• Journal of Korean Academic Society of Home Health Care Nursing
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• v.3
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• pp.53-66
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• 1996

Home Health Care is one part of the total health care system. It includes health care services that link the hospital to the community. While it is important for early discharge patients, home care is also important for people with chronic illnesses or handicapping conditions. In 1989 the Korean government passed a law that opened the way for formal development of home health care services beginning with education programs to certify nurses for home care, and then demonstration home care services. Part of the mandate of the demonstration projects was evaluation of home care services. This study was done in order to provide basic data that would contribute to the development of records that could be used for evaluation through a retrospective audit and to examine the care that had been given in Home Care at Wonju Christian Hospital over a twenty year period from 1974 to 1994. The purposes of the study were : to identify to characteristics of the clients who had received home care, to identify the reasons for client referrals, to identify the nursing problems of these clients, to identify the nursing care provided to these clients, and to identify differences in these areas over the twenty year period. The study was a descriptive study involving a retrospective audit of the client records. Demographic data on all clients were included : 4,171 clients from 2,564 families. Data on referrals, nursing diagnosis and nursing interventions were from even numbered records which had a patient problem list included in the record, 2,801 clients, Frequencies and ANOVA were used in the analysis. The results of the study showed that the majority of the clients were from Wonju city /county. There were more women than men related to the high number of postpartum clients(1,300). The high number of postparttum clients and newborns was also evident in the age distribution. An the number of maternal-child clients decreased over the 20 years, the mean age of the clients increased significantly. Other factors also contributed to this change ; as increasing number of clients with brain injuries or with cancer, and fewer children with burns, osteomyelitis and tuberculosis. There was a decrease in the mean number of visits and mean length of coverage, reflecting a movement towards a short term acute care model. The number of new clents dropped sharply after 1985. The reasons for this are : the development of other treatment alternatives for clients, the establishment of an active wellbaby clinic, many more options plus a decreasing number of new cases of Hansen's Disase, and insurance that allows people with burns to be kept in hospital until skin grafts are healed. Socioeconomic changes have resulted in an increase in the number of cases of cancer, stroke, head injuries following car accidents, and of diabetes. Of the 2,801 client records, 2,541(60.9%) contained a written referral but for 1,802 it contained only the medical diagnosis. The number of records with a referral requesting specific nursing care was 739(29.1%). Many family members who were identified as in need of nursing care had no written referral. Analysis of the patient problem list showed that 41.9% of the enteries were nursing diagnoses. Others incuded medical diagnosis, symptoms, and plans. The most frequently used diagnoses were alteration in nutrition, less than body requirements(115 entries), alteration in skin integrity(114), knowledge deficit(111), pain(78), self-care deficit(66), and alteration in pattern of urinary elimination(50). These are reflected in the NANDA categories for which the highest number of diagnosis was in the Exchanging pattern(446), followed by Moving(178), Feeling(136) and Knowing (115). Analysis of the frequency of interventions showed that exercise and teaching about exercise was the most frequent intervention, followed by teaching concering the need for follow-up care, checking vital signs, managing nutritional problems, managing catheters, giving emotional support, changing dressings, teaching about medication, teaching (subject not specified), teaching about diet, IM and IV medications or fluid, and skin care, in that order. Recommendations included: development of a record that would allow for efficient recording of frequently used nursing diagnoses and nursing interventions: expansion of the catchment area for Home Care at Wonju Christian Hospital ; expansion of the service to provide complication prevention, rehabilitation services, and support to increase the health maintenance /health promotion of the people being served as well as providing client dentered care ; and development of a clinical record that will allow efficient data collection from records, even though the recording is done by a variety of health care providers.

• Journal of Oral Medicine and Pain
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• v.38 no.3
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• pp.247-253
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• 2013

Renal osteodystrophy(RO) is characterized by skeletal changes in patients with renal disease and developed as a result of alterations in the metabolism of calcium, phosphate and secondary hyperparathyroidism. Bony changes in the craniofacial region include decreased bone density, radiolucent lesions(brown tumors), depletion of cortical bone and loss of lamina dura, but such changes rarely occur in the temporomandibular joint(TMJ). We report an uncommon case of bony changes and pain of both TMJs in a patient with RO. A 41-year-old man with RO came to our clinic due to TMJ pain and sounds. Occlusal change was also reported. Radiographs revealed degenerative changes of the both condyles. The patient had medical history of renal cancer therapy and hemodialysis. The patient was diagnosed with TMJ arthritis of RO and referred for systemic management through medication of calcium and vitamin D and parathyroidectomy. At 15-month follow-up, most of TMD symptoms disappeared and second radiographs revealed that bone density and cortical thickness of the mandible increased and the skeletal outline of the both condyles became relatively clear. As bony changes may begin in the early stage of the renal disease, dentists should be alert to detect the sign of the disease. In addition, it is important to differentiate TMJ arthritis of systemic cause because the treatment protocol is quite different.

• Korean Journal of Head & Neck Oncology
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• v.20 no.2
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• pp.128-134
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• 2004

Background and Objectives: Angiogenesis is the process of new blood vessel development from preexisting vessel. Angiogenenesis has been considered to be essential for the growth and expansion of a solid tumor. Vascular endothelial growth factor (VEGF), known as one of the most important vascular permeability factors, induces proliferation of endothelial cells, stiumulates angiogenesis, and increases vascular permeability. Several recents reports have documented that VEGF overexpression is associated with poor clinical outcomes in many maligmancies. The aims of this study were to determine whether microvessel density and VEGF expression are related to clinicopathologic factors such as age, sex, tumor size, tumor stage, and prognostic factors and to evaluate the relationship between VEGF expression and angiogenesis in benign and malignant thyroid tumors. Materials and Methods: The subjects were 65 patients (27 with papillary carcinoma, 27 with adenomatous hyperplasia, 11 with follicular adenoma) who underwent thyroidectomy from 1995 to 2001. Imuunohistochemistry was used to detect VEGF expression and microvessel density (MVD) in paraffin-embedded thryoid tumor specimens. Results: The intensity of the VEGF expression did not show stastically difference between benign and malignant thyroid tumors. There was no apparent correlation between VEGF expression and age, tumor size, T stage or scores of the AGES, AMES and MACIS systems. The neo-microvessel density was higher in the maligant tumor than the benign tumors. Also, higher neo-microvessel density was associated with metastases of the lymph nodes and scores of the AMES and AGES systems. Conclusion: Our results suggest that neo-microvessel vessel density may be a significant prognostic factor in the thyroid papillary carcinoma. But the VEGF expression does not appear to be an significant independent prognostic factor for thyroid papillary carcinoma.

• The Journal of Internal Korean Medicine
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• v.37 no.5
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• pp.776-785
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• 2016

The purpose of this study is to report and demonstrate the effect of Korean medical treatment on a wedge resection of a lung patient with mucinous adenocarcinoma. The patient was an 84-year-old female who was diagnosed with mucinous adenocarcinoma and underwent wedge resection. The patient was treated with acupuncture and herbal medicine (Banhahubak-tang and Gamiondam-tang). The EORTC Quality of Life Questionnaire, Core 30 (EORTC QLQ-C30), EORTC Quality of Life Questionnaire, Lung Cancer 13 (EORTC QLQ-LC13), numeric rating scale (NRS), and the Global Assessment (G/A) were used to assess the changes in symptoms, including operation site pain and dyspnea. After treatment, the patient showed improvement in operation site pain and dyspnea, based on the NRS and G/A. However, dyspnea and pain were aggravated based on the EORTC QLQ-C30 and EORTC QLQ-LC13. Therefore, Korean medicine may have a substantial benefit for patients with mucinous adenocarcinoma after wedge resection of the lung.

• Korean Journal of Clinical Pharmacy
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• v.10 no.3
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• pp.101-106
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• 2000

Menopausal women experience urogenitory and vasomotor symptoms with increased risk of osteoporosis and cardiovascular diseases, which can be reduced by hormone replacement therapy. However unopposed estrogen therapy has been associated with an increased risk of endometrial hypeiplasia or cancer. The objectives of this study were to compare effects of continuous vs. sequential hormone replacement therapy (HRT) on lipid profile, bone mineral density and menopausal symptoms of postmenopausal women and to assess how they perceive the menopause and HRT culturally. In this retrospective study, women in menopause longer than 6 months, normal in the mam-mogram and Papanicolaou smear, cholesterol level lower than 190 mg/dL or triglyceride level lower 4han 500 mg/dL were treated with Srogen (conjugated equine estrogen 0.625 mg tablet) and Provera (medroxyprogesterone acetate 2.5 mg tablet) for continuous treatment(CT) or Cycloprogynova (Estradiol valerate 2 mg and Norgestrel 0.5 mg complex tablet) for sequential treatment(ST). They were evaluated for lipid profile, bone mineral density, menopausal symptoms, side effects and their perception of menopause and HRT. As results, total sixty-seven patients out of ninety-four enrollees were included in final analysis (33 in continuous therapy, 34 in sequential therapy). There were significant decrease in total cholesterol ($15.04\pm3.17$, p=0.0001), LDL ($19.72\pm3.27$, p=0.0001), and increase in HDL ($5.89\pm1.63$, p=0.0001). Bone minora) density increased significantly with HRT ($0.02\pm0.11$, p=0.0001). But, there were no significant differences in change of lipid profile between continuous and sequential therapy: Total cholesterol, $13.12\pm4.7\;vs.\;16.91\pm4.3;\;LDL\;20.53\pm4.1\;vs.\;18.93\pm5.12:HDL\;7.15\pm2.3\;vs.\;4.67\pm2.2,\;p>0.05$. Incidences of flush reduced from $75\%\;(CT)\;to\;3.13\%\;and\;71.88\%\;(ST)\;to\;9.35\%$. The change of endometrium and breast were found 3 (CT) and 5 (ST) women, respectively. Most of women recognized that HRT is necessary $(70\%)$ for postmenopausal period but did not understand well the cardiovascular protective effect. In conclusion, hormone replacement therapy was effective in improving lipid profile, bone mineral density and menopausal symptoms in both continuous and sequential treatments with similar efficacy.

• Journal of Magnetics
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• v.22 no.1
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• pp.146-149
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• 2017

In this study, we compared the standardized value of each signal intensity, the apparent diffusion coefficient (ADC) that digitizes the diffusion of water molecules, and the signal to noise ratio (SNR) using b value 0 400, 1400 ($s/mm^2$). From March 2013 to December 2013, patients with suspicion of simple compound fracture and metastatic spine cancer were included in the MR readout. We used a 1.5 Tesla Achieva MRI system and a Syn-Spine Coil. Sequence is a DWI SE-EPI sagittal (diffusion weighted imaging spin echo-echo planar imaging sagittal) image with b-factor ($s/mm^2$) 0, 400, 1400 were used. Data analysis showed ROI (Region of Interest) in diseased area with high SI (signal intensity) in diffusion-weighted image b value 0 ($s/mm^2$) Using the MRIcro program, each SI was calculated with images of b-value 0, 400, and 1400 ($s/mm^2$), ADC map was obtained using Metlab Software with each image of b-value, The ADC is obtained by applying the ROI to the same position. The standardized values ($SI_{400}/SI_0$, $SI_{400}/SI_0$) of simple compression fractures were $0.47{\pm}0.04$ and $0.23{\pm}0.03$ and the standardized values ($SI_{400}/SI_0$, $SI_{400}/SI_0$) of the metastatic spine were $0.57{\pm}0.07$ and $0.32{\pm}0.08$ And the standardized values of the two diseases were statistically significant (p < 0.05). The ADC ($mm^2/s$) for b value 400 ($s/mm^2$) and 1400 ($s/mm^2$) of the simple compression fracture disease site were $1.70{\pm}0.16$ and $0.93{\pm}0.28$ and $1.24{\pm}0.21$ and $0.80{\pm}0.15$ for the metastatic spine. The ADC ($mm^2/s$) for b value 400($s/mm^2$) was statistically significant (p < 0.05) but the ADC ($mm^2/s$) for b value 1400 (p > 0.05). In conclusion, multi - b value recognition of signal changes in diffusion - weighted imaging is very important for the diagnosis of various spinal diseases.

• Korean Journal of Radiology
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• v.24 no.12
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• pp.1190-1199
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• 2023

Objective: This study aimed to investigate the feasibility of ultrafast magnetic resonance imaging (MRI) and radiomic features derived from breast MRI for predicting the upstaging of ductal carcinoma in situ (DCIS) diagnosed using percutaneous needle biopsy. Materials and Methods: Between August 2018 and June 2020, 95 patients with 98 DCIS lesions who underwent preoperative breast MRI, including an ultrafast sequence, and subsequent surgery were included. Four ultrafast MRI parameters were analyzed: time-to-enhancement, maximum slope (MS), area under the curve for 60 s after enhancement, and time-to-peak enhancement. One hundred and seven radiomic features were extracted for the whole tumor on the first post-contrast T1WI and T2WI using PyRadiomics. Clinicopathological characteristics, ultrafast MRI findings, and radiomic features were compared between the pure DCIS and DCIS with invasion groups. Prediction models, incorporating clinicopathological, ultrafast MRI, and radiomic features, were developed. Receiver operating characteristic curve analysis and area under the curve (AUC) were used to evaluate model performance in distinguishing between the two groups using leave-one-out cross-validation. Results: Thirty-six of the 98 lesions (36.7%) were confirmed to have invasive components after surgery. Compared to the pure DCIS group, the DCIS with invasion group had a higher nuclear grade (P < 0.001), larger mean lesion size (P = 0.038), larger mean MS (P = 0.002), and different radiomic-related characteristics, including a more extensive tumor volume; higher maximum gray-level intensity; coarser, more complex, and heterogeneous texture; and a greater concentration of high gray-level intensity. No significant differences in AUCs were found between the model incorporating nuclear grade and lesion size (0.687) and the models integrating additional ultrafast MRI and radiomic features (0.680-0.732). Conclusion: High nuclear grade, larger lesion size, larger MS, and multiple radiomic features were associated with DCIS upstaging. However, the addition of MS and radiomic features to the prediction model did not significantly improve the prediction performance.

• Korean Journal of Radiology
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• v.22 no.1
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• pp.131-138
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• 2021

Objective: Iterative reconstruction degrades image quality. Thus, further advances in image reconstruction are necessary to overcome some limitations of this technique in low-dose computed tomography (LDCT) scan of the chest. Deep-learning image reconstruction (DLIR) is a new method used to reduce dose while maintaining image quality. The purposes of this study was to evaluate image quality and noise of LDCT scan images reconstructed with DLIR and compare with those of images reconstructed with the adaptive statistical iterative reconstruction-Veo at a level of 30% (ASiR-V 30%). Materials and Methods: This retrospective study included 58 patients who underwent LDCT scan for lung cancer screening. Datasets were reconstructed with ASiR-V 30% and DLIR at medium and high levels (DLIR-M and DLIR-H, respectively). The objective image signal and noise, which represented mean attenuation value and standard deviation in Hounsfield units for the lungs, mediastinum, liver, and background air, and subjective image contrast, image noise, and conspicuity of structures were evaluated. The differences between CT scan images subjected to ASiR-V 30%, DLIR-M, and DLIR-H were evaluated. Results: Based on the objective analysis, the image signals did not significantly differ among ASiR-V 30%, DLIR-M, and DLIR-H (p = 0.949, 0.737, 0.366, and 0.358 in the lungs, mediastinum, liver, and background air, respectively). However, the noise was significantly lower in DLIR-M and DLIR-H than in ASiR-V 30% (all p < 0.001). DLIR had higher signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) than ASiR-V 30% (p = 0.027, < 0.001, and < 0.001 in the SNR of the lungs, mediastinum, and liver, respectively; all p < 0.001 in the CNR). According to the subjective analysis, DLIR had higher image contrast and lower image noise than ASiR-V 30% (all p < 0.001). DLIR was superior to ASiR-V 30% in identifying the pulmonary arteries and veins, trachea and bronchi, lymph nodes, and pleura and pericardium (all p < 0.001). Conclusion: DLIR significantly reduced the image noise in chest LDCT scan images compared with ASiR-V 30% while maintaining superior image quality.

• Radiation Oncology Journal
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• v.19 no.1
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• pp.53-65
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• 2001

Purpose : To improve the local control of patients with nasopharyngeal cancer, we have implemented 3-D conformal radiotherapy and forward intensity modulated radiation therapy (IMRT) to used of compensating filters. Three dimension conformal radiotherapy with intensity modulation is a new modality for cancer treatments. We designed 3-D treatment planning with 3-D RTP (radiation treatment planning system) and evaluation dose distribution with tumor control probability (TCP) and normal tissue complication probability (NTCP). Material and Methods : We have developed a treatment plan consisting four intensity modulated photon fields that are delivered through the compensating tilters and block transmission for critical organs. We get a full size CT imaging including head and neck as 3 mm slices, and delineating PTV (planning target volume) and surrounding critical organs, and reconstructed 3D imaging on the computer windows. In the planning stage, the planner specifies the number of beams and their directions including non-coplanar, and the prescribed doses for the target volume and the permissible dose of normal organs and the overlap regions. We designed compensating filter according to tissue deficit and PTV volume shape also dose weighting for each field to obtain adequate dose distribution, and shielding blocks weighting for transmission. Therapeutic gains were evaluated by numerical equation of tumor control probability and normal tissue complication probability. The TCP and NTCP by DVH (dose volume histogram) were compared with the 3-D conformal radiotherapy and forward intensity modulated conformal radiotherapy by compensator and blocks weighting. Optimization for the weight distribution was peformed iteration with initial guess weight or the even weight distribution. The TCP and NTCP by DVH were compared with the 3-D conformal radiotherapy and intensitiy modulated conformal radiotherapy by compensator and blocks weighting. Results : Using a four field IMRT plan, we have customized dose distribution to conform and deliver sufficient dose to the PTV. In addition, in the overlap regions between the PTV and the normal organs (spinal cord, salivary grand, pituitary, optic nerves), the dose is kept within the tolerance of the respective organs. We evaluated to obtain sufficient TCP value and acceptable NTCP using compensating filters. Quality assurance checks show acceptable agreement between the planned and the implemented MLC(multi-leaf collimator). Conclusion : IMRT provides a powerful and efficient solution for complex planning problems where the surrounding normal tissues place severe constraints on the prescription dose. The intensity modulated fields can be efficaciously and accurately delivered using compensating filters.

• The Journal of Korean Society for Radiation Therapy
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• v.18 no.2
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• pp.119-125
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• 2006

Purpose: To measure the dose for dose optimization at the reference point (A, B) and the critical organ with multi Purpose brachytherapy phantom (MPBP). For this wort the MPBP was custom made, and designed to reconstruct the treatment applicator using multi function applicator (MFA) in the same way as the treatment of patient. Materials and Methods: Dose measurements were made at the reference points (A, B) and the bladder with thermoluminescence dosimeter (TLD) for four patients with tandem and ovoid of uterine cervix cancer using the phantom. In Phantom, Total 20 times of the measurements were made with 5 times a patient. Results: The results of TLD measurements in MPBP phantom showed the relative error ranging from -3.2% to 3.8% at A point, and -1.4% to 4% at B point and 1.3% to 7.15% at the bladder of reference point. Conclusion: The reproducibility of dose measurement under the same condition as the treatment could be achieved using the custom-made MFA in phantom and the dose at the reference point (A, B) and bladder could be analyzed accurately. The measured dose acquired in MPBP can apply for the dose optimization.