• Radiation Oncology Journal
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• 제16권4호
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• pp.399-408
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• 1998

목적 : 본 연구는 비인강암 환자의 방사선치료에서 기존의 2차원적 치료계획과 3차원 입체조형 치료계획을 비교 분석하여 3차원적 치료계획의 우월성을 입증하고자 하였다. 대상 및 방법 : 병기가 T4인 환자를 대상으로 하였으며, 두 치료계획 모두 기존의 2차원적 치료방법으로 50.4Gy가 조사된 후 추가조사하는 과정을 2차원적 치료계획과 3차원적 치료계획으로 구분하여 수립하였다. 치료계획의 비교는 선량통계, 선량체적히스토그람, 국소제어율, 그리고 정상조직손상확률을 이용하여 시행하였다. 결과 : 3차원적 치료계획에서 2차원적 치료계획과 비교하여 계획용표적체적의 선량균일성이 더욱 향상되었으며 평균선량도 15.2$\%$의 증가를 보였다. 또한 종양 주위의 정상 장기인 측두엽, 뇌간, 이하선 및 측두하악골관절에 조사되는 평균선량은 3차원적 치료계획에서 낮았다. 종양제어확률은 3차원적 치료계획에서 2차원적 치료계획에서보다도 6$\%$ 증가하였으나 정상조직손상확률은 측두엽, 뇌간, 이하선, 측두하악골관절, 그리고 시신경교차 등 대부분의 정상장기에서 낮았다. 결론 : 3차원 입체조형치료계획은 2차원적 치료계획에 비교하여 종양의 국소제어율을 증가시킬수 있는 우월한 치료법임이 증명되었으나 임상적으로도 같은 결과를 가져올 지는 향후 전향적인 임상 연구가 요구된다.

• 동의생리병리학회지
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• 제20권6호
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• pp.1678-1727
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• 2006

This study was perfromed to develop the assessment guideline and endpoints for clinical trial with anticancer herbal medicine. The botanical products used to humans for long time may be applied to phase 3 clinical trial after submitting the evidences for safety and efficacy of them or completion of basic requirement of phase 1 and phase 2 for safety confirmation and dose determination. Syndrome improvement was chiefly evaluated by Zubrod and karnofsky(%) methods. We suggest the general clinical trial assessment with botanical products, by following assessment points, that is, tumor size for 50 points, survival fate for 10 points, major syndromes for 40 points. It is recommendable that the each symptom of Qi deficiency syndrome, blood deficiency syndrome and Qi stagnation syndrome was allocated by assessment points, Similarly, the each symptom was given the assessment points according to the severity of symptom, for example, slight for 3 points, moderate for 2 points and severe for 1 point in hepatocelluar carcinoma and lung cancer. Then, the efficacy of botanical products was evaluated by the difference between pre-treatment and post-treatment. Asking the neoplastic patients of questionnaire on physical, emotional, cognitive, social and role subjects availability, three more syndromes (Fatigue, Pain and Nausea/Vomit), quality of life(QOL) will be evaluated by GLM statistics. In addition, in case of lung cancer, 13 questions will be asked by the EORTC QLQ-C13 forms. As the assessment of endpoints for efficacy to reduce side effects induced by chemotherapy and radiotherapy, the data of image scanning and hemato-urinalysis can be usefully applied on immune response, weight loss, indigestion, hemopoietic damage and injury of liver and kidney, while the changes of syndromes of side effect can be evaluated by differentiation methods of Qi and blood and five viscera. However, it is still necessary to determine the ratio between scientific analytical method and Oriental differentiation method as well as confirm the Oriental assessment endpoints by clinical trial. In addition, we suggest the continuous development of assessment endpoints on other carcinomas except of hepatocelluar carcinoma and lung cancer in future.

• 동의생리병리학회지
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• 제26권1호
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• pp.88-97
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• 2012

DSOM(Diagnosis System of Oriental Medicine), questionnaire for oriental medical(medicine) diagnosis is an online survey system containing 152 questions for female, 149 questions for male that asking the basic symtoms of 16 pathogenic factors(病機). The result of DSOM denotes reliability according to the level of major symptoms of each pathogenic factor. Standard level of reliability is equal to all 16 pathogenic factor basically except phlegm(痰). In case of phlegm(痰) we give different weight depending on whether the factor includes gray color under the orbit(痰飮氣) or not. To examine reliability of DSOM, statistical analysis has been done to the data of felmale 10101, male 1564 except for bad responses and stored between 1st April 2000 to 3rd June 2011. Based on the study, the conclusions were as follows. Reliability of DSOM. For female, all pathogenic factors showed over 85% confidence level except for phlegm 82.6%. For male, all pathogenic factors showed more than 90% confidence level except two factors, phlegm(痰) indicates 87.% and damp(濕) indicates 89.8%. HH rates among pathogenic factors were more than 50 points. For female, HH rates of other 14 pathogenic factors were all over 80% except for heat(熱) 78.2% and insufficiency of Yang(陽虛) 75.3%. For male HH rates of all pathogenic factors were more than 80% except HH rates of heat 78.2% and damp 77.8%. Research based on a degree of satisfaction of reliability derived from pathogenic factors with scores of HH results in for all 16 pathogenic factors showed over 85% of relatively high level of satisfaction for both sexes whose reliability standard come under 5~4 points. Comparing appearance frequency of pathogenic factors for both sexes. Male only displays higer than female in heat(熱). Whereas female were higher than male for other 15 pathogenic factors and the difference was biggest in heart(心) and least in insufficiency of Yin(陰虛). Comparing appearance frequency order of pathogenic factors for both sexes. Female outdistanced male in blood stasis(血瘀) coldness(寒) blood-deficiency(血虛) phlegm(痰), while male outdistance female in heat(熱) insufficiency of Yin(陰虛) deficiency of qi(氣虛). Male had lower average of each pathogenic factors than female except heat(熱) as well as deficiency of qi(氣虛).

• Journal of Preventive Medicine and Public Health
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• 제34권4호
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• pp.337-346
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• 2001

Objective : To determine the clinical risk factors associated with the mode of delivery decision and to compare cesarean section rates after adjusting for risk factors identified among Korean hospitals. Methods Data were collected from 9 general hospitals in two provincial regions by medical record abstraction during February 2000. A total of 3,467 cases were enrolled and analyzed by stepwise logistic regression. Performance of the risk-adjustment model (discrimination and calibration) was evaluated by the C statistic and the Hosmer-Lemeshow test. Crude rates, predicted rates with 95% confidence intervals, and adjusted rates of cesarean section were calculated and compared among the hospitals. Results : The average crude cesarean section rate was 53.2%, ranging from 39.4% to 65.7%. Several risk factors such as maternal age, previous history of cesarean section, placenta previa, placental abruption, malpresentation, amniotic fluid abnormality, gestational anemia, infant body weight, pregnancy-induced hypertension, and chorioamnionitis were found to have statistically significant effects on the mode of delivery. It was confirmed that information about most of these risk factors was able to be collected through the national health insurance claims database in Korea. Performance of the risk-adjustment model was good (c statistic=0.815, Hosmer-Lemeshow test=0.0621). Risk factor adjustment did lead to some change in the rank of hospital cesarean section rates. The crude rates of three hospitals were beyond 95% confidence intervals of the predicted rates. Conclusions : Considering that cesarean section rates in Korean hospitals are too high, it is apparent that some policy interventions need to be introduced. The concept and methodology of risk adjustment should be used in the process of health policy development to lower the cesarean section rate in Korea.

• Journal of Hospice and Palliative Care
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• 제14권4호
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• pp.197-203
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• 2011

목적: 암환자에게 통증은 가장 흔하고 영향이 큰 증상이다. 그러나 말기암환자에서 통증 강도에 대한 연구는 부족하였다. 본 연구는 중등도 이상의 통증과 연관된 요인을 밝히고자 한다. 방법: 우리나라 완화의료 기관 6곳의 입원 병동을 대상으로 말기 암 환자 162명 자료를 사용하였다. 통증은 담당의가 10점 만점 숫자통증등급으로 측정하였다. 중등도 이상의 통증은 보건복지부 지침의 정의에 따랐다. 증상 평가에는 MD Anderson 증상 평가조사지 한국어본을 활용하였다. 생존기간 예측은 입원 당시 담당 전문의가 하였다. 결과: 예측 생존 기간이 6주 미만인 경우와 지난 24시간 졸린 정도가 6점 이상인 경우가 중등도 이상의 통증과 유의하게 연관되었다(각각 P=0.012, P=0.046). 마약성 진통제 투여량도 중등도 이상의 통증에 비례하였다(P=0.004). 결론: 중등도 이상의 통증과 유의하게 연관된 요인은 예측 생존 기간이 6주 미만인 것과 상당한 졸림이었다. 이러한 요인을 나타내는 말기 암 환자에서 주의 깊은 통증의 감시와 적극적인 대비가 필요하다.

• 한국산학기술학회논문지
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• 제12권11호
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• pp.4914-4923
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• 2011

본 연구는 PA(전담)간호사의 직무스트레스가 직무만족도에 미치는 영향을 파악하기 위하여 시도된 서술적 조사연구로 2010년 9월 1일부터 2011년 1월 10일까지 PA(전담)간호사 104명을 대상으로 시행하였다. 수집된 자료는 SPSS PASW Stastistics 18.0 Program으로 분석하였다. 직무스트레스에 대한 평균점수는 여성 45.07(${\pm}9.78$)점, 남성 43.47(${\pm}13.77$)점이었다. 직무만족도에 대한 평균점수는 2.72(${\pm}0.30$)점이었다. 일반적인 특성과 직무만족도 간의 통계적 유의성은 없었다. 직무스트레스의 하부영역 중 미혼에서 조직체계(p<.05)와 보상부적절(p<.01)에 대한 스트레스가 통계적으로 유의하게 높은 것으로 나타났다. 다중회귀분석결과 회귀모형에 대한 수정된 $R^2$ 값이 0.567로 회귀모형이 56.7%로 적합하며, 직무자율성이 적고 조직체계가 합리적이지 못할 때 직무만족도가 감소하였으며, 3교대 근무자에 비해 2교대 근무자의 직무만족도가 높은 것으로 분석되었다. 그러므로 직무만족도를 높이기 위해 PA(전담)간호사의 직무자율성과 조직체계에 대한 직무스트레스를 감소시키기 위한 병원정책이 필요하다.

• 임상간호연구
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• 제26권1호
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• pp.47-58
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• 2020

Purpose: The aim of this study was to develop a simulation-based High Flow Nasal Cannula Oxygen Therapy training program based on NLN/ISF to identify the effect on knowledge, clinical performance, and educational satisfaction compared to a group who had traditional High Flow Nasal Cannula Oxygen Therapy training after applying it to clinical nurses. Methods: 31 experimental groups and 33 control groups were conducted from August 2019 to September 2019 for inexperienced nurses over 4 months to 5 years with no experience using high-flow oxygen therapy. Educational programs were developed in scenarios according to Airvo2 and Optiflow, such as facilitator, participant, educational condition, design, characteristics, and educational outcomes. The education application was conducted in advanced for knowledge and clinical performance ability after watching therapy video. Since then, a total of 90 minutes have been conducted for respiratory failure theory training, airvo2 and optiflow simulation training, and debriefing. After applying the education, the medical institution measured nurses' knowledge, clinical performance, and education satisfaction. Data were analyzed using descriptive statistics, with the SPSS/WIN 22.0 program. Results: Both knowledge and educational satisfaction were higher in the experimental group than in the control group (t=-14.09, p<.001), (t=-12.99, p<.001). The clinical performance for both use of Optiflow and Airvo2 were higher in the experimental group than in the control group (t=-11.39, p<.001), (t=-11.38, p<.001). Conclusion: Results showed that the simulation-based High Flow Nasal Cannula Oxygen Therapy training was effective with the experimental group having increased scores for every area of this study.

• 임상간호연구
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• 제26권1호
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• pp.117-130
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• 2020

Purpose: This study aimed to develop a bedside nursing shift report protocol and evaluate the effect of the protocol in a tertiary hospital in South Korea. Methods: The bedside nursing handoff protocol with patient engagement was developed based on the literature review and the validation of an expert group. The effect of the protocol on clinical implication was tested in three medical-surgical units in a tertiary hospital. Outcomes were assessed by patient perception, nurse perception, and reporting time. Data collected from June to August in 2018 and analyzed with descriptive statistics and One-way ANOVA using SPSS version 25.0. Results: The bedside nursing shift report protocol with patient engagement consisted of two steps: nurse to nurse report and bedside report with patients. Nurse's perception with patient engagement was significantly increased after applying protocol (F=17.85, p<.001). Patient's perception was significantly improved in the areas of discharge plan (F=7.86, p<.001), health information privacy (F=4.46, p=.012) and identify attending nurse (F=3.19, p=.042). There were no differences in reporting time between the bedside nursing shift report and a traditional shift report (F=0.61, p=.054). Conclusion: Patient perception was significantly increased, while nurse perception was not different after applying this protocol. For the change in the perception of nurses, education may be preceded to improve nurses' competence for the bedside shift report. Furthermore, the support in enough nurse staffing should be needed for encouraging the bedside shift report. The bedside shift report may enhance patient engagement. Therefore it may improve patient safety and health outcome in clinics.

• Allergy, Asthma & Immunology Research
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• 제10권6호
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• pp.675-685
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• 2018

Purpose: This study aims to determine the efficacy and safety of house dust mite (HDM)-sublingual immunotherapy (SLIT) in elderly patients with AR. Methods: A total of 45 patients aged ${\geq}60years$ with HDM-induced AR who had ${\geq}3$ A/H ratio on skin prick test and/or ${\geq}0.35IU/L$ to both Dermatophagoides farinae and Dermatophagoides pteronyssinus by ImmunoCAP were enrolled in 4 university hospitals. To evaluate additional effects of HDM-SLIT, they were randomized to the SLIT-treated group (n = 30) or control group (n = 15). Rhinoconjunctivitis total symptom score (RTSS), rhinoscopy score, Korean rhinoconjunctivitis quality of life questionnaire, rhinitis control assessment test, asthma control test scores, and adverse reactions, were assessed at the first visit (V1) and after 1 year of treatment (V5); for immunological evaluation, serum levels of HDM-specific immunoglobulin A/IgE/IgG1/IgG4 antibodies and basophil response to HDMs were compared between V1 and V5 in both groups. Results: There were no significant differences in demographics, RTSS, skin reactivity to HDMs, or serum total/specific IgE levels to HDMs (P > 0.05, respectively) between the 2 groups. Nasal symptom score and RTSS decreased significantly at year 1 in the 2 groups (P < 0.05). There were no significant differences in percent decrease in nasal symptom score and RTSS at year 1 between the 2 groups (P > 0.05); however, rhinoscopic nasal symptom score decreased significantly in the SLIT-treated group (P < 0.05). Immunological studies showed that serum specific IgA levels (not specific IgE/IgG) and CD203c expression on basophils decreased significantly at V5 in the SLIT-treated group (P = 0.011 and P = 0.001, respectively), not in the control group. The control group required more medications compared to the treatment group, but there were no differences in adverse reactions. Conclusions: It is suggested that HDM-SLIT for 1 year could induce symptom improvement and may induce immunomodulation in elderly rhinitis patients.

• 한국아동복지학
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• 제26호
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• pp.7-30
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• 2008

의학기술의 발전으로 소아암 환아의 생존율이 1960년대 30%미만에서 최근 75%이상으로 향상되었다. 이에 따라 소아암은 더 이상 불치병이 아닌 만성질환으로 분류되고 있으나, 장기간의 투병생활로 인해 소아암 환아들은 신체적, 심리사회적 문제를 겪고 있다. 특히 외모에 관심이 많고, 또래관계가 중요한 10대 소아암 환아들에게 있어 신체적, 심리사회적 변화는 이들의 신체상과 질병적응에 영향을 미칠 것으로 예상된다. 이에 본 연구에서는 소아암 환아의 신체상(신체왜곡도) 및 질병적응 수준을 알아보고, 인구사회학적 특성, 질병관련 특성 및 신체상이 소아암 환아의 질병적응에 미치는 영향에 대해 알아보았다. 본 연구는 2007년 10월 22일부터 11월 16일까지 자기기입식 설문조사로 이루어졌으며, 조사대상자는 암진단 후 3년 이내의 10세에서 18세 환아 82명이었다. 수집된 자료는 기술통계, t-검정, 상관관계, 위계적 다중회귀방법으로 분석하였다. 분석결과, 연령, 학교생활여부, 신체상이 소아암 환아의 질병적응에 영향을 미치는 요인으로 나타났다. 즉, 연령이 높을수록, 학교생활을 하고 있는 환아가 그렇지 않은 환아보다, 신체왜곡도가 낮을수록 질병적응에 긍정적 영향을 미치는 것으로 나타났다. 소아암 환아의 질병적응을 돕기 위해서는 소아암 환아가 학교생활을 지속할 수 있도록 돕는 정책적 제도 구축, 긍정적 신체상 형성을 위한 프로그램 개발, 소아암 환아의 연령을 고려한 심리사회적 접근 등이 필요하며, 이를 위해 사회복지사의 적극적인 개입이 이루어져야 할 것이다.