• Title/Summary/Keyword: 장기적 순응도

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A Trend in Acquired Drug Resistances of Tuberculosis Patients Registered in Health Centers from 1981 to 2004 (1981년부터 2004년까지 보건소 재치료 결핵 환자의 항결핵제 내성률 추이)

  • Chang, Chulhun L.;Lee, Eun Yup;Park, Soon Kew;Jeong, Seok Hoon;Park, Young Kil;Choi, Yong Woon;Kim, Hee Jin;Lew, Woo Jin;Bai, Gill-Han
    • Tuberculosis and Respiratory Diseases
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    • v.59 no.6
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    • pp.619-624
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    • 2005
  • Background : The drug resistance rate in tuberculosis patients with history of chemotherapy is an important indicator of for evaluation of appropriateness of treatment regimens and compliance of patients. This study examined the long-term changes in the drug resistance rates among TB patients failed in treatment or reactivated. Methods : The results of drug susceptibility testing data from patients registered in health centers from 1981 to 2004 were analyzed. Results : The rate of resistance to isoniazid decreased from 90% to 20%, and the resistance to ethambutol decreased from 45% to 6%. The rate of resistance to rifampicin varied from 13% to 28% and the resistance to pyrazinamide was 5% to 10%. Multidrug resistance was about 2-3% lower than any rifampicin resistance rates. The second-line drug resistance was ranged from 1% to 3%. There was no difference between patients' genders. Patient numbers per 100,000 population increased with age. The regional distribution was even at 4-6 patients per 100,000 population, and drug resistance rates were significantly lower in big city areas than in small towns and rural areas. Conclusion : The rates of resistance of Mycobacterium tuberculosis isolated from TB patients with history of chemotherapy to isoniazid, rifampin, ethambutol, and isoniazid plus rifampin were significantly decreased during over two decades.

The Effects of Planned Discharge Nursing in Compliance, Knowledge, and Nursing Service Satisfaction for Patients having Video-Assisted Thoracoscopic Surgery (계획된 퇴원 간호 중재가 기흉 수술 환자의 약물복용 및 치료 지시 이행도, 질병에 대한 지식과 간호 만족도에 미치는 효과)

  • Lee, Won Jin;Bang, Yun Yi
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.20 no.11
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    • pp.121-129
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    • 2019
  • This study aimed to develop a planned discharge nursing intervention guideline for patients with pneumothorax, and to examine its influence on drug compliance, knowledge about disease, compliance level with therapeutic regimen, and nursing satisfaction. Methods: The planned discharge nursing intervention guideline was developed based on comprehensive literature reviews and clinical experiences. Patients having video-assisted thoracoscopic surgery at a single general hospital were allocated to either intervention (n=30) or control group (n=29). Participants in the intervention group were administered planned discharge nursing intervention thrice, 30 minutes each, by a cardiovascular nurse. Standard care was provided to patients in the control group. Data were collected from March, 2010 to December, 2010. Results: Participants in the intervention group presented statistically significant improvement in drug compliance (t=-2.05, p=0.044), pill count (t=-2.61, p=0.011), knowledge about disease (t=-4.39, p=0.001), and nursing satisfaction (t=-4.13, p=0.001). No significant difference in compliance levels was observed with standard therapeutic regimen. Conclusion: Planned discharge nursing intervention can be successfully implemented for patients undergoing thoracoscopic surgery. Further research is required to evaluate long-term effects like complication or relapse.

한국 가정과 교육과정의 현황과 과제

  • 윤인경
    • Proceedings of the KHEEA Conference
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    • 2002.08a
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    • pp.5-19
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    • 2002
  • 재한국, 1995년제일차출대국가제정적가정과교육과정. 지후, 한국적가정과교육과정경마료7차적수정여개혁과정. 재차과정중, 가정과정불단지추극출신, 기과목명칭재변화, 필수자선 등 선과성질야재변화, 과치함축, 여기술과정합. 이차, 가정과변위남녀생공수적과목, 저취순응료사회발전적수요. 종한국적교육과정래간, 1년급도10년급시국민공용기본교육계단, 11년급도12년급시자선교육계단. 거차, 가정과교육과정적접배위여하 : 소학(5~6학년)위실과, 중학화고중(7~10학년)위"기술.가정", 고중(11~12학년)위"가전과학". 장종2003년개시실시적가정과과시안배위여하 : 소학각2과시, 7~12학년시각2.3.3.3과시, 11~12학년위6개등차. 최근, 청소년문제, 교육환경, 상시인성, 가정파양, 소비과잉, 학대아동, 등사회문제도근가정생활유착밀절적연계, 인차, 재반지교육중, 가정교육응수중시. 단시, 실제상병불시여차. 작위교육주체적교사화부모도몰유인식도저개실정. 인차, 가정학자여교사유심요주근지거연구가정교육. 우기시, 유필요근중국, 일본, 등저사아주국가호상교류화합작적과정중거탐색가정교육적안정발전. 하면파미래가정학육발전적방향건의여하 : 1) "가정" 과시이가정과위연구대상적가정학적독립적연구요영역. 가정경적연구감상시 "가정", 타이가정생활질량적제고위기연구목적. 인차, 재가정교육중, 과목적명칭명명위 "기술. 가정", "가정일반". "가사" 시부합리적. 이응위 "가정" 2) 가정교육웅사중시성각색적변환, 직업적인직변고적각도출발, 사소학도고중분개위필수화선수과, 유남녀생공수. 3) 가정과과시재축점축단. 도시유우교육과정적축단이인기적피면불료적현상. 단시고 여가정과시실천, 실험성과목응보장기최저적과시, 최기마필수유지현재적과시. 4) 향래, 한국적가정교육과정기이가정과위기본철학배경화리념, 우급시파국가교육과정적배경화이념, 가정학적발전동태반영재교육과정중, 즉강조즘요교. 단시, 경력료반복적변혁지후, 최근, 각중시즘양거배양학생적십 요 양적능력여가치. 인차, 가정교육파교육목라방재즘루거제고가정생활적질량, 즘루거호조화가정생활화직업생활, 즘양거개발합리지해결화실천가정생활적가치관. 5) 최근, 가정교육파교육방향화목라방재거배양학생작위독립적개인, 작위가족적성원, 작위사회성원래주인생도로적능력. 인차, 가정교육이인적생활위중심. 우거섭급학생재성장과정중소우도적문제,재거포괄재가정화사회생활중소우도적문제. 즉거배양해결가정생활중소우도적소유적 문종적종합능력. 6) 가정과재교학방법화교학평개상, 응채용실험, 실습, 관찰 등방식, 응반체험성, 실천성경험. 위차, 응필편기험적실험, 실습설비. 7) 확정교육과정편제적치후, 응제고일반교육학자적참여율, 가정교육학자응적극참여 제정교청정책적유관교육적각종위원회. 재제정정책적과정중각진소능, 적극제출건고성적의황. 8) 한, 중, 일 삼국권원층립가정교육과정도작사, 위삼국교육과정적량호발전주공헌.

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Effects of Korean diet control nutrition education on cardiovascular disease risk factors in patients who underwent cardiovascular disease surgery (심혈관질환 수술을 받은 환자에서 한식식이조절 영양교육이 심혈관질환 위험요인에 미치는 영향)

  • Jung, Su-Jin;Chae, Soo-Wan
    • Journal of Nutrition and Health
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    • v.51 no.3
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    • pp.215-227
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    • 2018
  • Purpose: This study was conducted to verify the effects of increases in consuming Korean food in patients who underwent cardiovascular disease (CVD) surgery based on a Korean diet control education program and to investigate the effects of Korean diet control nutrition education on risk factors of CVD, changes in amounts of medication, and nutritional intakes. Methods: The subjects consisted of 15 patients who have undergone CVD surgery within three years and continuously taken cardiovascular drugs. The Korean traditional diet (KTD) emphasizes intake of vegetables and fermented foods to lower saturated fat and cholesterol intake. We applied a KTD education program that included a modified DASH (The dietary approaches to stop hypertension) diet for cardiovascular disease patients. Korean diet control education was then applied to the patients for 12 weeks to evaluate the risk factors of CVD and the state of nutritional intakes. Results: The Korean diet control compliance score increased significantly (p < 0.001) as Korean diet control education was implemented. Additionally, the obesity indexes, waist circumference (WC) (p = 0.002) and waist-to-hip ratio (WHR) decreased significantly (p < 0.001) after subjects received the education. Moreover, the glycemic control index, HbA1c, was significantly decreased (p < 0.05) from $7.3{\pm}1.0%$ before the education to $7.0{\pm}1.1%$ after the education. Changes in the amounts of Korean diet intake consisted of significant increases in cooked rice with whole grains, narmuls (vegetables either raw or cooked), kimchi, and traditional fermented foods following the education. Moreover, the nutritional intake after the education showed significant decreases (p < 0.05) in animal protein, animal lipids, and cholesterol. However, the intakes of Na, K, dietary fiber, vitamin A, vitamin $B_6$, vitamin C, and folic acid were significantly increased. Conclusion: The active encouragement of consuming Korean food and the intervention of implementing diet control education positively affected nutritional intake, the obesity index and glycemic control of patients who have undergone CVD surgery.

Anticoagulation Management after Mitral Valve Replacement with the St. Jude Medical Prosthesis (승모판치환 환자의 항응혈제 치료)

  • 김종환;김영태
    • Journal of Chest Surgery
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    • v.31 no.12
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    • pp.1172-1182
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    • 1998
  • Background: Primary goal of anticoagulation treatment in patients with mechanical heart valve is the effective prevention of thromboembolism and safe avoidance of bleeding as well. Material and Method: Two-hundred and nine patients with the St. Jude Medical prosthesis operated on between 1984 and 1995, for mitral(MVR 122), aortic(AVR 39) and double mitral and aortic valve replacement(DVR 48) respectively, were studied on the practically achieved levels of anticoagulation and the clinical outcomes. Patients were on Coumadin and followed up by monthly visit to outpatient clinic for examination and prothrombin time measurement to adjust the International Normalized Ratios(INRs) within the low-intensity target range between 1.5 and 2.5. Result: A total anticoagulation follow-up period was 1082.0 patient- years(mean 62.1 months) and INRs of 10,205 measurements were available for evaluation. The accomplished INRs among the replacement groups were not significantly different and only 65% of INRs were within the target range. And, in individual patients, only 37% of patients had INRs included within the target range in more than 70% of tests during follow-up period. The levels of INRs in patients with atrial fibrillation, which was found in 57% of patients, were definitely higher than the ones measured in patients with regular rhythm(p<0.001). Thromboembolisms were experienced by 15 patients with the incidence of 1.265%/patient- year(MVR 1.412%, AVR 0.462% and DVR 1.531%/patient-year) and major bleeding by 4 patients with the incidence of 0.337%/patient-year(MVR 0.424%, AVR none and DVR 0.383%/patient-year). Frequent as well as prolonged missing of prothrombin time tests was the main risk factor strongly associated with the thromboembolic complications(odds ratio 1.99). The proportion of INRs within target range of less than 60% in individual patient was the highly significant risk factor of both thromboembolic and overall embolic and bleeding complications(p<0.004 and p<0.002 respectively). Conclusion: In conclusion, the low-intensity therapeutic target range of INRs was adequate in patients with AVR and in sinus rhythm. However, the patients with replacement of the mitral valve were more likely to require higher target range of INRs, especially in the presence of atrial fibrillation, to achieve the practical levels of anticoagulation enough to prevent thromboembolic complications effectively. For the higher therapeutic target range of INRs between 2.0∼3.0, further accumulation of clinical evidences are required. It is highly desirable to improve the patients' compliance under continuous instructions in visiting outpatient clinic and in taking daily Coumadin without omission and to keep INRs consistently within optimal range with tight control for minimization of chances and of periods of exposure to the risk of complications. And, particularly, patients with high risk of complications and with wide fluctuation of INRs should be better managed with frequent monitoring anticoagulation levels.

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Preparation and Quality Characterization of Apple Jam with Rosa rugosa Thunb. Fruit (해당화 열매 첨가 사과잼 제조 및 품질 특성)

  • Kim, Mi-Hyun;Kim, Myung-Hee;Yun, Sun-Ju;Lee, Byung-Yong;Lee, Chang-Won;Kim, Bo-Ae;Jang, Ki-Hyo;Lee, Jae-Cheol;Surh, Jeong-Hee
    • Korean journal of food and cookery science
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    • v.26 no.4
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    • pp.367-380
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    • 2010
  • Various contents of Rosa rugosa Thunb. fruit(0, 10, 20%), which is grown along the seashore of Gangwon province, were applied to apple jams having different sugar concentrations(20, 40, 60%). The resulting jams were analyzed using a sensory scoring test as well as a response surface methodology to identify the optimum conditions for the preparation of high-preference apple jams. The sensory properties based on sense of sight, smell and taste appeared to be linked to the sugar contents. It could be attributed to the presence of flavor compounds and pigments generated from the caramelization of sugar molecules during heat processing. On the other hand, rheological properties such as viscosity and spreadability were associated with Rosa rugosa fruit content, which was also verified by textural analysis of the jams. As the contents of Rosa rugosa increased, the hardness, gumminess, and chewiness of the jams decreased, which eventually might have contributed to the less thick and thus more spreadable sensory characteristics. Sensory evaluation revealed that apple jams were preferred when prepared with $\leq$10% of Rosa rugosa fruit and $\geq$55% of sugar contents. In particular, apple jams containing 10% Rosa rugosa and 60% sugar showed better mechanical qualities as well as higher sensory preference among 10 jams formulated using central composite design.

Effectiveness of Public Credit Guarantee System and Its Coexistence with Market-based Finance Schemes (공적보증의 효과성과 시장기반 금융제도와의 공존)

  • Noh, Yong-Hwan;Hong, Jaekeun
    • The Journal of Small Business Innovation
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    • v.19 no.3
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    • pp.1-16
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    • 2016
  • Korean government had used public 'credit guarantee schemes' (CGS) as a counter-cyclical measure. However, it is still controversial about the effectiveness of policy financing on the SMEs. Criticism on policy financing involves the argument that supporting enterprises hampers competition and innovation of SMEs by increasing their dependence on the government and delays the exit of marginal firms. In this paper, we investigate how to effectively build up the rationale of running public CGSs. At the same time, we propose the ways to coexist of public credit guarantee and market-based private finance system for SMEs. First, CGS, as a counter-cyclical function, must coexist with the private financial system by compensating the market failure caused by pro-cyclical behavior of the private financial market. Second, CGS has the comparative advantages, compared to both the interest rate policy of the central bank and fiscal policy of the government. The credit guarantee is the symptomatic treatment that could revitalize the economy shortly by providing liquidity. Also, knowing that CGS is provided based on the leverage ratio defined by outstanding guarantee divided by capital fund, public 'credit guarantee' (CG) has an advantage that is free from the risk of government deficit. Third, the reason for existence of the CGS should be founded in supporting services for SMEs, available only in a public sector that is difficult to expect from private banks. In this regard, it is desirable to strengthen the publicness of credit guarantee over the support for start-ups, growing companies, the improvement of productivity, increase of exports, a long-term investment in facilities, the employment-creating businesses, and innovative enterprises.

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Results of Preoperative Concurrent Chemoradiotherapy for Locally Advanced Rectal Cancer (국소진행성 직장암의 수술 전 동시화학방사선요법의 결과)

  • Choi, Sang-Gyu;Kim, Su-Ssan;Bae, Hoon-Sik
    • Radiation Oncology Journal
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    • v.25 no.1
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    • pp.34-42
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    • 2007
  • [ $\underline{Purpose}$ ]: We performed a retrospective non-randomized clinical study of locally advanced rectal cancer, to evaluate the anal sphincter preservation rates, down staging rates and survival rates of preoperative chemoradiotherapy. $\underline{Materials\;and\;Methods}$: From January 2002 to December 2005, patients with pathologically confirmed rectal cancer with clinical stage T2 or higher, or patients with lymph node metastasis were enrolled in this study. A preoperative staging work-up was conducted in 36 patients. All patients were treated with preoperative chemoradiotherapy, and curative resection was performed for 26 patients at Hallym University Sacred Heart Hospital. Radiotherapy treatment planning was conducted with the use of planning CT for all patients. A total dose of $45.0{\sim}52.2\;Gy$ conventionally fractionated three-dimensional radiotherapy was delivered to the whole pelvis. Chemotherapy was given at the first and fifth week of radiation therapy with continuous infusion i.v. 5-FU (Fluorouracil) and LV (Leucovorine). Surgical resection was performed 2 to 4 weeks after the completion of the chemoradiotherapy regimen. $\underline{Results}$: The complete resection rate with negative resection margin was 100% (26/26). However, a pathologically complete response was not seen after curative resection. Surgery was done by LAR (low anterior resection) in 23 patients and APR (abdomino-perineal resection) in 3 patients. The sphincter preservation rate was 88.5% (23/26), down staging of the tumor occurred in 12 patients (46.2%) and down-sizing of the tumor occurred in 19 patients (73%). Local recurrence after surgical resection developed in 1 patient, and distant metastasis developed in 3 patients. The local recurrence free survival rate, distant metastasis free survival rate, and progression free survival rate were 96.7%, 87% and 83.1%, respectively. Treatment related toxicity was minimal except for one grade 3, one grade 4 anemia, one grade 3 leukopenia, and one grade 3 ileus. $\underline{Conclusion}$: Preoperative concurrent chmoradiotherapy for locally advanced rectal cancer seems to have some potential benefits: high sphincter preservation and down staging. Treatment related toxicity was minimal and a high compliance with treatment was seen in this study. Further long-term follow-up with a larger group of patients is required.

Concurrent Cisplatin-Radiation Therapy in Locally Advanced Head & Neck Cancers - Preliminary Report - (국소진행된 두경부종양의 Cisplatin-방사선 동시병용치료 - 예비적 임상결과보고 -)

  • Kim In Ah;Choi Ihl Bhong;Cho Seung Ho;Hong Young Seon;Choi Byung Ok;Kang Young Nam
    • Radiation Oncology Journal
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    • v.19 no.3
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    • pp.205-210
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    • 2001
  • Purpose : This study tried to evaluate the effectiveness of combined treatment using radiation therapy and concurrent cisplatin as a radiosensitizer in the management of locally advanced head and neck cancer. Materials and methods : From January 1995 to August 1998, 29 evaluable patients with locally advanced head & neck cancels (AJCC stage $II\~IV$) were received curative radiation therapy $(total\;70\~75.6\;Gy/35\~42\;fractions,\;1.8\~2\;Gy/fraction)$ and concurrent cisplatin chemotherapy ($100\;mg/m^2$, D1, D22, D43). The neck dissections were peformed for residual lymphadenopathy. Follow-up ranged from 5 to 55 months (median 24 months). Results : Twenty-one $(72.4\%)$ patients achieved clinical complete responses. The partial response and minimal response rates were $17.2\%\;and\;10.4\%$, respectively. Locoregional failure rate was $27.6\%$, and included 6 patients with local failures, 4 patients with regional failures, and 2 patients with combined local and regional failures. Four of 29 patients $(13.8\%)$ developed distant metastasis. The disease free survival rate at 3 years was $60\%$. Nasopharyngeal primary tumors or complete responders showed significantly higher disease free survival rate. The grade 3 mucositis and nausea/vomiting was noted in $34.5\%$, respectively. Major prolongation of radiation therapy duration was inevitable in three patients. Twenty-one patients $(72.4\%)$ completed 3 courses of cisplatin and 5 patients received 2 courses of cisplatin. Three patients received only one course of cisplatin due to nephrotoxicity and neurotoxicity, and then changed to 5-FU regimen. Conclusions : Concurrent cisplatin-radiation therapy in locally advanced head and neck cancer showed high response rate, reasonable locoregional control, and survival rate. As expected, acute toxicities were increased, but compliance to treatment was acceptable. Assessment of the effect of the combination in this setting requires further accrual and follow-up.

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The Government Organization Act and the Desirable Government Structure in the 21st Century (21세기 바람직한 정부조직과 정부조직법)

  • Sung, Nak-In
    • Journal of Legislation Research
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    • no.44
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    • pp.241-281
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    • 2013
  • First and foremost, a discussion concerning government structure has to be done in connection with the state form and the governmental form. For practical reasons, there is a need to balance the principle of legality and its exceptions under the Government Organization Act. To ensure the flexibility of government structure with respect to the principle of legality, the National Assembly should accept the government structure requested by the newly elected government. This mitigates the rigidity of the principle of the legality within the government organizations. However, excessive changes by each government could violate the principle of legality asked by Constitution. In this sense, arbitrary modification with respect to the government structure by the newly elected government is not desirable. The long term stability of the government organization is required in any case. Secondly, general administrative agencies, other than Executive Ministries, should not be established under the direct order of the President without the control of the Prime Minister. A hierarchy of the executive branch (President->Prime Minister-> Executive Ministries) is stipulated in the Constitution. Establishing a hierarchy of President -> executive institution should be considered unconstitutional. Therefore, only the Presidential Secretariat and institutions with special functions can be established in the Presidential Office. Establishing general administrative agencies in the Presidential Office for convenience purposes is against the spirit of the current Constitution. Consequently, only the office of staffs and special agencies can be placed in the presidential office. It is against the spirit of the current Constitution to found administrative agencies under the presidential office for convenience. Thirdly, the office of the Prime Minister should be the backbone of internal affairs. In that sense, the President, as the head of state, should focus on the big picture such as the direction of the State, while the Cabinet headed by the Prime Minister should be responsible for the daily affairs of the State. The cabinet surrounding the Prime Minister must control all the ordinary affairs of the State, while the President, as the head of the State, should focus on the big picture of blueprinting the aim of the State. Lastly, the Office of the Prime Minister and Executive Ministries are the two main bodies of the executive branch. It is important to reduce the confusion caused by repeated changes in the names of Executive Ministries, to restore the traditional names and authorities of these institutions, and to rehabilitate the legitimacy of the State. For the Korean democracy to take its roots, a systematic way of stabilizing a law-governed democratic country is needed. There is also the need not only to reform security and economic agencies, but also to rationally solve the integration of technique and policy, according to the changes of time.