Vancomycin Resistant Enterococci에 대한 Chloramphenicol의 항균력과 Angelica gigas Nakai Extract의 Chloramphenicol 골수독성 경감에 대한 연구

이현주 경성대학교 임상약학보건대학원 2018 국내석사

1928년 영국의 플레밍이 페니실린을 발견하였고, 2차 세계대전 중이던 1943년 미국에서 페니실린 대량생산에 성공한 후 인류는 세균성 질병으로부터 수명 연장이라는 획기적인 성과를 거두었다. 하지만 무분별한 항생제 사용에 따른 주요 미생물의 항균제 내성 증가와 다제내성균에 의한 감염은 최근 전세계적 문제로 대두되었다. 1940년대 페니실린 대량생산 1년 후 페니실린 내성 황색 포도상구균(PRSA)이 출현하였고, 1950년대에는 PRSA 내성률이 60% 이상으로 증가하였다. 포도상구균은 페니실린 분해효소를 생산하여 베타람탐 고리를 가수분해 함으로써 페니실린 내성을 보였고, 1960년 페니실린 분해효소에 의해 가수분해 되지 않는 반합성 페니실린인 Methicillin이 개발되었으나 1961년 메티실린 내성 황색 포도상구균(MRSA)도 출현하였다. 1956년 개발되었지만 불완전한 정제와 부작용으로 사용량이 적었던 Vancomycin을 MRSA 감염 치료에 사용하게 되었고, 1970년대 MRSA의 증가와 함께 Vancomycin의 사용량 또한 증가하였다. 1986년 유럽에서 처음 VRE가 출현한 후 1989년 미국, 1992년 한국에서 VRE가 보고되었고, 이 후 VRE 보고율은 지속적으로 증가였다. 2015년 한국의 종합병원 항균제 내성률에서 MRSA 61%, VRE 34%가 보고되었고, 중소병원, 의원, 요양병원으로 널리 전파되어 현재 국내 토착화된 양상을 보이고 있다. VRE 감염에 사용하던 Linezolid, Quinupristin/Dalfopristin 약물 내성 또한 증가하고 있어 치료 약제 선택에 어려움이 있다. 내성균 감염을 효과적으로 치료하기 위해 새로운 항생제를 개발하면 좋겠지만 신약 개발에는 막대한 시간과 비용이 소모된다. 신약 개발보다 빠른 내성균 출현으로 출시 후의 기대 수익이 떨어져 투자비용 회수도 어려운 상황이라 제약사는 소극적으로 대처하고 있다. 이에 70년 전에 개발된 고전적인 약물이지만 골수독성 부작용으로 최근 임상사용이 제한되었던 Chloramphenicol을 VRE 감염 치료에 사용하고자 본 연구를 진행하였다. 또한 한의원에서 Agnex(참당귀 정제추출물) 투여 후 혈소판이 증가했다는 임상 사례에 착안하여 Agnex를 병용 투여하여, Chloramphenicol 투여에 따른 골수독성 경감 정도를 관찰하고자 하였다. 첫번째, 경성대학교 약학대학 미생물실에서 연구 목적으로 보관중이던 VRE 5주를 배양하여, Vancomycin 내성 pattern을 확인하였고, MIC TEST를 통해 VRE 5주의 Chloramphenicol 감수성을 평가하였다. 두 번째, female BALB/c mice에 Chloramphenicol을 투여하여 골수 독성을 유발하였다. 대조군에는 Chloramphenicol, 실험군에는 Chloramphenicol과 Agnex를 병용 투여하였다. Chloramphenicol 투여 5일째, 대조군의 67%가 사망한 반면 실험군은 전체 생존하여 Chloramphenicol 독성실험은 종료하였다. 이 후 생존한 실험군에서 Agnex의 Chloramphenicol 유발 골수독성 경감 정도를 평가하는 실험을 동일한 약물 용량으로 7일간 진행하였다. 하지만 1회 투여 익일 Chloramphenicol을 투여했던 1마리가 사망하면서 남은 실험군은 Chloramphenicol 투여를 중단한 채 Agnex만 투여하였다. 전체 실험 마지막 날 Bradford 법으로 혈중 단백량을 정량하였고, CBC 혈액 분석 결과를 비교하였다. VRE 5주에 대한 Chloramphenicol 감수성 TEST 결과 모두 128 ㎍/ml 이하의 감수성을 보였다. 동물 실험에서 Chloramphenicol 투여 후 사망한 쥐에서 단백량의 절대적 감소가 관찰되었고, Agnex 투여군의 단백량 보존과 혈소판 증가 효과를 확인하였다. Agnex 투여는 Chloramphenicol 고용량 투여에 의한 단기 독성을 상쇄함에 도움이 된다고 사료되었다. 본 미생물실의 선행 연구에서 Agnex 투여로 WBC 증가를 확인한 바 있다. VRE 감염 치료에 Chloramphenicol 투여를 고려할 수 있고, Chloramphenicol의 부작용을 개선하기 위해 Agnex를 이용할 수 있으며, Chloramphenicol을 개량신약 형태로 개발한다면 다제내성균 치료의 새로운 option이 되리라 사료된다. 본 연구는 고용량의 Chloramphenicol 투여에 따른 골수독성과 Agnex 투여 효과를 단기간 연구한 것이므로 저용량, 장기간 투여에 대한 후속 연구도 필요할 것으로 사료된다.

수용전념치료 프로그램이 대졸 신입사원의 분노반추, 직무소진 및 수용행동에 미치는 효과

최혁재 경성대학교 임상약학보건대학원 2017 국내석사

he purpose of this study was to verify the effects of Acceptance and Commitment Therapy program on the anger rumination, job burnout and commitment action especially in new comers who have graduated from university and have been working for less than one year. In order to achieve the purpose of the study, Acceptance and Commitment Therapy was readjusted and then conducted for new comers in A Company located in Kyeongnam province, All 32 members were interested in this program, but during pre-orientation, 6 among 32 persons withdrew their interest, so finally 26 persons have joined after pre-orientation. The objects were divided into two parts of 14 members and 12 members considering their working condition & hope ; an experimental group 16 and a control group 12, respectively. And then the experimental group participated in a program in 8 sessions, and each session was conducted once a week for 110 minutes. In contrast, any action was not taken for the control group. To verify the effects of the program, the nonequivalent control group pretest-posttest design was applied to the selected experimental and control groups in order to prove the effectiveness of the program. The SPSS 22.0 was used for the statistical process of the results and the analysis of covariance(ANCOVA) and multi-covarianceMANCOVA) with statistical methods was calculated to verify the hypothesis of the study. In addition, for more detailed information, the content analysis was performed in parallel to complement the quantitative research of the statistical analysis analyzing the effect which are based on checking on the each experience reports and program evaluations results which participants had submitted during program session. The findings of the study were as follows: First, the experimental group that participated in the acceptance and commitment therapy program made better improvement in anger rumination than the control group that didn't. Second, the experimental group that participated in the acceptance and commitment therapy program showed more improvement in job burnout than the control group that didn't. Third, the experimental group that participated in the acceptance and commitment therapy program showed better improvement in commitment action than the control group that didn't. The findings of the study illustrated that the Acceptance and Commitment Therapy program was effective at reducing the anger rumination, job burnout and at enhancing commitment action of the university graduated new employees. Limitations to the current study and recommendations for future research are discussed. Keywords : Acceptance and Commitment Therapy Program, New Employees, Anger Rumination, Job Burnout, Commitment Action.

유아의 기질, 부모의 기질 및 성격과 어머니의 양육태도가 유아의 문제행동에 미치는 영향

배문경 경성대학교 임상약학보건대학원 2018 국내석사

본 연구의 목적은 부모의 기질 및 성격과 양육태도가 유아의 문제행동에 어떠한 영향을 미치는지 살펴보고자 하였다. 부산지역의 유치원 5곳의 5, 6, 7세 유아와 그 부모를 대상으로 520부의 설문을 실시하였으며, 최종 연구에 사용된 자료는 251부이다. 유아의 기질을 측정하기위해 J-TCI 3-6을 사용하였으며, 부모의 기질 및 성격을 측정하기위해 TCI-RS성인용을 사용하였다. 양육태도를 알아보기 위해서는 Schaefer의 MBRI를 이원영이 수정, 번안 한 척도를 사용하였으며, 유아의 문제행동을 확인하기위해 ASEBA의 K-CBCL 1.5-5를 사용하였다. 내재화 문제행동과 외현화 문제행동에 대한 상관과 단계적 회귀분석을 실시한 결과 유아의 내재화 문제행동에는 부정적 양육이 정적으로, 긍정적 양육이 부적으로 높은 영향력을 보였다. 유아의 외현화 문제행동에는 아버지의 자기초월과 어머니의 자율성이 높은 영향력을 나타냈으며, 부정적 양육과 아버지의 사회적 민감성 역시 의미 있는 영향력을 보였다. 또한 문제행동을 잠재적 계층분석을 한 결과 문제행동이 낮은 집단과 문제행동이 높은 집단으로 선정되어, 그 두 집단을 대상으로 주요 변인(부모의 기질 및 성격과 양육태도)에 대한 t검정을 실시하였다. 그 결과 문제행동이 높은 집단에서 부정적 양육이 더 높고, 긍정적 양육은 낮은 유의미한 차이를 나타내며, 기질 및 성격이외에도 양육태도의 중요성을 나타냈다. 본 연구의 의의는 문제행동에 미치는 주요 변인이 기질 이외에도 성격의 영향력을 확인하였으며, 양육태도 역시 성격만큼이나 중요한 변인으로써 부모 교육 등의 유아의 문제행동 예방의 시사점을 제시하였다.

대학생의 기질 및 성격과 진로준비행동의 관계에 있어서 사회적 지지와 진로결정자기효능감의 매개효과 : 사회인지진로이론의 관점에서

구정선 경성대학교 임상약학보건대학원 2019 국내석사

The purpose of this study was to examine the mediating effects of perceived social support and career decision-making self-efficacy on the relation between personality and career preparation behaviors in college students. 268 four-year-collage students (109 meal, 159 female) in Busan Metropolitan area were recruited. The Temperament and Character Inventory(TCI), Career Preparation Behavior Scale, Perceived Social Support Scale, Career Decision-Making Self-Efficacy Scale were used. The results of the study were as followed; first, Novelty Seeking (NS) did not influence on perceived social support, career decision-making self-efficacy and career preparation behaviors. Second, Harm Avoidance (HA) negatively influenced on perceived social support, career decision-making self-efficacy and career preparation behaviors. Third, Reward Dependence (RD) and Self-Transcendence (ST) positively influenced on perceived social support in low-grade college students. Forth, Persistence (PS) and Self-Directedness (SD) significantly influenced on perceived social support, career decision-making self-efficacy and career preparation behaviors. Fifth, Cooperativeness (CO) influenced on perceived social support, influenced on perceived social support influenced on career decision-making self-efficacy and career decision-making self-efficacy influenced on career preparation behaviors.

근전도를 이용한 최대 수의적 등척성 수축의 측정 시 영향을 미치는 요인에 대한 분석

조맑은 경성대학교 임상약학보건대학원 2016 국내석사

It is well known that maximal voluntary isometric contraction(MVIC) is one of the normalization methods of electromyography(EMG). The %MVIC can be influenced by a number of factors, including gender, age, condition of patient, muscle fatigue, presence of synergists, activation of trunk muscles, and body stability. In particular, %MVIC can be affected by external factors, such as different body position, ventilation condition, and presence of auditory stimulation. The purposes of this study was to verify the effect of these factors on the %MVIC of biceps brachii(BB). Twenty healthy subjects performed MVIC of BB to standing, sitting and supine positions. For each posture, MVIC was performed under three different ventilation conditions : inspiration after maximum expiration, expiration after maximum inspiration, and the valsalva maneuver. For each condition, MVIC was performed both with and without the presence of auditory stimulation. Surface EMG(Noraxon DTS, Germany) was used for the measurements. The results showed that the auditory stimulation and the different positions led to changes in the %MVIC of BB. The %MVIC of BB showed greater activation when sitting than when supine(p<.05). Also, the %MVIC of BB indicated greater activation with auditory stimulation than without auditory stimulation(p<.05). However, there was no significant difference(p>.05) in the BB based on the ventilation conditions. Both body position and auditory stimulation significantly affected the %MVIC of BB. Therefore, it is important that the same positions and auditory stimulation be utilized to facilitate maximal muscle activation for all subjects the during measurement of MVIC for a normalization during EMG.

국내 대학병원에서의 Rivaroxaban 처방 적정성 평가

이수연 경성대학교 임상약학보건대학원 2014 국내석사

어깨 가쪽돌림 시 목의 돌림 방향에 따른 등세모근의 근활성도 비교

신용욱 경성대학교 임상약학보건대학원 2020 국내석사

The purpose of this research is to examine the effect of the direction of neck rotation on the muscle activity and the rate of upper trapezius and lower trapezius during shoulder external rotation. Based on three different neck rotation directions (ipsilateral direction, neutral direction, and contralateral direction), 31 adults’muscle activity and rate of upper trapezius and lower trapezius are analyzed. By following the tester’s commands performed on a therapeutic table, the subjects of this research externally rotated their shoulder with shoulder abduction 90°and elbow flexion 90°in three different neck directions. The posture was maintained for five seconds and repeated three times for each different neck rotation direction. To minimize muscle fatigue, 60-seconds of rest was provided before the repetitive measurements in same task, and 10-minutes of rest was offered before starting a new test. Repeated measures ANOVA is used for statistical analysis. The results are as follows. In upper trapezius, rotating the neck in the ipsilateral direction reduces the muscle activity of upper trapezius during external shoulder rotation in a prone position. Also, compared with neutral direction, the contralateral direction exhibits significantly increased muscle activity of upper trapezius. In lower trapezius, the muscle activity of lower trapezius increases more for the ipsilateral direction than the neutral direction during the external shoulder rotation in a prone position, but the difference is not significant whereas it is lower for the contralateral direction with a significance level of difference. As a result of comparing the rate of muscle activity of upper trapezius for lower trapezius, the rate of muscle activity of upper trapezius for lower trapezius significantly increases more for the ipsilateral direction than the neutral direction during external shoulder rotation. Compared with the neutral direction, the contralateral direction demonstrates a lower level of rate of muscle activity of upper trapezius for lower trapezius. Therefore, the rate of muscle activity of upper trapezius for lower trapezius significantly increased in the ipsilateral direction than the neutral and contralateral direction. To resolve the muscle imbalance caused by the over-activation of upper trapezius and the weakening of lower trapezius, this research indicates that the muscle activity of upper trapezius should be limited while selectively reinforcing lower trapezius. An effective intervention is to rotate neck in the ipsilateral direction during external shoulder rotation. Conclusionally, when a scapular is a mal-alignment caused by over-activation of upper trapezius and weakness of lower trapezius or when it is difficult to raise their arm in a prone position due to other pathological problems, an alternative solution is to rotate their neck in the ipsilateral direction during external shoulder rotation.

대학생용 성적자기주장 척도 개발 및 타당화

정진아 경성대학교 임상약학보건대학원 2016 국내석사

The purpose of this study was to sexual assertiveness scale for university students and to examine it's validity. Four research questions set up for the study were following: First, what are the constructs and the factors of preliminary questionnaire? Second, what are the constructs, the factors and the reliability of final questionnaire? Third, how is construct validity of the scale? Finally, how is concurrent validity of the scale? In order to solve the research question, the following methods were used for this study. To sexual assertiveness scale for university students, reviewing previous studies and various scholars' definitions and categories about sexual assertiveness of university students were examined. And then 185 questions were selected by analyzing the existing scales for sexual assertiveness for university students, and 117 questions were selected by analyzing individual interviews data of university students and counseling experts. As a result of this process, 117 questions were selected. Next the content validity about preliminary questionnaire was checked. First, the selected questions were constructed and reviewed by this researcher, two counseling psychology professor, and two master course students majoring in counseling psychology for the first content validity examination and 72 questions were selected as the first preliminary questions. Second, the 67 preliminary questions were reviewed by two counseling psychology professors, two master course students majoring in counseling psychology for the first content validity examination and 67 questions were selected as the first preliminary questions. Third, the 67 preliminary questions were reviewed by two counseling psychology professors, two master course students majoring in counseling psychology for the first content validity examination and 67 questions were selected as the first preliminary questions. Finally, students' understanding of questions was examined by 10 university students. As a result of this process, total 15 questions were selected the same as third content validity and once face validity. And, an exploratory factor analysis was made using the scales, which consisted of the final preliminary questions, for sexual assertiveness for university students. As a survey conducted on 326 students of university located in Busan and Gyeongnam, 67 questions were selected. As a result, scales for sexual assertiveness for university students, which were categorized into three sub-factors – Sexual communication, Sexual stereotypes, Positive sexual attitude. Finally, scales for sexual assertiveness for university students, which consist of three factors and 15 questions, were developed. As a result of test of reliability on 15 questions of finally selected scales for sexual assertiveness for university students, internal consistency (Cronbach's ⍺) showed good between .686 and .815 in three sub-factors and all the scales. In order to verify the construct validity and concurrent validity of scales for sexual assertiveness for university students, 574 students of university located in Busan, Daegu, Junju, Chungcheong, Seoul were surveyed. A confirmatory factor analysis and a correlation analysis were conducted related to the Sexual autonomy Scale, Sexual attitude Scale. The scales turned out good in every regard. As a result of the confirmatory factor analysis, CFI, TLI, SRMR and RMSEA were examined for sub-factors of scales for sexual assertiveness for university students, validity turned out generally good. In addition, the scale model of the internal structure of the convergent and discriminant validity check was good, respectively. As a result of concurrent validity, final questionnaire had a positive correlation with Sexual autonomy Scale while a negative correlation with Sexual attitude Scale. Based on the results, some conclusions can be drawn: First, preliminary questionnaire was set after reviewing previous studies, analyzing the existing scales and individual interviewing for university students. Also, content validity by experts on psychological counseling was examined and confirmatory factor analysis and verification of reliability were conducted. Through this process, final 15 questions including 3 factors (Sexual communication, Sexual stereotypes, Positive sexual attitude) were selected as sexual assertiveness scale for university students. Second, verification of construct validity (confirmatory factor analysis), concurrent validity (correlation analysis with Sexual autonomy Scale and Sexual attitude Scale) were conducted to verify validity. According to these results, sexual assertiveness scale for university students developed in this study turned out to be a valid questionnaire. In addition, the limitations of the study and possible follow-up projects are proposed in the conclusion section.

정서조절 프로그램이 따돌림 외상 청소년의 정서조절, 자아존중감 및 또래관계에 미치는 효과

변정은 경성대학교 임상약학보건대학원 2015 국내석사

The purpose of this study is to verify the effects of the Emotional Regulation Program carried out on the Bullying Trauma Youth; if it effects on their emotion regulation, self-esteem and peer relationships. In order to achieve such goal, this study carried out a screening inspection for the Bullying trauma youth in a J girls' middle school in Busan and asked 30 students of the top 20% for their will to participate in the program. Finally, the selected 14 students were divided into two 7 student groups assigned to an experimental and a control group. The Emotional Regulation Program was carried out for the experimental group for 10 times each 90 mins, whereas not a single treatment was applied to the control group. In order to verify the effectiveness of the program, pre-post test for the emotion regulation, self-esteem and peer relationships were carried out for both control group and experimental group. And by using SPSS / WIN +20.0 statistical programs, the mean and standard deviation for each scale were calculated. To verify the difference between the experimental and the control group, the analysis of covariance was performed putting the pre-test scores as a covariate. The results of this study are as follows. First, the emotion regulation for the experimental group after participating the Emotional Regulation Program was much improved than the control group not participated in the program. Second, the self-esteem for the experimental group after participating the Emotional Regulation Program was much improved than the control group not participated in the program. Third, the peer relationships for the experimental group after participating in the Emotional Regulation Program was much improved than the control group not participated in the program. According to the results of the study, it was clear that the Emotional Regulation Program which was made up for the Bullying Trauma Youth who had Unstable emotion regulation and low self-esteem and peer relationship help them ease their tension, understand the feelings of themselves as well as others and have the confidence of adapting these skills to peer relationships. 본 연구는 정서조절 프로그램을 따돌림 외상 청소년을 대상으로 실시하여 정서조절, 자아존중감 및 또래관계에 미치는 효과를 검증하는데 그 목적을 두었다. 이러한 목적을 이루기 위해 본 연구는 부산광역시 소재 J여자중학교 1학년 전체 학생을 대상으로 따돌림피해 학생판별 검사를 실시하여 상위 20%에 속하는 30명을 대상으로 프로그램 참가의사를 확인한 후 선발된 학생 14명을 최종 대상으로 선정하여 각각 7명씩 실험집단과 통제집단으로 배정한 후 한 회기마다 90분씩 총 10회기의 정서조절 프로그램을 실시하였다. 실험집단에는 정서조절 프로그램이 실시되었으며 같은 기간 동안 통제집단에 대해서는 아무런 처치를 가하지 않았다. 본 프로그램의 효과를 검증하기 위하여 실험집단과 통제집단의 정서조절, 자아존중감, 또래관계의 사전-사후검사를 실시하였고, SPSS/WIN+20.0 통계프로그램을 이용하여 각 척도별로 평균과 표준편차를 구하였다. 실험집단과 통제집단 간 차이를 검증하기 위해 각 집단의 사전검사 점수를 공변인으로 하여 두 집단 간의 사후검사 점수에 대해 공변량분석(ANCOVA)을 실시하였다. 이러한 연구절차를 통하여 나타난 본 연구의 결과는 다음과 같다. 첫째, 정서조절 프로그램에 참여한 실험집단은 참여하지 않은 통제집단보다 프로그램에 참여한 후 정서조절이 향상되었다. 둘째, 정서조절 프로그램에 참여한 실험집단은 참여하지 않은 통제집단보다 프로그램에 참여한 후 자아존중감이 향상되었다. 셋째, 정서조절 프로그램에 참여한 실험집단은 참여하지 않은 통제집단보다 프로그램에 참여한 후 또래관계가 향상되었다. 이와 같은 연구 결과에 비추어 볼 때, 본 프로그램은 따돌림 외상 청소년의 정서조절, 자아존중감 및 또래관계를 향상시키는 데 효과적인 프로그램임을 알 수 있다. 따돌림 외상 청소년의 불안정한 정서조절, 낮은 자아존중감과 또래관계를 고려하여 구성한 정서조절 프로그램을 따돌림 외상 청소년들에게 적용함으로써 자신과 타인의 감정을 이해하고 조절하여 자신감을 가지고 적극적으로 또래관계에 적응할 수 있는 역량을 갖도록 해줄 것이다.

중추신경계 손상 환자 보호자의 자아존중감과 삶의 질의 관계에서 우울의 매개효과

박상진 경성대학교 임상약학보건대학원 2015 국내석사

This study is to confirm the mediating effect of depression on the relation between self-esteem of central nervous system injury patients' caregivers and quality of life. For this study, self-esteem, depression and quality of life was conducted with 216 caregivers who were doing in M hospital and W hospital in Busan. And research model is as follow : depression as mediating variable in the relation between self-esteem and quality of life. Pearson's correlation analysis was conducted to find the relation in major variable, and multiple regression analysis was used to find the influence on variables. To find the mediation effects, this research used hierarchical regression analysis and the mediation effects was verified by Sobel Test. The findings of this study were as follows. First, self-esteem had significantly positive correlation with quality of life, self-esteem had significantly negative correlation with depression, and depression had significantly negative correlation with quality of life. Second, the research selected final model with partial mediating model. Depression mediated partly in the relation between self-esteem and quality of life. The conclusion of this research based on the result is that the meaningful relation was found among self-esteem, quality of life and depression, and depression was the major variable mainly being used as a key to raise quality of life. According to this study, it suggest a future study to develop a program for the management of depression. Limitations to the current study and recommendations for future research are discussed.