억제대 적용지침 개발을 통한 불필요한 억제대 적용율 감소활동

곽경선,김성은,배은경,이은숙,이은혜,최윤정,이윤경 한국의료QA학회 2009 한국의료질향상학회지 Vol.15 No.2

문제: 억제대 적용에 대한구체적 적용지침 없이 의례적으로 억제대를사용함으로 인해 환자들의 신체적 또는 정신적 안전을 위협할 수 있다. 목적: 완전 진정상태 이거나 근력이 약하여 발관능력이 없는 환자에 대한 예방적 적용, 바빠서 환자를볼수 없 는경우, 간호사본인의 판단이 없이 타인의 요구에 따르는등의 불필요한 억제대 적용이 증가하는 원인을 파악하여 중환자실의 특수성에 맞는 억제대 적용및 제거 지침을 마련하고자 한다. 의료기관: 인천광역시에 소재한 의과대학 소속병원의 집중치료실 개선효과: 억제대 적용에 대한중환자실 간호사에게 미치는 영향을 보면 태도 정도 p=0.09(p<0.1), 올바른 수행 능력은 p= 0.005 (p <0.0히로통계적으로유의한것으로 나타났다. 지식 정도 p=0.172(p<0.05) 통계적으로 유의 하지는 않지만 모든항목이 개선 활동전 에 비해 2,3차 개선 활동후에 향상한 것으로 나타났다. 개선활동전에 8.1%였던 간호 기록, 0.7%였던 간호중재, 0%였던 의사처방율이 3차 개선 활동 후 3가지 모두 100% 달성되었다. 이는 억제대 적용율 갑소 및 부적절한 억제대 적용율은 유의하게 감소하였다. 교훈: 중환자실 간호사의 억제대 적용에 대한태도, 지식, 올바른 간호 수행 능력은 지속적으로 재평가 되어지고, 교육내용은좀더 나은 간호제공을 위하여 개발 되어져야 할 것이다. 억제대 적용 기준과 제거 기준을 Check List 하여 객관성의 유지를 위한 개선 활동은계속적으로 Feedback 되어야 할 것이다.

대동맥 협착증과 동반된 출혈성 위장관 동정맥 기형에서 Estrogen-Progesterone 치료 1예

김도연,김화정,김효정,남준식,박수영,박영미,신정은,주미순,황민규,정혜경,손혜영,이선영,이한주 大韓消化器內視鏡學會 1999 Clinical Endoscopy Vol.19 No.부록2

일개 대학병원에서 2년동안 분리된 Escherichia coli의 항생제 내성 양상에 대한 조사

정혜원, 차은종, 김학순 충북대학교 의과대학 충북대학교 의학연구소 2013 忠北醫大學術誌 Vol.23 No.2

연구목적: 여러 가지 지역사회 획득 감염증 및 병원 획득 감염증의 주요 원인균인 대장균 (Escherichia coli)의 항생제 내성 양상을 파악하는 것은, 감염성 질환의 치료제 권장 지침을 제시하 거나, 경험적 항생제 치료를 결정하는 데 중요한 자료가 된다. 대상 및 방법: 이 연구는 2011 ~ 2012년도에 충북대학교병원에서 분리된 대장균의 항생제 내성을 임상 검체, 환자의 임상적 특성에 따라 분석한 것이다. 미생물검사 전산 결과 및 환자 의무기록 검토를 통하여 자료를 조사하였다. 결과: 연구 기간동안 총 3233 균주의 대장균이 분리되었다. 균이 빈번하게 분리된 검체를 순서대로 살펴보면 소변, 혈액, 담즙, 농, 객담 및 기관 흡인액, 질 분비물, 복수, 관절액, 뇌척수액, 기타 검체 순이었다. 분리검체별, 나이 및 성별에 따른 대장균의 항생제 감수성 양상 (trimethoprim/ sulfamethoxazole, quinolones, amikacin) 및 광범위 베타락탐 분해 효소 (ESBL) 생성 유무를 조사한 결과, 주로 소변과 혈액에서 배양된 균주가 객담이나 복수, 농, 에서 배양된 균주보다 trimethoprim/sulfamethoxazole, quinolones 에 대하여 항생제 감수성 비율이 높았고, ESBL 생 성 균주 비율도 더 낮았다. 성별로는 여성 환자에서 분리된 균이 trimethoprim/sulfamethoxazole, amikacin 감수성 비율이 더 높았고 ESBL 생성 균주 비율은 낮았다. 65세 이상인 환자에서 trimethoprim/sulfamethoxazole 감수성 비율이 65세 미만 환자보다 높았지만, quinolone계 항생 제에 대하는 오히려 내성률이 65세 미만 보다 유의하게 높았다. 결론: 이러한 결과를 종합하여 볼 때, 심한 담도계 감염, 병원 획득 폐렴, 복막염 등의 경우 대장균의 quinolone 감수성이 50% 미만으로 나타나 초기 항생제 선택에 주의를 기울여야 할 것으로 보이며 요 로 감염의 경우 trimethoprim/sulfamethoxazole에 감수성이 확인된 경우라면 이 약제를 치료 약재 로 고려할 수 있을 것으로 생각된다.

방사선 치료를 받는 암 환자들의 사회적 지지와 삶의 질과의 관계

정주희,류소연,윤혜은,남택근,오윤경,안현옥,박계남,이영선 朝鮮大學校 附設 醫學硏究所 2002 The Medical Journal of Chosun University Vol.27 No.2

Objective : This study was performed to investigate the relationship between social support and quality of life among cancer patients receiving radiation therapy. Matehals and Methods : The data were collected from 98 patients, who were receiving radiation therapy at two university hospitals located in GwangUJu, used by structured questionnaire. For statistical analyses of the association between quality of life and various characteristics, data were analyzed using t-test, ANOVA, Pearson 's correlation, and multiple regression analysis. Results: 1. There were 56(57.1%) males and 42(42.9%) females. Age ranged from 21 to 82 years. The primary sites of cancer were gastrointestinal tract (24.5%), lung (23.5%), breast (21.4%), and head and neck (11.2%) in order. 2. The mean scores of social, family, and medical support were 4.30 0.58, 4.49 0.78, 4.11 0.65, respectively. The score of quality of life was 5.83 1.63 (range: 1.95 ~ 9.05). 3. An analysis of the association between several factors of patients and quality of life showed that the statistically significant factors were age, the presence of distant metastasis, family support, medical support and social support. 4. As a result of the multiple regression analysis, only social support was significant (β=0.932, P=0.02) with quality of life, but age and presence of distant metastasis were not significant. Conclusion : This suggests that quality of life in cancer patients could be improved by strengthening the social support which consists of family and medical support. Further study would be necessary to evaluate separately several aspects of quality of life among cancer patients.

역류식 충진탑에서 수력학적인 분석과 이산화탄소의 탈착에 관한 연구

楊善惠,崔東勳,지혜미,金恩貞,金彰昊 동아대학교 환경문제연구소 1996 硏究報告 Vol.19 No.1

This study was carried out to interpret hydraulic behavior and CO₂gas desorption in countercurrent packing tower which packed 50 mm plastic Hiflow-ring. The results are as follows: 1. To compare with conventional packing, 50mm Hiflow-ring could save energy because of low pressure drop under high load. 2. As relative error between calculated value and investigated value was less than 6% in the loading point and flooding point we found that we can predict results mathematically which occurres in the packing tower. 3. The unique magnituteds of packing which was used are as follows. C_(L) = 2.1×10^(-4), n = 0.787 so we can predict efficency which occurres.

숙명박물관 브랜드 프로모션을 위한 통합적 브랜드 개발 -2D, 3D, 4D 디자인 프로세스를 중심으로-

길혜경,김보현,오정은,이서연,이지원,이진민,장미정,이성애 숙명여자대학교 산업디자인연구소 2017 숙명디자인학 연구 Vol.24 No.-

본 연구는 여성생활사 중심의 유물 박물관인 숙명박물관의 인지도와 브랜딩의 문제를 해결하기 위해 브랜드·스페이스·마케팅을 활용한 통합 브랜드 개발 프로세스를 제안하는데 목적이 있다. 아울러 본 연구는 박물관의 브랜드를 프로모션하고 그래픽, 제품, 공간의 통합 브랜드를 구축하는 일련의 프로세스를 밝히는데 목적이 있다. 이에 본 연구의 시간적 범위는 2017년 3월부터 6월까지 총 15주간 숙명여대 환경디자인학과 <브랜드·스페이스·마케팅>수업에서 진행된 수업의 결과물로서 4개 팀 중, 1개 팀의 작업물로 한다. 본 연구의 대상적 범위는 ‘숙명여자대학교 숙명박물관'의 2D~4D까지의 전반으로 설정한다. 그 결과, 제품부터 공간까지 숙명박물관의 통합된 브랜딩은 일 관성과 객관성, 스토리성을 얻을 수 있었다. ’숙명박물관'은 학교의 박물관이라는 장점을 극대화시켜 가치와 스토리를 부여하고 하나의 브랜드로 리뉴얼했다는 점에서 의의가 있다. 또한 향후 보편적인 박물관들의 차별화된 브랜드 개발의 참고자료로 활용될 수 있을 것으로 기대하며 브랜드 개발에 있어서 G·I, P·I, S·I의 통합 브랜드 메뉴의 기초 자료로 활용될 것으로 사료된다.

정맥내 주사로 인한 정맥염 발생의 다기관 공동 역학 조사 : 서울, 경기도 6개 종합병원을 대상으로:Focused on 6 hospitals in Seoul or Gyonggi-do, Korea

최정실,박은숙,진혜영,정선영,박미라,김정은,김금순 대한병원감염관리학회 2003 의료관련감염관리 Vol.8 No.2

대학생 흡연자의 금연경험에 따른 건강신념차이

구정일,김민정,김동희,백정희,안현실,은가희,우혜령,이명희,이수현,김수지 이화여자대학교 간호과학대학 2003 이화간호학회지 Vol.- No.37

It has been generally known that smoking is one of the worst factor increasing disease and mortality in human health since in 1950's and nowadays. But regardless of various proofs about social or economical problems due to smoking, current smoking rate has not been decreased in our country. Until now, most of tobacco use and its addiction researches have been focused on the adolescent or adult women smokers not on the university students. Therefore, the purpose of this study was to investigate smoking cessation of university smokers and analyze the health belief-perceived sensitivity, severity, benefits and barriers- difference, then to provide basic data for effective smoking cessation strategy for university smokers. The subjects were comprised of 181 university smokers from 15 universities in Seoul. The data were collected by structured questionaires. The questionaires were designed to measure general characteristics, smoking cessation and health belief, based on Ahn(2003)'s result on the Study of Smoking attitude, Behavior and Smoking Cessation of Adult Male and Lee(1987)'s result on Relationships Between the Health Belief Model and Smoking Habits. The data were collected from May 5 to 16. The collected data were analyzed by SPSS program. The actual number, percentiles, means, standard deviation, t-test and ANOVA were done. The result of this study were as follows; 1. The general characteristics of the subjects of this study The range of age was from 18 to 34 and the averaging age was 23. The subjects of this study were 141 males and 40 females. The religions were Christianity 25.4%(46), Buddhism 12.7%(23), Catholic 23.2%(42), no religion 37.0%(67). The residential forms were living with family 59.1%(107), cooking food for oneself 28.7%(52), dormitory 5.0%(9), boarding house 1.7%(3). Smoking starting age were university 43.1 %(78), high school 29.8%(54), middle school 14.9%(27), in the army 6.1 %(11), elementary school 1.1 %(2). 2. The smoking cessation of the subjects 80% of current smokers showed quitting smoking decision and 20% have not tried. The frequency of quitting smoking decision were from 1 to above 8 and mean was 3.06. As for smoking cessation plan, 54.7%(99) current smokers answered yes, 3.9%(7) said no, 35.4%(64) had no idea and 6.1 %(11) didn't answer. As for the reason of never quitting smoking decision, 71.42%(25 among total 35) have no need to quit smoking and the others said difficulty of smoking cessation. As for the main reason of smoking cessation decision, 54.7%(99) answered for the health, 7.2%(13) family advice, 15.5%(28) girl/boy friend's advice, 1.7%(3) to save money. As for the reason to fail smoking cessation, 56.7%(68) were will-lack, 17.5%(21) stress, 15%(18) smoking mood, 10%(12) withdrawl symptom. As for the smoking cessation method, 85.0%(125) were oneself-will, 2.7%(4) way acquired by mass-media, 2%(3) doctor's prescription, 2%(3) religion's help, 0.7%(1) smoking cessation school. As for the difficulty in smoking cessation, 42.2%(62) were drinking meeting, 23.1 %(34) no alternative of stress release, 12.2%(18) withdrawl symptom, 11.6%(17) having nothing to do, 7.5%(11) friend's encouragement. As for the most difficult cigarette to quit, 67.8%(99) were all-day smoking except the first smoking in the morning, 32.2%(47) the first smoking in the morning. 3. Health belief as for general characteristics Gender - The total point in benefits showed higher in male(28.5177) than female(26.6750). There was significant difference(t=.778, p<.05). The total point in health belief showed higher in male (105.8298) than female(l00.5000). So there was significant difference(t=.345, p<.05). Age - There was significant difference in benefits between age(10's-25.83, 20's-28.39, 30's-32.00)(F=3.73, p<.05). Smoking starting age - There was significant difference in total point of sensitivity and health belief(sensitivity F=4.00, p<.Ol, health belief F=2.843, p<.05). As for sensitivity, subjects who started smoking in the army showed the highest(33.36) and ones in high school showed the lowest(26.96). The total point in health belief showed the highest in elementary school(l19.00) and the lowest in high school(100.98). 4. Health belief as for smoking cessation There was significant difference in health belief as for smoking cessation(t=0.189, p=0.OO2). Sensitivity point showed higher in smoking quitting trial smokers(29.2) than non-trial smoker (26.9). Severity point showed higher in trial smokers (30.7) than non-trial smokers(28.9). Benefit point showed higher in trial smokers(28.6) than non-trial smokers(26.2). There was no significant difference in barriers point.

선천성 대사 이상 환아에서 발생한 대사 위기의 복막 투석 치료 효과

강정혜,이동환,문철,김은미 순천향의학연구소 1996 Journal of Soonchunhyang Medical Science Vol.2 No.2

Purpose : We have evaluated the outcomes of peritoneal dialysis in patients with metabolic crises caused by in born error of metabolism. Methods : There are 6 patients(8 episodes, 4 males and 2 females) who had inherited inborn errors of metabolism and were admitted to the department of pediatrics, Shoonchunhyang university hospital in Seoul from December 1991 to December 1994. The technique of dialysis is discribed, in short: A Tenckhoff catheter was inserted surgically in all patients through the lateral abdominal wall. Commerically available dialysate solutions(Peritosol, Korea Green Cross Co.) was applied to 5 patients(7 cases) with hyperammonemia. In a patient with propionic acidemia, we used a special custiom made dialysate that replaces lactate by bicarbonate. Results : 1) The mean age was 5.3 months old. There were 6 patients with 8 episodes. Six cases had Ornithin transcarbamylase deficiency. The remaining cases are Multiple carboxylase deficiency and Propionic acidemia (Table 1) 2) In 7 cases with hyperammonemia, mean levels of pre and post 24hrs peritoneal dialysis serum ammonia were 1000.2±310.9 ㎍/dl and 388.8 ±156.7 ㎍/dl at 24 hours respectively. Time on serum ammonia levels reached below 300 ㎍/dl was 88.7 ±39.6 ㎍/dl hours. 3) Four out of seven cases were a recorvert of mental status. Each episode of serum ammonia mean levels was 388.8 ±156.7 ㎍/dl after 19.7 ±5.8 hours of peritoneal dialysis (Table 3). 4) Peak serum ammonia levels of the survived group reached 1356.5 ㎍/dl, higher than the expired group of 847.5 ㎍/dl and time period of starting peritoneal dialysis after onset of the survived group was 15.5 hours earlier than the expired group of 23 hours(P>0.05)(Table 4). 5) 3 out of 7 cases of hyperammonemia died. The cause if death were 3 brain edema, 1 hyperkalemla and 1 intracranlal hemorrhage. 6) In onecase with Multiple carboxylase deficiency, serum ammonia level was normalized after 12 hours of peritoneal dialysis. The reduction of serum levels of the branched amino acid was also observed. 7) In a case of Propionic acidemia with severe metabolic acidosis, the prior serum bicarbonate level was 8 mmol/L and was increased up to 18 mmol/L by peritoneal dialysis lasting 19 hours. 8) Among 8 cases, complications of peritoneal dialysis were 5 hypoalbuminemia, 4 hyoercalcemia, 4 hyperglycemia and leakage of peritoneal dialysate. Conclusions : In cases of hyperammonemia, survival rate is 57.1%. They are showed excellant efficacy of treatment of peritoneal dialysis for metabolic crises. In a case of propinic acidemia is fastly corrected by peritoneal dialysis. But unfortunally clinical manifestations is not improved. Therefore, further studies is required with treatment of severe metabolic acidic conditions.

중환자실 병원감염에 대한 다기관 공동 조사연구

박은숙,박미라,진혜영,김정은,최정실,송영구,최영화,이위교,홍성관,허애정,양동규,김준명 대한병원감염관리학회 2003 의료관련감염관리 Vol.8 No.1