중증 외상환자에서 염기 결핍수치의 유용성

문준동,김수진,문철규,최성혁,전정민,이성우,홍윤식 대한응급의학회 2001 대한응급의학회지 Vol.12 No.3

Background: This study's objective was to determine the prognostic value of the base deficit measured in the emergency department(ED) and to determine whether base deficit can provide information not provided by advanced injury scoring system. Methods: This study was a retrospective analysis of data collected for two years. Thirty-two severe trauma patients who were admitted to the Emergency Department of Korea University Hospital were included in this study. The patients were divided into two groups: the normal base deficit group(-3 mmol/L to 3 mmol/L) and the elevated base deficit group(>3 mmol/L). The base-deficit value, age, sex, head injury, organ failure rate, and survival were considered, and the also Revised Trauma Score(RTS), Acute Physiology And Chronic Health Evaluation(APACHE II), and Injury Severity Score(ISS) were measured. Result: The elevated base-deficit group showed a lower survival rate and a higher organ failure rate compared to the normal base deficit group. Logistic Regression showed a strong association between base deficit and mortality rate. Among the previous injury scoring Systems(RTS, APACHE II, ISS), base deficit had the strongest correlation with RTS. By using base deficit value and the RTS together, we obtained a higher positive predictive value than that obtained by using base deficit or RTS alone. Conclusion: The admission value of the base deficit in the ED is a useful tool in predicting the outcome in severe trauma patients, and it can be an adjunct to previous injury scoring systems. As an advanced injury scoring System is developed in the future, the base deficit may have some significant role.

초등학교 교사들의 주목하기 분석: 강점 기반 프레이밍과 결점 기반 프레이밍을 중심으로

이수진,김리나,방정숙 대한수학교육학회 2025 수학교육학연구 Vol.35 No.2

교사가 학생의 수학적 사고나 문제해결 과정에 나타나는 오류뿐만 아니라 강점에도 주목하는 것은 중요하다. 하지만 기존의 노티싱 연구는 대개 학생의 수학적 결점에 주목하고 이를 교정하는 방향으로 이루어져 왔다. 이러한 배경으로 인하여 교사들이 학생들의 강점에 주목하는 것은 어려울 수 있지만, 교사가 학생의 수학적 사고를 어떻게 프레이밍(framing)하느냐에 따라 노티싱의 양상이 달라질 수 있으므로 교사는 학생의 수학적 사고의 강점과 결점 모두에 주목할 필요가 있다. 본 연구에서는 초등학교 교사들에게 강점 및 결점 기반 프레이밍에 따른 노티싱을 모두 경험하게 한 후, 이러한 경험이 이후 학생의 수학적 사고와 문제해결 과정을 주목하는 데 어떠한 영향을 미치는지 분석하였다. 특히 학생의 성취 수준에 따라 교사들의 프레이밍 양상에 어떤 차이가 있는지를 비교⋅분석하였다. 연구 결과, 교사들은 강점 및 결점 기반 프레이밍에 따른 노티싱을 경험한 후 비슷한 수준의 문제해결 결과지에 주목할 때 결점 기반 프레이밍은 유지하면서도 강점에도 함께 주목하려는 경향을 보였다. 또한 상대적으로 성취 수준이 높은 학생의 답변에 대해서는 결점에 더 주목하려는 모습이 나타났으며, 성취 수준이 낮은 학생의 답변에서는 칭찬할 만한 강점을 찾으려고 노력하는 경향이 나타났다. 교사들은 학생들의 정의적 측면에서 강점 기반 프레이밍에 따른 노티싱이 필요하다는 점에는 공감하였으나, 오답이 포함된 문제해결 결과지에서 칭찬할 만한 점에 주목하는 데는 어려움을 느꼈다고 밝혔다. 본 연구는 이와 같은 결과를 토대로 강점 및 결점 기반 프레이밍에 따른 노티싱 연구에 대한 시사점과 향후 연구의 방향을 논의하였다. Attending to students’ mathematical strengths is an important practice for teachers; however, it can be challenging given the prevailing emphasis on students’ deficits. While this background can make it difficult for teachers to attend students' strengths, it is important for teachers to attend both strengths and deficits in students' mathematical thinking, as noticing can be shaped by how teachers framing their students' mathematical thinking. In response, this study was designed to help elementary school teachers experience the process of noticing through both deficit-based and strength-based framing. We compared and contrasted how these two framings of noticing influenced the teachers’ subsequent attention to students’ mathematical thinking and problem-solving processes with different achievement levels. The findings indicate that after teachers experienced both deficit-based and strength-based framings, they tended to maintain a deficit-based orientation yet simultaneously recognized certain strengths in students’ solutions of comparable complexity. In addition, teachers tended to focus more on shortcomings in the work of higher-achieving students, while some sought commendable aspects in the work of lower-achieving students. Although teachers acknowledged the importance of a strength-based framing from an affective perspective, they found it difficult to identify praiseworthy elements in problem-solving results that contained errors. Based on these results, this study discusses implications for research on noticing and for the integration of both deficit-based and strength-based framings in mathematics education.

프레이밍 탐색을 통한 초등교사의 노티싱 능력 향상을 위한 비디오클럽 기반의 프로그램 개발 연구

김리나,이수진,방정숙 한국수학교육학회 2024 수학교육 Vol.63 No.4

교사는 학생의 수학적 사고에서 결점뿐만 아니라 강점에도 주목하고 해석하여 반응할 필요가 있고, 이는 교사의 노티싱 능력의 함양과도 연결된다. 본 연구의 목적은 강점 및 결점 기반 프레이밍의 탐색을 통하여 초등교사의 노티싱 능력을 향상시킬 수 있는 비디오클럽 프로그램을 개발하는 것이다. 이를 위해 준비, 개발, 검증 단계를 거쳐 강점 및 결점 기반 프레이밍으로 학생의 수학적 사고를 노티싱하는 일련의 과정, 즉 사전 활동, 8회에 걸친 비디오클럽, 사후 활동으로 구성된 프로그램을개발하였다. 사전 활동은 연구 참여자가 비디오 클립에서 드러난 학생의 수학적 사고를 주로 어떠한 프레이밍으로 노티싱하는지에 대한 정보를 수집하기 위해 설계되었다. 비디오클럽에서는 우선 강점 및 결점 기반 프레이밍의 개념에 대하여 학습하고 각각의 프레이밍으로 비디오 클립에 드러난 학생들의 수학적 사고를 노티싱하는 방법을 연습하게 하였다. 이어 다양한비디오 클립으로 강점 및 결점 기반 프레이밍에 대한 도식 또는 문장 틀을 활용하여 노티싱하는 방법을 경험하게 하였다. 사후 활동은 연구 참여자가 프로그램에서 학습한 내용을 전반적으로 어떻게 인식하는지 살펴보기 위한 내용으로 구성하였다. 이를 바탕으로 본 연구에서 개발한 비디오클럽 프로그램의 의의와 활용에 대한 시사점을 논의하였다 Teachers need to attend, interpret, and respond to students’ strengths as well as deficits in mathematical thinking, and this is also connected to improving teachers’ noticing abilities. The purpose of this study was to develop a video club based program to improve elementary teachers’ noticing skills by exploring strengths- and deficits-based framing. To achieve this purpose, we developed a program that went through a series of stages of preparation, development, and validation to notice students' mathematical thinking through strengths- and deficits-based framing, including a pre-activity, eight video club sessions, and a post-activity. The pre-activity was designed to gather preliminary information about the framing that the participanting teachers primarily used to notice the students’ mathematical thinking in video clips. The video club sessions were designed to inform participants about strengths- and deficits-based framing and to practice noticing students’ mathematical thinking in video clips using each framing approach. The sessions then used a variety of video clips to experience how to notice using schemes or sentence frames for strengths- and deficits-based framing. The post-activity was designed to explore the participants’ overall perceptions of the program and what they had learned. The paper concludes by discussing on the importance of the video club program developed and its implications for practice.

주의산만 아동의 주의집중력 향상을 위한 활동중심 미술치료 사례연구

복재현,김현정 사)한국아동발달지원연구소 2025 임상미술심리연구 Vol.15 No.1

이 연구는 주의산만 아동에게 활동중심 미술치료를 적용하여 회기별 언어행동 변화와 척도에서의 결과로 주의집중력 변화를 살펴본 사례연구이다. 연구대상은 초등학교 1학년 만 7세 남아 한 명이다. 연구는 총 16회기를 진행하였으며, 1회 50분 활동중심 미술치료를 개별로 진행하였다. 연구도구로는 축어록을 통한 회기별 언어행동의 변화를 분석하였으며, 아동·청소년행동평가척도(CBCL)척도를 사전과 사후에 실시하여 비교분석 하였다. 자료처리는 축어록에서, 평정자 1명 외 수퍼바이져 2인이 검토하여 의미있는 변화로 100%일치한 내용을 중심으로 기술하였다. 연구결과 연구대상은 활동중심 미술치료 프로그램 회기가 진행될수록 회기별 언어·행동변화에서 언어적 자기표현과 상호작용이 증가하였으며, 불안이 감소하는 것이 관찰되었다. 또한 미술활동시 과제집중 시간이 증가하였으며, 연구자의 지시와 대화에 집중하는 등 주의집중력이 향상된 모습을 보였다. 척도에 의한 결과 주의집중문제 영역이 임상범주에서 준임상범주로 변화하였고, 총 문제행동 및 외현화 문제행동이 감소하였다. 이 연구 결과의 내용을 토대로 연구의 의의를 논의하였다. This study is a case study investigating the effects of activity-based art therapy on improving attention in a child with attention deficit. The subject was a seven-year-old boy enrolled in the first grade of elementary school. The intervention consisted of 16 individual sessions, each lasting 50 minutes. Changes in language behavior were analyzed session-by-session using transcripts, while the Child Behavior Checklist (CBCL) was administered before and after the intervention to compare and evaluate changes quantitatively. For data validation, one evaluator and two supervisors reviewed the transcripts and described contents that showed 100% agreement regarding meaningful changes. The results revealed that, as the sessions progressed, the participant demonstrated increased verbal self-expression and interaction, along with a noticeable decrease in anxiety. Additionally, the duration of task-focused behavior during art activities improved, and attention to the researcher's instructions and conversations was enhanced. CBCL results indicated that the attention problems shifted from the clinical to the subclinical range, and both total problem behaviors and externalizing behaviors decreased. The significance of these findings is discussed in relation to the potential of activity-based art therapy as an effective intervention for children with attention deficits.

태아 저산소증의 생화학적 지표

박교훈 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.2

Perinatal asphyxia, whether prenatal, intrapartum, or neonatal is thought to be a significant contributor to newborn morbidity and mortality as well as long-term neurological deficits. Development of an intrapartum test that can reliably identify and discriminate between varying degrees of fetal acidemia and suggest whether it is respiratory or metabolic in nature would be highly desirable. Umbilical cord blood acid-base analysis may be used to assess the condition of fetus and newborn more objectively. Newborn acid-base status is an important criterion when we attempt to define perinatal asphyxia. It also has medicolegal ramifications because it enables the documentation of the presence of a biochemical milieu that is not related to the later development of cerebral palsy. Acidemia is defined as an umbilical artery pH value less than 7.2 because most studies have used this cutoff. However, this traditional level is probably too high. Recent studies suggest that the pH cutoff should be lower, perhaps as low as less than 7.0. We anticipate future research will focus on the redefinition of acidemia and its relationship to fetal and new-born outcomes.

외상환자에서 혈중 알코올이 염기결핍에 미치는 영향

강태경,류석용,조석진,오성찬,김성준,안지영,김홍용,이상래 대한응급의학회 2007 大韓應急醫學會誌 Vol.18 No.3

Purpose: Alcohol intake is commonly found in injured patients, and alcohol affects base deficit independently with trauma. The purpose of this study was to evaluate the effect of alcohol on base deficit in trauma patients. Methods: Data was retrospectively collected from trauma patients over 18 years of age who were admitted at the emergency center between October 2005 and July 2006. Blood sampling for alcohol level, base deficit evaluation were done within first hour for all patients. Patients were divided according to the serum alcohol level into an alcohol group(serum alcohol level10 mg/dl) and a non-alcohol group. The patients were also stratified into minor (ISS15) and major (ISS16) injury groups according to their injury severity score (ISS). Results: The study enrolled 63 patients of whom 37 fell into the alcohol group and 26 into the non-alcohol group. The mean alcohol level within the alcohol group was 210±85 mg/dl. Base deficit and serum lactate were not found to be significantly different in minor and major injuries, and ISS, base deficit were not significantly different with serum alcohol level. Base deficit was somewhat higher on average but not statistically significant in the non-alcohol group than in the alcohol group (-3.0±4.5 vs. -1.8±6.7 mmol/L, p=0.444). The base deficit was higher for the major injury-alcohol group than for the major injury-non-alcohol group, but this difference also did not achieve statistical significance (-4.6 ±5.8 vs -2.4±8.1 mmol/L, p=0.117) Conclusion: In the severely injured patients, base deficit appears to be increased with alcohol but we found no statistically significant differences in base deficit and ISS between alcohol group and non-alcohol group of injured patients.

외상환자의 초기 사망 예측 지표로서의 내원 초기의 염기 결핍, 젖산 및 강이온 차이의 유용성 비교

박경혜 ( Kyung Hye Park ),이강현 ( Kang Hyun Lee ),김선휴 ( Seon Hyu Kim ),오성범 ( Sung Bum Oh ),문중범 ( Joong Bum Moon ),김현 ( Hyun Kim ),황성오 ( Sung Oh Hwang ),김헌주 ( Heon Ju Kim ) 대한외상학회 2005 대한외상학회지 Vol.18 No.2

Purpose: Currently, there is a variety of systems available for predicting prognosis of trauma patients such as trauma score, Injury severity score (ISS) and acid-base variables. But it is not clear that the initial acid-base variables are predictors of prognosis in trauma patients at the emergency department. The objective of this study is to compare the base deficit, lactate and strong ion gap as an early predictor of mortality in trauma patients. Methods: Retrospective record review of 136 trauma patients needed to admit to intensive care unit via emergency department (June 2004 to February 2005). Data included age, injury mechanism, ISS, Revised trauma score (RTS), Multiple organ dysfunction score (MODS), Acute physiology and chronic health evaluation III (APACHE III), Glasgow coma scale (GCS), laboratory profiles, calculated anion gap and strong ion gap. Patients were divided into survivors and non-survivors, shock group and non-shock group with comparison by t-test; significance was assumed for p<0.05. Correlation between acid-base variables and mean arterial blood pressure (MABP) was evaluated. Results: There was a significant difference between the RTS (p=0.00), APACHE III (p=0.00), MODS (p=0.00), GCS (p=0.00) of survivors and non-survivors. There was no significant difference between the ISS (p=0.082), lactate (p=0.541), base excess (p=0.468) and SIG (p=0.894) of survivors and non-survivors. There was a significant difference between the RTS (p=0.023), APACHE III (p=0.002), lactate (p=0.000), base excess (p=0.000) and SIG (p=0.000) of shock and non-shock group. There was no significant difference between the ISS (p=0.270), MODS (p=0.442) and GCS (p=0.432) of shock and non-shock group. The base excess was most correlated to MABP (r2=0.150). Conclusion: Initial base deficit, serum lactate and SIG are not predictors of mortality in moderate to severe trauma patients. Initial base deficit, serum lactate and SIG are correlated with the mean arterial blood pressure in trauma patients in emergency department.

두부손상을 동반한 다발성 외상환자에서 중증도 평가지표로서 염기결핍의 유용성

김봉주 ( Bong Joo Kim ),강태경 ( Tae Kyung Kang ),최승운 ( Seung Woon Choi ),김혜진 ( Hye Jin Kim ),오성찬 ( Sung Chan Oh ),조석진 ( Suk Jin Cho ),류석용 ( Seok Yong Ryu ) 대한외상학회 2012 대한외상학회지 Vol.25 No.4

Purpose: The arterial base deficit and the serum lactate level are widely recognized indicators of injury severity, adequacy of resuscitation and outcome. The purpose of this study is to evaluate the usefulness of the arterial base deficit as an injury-severity indicator in multiple-trauma patients with head injuries. Methods: Data were retrospectively collected from trauma patients over 18 years of age who had been admitted at the emergency center between October 2005 and July 2006. The patients were divided into headinjury and non-head-injury groups. These patients were then sub-divided into minor (ISS≤15)-injury and major (ISS≥16)-injury groups according to their injury severity scores (ISS). We analyzed the differences in the base deficits and the serum lactate levels between the major- and the minor-injury sub-groups in both the head-injury and the non-head-injury groups. Results: In the non-head-injury group, we found statistically significant differences in the arterial base deficit between the major-injury and the minor-injury sub-groups(-6.86±2.40mmol/L vs. -1.37±0.73mmol/L, p=0.010). In the head-injury group, no significant differences were noted between the two sub-groups(-2.50±1.28mmol/L vs. -1.51±0.74mmol/L, p=0.897). Moreover, the differences in arterial base deficit between the major-injury and the minor-injury sub-groups were not significant both for either single-head-trauma or multiple-head-trauma patients (p=0.643 vs. p=0.832). Conclusion: We conclude that neither the arterial base deficit nor the serum lactate level can be used to predict injury severity in multiple-trauma patients with head injuries. (J Trauma Inj 2012;25:223-229)

내원 초기에 측정한 외상환자의 동맥혈 염기결핍의 유용성

이은헌 ( Eun Hun Lee ),최재영 ( Jae Young Choi ),최영철 ( Young Cheol Choi ),황성연 ( Seong Youn Hwang ) 대한외상학회 2006 대한외상학회지 Vol.19 No.1

Purpose: The arterial base deficit (BD) has proven to be useful in the evaluation and management of trauma patients. Indicators such as the Triage-Revised Trauma Score (t-RTS) and the systemic inflammatory response syndrome (SIRS) score have been used as triage tools for emergency trauma patients in Korea. The purpose of this study was to assess the usefulness of the initial BD in predicting injury severity and outcome in the trauma population. Methods: The medical records of 308 consecutive trauma patients admitted to the Emergency Center of Masan Samsung Hospital from January 2004 to December 2004 were carefully examined prospectively and retrospectively, and 291 patients were selected as subjects for this research. The SIRS score and the t-RTS were calculated based on the records from the emergency department, and the BD was calculated based on the arterial blood gas analysis obtained within 30 minutes of admission. The efficiency of the three indicators as triage tools was evaluated by using cross tabulations in two - by - two matrices and by using a receiver operating characteristic (ROC) curve analysis. Results: When the mortality was used as the outcome parameter, the sensitivity and the accuracy of the initial BD were higher than those of the SIRS score (p<0.05) and were same as those of the t-RTS. The areas under the ROC curves of the initial BD, the SIRS score, and the t-RTS were 0.740±0.087, 0.696±0.082, and 0.871±0.072, respectively (95% confidence interval). When emergency operation and blood transfusion requirements were used as outcome parameters, the comparisons of the sensitivities and the accuracies of the initial BD and the other two indicators showed the same pattern as mentioned above. The areas under the ROC curves of the initial BD were 0.7~0.8 and were larger than those of the SIRS score (p<0.05). Conclusion: The ability of the initial BD to predict injury severity and outcome was similar to those of the t-RTS and the SIRS score. Therefore, the authors suggest that the initial BD may be used as an alternative to previous triage tools for trauma patients. (K Korean Soc Traumatol 2006;19:67-73)

Genome-Wide Analysis Reveals Four Novel Loci for Attention-Deficit Hyperactivity Disorder in Korean Youths

Kukju Kweon,Eun-Soon Shin,Kee Jeong Park,Jong-Keuk Lee,Yeonho Joo,Hyo-Won Kim 대한소아청소년정신의학회 2018 소아청소년정신의학 Vol.29 No.2

Objectives: The molecular mechanisms underlying attention-deficit hyperactivity disorder (ADHD) remain unclear. Therefore, this study aimed to identify the genetic susceptibility loci for ADHD in Korean children with ADHD. We performed a case-control and a family-based genome-wide association study (GWAS), as well as genome-wide quantitative trait locus (QTL) analyses, for two symptom traits. Methods: A total of 135 subjects (71 cases and 64 controls), for the case-control analysis, and 54 subjects (27 probands and 27 unaffected siblings), for the family-based analysis, were included. Results: The genome-wide QTL analysis identified four single nucleotide polymorphisms (SNPs) (rs7684645 near APELA, rs12538843 near YAE1D1 and POU6F2, rs11074258 near MCTP2, and rs34396552 near CIDEA) that were significantly associated with the number of inattention symptoms in ADHD. These SNPs showed possible association with ADHD in the family-based GWAS, and with hyperactivity-impulsivity in genome-wide QTL analyses. Moreover, association signals in the family-based QTL analysis for the number of inattention symptoms were clustered near genes IL10, IL19, SCL5A9, and SKINTL. Conclusion: We have identified four QTLs with genome-wide significance and several promising candidates that could potentially be associated with ADHD (CXCR4, UPF1, SETD5, NALCN-AS1, ERC1, SOX2-OT, FGFR2, ANO4, and TBL1XR1). Further replication studies with larger sample sizes are needed.