• Title/Summary/Keyword: Acceptable risk

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A Study of Dose Distribution in Postoperative Radiotherapy in Uterine Cervical Cancer (자궁 경부암의 수술후 방사선 치료에서 선량 분포에 관한 연구)

  • Shin, Sei-One;Kim, Sung-Kyu;Kim, Myung-Se
    • Journal of Yeungnam Medical Science
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    • v.8 no.1
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    • pp.166-177
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    • 1991
  • Uterine cervical cancer is the most common malignancy in korean women. In spite of recent development of early diagnostic and therapeutic modalities, about 40% of treated patient will develop relapse. So more aggressive local treatment such as more extensive surgery and higher radiation dose and administration of systemic chemotherapy will promote the curability but treatment related complications can not be avoidable. We used 22 cases of early cervical cancer, treated with surgery and post-operative radiotherapy, clinical data of these patients were analized to determine relationship between clinical parameters and final outcome. Three out of 22 cases revealed relapse and one patient showed rectovaginal fistula and another patient showed small bowel obstruction and the other patient showed rectal obstruction. Two out of three recurrence were stage IIa and the other one case was stage Ib adenocarcinoma with lymphovascular involvement. Nineteen out of 22 cases were followed without remarkable side effect or treatment related complication or sequelae. We concluded that our treatment policy was safe and effective to eradicate high risk postoperative cervical cancer with acceptable side effects or complication.

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A Validation Study of Temperature Field Predicted by Computational Fire Model for Spray Fire in a Multi-Compartment (다중구획공간내 분무화재시 화재해석모델의 온도장 검증연구)

  • Kim, Sugn-Chan
    • Fire Science and Engineering
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    • v.28 no.5
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    • pp.23-29
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    • 2014
  • The present study has been conducted to investigate the validity of the computational fire model and the results predicted by BRANZFIRE zone model and FDS field model are compared with a real scale fire test with spray fire in a multi-compartment. The liquid spray fires fueled with toluene and methanol are used as the fire source and the quantitative measurement of heat release rate is performed in an isolated ISO-9705 compartment with a standard door opening. The temperature field predicted by FDS model showed good agreement with the measurement in the fire room and the corridor, and BRANZFIRE model also gave acceptable result in spite of its simplicity and roughness. The mean temperature predicted by FDS model corresponds with measurement within maximum discrepancy range of 25% and the overall mean value of FDS model matched well with experimental data less than 10%. This study can contribute to establish the limitation and application scope of computational fire model and provide reference data for applying to reliable fire risk assessment.

A Study on the Development of the Normative Scores for the IT-HOME Inventory (영아기 가정환경검사(IT-HOME) 규준 개발 연구)

  • Lee, Young;Lee, Jeong Rim;Park, Shin Jin;Woo, Hyun Kyung;Koo, Ja Yeun;Chung, Hyun Joo
    • Human Ecology Research
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    • v.53 no.4
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    • pp.433-445
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    • 2015
  • This study develops normative scores of the Infant/Toddler version of the Home Observation for Measurement of the Environment (IT-HOME) inventory for Korean infants and toddlers. We selected 482 0- to 36-month-old infants and families by a stratified sampling procedure that considered residency, age, and gender of children. The pass rate, discrimination rate, and internal consistency were analyzed for the item analysis. Statistical validity included intercorrelation among the IT-HOME subscales, correlation between IT-HOME scores and environmental status variables, and correlation between IT-HOME and Korean Bayley Scales of Infant Development second edition (K-BSID-II) scores. Normative scores were prepared by percentile ranks. The results of this study were as follows: First, 45 items were acceptable for Korean subjects with few exceptions. IT-HOME was developed to screen unfavorable environmental factors during infancy; therefore, items such as 12, 17, 23, 39, 44 need to be retained even though they had low discriminating power. Second, IT-HOME subscales were correlated, and IT-HOME was significantly related to parents' education level, household income level, and infant' developmental levels. Third, percentile scores and the median of each IT-HOME subscales were suggested as normative scores. We discussed the normative scores of the IT-HOME to screen the quality of home environments for children aged 0-36 months in Korea, and provide the intervention basis for the at-risk population.

Epidural Infusion of Morphine and Levobupivacaine through a Subcutaneous Port for Cancer Pain Management

  • Heo, Bong Ha;Pyeon, Tae Hee;Lee, Hyung Gon;Kim, Woong Mo;Choi, Jeong Il;Yoon, Myung Ha
    • The Korean Journal of Pain
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    • v.27 no.2
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    • pp.139-144
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    • 2014
  • Background: To manage intractable cancer pain, an alternative to systemic analgesics is neuraxial analgesia. In long-term treatment, intrathecal administration could provide a more satisfactory pain relief with lower doses of analgesics and fewer side-effects than that of epidural administration. However, implantable drug delivery systems using intrathecal pumps in Korea are very expensive. Considering cost-effectiveness, we performed epidural analgesia as an alternative to intrathecal analgesia. Methods: We retrospectively investigated the efficacy, side effects, and complications of epidural morphine and local anesthetic administration through epidural catheters connected to a subcutaneous injection port in 29 Korean terminal cancer patients. Patient demographic data, the duration of epidural administration, preoperative numerical pain rating scales (NRS), side effects and complications related to the epidural catheterization and the drugs, and the numerical pain rating scales on the 1st, 3rd, 7th and 30th postoperative days were determined from the medical records. Results: The average score for the numerical pain rating scales for the 29 patients decreased from $7{\pm}1.0$ at baseline to $3.6{\pm}1.4$ on postoperative day 1 (P < 0.001). A similar decrease in pain intensity was maintained for 30 days (P < 0.001). Nausea and vomiting were the most frequently reported side effects of the epidural analgesia and two patients (6.9%) experienced paresthesia. Conclusions: Epidural morphine and local anesthetic infusion with a subcutaneous pump seems to have an acceptable risk-benefit ratio and allows a high degree of autonomy to patients with cancer pain.

Repair of Tetralogy of Fallot in Infancy via the Atrioventricular Approach

  • Bigdelian, Hamid;Sedighi, Mohsen
    • Journal of Chest Surgery
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    • v.49 no.1
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    • pp.9-14
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    • 2016
  • Background: Tetralogy of Fallot (TOF) is a well-recognized congenital heart disease. Despite improvements in the outcomes of surgical repair, the optimal timing of surgery and type of surgical management of patients with TOF remains controversial. The purpose of this study was to assess outcomes following the repair of TOF in infants depending on the surgical procedure used. Methods: This study involved the retrospective review of 120 patients who underwent TOF repair between 2010 and 2013. Patients were divided into three groups depending on the surgical procedure that they underwent. Corrective surgery was done via the transventricular approach (n=40), the transatrial approach (n=40), or a combined atrioventricular approach (n=40). Demographic data and the outcomes of the surgical procedures were compared among the groups. Results: In the atrioventricular group, the incidence of the following complications was found to be significantly lower than in the other groups: complete heart block (p=0.034), right ventricular failure (p=0.027) and mediastinal bleeding (p=0.007). Patients in the atrioventricular group had a better postoperative right ventricular ejection fraction (p=0.001). No statistically significant differences were observed among the three surgical groups in the occurrence of tachycardia, renal failure, and tricuspid incompetence. The one-year survival rates in the three groups were 95%, 90%, and 97.5%, respectively (p=0.395). Conclusion: Combined atrioventricular repair of TOF in infancy can be safely performed, with acceptable surgical risk, a low incidence of reoperation, good ventricular function outcomes, and an excellent survival rate.

Retrospective Evaluation of Alfaxalone as an Induction Agent of Inhalation Anesthesia: 150 Cases (호흡마취 유도제로서 alfaxalone의 후향적 평가: 150례)

  • Jang, Min;Son, Won-gyun;Jo, Sang-min;Lee, Inhyung
    • Journal of Veterinary Clinics
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    • v.34 no.2
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    • pp.135-139
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    • 2017
  • This study was performed to evaluate the clinical efficacy of alfaxalone for induction of inhalation anesthesia in small animal practice. Patient data were collected according to anesthetic records (136 dogs and 14 cats) presented to the Veterinary Medical Teaching Hospital of Seoul National University for surgeries and diagnostic imaging from July 2013 to March 2014. Anesthetic results included signalment, American Society of Anesthesiologists (ASA) grade, premedicated drugs, procedures, induction quality, and recovery after anesthesia. One hundred fifty anesthetic events were classified according to the ASA grade. Three patients were ASA grade I, 52 patients grade II, 86 patients grade III, and 9 patients grade IV, respectively. The most common premedication was midazolam and hydromorphone combination (n = 59, 39.3%) follow by acepromazine and hydromorphone combination (n = 22, 14.7%). The majority of anesthesia procedures were diagnostic imaging (n = 33, 22.0%) and ophthalmic surgeries (n = 31, 20.7%), followed by soft tissue surgeries (n = 27, 18.0%), and orthopedic surgeries (n = 20, 13.3%). Intravenous alfaxalone provided smooth induction for inhalation anesthesia in almost cases, but transient apnea and twitching/paddling were observed after induction and during recovery, respectively. In addition, alfaxalone did not show pain response during intravenous administration. Alfaxalone showed smooth induction of inhalation anesthesia in dogs and cats with mild to severe systemic disease (ASA 2-4). Alfaxalone was considered as an acceptable induction agent for patients with higher risk in small animal practice.

Long-Term Results of the Leaflet Extension Technique for Rheumatic Aortic Regurgitation: A 20-Year Follow-up

  • Kwak, Yu-jin;Ahn, Hyuk;Choi, Jae Woong;Kim, Kyung-Hwan
    • Journal of Chest Surgery
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    • v.52 no.1
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    • pp.9-15
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    • 2019
  • Background: Although aortic valve repair can reduce prosthesis-related complications, rheumatic aortic regurgitation (AR) caused by leaflet restriction is a significant risk factor for recurrent AR. In this study, we evaluated the long-term results of the leaflet extension technique for rheumatic AR. Methods: Between 1995 and 2016, 33 patients underwent aortic valve repair using the leaflet extension technique with autologous pericardium for rheumatic pure AR. Twenty patients had severe AR and 9 had combined moderate or greater mitral regurgitation. Their mean age was $32.2{\pm}13.9$ years. The mean follow-up duration was $18.3{\pm}5.8$ years. Results: There were no cases of operative mortality, but postoperative complications occurred in 5 patients. Overall survival at 10 and 20 years was 93.5% and 87.1%, respectively. There were no thromboembolic cerebrovascular events, but 4 late deaths occurred, as well as a bleeding event in 1 patient who was taking warfarin. Twelve patients underwent aortic valve reoperation. The mean interval to reoperation was $13.1{\pm}6.1$ years. Freedom from reoperation at 10 and 20 years was 96.7% and 66.6%, respectively. Conclusion: The long-term results of the leaflet extension technique showed acceptable durability and a low incidence of thromboembolic events and bleeding. The leaflet extension technique may be a good option for young patients with rheumatic AR.

Determination of Ceftiofur Residues by Simple Solid Phase Extraction Coupled with Liquid Chromatography-Tandem Mass Spectrometry in Eel, Flatfish, and Shrimp

  • Kim, Joohye;Shin, Dasom;Kang, Hui-Seung;Lee, Eunhye;Choi, Soo Yeon;Lee, Hee-Seok;Cho, Byung-Hoon;Lee, Kang-Bong;Jeong, Jiyoon
    • Mass Spectrometry Letters
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    • v.10 no.2
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    • pp.43-49
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    • 2019
  • The aim of this study was conducted to develop an analytical method to determine the concentration of ceftiofur residue in eel, flatfish, and shrimp. For derivatization and extraction, the sample was hydrolyzed with dithioerythritol to produce desfuroylceftiofur, which was then derivatized by iodoacetamide to obtain desfuroylceftiofur acetamide. For purification, the process of solid phase extraction (Oasis HLB) was used. The target analytes were confirmed and quantified in $C_{18}$ column using liquid chromatography-tandem mass spectrometry with 0.1% formic acid in water (A) and 0.1% formic acid in acetonitrile (B) as the mobile phase. The linearity of the standard calibration curve was confirmed by a correlation coefficient, $r^2>0.99$. The limit of quantification for ceftiofur was 0.002 mg/kg; the accuracy (expressed as the average recoveries) was 80.6-105%; the precision (expressed as the coefficient of variation) was below 6.3% at 0.015, 0.03, and 0.06 mg/kg. The validated method demonstrated high accuracy and acceptable sensitivity to meet the Codex guideline requirements. The developed method was tested using market samples. As a results, ceftiofur was detected in one sample. Therefore, it can be applied to the analysis of ceftiofur residues in fishery products.

"Dangerous Media vs. Reliable Childcare Helper" : Discursive Analysis of Infants' Smart Media Use ('위험한 미디어 vs 든든한 육아 도우미' : 영유아 스마트 미디어 이용 담론에 대한 탐구)

  • Choi, Yisook;Kim, Banya
    • The Journal of the Korea Contents Association
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    • v.21 no.8
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    • pp.515-525
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    • 2021
  • The study examines how the discourse on infants' smart media use has been constructed under media-saturated situations. Infants' use of smart media has been regarded as a dangerous activity, rate of overdependence has been increasing. Newspapers during the recent three years (2018-20) were analyzed. The most prominent speakers in the news field were smart media content producers and platform operators. There were negative views and concerns about infants' smart media use by academics, civic groups, and parents. However, the industry went beyond these risk discourses and gave positive meaning: Smart media was redefined as safe media for infants and reliable childcare helpers for parents. Parents were portrayed as those responsible for their children's media use and in need of help for childcare, rather than being blamed for their children's overdependence on smart media. Digital parenting seems to be emerging as an acceptable and practicable way of childcare rather than harmful and incomplete parenting.

Development and effects of a webtoon education program on preventive self-management related to premature labor for women of childbearing age: a randomized controlled trial

  • Kim, Sun-Hee
    • Women's Health Nursing
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    • v.28 no.3
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    • pp.250-263
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    • 2022
  • Purpose: The purpose of this study was to develop a webtoon education program on preventive self-management related to premature labor (PSM-PL) for women of childbearing age, to evaluate its effects, and to assess the usability of webtoon education for women of childbearing age. Methods: The study design was a stratified randomized trial with repeated measures. The participants were Korean women of childbearing age (between the ages of 19 and 49 years), with 49 participants each. The preventive health management self-efficacy related to premature labor (PHMSE-PL) scale, the preventive self-management knowledge related to premature labor (PSMK-PL) scale, and usability of webtoon education were assessed. The intervention group read six episodes of the PSM-PL webtoon within 2 days after clicking an online link. The control group did not receive anything but was given the webtoon after the last measurement. To test the effect of the repeatedly measured variables, a generalized estimating equation model was used. Results: The experimental group had statistically significantly greater increases in PHMSE-PL and PSMK-PL scores from baseline to immediately after and 2 weeks later than the control group. The average score for usability of webtoon education was high (4.52; standard deviation, 0.62) on a scale of 1-5. Conclusion: This webtoon education program on PSM-PL was a feasible and acceptable program that increased self-efficacy and knowledge of preventive health management of premature labor in women of childbearing age. Future studies that adopt a webtoon format can be beneficial for childbearing women with other risk factors.