• Journal of Korean Neurosurgical Society
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• v.30 no.10
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• pp.1210-1219
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• 2001

Introduction : The purpose of this study was to analyze the safety, pullout strength and radiographic characteristics of unicortical and bicortical screws of cervical facet within cadaveric specimens and evaluate the influence of level of training on the positioning of these screws. Methods : Twenty-one cadavers, mean 78.9 years of age, underwent bilateral placement of 3.5mm AO lateral mass screw from C3-C6(n=168) using a slight variation of the Magerl technique. Intraoperative imaging was not used. The right side(unicortical) utilized only 14mm screws(effective length of 11mm) while on the left side to determine the length of the screw after the ventral cortex had been drilled. Three spine surgeons(attending, fellow, chief resident) with varying levels of spine training performed the procedure on seven cadavers each. All spines were harvested and lateral radiographs were taken. Individual cervical vertebrae were carefully dissected and then axial radiographs were taken. The screws were evaluated clinically and radiographically for their safety. Screws were graded clinically for their safety with respect to the spinal cord, facet joint, nerve root and vertebral artery. The grades consisted of the following categories : "satisfactory", "at risk" and "direct injury". Each screw was also graded according to its zone placement. Screw position was quantified by measuring a sagittal angle from the lateral radiograph and an axial angle from the axial radiograph. Pull-out force was determined for all screws using a material testing machine. Results : Dissection revealed that fifteen screws on the left side actually had only unicortical and not bicortical purchase as intended. The majority of screws(92.8%) were satisfactory in terms of safety. There were no injuries to the spinal cord. On the right side(unicortical), 98.9% of the screws were "satisfactory" and on the left side(bicortical) 68.1% were "satisfactory". There was a 5.8% incidence of direct arterial injury and a 17.4% incidence of direct nerve root injury with the bicortical screws. There were no "direct injuries" with the unicortical screws for the nerve root or vertebral artery. The unicortical screws had a 21.4% incidence of direct injury of the facet joint, while the bicortical screws had a 21.7% incidence. The majority of "direct injury" of bicortical screws were placed by the surgeon with the least experience. The performance of the resident surgeon was significantly different from the attending or fellow(p<0.05) in terms of safety of the nerve root and vertebral artery. The attending's performance was significantly better than the resident or fellow(p<0.05) in terms of safety of the facet joint. There was no relationship between the safety of a screw and its zone placement. The axial deviation angle measured $23.5{\pm}6.6$ degrees and $19.8{\pm}7.9$ degrees for the unicortical and bicortical screws, respectively. The resident surgeon had a significantly lower angle than the attending or fellow(p<0.05). The sagittal angle measured $66.3{\pm}7.0$ degrees and $62.3{\pm}7.9$ degrees for the unicortical and bicortical screws, respectively. The attending had a significantly lower sagittal angle than the fellow or resident(p<0.05). Thirty-three screws that entered the facet joint were tested for pull-out strength but excluded from the data because they were not lateral mass screws per-se and had deviated substantially from the intended final trajectory. The mean pull-out force for all screws was $542.9{\pm}296.6N$. There was no statistically significant difference between the pull-out force for unicortical($519.9{\pm}286.9N$) and bicortical($565.2{\pm}306N$) screws. There was no significant difference in pull-out strengths with respect to zone placement. Conclusion : It is our belief that the risk associated with bicortical purchase mandates formal spine training if it is to be done safely and accurately. Unicortical screws are safer regardless of level of training. It is apparent that 14mm lateral mass screws placed in a supero-lateral trajectory in the adult cervical spine provide an equivalent strength with a much lower risk of injury than the longer bicortical screws placed in a similar orientation.

• Journal of the Korean housing association
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• v.28 no.3
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• pp.23-33
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• 2017

The purpose of this study is to identify the characteristics of the community design ordinance in Seoul as view of the community design activation and to seek improvement. The findings of this study are as followings; Most of the provisions of the ordinance, such as the concept of community design, the basic plan, and the contents of the project, are defined in a similar manner. From the establishment of the concept of community design, it is necessary to establish the regulations that reflect the actual situation and characteristics of the village. In addition to physical facilities improvement, the ordinance should include support for securing space at the core center, which plays an important role in revitalizing community design. Step-by-step approaches are needed to understand the residents at the beginning of the project, because there is not enough practical support related to resident capacity and community solidarity. As the importance of the competent residents increases, the support elements related to humanware areas should also be expanded. In particular, the supporting process and contents for the support system and program for the training of village leaders and the securing of professional manpower should be well established.

• Journal of the Korean housing association
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• v.27 no.5
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• pp.25-35
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• 2016

he objective of this study was to investigate home network systems presently applied in multi-housing complexes and resident's usage to improve the utilization of these systems and services as well as maintenance methods. Subjects were 27 housing complexes equipped with home network systems in west Pangyo area. The investigation methods of communal network systems were observed and photographed. Unit systems were investigated through photography, interviews, and observation focusing on the utilization of Wall-Pads by visiting one unit of each housing complex. The results are as follows: (1) Most housing complexes that we investigated were built with high-grade IT infrastructure. Also, remote meter reading, electronic security, vehicle access, and building access systems were established. Wall-Pads with similar functions were installed in 23 housing complexes, excluding private rental housing complexes. (2) Even though people were well aware of the need for common systems within their housing complexes, only 10~20% of Wall-Pad menus were used. (3) Low utilization rates of home network stem from Wall-Pad menus which were user-unfriendly, and a lack of user training for the complex's common system and unit system. Therefore, to promote active use of home network systems, the systems must be diversified in accordance with user characteristics. In addition, the Wall-Pad menus should be reorganized to be user-friendly.

• Korean Medical Education Review
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• v.22 no.1
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• pp.9-15
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• 2020

Currently, accreditation within medical education is a priority on the agenda for many countries worldwide. The World Federation for Medical Education's (WFME) launch of its first trilogy of standards in 2003 was a seminal event in promoting accreditation within basic medical education (BME) globally. Parallel to that, WFME also actively spearheaded a project to recognize the accrediting agencies within individual countries. The introduction of competency-based medical education (CBME) with the two key concepts of "entrusted professional activity" and milestones has enabled researchers to identify the relationship between patient outcomes and medical education. Recent data driven by CBME has been used for the continuous quality improvement of trainees and training programmes as well. The goal of accreditation has shifted from the single purpose of quality assurance to balancing quality assurance and quality improvement. Even though there are a plethora of types of postgraduate medical education (PGME), it may be possible to accredit resident programmes on a global scale by adopting the concept of CBME. In addition, the alignment of the accreditation for BME and PGME, which center on competency, will be achievable. This argument may extend the possibility of measuring the outcomes of the accreditation itself against patient outcomes as well. Therefore, evidence of the advantages of costly and labor-consuming accreditation processes will be available in the near future and quality improvement will be the driving force of the accreditation process.

• Journal of the Korea Safety Management & Science
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• v.18 no.3
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• pp.9-15
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• 2016

Currently the forest area is 6,370,000 hectare (ha) which occupies 63.7% in Korea. The forest has good functions such as production of forest products, conservation of national land, prevention of disasters, etc. However constructing houses near the forest area make bad situation like illegal waste incineration by resident. So research subject is forest fire caused by waste incineration place including facility. And this study was conducted about statistical analysis and research analysis of the 100 waste incineration places including facilities at the country town. Statistical analysis shows that March is 27% which percentage is the highest number of forest fire in 10 years' average. The number of forest fire caused by waste incineration is 45 which is the third highest number in the fire statistic. The distance between waste incineration place including facility and forest area is 30m, 40m and 50m. That 40m (36%) is the most common distance from forest area. The types of waste incineration are ground (62%), the temporary facility made with oil drum can (35%) and other made with steel sheet, concrete, etc. The result of this study is that government and local government must conduct the improvement measure to reduce illegal incineration such as waste pickup area made with rain and wind proof type installed near residence, expenses for waste treatment, enlightenment and training, etc. Also considering their age and income are needed for realistic improvement.

• Quality Improvement in Health Care
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• v.5 no.1
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• pp.140-150
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• 1998

A mailed survey with structured questionnaire was conducted to study the demand of private physicians who were operating their own clinics in the community to be a attending physician at the general hospital. The responding proportion was 21.6 percent of the 960 private physicians. A total of 207 responders; 65.2 percent wanted to be a attending physician. In particular, the physicians who were male, young, surgeon and teaching hospital careered after specialist were more highly motivated. The major activities what they wanted as a attending physician were medical care for the admission patients. They responded that the hospital charges for the medical services and the responsibility of malpractice issues should be fairly shared by attending physician and hospital according to their contributions. There is growing consensus that the need of attending physician at the general hospital will become wide spread, but little organizational preparation to assure the quality of medical care of attending physicians including training of resident physicians and students. In addition, the effective reimbursement system should be develop to compensate appropriately according to the medical achievement of the attending physicians.

• Journal of Korean Academy of Nursing
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• v.54 no.3
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• pp.300-310
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• 2024

Purpose: Medical support staff nurses have traditionally performed various supportive tasks for physicians, often extending beyond standard nursing roles. Despite these long-standing practices, there is a notable lack of official recognition and legal protection for these expanded responsibilities, leading to increasing legal concerns. Therefore, there is a need for proposing a rational solution to address these issues. Methods: The number of medical support staff nurses is rising, particularly as they fill gaps left by the 2024 resident physician strike. The study focuses on identifying potential challenges arising from this shift and developing strategic improvements to address these challenges effectively. Results: This study proposed legally expanding the scope of nursing duties and creating a robust system for training and certifying nurses to handle these responsibilities effectively, by integrating these roles within the advanced practice nurse (APN) framework. Conclusion: Integrating these roles within the framework of APN can offer a sustainable and legally sound solution to the ongoing healthcare crisis, ensuring patient safety and safeguarding healthcare workers' legal rights.

• Korea Journal of Hospital Management
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• v.2 no.1
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• pp.48-64
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• 1997

This study was conducted to evaluate the satisfaction level of interns and residents on training and job environment of two university hospitals in Pusan. The concept of subject's satisfaction was evaluated in general characteristics, socioeconomic status, working condition, human relationship, and job status and scored from 1 to 5. The newly developed questionnaire for this study(32 items) was revised and modified by the preliminary survey. The internal consistency of questionnaire was 0.73(Cronbach's alpha). The self-administered questionnaire was provided to 218 subjects and collected the answering from March 2 to March 25th, 1997, and statistical significances were tested by $x^2-test$, t-test and ANOVA. The satisfaction level between the residents group was significantly different, but satisfaction level of working condition, human relationship and job status showed no difference. The service division part showed highest(2.73) and the surgical division part showed lowest(2.57). The job satisfaction level between the subjects showed higher satisfaction level in working condition, socioeconomic status, and total satisfaction dimension, and intern group showed higher satisfaction level than resident group. Satisfaction level in human relationship dimension, resident group showed higher satisfaction level than intern group, but showed no statistically difference. To improve the working condition for residents, public welfare facilities was firstly suggested and the next was salary increase, overloaded work, respectively. For intern groups, overloaded work and waste work were firstly suggested and the next was public welfare facilities and salary increase, sequentially. The career gets longer, the satisfaction level on general characteristics of working condition, socioeconomic status, and total satisfaction level were increased. The subjects who have religion and higher socioeconomic status showed higher satisfaction level than the other group. The general satisfaction level of subjects in all dimensions showed lower aver age(3.0) and the overall satisfaction level showed below than average. Thus, in order to improvement of subject's working condition, higher quality of life is necessary rather than economic state. In future, these results might be considered to improve the working condition for interns and residents.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.9
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• pp.3835-3838
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• 2015

Objective: To evaluate the diagnostic performance of IOTA simple rules in predicting malignant adnexal tumors by non-expert examiners. Materials and Methods: Five obstetric/gynecologic residents, who had never performed gynecologic ultrasound examination by themselves before, were trained for IOTA simple rules by an experienced examiner. One trained resident performed ultrasound examinations including IOTA simple rules on 100 women, who were scheduled for surgery due to ovarian masses, within 24 hours of surgery. The gold standard diagnosis was based on pathological or operative findings. The five-trained residents performed IOTA simple rules on 30 patients for evaluation of inter-observer variability. Results: A total of 100 patients underwent ultrasound examination for the IOTA simple rules. Of them, IOTA simple rules could be applied in 94 (94%) masses including 71 (71.0%) benign masses and 29 (29.0%) malignant masses. The diagnostic performance of IOTA simple rules showed sensitivity of 89.3% (95%CI, 77.8%; 100.7%), specificity 83.3% (95%CI, 74.3%; 92.3%). Inter-observer variability was analyzed using Cohen's kappa coefficient. Kappa indices of the four pairs of raters are 0.713-0.884 (0.722, 0.827, 0.713, and 0.884). Conclusions: IOTA simple rules have high diagnostic performance in discriminating adnexal masses even when are applied by non-expert sonographers, though a training course may be required. Nevertheless, they should be further tested by a greater number of general practitioners before widely use.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.11
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• pp.6797-6802
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• 2013

Background: Prevalence of tobacco use is higher in the rural than urban areas of India. Unlike tobacco cessation clinics located in urban areas, community-based smoking cessation intervention has the potential to reach a wider section of the community to assist in smoking cessation in the rural setting. The present study aimed to assess the effectiveness of a cessation intervention in rural Kerala state, India. Materials and Methods: Current daily smoking resident males in the age group 18-60 years from four community development blocks in rural Kerala were randomly allocated to intervention and control groups. The intervention group received multiple approaches in which priority was given to face-to-face interviews and telephone counselling. Initially educational materials on tobacco hazards were distributed. Further, four rounds of counselling sessions were conducted which included a group counselling with a medical camp as well as individual counselling by trained medical social workers. The control group received general awareness training on tobacco hazards along with an anti-tobacco leaflet. Self-reported smoking status was assessed after 6 and 12 months. Factors associated with tobacco cessation were estimated using binomial regression method. Results: Overall prevalence of smoking abstinence was 14.7% in the intervention and 6.8% in the control group (Relative risk: 1.85, 95% CI: 1.05, 3.25). A total of 41.3% subjects in the intervention area and 13.6% in the control area had reduced smoking by 50% or more at the end of 12 months. Lower number of cigarettes/ bidi used, low nicotine dependence and consultation with a doctor for a medical ailment were the statistically significant predictors for smoking cessation. Conclusions: Rigorous approaches for smoking cessation programmes can enhance quit rates in smoking in rural areas of India.