• 제목/요약/키워드: Medical charge

검색결과 524건 처리시간 0.027초

단백질의 과전하화를 이용한 인공 항체의 분비 개선 (Improvement of Artificial Antibody Secretion Using Supercharged Protein)

  • 박지연;최희주;이혜진;안정훈
    • 생명과학회지
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    • 제30권5호
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    • pp.420-427
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    • 2020
  • Repebody는 비면역 글로블린 인공 항체로 저렴하고 빠르게 생산 가능한 맞춤형 항체이다. 그러나 의료용 repebody의 생산은 저수율 및 복잡한 정제 공정으로 인해 여전히 어려움을 겪고 있다. Pseudomonas fluorescens의 ABC transporter를 사용한다면 생산 공정을 간소화하고 비용을 줄일 수는 있지만 repebody는 양전하를 띠어 분비 효율이 낮다. 따라서 등전점(pI)이 높은 repebody의 등전점을 낮추어 음전하를 띄도록 해야 한다. 이것을 위해 repebody의 N 말단과 C 말단에 연속된 아스파탐산을 붙여 보았지만 분비가 증가하지 않았다. 다른 방법으로 ABC transporter를 통한 repebody 분비 효율을 높이기 위해 repebody의 항원 결합 부위의 반대쪽에 존재하는 열다섯 개의 양전하 아미노산을 아스파탐산으로 변환하여 repebody 표면이 강한 음전하를 띠도록 하였다. 그 결과, 기존 repebody의 발현 단백질 당 분비효율은 21.2%였으나 변형한 과음전하 repebody의 분비효율은 58.5%로 향상되었다. 결론적으로 과음전하를 통해 만들어진 repebody는 P. fluorescens에 의해 세포 바깥에 분비 생산할 수 있었다.

양성자 빔 선량 분포 검증을 위한 감마 꼭지점 영상 장치의 양면 실리콘 스트립 검출기 신호처리 모듈 개발 (Development of Signal Processing Modules for Double-sided Silicon Strip Detector of Gamma Vertex Imaging for Proton Beam Dose Verification)

  • 이한림;박종훈;김재현;정원균;김찬형
    • Journal of Radiation Protection and Research
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    • 제39권2호
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    • pp.81-88
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    • 2014
  • 최근, 인체 내 양성자 빔의 선량 분포를 검증하기 위해 새로운 개념의 영상기법인 감마 꼭지점 영상(gamma vertex imaging, GVI)이 제안되었다. GVI는 양성자 빔과 매질과의 핵반응으로 인해 발생하는 즉발감마선의 발생 위치를 결정하기 위해 입사한 감마선을 전자 변환기에서 전자로 변환한 후 전자의 궤적을 추적하는 방법을 사용한다. GVI 영상장치는 감마선을 전자로 변환하기 위한 전자 변환기, 전자 궤적을 추적하기 위한 2대의 양면 실리콘 스트립 검출기(double-sided silicon strip detector, DSSD)와 전자의 에너지 결정을 위한 섬광체 흡수부 검출기로 이루어진다. 본 연구에서는 GVI 영상 장치를 구성하는 DSSD 전용의 신호처리 장치를 구성하는 핵심 장치인 전하 민감형 전치증폭기(charge sensitive preamplifier, CSP) 모듈과 성형 증폭기 모듈을 개발하였으며, 상용 제품과 성능을 비교해 보았다. 감마선원의 에너지 스펙트럼 측정 결과, 자체제작 CSP 모듈이 상용 제품보다 에너지 분해능이 약간 낮은 것을 확인하였으며, 성형 증폭기의 경우 거의 동일한 성능을 보여주는 것을 확인할 수 있었다. 개발된 신호처리 장치의 노이즈의 크기를 나타내는 $V_{rms}$ 값은 6.48 keV으로 평가되었으며, 이는 145 ${\mu}m$의 DSSD에 전달되는 전자의 에너지( > ~51 keV)를 고려할 때 본 장치를 이용하여 전자의 궤적을 충분히 정확하게 결정할 수 있음을 확인할 수 있음을 보여준다.

보행보조차 손잡이 높이에 따른 노인들의 건강생활의 변화 : 상태불안과 심박수, 낙상효능감을 중심으로 (Changes in the Health Life of the Elderly Through the Handle Height of Walking Assistant Vehicle Article : Emphasizing on State Anxiety, Heart Rate and Fall Efficacy)

  • 손성민;곽성원
    • 한국엔터테인먼트산업학회논문지
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    • 제14권7호
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    • pp.519-528
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    • 2020
  • 본 연구의 목적은 보행보조차 손잡이 높이에 따른 노인들의 상태불안과 심박수, 낙상효능감의 변화를 분석하는 데 있다. 연구대상은 정상노인 32명이다. 보행보조차는 유모차 형태로 손잡이 높이를 대상자들의 신장의 48%를 기준으로 설정하였으며, 손잡이 높이를 5%씩 감소시켜, 48, 43, 38 %로 구성하였다. 상태불안 평가는 한국판 상태불안 척도를 활용하였으며, 심박수 평가는 Fitbit Charge 2 손목형 심박수 측정기를 활용하였다. 낙삭효능감 평가는 한국판 낙상효능감 척도를 활용하였다. 그 결과, 보행보조차 손잡이 높이에 따라 상태불안과 심박수는 통계적으로 유의미한 증가가 나타났으며, 낙상효능감은 통계적으로 유의미한 감소가 나타났다. 사후검정 결과에서도 상태불안과 낙상효능감의 분석결과 각각의 보행보조차 손잡이 높이에 따라 통계적으로 유의미한 차이가 나타났으며, 심박수의 분석결과 48, 43%의 손잡이 높이와 38%의 손잡이 높이 간의 통계적으로 유의미한 차이가 나타났다. 따라서, 노인들의 보행보조차 사용시 상태불안과 심박수를 감소시키고 낙상효능감을 향상시키기 위해서, 보행손잡이 높이를 적절하게 위치하여야 할 것이며, 보행보조차 사용자 전체 신장의 48%의 위치로 조정하여야 할 것이다.

한국농촌보건(韓國農村保健)의 문제점(問題點)과 개선방안(改善方案) (Innovative approaches to the health problems of rural Korea)

  • 노인규
    • 농촌의학ㆍ지역보건
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    • 제1권1호
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    • pp.5-9
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    • 1976
  • The categories of national health problems may be mainly divided into health promotion, problems of diseases, and population-economic problems which are indirectly related to health. Of them, the problems of diseases will be exclusively dealt with this speech. Rurality and Disease Problems There are many differences between rural and urban areas. In general, indicators of rurality are small size of towns, dispersion of the population, remoteness from urban centers, inadequacy of public transportation, poor communication, inadequate sanitation, poor housing, poverty, little education lack of health personnels and facilities, and in-accessibility to health services. The influence of such conditions creates, directly or indirectly, many problems of diseases in the rural areas. Those art the occurrence of preventable diseases, deterioration and prolongation of illness due to loss of chance to get early treatment, decreased or prolonged labour force loss, unnecessary death, doubling of medical cost, and economic loss. Some Considerations of Innovative Approach The followings art some considerations of innovative approaches to the problems of diseases in the rural Korea. 1. It would be essential goal of the innovative approaches that the damage and economic loss due to diseases will be maintained to minimum level by minimizing the absolute amount of the diseases, and by moderating the fee for medical cares. The goal of the minimization of the disease amount may be achieved by preventive services and early treatment, and the goal of moderating the medical fee may be achieved by lowering the prime cost and by adjusting the medical fees to reasonable level. 2. Community health service or community medicine will be adopted as a innovative means to disease problems. In this case, a community is defined as an unit area where supply and utilization of primary service activities can be accomplished within a day. The essential nature o the community health service should be such activities as health promotion, preventive measures, medical care, and rehabilitation performing efficiently through the organized efforts of the residents in a community. Each service activity should cover all members of the residents in a community in its plan and performance. The cooperation of the community peoples in one of the essential elements for success of the service program, The motivations of their cooperative mood may be activated through several ways: when the participation of the residents in service program of especially the direct participation of organized cooperation of the area leaders art achieved through a means of health education: when the residents get actual experience of having received the benefit of good quality services; and when the health personnels being armed with an idealism that they art working in the areas to help health problems of the residents, maintain good human relationships with them. For the success of a community health service program, a personnel who is in charge of leadership and has an able, a sincere and a steady characters seems to be required in a community. The government should lead and support the community health service programs of the nation under the basis of results appeared in the demonstrative programs so as to be carried out the programs efficiently. Moss of the health problems may be treated properly in the community levels through suitable community health service programs but there might be some problems which art beyond their abilities to be dealt with. To solve such problems each community health service program should be under the referral systems which are connected with health centers, hospitals, and so forth. 3. An approach should be intensively groped to have a physician in each community. The shortage of physicians in rural areas is world-wide problem and so is the Korean situation. In the past the government has initiated a system of area-limited physician, coercion, and a small scale of scholarship program with unsatisfactory results. But there might be ways of achieving the goal by intervice, broadened, and continuous approaches. There will be several ways of approach to motivate the physicians to be settled in a rural community. They are, for examples, to expos the students to the community health service programs during training, to be run community health service programs by every health or medical schools and other main medical facilities, communication activities and advertisement, desire of community peoples to invite a physician, scholarship program, payment of satisfactory level, fulfilment of military obligation in case of a future draft, economic growth and development of rural communities, sufficiency of health and medical facilities, provision of proper medical care system, coercion, and so forth. And, hopefully, more useful reference data on the motivations may be available when a survey be conducted to the physicians who are presently engaging in the rural community levels. 4. In communities where the availability of a physician is difficult, a trial to use physician extenders, under certain conditions, may be considered. The reason is that it would be beneficial for the health of the residents to give them the remedies of primary medical care through the extenders rather than to leave their medical problems out of management. The followings are the conditions to be considered when the physician extenders are used: their positions will be prescribed as a temporary one instead of permanent one so as to allow easy replacement of the position with a physician applicant; the extender will be under periodic direction and supervision of a physician, and also referral channel will be provided: legal constraints will be placed upon the extenders primary care practice, and the physician extenders will used only under the public medical care system. 5. For the balanced health care delivery, a greater investment to the rural areas is needed to compensate weak points of a rurality. The characteristics of a rurality has been already mentioned. The objective of balanced service for rural communities to level up that of urban areas will be hard to achieve without greater efforts and supports. For example, rural communities need mobile powers more than urban areas, communication network is extremely necessary at health delivery facilities in rural areas as well as the need of urban areas, health and medical facilities in rural areas should be provided more substantially than those of urban areas to minimize, in a sense, the amount of patient consultation and request of laboratory specimens through referral system of which procedures are more troublesome in rural areas, and more intensive control measures against communicable diseases are needed in rural areas where greater numbers of cases are occurred under the poor sanitary conditions.

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Westgard Multi-Rules의 효율적 적용과 조치사항의 개선 (Efficient Application of Westgard Multi-Rules and Quality Control Implementation Improvement)

  • 정흥수;오윤정;배진수;백진영;황보라;신용환
    • 핵의학기술
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    • 제21권1호
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    • pp.60-64
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    • 2017
  • 검사의 질 향상과 국제표준화의 상용화 정도관리물질을 이용한 Westgard multi-rules 적용의 유용성은 이미 알려져 있다. 그러나 핵의학 체외검사의 특성상 정도관리물질과 환자검체의 동시 계측으로 인한 측정횟수의 증가에 따라 Westgard multi-rules법을 적용함에 있어 어려움이 있다. 이에 본 연구는 핵의학 체외검사에서 상용화 정도관리물질을 이용한 Westgard multi-rules 적용의 유용성과 보완, 개선을 통해 내부정도관리의 효율성 향상을 조사하였다. 2013년 01월부터 2016년 06월까지 삼성서울병원 핵의학과 체외검사실 통합의료시스템에 기록된 총 282건의 적용된 계통오차 multi-rules (22s, 101s)과 117건의 조치사항 기록을 분석하였다. 조치사항은 multi-rules 중 계통오차의 규칙이 적용 되었을 때 기록하는 원인분석으로 정도관리물질 오류, 실험과정 오류, 검사키트 로트번호 관리 오류, 기타 등 총 4개의 대분류로 구성하였다. Westgard multi-rules 적용을 통해 조치사항을 분석한 결과 정도관리물질 오류가 62건, 실험과정 오류가 24건, 검사키트 로트번호 관리오류가 18건, 기타 13건으로 분류되었다. 정도관리물질 오류를 방지하고자 개선사항으로 기존에 각 검사자마다 사용하던 방식을 담당자 지정 방식으로 변경하여 모든 검사의 하루 소비량을 분주하여 공동사용을 하였고, 나머지 오류를 방지하고자 검사 전후 모든 과정을 표준화 하여 검사실내 어느 검사자가 시행 하더라도 일원화할 수 있게 하였다. 정도관리물질 오류를 개선한 결과 해동 후 2일 이내 신선한 물질을 사용 가능하였고 같은 물질을 사용하는 검사끼리 비교가 가능해져 물질에 의한 오류인지 명확해짐으로 계통오차 발생원인이 정도관리물질 오류로 기록하는 건수가 줄어들었다. 또한 정도관리물질의 로트번호 변경 시 교체시기가 같아 관리가 용이해졌고, 물질 사용량의 감소로 경제적 효과를 얻을 수 있었다. 그리고 검사표준화 적용 후, 계통오차의 규칙인 22s와 101s의 발생건수가 개선 전 보다 월 평균 2건 이상 줄어드는 결과를 보였다. Multi-rules의 적용을 통한 계통오차의 빠른 확인을 위해 정도관리물질의 체계적인 관리와 목표값과 표준편자의 설정 및 관리가 바탕이 되어야하며, 계통오차 발생 시 검사의 원인분석을 통한 조치사항을 기록하는 것이 중요함을 확인하였다. 본 실험의 결과로 Westgard multi-rules 적용 분석을 통해 발생 오류의 기재와 원인을 효율적으로 분석함으로써 핵의학 검사 내부정도관리의 질적 향상과 정확하고 신속한 결과보고에 기여할 것으로 사료된다.

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가정간호 사업에 대한 의사, 간호사, 진료관련부서 직원 및 환자의 인식 비교 (A Study on Differences of Opinions on Home Health Care Program among Physicians, Nurses, Non-medical personnel, and Patients.)

  • 김용순;임영신;전춘영;이정자;박지원
    • 대한간호
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    • 제29권2호
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    • pp.48-65
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    • 1990
  • The government has adopted a policy to introduce Home Health Care Program, and has established a three stage plan to implement it. The three stage plan is : First, to amend Article 54 (Nurses for Different Types of Services) of the Regulations for Implementing the Law of Medical Services; Second, to tryout the new system through pilot projects established in public hospitals and clinics; and third, to implement at all hospitals and equivalent medical institutions. In accordance with the plan, the Regulation has been amend and it was promulgated on January 9,1990, thus establishing a legal ground for implementing the policy. Subsequently, however, the Medical Association raised its objection to the policy, causing a delay in moving into the second stage of the plan. Under these circumstances, a study was conducted by collecting and evaluating the opinions of physicians, nurses, non-medical personnel and patients on the need and expected result from the home health care for the purpose of help facilitating the implementation of the new system. As a result of this study, it was revealed that: 1. Except the physicians, absolute majority of all other three groups - nurses, non-medical personnel and patients -gave positive answers to all 11 items related to the need for establishing a program for Home Health Care. Among the physicians, the opinions on the need for the new services were different depending on their field of specialty, and those who have been treating long term patients were more positive in supporting the new system. 2. The respondents in all four groups held very positive view for the effectiveness and the expected result of the program. The composite total of scores for all of 17 items, however, re-veals that the physicians were least positive for the- effectiveness of the new system. The people in all four groups held high expectation on the system on the ground that: it will help continued medical care after the discharge from hospitals; that it will alleviate physical and economic burden of patient's family; that it will offer nursing services at home for the patients who are suffering from chronic disease, for those early discharge from hospital, or those who are without family members to look after the patients at home. 3. Opinions were different between patients( who will receive services) and nurses (who will provide services) on the types of services home visiting nurses should offer. The patients wanted "education on how to take care patients at home", "making arrangement to be admitted into hospital when need arises", "IV injection", "checking blood pressure", and "administering medications." On the other hand, nurses believed that they can offer all 16 types of services except "Controlling pain of patients", 4. For the question of "what types of patients are suitable for Home Health Care Program; " the physicians, the nurses and non-medical personnel all gave high score on the cases of "patients of chronic disease", "patients of old age", "terminal cases", and the "patients who require long-term stay in hospital". 5. On the question of who should control Home Health Care Program, only physicians proposed that it should be done through hospitals, while remaining three groups recommended that it should be done through public institutions such as public health center. 6. On the question of home health care fee, the respondents in all four groups believed that the most desireable way is to charge a fixed amount of visiting fee plus treatment service fee and cost of material. 7. In the case when the Home Health Care Program is to be operated through hospitals, it is recommended that a new section be created in the out-patient department for an exclusive handling of the services, instead of assigning it to an existing section. 8. For the qualification of the nurses for-home visiting, the majority of respondents recommended that they should be "registered nurses who have had clinical experiences and who have attended training courses for home health care". 9. On the question of if the program should be implemented; 74.0% of physicians, 87.5% of non-medical personnel, and 93.0% of nurses surveyed expressed positive support. 10. Among the respondents, 74.5% of -physicians, 81.3% of non-medical personnel and 90.9% of nurses said that they would refer patients' to home health care. 11. To the question addressed to patients if they would take advantage of home health care; 82.7% said they would if the fee is applicable to the Health Insurance, and 86.9% said they would follow advises of physicians in case they were decided for early discharge from hospitals. 12. While 93.5% of nurses surveyed had heard about the Home Health Care Program, only 38.6% of physicians surveyed, 50.9% of non-medical personnel, and 35.7% of patients surveyed had heard about the program. In view of above findings, the following measures are deemed prerequisite for an effective implementation of Home Health Care Program. 1. The fee for home health care to be included in the public health insurance. 2. Clearly define the types and scope of services to be offered in the Home Health Care Program. 3. Develop special programs for training nurses who will be assigned to the Home Health Care Program. 4. Train those nurses by consigning them at hospitals and educational institutions. 5. Government conducts publicity campaign toward the public and the hospitals so that the hospitals support the program and patients take advantage of them. 6. Systematic and effective publicity and educational programs for home heath care must be developed and exercises for the people of medical professions in hospitals as well as patients and their families. 7. Establish and operate pilot projects for home health care, to evaluate and refine their programs.

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상고시대(上古時代)와 고조선시대(古朝鮮時代)의 의학(醫學)에 관(關)한 문헌적(文獻的) 고찰(考察) (A bibliographic study on medical science ancient period (上古時代) and the era of the old-Korea (古朝鮮時代))

  • 권학철;박찬국
    • 대한한의학원전학회지
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    • 제3권
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    • pp.218-247
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    • 1989
  • As mentioned above, I got the next conclusion since I had considered the medical contents of the ancient period(上古時代) and the era of the old-Korea(古朝鮮時代) through several bibliographic records. 1. There were Pung-baeg(風伯), Uh-sa(雨師), Un-sa(雲師) that were the names of the governmental officials during the ancient period of Whan-ung(桓雄). Among them, Uh-sa specially managed the treatment for diseases. When we think of the significance of Pung(風)-which means the winds, Uh(雨)-which means the rain, Un(雲)-which means of clouds, we will find out that the human life will be affected by all kinds of phenomena of the nature. So I can infer that ancestries could prevent and treat diseases with adjusting them tn the changes in the weather. 2. There were five government officials(五事) in the ancient period of Whan-ung(桓雄上古時代). They are Uh-ga(牛加), Ma-ga(馬加), Ku-ga(狗加), Cheo-ga(猪加) and Yang-ga(羊加), and had charges of five important duties. Among them, Cheo-ga was set to a charge of treatment for diseases. So we can notice that there existed people who treated for diseases professionally. When we think of the meanings of Uh(牛)-which intends cows or bulls. Ma(馬)-which intends horses, Ku(狗)-which intends dogs, Cheo(猪)-which intends wild boars and Yang(羊)-which intends sheep, we can see that livestocks would be raised at that time, and they came to have more chances to digest meat. Since the digestion of meat became to be a burden on the stomach and the intestines, it might cause a lot of indigestive troubles. 3. When I compared Tan-gun Pal-ga(檀君八加) with the Oh-ga(五加) in the ancient period of Whan-ung(桓雄上古時代), I could tell that the community of Tan-gun's period is more advanced and specialized than one of Whan-ung's. When I think of the next sentence ; "The Prince Imperial, Bu-u(夫虞) become to be a Ro-ga(鷺加), who treat for diseases professionally.", I am sure that the treatment for diseases was more importment than any other things, because he was the third son of Tan-gun(檀君). 4. According to Tan-gun(檀君) mythology, Whan-ung(桓雄) came down from the heaven of the pure Yang(純陽) to the earth and then changed into a man who had had more Yang(陽) than Yin(陰). And a bear came up from the underground(or the cave) to the ground and then changed into a women who had had more Yin(陰) than Yang(陽). So both of them became to hold together. This story implicated that ancestors had taken a serious view of each of them, namely the ancestors didn't give the ascendance to the one side of them, and made much account of the mutual harmony. So I am sure that this fact coincided with the basic theories of oriental medical science. To refer to two proverbs of Tan-gun mythology that are "Ki-Sam-Chil-Il(忌三七日)" which means caring for twenty one days, and "Pul-Gyon-Il-Gwang-Baeg-Il(不見日光百日)" which means keeping indoors for one hundred days, I can tell you that "twenty-one-day" involves the principle of the birth of life, and "one-hundred-day" contains a preparatory period or the period of death to bear another life. 5. From the medical stuff, such as wormwood(艾), garlic(蒜), or wonder-working herbage(靈草), that had been written at the bibliographic papers of the ancient period(上古時代) and the era of the old-Korea(古朝鮮時代), I consider that many people might get a lot of women's diseases, indigestive troubles, and other diseases that were caused by the weakness, but with using various spices, such as the leaves of water pepper(蔘), they could prevent the occurrance of all kinds of diseases previously. So I regard this treatment as the medicine from food. 6. One of the sayings at Nae-gyong(內經) is that "The stone accupuncture(砭石) came from the orient." We can see both "wonder-wor-king wormwood(靈草)" and "dried wormwood(乾艾)" in the several bibliographic papers of the ancient history of the old-Korea(朝鮮上古史). From these records, I can be convinced that ancestors would utilize the acupuncture(針) and the moxa cautery(灸) to cure a patient of a disease. 7. Even though someone claimed that the book, "medical science and chemistry(醫學化學)" and "medical treatment(醫學大方)" had had been written during the ancient period of the old-Korea(上古朝鮮時代), such a fact can't have been ascertained historical evidence. But it has been handed down that there existed the original phonetic alphabet, such as the "Ka-Im-To alphabet(加臨土文字)" at that time. The terms about the diseases, which had been occurred at the community of the old-Korea(古朝鮮地域), were recorded fragmentarily at other records after that time. The origin of confucianism came from the race of the eastern barbarians, and Tae-Ho-Pok-Hi(太嗅伏義) and the king. Sun(舜) came from the eastern barbarians, too. The divination of tortoise shells at the country of Un(殷) is another from which was developed at the eastern barbarians' fortune-telling of animal bones. From these facts, I can infer that, by all means, they might record the medical knowledge which had been stored for thousands of years while contacting with china directly.

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석곡 이규준의 부양론(扶陽論)에 관한 연구(硏究) (A Study on Seok-kok Lee, Kyu-jun's Pu-yang-non)

  • 황원덕
    • 대한한의학원전학회지
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    • 제12권2호
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    • pp.16-53
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    • 1999
  • On the viewpoint of Nae-Kyung and Ju-Yeok, the Seok-Kok's Pu-Yang-Non and other oriental medical doctor's Po-Eum-Eok-Yang, Pu-Yang-Eok-Eum theory which are on the basis of the Kun-Shin-Sang-Wha theory of Nae-Kyung and Myung-Mun theory of Nan-Kyung were compared and studied. The results were as follows : 1. Ju-Yeok and Nae-Kyung said the South is Fire. And explained it as the chief object of life activity by likening to king or saint. And said the North is Water. but didn't mentioned that there exists Fire. The activity of Kun-Wha is regarded as the the chief object of life activity and the Shin-Su can be vatalized by receiving the Shim-Kun-Wha. Therefore, the Seok-Kok's opinion that Shang-Wha is the Fire received by Shin-Su matchs the theory of Nae-Kyung and Nan-Kyung. 2. The Kidney(Shin) in Nae-Kyung means Puk-Bang- Han-Su(The North Cold Water) which has two characters, charging and discharging, ascending and descending. The paragrap "Kam-Ga-Seub(坎加習)" in Ju-Yeok means Puk-Bang-Su(The North Water) which also has two characters, charging and discharging, ascending and descending. The beginning and the end. And One Eum and Two Yang of Ri Sign of divination(離卦) cannot be divided into Su-Jang and Wha-Jang, the same as that, One Yang and Two Eum of Kam Sign of divination(坎卦) is Puk-Bang-Han-Su which cannot be divided into Shin and Myung-Mun. The theory of Choa-Shin-Woo-Myung-Mun of Nan-Kyung is the result that the Shin which has two characters is regarded as two organs. Therefore, from the viewpoint of Nae-Kyung and Ju-Yeok, the Seok-Kok's opinion that the Shin is the Puk-Bang-Han-Su which charges from the right and discharges to the left is more proper. 3. For the first time, the right kidney(Woo-Shin) defined as Myung-Mun in the Nan-Kyung and it is trailblazing theory which dosen't exist in the Nae-Kyung. But from the viewpoint of Nae-Kyung, Myung-Mun-Shang-Wha which some oriental medical doctors thought importantly is considered as Shim-Po which is in charge of the order of Shim(心命). 4. The rush of heat to the upper part(上熱) is raised by blind acting of Shang-Wha which exists in the lower part. This theory is on the basis of the Myung-Mun-Shang-Wha theory of Nan-Kyung. The theory that Wha is in the Shin(Kidney) doesn't exist and only the theory exists that the fever happens by the Kun-Wha not going down but ascending in the Nae-Kyung. Therefore the Shang-Wha blind acting theory of the lower part is not coincided with the theory of Nae-Kyung. 5. When the Vital power(陽氣) is blocked by bad tendencies(邪氣) like uncontrolled joy and anger or too much cold and heat etc, the trapped heat(鬱熱) or Ascending Shang-Wha apper, so Vital power itself cannot have blind activity or excess. Therefore, the theory of oriental medical doctors that the remaining vital power is the fire(氣有餘便是火) cannot be materialized. 6. On the basis of the Woo-Shin-Myung-Mun theroy, oriental medical doctors attached importance to Shin-Eum and Shin-Yang. So they emphasized on Ja-Eum-Gang-Wha or On-Bo-Shin-Yang for curing the Fire. Contrarily, On the viewpoint of siding with the vital power which is the Good and repressing the bad tendency which is the Bad, and another viewpoint that when the vital power which is Shim-Kun-Wha moves through the body consistently and fills up the body, then the enery and blood can be made, the Seok-Kok's theory is coincided with the theory of Nae-Kyung.

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방광암 환자의 영상유도 방사선치료에 관한 고찰 (The Investigation Image-guided Radiation Therapy of Bladder Cancer Patients)

  • 배성수;배선명;김진산;강태영;백금문;권경태
    • 대한방사선치료학회지
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    • 제24권1호
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    • pp.39-43
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    • 2012
  • 목 적: 현재 본원에서 방광암 환자의 영상유도 방사선치료는 재현성을 높이기 위하여 환자의 상태에 따라 알맞은 양의 생리식염수를 주입하고 영상유도 시스템(On-Board Imager system, OBI, VARIAN, USA)의 Cone.Beam CT (CBCT)로 3차원 정합(3D-3D matching)을 하여 치료를 한다. 본 연구에서는 방광암 환자의 치료 시 획득한 CBCT 영상의 분석을 통해 뼈를 기준으로 한 정합과 방광을 기준으로 한 정합의 차이를 알아보고, 생리 식염수를 주입한 방광의 체적 변화를 알아보고 방광암 환자의 치료 시 더욱 적절한 영상정합방법을 평가하고 고찰하고자 한다. 대상 및 방법: 본원에서 2009년 1월에서 2010년 4월까지 방사선치료를 위해 내원한 방광암 환자 7명을 대상으로 Folly catheter를 이용하여 방광 내 잔류 소변을 제거한 뒤 환자 개개인에 맞게 정해진 양 만큼의 생리식염수를 주입하고 CT-Sim 후 치료계획을 설계하였다. 그 뒤 OBI system을 이용하여 치료 전 자세 확인을 위해 CBCT를 찍었고, 담당 주치의가 모든 대상 환자의 영상 정합을 진행하였다. 총 45개 CBCT 영상을 이용하여 뼈를 기준으로 한 영상정합과 방광을 기준으로 한 영상정합의 차이를 분석하였다. 또, 방광의 체적 변화를 Eclipse (version 8.0, VARIAN, USA)를 통해 얻어냈다. 결 과: 뼈를 기준으로 한 영상정합을 한 후 다시 방광을 기준으로 한 정합의 차이는 X축으로 평균 $3{\pm}2mm$, Y축으로 $1.8{\pm}1.3mm$, Z축으로 $2.3{\pm}1.7mm$이고 전체 이동거리는 $4.8{\pm}2.0mm$로 나타났다. 또 방광의 체적은 기준 대비 $4.03{\pm}3.97%$의 차이를 나타냈다. 결 론: 방광의 특성상 해부학적 위치 및 내부의 움직임으로 인해 뼈를 이용한 영상정합 후에도 방광의 위치 차이가 발생하였다. 또, 생리식염수를 채운 방광의 체적은 4.03%의 차이를 나타냈으나 영상 정합 시 모두 계획한 볼륨 안에 포함되는 것을 확인 할 수 있었다. 따라서 생리식염수를 주입한 뒤 방광을 기준으로 영상 정합을 실시함으로써 더욱 정확한 치료를 실시 할 수 있을 것으로 사료된다.

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암환자 인식에 관한 연구 - 간호사ㆍ의사를 중심으로

  • 조인향
    • 호스피스학술지
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    • 제2권1호
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    • pp.58-74
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    • 2002
  • This paper constitutes a descriptive investigation and used a structured questionnaire to investigate nurses' and doctors' recognition of cancer patients. The subjects were extracted from the medical personnel working at the internal medicine, the surgery ward, the obstetrics and gynecology department, the pediatrics department, the cancer ward, and the emergency room of five general hospitals located in Seoul and Gyeonggi Province. The research lasted from August, 2001 to September 2001. Total 137 nurses and 65 doctors were included and made out the questionnaires directly distributed by the investigator. The study tool was also developed by the investigator and consisted of such items as the demographic and social characteristics, the medical personnel's recognition degree of cancer and cancer patients, their recognition of the management of cancer patients, and their participation in a hospice. The results were analyzed using the SPSS Window program in terms of technological statistics, ranks, t-test, and ANOVA. The reliability was represented in Cronbach' α=.75. The nurses' and doctors' recognition degree of cancer and cancer patients had an overall average of 3.86 at the 5 point-scale. The items that received an average of 4.0 or more included 'Medical personnel should explain about the cancer cure plans to the cancer patient and his or her family', 'A patient whose case has been diagnosed as a terminal cancer should be notified of it, 'If I were a cancer patient, I would want to get informed of it,' and 'Cancer shall be conquered whenever it is'. In the meantime, the items that received an average of 3.0 or less was 'My relationship with the cancer patient's family has gotten worse since I announced his or her impending death.' And according to the general characteristics and the difference test, the recognition degree of cancer and cancer patient was high among the subgroups of nurses, females, married persons, who were in their 30s, who had a family member that was a cancer patient, and who received a hospice education. The biggest number of the nurses and doctors saw 'a gradual approach over several days'(68.8%) as a method to tell a cancer patient about his or her cancer diagnosis or impending death. Those who usually tell tragic news were the physician in charge(62.8%), the family members or relatives(32.1%) and the clergymen(3.8%) in the order. The greatest number of them recommended a cancer patient's home as the place where he or she should face death because they thought 'it would stabilize his or her mentality'(91.9%) while a number of them recommended the hospital because they 'should give the psychological satisfaction to the patient'(40%) or 'should try their best until the last moment of the patient's death'(30%). A majority of the medical personnel regarded 'smoking or drinking' and 'diet' as the causes of cancer. The biggest symptom of a cancer patient was 'pain' and the pain management of a cancer patient was mostly impeded by the 'excessive fear of drug addiction, tolerance to drugs and side effects of drugs' by medical personnel, the patient, and his or her family. The most frequently adopted treatment plan of a terminal cancer patient was 'to do whatever the patient or his or her family wants' to resort to a hospice' and 'to continue active treatment efforts' in the order. The biggest reasons why a terminal cancer patient went to see a doctor were 'pain alleviation' 'control of symptoms other than pain(intravenous supply)' and 'incapability of the patient's family' in the order. Terminal cancer patients placed their major concern in 'spiritual(religious) matter' 'emotional matters' their family' 'existence' and 'physical matters' in the order. 113(58.5%) of the whole medical personnel answered they 'would recommend' an alternative treatment to a terminal cancer patient mostly because they assumed it would 'stabilize the patient's mentality.' Meanwhile, 80(41.5%) of them chose 'not to recommend it mostly due to the unverified effects and high cost of it(78.7%). A majority of them, I. e. 190(94.1%) subjects said they 'would recommend' a hospice to a terminal cancer patient mostly because they thought it would help the patient to 'mentally prepare'(66.6%) Only 17.3% of them, however, had received a hospice education, most of which was done through the hospital duty education(41.4%) and volunteer training(34.5%). The follows are results of this study: 1. The nurses and the doctors turned out to be still passive and experience confusion in dealing with a cancer patient despite their great sense of responsibility for him or her. 2.Nurses and Doctors realize the need of a hospice, but an extremely small number of them participate in a hospice education or performance. Thus, a whole recognition of a hospice should be changed, for which purpose a hospice education for nurses and doctors should be provided. 3.Terminal cancer patients preferred their home to a hospital as the place to face their impending death because they felt it would bring 'mental stability.' And most of nurses and doctors think it would be unnecessary for them to be hospitalized just for control of their symptoms. Accordingly a terminal cancer patient can be cared at home, and a home hospice care needs to be activated.

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