• 대한간호학회지
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• 제23권4호
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• pp.569-584
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• 1993

This study was done to verify validity of nursing diagnoses related to difficulty in respiratory function. First, content validity was examined by an expert group considering the etiology and the signs / symptoms of three nursing diagnoses - ineffective airway clearance, ineffective breathing pattern, impaired gas exchange. Second, clinical validity was examined by comparing the frequencies of the etiologies and signs / symptoms of the three nursing diagnoses in clinical case studies with the results of the content validity. This study was a descriptive study. The sample consisted of 23 experts (professors, head nurses and clinical instructors) who had had a variety of experiences using nursing diagnoses in clinical practice, and 102 case reports done by senior student nurses of the college of nursing of Y-university. These reports were part of their clinical practice in the ICU. The instrument used for this study was a checklist for etiologies and signs and symptoms based on the literature, Doenges and Moorhouse (1988), Kim, McFarland, McLane (1991), Lee Won Hee et al. (1987), Kim Cho Ja et at. (1988). The data was collected over four month period from May 1992 to Aug. 1992. Data were analyzed using frequencies done with the SPSS / PC＋ package. The results of this study are summarized as follows : 1. General Characteristics of the Expert Group A bachelor degree was held by 43.5% and a master or doctoral degree by 56.5% of the expert group. The average age of the expert group was 35.3 years. Their average clinical experience was 9.3 years and their average experience in clinical practice was 5.9 years. The general characteristics of the patients showed that there were more women than men, that the age range was from 1 to over 80. Most of their medical diagnoses were diagnoses related to the respiratory. system, circulation or neurologic system, and 50% or more of them had a ventilator with intubation or a tracheostomy. The number of cases for each nursing diagnoses was : · Ineffective airway clearance, 92 cases. · Ineffective breathing pattern, 18 cases. · Impaired gas exchange, 22 cases. 2. The opinion of the expert group as to the classification of the etiology, and signs and symptoms of the three nursing diagnoses was as follows : · In 31.8% of the cases the classification of etiology was clear. · In 22.7%, the classification of signs and symptoms was clear. · In 17.4%, the classification of nursing interventions was clear. 3. In the expert group 80% or mere agreed to ‘dysp-nea’as a common sign and symptom of the three nursing diagnoses. The distinguishing signs and symptoms of (Ineffective airway clearance) were ‘sputum’, ‘cough’, ‘abnormal respiratory sounds : rales’. The distinguishing sings and symptoms of (Ineffective breathing pattern) were ‘tachypnea’, ‘use of accessory muscle of respiration’, ‘orthopnea’ and for (Impaired gas exchange) it was ‘abnormal arterial blood gas’, 4. The distribution of etiology, and signs and symptoms of the three nursing diagnoses was as follows : · There was a high frequency of ‘increased secretion from the bronchus and trachea’ in both the expert group and the case reports as the etiology of ineffective airway clearance. · For the etiologies for ineffective breathing pat-tern, ‘rain’, ‘anxiety’, ‘fear’, ‘obstructions of the tract, ca and bronchus’ had a high ratio in the ex-pert group and ‘decreased expansion of lung’ in the case reports. · For the etiologies for impaired gas exchanges, ‘altered oxygen -carrying capacity of the blood’ and ‘excess accumulation of interstitial fluid in lung’ had a high ratio in the expert group and ‘altered oxygen supply’ in the case reports. · For signs and symptoms for ineffective airway clearance, ‘dyspnea’, ‘altered amount and character of sputum’ were included by 100% of the expert group. ‘Abnormal respiratory. sound(rate, rhonchi)’ were included by a high ratio of the expert group. · For the signs and symptoms for ineffective breathing pattern. ‘dyspnea’, ‘shortness of breath’ were included by 100% of the expert group. In the case reports, ‘dyspnea’ and ‘tachypnea’ were reported as signs and symptoms. · For the sign and symptoms for impaired gas exchange, ‘hypoxia’ and ‘cyanosis’ had a high ratio in the expert group. In the case report, ‘hypercapnia’, ‘hypoxia’ and ‘inability to remove secretions’ were reported as signs and symptoms. In summary, the similarity of the etiologies and signs and symptoms of the three nursing diagnoses related to difficulty in respiratory function makes it difficult to distinguish among them But the clinical validity of three nursing diagnoses was established through this study, and at last one sign and symp-tom was defined for each diagnosis.

• 한국산학기술학회논문지
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• 제14권5호
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• pp.2315-2321
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• 2013

본 연구는 혈류에 의한 조영제 peak time을 산출하는 새로운 방법을 개발하여 기존의 수식에 의한 부작용을 최소화 하고, 대체할 수 있는 새로운 검사법을 제시하고자 하였다. 시험적조영제주입법을 이용하여 CE MRA를 검사한 환자 127명을 대상으로, 기존의 수식에 의해 산출된 조영제 peak time이 조영제 주입 후 혈류에 의한 영상화 범위의 어느 뇌혈관 측정값과 일치하는지 각 뇌혈관의 조영제 inflow time과 peak time을 측정하였다. 연구결과, 유의수준 0.05에 대한 4개의 집단 간 차이가 존재하였으나 집단 1에서 수식에 의해 산출된 조영제 peak time과 S상 정맥동의 조영제 inflow time이 통계적으로 유의한 차이가 없어 일치하였으며, Bland Altman plot를 시행한 결과 일치도가 상당히 높은 것을 확인할 수 있었다. 따라서 본 연구의 혈류에 의한 새로운 방법을 적용한다면, 부작용 가능성을 최소화하고, 영상의 질은 유지하면서, 쉽고 빠르게 적용할 수 있어, 기존의 수식에 의해 산출된 조영제 peak time을 대체 할 수 있으리라 사료된다.

• 한국산학기술학회논문지
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• 제10권5호
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• pp.1126-1132
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• 2009

본 연구는 가정간호사의 표준간호중재를 개발하여 이를 근거로 각각의 진단과 연결된 중재를 분류하고 프로토콜을 전산화하여 사용함으로써 의료기관간, 또한 의료인간의 격차를 없애고 서비스의 질 개선에 도움을 주고자 시행하였다. 연구방법은 크게 가정간호 표준중재 개발과정과 개발된 가정간호 표준중재 프로토콜을 전산화하는 과정으로 나누었는데, 가정간호 표준중재를 개발하기 위하여 먼저, 국내외 가정간호사의 직무분석, 대상자 사정 프로토콜 개발, 대상자 진단 프로토콜 개발, 대상자 중재 프로토콜 개발의 4가지 연구내용으로 구성하였다. 개발된 가정간호 표준 중재 프로토콜을 전산화하는 과정으로, 크게 가정간호 정보시스템을 위한 전략수립과 가정간호 정보시스템의 분석, 설계, 운영 및 평가 등의 4개 연구내용으로 구성하였다. 개발된 프로그램은 P시에서 가정간호사업 실시 기관에 근무하는 가정간호사를 대상으로, 가정간호 정보시스템 매뉴얼을 사용하여 직접 시범, 교육하였다. 따라서 본 연구에서는 표준 가정간호중재에 속하는 구성요소를 가정간호정보조사지, 가정간호경과기록지, 가정간호경과요약서, 가정간호종결 요약서 양식에 포함될 수 있도록 개발하였으며, 표준 가정간호중재가 개발됨으로써 가정간호사업부서 간의 정보교환이 용이하고 기록의 누락 및 중복을 막을 수 있으며 EMR, HMR 개발시 병원용어의 표준화에 기여할 수 있을 것이다.

• 산경연구논집
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• 제10권3호
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• pp.73-83
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• 2019

Purpose - This study is to clarify the structural relationship between the direct supervisor and organizational commitment and organizational citizenship behavior through mediation of the Leader-member exchange (LMX) in the hospital organization, and to confirm the mediating effect of the LMX. Through this study, we will provide basic data on the aspects of HR to enhance organizational immersion and organizational civic behavior in hospital organizations, and present suggestions on academic contribution and effective organizational operation measures. Research design, data, and methodology - This study is to investigate the relationship between authentic leadership and OC and OCB of the organization member, which is proposed to secure more active and high competitiveness in the recent changing medical environment, with multi-regression and B&K(1986) method. For this purpose, 653 employees of senior hospitals in Seoul and Kyeong-In area were surveyed using structured questionnaires. Each questionnaire was composed of 7-point scale, and each hypothesis was testified by multiple leaner regression and by BK method for testifying mediator effect. Result - As a result of the analysis, it was found that the male and non-medical staff had higher recognition level than the medical staff in the LMX, organizational commitment and organizational citizenship behavior. In the senior management or more than 5 years' experience group, organizational commitment and organizational citizenship behavior were recognized higher than the group of subordinate managers. Second, authentic leadership has a positive influence on LMX, organizational commitment and organizational citizenship behavior, and LMX has a significant positive impact on organizational commitment and organizational citizenship behavior. In addition, as a result of analyzing LMX mediating effect in the relationship of authentic leadership and organizational effectiveness by BK method, LMX had partial mediating effects between authentic leadership and organizational citizenship behavior, and between authentic leadership and organizational commitment. Conclusion - Results of the study confirmed that all the members of the hospital organization that were lacking served as positive factors for the relationships of authentic leadership and LMX, and authentic leadership and organizational effectiveness. It is expected that the hospital organization will be able to suggest such as the organizational approach to expect high organizational effectiveness centering on authentic leadership ability as psychological capital.

• Molecules and Cells
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• 제40권8호
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• pp.567-576
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• 2017

The $Na^+/H^+$ exchanger is responsible for maintaining the acidic tumor microenvironment through its promotion of the reabsorption of extracellular $Na^+$ and the extrusion of intracellular $H^+$. The resultant increase in the extracellular acidity contributes to the chemoresistance of malignant tumors. In this study, the chemosensitizing effects of cariporide, a potent $Na^+/H^+-exchange$ inhibitor, were evaluated in human malignant mesothelioma H-2452 cells preadapted with lactic acid. A higher basal level of phosphorylated (p)-AKT protein was found in the acid-tolerable H-2452AcT cells compared with their parental acid-sensitive H-2452 cells. When introduced in H-2452AcT cells with a concentration that shows only a slight toxicity in H-2452 cells, cariporide exhibited growth-suppressive and apoptosis-promoting activities, as demonstrated by an increase in the cells with pyknotic and fragmented nuclei, annexin V-PE(+) staining, a $sub-G_0/G_1$ peak, and a $G_2/M$ phase-transition delay in the cell cycle. Preceding these changes, a cariporide-induced p-AKT down-regulation, a p53 up-regulation, an ROS accumulation, and the depolarization of the mitochondrial-membrane potential were observed. A pretreatment with the phosphatidylinositol-3-kinase (PI3K) inhibitor LY294002 markedly augmented the DNA damage caused by the cariporide, as indicated by a much greater extent of comet tails and a tail moment with increased levels of the p-histone H2A.X, $p-ATM^{Ser1981}$, $p-ATR^{Ser428}$, $p-CHK1^{Ser345}$, and $p-CHK2^{Thr68}$, as well as a series of pro-apoptotic events. The data suggest that an inhibition of the PI3K/AKT signaling is necessary to enhance the cytotoxicity toward the acidtolerable H-2452AcT cells, and it underlines the significance of proton-pump targeting as a potential therapeutic strategy to overcome the acidic-microenvironment-associated chemotherapeutic resistance.

• 한국콘텐츠학회논문지
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• 제19권5호
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• pp.331-341
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• 2019

본 연구는 외환위기 이후 소득계층별 보건의료비 지출이 가구소득 불평등에 미치는 영향과 그 변화를 확인하기 위하여 1996년부터 2016년도 가계소득조사를 활용하여 지니계수를 시계열적으로 산출하였다. 도출된 결과와 함의는 다음과 같다. 첫째, 외환위기 이후 가구 총소득 불평등은 연도별로 다소 변화는 있지만 지속적으로 심화되어 왔다. 둘째, 소득계층별 보건의료비 지출은 고소득층이 더 많이 지출하는 다소 불평등한 수준을 지속적으로 유지하고 있다. 셋째, 가구소득 불평등에 대한 보건의료비 지출의 영향을 평가하기 위하여 보건의료비 지출을 제외한 가구소득에 대한 지니계수를 산출한 결과, 총소득 지니계수 보다 그 값이 커져서 가구의 보건의료비 지출로 인하여 소득불평등이 심화되는 것으로 나타났다. 보건의료비 지출로 인한 가구소득 불평등 심화현상은 외환위기 이후 지속적으로 증가하는 경향을 보였다. 국민의료비 부담을 감소시키기 위한 목적으로 건강보험보장성 강화 등 노력이 지속적으로 이루어지고 있지만 소득불평등 해소에는 기여하지 못하는 것이다. 향후 저소득층의 의료비 지출 감소를 위한 보다 저소득층을 위한 선택적인 의료비 지원제도의 마련이 필요할 것이다.

• 의료법학
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• 제23권3호
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• pp.47-87
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• 2022

코로나19 감염병 확산으로 인해 비대면진료가 일시적으로 허용되었고 지속 필요성에 대한 공감대가 커지고 있다. 그러나 현행 「의료법」은 의사와 의료인 간의 원격의료만 허용하고 있다. 비록 법률해석을 통해 의사와 환자 간의 비대면진료가 허용된다는 의견도 있지만 전체적인 법률체계를 고려할 때 허용되지 않는 것으로 보는 것이 타당하다. 그럼에도 불구하고 과학기술의 발달과 감염병 출현 시기의 단축 등을 종합적으로 고려할 때 앞으로 대면진료만을 고집하는 것은 바람직하지 않다. 따라서 안전하고 효과적인 비대면진료가 이뤄질 수 있는 방안을 고민하고 제도화하는 것이 전략적으로 필요하며, 또 중요하다. 이를 위해 앞으로 논의되어야 할 법률적 쟁점들을 미리 살펴보는 것이 이 글의 목적이다. 비대면진료를 구체적으로 규율하기 위해서는 우선 비대면진료의 범위와 대상 질환 그리고 시행 주체가 명확해야 한다. 또한 비대면진료가 시행되기 위해서는 구조적으로 시설과 장비 기준이 마련되어야 하고 기능적으로는 해당 시설과 장비를 통해 의사와 환자가 적극적으로 소통하고 정보를 실시간 교환할 수 있어야 하고 비대면진료 과정에서 발생하는 정보를 보호하기 위한 관리체계가 구체적으로 마련되어야 한다. 이처럼 비대면진료를 시행하기 위해 새롭게 정비되어야 할 내용뿐만 아니라 비대면진료를 통해 발생할 수 있는 책임의 문제와 비용의 문제도 구체적으로 정리될 필요가 있는 법적 쟁점이다.

• Journal of Preventive Medicine and Public Health
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• 제34권3호
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• pp.269-276
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• 2001

Objectives : To evaluate the internal burden and hazardous effects associated with smoking in middle and high school students. Methods : We analysed urinary cotinine(U-cotinine) concentrations and the frequency of Sister Chromatid Exchanges (SCE). A comparison was done of U-cotinine concentrations and the frequency of SCE in peripheral lymphocytes across school levels (middle vs. high) and smoking types (direct: daily & occasional smoking, indirect; usual indirect & non-smoking), in 122 males. Results : The middle school student group comprised 6.8% daily smokers, 15.9% occasional smokers, 40.9% daily indirect smokers, and 35.4% nonsmokers, while the high school student group comprised 18.0%, 20.5%, 35.7%, and 21.8%, respectively. The U-cotinine concentration and the frequency of SCE among the middle school students were $79.11{\mu}g/l$ and 2.0 per cell, respectively, which were significantly lower than the $146.85{\mu}g/l$ (p=0.078) and 2.6 per cell (p=0.005) of the high school students. Among the 40 direct smokers, these two biomarkers were $236.66{\mu}g/l$ and 2.59 per cell, significantly higher than the $67.33{\mu}g/l$ (p=0.0001) and 2.1 per cell (p=0.003) among indirect smoking groups. The variation in individual U-cotinine concentration ranged widely in both the indirect and direct smoking groups. Conclusion : Urinary cotinine concentrations and the frequency of Sister Chromatid Exchange seem to objectively and effectively evaluate student exposure whether it was direct or indirect smoking. Consequently, these biomarkers may be useful in monitoring the objective efficacy of anti-smoking programs in adolescent populations.

• 한국환경과학회지
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• 제19권12호
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• pp.1343-1354
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• 2010

The purpose of the study was to analyze the persistence of HCH in atmosphere, soil, sediment and water of the western and southern regions of Korea. The samples from the western region were collected from Anmyeon Island, and the samples from the southern region were collected from Kimhae and Busan. The concentration of HCH isomers in atmosphere showed the pattern of $\alpha$-HCH>$\gamma$-HCH>$\beta$-HCH. The regions with high HCH concentration in the atmosphere are the regions that have been highly exposed to HCH used in the past, and the areas that have been influenced by the long range transport. The HCH that persists in the soil, water and sediment evaporates into the atmosphere, showing the characteristics of Air-Surface exchange. When the regional concentration distributions are compared, the concentration of HCH was higher in the atmosphere of a plain and the cities near the plain, than the urban areas. In this study, the ratio of $\alpha/\beta$-HCH was used as an indicator for estimating the source of Technical HCH and Lindane. According to the result, the contribution of Lindane was high in Kimhae plain and Kimhae urban areas. However, in Busan, the contribution of Technical HCH was higher than Lindane. In case of Anmyeon Island, the western region of Korea had high contribution from Tehcnical HCH. In soil and sediment, $\beta$-HCH was dominant. In water, $\gamma$-HCH was dominant among other isomers. Such results are due to $\gamma$-HCH inLindane. Furthermore, the source of $\gamma$-HCH in urban areas is assumed to be the use of medicine, medical supplies and other living supplies. Based on the results of this study, the management of HCH, a newly list up emerging POPs, should be strengthened by further research on sources, fate, persistency, accumulation and exposures and etc. to the risk assessments.

• 한국산학기술학회논문지
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• 제21권9호
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• pp.559-568
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• 2020

세포 분열 및 성장 촉진에 영향을 주는 상피세포 성장인자(Epidermal Growth Factor, EGF)는 다양한 의학적 용도를 갖고 있는 호르몬 단백질이다. 본 연구에서는 human EGF 유전자를 대장균 코돈에 최적화 하고 pRSET 벡터에 클로닝하여 발현벡터를 구축하였다. Human EGF를 봉입체가 아닌 활성이 있는 형태로의 과량 발현을 위해 코돈의 최적화와 더불어 최초로 샤페론 공발현이 시도되었다. 발현된 Native protein 형태의 재조합 human EGF는 고순도로 정제하기 위해 Ion Exchange Chromatography를 2번 연속적으로 수행하여 순수 분리 정제되었고, ELISA 분석결과 99% 이상으로 재조합 EGF의 활성도가 상업용 EGF와 유사하게 나타났으며, 세포증식시험 결과 인간 재조합 EGF는 인체 피부 섬유아세포의 세포증식을 촉진하는 것으로 확인 되었다. 본 연구의 인간 EGF 발현 시스템은 양적인 측면 뿐 아니라 성공적인 활성형태의 발현으로 추가적인 재접힘 과정 및 N 말단의 융합부분을 제거하기 위한 크로마토그래피 작업이 필요가 없다는 점에서 기존의 방법들에 대체 될 수 있는 효과적인 인간 EGF 발현 시스템을 제공하고 있다.