• Journal of Acupuncture Research
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• 제35권4호
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• pp.238-243
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• 2018

Background: Various factors can alter the efficacy of acupuncture treatment, such as the location of points, manipulations, depth of insertion, needle retention time, and needle type. In this study, the effect of needle diameter on the efficacy of acupuncture treatment was quantitatively evaluated. Methods: Five acupuncture needles of different diameters used in clinical practice were compared. Force on the porcine tissue phantom was measured using a sensor. Lifting-thrusting and twisting-rotating movements were performed using a needle insertion-measurement system. After repeated measurements, force magnitude was calculated and compared. Following this, we correlated needle diameter and force magnitude during lifting-thrusting and twisting-rotating movements. Results: The force magnitude was significantly altered between needle diameters during lifting-thrusting movements, as shown by a significant positive correlation between needle diameter and force magnitude. In contrast, there was no difference in force magnitude with different needle diameters during twisting-rotating movements. Conclusion: Needle diameter can significantly affect stimuli and force magnitude dependent upon the type of manipulation. Research into the effect of other needle type characteristics and stimulation method is necessary to fully elucidate the role of acupuncture needle choice in treatment efficacy.

• Journal of Chest Surgery
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• 제48권1호
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• pp.40-45
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• 2015

Background: Surgical enucleation is the treatment of choice for esophageal submucosal tumors (SMTs) with symptomatic, larger, or ill-defined lesions. The enucleation of SMTs has traditionally been performed via thoracotomy. However, minimally invasive approaches have recently been introduced and successfully applied. In this study, we present our experiences with the thoracotomic and thoracoscopic approaches to treating SMTs. Methods: We retrospectively reviewed 53 patients with SMTs who underwent surgical enucleation between August 1996 and July 2013. Demographic and clinical features, tumor-related factors, the surgical approach, and outcomes were analyzed. Results: There were 36 males (67.9%) and 17 females (32.1%); the mean age was $49.2{\pm}11.8$ years (range, 16 to 79 years). Histology revealed leiomyoma in 51 patients, a gastrointestinal stromal tumor in one patient, and schwannoma in one patient. Eighteen patients (34.0%) were symptomatic. Fourteen patients underwent a planned thoracotomic enucleation. Of the 39 patients for whom a thoracoscopic approach was planned, six patients required conversion to thoracotomy because of overly small tumors or poor visualization in five patients and accidental mucosal injury in one patient. No mortality or major postoperative complications occurred. Compared to thoracotomy, the thoracoscopic approach had a slightly shorter operation time, but this difference was not statistically significant ($120.0{\pm}45.6$ minutes vs. $161.5{\pm}71.1$ minutes, p=0.08). A significant difference was found in the length of the hospital stay ($9.0{\pm}3.2$ days vs. $16.5{\pm}5.4$ days, p<0.001). Conclusion: The thoracoscopic enucleation of submucosal esophageal tumors is safe and is associated with a shorter length of hospital stay compared to thoracotomic approaches.

• The Journal of Advanced Prosthodontics
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• 제11권5호
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• pp.286-296
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• 2019

PURPOSE. The aim was to study the masking ability of high-translucency monolithic zirconia and provide guidance in selecting resin luting cements in order to mask discolored substrates. MATERIALS AND METHODS. 160 high-translucency zirconia specimens were divided into 32 groups depending on their thickness and shades. Using five shades of try-in paste, the specimens were luted onto the substrates (Co-Cr, precious-metal, opaque porcelain-sintered Co-Cr, opaque porcelain-sintered precious-metal, and 5M3-shade zirconia). All CIELAB color parameters were measured and statistically analyzed. RESULTS. Zirconia shade and thickness and try-in paste shade affected CIELAB color parameters (P=.000) in different substrates groups, and there were interactions among these factors (P=.000). All five try-in paste shades can be chosen to achieve ${\Delta}E$ values of zirconia with 1.2 - 1.5 mm for masking dark-tooth-like 5M3-shade and zirconia with 1.5 mm for masking precious-metal groups < 2.6. Only suitable try-in paste shades were used, can ${\Delta}E$ values that less than 2.6 be achieved when applied translucent monolithic zirconia with 0.7-1.0 mm for masking dark-tooth-like 5M3-shade and zirconia with 0.7 - 1.2 mm for masking precious-metal groups. CONCLUSION. Choosing suitable resin cement shades is necessary for high-translucency monolithic zirconia to achieve ideal masking ability (${\Delta}E$ < 2.6) on the dark-tooth.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제32권1호
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• pp.3-9
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• 2021

Objectives: It is hard to accumulate research data on adolescents' suicide, because friends and family of the suicide completers might be reluctant to share the experience. To overcome the lack of information on adolescent suicide victims, the authors examined the risk and protective factors for adolescents' suicide from a character in a novel. Methods: Krystal, an adolescent female in the novel The Casual Vacancy by Joanne Rowling, failed to overcome her unfortunate circumstances and committed suicide. The authors analysed Krystal's case based on the guideline for patients with suicidal behaviours to address the complicated situation of her death. Results: Krystal grew up in a poor and dangerous environment. Despite the environmental hardships, she developed ego maturation with affectionate help from Mr Fairbrother, an assistant coach of the Girls' Rowing Team and a parish councillor. The sudden passing away of Mr Fairbrother brought on a crisis of identity for Krystal. In addition, a villainous character raped her and her brother drowned to death, which brought her great sorrow. She felt helpless and committed suicide. Conclusion: In spite of many risk factors for suicide, Krystal was able to keep her life with a few protective factors, a younger brother in the home, and a sense of responsibility for the family. After the loss of her brother, however, she collapsed in a moment. Krystal's suicide might not only be a personal choice but a breakdown of the social protection system for the youth.

• 융합정보논문지
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• 제9권11호
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• pp.55-61
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• 2019

본 연구는 간호대학생을 대상으로 취업선호도, 중소병원에 대한 인지도를 파악하여 지역 중소병원 선택의 예측요인을 파악하기 위하여 시도되었다. 광주광역시와 전라남도 소재 4개 대학교에 재학 중인 간호대학생을 대상으로 2018년 9월부터 2018년 10월까지 자료를 수집하였으며, 부적절한 응답지를 제외한 476명의 설문지를 SPSS/WIN 24.0 프로그램을 이용하여 분석하였다. 연구결과, 간호대학생이 지역 중소병원을 선택한 경우는 66.0%였고, 중소병원 선택의 예측요인은 고등학교 졸업지역, 학업성취도, 중소병원에 대한 인지도였다. 본 연구결과를 통해 간호대학생이 지역 중소병원으로의 취업률을 높이기 위해서는 간호교육자들은 중소병원취업을 희망하는 학생들에게는 역량을 고려한 맞춤형 진로지도 및 상담을 해야겠으며, 병원 관계자들은 중소병원에 대한 인지도를 높이기 위한 다양한 홍보활동 및 마케팅 전략을 수립해야겠다.

• 보건의료산업학회지
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• 제2권1호
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• pp.137-154
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• 2008

The increase of the supply of medical service and the increase of hospitals have intensified the competition of hospitals, and the advancement towards internationalization in the opening of medical industry has triggered the infinite competition of medical profession. In addition, the high expectation of customers and quality improvement in the medical care in accordance with the improvement of overall income, and the change of active role of medical consumers according to the popularization and the improvement of rights awareness reflect the customer needs and choice in the medical service. Customers wanted to receive the kind and pleasant service under the up-to-date medical service. Therefore, as a solution, hospital coordinators were emerged for the purpose of smooth treatment and customer satisfaction by generalizing all service of hospital. Accordingly, this thesis attempted to investigate the effect of hospital coordinator education curriculum on the education satisfaction and the quality of medical service. In order to solve the purpose of this study, I, author reviewed the existing literatures, established hypothesis, and verified hypothesis by using the variety of statistics techniques such as reliability, validity, frequency analysis, and regression analysis. The verification of hypothesis is as followings: First, among education training factors of hospital coordinators, the quality of instructor significantly affects the satisfaction of hospital coordinator education training. Second, among training factors of hospital coordinator, the attitude of trainee significantly affects the training satisfaction of hospital coordinator. Third, among education training factors of hospital coordinator, education course significantly affects the training satisfaction of hospital coordinator education. As the qualities of instructor are better equipped, the satisfaction of education becomes higher. It indicates that the education method of instructors is important as an index to represent the qualities of instructor such as the appropriateness of education method, preparation, passion, visual materials, the adequacy of education procession, and specialized knowledge, and it has important effect on the satisfaction of education. In order to enhance the satisfaction of hospital coordinator education, the creation of education environment, making trainee concentrate on the education, is required by appropriately allocating programs, arousing interest in education, based on the attitude of trainee, discussion, and preliminary programs, preparation, ahead of enforcement of education. Fourth, the satisfaction of hospital coordinator education training significantly affects the reliability among the qualities of medical service. Fifth, satisfaction of hospital coordinator education training significantly affects hospitality I kindness among the qualities of medical service. If the education satisfaction of trainee is high, it is effective in the practical application such as dealing with complaints, the duty performance for the patients, and so on in offering the medical service, related to reliability and furthermore, we can find the positive change in the attitude change of medical professions related to the reliability of hospital coordinator. In addition, in the process of offering medical services such as the kind explanation on the duty, rapid response to the customers inquiry, and tidy uniform, practical effect was verified. Sixth, the education training factor of hospital coordinator significantly affects the reliability among the quality of medical service. Seventh, the education training factors of hospital coordinator significantly affect hospitality/kindness. In the education of hospital coordinator, the methods to attract the interest of trainee by emphasizing reliability should be sought and for gaining the practical effect of hospital coordinator education, the sufficient preparation and investigation on the education curriculum should be prerequisite and under this condition, intensified discussion on the instructor and education course is needed. In the design of education course, more education hours and subjects should be allocated in the part of hospitality in order to improve the practical application of hospitality. Therefore, it is meaningful in a sense that this study newly approached the components of hospital coordinator education and the need to modify the quality components of medical service in accordance with the study subjects was raised. This study also finds its meaning in that it provides basic materials for the study of future hospital coordinator education by suggesting the system development model of hospital coordinator education through preliminary study of education training. In addition, this study is meaningful in the aspect that it suggested the direction of education training by showing how the hospital coordinator education training would applied to the hospital coordinator course of the Continuing Education Center at Pusan and Kyungnam National University to some extent. Since all investigation of this study was approached from the side of hospital coordinator, the thoughts of patients who are beneficiaries of medical service, and care givers cannot be identified. Therefore, the satisfaction of patients and care givers through the experience of medical service, which is the essential prerequisite of medical service, should be importantly considered and investigated. Accordingly, The study of comparing and analyzing the views of both patients and care givers should be carried out in the future.

• 대한두개안면성형외과학회지
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• 제21권5호
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• pp.269-275
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• 2020

Background: The advance in microsurgical technique has facilitated a proper approach for reconstruction of extensive head and neck defects. For the success of free tissue reconstruction, selection of the recipient vessel is one of the most important factors. However, the vascular anatomy of this region is very complex, and a clear guideline about this subject is still lacking. In this study, we present our 30 years of experiences of free tissue reconstruction for head and neck defects. Methods: In this retrospective study, we analyzed a total of 138 flaps in 127 patients who underwent head and neck reconstruction using free tissue transfer following tumor resection between October 1986 to August 2019. Patients who underwent facial palsy reconstruction were excluded. Medical records including patient's demographics, detailed operation notes, follow-up records, and photographs were collected and analyzed. Results: Among a total of 127 patients, 10 patients underwent a secondary operation due to cancer recurrence. The most commonly used type of flap was radial forearm flap (n=107), followed by the anterolateral thigh flap (n=18) and fibula flap (n=10). With regard to recipient vessels, superior thyroid artery was most commonly used in arterial anastomosis (58.7%), and internal jugular vein (51.3%) was the first choice for venous anastomosis. The flap survival rate was 100%. Four cases of venous thrombosis were resolved with thrombectomy and re-anastomosis. Conclusion: Superior thyroid artery and internal jugular vein were reliable choices as recipient vessels. Proper recipient vessel selection could improve the result of head and neck reconstruction.

• Journal of Gastric Cancer
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• 제22권4호
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• pp.408-417
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• 2022

Purpose: Treatment options are limited after the failure of first-and second-line treatments in patients with HER2⁺ metastatic gastric cancer (mGC). The present study aimed to explore the efficacy, safety, and prognostic factors of apatinib efficacy as a third-line therapy for patients with human epithelial growth factor receptor 2-positive (HER2⁺) mGC. Materials and Methods: A total of 59 HER2⁺ mGC patients who received apatinib as third-line therapy were retrospectively enrolled in this two-center, single-arm, cohort study; the clinical response, survival data, and adverse events were retrieved. Results: The median progression-free survival (PFS) was 5.2 months (95% confidence interval [CI], 3.9-6.5), and the median overall survival (OS) was 8.2 months (95% CI, 6.6-9.8) Furthermore, forward stepwise multivariate Cox regression analysis showed that a higher Eastern Cooperative Oncology Group performance status score and multiple metastases were independently correlated with decreased PFS and OS (both P<0.05). The main adverse events were leukopenia (45.8%), hypertension (44.1%), thrombocytopenia (39.0%), hand-foot syndrome (37.3%), and elevated transaminase (33.9%). Grade 3 adverse events mainly included hypertension (5.1%) and neutropenia (5.1%); grade 4 adverse events did not occur. Conclusions: Apatinib is efficient and well tolerated in patients with HER2⁺ mGC as a third-line treatment, suggesting that it may be a candidate of choice for these patients.

• 보건행정학회지
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• 제13권1호
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• pp.46-68
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• 2003

In the model tested here, individual innovative work behavior is considered as the outcome of two antecedent factors-empowerment and organizational supports. The relationships between those variables and innovative work behavior are analyzed form the data collected through a questionnaire survey of 389 employees in five general hospitals. Results of multiple regression analyses show that three dimensions of empowerment-meaning, competence, and impact, and supports from organizational culture have significant effects on innovative work behavior whereas the effects of choice dimension of empowerment and managerial supports are not significant. These results emphasize the importance of empowerment and innovation oriented organizational culture for individual members' innovative work behavior. Theoretical and practical Implications and suggestions for future research are discussed.

• Journal of Chest Surgery
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• 제18권4호
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• pp.598-604
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• 1985

One hundred consecutive patients with the Tetralogy of Fallot underwent total correction at National Medical Center during the period 1977 to 1984, Oct. During this study period, we adopted more active policy towards reconstruction of right ventricular outflow tract across pulmonary valve. The mortality was 48% for patients less than 15 kg and 19% in patients above 15kg. Initially Bretschneider`s solution was used as cardioplegia, which was replaced by St. Thomas` solution since 1983, Jan. After then overall mortality dropped to 9% compared to 45% of initial learning period. Heart block occurred In 11 patients, 10 of whom died of combined low cardiac output syndrome. Pure low cardiac output syndrome was noted in 18 patients, most of whom responded to medical measures well except 4 patients. Recently sepsis of Serratia marcescence, which occurred explosively during several months to open heart surgery patients, attacked 3 tetralogy patients resulting in 2 hospital deaths. Our experience has shown that body weight, choice of cardioplegia and accumulation of experience as well as advance of operative and postoperative techniques are still important factors affecting survival rate at initial learning period.