보완대체의학에 대한 간호학과 학생의 주관성 연구

박은영 ( Eun Young Park ),이은남 ( Eun Nam Lee ),강지연 ( Ji Yeon Kang ),주현옥 ( Hyeon Ok Ju ),김삼숙 ( Sam Sook Kim ),최은정 ( Eun Jung Choi ),김학선 ( Hack Sun Kim ) 경희대학교 동서의학연구소 2011 동서간호학연구지 Vol.17 No.1

보완대체의학은 건강증진과 질병예방을 위한 총체적인 접근법의 하나로 환자뿐 아니라 일반인들 사이에서도 이용률이 증가하고 있고, 교육에 있어서도 보완대체요법 관련 교과목을 의학이나 간호학의 정규 교과과정 내에 포함시키는 대학이 늘어남에 따라 미래의 건강관리 제공자인 간호학생들의 보완대체의학에 대한 인식이나 태도를 파악하는 것은 중요하다. 이에 본 연구는 Q방법론을 이용하여 보완대체의학에 대한 간호학생의 반응을 유형화하고 구체적인 특성을 파악하고자 시도되었다. 보완대체의학에 대한 간호학생의 반응은 4개로 유형화되었으며, 각 유형은 실용적 확신형, 견제형, 가치 인정형, 제한적 수용형으로 명명하였다. 각 유형의 명명에서 볼 수 있듯이 간호학생들은 인식에서 약간씩은 차이가 있지만 보완대 체의학에 대해 비교적 긍정적인 태도를 갖고 있는 것으로 나타났다. 이러한 결과는 간호학생들이 보완대체요법에 대해 긍정적인 태도를 보였음을 보고한 Kim (2004), Kim, Erlen, Kim 과 Sok (2006), Uzun과 Tan (2004)의 연구결과와 일치한다고 할 수 있다. 제1유형은 ‘실용적 확신형’으로 보완대체요법의 효과를 단순히 인정하기보다는 실용성에 초점을 맞춘 유형이다. 보완대체요법의 문제점으로 많이 지적되는 것 중의 하나가 사람마다 효과가 다르기 때문에 일률적으로 적용하기 어렵다는 것인데, 제1유형의 대상자들은 이를 오히려 실용적인 측면으로 인식하여, 보완대체요법의 효과는 사람마다 결과가 다르게 나타날 수 있기 때문에 어떤 치료법을 일률적으로 적용하기보다는 자신한테 맞는 보완대체요법을 찾아야 한다고 인식하는 것이다. 또한 제1유형의 대상자들은 보완대체요법에 대해 효과가 없거나 의미 없는 행위이며 의학적 치료를 방해하거나 효과를 믿을 수 없다는 데는 강하게 반대를 했다. 간호학생의 보완요법에 대한 태도를 조사한 Kim (2004)의 연구에서도 보완대체요법이 엉터리 치료법이라는 데에 대해 가장 부정적인 태도를 보임으로써 본 연구결과와 일치한다. 간호학생의 주관성을 조사한 Hwang (2004)의 연구에서는 간호학생의 인식이 세 가지로 유형화되었는데 ‘긍정적 인정형’으로 명명된 사람들은 보완대체요법이 건강의 유지와 증진에 도움이 되며, 면역력을 향상시키고 심리적 지지를 제공하고 몸을 보호하며 안위를 증진시키는 것으로 인식하고, 엉터리 치료법이고 환자의 치유에 방해가 되므로 사용을 피해야 하고 과학적인 근거를 설명할 수 없으므로 신뢰할 수 없다는 데대해서는 강한 반대의 의사를 표함으로써 본 연구에서 ‘실용적 확신형’으로 명명된 대상자들과 유사한 인식양상을 보였다. 본 연구에서의 ‘실용적 확신형’의 사람은 보완대체요법에 대해 쉽게 접근할 수 있고 여러 가지 효과를 한꺼번에 기대할 수 있다는 점에서 좀 더실용적인 면을 강조한 점이 차이라고 할 수 있다. 제2유형은 ‘견제형’으로 보완대체의학의 부작용에 대한 염려와 효과에 대한 정확한 작용기전의 뒷받침을 요구하는 유형으로, Hwang (2004)의 연구에서 보완대체요법은 체계적인 검증 후에 정통적인 치료와 병행해서 사용해야 효과가 있다고 하여 ‘객관적 수용형’으로 명명한 것과 매우 유사하다. 또한 간호사를 대상으로 한Son (2002)의 연구에서 보완대체요법을 현대의학을 보완해주는 치료법으로 고려하면서 과학적인 근거를 확립하는 일이 필요하다고 제시한 것과 일치한다. Ernst (2000)도 보완대체요법을 이용하는 대상자들은 보완대체요법의 안전성과 효율성에 대해서 알고자 하며, 보완대체요법에 대해 건강관리자와 개방적으로 의사소통할 때 안정성이 확립된다고 하여 본 연구의 ‘견제형’ 유형과 유사한 것을 볼 수 있다. ‘견제형’의 사람들은 보완대체요법에 대한 효과가 사람마다 다르게 나타나므로 보완대체요법을 무조건적으로 받아들이기 이전에 임상적인 효율성에 대한 정확한 근거와 과학적인 검증에 관한 많은 연구들이 이루어져야 할 것을 강조한 유형이다. 이러한 견해는 최근 의학이나 간호학 교육에서 근거중심의 행위를 강조하고 있는 것을 반영하는 것이라 할 수 있다. 제3유형은 ‘가치 인정형’으로 보완대체의학에 대해 과학적 신뢰를 갖고 있지는 않지만 보완대체요법의 건강증진에 대한 가치를 인정하는 유형이다. 의사를 대상으로 보완대체요법의 치료 효과에 대한 태도를 분석한 Jang 과 Park (2003)의 연구에서 62.2%는 ‘설명하기는 어렵지만 보완대체요법은 효과가 있다’고 하여 작용기전에 대한 이론적 근거는 부족하지만 치료효과에 대해서는 비교적 긍정적으로 인식하고 있는 것으로 나타나 본 연구 대상자의 ‘가치 인정형’과유사한 태도를 보였다. 또한 초등학교 보건교사를 대상으로 보완대체요법의 문제점에 대한 인식을 조사한 Kim, Kim과 Cho (2007)의 연구에서 40.5%가 ‘과학적인 검증의 부족으로 치료효과가 의심된다’고 지적하였지만 학교보건실무에서 보완대체요법의 적용가능성에 대한 질문에는 72.1%가 ‘가능하다’고 하였으며, 78%가 보완대체요법의 적용이유로 ‘증상완화, 치료보조의 효과’ 때문이라고 답하여 본 연구결과와 유사한 인식을 보였다. 또한 보완대체요법 교과목을 수강한 간호학생들에게 보완대체요법의 치료적 효과에 대해조사한 Kim (2005)의 연구에서도 ‘건강유지증진을 위해 일반 대중들도 보완대체요법을 많이 적용하고 있다’에 대해 5점 만점에 3.7점으로 응답하여 비교적 긍정적 태도를 보였다. 위의 결과들을 종합해 볼 때 보완대체요법이 체계적인 지식체로 인정하기엔 과학적 근거가 부족하지만 신체의 자연 치유력과 면역력을 증가시켜 건강증진에 영향을 미친다는 본 연구의 ‘가치 인정형’과 유사하다고 할 수있다. 제4유형은 ‘제한적 수용형’으로 보완대체의학이 건강증진에 도움이 되고 심리적 안정감을 주는 여러 가지 효과가 있는 반면 부작용이 있을 수 있고 사람마다 효과가 다르게 나타날 수 있으므로 작용기전에 대한 연구도 더 필요하다고 생각하는 유형으로 무조건적으로 수용하기보다는 제한적으로 수용하는 유형이다. 대학생을 대상으로 보완대체요법의 문제점에 대한 인식을 조사한 Gwon 등(2008)의 연구에서 ‘부작용을 예측할 수 없다’가 37.7%로 가장 높았고, 23.2%가 ‘비과학적이다’라고 응답함으로써 자신에게 맞는 보완대체요법을 찾아 효과를 볼 수는 있지만 부작용에 대한 우려, 효과에 대한 객관성 부족 및 작용기전에 대한 체계적 검증의 필요성을 언급한 본 연구에서의 ‘제한적 수용형’ 대상자와 유사한 인식을 보였다. Purpose: The purpose of this study was to grasp the subjectivity of the nursing students toward CAM and put the outcomes into use as basic facts and figures in developing and applying a curriculum associated with CAM. Methods: Q methodology was employed to explore the nursing students` subjectivity from their rank-order statements. For the Q population, individual in-depth interviews and literature research were conducted. Finally, 30 participants completed 40 Q statements. The data were analyzed using the QUANL software package. Results: The current survey that probed into the subjectivity of the nursing students relative to CAM abstracted four categories, namely, practical and convinced type, keep-under-control/wait-and-see type, merit acknowledging type and limitedly accepting type. Conclusion: It is recommended that various educational programs should be developed to shift the awareness of CAM on the part of the nursing students, based on the findings set forth in the current study.

Surgical technique for single-port laparoscopy in huge ovarian tumors: SW Kim`s technique and comparison to laparotomy

( Jeong Sook Kim ),( In Ok Lee ),( Kyung Jin Eoh ),( Young Shin Chung ),( Inha Lee ),( Jung-yun Lee ),( Eun Ji Nam ),( Sunghoon Kim ),( Young Tae Kim ),( Sang Wun Kim ) 대한산부인과학회 2017 Obstetrics & Gynecology Science Vol.60 No.2

Objective This study aimed to introduce a method to remove huge ovarian tumors (≥15 cm) intact with single-port laparoscopic surgery (SPLS) using SW Kim`s technique and to compare the surgical outcomes with those of laparotomy. Methods Medical records were retrospectively reviewed for patients who underwent either SPLS (n=21) with SW Kim`s technique using a specially designed 30×30-cm2-sized 3XL LapBag or laparotomy (n=22) for a huge ovarian tumor from December 2008 to May 2016. Perioperative surgical outcomes were compared. Results In 19/21 (90.5%) patients, SPLS was successfully performed without any tumor spillage or conversion to multi-port laparoscopy or laparotomy. There was no significant difference in patient characteristics, including tumor diameter and total operation time, between both groups. The postoperative hospital stay was significantly shorter for the SPLS group than for the laparotomy group (median, 2 [1 to 5] vs. 4 [3 to 17] days; P<0.001). The number of postoperative general diet build-up days was also significantly shorter for the SPLS group (median, 1 [1 to 4] vs. 3 [2 to 16] days; P<0.001). Immediate post-operative pain score was lower in the SPLS group (median, 2.0 [0 to 8] vs. 4.0 [0 to 8]; P=0.045). Patient-controlled anesthesia was used less in the SPLS group (61.9% vs. 100%). Conclusion SPLS was successful in removing most large ovarian tumors without rupture and showed quicker recovery and less immediate post-operative pain in comparison to laparotomy. SPLS using SW Kim`s technique could be a feasible solution to removing huge ovarian tumors.

Rifampicin에 의한 것으로 추정되는 위막성 대장염1예

김수현,이은우,정종혁,문승현,김동한,양혁승,오영상,김호동,김도현,박혁,박정환,박경옥,이영직 朝鮮大學校 附設 醫學硏究所 2006 The Medical Journal of Chosun University Vol.31 No.2

Pseudomembranous colitis, caused by altering the normal colonic flora and allowing the multiplication of Clostridium difficile, is an deleterious adverse effect of antibiotics. But it is rarely reported by rifampicin. Rifampicin is one of the first line drug in the treatment of tuberculosis and many patients are exposed to its potential adverse effects. We experienced a patient that had abdominal discomfort and hematochezia due to pseudomembranous colitis after receiving antituberculous medication, and which was probably caused by rifampicin. A 82 years old man was admitted with abdominal discomfort and hematochezia for one week. On the past history he had been diagnosed as endobronchial tuberculosis about 4 months ago. Colonoscopy revealed multiple discrete whitish mucosal lesion on rectosigmoid colon, and histologic findings were consistent with pseudomembranous colitis. The antituberculous agents were discontinued and vancomycin was administered. The patient's symptoms were resolved within several days. There was no recurrence after reinstitution of the antituberculous agents excluding rifampicin. We report here on a case of pseudomembranous colitis probably due to rifampicin.

Caffeine이 지구성 운동 수행능력에 미치는 영향과 억제성 아미노산에 의하여 활성화되는 이온통로의 조절작용

김은경,김영표,천병옥,이계영,김연정,임백빈,조영욱,김창주,김성수 대한스포츠의학회 1999 대한스포츠의학회지 Vol.17 No.1

To investigate the effect and mechanism of caffeine on endurance exercise, two experiments were performed. First, to test caffeine effect on aerobic exercise, 200-300g Sprague-Dawley rats were used and three groups, control group, low caffeine injection group and high caffeine injection group, were divided. Blood smpling by heart puncture were done at rest, after 30 min treadmill exercise, and after maximal exercise. Blood glucose, free fatty acid concentration were detected and following results were obtained. Glucose concentration showed significant difference between groups(p=0.0305) and also significant changes were exhibited between time(p=0.0004). Free fatty acid concentration had no difference between groups. but had significance between times(p=0.00065). Exercise endurance performance time showed significant difference(p=0.02350 in high caffeine injection group compared to control group. In this experiments, endurance exercise capacity was increased by caffeine injection. Therefore, second experiment was performed to investigate the effect of caffeine on ion current induced inhibitory amino acid neurotransmitter. GABA and glycine. Single periaqueductal gray neuron was acutely dissociated and nystatin perforated patch clamp was performed under voltage clamping condition. Caffeine evoked outward current in PAG neuron dose dependent manner. 1mM of caffeine application had no response. but 3mM caffeine evoked about 32.5±8.539pA outward ion current and 10mM caffeine evoked about 215.46±19.4pA outward current. 10^-2mM GABA activated Cl￣current and recorded by inward current. Caffeine inhibited GABA activated Cl￣ current concentration dependent manner. 10^-2mM of caffeine had no effect on 1-^-2mM of GABA response. but 10^-1mM caffeine inhibited GABA activated Cl￣ current about 5.74±2.13%, 1mM caffeine inhibited about 17.25±2.70%, 10mM caffeine inhibited GABA response about 45.31±7.71%. 10^-1mM of glycine activated Cl￣ current and also recorded by inward current. Caffeine inhibited glycine activated Cl￣ current concentration dependent manner. 10^-2mM caffeine decreased glycine activated Cl￣ current about 4.61±1.650%, 10^-1mM caffeine decreased about 6.49±2.24%, 1mM caffeine decreased about 26.82±4.27%, and 10mM caffeine decreased glycine response about 94.47±1.39%. These results suggest that caffeine inhibite inhibitory amino acid, GABA and glycine, this response causes excitation of CNS and this seems to be the basic mechanism of increasing effect to aerobic exercise performance by caffeine.

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.

TV 요리프로그램 진행자의 전문성 여부에 따른 구성내용의 질에 대한 시청자의 평가

김운주,최은희,김기현,김정숙,송현숙,정은옥 충북대학교 교육 ·생활연구소 생활과학연구센터 2002 생활과학연구논총 Vol.6 No.1

The purpose of this study was to develop the instrument to assess the TV cooking program contents and to indentify the difference of cooking program contents according to professionalism of MC. The evaluation sheet was composed of 5 sectors(sanitary practices, cooking process, information & proceeding, table setting & tasting, applicability) with all 32 questions, 5-Likert scale was used. College students majoring in food & nutrition were very interested in cooking program and 72.4% of respondents knew the cable TV Food channel. The major source of cooking information was TV(51.5%). The comparison of four TV cooking programs with professional MC(2 program) and amateur MC(2 program) was performed. Except applicability sector, the mean evaluation scores of professional cooking program were higher than amateur cooking program. In the amateur MC program, 'hand washing', 'use of hair restraints', 'separate use of cutting board', 'dish towel cleanliness', 'separation of service table', 'taking a chair in tasting', 'use of individual dish' items rated low rating score(<2.00) so more control was needed. The findings of this research suggest that cooking professional should be participate in developing TV cooking program as MC or staff.

자기 효능의 개념 분석

서순림,이은남,박송자,양영희,이동숙,최은옥,구미옥,김인자,이인숙,김성재,박영임,이은옥 서울대학교 간호대학 간호과학연구소 1997 간호학 논문집 Vol.11 No.1

Today human needs for health promotion and maintenance are increasing. The nursing progression has a great responsibility for helping clients to practice good health behavior. self efficacy was found to be potent predictor in initiating and maintaining the health-related behavior. Therefore, the concept is important in nursig intervention for change of health behavior. The purpose of this paper was to analyze and clarify the meaning of the concept, self efficacy. This study used Walder & Avant's process of concept analysis. Critical attributes of self efficacy were : 1) positive perception of his won capability; 2) intrapersonal strength; 3) possibility of being learned; 4) individuality; 5) specificity; 6) generalizability. Antecedents of self efficacy consist of those facts that 1) new situation occurs; 2) individuals have needs to change the new situation; 3) there are some required actions in new situation. Consequences occurring as a result of self efficacy consist of those facts that 1) individual initiates the of failure; 5) cope with the situation; 6) controls the situation; 7) the level of self efficacy is enhanced; 8) the level of self-esteem is enhanced.

패류중 중금속함량에 관한 연구

신현수,허옥순,이진하,김세은,주인선,신동우,강석종,박만종,김지연,김근희,강숙경,정래석,허숙진,소유섭,최장덕,문병우,김진수 식품의약품안전청 2001 식품의약품안전청 연보 Vol.5 No.-

본 연구는 패류중 중금속함량 측정을 위한 분석효율이 높고 간편한 분해법을 찾아내어 그 방법에 의끓 유종중인 패류중 중금속함량을 파악하고자 수행하였다. 시료를 분해시키는 Microwave와 습식, 건식회법을 비교한 결과 변형습식회화르가 가장 적합하였다. 변형습식회차딘는 려린0,3+C104+H2SOf의 혼찰산을 쪼 · j 1 (v/v)의 비율로 혼합하여 사용하였 을 때 회수을 Pb린틴. Cd 97.8, Cu 94.2, Zn 92.8%를 나타내었근 분해시간은 2~2.5시간 소요되었다. 유통중인 패류중 중금속함량 」최소~최대(평균), mgAgl 은 Pb 0.028~o.528(0.153), Cd 0.OO7~1,832(0.587), Cu 0.360~37.375(4.6691, Zn 6.317~233.2iO(38.881), Hg 0.001 ~O.151(0.012)mg/ltg으로 나타났다. 또한 유통중인 5종의 패류중 중금속평균항량이 생산지 하재지역에서 구입한 패류에 비해 모든 중금속언써 약간 높은 함량을 보였으나 오염된 수준이 아닌 자연함유량수준이었다. This study was conducted to improve the digestion method for the determination of heavy metals in shellfishes and to estimate the contents of heavy metal in commercial shellfishes by their digestion method. This digestion method was compared microwave with wet and dry ash digestion for shellfish samples, obtained results showed that the modified wet ash Ⅱ digestion was convenient and easy to use. For the modified wet ash Ⅱ digestion, The mixed acid of HNO₃+HClO₄+H₂SO₄(25:5:1, v/v) was used. Under this condition, Recoveries were Pb 94.3, Cd 97.8, Cu 94.2 and Zn 92.8% and digestion time was ∼2.5 hours. The contents of heavy metal [minimum∼maximum (mean), mg/kg in commercial shellfishes were as follows ; Pb:0.028∼0.528(0.153), Cd:0.007∼1.832(0.587), Cu:0.360∼37.375(4.669), Zn:6.317∼233.250(38.881), Hg:0.001∼0.151(0.013). The contents of heavy metal in commercial shellfishes of five species were slightly greater than those of shellfishes purchased at Hajae. There was no great difference between the contents of heavy metal of Hajae and those of shellfishes purchased at Whole market.

성인이 지각한 운동 장애 요인에 대한 성별, 나이별, 지역별 비교

김인자,이은옥,최희정 성인간호학회 2003 성인간호학회지 Vol.15 No.2

Perceive barriers to exercise were investigated for adults. Method: A total 1266 subjects were selected by a quota sampling method with age, gender, and residence. Perceived barriers were categorized under 4 groups: knowledge, psychological, physical, and external factors. All 23 items of perceived barriers were responded on a dichotomous(yes/no) scale. Result: Mean number of perceived barriers was 4.61 and 87.9% subjects perceived at least one barrier which prevented involvement in exercise. External barriers ranked highest. Followed in order by psychological, knowledge, and physical barriers. Most acts of perceived barriers were found to be different by age, gender, and residence, in that, the younger, female, living in Daejeon subjects were found to respond with more barriers than the older, male, living in Chungju or Seoul. Conclusion: Perceived barriers to exercise are different by age, gender, and residence. Therefore, it is recommended that age, gender, and residence of subjects must be considered in order to develop exercise programs and public campaigns.

졸-겔법에 의한 알루미나 환외여과막의 제조및 특성에 관한 연구

김은옥 수원대학교 기초과학연구소 1995 基礎科學論文集 Vol.4 No.-

Alumina(Al_2O_3) MF membrane were prepared by sol-gel process and their gas permeabilities were characterized. Alumina MF membrane with average pore diameter about 0.15㎛ and tubular shape was used as a support. The permeability ratio measurements of helium and nitrogen gas was 2.5.