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A Study on Systems Analysis Applied to Library Management (도서관경영(圖書館經營)에 있어서의 시스팀 분석기법응용(分析技法應用)에 관한 연구(硏究))

  • Gweon, Gyi-Won
    • Journal of the Korean BIBLIA Society for library and Information Science
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    • v.2 no.1
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    • pp.178-210
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    • 1974
  • It needs to put into practice the systems analysis in the analysis of some operations and status of library for the purpose of systematizing the work of reforming in the new easier form to process, to storage, to retrieve and to make use of the increasing informations and data of library. In this study, some of systems which are generally using in every library was caught in the case study of K university library. Having analyzed them with the two methods of the flowcharting and mathematical analysis, we found the obstructive factors in operation. As the result of this research, it was gained the new system as the alternative one. A. Alternative System B. Advantages of alternative systems 1. In the reference room When it converts the present system into the new system, it can profit 6.771 won/user (13.815won-7.044won=6.771 won). Therefore, a half the average required cost of the present system can be saved. If this saving would be alloted for the cost 33,000won required to make the cataloging cards, it would be taken for 94 days (33,000 won ${\div}$ 6,771 won/user=4,874users. 4,874users ${\div}$ 52users/day=94days) to get it. The saving cost/year by the new system will be 95,417 won, and in the first year the initial cost (33,000won) reduces the saving cost to 62,417won. 2. In the periodical room The average required time for using the materials of the present system is 17 minutes/user and the average required cost/user is 23.775won, while the average required time of the new system is 4 minutes and the average required cost/user is 5.33won. Therefore, the new system has profit 4 times of the present system. Accordingly, it occurs when the dispersed periodical materials get together. 3. In the classification and cataloging When one processes - the oriental books - by the Linear Programming Technique, the maximum of the process can be increased from 11.6 volumes per librarian of the present system to 12 volumes per librarian of the new system increased 0.4 volume in a day, and cataloging by the manual printer can be shorten from 3 minutes per card of the present system to 1.5 minutes per card of the new system. Consequently, we can complete the other operations (books equipment, updating of cataloging cards, etc.) with 141 minutes which are saved in the course of the afore-mentioned works. 4. In the status of collections The average growth rate of 4 years from 1968 to 1971 is 9.825 %, and that of the purchased materials is 6.2% similar to the advanced nations, but it has the different position from 215,000 volumes by the Standard Degree for Establishment of College and University, and the difference between the total collections 151,671 volumes and Dunns' growth model ($N_t=N_oe^{-at}$) claimed by Leimkuhler 155,297 volumes in 1971 is 3,626 volumes, and for the purpose of compensation the difference, we found the fact that it needs to have the increased budget of 24~30% per year, Thus, if the budget of 24~30 % per year. Thus, if the budget would be increased per year as the rate of the afore-mentioned figure, it would be reached at the Standard Degree for Establishment of College and University in 1975, and thereafter, it can be decreased to the lebel which is able to maintain the growth rate of 5~6% per year.

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Future Development Strategies for KODISA Journals : Overview of 2017 and Strategic Plans for the Future (KODISA 학술지 성장전략: 2017 개관 및 미래 성장개요)

  • Hwang, Hee-Joong;Shin, Dong-Jin;Lee, Jung-Wan;Kim, Dong-Ho;Lee, Jong-Ho;Kim, Byung-Goo;Kim, Tae-Joong;Lee, Yong-Ki;Suh, Eung-Kyo;Kang, Min-Soo;Seo, Won-Jae;Kim, Jong-Jin;Zhang, Fan;Su, Shuai;Youn, Myoung-Kil
    • Journal of Distribution Science
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    • v.16 no.5
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    • pp.83-90
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    • 2018
  • Purpose - Journals of Korea Distribution Science Association (KODISA) made great efforts in responding to the constant shifts in academic paradigms and in producing synergetic effects among KODISA journals to achieve the goal of maintaining their status in the world's reputable scholarly journals. The aim of this study is to analyze the current practice and performance of KODISA journals and develop strategies that will continuously meet and respond to the changes and success in the future. Research design, data, and methodology - This is a case study, an analytical approach, which focuses on analyzing current and previous strategies, practices, and performances of the four major journals of KODISA and the association. The organizational structure, including election and terms of KODISA officers, new membership, and members of editorial board, is discussed and analyzed. The citation, submission, publication, and rejection rates of all four journals are examined, and the progress, including the status of indexing of each journal, is discussed. Results - The analysis indicates that KODISA has significantly invested its resources into improving its journals and attracting new members. The analysis also shows the strategy of the organizational structure, which includes election and terms of officers and editorial board members that implemented over the years, was successful. Both Journal of Distribution Science (JDS) and Journal of Finance, Economics, and Business (JAFEB) are indexed in SCOPUS, with East Asian Journal of Business Management (EAJBM) in the final stage of the SCOPUS indexing evaluation, and International Journal of Industrial Distribution and Business (IJIDB) will complete and submit their indexing evaluation materials to SCOPUS this summer. Conclusions - The success and progress of KODISA and its journals clearly support the need for continuous development, analysis, revision, and implementation of strategies. Based on the analysis, conducting the annual performance reviews of the association and its journals and planning and strategizing based on the reviews since 2011 have greatly contributed to the overall success. In terms of meeting the short term strategy, KODISA has to continue developing relationships with relevant and appropriate scholarly/academic associations to expand the scope of its business, establishing independence of each journal and its respective procedures and practices and improving the quality of the journals and their publications through KODISA's international conferences.

The Study on the Influence of Capstone Design & Field Training on Employment Rate: Focused on Leaders in INdustry-university Cooperation(LINC) (캡스톤디자인 및 현장실습이 취업률에 미치는 영향: 산학협력선도대학(LINC)을 중심으로)

  • Park Namgue
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.18 no.4
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    • pp.207-222
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    • 2023
  • In order to improve employment rates, most universities operate programs to strengthen students' employment and entrepreneurship, regardless of whether they are selected as the Leading Industry-Innovative University (LINC) or not. In particular, in the case of non-metropolitan universities are risking their lives to improve employment rates. In order to overcome the limitations of university establishment type and university location, which absolutely affect the employment rate, we are operating a startup education & startup support program in order to strengthen employment and entrepreneurship, and capstone design & field training as industry-academia-linked education programs are always available. Although there are studies on effectiveness verification centered on LINC (Leaders in Industry-University Cooperation) in previous studies, but a longitudinal study was conducted on all factors of university factors, startup education & startup support, and capstone design & field training as industry-university-linked education programs as factors affecting the employment rate based on public disclosure indicators. No cases of longitudinal studies were reported. This study targets 116 universities that satisfy the conditions based on university disclosure indicators from 2018 to 2020 that were recently released on university factors, startup education & startup support, and capstone design & field training as industry-academia-linked education programs as factors affecting the employment rate. We analyzed the differences between the LINC (Leaders in Industry-University Cooperation) 51 participating universities and 64 non-participating universities. In addition, considering that there is no historical information on the overlapping participation of participating students due to the limitations of public indicators, the Exposure Effect theory states that long-term exposure to employment and entrepreneurship competency enhancement programs will affect the employment rate through competency enhancement. Based on this, the effectiveness of the 2nd LINC+ (socially customized Leaders in Industry-University Cooperation) was verified from 2017 to 2021 through a longitudinal causal relationship analysis. As a result of the study, it was found that the startup education & startup support and capstone design & field training as industry-academia-linked education programs of the 2nd LINC+ (socially customized Leaders in Industry-University Cooperation) did not affect the employment rate. As a result of the longitudinal causal relationship analysis, it was reconfirmed that universities in metropolitan areas still have higher employment rates than universities in non-metropolitan areas due to existing university factors, and that private universities have higher employment rates than national universities. Among employment and entrepreneurship competency strengthening programs, the number of people who complete entrepreneurship courses, the number of people who complete capstone design, the amount of capstone design payment, and the number of dedicated faculty members partially affect the employment rate by year, while field training has no effect at all by year. It was confirmed that long-term exposure to the entrepreneurship capacity building program did not affect the employment rate. Therefore, it was reconfirmed that in order to improve the employment rate of universities, the limitations of non-metropolitan areas and national and public universities must be overcome. To overcome this, as a program to strengthen employment and entrepreneurship capabilities, it is important to strengthen entrepreneurship through participation in entrepreneurship lectures and actively introduce and be confident in the capstone design program that strengthens the concept of PBL (Problem Based Learning), and the field training program improves the employment rate. In order for actually field training affect of the employment rate, it is necessary to proceed with a substantial program through reorganization of the overall academic system and organization.

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Investigating Dynamic Mutation Process of Issues Using Unstructured Text Analysis (부도예측을 위한 KNN 앙상블 모형의 동시 최적화)

  • Min, Sung-Hwan
    • Journal of Intelligence and Information Systems
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    • v.22 no.1
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    • pp.139-157
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    • 2016
  • Bankruptcy involves considerable costs, so it can have significant effects on a country's economy. Thus, bankruptcy prediction is an important issue. Over the past several decades, many researchers have addressed topics associated with bankruptcy prediction. Early research on bankruptcy prediction employed conventional statistical methods such as univariate analysis, discriminant analysis, multiple regression, and logistic regression. Later on, many studies began utilizing artificial intelligence techniques such as inductive learning, neural networks, and case-based reasoning. Currently, ensemble models are being utilized to enhance the accuracy of bankruptcy prediction. Ensemble classification involves combining multiple classifiers to obtain more accurate predictions than those obtained using individual models. Ensemble learning techniques are known to be very useful for improving the generalization ability of the classifier. Base classifiers in the ensemble must be as accurate and diverse as possible in order to enhance the generalization ability of an ensemble model. Commonly used methods for constructing ensemble classifiers include bagging, boosting, and random subspace. The random subspace method selects a random feature subset for each classifier from the original feature space to diversify the base classifiers of an ensemble. Each ensemble member is trained by a randomly chosen feature subspace from the original feature set, and predictions from each ensemble member are combined by an aggregation method. The k-nearest neighbors (KNN) classifier is robust with respect to variations in the dataset but is very sensitive to changes in the feature space. For this reason, KNN is a good classifier for the random subspace method. The KNN random subspace ensemble model has been shown to be very effective for improving an individual KNN model. The k parameter of KNN base classifiers and selected feature subsets for base classifiers play an important role in determining the performance of the KNN ensemble model. However, few studies have focused on optimizing the k parameter and feature subsets of base classifiers in the ensemble. This study proposed a new ensemble method that improves upon the performance KNN ensemble model by optimizing both k parameters and feature subsets of base classifiers. A genetic algorithm was used to optimize the KNN ensemble model and improve the prediction accuracy of the ensemble model. The proposed model was applied to a bankruptcy prediction problem by using a real dataset from Korean companies. The research data included 1800 externally non-audited firms that filed for bankruptcy (900 cases) or non-bankruptcy (900 cases). Initially, the dataset consisted of 134 financial ratios. Prior to the experiments, 75 financial ratios were selected based on an independent sample t-test of each financial ratio as an input variable and bankruptcy or non-bankruptcy as an output variable. Of these, 24 financial ratios were selected by using a logistic regression backward feature selection method. The complete dataset was separated into two parts: training and validation. The training dataset was further divided into two portions: one for the training model and the other to avoid overfitting. The prediction accuracy against this dataset was used to determine the fitness value in order to avoid overfitting. The validation dataset was used to evaluate the effectiveness of the final model. A 10-fold cross-validation was implemented to compare the performances of the proposed model and other models. To evaluate the effectiveness of the proposed model, the classification accuracy of the proposed model was compared with that of other models. The Q-statistic values and average classification accuracies of base classifiers were investigated. The experimental results showed that the proposed model outperformed other models, such as the single model and random subspace ensemble model.

제주도 지하수자원의 최적 개발가능량 선정에 관한 수리지질학적 연구

  • 한정상;김창길;김남종;한규상
    • Proceedings of the Korean Society of Soil and Groundwater Environment Conference
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    • 1994.07a
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    • pp.184-215
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    • 1994
  • The Hydrogeologic data of 455 water wells comprising geologic and aquifer test were analyzed to determine hydrogeoloic characteristics of Cheju island. The groundwater of Cheju island is occurred in unconsolidated pyroclastic deposits interbedded in highly jointed basaltic and andesic rocks as high level, basal and parabasal types order unconfined condition. The average transmissivity and specific yield of the aquifer are at about 29,300m$^2$/day and 0.12 respectively. The total storage of groundwater is estimated about 44 billion cubic meters(m$^3$). Average annual precipitation is about 3390 million m$^3$ among which average recharge amount is estimated 1494 million m$^3$ equivalent 44.1% of annual precipitation with 638 million m$^3$ of runoff and 1256 million m$^3$ of evapotranspiration. Based on groundwater budget analysis, the sustainable yield is about 620 million m$^3$(41% of annual recharge)and rest of it is discharging into the sea. The geologic logs of recently drilled thermal water wens indicate that very low-permeable marine sediments(Sehwa-ri formation) composed of loosely cemented sandy sat derived from mainly volcanic ashes, at the 1st stage volcanic activity of the area was situated at the 120$\pm$68m below sea level. And also the other low-permeable sedimentary rock called Segipo-formation which is deemed younger than former marine sediment is occured at the area covering north-west and western part of Cheju at the $\pm$70m below sea level. If these impermeable beds are distributed as a basal formation of fresh water zone of Cheju, most of groundwater in Cheju will be para-basal type. These formations will be one of the most important hydrogeologic boundary and groundwater occurences in the area.

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Long-term Results of Gamma Knife Radiosurgery for Craniopharyngioma (두개인두종의 감마나이프 치료 후 장기 추적 결과)

  • Kim, Yun Sok;Lee, Do Heui;Ra, Dong Suk;Chun, Young Il;Ahn, Jae Sung;Jeon, Sang Ryong;Kim, Jeong Hoon;Roh, Sung Woo;Ra, Young Shin;Kim, Chang Jin;Kwon, Yang;Rhim, Seung Chul;Lee, Jung Kyo;Kwun, Byung Duk
    • Journal of Korean Neurosurgical Society
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    • v.30 no.sup2
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    • pp.289-293
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    • 2001
  • Objectives : The optimal treatment of craniopharyngioma is controversial. Despite recent advances in microsurgical management, complete surgical removal of craniopharyngioma remains very difficult. Radiation added to surgery is effective, but radiation therapy resulted in untoward side effect in young patient. Gamma knife radiosurgery offers the theoretical advantage of a reduced radiation dose to surrounding structures during the treatment of residual or recurrent craniopharyngioma compared with fractionated radiotheraphy. We described retrospective analysis of tumor size and clinical symptoms of patients after gamma knife radiosurgery in residual or recurrent craniopharyngioma were performed. Material and Methods : From September 1990 to January 2000, 18 patients of craniopharyngioma were treated by gamma knife radiosurgery. All patient had undergone surgery, but residual or recurrent tumor was found and all of them treated postoperative gamma knife radiosurgery. The mean age was 19(from 6 to 66) and male to female ratio was 10 to 8 and 8 patients were below 15 years old. In young age group(below age 15), the average volume of the tumor was $2904.8mm^3$ and mean maximal gamma knife dose was 34.9Gy. In old age group(older than 15), the average volume of the tumor was $2590.4mm^3$ and mean maximal gamma knife dose was 45.2Gy. The size of the tumor was average $2730.1mm^3$($88-12000mm^3$), mean average radiation dose was 40.7Gy and the mean prescription dose was 17.6 Gy(4-35Gy) delivered to a median prescription 50.7% isodose. Results : The follow up was from 1 year to 9 years(mean 59.1 months) after gamma knife radiosurgery. The tumor was controlled in 13(72.2%) patients. The tumor decreased in 9 patients and not changed in 4 patients. The tumor size increased in 4(22.2%) patients during follow up period. In two cases the tumor size increased because of its cystic portion was increased, but their solid portion of the tumor was not changed. In another two patients, the solid portion of the tumor was increased. So, one patient underwent reoperation and the other patient underwent operation and repeated gamma knife radiosurgery. The tumor recurred in one case(5.6%) that is a outside of irradiated site. The presenting symptoms were improved in 4 patients(improved visual acuity in 1, controlled increased intracranial presure sign in 3 patients). In one case, visual acuity decreased after gamma knife radiosurgery. The endocrine symptoms were not influenced by gamma knife radiosurgery. Conclusion : Craniopharyngioma can be treated successfully by gamma knife radiosurgery. Causes of the tumor regrowth are inadequate dose planning because of postoperatively poor margination of the tumor, close approximation of optic nerve and residual tumors outside the target lesion. Recurrence can develop 4 years after gamma knife radiosurgery. Volume is important, but the accurate targeting is more important to prevent tumor recurrence. If the tumor definition is not clear during planning gamma knife surgery, long-term image follow up is required.

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Animal Infectious Diseases Prevention through Big Data and Deep Learning (빅데이터와 딥러닝을 활용한 동물 감염병 확산 차단)

  • Kim, Sung Hyun;Choi, Joon Ki;Kim, Jae Seok;Jang, Ah Reum;Lee, Jae Ho;Cha, Kyung Jin;Lee, Sang Won
    • Journal of Intelligence and Information Systems
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    • v.24 no.4
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    • pp.137-154
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    • 2018
  • Animal infectious diseases, such as avian influenza and foot and mouth disease, occur almost every year and cause huge economic and social damage to the country. In order to prevent this, the anti-quarantine authorities have tried various human and material endeavors, but the infectious diseases have continued to occur. Avian influenza is known to be developed in 1878 and it rose as a national issue due to its high lethality. Food and mouth disease is considered as most critical animal infectious disease internationally. In a nation where this disease has not been spread, food and mouth disease is recognized as economic disease or political disease because it restricts international trade by making it complex to import processed and non-processed live stock, and also quarantine is costly. In a society where whole nation is connected by zone of life, there is no way to prevent the spread of infectious disease fully. Hence, there is a need to be aware of occurrence of the disease and to take action before it is distributed. Epidemiological investigation on definite diagnosis target is implemented and measures are taken to prevent the spread of disease according to the investigation results, simultaneously with the confirmation of both human infectious disease and animal infectious disease. The foundation of epidemiological investigation is figuring out to where one has been, and whom he or she has met. In a data perspective, this can be defined as an action taken to predict the cause of disease outbreak, outbreak location, and future infection, by collecting and analyzing geographic data and relation data. Recently, an attempt has been made to develop a prediction model of infectious disease by using Big Data and deep learning technology, but there is no active research on model building studies and case reports. KT and the Ministry of Science and ICT have been carrying out big data projects since 2014 as part of national R &D projects to analyze and predict the route of livestock related vehicles. To prevent animal infectious diseases, the researchers first developed a prediction model based on a regression analysis using vehicle movement data. After that, more accurate prediction model was constructed using machine learning algorithms such as Logistic Regression, Lasso, Support Vector Machine and Random Forest. In particular, the prediction model for 2017 added the risk of diffusion to the facilities, and the performance of the model was improved by considering the hyper-parameters of the modeling in various ways. Confusion Matrix and ROC Curve show that the model constructed in 2017 is superior to the machine learning model. The difference between the2016 model and the 2017 model is that visiting information on facilities such as feed factory and slaughter house, and information on bird livestock, which was limited to chicken and duck but now expanded to goose and quail, has been used for analysis in the later model. In addition, an explanation of the results was added to help the authorities in making decisions and to establish a basis for persuading stakeholders in 2017. This study reports an animal infectious disease prevention system which is constructed on the basis of hazardous vehicle movement, farm and environment Big Data. The significance of this study is that it describes the evolution process of the prediction model using Big Data which is used in the field and the model is expected to be more complete if the form of viruses is put into consideration. This will contribute to data utilization and analysis model development in related field. In addition, we expect that the system constructed in this study will provide more preventive and effective prevention.

Etiologic Survey on the Acute Diarrhea of Puppies in Seoul (서울지역에서 문제되고 있는 강아지의 급성설사증에 관한 병인학적 연구)

  • Han Hong-Ryul;Park Hee-Myung;Lee Jin-Hee;Oh Tae-Ho;Jeong Soon-Wuk;Youn Sin-Keun;Park Cheol-Man
    • Journal of Veterinary Clinics
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    • v.10 no.2
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    • pp.171-184
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    • 1993
  • In Seoul area, there are so many kennel clubs, veterinary hospital, pet establishment and breeding confers that various problems have occurred. They are crowed pet houses, poor sanitation, stress to puppies, sudden environmental changes to puppies and unvaccination against parvovirus, canine distemper virus, parainfluenza virus, infectious hepatitis caused by Adenovirus type I and Leptospira. Several studies were made to survey the infectious agents involved in acute diarrhea of poppies in Seoul are, such as history taking, physical examination, complete blood count and serum chemistry, histopathological finding, bacterial isolation and identification, and hemagglutination test in feces and hemagglutination inhibition test in serum against parvovirus, respectively. The results obtained are summarized as followed. 1. The percent of PCV (30.5$\pm$5.6) and concentration of Total protein(5.0$\pm$0.8) resulted from statistical analysis are significantly lower than normal values (p<0.05), respectively. In addition, fibrinogen (505$\pm$326) was significantly higher an normal value (p<0.001), Band neutrophil (22.9$\pm$12.7) showed signifiant difference (P<0.01). decreased monocyte (3.2$\pm$2.1) and eosinophil (0.7$\pm$0.8) values appeared statistically significant (p<0.001), lymphocyte (16.7$\pm$9), as well. 2. The concentrations of calcium .(8.0$\pm$2.8), glucose (40.1$\pm$31.4), and albumin (2.0$\pm$0.39) were lower than normal values (p<0.01, p<0.01, p<0.001), respectively. Also Inorganic phosphate (7.1$\pm$2.4), pH (p<7.9f:0.2), and Blood Urea Nitrogen (40.41=37.1) were significantly higher than normal values (p<0.001, p(0.001, p<0.05), respectively. 3. Simple and mixed infections occupied 18% and 82% in the distribution of causes in puppies with acute diarrhea, respectively. 4. As puppies got older, incidence of acute diarrhea caused by Staphylococcus aureus was decreased to 13% and infection of canine distemper virus was increased to 53%, but E coli and canine parvovirus always showed high frequency of outbreak in the body weight ranged from 35g to 7.8Kg. 5. As showed in table 5, infections of E coli and Canine Parvovirus showed high outbreak regardless of the age which is classified into three stages, 35~50 day, 60 day and 75~day to 1 year, canine distemper virus appeared increased, but in case of Staphylococcus aureus, visa versa. 6. In comparison wi methods for the laboratory diagnosis diagnosis parvovirus, Hemagglutination test showed positive reaction in 25% and mean serum antibody titer measured by Hemagglutination inhibition test showed 2779 (n=20). In addition, positive reaction was 90% (18/20). 7. In histopathological studies, enteritic and pneumonic lesions were indicated in 53.7% and 39.5% of samples, respectively. 8. Etiologic diagnosis based on the history taking, clinical signs and histopathological findings in puppies with acute diarrhea and vomiting indicated that 50% of puppies were infected by canine parvovirus and distemper virus. 9. In the parasitological examination made by simple flotation with saturated zinc sulfate tour parasites found were Isospora canis, Toxocara canis, Ancylostoma spp and Toxocara spp. Isospora canis and Toxocara canis were more frequently found among those parasites of diarrhoeic causes in puppies ranged from 35 days to 1 year. Their infestation rates were 15% and 13% respectively.

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Postoperative External Beam Radiotherapy for Retroperitoneal Soft Tissue Sarcoma (후복막 연조직 육종의 수술 후 외부 방사선 치료)

  • Jang, Na-Young;Kim, Il-Han;Choi, Jin-Hwa;Park, Charn-Il
    • Radiation Oncology Journal
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    • v.26 no.3
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    • pp.135-141
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    • 2008
  • Purpose: To evaluate the clinical outcomes and prognostic factors in retroperitoneal soft tissue sarcomas treated by postoperative radiotherapy. Materials and Methods: The records of 23 patients with retroperitoneal soft tissue sarcomas, who underwent postoperative radiotherapy between 1985 and 2003, were analyzed. The median follow-up period was 77 months (range, $8{\sim}240$ months). A total of 21 patients presented with primary disease, and two patients presented with recurrent disease. Liposarcomas and leiomyosarcomas represented 78% of the diagnosed tumor cases. Moreover, 17 cases were of high grade (grade 2 or 3). The median tumor size was 13 cm (range, $3{\sim}50\;cm$). Complete excision was achieved in 65% of patients. The median radiation dose was 50.4 Gy (range, 45.0 to 59.4 Gy), with conventional fractionation. Results: The 5-year overall, local recurrence-free, and distant metastasis-free survival rates were 68%, 58%, and 71%, respectively. Eleven patients experienced local recurrence, while 9 patients experienced distant metastasis. The most common site for distant metastasis was the liver. A univariate analysis revealed that adjacent organ invasion and age (>60 years) as the significant risk factors contributing to the prediction of poor overall survival. Moreover, multivariate analyses indicated that adjacent organ invasion remained significantly associated with a higher risk of death. In addition, patient age (>60 years) was the other identified risk factor for local recurrence by univariate and multivariate analyses. Except for one case of grade 3 diarrhea, no patient suffered grade 3 or higher complications. Conclusion: Our results were comparable to previous reports in that adjacent organ invasion and patient age (>60 years) were significant predictors of poor survival and tumor recurrence, respectively.

Cardiac Intracoronary Stenting vs CABG: Prevention of Medical Accident (심장 스텐트 시술과 의료사고 예방)

  • Kim, Kyoung Reay;Park, Kook Yang
    • The Korean Society of Law and Medicine
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    • v.18 no.2
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    • pp.163-194
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    • 2017
  • Coronary artery disease has increased in Korea as the country enters the aged society. It is well known that the incidence of coronary artery disease is related to aging, hypertension, diabetes, hyperlipidemia, and dietary habit. For effective treatment of significant coronary stenosis, close coordination between cardiac surgery and cardiology team is essential. Especially cardiologists' decision whether to do the stent placement or CABG is very important because the cardiologists usually start to consult the patients for their treatment. Recently, non-surgical interventions(that is stent placement) in cardiology field have dramatically increased as the national insurance system removed the limitation of the number of stents deployed. However, accidents are often caused by inappropriate use of stents, especially in patients with triple coronary disease or left main disease with heavy coronary calcifications. Another aspect of stent placement is to cope with an emergency case in the event of coronary rupture or pericardial tamponade during coronary interventions without cardiac surgeons. In the past two years, the Korea Consumer Agency (Consumer Dispute Coordination Committee) analyzed eight cases of medical dispute settlement. Only two hospitals were manned with both cardiologists and cardiac surgeons. Seven patients died of procedures of stenting and five patients died on the day of the procedure. Among the 8 cases, 5 cases showed 3 vessel disease and the rest of the cases had either severe calcification, complete occlusion or poor coronary antomies for stenting According to a 2017 national data registry of coronary stenting, less than 3 drug-eluting stents were implanted in 98% of all patients. In 2015, the number of stent procedures was 38,922, and approximately in 800 (2%) cases, more than four stents were used per patient. We emphasize that it is necessary to seriously consider the cost-benefit analysis between stent and CABG. The patient has the right to choose the right procedure by asking the liability of 'instruction explanation obligation'. He should be well informed of the pros and cons of both procedures to avoid overuse of stent. It can be solved by intimate discussion of individual cases with the cardiac surgeon and the patient. Unilateral dialogue with the patient, forceful restriction on the number of stenting, lack of surgeon's backup in difficult cases should all be avoided. It is also necessary to solve the problem not only at the hospital level, such as multidisciplinary integrated medical care, but also a nationwide solution such as expanding cardiac surgeons as essential personnel to public officials.

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