발열을 동반한 호중구감소증에서 Cefepime 단독투여와 Ceftazidime 및 Tobramycin 병합투여의 효능비교

정현욱,채제욱,강미라,양정채,문치숙,기현균,장현하,오원섭,김기현,백경란,이남용,송재훈 대한감염학회 2004 감염과 화학요법 Vol.36 No.6

목적 : 국내에서 발열을 동반한 호중구감소증이 있는 악성 종양환자에게 경험적 항생제로 베타락탐계 항생제와 아미노배당체의 병합요법의 사용이 일반적이다. Cefepime은 광범위 항균 작용을 가지고 있어, 그람 음성균 뿐만 아니라 그람 양성균에 대해서도 우수한 효과를 나타낸다. 재료 및 방법: 발열을 동반한 호중구감소증이 있는 악성 종양환자를 대상으로 무작위, 공개, 비교 연구를 시행하였다. 대상 환자를 무작위로 cefepime 단독요법군과 ceftazidime 및 tobramycin 병합요법군으로 나누어 투여하고 각각의 임상적 효능과 안전성을 비교하였다. 구강및 인후 점막염이 있는 환자에서 분리된 녹색 연쇄알 구균에 대한 항생제 내성 정도를 조사하였다. 결과 : 대상환자 89명 중 CA 투여군이 48예(53.9%), CT 투여군이 41예(46.1%)이었다. 발열의 유형별로 MDI는 18예(20.2%), CDI는 9예(10.1%), UF는 62예(69.7%)로 두 군 간에 차이가 없었다. CA 투여군과 CT 투여군의 임상적 호전률은 시험약 투여 후 2-4일째 각각 91.7%, 85.4% (P=0.31), 치료 종료 시 각각 91.7%, 100% (P=0.15)로 두 군간에 유의한 차이가 없었다. 치료 종료 시 CA 투여군과 CT 투여군의 세균학적 소실률은 모두 100%로 두 군간의 유의한 차이가 없었다(P=0.78). 점막염이 있는 환자로부터 녹색 연쇄알 구균이 분리된 경우는 25예(28.1%)이었으며, 분리된 녹색 연쇄알 구균은 penicillin, ceftriaxone, cefepime, vancomycin에 모두 감수성을 보였다. 약제 관련 이상 반응의 발생 빈도도 두 군간에 유의한 차이가 없었다. 결론 : 발열을 동반한 호중구감소증이 있는 악성 종양환자의 경험적 항생제로서 cefepime 단독요법은 ceftazidime 및 아미노배당체의 병합요법만큼 효과적이고 안전하였다. Background : Broad-spectrum antibiotic therapy has been recommended as an empirical regimen in cancer patients with febrile neutropenia. Cefepime is a fourth generation cephalosporin with good activity against both gram-positive cocci and gram-negative bacilli. Materials and Methods : To compare the efficacy and safety of cefepime alone with ceftazidime plus tobramycin as empirical regimen for adult cancer patients with febrile neutropenia, a randomized, open label, comparative trial was performed. If the patient showed clinical improvent 72 hours, antibiotic could be changed to oral ciprofloxacin. Clinical and microbiological responses were determined at 72 hours and at the end of therapy. To investigate the antimicrobial resistance of viridans streptococci, swab cultures were obtained from throat in all enrolled patients and antimicrobial susceptibility tests were performed by using microdilution method according to the NCCLS. Results : A total of 89 patients were enrolled. Forty-eight patients received cefepime alone (CA), and 41 patients received ceftazidime plus tobramycin (CT). Demographic and baseline clinical characteristics were similar in both groups (P>0.05). The initial clinical success rate at day 2-4 in group CA (91.7%) was similar with that in CT group (85.4%) (P=0.31). At the end of therapy, the final clinical success rate in CA group (91.7%) was similar to that in CT group (100%) (P=0.15). In 18 patients, with microbiologically defined infections, the eradication rate was 100% in both groups. Adverse events including liver dysfunction (21.3%) and renal dysfunction (2.2%), were similar in both groups (P=0.87). Viridans streptococci were isolated from the throat cultures in 25 cases, and all of these strains were susceptible to penicillin (MIC_(90) 0.12 ㎍/mL), cefepime (1 ㎍/mL), and vancomycin (0.12 ㎍/mL). Conclusion : Efficacy and safety of cefepime monotherapy was comparable to the combination of ceftazidime and tobramycin. It could be used as an alternative empirical regimen for treating cancer patients with febrile neutropenia.

배우자 지지가 미취학아동 어머니의 양육스트레스와 삶의 질에 미치는 영향

채선미,강희선,이한주,신현숙 한국모자보건학회 1999 한국모자보건학회지 Vol.3 No.2

농촌주민의 혈중 납과 카드뮴 농도에 관한 조사연구

정현숙,조영채,이동배 忠南大學校 環境問題硏究所 1991 環境硏究 Vol.9 No.-

The purpose of this study was to find out blood lead and cadmium concentration levels of rural residents. The blood samples were collected from 140 rural residents in 5 nonpolluted regions in Kunbuk-Myun, Kumsan-Gun, Chungnam province from August 31 to September 30, 1990 and analyzed by atomic absorption spectrophotometry. The results were summerized as follow : The mean concentration level(range) of blood lead was 0.240±0.060㎍/ml(0.130-0.390㎍/ml) for males and 0.237±0.056㎍ /ml(0.120-0.370㎍/m) for females. There was no statistically significant difference among age groups and sexes. The distributions were similar to normal distribution in both sexes. The mean concentration level(range) of blood cadmium was 0.066±0.099㎍/ml(0.012-0.582㎍/ ml) for males and 0.060±0.062㎍/ml(0.015-0.392㎍/ml) for females. There was no statistically significant difference among age groups and sexes. The distributions were skewed to the low level ranges in both sexes. The lead concentration level in whole blood did not show statistically sinificant difference among kinds of farming product. But the cadmium level of the rice-ginseng-tobacco farmers was statistically significantly high (p<0.005). The cadmium concentration level in whole blood was 0.040±0.027㎍/ml for the rice-ginseng farmers, 0.076±0.100㎍/ml ofr the rice-tobacco famers, and 0.158±0.171㎍/ ml for the rice-ginseng-to-bacco farmers. There were no statistically significant difference in blood lead and cadmuim concentration levels among groups classified by drinking habit, smoking habit and exposed years to pesticides. The correlation coefficent between the blood lead and cadmium concentration levels was statistically significant(R=0.2054, P<0.05).

데이터마이닝을 이용한 의료의 질 측정지표 분석 및 의사결정지원시스템 개발

김혜숙,채영문,탁관철,박현주,호승희 한국의료QA학회 2001 한국의료질향상학회지 Vol.8 No.2

Background : This study presented an analysis of healthcare quality indicators using data mining and a development of decision support system for quality improvement. Method : Specifically, important factors influencing the key quality indicators were identified using a decision tree method for data mining based on 8,405 patients who discharged from a medical center during the period between December 1, 2000 and January 31, 2001. In addition, a decision support system was developed to analyze and monitor trends of these quality indicators using a Visual Basic 6.0. Guidelines and tutorial for quality improvement activities were also included in the system. Result : Among 12 selected quality indicators, decision tree analysis was performed for 3 indicators ; unscheduled readmission due to the same or related condition, unscheduled return to intensive care unit, and inpatient mortality which have a volume bigger than 100 cases during the period. The optimum range of target group in healthcare quality indicators were identified from the gain chart. Important influencing factors for these 3 indicators were: diagnosis, attribute of the disease, and age of the patient in unscheduled returns to ICU group ; and length of stay, diagnosis, and belonging department in inpatient mortality group. Conclusion : We developed a decision support system through analysis of healthcare quality indicators and data mining technique which can be effectively implemented for utilization review and quality management in a healthcare organization. In the future, further number of quality indicators should be developed to effectively support a hospital-wide Continuous Quality Improvement activity. Through these endevours, a decision support system can be developed and the newly developed decision support system should be well integrated with the hospital Order Communication System to support concurrent review, utilization review, quality and risk management.

열산화된 알루미늄이 첨가된 Tin black filter를 가지는 메탄센서

권오식,황숙이,심창현,임채근,방영일,김봉철,허증수,류기홍,이덕동 경북대학교 센서기술연구소 2002 센서技術學術大會論文集 Vol.13 No.1

노인의 영적 간호요구

최미혜,김경희,김귀옥,김기숙,김수강,김정신,김춘숙,노흥진,박지연,성혜연,오명선,이선희,이원옥,이윤영,이현수,장명재,차혜경,채정선,홍상희 중앙대학교 의과대학 간호학과 간호과학연구소 2001 중앙간호논문집 Vol.5 No.1

This study was designed to exam the aged's needs for spiritual nursing care. The purpose was to serve as a basis for the development of spiritual nursing practice. The major findings are as follows : 1. The degree of needs for spiritual nursing care as area was that needs of love and relationship mean 22.0, needs of meaning and object mean 28.2, needs of forgiving mean 13.5. Total needs for spiritual nursing care mean 63.7, which was on the upper middle level. The needs of meaning and object was rated highest. 2. Among the general characteristics of the subjects, needs of love and relatiohship wasn't significanlty different. 3. Among the general characteristics of the subjects, needs of meaning and object was significantly different according to two factors : age(F=7.260, p=0.001), religion(F=5.275, p=0.001). Higher needs of meaning and object was possessed by the older than the younger, by the one who have religion than the other. 4. Among the general characteristics of the subjects, four factors made a significantly difference to needs of forgiving : sex(t=-2.851, p=0.006), age(F=8.201, p=0.001), religion(F=6.928, p=0.000), disease(t=2.327, p=0.024). Higher needs of forgiving was possessed by man than woman, by the older than the younger, by the one who have religion than the other, by the one who have disease than the other.

기저귀 사용실태와 피부자극도 조사 : Cost, Environment, and Skin Irritability

한정석,김동건,신현숙,정예리,정태석,채선미 한국모자보건학회 2000 한국모자보건학회지 Vol.4 No.1

연쇄알구균 감염에 의한 급성 인후염 후 반응성 관절염 1예

박은하,도연실,양정채,강미라,서현주,정숙인,손준성,기현균,오원섭,백경란,송재훈 대한감염학회 2004 감염과 화학요법 Vol.36 No.6

연쇄알구균에 의한 급성 인후염 후 발생한 반응성 관절염은 급성 류마티스열의 개정된 진단기준을 충족하지 못하면서, 지속적 혹은 재발성의 비이동성 관절염과 발열, 홍반성 결절, 일시적 간기능 이상 등을 보이면서 심장염과 무도증을 드물게 동반하는 질환이다. 따라서, 발열을 동반한 급성 관절염 환자에서 감별해야 할 질환 중의 하나이며, 심근염 예방을 위한 페니실린 요법의 적응증 및 기간에 대해서는 아직 이론이 많은 상황으로, 보다 광범위한 연구가 필요하다. 저자들은 연쇄알구균에 의한 급성 인후염 1주 후에 발생한 하지의 다발성 비이동성 관절염과 함께 결절홍반 및 일시적 간기능 이상을 보인 환자에서 PSRA로 진단하고 비스테로이드성 항염증제 및 스테로이드로 성공적인 치료를 하였기에 이를 문헌 고찰과 함께 보고하는 바이다. Poststreptococcal reactive arthritis (PSRA) is associated with recent streptococcal infections. However, PSRA is distinct from acute rheumatic fever by its clinical manifestations: non-migrating arthritis, erythema nodosum or erythema multiforme, and transient elevation of serum transaminases. We experienced a 33-year-old man who presented with fever, arthritis of both knees and ankles, and erythema nodosums on extensor surfaces of lower legs which developed 6 days after the onset of pharyngitis symptoms. Blood and urine cultures were negative. Throat culture was negative for group A β-hemolytic streptococcus. The ASO titers increased up to 2080 IU/mL in sequential monitoring. The result of bone scan was compatible to arthritis of both knees and ankles. There were no signs or symptom of carditis. He showed clinical improvement with anti-inflammatory drugs (naproxen 1,000 mg/day and prednisolone 7.5 mg/d). PSRA should be included in the differential diagnosis of patients presenting with arthritis combined with fever.

대학급식의 미생물적 품질보증을 위한 HACCP의 적용 : 참치샐러드 Tuna Salad

김운주,최은희,최현미,배주희,채현숙 충북대학교 교육 ·생활연구소 생활과학연구센터 2002 생활과학연구논총 Vol.6 No.1

The purpose of this study was to evaluate the microbiological quality, and to assure the safety of the food production process in the university foodservice facilities in accordance with the Hazard Analysis Critical Control Point(HACCP) concepts. The kitchen layout and time-temperature relationship, miciobiological quality(total plate count, coliform) were assessed to identify the critical point during each of the production phases. The results were as follows: 1) The kitchen layout had to be improved because contamination area was not separated from non-contamination area, and work table was in contact with washing sink. 2) Some employee did not follow personal hygiene standards(hand washing), and did not wear proper working uniforms(hair restraints). 3) The production time of tuna salad was 120 min, and environment temperature was 20.1~26.0℃. Improper receiving temperature, inproper holding practices(without cover at room temperature) were observed. 4) In the purchasing phase of the raw materials, the microbiological quality of green pepper was not at acceptable level based on the TPC(2.3×10^6CFU/g)and coliform(>14,000 MPN/g). During washing phase TPC was decreased about 3 log cycle. After cutting and holding phase the level of TPC and coliform were increased rapidly. At serving phase the microbiological quality of tuna salad were not at acceptable level(TPC 3.3×10^6 CFU/g, coliform 11,000 MPN/g) according to the standard set(TPC <10^5 CFU/g, coliform <100 MPN/g) by Sorberg et al. 5) For tuna salad, critical control points were purchasing and receiving of fresh vegetables, washing, cutting, holding, mixing and serving phase.

ABSTRACTS ; Posters : STRUCTURE AND EXPRESSION OF cDNAs ENCODING SAM SYNTHETASE AND ACC OXIDASE , ETHYLENE BIOSYNTHETIC ENZYMES , IN RICE

Hyun Sook Chae,Dae Sun Park,Mi Young Park,Myung Cheul Lee,Moo Young Eun,Woo Taek Kim,Bin G . Kang 생화학분자생물학회(구 한국생화학분자생물학회) 1995 추계학술대회집 Vol.- No.-