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Comparison of Outcomes after Curative Resection of Primary Lung Cancer between 50 Year or Younger and 70 Year or Older Patients (50세 이하와 70세 이상 원발성 폐암 환자에서의 근치적 수술 후 성적 비교)

  • Lee, Jae-Ik;Kim, Keun-Woo;Park, Kook-Yang;Park, Chul-Hyun;Jeon, Yang-Bin;Choi, Chang-Hyu
    • Journal of Chest Surgery
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    • v.42 no.2
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    • pp.206-213
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    • 2009
  • Background: Previous series have suggested that younger patients with primary lung cancer exhibit a more aggressive disease course with a worse prognosis, as compared to older patients, although this issue is still debatable. Material and Method: We reviewed the medical records of 79 patients (32 patients 50 years and younger (Group I) and 47 patients 70 years and older (Group II)) who underwent curative resection for primary lung cancer between July 2000 and June 2008. Result: The median age of the patients was 46.5 years in Group I and this was 73 years in Group II. The older patients were more likely to have major comorbidities (44% versus 77%, respectively; p=0.003). Histological examinations identified that the minor histological types (excluding non-small cell lung cancer (NSCLC)) were predominantly found in the Group I patients (16% versus 2%, respectively; p=0.037). For the TNM staging of the NSCLC, with excluding the minor histologic types, a higher proportion of patients had stage III disease in Group I (33% versus 13%, respectively; p=0.038). There was no significant difference in major morbidity (16% versus 30%, respectively; p=0.148) and operative mortality (0% versus 4.3%; p=0.512) between the groups. The mean follow-up interval was 33 months (range: $1{\sim}98$ months) for patients in both groups. For the patients with NSCLC, the five-year overall survival rate was 52.3% for Group I and 53.7% for Group II (p=0.955). The rate of freedom from recurrence at five years was significantly lower for the Group I patients than for the Group II patients (39.4% versus 70.4%, respectively; p=0.027), and only being a member of Group I impacted recurrence, based on the Cox proportional hazard analysis (p=0.034). Of the patients who had recurrence, four patients in Group I underwent aggressive surgical treatment. All of these patients exhibited long-term survival (range: $46{\sim}87$ months). Conclusion: In our study, the early outcome and long-term survival were similar for the younger and older patients after curative resection of primary lung cancer. However, we think that younger patients require meticulous follow-up as they had a tendency to proceed to surgery with advanced stage disease, a higher recurrence rate than did the older patients and the survival rates were improved, even for the recurred cases, with early aggressive treatment.

Current Status and Prospects of Community Nutrition in Korea (한국 지역사회영양의 현황과 전망)

  • 채범석;한정호
    • Korean Journal of Community Nutrition
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    • v.1 no.1
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    • pp.9-27
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    • 1996
  • The nutritional status is strictly related with flood production, flood processing, and distribution along with habits, education and technological achievement, adapted and adjusted to socio-economic conditions. All these factors are independently affecting the nutritional status of populations. In addition to the above mentioned factors launch of it is useful to consider two points ; unification of the South and the North Korea and WTO. The present study gives and overview of basic knowledge about nutritional status of Korean by using availab1e data in relation to nutrition. The basic characteristics of Korean diet with proportions high in carbohydrate and low in fat, have been relatively constant for the past two decades. The average daily flood intake in terms of weight of flood per person is relatively constant throughout the years. Although the proportion of animal food intake tends to increase recently, the Korean diet is still insufficient in meat, eggs, milk, and fish. Moreover because milk has not been accustomed flood with the general population and not much used in traditional flood preparation in Korea, milk consumption was especially low in comparison with western countries. The total energy intake was relatively constant throughout the years from 1969 to 1993. However, changes in the composition have occurred in the past two decades. The amount and proportions of fat have been s1ightly increasing while the total amount of carbohydrate has been decreasing. The nutrition preblems of Korea have changed over the past severa1 decades. The general adequacy of protein and energy existing after Korean War(1950) was resolved now. Since then the average diet appears to be nearly desirable in terms of rapid rates of growth during childhood and attainment of progressively stature and body weight at maturity. The dietary habits of some young people in these days seem to be taking a more western style diets. This trends if established by habit may lead to a marked change in the traditional diet and health. I think Korean nutritional experiences have potential values for tole other countries in Asia and in western countries. Korean diet illustrates a high level of nutritional status and health attainable will a largely vegetable diet : high in complex carbohydrates, and dietary fibre, and low in tat, and reasonable amount of total protein. This is significant for developing and developed countries that must select specific goals fir adequate nutrition for the people. Compared to the western countries, Koreas different incidence of coronary heart disease and malignancy demonstrates the significance of environment and probably the prominent role of diet in the development of these diseases. The changes occurring in the Korean diet of fir the unusual opportunity to assess the effect of diet upon chronic degenerative disease. In the future, the Korean diet might be continue to change significantly These changes are being influenced by socioeconomic factors that have been emerging and growing stronger since mid-l980 and that probably continue to be potent. The expanded purchasing power of the consumer results in increased discretionary purchases. In the case of foodstuffs, the consumer demands appear to be directed toward items of higher protein content, which, being primarily animal products, are inevitably accompanied by an increased consumption of fat. The continued availability of these more expensive flood items depends upon the balance of foreign trade favouring their importation and domestic production. A regression of foreign trade could result in a decreased supply for the consumer, whereas continued growth of trade iou]d provide freedom for increasing availability to the consumer. In this latter situation the exact choice of foodstuffs is depending upon comsumer tastes and the pressures that may influence it.

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A study on the infant daycare center teacher practicing infant's rights respect in care giving daycare center's daily work (어린이집의 하루일과에서 영아반 보육교사가 실행하는 영아권리존중보육에 관한 연구)

  • Youn, Jin-Ju
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.18 no.6
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    • pp.407-417
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    • 2017
  • This study examined the extent to which childcare methods of infant classroom childcare teachers who respect infant rights in the everyday teaching curriculum at day-care centers occurs. To achieve these objectives, a questionnaire survey was conducted on 210 infant classroom childcare teachers who were in charge of the day-care center classrooms located in [G] city of [J] province. The results of the research confirmed that first there were no statistically significant differences when verifying the extent to which childcare methods of infant classroom childcare teachers who respect infant rights in the everyday teaching curriculum at day-care centers according to the final education level, professional experience, age, and education major of the infant classroom childcare teacher. On the other hand, the results confirmed that when analyzing for arrival time for infant classroom childcare instruction at the day-care center and for the time spent taking the infant to and from the bathroom, the infant classroom childcare teachers who had graduated from 2 year colleges showed more respect for infant rights compared to that of infant classroom childcare teachers who had graduated from 4 year universities, and for the arrival time for infant classroom childcare instruction at the day-care center and nap times, the infant classroom childcare teachers who were above 50 years of age showed more respect for infant rights compared to that of infant classroom childcare teachers who were in their 30s and 40s. The results of the research confirmed that there were statistically significant differences for both the age and education major of the infant classroom childcare teachers. When examining each of the sub-factor, the age of the infant classroom childcare teachers, respect for the infant's opinion, respect for individuality, and for information provision, infant classroom childcare teachers older than 50 years of age were shown to exercise a higher level of respect for the infant according to the rule of prioritizing the infant compared to infant classroom childcare teachers in their 30s and 40s, and infant classroom childcare teachers who majored in infant education-related majors exercised a higher level of respect for the infant for respecting freedom and autonomy compared to that of infant classroom childcare teachers who majored in welfare and childcare-related fields. The results of the research confirmed a statistically significant static correlation between the two related variables. Therefore, this suggests that the more childcare methods of infant classroom childcare teachers who respect infant rights in the everyday teaching curriculum at day-care centers, the more childcare methods of infant classroom childcare teachers who respect infant rights occurred according to the rule of prioritizing the infant. These results can be used to establish both quantitatively and qualitatively an excellent and balanced respect for infant rights.

American Culture at the Crossroad : Debates over NEA(National Endowments for the Arts) (미국 문화, 그 기로에 서서 - NEA(국립예술진흥기금)를 둘러싼 논쟁 중심으로)

  • Kim, Jin-A
    • The Journal of Art Theory & Practice
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    • no.4
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    • pp.33-56
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    • 2006
  • The cultural debates between conservatives and liberals at the end of the 1980s and in the early 1990s were termed as "culture wars." The "culture wars" involved a diverse range of controversial issues, such as the introduction of multicultural curricula in educational institutions, prayers in schools, whether to allow gays to serve openly in the military, and whether abortion should be permitted. The most heated debates of the "culture wars" regarding art raged over the NEA and the question of whether Andres Serrano's works should have been publicly funded, in addition to the exhibition "Robert Mapplethorpe: The Perfect Moment" which were charged as projecting "obscene" or "blasphemous" images. This paper examines the development of culture wars in art and focuses on several issues invoked by the NEA debates. However, it is not a detailed chronological investigation. Rather it pays attention to the several phases of the debates, analyzing and criticizing the clashes of the political and esthetical points of views between conservatives and liberals. How could NEA funding, a mere fraction of the federal budget, have become so critical for both sides(conservative and liberal), for politicians and artists' groups, and for academics and the general public? The art community was astounded by this chain of events; artists personally reviled, exhibitions withdrawn and under attack, the NEA budget threatened, all because of a few images. For conservative politicians, the NEA debate was not only a battle over the public funding of art, but a war over a larger social agenda, a war for "American values and cultures"based on the family, Christianity, the English language, and patriarchy. Conservative politicians argued the question was not one of "censorship" but of "sponsorship," since the NEA charter committed it to "helping museums better serve the citizens of the United States."Liberals and art communities argued that the attempt to restrict NEA funding violated the First Amendment rights of artists, namely "free speeches." "No matter how divided individuals are on matters of taste," Arthur C. Danto wrote, "freedom is in the interest of every citizen." The interesting phase is that both sides are actually borrowing one another's point of view when they are accompanied by art criticism. Kramer, representative of conservative art critic, objected the invasion of political contents or values in art, and struggled to keep art's own realm by promoting pure aesthetic values such as quality and beauty. But, when he talked about Mapplethorpe's works, he advocated political and ethical values. By contrast, art experts who argued for Mapplethorpe's works in the Cincinnati trial defended his work, ironically by ignoring its manifest sexual metaphor or content although they believed that the issues of AIDS and homosexuality in his work were to be freely expressed in the art form. They adopted a formalistic approach, for example, by comparing a child nude with putti, a traditional child-angel icon. For a while, NEA debates made art institutions, whether consciously or unconsciously, exert self-censorship, yet at the same time they were also producing positive aspects. To the majority of people, art was still regarded as belonging to the pure aesthetic realm away from political, economical, and social ones. These debates, however, were expanding the very perspective on the notion of what is art and of how art is produced, raising questions on art appreciation, representation, and power. The interesting fact remains: had the works not been swiped in NEA debates, could the Serrano's or Mapplethorpe's images gain the extent of power and acceptance that it has today?

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A Study on the Traditional Aesthetic Characteristics Appearing in the Chinese Animation -Focusing on Three Elements of Zong Baihua's Artistic Conceptions- (중국 애니메이션<대어해당 (大魚海棠)>중에 나타난 전통 미학 특징 연구 -쭝바이화(宗白華)의 의경(意境) 3가지 구성 요소 중심으로)

  • Yang, Kun;Lee, Seel- ku
    • Cartoon and Animation Studies
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    • s.47
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    • pp.53-79
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    • 2017
  • This study explored Chinese traditional art aesthetics in the , focusing on three elements 'principle', 'dance', 'blank' which consist of the artistic conception of Zong Baihua. In addition, this paper is aimed to prove that Chinese traditional aesthetics is still available as a creative element that can provides future direction and implication for modern animation movies by analyzing how the components of these three elements were used in the and how the artistic beauty of the animation was presented. In the critiques of Chinese art, the scope of 'conception' is the 'qualified' standard about art. This 'qualified' standard includes not only external similarity in forms but also internal similarity in spirits. The authors of the early Chinese animations integrated the artistic conceptions with the animations and expressed the national cultural contents of the Chinese animations, so that the audience could deeply understand the characteristics of Chinese animation with cultural and spiritual contents. Based on the artistic conceptions that Zong Baihua proposed, this study analyzed the character setting, the ideas that connotes and the scene composition. succeeded to the innovative spirits about Chinese early animation conceptions. The animation presented the view of life that includes the absolute freedom from Zhuangzi's "A Happy Excursion" and the oblivion of external objects. The heroine Spring's change from human to dolphin was presented by dancing. Besides, in the animation, the sea of clouds, the sky full of stars, sea, the sea melting into the sky were also presented in quantity. The large area of colors fantastically presenting in 'blank' scenes fully expressed the stories and sentiments of this animation. According to the analysis in this study, by identifying the traditional atmosphere that included heavy Chinese characteristics and harmonious conceptions in through the wisdom of Chinese classics and artistic conceptions, it can be confirmed that nowadays the artistic tradition of the classics still works as an extending innovative element in the future animations.

A Study on Needs of 'Strolling (Yu)' at the Fine Arts Education - Focused on Oriental Painting - (미술교육에 있어서 '노닐음(遊)'에 대한 필요성 연구 - 동양화를 중심으로 -)

  • Jeong, Gyeong-Cheol
    • Journal of Science of Art and Design
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    • v.12
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    • pp.97-124
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    • 2007
  • The paper examined whether the fine arts education needed concept of 'Yu' that was suggested by, 'Soyoyu' of Jangja, a representative philosopher of Doka. At first, the paper defined concept of 'Yu' of Jangja as well as background and needs of the fine arts education, and investigated values of 'Yu' of the Oriental painting in aesthetic way to examine whether today's Yu concept can be applied to modern Oriental fine arts education to express. Chapter 2 examined concept and thought of 'strolling (Yu)', and Chapter 3 did background and needs of the fine arts education. Chapter 4 examined an access to practical technique education of the Oriental painting through 'strolling (Yu)': At first, the chapter investigated 'Heosil' of space concept that was researched at Chapter 2, 'Pilmuk' of expression technique, and 'Saeui' of state of spiritual canvas of painters. The findings were as follow: Firstly, when relation between Yu and Oriental paintings was investigated based on formative idea, 'Heo' reminded appreciators of association of ideas, hint and imagination, etc by, 'Sil' that other objects disclosed intrinsic attributes so that it indicated border of positive forgetfulness expressed by artists to have same border between 'Heo' and 'Yu'. Therefore, both 'Heo' and 'Sil' could build up expression as well as appreciation ability by experiencing formative idea to develop creativity and to build emotion and to cognize needs of the fine arts education. Secondly, the artistic state of 'Shin', 'Ki (Simjae)', 'Jeonshin' and, Saeui', etc could be expressed with strength and weakness of both Yin and Yang of Pilmuk. Therefore, the Pilmuk were linked even with creation of both Hyeongsa and artistic form of Saeui. Therefore, freedom at border of spiritual 'strolling' could produce creative power being expressed by thinking, natural appreciation ability, and education that could judge values of aesthetic culture. Therefore, cultivation of aesthetic eye, development of creativity, build up of formative ability and education of human nature, etc could keep identity of the Oriental fine arts education at various modern fine arts.

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Long-term Results after 1,144 CarboMedics Mechanical Valve Implantation (CarboMedics 기계판막을 이용한 1,144예 판막치환술의 장기 성적)

  • Kang, Chang-Hyun;Kim, Kyung-Hwan;Kim, Ki-Boong;Ahn, Hyuk
    • Journal of Chest Surgery
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    • v.37 no.7
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    • pp.559-569
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    • 2004
  • The CarboMedics mechanical valve has been reported to show acceptable valve-related complication rates. The aim of this study is to evaluate our clinical experience with the CarboMedics valve. Material and Method: Between August 1988 and September 1999, we implanted 1,144 CarboMedics valves in 850 patients (aortic 179; mitral 385; double-valve 234; tricuspid 52). The mean age was 44.5 $\pm$ 12.5 years. Follow-up was completed in 95.2% and median follow-up period was 7.9 years (6753 patient-years). Result: The overall hospital mortality rate was 3.4% and the mortality rate for each group was 1.7% for aortic group, 2.6% for mitral group, 4.7% for double-valve group, and 9.6% for tricuspid group, Tricuspid group showed significantly higher mortality rate than aortic and mitral group (p〈0.05). The actuarial survival at 10 years was 87.1 $\pm$ 2.6%, 88.9 $\pm$ 1.7%, 82.4 $\pm$ 2.9%, and 77.5 $\pm$ 7.0% for aortic, mitral, double, and tricuspid valve group, respectively. Age and tricuspid valve replacement were significant risk factors for long-term survival in multivariate analysis (p 〈 0.05). Freedom from valve thrombosis at 10 years was 99.4 $\pm$ 0.6%, 98.2 $\pm$ 0.8%, 99.2 $\pm$ 0.8%, and 87.6 $\pm$ 0.5% for aortic, mitral, double and tricuspid valve group. Tricuspid valve group showed significantly higher rate of valve thrombosis (p 〈 0.05). Conclusion: Long-term results of our experience demonstrated that CarboMedics valve showed acceptable incidence of valve-related complications. However, tricuspid valve replacement showed higher rate of early mortality and valve thrombosis than other valve replacement groups.

The Effects of Additional Tetracycline Pleurodesis during Thoracoscopic Procedures for Treating Primary Spontaneous Pneumothorax (일차성 자연 기흉의 흉강경 수술 시 추가로 시행한 Textracycline 흉막 유착술의 효용)

  • Lee, Hyeon-Woong;Lee, Jae-Ik;Kim, Keun-Woo;Park, Kook-Yang;Park, Chul-Hyun;Hyun, Sung-Youl;Jeon, Yang-Bin;Choi, Chang-Hyu
    • Journal of Chest Surgery
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    • v.41 no.6
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    • pp.729-735
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    • 2008
  • Background: This study was performed to evaluate the safety and efficacy of performing additional tetracycline pleurodesis during the thoracoscopic treatment of primary spontaneous pneumothorax. Material and Method: Between March 2004 and December 2007, 91 cases of primary spontaneous pneumothorax were treated by video-assisted thoracoscopic surgery. The thoracoscopic procedures included resection of the blebs and mechanical pleurodesis by scrubbing the parietal pleura. For 27 cases (Tetracycline group, group I), 20 mg/kg tetracycline was instilled into the pleural space through a trocar before closing the chest. The control group (group II) consisted of 64 cases of primary spontaneous pneumothorax for which the same thoracoscopic procedures alone were performed during the same study period. Result: There was no significant difference between the two groups in terms of the demographic data, the operative findings and the operation time. The percentage of cases that needed intravenous analgesics and the duration of intravenous analgesics were comparable in both groups. There was no significant difference in the duration of air leaks and complications between the two groups. The patients treated with tetracycline pleurodesis had a longer period of postoperative chest drainage (4.2 days vs 3.5 days, respectively, p=0.03) and hospitalization (5.0 days vs 4.0 days, respectively, p=0.006). During the follow up period, the ipsilateral recurrence rate was much lower for the patients who were treated with tetracycline pleurodesis (0% vs 10.9%, respectively, p=0.099), and freedom from recurrence tended to be more favorable for group I (p=0.077), although this was not statistically significant. Conclusion: Additional tetracycline pleurodesis during thoracoscopic treatment for primary spontaneous pneumothorax caused prolongation of chest drainage and a prolonged hospital stay. However, further investigations are needed because tetracycline pleurodesis can be performed safely without serious complications and it showed a distinct tendency to reduce the rate of recurrence.

Ethnography of Caring Experience for the Senile Dementia (노인성 치매 환자의 돌봄경험에 대한 문화기술지)

  • 김귀분;이경희
    • Journal of Korean Academy of Nursing
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    • v.28 no.4
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    • pp.1047-1059
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    • 1998
  • Senile Dementia is one of the dispositional mental disorder which has been known to the world since Hippocratic age. It has become a wide-spread social problem all over the world because of chronic disease processes and the demands of dependent care for several years as well as improbability of treatment of it at the causal level. Essentially, life styles of the older generation differ from those of the younger generation. While the fomer is used to the patriarchal system and the spirit of filial piet and respect, the latter is pragmatized and individualized under the effects of the Western material civilization. These differences between the two generations cause conflict between family members. In particular, the pain and conflict of care-givers who take care of a totally dependent dementia patient not only is inciting to the collapse of the family union, but is expanding into a serious social problem. According to this practical difficulty, this study has tried to compare dementia care-givers' experiences inter-culturally and to help set up more proper nursing interventions, describing and explaining them through ethnographies by participant observation and in-depth interviews that enable seeing them in a more close, honest and certain way. It also tries to provide a theoetical model of nusing care for dementia patients which is proper to Korean culture. This study is composed of 12 participants (4 males, 8 females) whose ages range from 37-71 years. The relations of patients are 5 spouses(3 husbands, 2 wives), 4 daughters-in-law, 2 daughters, and 1 son-in-law. The following are the care-givers' meaning of experiences that results of the study shows. The first is "psychological conflict". It contains the minds of getting angry, reproaching, being driven to dispair, blaming oneself, giving up lives, and being afraid, hopeless, and resigned. The second is "physical, social and psychological pressure" . At this stage, care-givers are shown to be under stress of both body and soul for the lack of freedom and tiredness. They also feel constraint because they hardly cope with the care and live through others' eyes. The third is "isolation". It makes the relationship of patient care-giver to be estranged, without understanding each other. They, also, experience indifference such as being upset and left alone. The forth is "acceptance" They gradually have compassion, bear up and then adapt themselves to the circumstances they are in. The fifth is "love". Now they learn to reward the other with love. It is also shown that this stage contains the process of winning others' recognition. The final is "hope". In this stage they really want situations to go smoothly and hope everything will be O.K. These consequences enable us to summarize the principles of cue experience such as, in the early stage, negative response such as physical·psychological confusion, pain and conflict are primary. Then the stage of acceptance emerges. It is an initial positive response phase when care-givers may admit their situations. As time passes by a positive response stage emerges. At last they have love and hope. Three stages we noted above : however, there are never consistent situations. Rather it gradually comes into the stage of acceptance, repeating continuous conflict, pressure and isolation. If any interest and understanding of families or the support of surrounding society lack, it will again be converted to negative responses sooner or later. Otherwise, positive responses like hope and love can be encouraged if the family and the surroundings give active aids and understanding. After all, the principles of dementia care experiences neither stay at any stage, nor develop from negative stages to positive stages steadily. They are cycling systems in which negative responses and positive responses are constantly being converted. I would like to suggest the following based on the above conclusions : First, the systematic and planned education of dementia should be performed in order to enhance public relations. Second, a special medical treatment center which deals with dementia, under government's charge, should be managed. Third, the various studies approaching dementia care experiences result in the development of more reasonable and useful nursing guidelines.

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Development of the Information Delivery System for the Home Nursing Service (가정간호사업 운용을 위한 정보전달체계 개발 I (가정간호 데이터베이스 구축과 뇌졸중 환자의 가정간호 전산개발))

  • Park, J.H;Kim, M.J;Hong, K.J;Han, K.J;Park, S.A;Yung, S.N;Lee, I.S;Joh, H.;Bang, K.S
    • Journal of Korean Academic Society of Home Health Care Nursing
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    • v.4
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    • pp.5-22
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    • 1997
  • The purpose of the study was to development an information delivery system for the home nursing service, to demonstrate and to evaluate the efficiency of it. The period of research conduct was from September 1996 to August 31, 1997. At the 1st stage to achieve the purpose, Firstly Assessment tool for the patients with cerebral vascular disease who have the first priority of HNS among the patients with various health problems at home was developed through literature review. Secondly, after identification of patient nursing problem by the home care nurse with the assessment tool, the patient's classification system developed by Park (1988) that was 128 nursing activities under 6 categories was used to identify the home care nurse's activities of the patient with CAV at home. The research team had several workshops with 5 clinical nurse experts to refine it. At last 110 nursing activities under 11 categories for the patients with CVA were derived. At the second stage, algorithms were developed to connect 110 nursing activities with the patient nursing problems identified by assessment tool. The computerizing process of the algorithms is as follows: These algorithms are realized with the computer program by use of the software engineering technique. The development is made by the prototyping method, which is the requirement analysis of the software specifications. The basic features of the usability, compatibility, adaptability and maintainability are taken into consideration. Particular emphasis is given to the efficient construction of the database. To enhance the database efficiency and to establish the structural cohesion, the data field is categorized with the weight of relevance to the particular disease. This approach permits the easy adaptability when numerous diseases are applied in the future. In paralleled with this, the expandability and maintainability is stressed through out the program development, which leads to the modular concept. However since the disease to be applied is increased in number as the project progress and since they are interrelated and coupled each other, the expand ability as well as maintainability should be considered with a big priority. Furthermore, since the system is to be synthesized with other medical systems in the future, these properties are very important. The prototype developed in this project is to be evaluated through the stage of system testing. There are various evaluation metrics such as cohesion, coupling and adaptability so on. But unfortunately, direct measurement of these metrics are very difficult, and accordingly, analytical and quantitative evaluations are almost impossible. Therefore, instead of the analytical evaluation, the experimental evaluation is to be applied through the test run by various users. This system testing will provide the viewpoint analysis of the user's level, and the detail and additional requirement specifications arising from user's real situation will be feedback into the system modeling. Also. the degree of freedom of the input and output will be improved, and the hardware limitation will be investigated. Upon the refining, the prototype system will be used as a design template. and will be used to develop the more extensive system. In detail. the relevant modules will be developed for the various diseases, and the module will be integrated by the macroscopic design process focusing on the inter modularity, generality of the database. and compatibility with other systems. The Home care Evaluation System is comprised of three main modules of : (1) General information on a patient, (2) General health status of a patient, and (3) Cerebrovascular disease patient. The general health status module has five sub modules of physical measurement, vitality, nursing, pharmaceutical description and emotional/cognition ability. The CVA patient module is divided into ten sub modules such as subjective sense, consciousness, memory and language pattern so on. The typical sub modules are described in appendix 3.

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