• 제목/요약/키워드: Physical activity Program

검색결과 858건 처리시간 0.033초

Ginseng Gintonin Activates the Human Cardiac Delayed Rectifier K+ Channel: Involvement of Ca2+/Calmodulin Binding Sites

  • Choi, Sun-Hye;Lee, Byung-Hwan;Kim, Hyeon-Joong;Jung, Seok-Won;Kim, Hyun-Sook;Shin, Ho-Chul;Lee, Jun-Hee;Kim, Hyoung-Chun;Rhim, Hyewhon;Hwang, Sung-Hee;Ha, Tal Soo;Kim, Hyun-Ji;Cho, Hana;Nah, Seung-Yeol
    • Molecules and Cells
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    • 제37권9호
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    • pp.656-663
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    • 2014
  • Gintonin, a novel, ginseng-derived G protein-coupled lysophosphatidic acid (LPA) receptor ligand, elicits $[Ca^{2+}]_i$ transients in neuronal and non-neuronal cells via pertussis toxin-sensitive and pertussis toxin-insensitive G proteins. The slowly activating delayed rectifier $K^+$ ($I_{Ks}$) channel is a cardiac $K^+$ channel composed of KCNQ1 and KCNE1 subunits. The C terminus of the KCNQ1 channel protein has two calmodulin-binding sites that are involved in regulating $I_{Ks}$ channels. In this study, we investigated the molecular mechanisms of gintonin-mediated activation of human $I_{Ks}$ channel activity by expressing human $I_{Ks}$ channels in Xenopus oocytes. We found that gintonin enhances $I_{Ks}$ channel currents in concentration- and voltage-dependent manners. The $EC_{50}$ for the $I_{Ks}$ channel was $0.05{\pm}0.01{\mu}g/ml$. Gintonin-mediated activation 1 of the $I_{Ks}$ channels was blocked by an LPA1/3 receptor antagonist, an active phospholipase C inhibitor, an $IP_3$ receptor antagonist, and the calcium chelator BAPTA. Gintonin-mediated activation of both the $I_{Ks}$ channel was also blocked by the calmodulin (CaM) blocker calmidazolium. Mutations in the KCNQ1 $[Ca^{2+}]_i$/CaM-binding IQ motif sites (S373P, W392R, or R539W)blocked the action of gintonin on $I_{Ks}$ channel. However, gintonin had no effect on hERG $K^+$ channel activity. These results show that gintonin-mediated enhancement of $I_{Ks}$ channel currents is achieved through binding of the $[Ca^{2+}]_i$/CaM complex to the C terminus of KCNQ1 subunit.

Panax ginseng as an adjuvant treatment for Alzheimer's disease

  • Kim, Hyeon-Joong;Jung, Seok-Won;Kim, Seog-Young;Cho, Ik-Hyun;Kim, Hyoung-Chun;Rhim, Hyewhon;Kim, Manho;Nah, Seung-Yeol
    • Journal of Ginseng Research
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    • 제42권4호
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    • pp.401-411
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    • 2018
  • Longevity in medicine can be defined as a long life without mental or physical deficits. This can be prevented by Alzheimer's disease (AD). Current conventional AD treatments only alleviate the symptoms without reversing AD progression. Recent studies demonstrated that Panax ginseng extract improves AD symptoms in patients with AD, and the two main components of ginseng might contribute to AD amelioration. Ginsenosides show various AD-related neuroprotective effects. Gintonin is a newly identified ginseng constituent that contains lysophosphatidic acids and attenuates AD-related brain neuropathies. Ginsenosides decrease amyloid ${\beta}$-protein ($A{\beta}$) formation by inhibiting ${\beta}$- and ${\gamma}$-secretase activity or by activating the nonamyloidogenic pathway, inhibit acetylcholinesterase activity and $A{\beta}$-induced neurotoxicity, and decrease $A{\beta}$-induced production of reactive oxygen species and neuro-inflammatory reactions. Oral administration of ginsenosides increases the expression levels of enzymes involved in acetylcholine synthesis in the brain and alleviates $A{\beta}$-induced cholinergic deficits in AD models. Similarly, gintonin inhibits $A{\beta}$-induced neurotoxicity and activates the nonamyloidogenic pathway to reduce $A{\beta}$ formation and to increase acetylcholine and choline acetyltransferase expression in the brain through lysophosphatidic acid receptors. Oral administration of gintonin attenuates brain amyloid plaque deposits, boosting hippocampal cholinergic systems and neurogenesis, thereby ameliorating learning and memory impairments. It also improves cognitive functions in patients with AD. Ginsenosides and gintonin attenuate AD-related neuropathology through multiple routes. This review focuses research demonstrating that ginseng constituents could be a candidate as an adjuvant for AD treatment. However, clinical investigations including efficacy and tolerability analyses may be necessary for the clinical acceptance of ginseng components in combination with conventional AD drugs.

천마(Gastrodia elata)로부터 분리한 VHR DS-PTPase 저해 물질 (The VHR Dual-Specificity Protein Tyrosine Phosphatase (DS-PTPase) Inhibitor Isolated from Gastrodia elata)

  • 이명선;오원근;배은영;안순철;손천배;히로유키 오사다;안종석
    • 한국식품과학회지
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    • 제34권3호
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    • pp.505-509
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    • 2002
  • 천마의 methanol 추출물로부터 VHR DS-PTPase 저해 물질을 분리하여 이를 HREI-MS와 $^1H-NMR$, $^{13}C-NMR$, DEPT 등의 기기 분석 자료에 의하여 baicalein으로 구조를 동정 하였다. 이 물질은 VHR에 대하여 $2.4{\mu}M$$IC_{50}$값을 나타내었고 T-cell PTPase나 PPase 1과 같은 다른 단백질 탈인산화 효소에 대하여는 저해 활성을 나타내지 않았다. 또한 7종류의 인간 암세포주(흑색종 세포주인 LOX-IMVI, 폐암 세포주인 NCI H23과 A549, 대장암 세포주인 HCT 116와 SW 620, 전립선암 세포주인 PC-3와 백혈병 세포주인 MOLT 4F)에 대한 세포독성을 조사하여 본 결과 $5.26{\sim}12.93\;{\mu}g/mL$에서 $GI_{50}$값을 나타내었다.

고령장애인 실태와 생활만족도 영향 요인: 1인가구와 다인가구 비교 (Characters and Factors Affecting the Life Satisfaction of the Older Adults with Disabilities: A Comparison of one-person and multi-person households)

  • 박주영
    • 한국콘텐츠학회논문지
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    • 제18권12호
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    • pp.272-280
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    • 2018
  • 본 연구는 고령장애인 실태와 생활만족도를 분석하여 생활만족도를 향상시키는 방안을 제시하는데 목적이 있다. 연구자료는 한국장애인고용공단에서 조사한 8차 장애인고용패널 자료를 활용하고, 연구대상은 1인 가구 126명, 다인가구 326명이다. 분석은 $x^2$, ANOVA, 로지스틱 회귀분석으로 SPSS 24.0 프로그램을 활용하였다. 연구결과 첫째, 연구대상자는 남성, 유배우자, 경증장애, 신체외부 장애, 비수급자, 미취업자가 많고, 생활만족도 수준은 3.27로 나타났다. 둘째, 고령장애인 1인가구는 다인가구에 비해 여성, 무배우자, 중증 장애, 장애수용이 낮은 경우, 전반적 건강상태가 좋지 않은 경우, 일상생활에서 도움이 필요하고, 차별경험이 많은 경우, 미취업, 낮은 월소득, 수급자, 주관적 소속계층이 낮은 것으로 나타났다. 셋째, 1인가구 고령장애인 생활만족도 영향 요인은 장애수용(p<.05), 전반적 건강상태(p<.05), 사회활동 참여도(p<.05), 종교생활(p<.05)이 유의미하게 나타났고, 다인가구 고령장애인 생활만족도 영향 요인은 장애수용(p<.001), 전반적 건강상태(p<.001), 주관적 소속계층(p<.05)이 유의미하게 나타났다. 결과를 바탕으로 고령장애인 생활만족도를 향상시키기 위한 방안을 제시하였다.

교각운동시 이마면에서 엉덩관절 위치가 배근육 근활성도에 미치는 영향 (Effect of hip positions in frontal plane on abdominal muscle activities during bridging exercise)

  • 이원휘
    • 한국산학기술학회논문지
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    • 제20권3호
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    • pp.224-230
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    • 2019
  • 본 연구의 목적은 이마면에서 엉덩관절 위치에 따라 배근육들의 근활성도를 측정하여 비교함으로 이마면에서 엉덩관절의 위치가 배근육들의 근활성도에 영향을 미치는지 알아보는 것이다. 연구방법은 20대의 건강한 남녀 26명을 대상으로 엉덩관절 중립, 모음, 그리고 벌림 자세에 따라 교각운동을 하였을 때 표면 근전도 장비를 이용하여 양쪽 배곧은근과 배바깥빗근, 배속빗근의 근활성도를 비교하였다. 통계 방법은 반복측정 일요인 분산분석을 실시하였고, 유의수준은 0.05로 하였다. 연구 결과 배바깥빗근과 배속빗근은 이마면에서 엉덩관절 위치에 따라 유의한 차이가 있었고, 배곧은근은 유의한 차이가 없었다. 양쪽 배바깥빗근과 왼쪽 배속빗근은 엉덩관절 중립자세보다 엉덩관절 모음 자세에서 근활성도가 유의하게 증가하였으며 오른쪽 배속빗근은 엉덩관절 벌림 자세보다 엉덩관절 모음 자세에서 근활성도가 유의하게 증가하였다. 본 연구를 통해 엉덩관절 모음 자세가 다른 자세들에 비해 안정화 운동에 더욱 효과적일 수 있다는 것을 알 수 있었고, 안정화 운동 프로그램을 고안할 때 운동의 강도를 조절하기 위해 이마면에서 엉덩관절의 위치에 대한 요소를 적용할 수 있을 것이다.

지체장애인의 심리적 재활을 위한 성격 및 가치관 분석 (An Analysis of Value and Personality for the Crippled Person's Psychological Rehabilitation)

  • 엄익곤;김규수
    • The Journal of Korean Physical Therapy
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    • 제4권1호
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    • pp.79-93
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    • 1992
  • This study is search for analyzed the primary factor of psychological characters of crippled person toward psychological rehabilitation that is the most foundmental to all rehabilitation for a crippled person. The research is, make a comparative analyze to personality character, value character, and motion, and then examined the relation of among then, by applies to high school's crippled students. First. in the personality character aspect, a group of crippled student's is shown that the factor of family relations is lack harmony than normal group, that is, shown up that a parents and family members is oversensitiveness to crippled person, So sometimes they overprotectiveness, unconcered, and not accept it is. Also, in the factor of confrontability aspect, a group of crippled person's average is shown to high as compared with normal group, and then, it shown that they are irresponsible, have a weak self-control, and show a marked trend toward self-control. This is means that crippled person have scruples about psychological and social adaptation. But friendship, adaptability, cheefulness. and emotonal stability is shown no difference with normal person. Accordingly, in the personality aspect, the falter of family-relation and confrontability can be know that the object of psychological rehabilitation. Second, in the sence of value aspect, crippled students is show that the average score had higher than normal group toward the factor of variety, therefor we can know that they have purpose to more pursur of variety in the living. This is consideration that a raise from the limited of social contact chance and badly informed and experience. Also, the factor of purpose-intention is shown that crippled students had low non than normal group, then, that means that they have a weak will toward cope with various problems in daily living. Crippled student is, in contrast to lacked fixed purpose with self-living, and also insufficient tring to accomplish their objects. Third, crippled students motion shown that related to low level of personality character and a sence of value factor. Daily living activity is show that related to the factors of confrontability and cheerfulness. This means that rehabilitation service given a change to confrontability and cheerfulness that can be effect is related. And the activity of home is related with confrontability, psychological rehabilitation for the change of activity is can say that it should be contribute to strengthen toward responsibility and self-control from self-central to intention at rho others. Fourth, the relation between an motion and a value of crippled student is shown low level of regulations that can be ignore. In sum, in the rehabilitation of crippled person, hereafter, a study subject is if which search to character factor and to find out effect inter-factors within the the factor of psychological rehabilitation as medical, occupational, social rehabilitation, then probably more effective development toward rehabilitation programs. Conseguently, hereafter for the crippled person's rehabilitaton, the study should be rquirement for establish a character and factors each filed of rehabilitation. The study sibject toward crippled person's rehabilitation for the fature is search for character factor toward medical. occupational, and social rehabilitation. and find out inter-relation among then like as search of this study for psychological rehabilitation. For the rehabilitation of crippled person, if is not preceding of study like this, it ought to be difficult to creation service as well as development to effective program.

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보건진료원 직무교육 교과과정 개선을 위한 일 연구 (A Study on Curriculum Development For Community Health Practitioners)

  • 조원정;이경자
    • 대한간호학회지
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    • 제22권2호
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    • pp.207-226
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    • 1992
  • This study was designed to develop a conceptual framework for the curriculum and develop the details of the learning content for the education of Community Health Practitioners (CHPs). Since education programs for CHPs started 10 years ago, concepts related to CHP services have changed because of changes in society. The objectives of the study were as follows : 1) to analyse the usefulness of the present education program for CHPs, 2) to analyse the Job performance and self -confidence of the CHPs, 3) to identify the health needs of the clients served by the CHPs and the community problems related to health. 4) to develop a conceptual framework for the curriculum, for the education of CHPs, 5) to develops details for the learning content of the education program for CHPs. Phase I of the study was conducted by questionnaires to 150 CHPs who have worked in remote rural areas for more than 2 years. Among them, 147 responded. Data was collected from August 16, to August 25, 1990. In order to identify the health needs of the community people, research within the last five years was reviewed and analyzed. The data on 1, 842 communities gathered by the WHO Nursing Collaborations Center of the College of Nursing, Yonsei University was utilized to identify community problems related to health and the self - confidence in job performance of the CHPs. Psase II of the study consisted of a workshop with 13 professionals including Community Health Practitioners to evaluate the existing education program and a conceptual framework of the curriculum for the job education of CHPs. The results of the study are Summariged below : 1. The only 26 among 45 content items of the education program related to job skills was used by 80% of the responding CHPs. The knowledge of $\ulcorner$Networking community organization$\lrcorner$ was used by only 53.7% of the respondents. Educational content about $\ulcorner$Mental disease$\lrcorner$ was used by less than 50% of CHPs because of a knowledge deficit. 2. The CHPs reported that their activities concentrated on clinical services during the last six months. The survey showed that they seemed to neglect the activities for health promotion and disease prevention. Thus, $\ulcorner$Education for community loaders$\lrcorner$(15.9%), $\ulcorner$Activity for eavironmental health$\lrcorner$(16.3%) and $\ulcorner$Social work for needey people$\lrcorner$(23.3%) were done by less than 30% of CHPs. 3. More than 90% of CHPs reported being self - confident for the activities of $\ulcorner$Health education and counselling$\lrcorner$, $\ulcorner$Medicine prescription$\lrcorner$ and $\ulcorner$Immunization$\lrcorner$. But 50% of CHPs reported that they were not have self - confident in $\ulcorner$Management of water and environmental health$\lrcorner$ and only 25.6% of CHPs could insert an IUD independently. 4. It was identified that respiratory diseases and the gastrointestinal diseases were most common problems for the community people, followed by musculoskeletal and skin problems. 5. The community problems were classified into eight categories : physical environmental problems, environmental hygiene, health problems, health behavior, social problem, lack of resources, financial problem and the problems of the cultural and value system. 6. The conceptual framework consisted of the target population and their health status, nursing process working site and primary health care services such as health promotion, disease prevention, treatment and rehabilitation. 7. The contents of curriculum of education program for CHPs were formulated from the results of this study.

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한국의 예술치료와 호스피스 완화의료 (Art Therapy and Hospice & Palliative Care in Korea)

  • 김창곤
    • Journal of Hospice and Palliative Care
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    • 제18권2호
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    • pp.85-96
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    • 2015
  • 한국의 현대적 예술치료는 1960~1970년대 국내 정신과 환자들을 대상의 보조치료인 활동요법(activity program)의 형태에서, 1982년 정신과 의사들을 중심으로 한국임상예술학회가 창립되면서, 음악치료(music therapy), 미술치료(art therapy), 무용치료(dance therapy), 시치료(poetry therapy), 정신치료극(Psychodrama) 등의 예술치료가 정신장애환자를 대상으로 발전하였다. 1990년대에는 한국미술치료학회와 한국음악치료학회 등 분야별 전문단체가 본격적으로 출범하였고, 2001년 한국예술치료학회가 창립되었다. 통합예술치료의 예술은 한 개인의 내적인 세계와 연관된 인간자체가 가지는 본연의 능력인 창조적 활동이며, 여기에는 음악치료, 미술치료, 무용치료, 시치료 등이 포함된다. 통합예술치료는 인간의 체험현상을 그대로 인정하고 자각하게 하는 현상학적 측면에서 신체와 창조성의 회복을 목표로 예술매체를 활용한 심신치료활동이면서 심신의 성장과 발달을 목표로 하는 치료예술활동이다. 최근 국내 음악치료, 미술치료, 무용동작치료, 통합예술치료를 중심으로 예술치료의 효과에 대한 메타분석 결과, 신체기능 효과 변인군을 제외한 모든 변인군에서 효과크기가 유의했고, 심리적응 효과, 행동적응 효과 그리고 생리적 효과 변인군 순으로 효과크기가 확인되었다. 2015년 7월, 보건복지부는 완화의료 건강보험수가 급여를 일당정액제로 시행하면서, 국내 56개 호스피스전문기관에서 대부분 시행중인 음악치료, 미술치료, 원예치료에 대한 수가를 인정하는 방향으로 논의하고 있다. 이것은 1977년 정신과 환자에 대한 예술요법의 수가가 인정된 이후, 호스피스 완화의료 환자에 대한 예술치료의 수가가 인정된다는 데 그 의의가 있다. 그러나, 예술치료매체와 중재유형, 그리고 치료효과간의 인과관계의 명확한 제시, 즉 치료기전의 문제와 무분별하게 발급되는 자격증 취득자의 교육 수련 수퍼비젼을 통한 전문성과 정체성의 문제를 해결하기 위해, 전문학회 및 협회 등 전문단체간의 유기적인 협력과 노력이 요구된다.

농촌주민의 건강증진행위, 건강문제, 지각된 건강상태 및 농부증 (Health Promotion Behavior, Health Problems, Perceived Health Status and Farmers' Syndrome of Rural Residents)

  • 박정숙;권상민;오윤정
    • 농촌의학ㆍ지역보건
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    • 제34권1호
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    • pp.47-57
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    • 2009
  • 이 연구는 농촌주민들의 건강증진행위, 건강문제, 지각된 건강상태, 농부증에 대해 알아봄으로써 농촌주민을 위한 맞춤형 건강증진프로그램 개발에 기초자료를 제공하기 위해 시도되었다. 연구대상자는 전국 보건진료소 1,875개소 중 지역별 임의표출한 19개 보건진료소의 농촌지역에 거주자 637명을 대상으로 이루어졌으며, 2006년 2월 6일부터 2월 27일까지 자료수집을 실시하였다. 자료 분석 방법은 SPSS 12.0을 이용하여 서술적 통계, 평균과 표준편차, Pearson Correlation Coefficient로 분석하였다. 이 연구결과는 다음과 같다. 농촌주민의 건강증진행위 평균평점은 2.23점으로 나타났으며, 하위영역별로 영양이 2.42점, 영적성장 2.33점, 대인관계 2.30점, 스트레스관리 2.19점, 건강책임이 2.17점, 신체활동이 2.07점으로 가장 적게 수행하는 것으로 나타났다. 농촌주민의 신체계통별 건강문제에서는 근골격계에 대한 건강문제가 가장 많은 것으로 나타났으며, 그 다음이 피로, 눈 귀, 심장혈관계, 소화기계, 신경계, 비뇨생식기계, 호흡기계, 피부의 순으로 나타났고, 농부증 양성율이 98.4%로 나타났으며, 여성이 남성보다 농부증 점수가 더 높은 것으로 나타났다. 농촌주민의 지각된 건강상태는 보통, 1년 전과 비교 시 마찬가지이다, 하고 싶은 것이 있으나 건강상태에 약간의 문제가 있다, 동년배와 비교했을 때 건강상태가 '비슷하다'에 응답율이 가장 높았고 지각된 건강상태의 평균점수는 8.54점으로 나타났다. 농촌주민의 건강증진행위, 건강문제, 지각된 건강상태와 농부증 간의 상관관계에서는 건강증진 행위와 지각된 건강상태 간에 유의한 양의 상관관계가 있었고, 건강증진행위와 농부증 간에 유의한 음의 상관관계가 있었다. 건강문제와 지각된 건강상태 간에 유의한 음의 상관관계, 건강문제와 농부증과도 유의한 양의 상관관계가 있는 것으로 나타났다. 지각된 건강상태와 농부증간에 유의한 음의 상관관계가 있는 것으로 나타났다. 결론적으로 농촌주민의 다양한 건강문제와 농부증 발생률을 감소시키고 건강증진행위를 증진시키기 위해서는 지역 환경적인 요소를 고려한 농촌주민을 위한 맞춤형 건강증진프로그램의 개발 및 실시가 필요할 것으로 생각된다.

119 구급대원들이 지각하는 의료지도의 필요성 인식과 요구도 (Recognition and Request for Medical Direction by 119 Emergency Medical Technicians)

  • 박주호
    • 한국응급구조학회지
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    • 제15권3호
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    • pp.31-44
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    • 2011
  • Purpose : The purpose of emergency medical services(EMS) is to save human lives and assure the completeness of the body in emergency situations. Those who have been qualified on medical practice to perform such treatment as there is the risk of human life and possibility of major physical and mental injuries that could result from the urgency of time and invasiveness inflicted upon the body. In the emergency medical activities, 119 emergency medical technicians mainly perform the task but they are not able to perform such task independently and they are mandatory to receive medical direction. The purpose of this study is to examine the recognition and request for medical direction by 119 emergency medical technicians in order to provide basic information on the development of medical direction program suitable to the characteristics of EMS as well as for the studies on EMS for the sake of efficient operation of pre-hospital EMS. Method : Questionnaire via e-mail was conducted during July 1-31, 2010 for 675 participants who are emergency medical technicians, nurses and other emergency crews in Gyeongbuk. The effective 171 responses were used for the final analysis. In regards to the emergency medical technicians' scope of responsibilities defined in Attached Form 14, Enforcement regulations of EMS, t-test analysis was conducted by using the means and standard deviation of the level of request for medical direction on the scope of responsibilities of Level 1 & Level 2 emergency medical technicians as the scale of medical direction request. The general characteristics, experience result, the reason for necessity, emergency medical technicians & medical director request level, medical direction method, the place of work of the medical director, feedback content and improvement plan request level were analyzed through frequency and percentage. The level of experience in medical direction and necessity were analyzed through ${\chi}^2$ test. Results : In regards to the medical direction experience per qualification, the experience was the highest with 53.3% for Level 1 emergency medical technicians and 80.3% responded that experience was helpful. As for the recognition on the necessity of medical direction, 71.3% responded as "necessary" and it turned out to be the highest of 76.9% in nurses. As for the reason for responding "necessary", the reason for reducing the risk and side-effects from EMS for patients was the largest(75.4%), and the reason of EMS delay due to the request of medical direction was the highest(71.4%) for the reason for responding "not necessary". In regards to the request level of the task scope of emergency medical technicians, injection of certain amount of solution during a state of shock was the highest($3.10{\pm}.96$) for Level 1 emergency rescuers, and the endotracheal intubation was the highest($3.12{\pm}1.03$) for nurses, and the sublingual administration of nitroglycerine(NTG) during chest pain was the highest($2.62{\pm}1.02$) for Level 2 emergency medical technicians, and regulation of heartbeat using AED was the highest($2.76{\pm}.99$) for other emergency crews. For the revitalization of medical direction, the improvement in the capability of EMS(78.9%) was requested from emergency crew, and the ability to evaluate the medical state of patient was the highest(80.1%) in the level of request for medical director. The prehospital and direct medical direction was the highest(60.8%) for medical direction method, and the emergency medical facility was the highest(52.0%) for the placement of medical director, and the evaluation of appropriateness of EMS was the highest(66.1%) for the feedback content, and the reinforcement of emergency crew(emergency medical technicians) personnel was the highest(69.0%) for the improvement plan. Conclusion : The medical direction is an important policy in the prehospital EMS activity because 119 emergency medical technicians agreed the necessity of medical direction and over 80% of those who experienced medical direction said it was helpful. In addition, the simulation training program using algorithm and case study through feedback are necessary in order to enhance the technical capability of ambulance teams on the item of professional EMS with high level of request in the task scope of emergency medical technicians, and recognition of medical direction is the essence of the EMS field. In regards to revitalizing medical direction, the improvement of the task performance capability of 119 emergency medical technicians and medical directors, reinforcement of emergency medical activity personnel, assurance of trust between emergency medical technicians and the emergency physician, and search for professional operation plan of medical direction center are needed to expand the direct medical direction method for possible treatment beforehand through the participation by medical director even at the step in which emergency situation report is received.