade level, a greater number of the students did not eat breakfast. The reasons given were that there were not enough time before classes started(40.4%) and a lack of appetite in the morning(10.6%) in high school students. 3) As for supper, from 67.8 to 81.9% of subjects reported having regular supper. However the rest of the subjects did not eat supper because of anorexia and fear of weight gain. 4) The results identified risk groups according to their BMI showed that for elementary school students, 55.9% were in the low weight group, 5.5% in the overweight group, and 0.9% in the obese group. For middle and high school students, 40.6% and 35.5% respectively were in the low weight group, 7.4% and 6.3% in the overweight group, and 4.1% and 2.5% the obese group. 5) Comparisons of the eating behavior of students in the normal weight group with that of those in the three risk groups showed that there were significant differences in 'hunger' and 'cognitive restraint of eating' in elementary school students, and significant differences in 'cognitive restraint of eating' in middle and high school students. Conclusion : The results of this study show that management of diet in school health sholud be addressed from both the aspect of lack of nutrition and that of excess nutrition. In other words, good diet is as important for students in the low weight group as it is f3r those in the overweight and obese groups. The estatblishment of good dietary habits and eating behavior in students, by nurses and dieticians should be done by providing repeated diet education and involvement in diet counseling.

심한 척추후측만증 환자의 대퇴골절 복원술을 위한 부위마취 : 증례보고 A case report

김지은,박대용,유시현,강규식,권진형,김천숙,안기량 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Kyphoscoliosis is a disease manifested as lateral curvature of spine and accompanying rotation of the vertebrae, resulting in distortion of rib cage. Restrictive lung disease and pulmonary hypertension progressing to cor pulmonale are the major cause of mortality in patients with kyphoscoliosis. We had experienced a successful spinal and caudal epidural anesthesia for the open reduction and internal fixation with plate of fractured femur shaft in two patients with severe kyphosoliosis. We had chosen regional anesthesia as an anesthetic method because of there poor pulmonary function and severe deformities of thoracolumbar spine. We could achieve the adequate anesthetic sensory dermatome level, T_(5) and T_(8), for operation without any significant deterioration of blood pressure and respiration. We recommended that regional anesthesia is a useful anesthetic method for a patients with severe kyphoscoliosis when the operation on hip or lower extremity is required.

찬물섭취가 정상성인의 혈압및 심박동수에 미치는 영향

김종임,홍춘식,박인숙 충남대학교 의과대학 지역사회의학연구소 1989 충남의대잡지 Vol.16 No.2

This study was undertaken to elucidate effect of ingesting cold water on blood pressure and pulse rate of normal healthy men with the purpose of furnishing basic data for nursing intervention of heart disease patients. The subjects for this study were normal healthy men consisting of 15 women and 15 men in age from 21 to 33 years. The subjects consisting of 30 men drank 240cc cold water on the first day, ingested 720cc cold water on the second day. Blood pressure and pulse rate were taken in a sitting position through all trial. Changes of blood pressure and pulse rate after ingesting cold water were compaired with those of pre-ingestive period. The results of the study were as follows. 1. There were no significant changes in blood pressure and pulse rate after ingesting 240cc cold water comparing with those of pre-ingestive period. 2. Changes of blood pressure and pulse rate were significantly decreased after ingesting 720cc cold water comparing with those of pre-ingestive period. In conclusion, the researchers think it is necessary that a nurse must give her careful consideration to prevent the potential crisis of an ingestion of cold water in coronary care unit and field of critical care.

요하지통 환자에서 두 개의 캐눌라를 이용한 박동성 고주파 신경근 응고술의 임상 연구

김천숙,배재영,배덕구,강규식,안기량,권진형,김지은,유시현 순천향의학연구소 2003 Journal of Soonchunhyang Medical Science Vol.9 No.1

Dorsal root ganglion(DRG) block by the local anesthetics and steroids which has done classically in low back pain(LBP) patients with radiculopathy has high incidence of recurrence rate and side effects of steroids. Recently a new technique of pulsed radiofrequency thermocoagulation(P-RFTC) was introduced and substituted for it because of the benefits such as relatively low recurrence rate, low risk of nerve injury and comfort during the procedure. We experienced 15 patients who had LBP with radiculopathy and no or little response to epidural steroid injection. When we performed DR ganglionotomy by P- RFTC under the C-arm guide in these patients, we tried to approach the exact DR ganglion using tow cannulas - the one for obtaining patient's subjective symptoms and injection of contrast dye, the other for making a RF lesioning after identifying the impedance of sensory and motor stimulation. In conclusion, DR ganglionotomy by P- RFTC using two cannulas in LBP patients is an easy and safe procedure with satisfactory results.