• Tuberculosis and Respiratory Diseases
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• 제41권5호
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• pp.537-545
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• 1994

연구배경: 중증 원외폐렴은 1987년 영국흉부학회에서 453명의 원외폐렴환자를 대상으로 전향적조사를 한 이후, 여러 학자들에 의해 조기에 위험군을 찾아내어 치료에 도움을 주려는 노력이 있어 왔다. 외국의 경우 중증 원외폐렴에 관한 많은 보고가 있으나 국내에서는 중증 원외폐렴에 대한 임상양상과 특징이 잘 연구되지 못한 상태이다. 이에 본 관찰에서는 계명대학교 동산병원에 입원하여 중증 원외폐렴으로 중환자실에서 치료중 사망한 환자 10명을 대상으로 임상적 고찰을 하였다. 방법: 1987년 7월 부터 1993년 7월 까지 계명대학교 동산병원에서 면역억제 치료중이거나 폐암으로 인한 이차성 폐렴 그리고 결핵성 폐렴을 제외한 원외폐렴으로 498명이 입원하였다. 중환자실에서 치료를 받은 환자는 77명이었으며 이들중 치료중에 사망한 10예를 대상으로 나이, 성별, 임상소견, 검사실성적, 중환자실 전원이유, 원인균, 항생제치료, 및 입원기간 등을 후향적으로 분석하였다. 결과: 1) 10예중 남자가 7예 여자가 10예로 남자의 발생빈도가 높았고, 연령분포는 20대에서 70대까지의 분포를 보였으나 60대 이상이 7예로 고령에서 가장 많은 분포를 보였으며 평균나이는 56.2세였다. 2) 입원당시 임상양상은 호흡수증가 5예, 저산소혈증 5예, 의식변화 4예, 청색증 4예, 백혈구감소증 4예, 백혈구증가증 4예, 혈청 크레아티닌증가 4예, 저혈압 3예, 저알부민혈증 3예 순으로 관찰되었다. 이학적검사에서 이상소견이 없는 경우가 2예였고 한가지만 이상소견을 가지는 경우가 3예에서 관찰되었다. 검사실성적에서는 모든 환자에서 한가지이상의 이상소견이 관찰되었다. 3) 객담배양 검사에서 E.coli와 Enterobacter species가 각각 한 예씩 검출되었으며, 객담도말검사에서는 그람양성구균만 검출된 경우가 6예, 그람양성구균과 그람음성간균이 함께 검출된 경우가 2예에서 관찰되었다. 4) 중환자실로 전원된 이유로는 저산소혈증 5예, 고탄산혈증 2예, 산혈증 2예, 심장 또는 폐정지 2예, 신부전 2예, 간부전 2예의 순으로 관찰되었다. 5) 사용한 항생제는 aminoglycoside 8예, 1세대 cephalosporin 7예, 3세대 cephalosporin 5예, vancomycin 2예였으며 환자당 평균 2.7종류의 항생제를 사용하였다. 가장 많이 사용한 항생제 조합은 1세대 cephalosporin과 aminoglycoside 였다. 6) 평균 입원일수는 11.2일 이었으며, 7예(70%)에서 5일 이내에 사망하였다. 결론: 대부분의 사망환자는 입원초기에 사망하여 조기 집중치료가 중요할 것으로 생각되며, 고령의 환자는 많은 주의를 요할 것으로 사료된다. 앞으로 조기에 위험군을 확인하기 위한 노력이 필요할 것으로 생각된다.

• 대한기관윤리심의기구협의회지
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• 제3권2호
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• pp.19-27
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• 2021

Purpose: This study aimed to analyze the knowledge levels, attitudes, and factors affecting the choices on the education of the participants who completed their education of persons conducting clinical trial workers, and to assess the problems of the current education system for clinical trial workers, leading to improvements. Methods: Clinical trial workers (including principal investigators/subinvestigators, members of the Institutional Review Board [IRB], clinical research coordinators) who were affiliated to one of the 4 university hospitals running their own clinical trial center and IRB in Daegu and completed their education of persons conducting clinical trial workers were the subjects of this study. One hundred seven online questionnaires were answered from 2021-04-02 to 2021-04-17. Descriptive statistics and Pearson correlation analysis were used to analyze the acquired data. Independent t-test and 1-way analysis of variance were used to analyze the differences in the knowledge levels and attitudes following the characteristics of the education participants. Results: The baseline characteristics of the 107 participants were as follows: the majority of the participants were female (72.0%), were in their 30s (36.4%), had a nursing major (29.0%), were clinical research coordinators (63.6%), had never experienced a principal investigator (79.4%), had participated 3 or more educations (58.9%), had completed their maintenance course (55.1%), had 5 or more years of clinical trial experiences (34.6%). The fields on which participants had low levels of objective knowledge were "types and preparations on audits of clinical trials," "regulations on clinical trials (Pharmaceutical Affairs Act, Korea Good Clinical Practice)." The difficulties that the participants faced were on "annual educations" and "lack of information regarding the educations." Factors that showed significant differences in objective knowledge were sex (p=0.02), number of educations (p=0.004), the curriculum of 2020 (p=0.001). Age (p=0.004), having experienced a principal investigator (p=0.006), number of educations (p<0.001), the curriculum of 2020 (p<0.001), clinical trial career (p=0.001) were factors that significantly affected subjective knowledge. Attitudes toward the education were positively correlated with objective knowledge (r=0.20, p=0.04) and subjective knowledge (r=0.32, p=0.001). Major sources through which information on educations was acquired were "institutional notices," and major factors affecting the choices on the education were "when the education took place" and "where the education took place." "Within the affiliated institution," "Online classes (recorded)" and "IRB and review processes" were each the most preferred place, mode, and content of the education. Conclusion: Knowledge levels varied largely among participants who completed their education of persons conducting clinical trial workers, depending on their characteristics such as the number of educations. Participants also complained about their lack of information on educations. The quality of education may be improved if clinical trial organizations are designated as education facilities. Education programs must be developed considering the knowledge level and demand of the participants. Furthermore, as offline classes may be impossible due to pandemics such as the coronavirus disease 2019, the development of diverse and sophisticated online classes is looked forward to.

• 대한기관윤리심의기구협의회지
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• 제6권1호
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• pp.5-16
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• 2024

Purpose: The purpose of this study is to investigate the current status of pediatric assent in nationwide hospitals and to assess the children's comprehension for pediatric assent by interviewing pediatricians/pediatric neurologists to determine whether children of the age (elementary and middle school students) can understand the purpose, risks, benefits, and concepts of voluntary participation in clinical research described in the assent form, and to help improve the administrative efficiency of multicenter clinical trials. Methods: The status of pediatric assent was surveyed online using Google Forms at 141 university hospitals with administrative staff who are members of the Institutional Review Board (IRB) administrative staff subcommittee with in Korean Association of Institutional Review Boards (KAIRB). Additionally, face-to-face interviews were conducted with 7 pediatricians/pediatric neurologists. Survey and interview responses were summarized using descriptive statistics. Results: Out of the 141 institutions surveyed, 35 institutions (24.8%) responded. Among them, 30 institutions (85.7%) reported having age criteria for acquiring pediatric assent forms in the case of children. The age range for pediatric assent acquisition have been from 7 years old to 12 years old (15 institutions, 50%), and from 7 years old to 15 years old (7 institutions, 23.3%). Nine institutions (25.7%) have had criteria for obtaining both parents' consent in cases involving the participation of children. Nineteen institutions (54.3%) have had checklists or guidelines available for use by IRB members in study protocols involving vulnerable research subjects. Three pediatricians/pediatric neurologists have believed that upper-grade elementary school students (5th-6th grade) could comprehensively understand informed consent forms. Two have believed that middle school students would be able to understand them if they included personal information. Two pediatricians/pediatric neurologists have believed that even lower-grade elementary school students (1st-4th grade) could understand the explanations if they were made simpler. Conclusion: It is suggested that not only elementary school students (7-12 years old) but also middle school students (13-15 years old) should receive pediatric assent forms, as it would facilitate a comprehensive understanding of the forms. To enhance the comprehension of assent form content, it is necessary to use age-appropriate words, language, and expressions in the forms hospital. It is also recommended to create comics or videos to make the content of the assent forms more accessible for children.

• Journal of Sleep Medicine
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• 제15권2호
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• pp.37-42
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• 2018

Objectives: To assess the effect and safety of transcranial direct-current stimulation (tDCS) in primary chronic insomnia. Methods: A one-month, double-blind, randomized, sham-controlled trial was performed. A total of 7 patients with primary chronic insomnia received tDCS using anodal (n=3), cathodal (n=2), or sham stimulation (n=2). They were followed up at 1 week and 1 month after treatment. The primary outcome measures included improvement in total sleep time (TST), sleep latency (SL), and sleep efficiency (SE) at 1 month follow-up. Results: TST and SE were improved with tDCS at 1 month follow-up in all patients (100%) of the anodal group, one (50%) of the cathodal group, and one (50%) of the sham group. tDCS improved SL at 1 month follow-up in two patients (67%) of the anodal group, one (50%) of the cathodal group, and none (0%) of the sham group. With respect to adverse events, transient itching sensation occurred in one patient of the anodal group. None of the other groups reported adverse events. Conclusions: Our results suggest that tDCS may be effective and safe for treatment of primary chronic insomnia. A larger controlled study needs to be further investigated.

• 임상간호연구
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• 제17권3호
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• pp.421-432
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• 2011

Purpose: The purpose of this study was to investigate the sleep patterns and the factors related to sleep disturbance in mechanically ventilated patients in intensive care units (ICUs). Sleep patterns in this study included both quality and quantity of sleep. Methods: Forty-four subjects were recruited in ICUs at a tertiary university hospital in D city. Data were collected using questionnaires, observation, and medical record from June, 2008 to May, 2009. Results: The total mean of sleep quality was $1.99{\pm}1.68$. The mean of total sleep time per 24-hour period was $3.75{\pm}1.94$hour (range 1-7.25) in mechanically ventilated ICU patients. The main sleep disturbance factors were listed as frequent nursing activities, attachment of medical appliances, and noise. All these factors were also significantly related to the sleep quality. Conclusion: These results indicated that mechanically ventilated patients were both qualitatively and quantitatively deprived of sleep far more than other ICU patients. In summary, a deeper understanding of sleep characteristics in mechanically ventilated ICU patients could help nurses to improve sleep derangements and patient outcome.

• 임상간호연구
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• 제16권3호
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• pp.39-50
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• 2010

Purpose: The study was done to examine the development and effects of horticulture therapy on quality of sleep and immune function in patients in hospice units. Methods: The participants in this study were hospice patients in D hospital in D city. Thirty hospice patients were assigned to the experimental group, thirty to the control group. Data were collected from April 29 to July 26, 2009. The horticulture therapy program consisted of indoor and outdoor horticultural activities. The horticulture therapy was conducted for 30 minutes, 6 times a week for 3 weeks (a total 18 times). Measures were quality of sleep, and immune function by serum T-cell, NK-cell count. Data were analyzed using descriptive statistics, chi-square test and t-test with SPSS/WIN 13.0 version. Results: Patients in the experimental group receiving horticulture therapy had a significant difference in changes in the quality of sleep compared to the control group. There were also a significant difference in changes in the immune function (serum T cell and serum NK cell) between the experimental group and control group. Conclusion: The study results indicate that horticulture therapy developed for hospice patients is an effective, palliative intervention program to improve the quality of sleep and immune function of hospice patients.

• 임상간호연구
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• 제15권1호
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• pp.123-132
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• 2009

Purpose: This study was conducted to identify the effects of provision of a cancer pain guideline and education for patients with cancer and their families on their knowledge and attitude toward cancer pain control. Method: A nonequivalent control group pre-post test design was used. The participants were selected according to a selection criteria from patients and their families on the medical ward at K university hospital in D city. Both the experimental group for patients with cancer and control group consisted of 16 patients and their families. Results: The first hypothesis, which assumed that there was a difference between the patients in the experimental group and the control group on knowledge (t=-20.006, p=.000) and attitude (t=-13.492, p=.000), was accepted. The second hypothesis, which assumed there was a difference between families in the experimental group and the control group on knowledge (t=-16.087, p=.000) and attitude (t=-10.262, p=.000), was supported. Conclusion: Education for cancer related pain control with a patient guideline had a positive effect on knowledge and attitude of patients with cancer patients and their families suggesting that there is a need to developed this type of guidelines.

• 의료커뮤니케이션
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• 제13권2호
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• pp.217-221
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• 2018

Background: There are practical difficulties to show exact clinical symptoms such as seizure to medical students at Clinical Performance Examination (CPX). We developed a new CPX case of child's seizure on video using smartphone. Methods: A total of 356 $4^{th}-year$ students of five universities in Daegue-Gyeongbuk and Gyeongnam area took the clinical skill examination from June $13^{th}$ to $17^{th}$ in 2016. Among them, 72 students took the new CPX case in June $15^{th}$ and 71 students filled out the questionnaire on whether the new CPX with smartphone video is helpful, authentic, difficult, and necessary for other CPX. All the questions were measured on 5-Likert scale. Results: Mean score of the new CPX was 57.1, lower than the mean scores of the other 11 CPX cases, 62.8. For the question "Smartphone videos helped to solve the problem", 45 students (63.4%) answered 'Very much'. For the question "Is it realistic compared to other questions?" 30 students (42.3%) and 25 students (35.2%) answered 'Very much' and 'Much'. For the question "Is it difficult compared with other questions?" 18 students (25.4%) and 26 students (36.6%) answered 'Very much' and 'Much'. As for the question "I would like to have more tests using smartphone video", 26 students (36.6%) answered 'So and so'. Conclusion: A majority of students responded that video presentation was helpful and authentic to figure out the CPX, whereas they assessed smartphone video was more difficult compared with other CPXs. Further, students were negative toward using smartphone video for the other CPXs.

• Clinical and Experimental Pediatrics
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• 제46권6호
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• pp.572-575
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• 2003

목 적 : 알레르기성 자반증 환아에서 상부위장관 내시경 소견을 관찰하고, 또한 위장관 증상이 있는 환아와 없는 환아에서 상부위장관 내시경 소견의 차이가 있는지 보고자 이 연구를 시행하였다. 방 법 : 1996년 9월부터 2002년 10월까지 계명대학교 동산병원 소아과에 입원하였던 알레르기성 자반증 환아 중 위장관내시경 검사를 실시한 65명을 대상으로 하였다. 위장관 증상의 유무에 따른 내시경 소견을 비교 관찰하였으며 피부 병변 3일 전부터 퇴원까지의 기간 동안 복통, 구토, 위장관 출혈, 설사 등의 증상을 기록하여 위장관 증상의 유무를 판단하였다. 결 과 : 위장관 내시경을 시행한 65명 중 위장관 증상이 있던 환아는 53명이었고, 증상이 없는 환아는 12명이었다. 6-10세 연령군이 많았고 위장관 증상은 남아에서 그리고 증상으로는 복통과 구토가 많았다. 위장관 내시경을 시행한 65명 중 십이지장 점막에 이상 병변의 빈도가 가장 높았으며, 병변의 양상에 따른 빈도는 십이지장염 12명, 위염과 십이지장염 9명, 십이지장미란 6명, 위염 5명, 십이지장궤양 5명, 위궤양 2명, 결장미란 1명의 순으로 관찰되었으며 정상소견은 25명이었다. 증상이 있던 환아 53명 중 38명에서 그리고 증상이 없던 환아 12명 중 2명에서 위장관 내시경 소견상 이상 소견을 보였다. 결 론: 위장관 증상이 있는 알레르기성 자반증 환아에서는 내시경 검사를 시행하는 것이 병변의 진단과 치료에 도움이 되었으나 더 많은 예에서 연구가 필요하리라 생각된다.

• Clinical and Experimental Pediatrics
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• 제46권11호
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• pp.1112-1117
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• 2003

목 적 : 소아의 악성 종양에 대한 새로운 치료법의 개발로 환아의 생존 기간이 증가하는 추세에 있으나 이로 인한 신경계 합병증의 발생도 증가하고 있다. 저자들은 항암 치료를 시행한 소아 종양 환아에서 나타난 중추 신경계 합병증에 대한 임상 양상을 알아보고자 하였다. 방 법 : 1995년 1월부터 2002년 11월까지 동산병원 소아과에서 항암치료를 시행한 환아 중 신경계 합병증이 동반되었던 15례의 환아를 대상으로 그 임상상을 후향적으로 검토하였다. 결 과 : 전체 15례 중에서 방사선학적 검사로 원인 질환을 밝힌 경우는 모두 13례로 백질뇌병증이 7례, 무기질화 미세혈관병증이 4례, 뇌경색이 3례, 뇌출혈이 1례, 저산소성 허혈성 뇌증이 1례, 2가지 이상의 합병증을 함께 나타낸 경우는 2례였으며, 혈액학적 방사선학적 검사상에서 이상 소견이 없이 MTX의 부작용으로 생각되는 경련성 질환이 2례였다. 뇌출혈과 뇌경색이 나타낸 경우는 예후가 나빴으며 전해질 불균형으로 인한 저산소성 허혈성 뇌증에서는 원인 교정 후 후유증 없이 회복되었다. 결 론 : 소아 종양 환아에서 치료 중 발생한 신경계 합병증은 질환의 예후에 큰 영향을 미치고 신경인지 발달에 장애를 남기므로 이들 합병증에 대한 예방, 진단 및 즉각적인 치료와 추적관찰이 필요할 것이다.