• Journal of agricultural medicine and community health
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• v.26 no.1
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• pp.19-35
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• 2001

This study was conducted to investigate the internal changes and the countermeasure for performance improvement by Separation of Prescribing and Dispensing Practice (SPDP) in Health Center. Data were collected from two sources: Performance report before and after SPDP of 25 Health Centers in Kyongsangbuk-do and 6 Health Centers in Daegu-City and self-administerd questionnaire survey of 221 officials at health center. The results of this study were summarized as follows: Twenty-four health centers(77.4%) of 31 health centers took convenience measures for medical treatment of citizens and convenience measures were getting map of pharmacy, improvement of health center interior, introduction of order communication system in order. After the SPDP in health centers, 19.4% of health centers increased doctors and 25.8% decreased pharmacists. 58.1% of health centers showed that number of medical treatments were decreased. 96.4%, 80.6% 80.6% 96.7% of health centers showed that number of prescriptions, total medical treatment expenses, amounts paid by the insureds and the expenses to purchase drugs, respectively, were decreased. More than fifty percent(54.2%) of health centers responded that the relative importance of health works increased compared to medical treatments after the SPDP, and number of patients decreased compared to those in before the SPDP. And there was a drastic reduction in number of prescriptions, total medical treatment expenses, amounts paid by insureds, the expenses to purchase drugs after the SPDP. Above fifty percent(57.6%) of officers at health center responded that the function of medical treatment should be reduced after the SPDP. Fields requested improvement in health centers were 'development of heath works contents'(62.4%), 'rearrangement of health center personnel'(51.6%), 'priority setting for health works'(48.4%), 'restructuring the organization'(36.2%), 'quality impro­vement for medical services'(32.1%), 'replaning the budgets'(23.1%) in order. And to better the image of health centers, health center officers replied that 'health information management'(60.7%), 'public relations for health center'(15.8%), 'kindness of health center officers'(15.3%) were necessary in order. Health center officers suggested that 'vaccination program', 'health promotion', 'maternal and children health', 'communicable disease management', 'community health planning' were relatively important works, in order, performed by health center after SPDP. In the future, medical services in health centers should be cut down with a momentum of the SPDP so that health centers might reestablish their functions and roles as public health organizations, but quality of medical services must be improved. Also health centers should pay attention to residents for improving health through 'vaccination program', 'health promotion', 'mother-children health', 'acute and chronic communicable disease management', 'community health planning', 'oral health', 'chronic degenerative disease management', etc. And there should be a differentiation of relative importance between health promotion services and medical treatment services by character of areas(metropolitan, city, county).

• Journal of agricultural medicine and community health
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• v.25 no.1
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• pp.29-49
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• 2000

Objectives: To estimate the prevalence rate of hypertension, the changes of health behavior, and compliance for the drug treatment after diagnosed as hypertension. Methods: 7,030 persons who live in Cheonan City of Chungnam Province were selected by the cluster sampling method, and 5,372 persons were surveyed by questionnaire and health examination. This data is analyzed by Chi-square test on each variable. Results: 49.8%- of men and 38.8%- of women had been diagnosed as hypertension, and the prevalence rate of hypertension was significantly increased with aging in both gender. The prevalence rate tended to decrease in highly educated women group. Unemployed persons or obese persons showed relatively higher prevalence rate. The prevalence rate of hypertension increased in groups with higher total cholesterol levels over 240 mg/dl, and groups with glucose level over 200 mg/dl. 53.1%- of male patients and 66.6%- of female patients showed compliance for antihypertensive treatment. Compliance for treatment was higher in aged group or lower educated group in both gender. Among men, proportion of compliant subjects was higher in unemployed group(49.3%-), and lower in labor or primary industry than the others but among women, there was not any significant difference. And men with compliance for treatment had higher monthly income than the others, but women did not show any. Conclusion : This population had a high prevalence rate of hypertension which may lead to cardiovascular disease. Therefore health education programs and distribution of information must be emphasized in order to increase compliance to treatment and encourage the change of health behavior to promote health.

• Tuberculosis and Respiratory Diseases
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• v.44 no.6
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• pp.1318-1325
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• 1997

Background : Since the late 1960s, mechanical ventilation has been accomplished primarily using volume controlled ventilation(VCV). While VCV allows a set tidal volume to be guaranteed, VCV could bring about excessive airway pressures that may be lead to barotrauma in the patients with acute lung injury. With the increment of knowledge related to ventilator-induced lung injury, pressure controlled ventilation(PCV) has been frequently applied to these patients. But, PCV has a disadvantage of variable tidal volume delivery as pulmonary impedance changes. Since the concept of combining the positive attributes of VCV and PCV(dual control ventilation, DCV) was described firstly in 1992, a few DCV modes were introduced. Pressure-regulated volume control(PRVC) mode, a kind of DCV, is pressure-limited, time-cycled ventilation that uses tidal volume as a feedback control for continuously adjusting the pressure limit However, no clinical studies were published on the efficacy of PRVC until now. 'This investigation studied the efficacy of PRVC in the patients with unstable respiratory mechanics. Methods : The subjects were 8 mechanically ventilated patients(M : F=6 : 2, $56{\pm}26$ years) who showed unstable respiratory mechanics, which was defined by the coefficients of variation of peak inspiratory pressure for 15 minutes greater than 10% under VCV, or the coefficients of variation of tidal volume greater than 10% under PCV. The study was consisited of 3 modes application with VCV, PCV and PRVC for 15 minutes by random order. To obtain same tidal volume, inspiratory pressure setting was adjusted in PCV. Respiratory parameters were measured by pulmonary monitor(CP-100 pulmonary monitor, Bicore, Irvine, CA, USA). Results : 1) Mean tidal volumes($V_T$) in each mode were not different(VCV, $431{\pm}102ml$ ; PCV, $417{\pm}99ml$ ; PRVC, $414{\pm}97ml$) 2) The coefficient of variation(CV) of $V_T$ were $5.2{\pm}3.9%$ in VCV, $15.2{\pm}7.5%$ in PCV and $19.3{\pm}10.0%$ in PRVC. The CV of $V_T$ in PCV and PRVC were significantly greater than that in VCV(p<0.01). 3) Mean peak inspiratory pressure(PIP) in VCV($31.0{\pm}6.9cm$ $H_2O$) was higher than PIP in PCV($26.0{\pm}6.5cm$ $H_2O$) or PRVC($27.0{\pm}6.4cm$ $H_2O$)(p<0.05). 4) The CV of PIP were $13.9{\pm}3.7%$ in VCV, $4.9{\pm}2.6%$ in PVC and $12.2{\pm}7.0%$ in PRVC. The CV of PIP in VCV and PRVC were greater than that in PCV(p<0.01). Conclusions : Because of wide fluctuations of VT and PIP, PRVC mode did not seem to have advantages compared to VCV or PCV in the patients with unstable respiratory mechanics.

• Tuberculosis and Respiratory Diseases
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• v.44 no.6
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• pp.1343-1352
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• 1997

Background : Heat-treated cells are known to be protected from lysis by TNF, which is considered to play a central role in the pathogenesis of sepsis-induced acute lung injury. The objective of the study was to investigate the effect of heat shock response by heat-pretreatment on the acute lung injury of the rats induced by intratracheally administered TNF-$\alpha$, Methods : We intratracheally instilled either saline or TNF (R&D, 500ng) with and without heat pretreatment in Sprague-Dawley rats weighing 250~350 g. The heated rats were raised their rectal temperature to $41^{\circ}C$ and was maintained thereafter for 13 minutes at 18 h before intratracheal administration of saline or TNF. After 5 h of intratracheal treatment, lung leak, lung myeloperoxidase activity (MPO) and heat shock proteins were measured in rats. Lung leak index was defined as counts per minute of $I^{25}$ in the right lung divided by counts per minutes of $I^{25}$ in 1.0 ml of blood. All data are expressed as means ${\pm}$SE. Results : There is no difference in acute lung leak index ($0.099{\pm}0.024$ vs $0.123{\pm}0.005$) among the rats given saline intratracheally with and without heat pretreatment, but MPO activity showed a decreased tendency in heat-pretreated rats ($4.58{\pm}0.79\;U/g$) compared with heat-unpretreated rats ($7.32{\pm}0.97\;U/g$) (P=0.064). Rats administered TNF intratracheally with heat-pretreatment had decreased lung leak index ($0.137{\pm}0.012$) and lung MPO activity ($5.51{\pm}1.04\;U/g$) compared with those of heat-unpretreated and TNF-administered rats ($0.186{\pm}0.016$, $14.34{\pm}1.22\;U/g$) (P<0.05 in each). There were no significant difference of lung leak index and MPO activity between TNF-treated rats with heat-pretreatment and saline-treated rats with and without heat-pretreatment. Conclusion : The heat shock response attenuated neutrophil recruitment and acute lung leak induced by intratracheal instillation of TNF-in rats.

• Tuberculosis and Respiratory Diseases
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• v.49 no.6
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• pp.740-751
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• 2000

Background : Moxifloxacin is a newly developed drug which is more potent and safe compared to previous fluoroquinolones. This drug effectively eradicates organisms such as beta-lactamase-producing or other resistant bacteria. Moxifloxacin is known to be effective in treating respiratory infections such as Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Chlamydia pneumoniaeme, Legionella spp. and Mycoplasma pneumoniae. Methods : In a multicenter, randomized, open, comparative study, the efficacy and safety of oral moxifloxacin taken 400 mg once a day and clarithromycin taken 500 mg twice daily for 7 days were compared for the treatment of Korean patients with acute exacerbations of chronic bronchitis. Results : A total of 170 patients were enrolled, and they were divided into two groups: 87 in the moxifloxacin group and 83 in the clarithromycin group. Of those enrolled, 76 (35 for bacteriologic efficacy) in the moxifloxacin group and 77 (31 for bacteriologic efficacy) in the clarithromycin group were included in the efficacy analysis. All were included in the safety analysis. Clinical success was noted in 70 (92.1%) of 76 moxifloxacin-treated patients and 71 (92.2%) of 77 clarithromycin-treated patients. Bacteriologic success rate seemed to be higher in moxifloxacin group (73.5%) than in clarithromycin group (54.8%), but statistically insignificant (p=0.098). Drug susceptibility among organisms initially isolated was higher in moxifloxacin group on Streptococcus pneumoniae, Pseudomonas aeruginosa, Klebsiella pneumoniae (p<0.001). Adverse events were reported by 12.8% of 86 patients receiving moxifloxacin and 21.7% of 83 patients receiving clarithromycin. Headache (4.7% vs 4.8%, moxifloxacin group vs clarithromycin group, respectively) and indigestion (2.3% vs 6.0%, moxifloxacin group vs clarithromycin group, respectively) were the most frequent side effects in the two groups. Conclusion : This study demonstrated that for the treatment of acute exacerbations of chronic bronchitis a 7-day course of moxifloxacin 400 mg od was clinically equivalent and microbiologically superior to clarithromycin 500 mg bid.

• Tuberculosis and Respiratory Diseases
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• v.45 no.2
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• pp.322-332
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• 1998

Background: Accurate staging is important to determine treatment modalities and to predict prognosis for the patients with lung cancer. The simple two-stage system of the Veteran's Administration Lung Cancer study Group has been used for staging of small cell lung cancer(SCLC) because treatment usually consists of chemotherapy with or without radiotherapy. However, this system does not accurately reflect segregation of patients into homogenous prognostic groups. Therefore, a variety of new staging system have been proposed as more intensive treatments including either intensive radiotherapy or surgery enter clinical trials. We evaluate the prognostic importance of TNM staging, which has the advantage of providing a uniform detailed classification of tumor spread, in patients with SCLC. Methods: The medical records of 166 patients diagnosed with SCLC between January 1989 and December 1996 were reviewed retrospectively. The influence of TNM stage on survival was analyzed in 147 patients, among 166 patients, who had complete TNM staging data. Results: Three patients were classified in stage I / II, 15 in stage III a, 78 in stage IIIb and 48 in stage IV. Survival rate at 1 and 2 years for these patients were as follows: stage I / II, 75% and 37.5% ; stage IIIa, 46.7% and 25.0% ; stage III b, 34.3% and 11.3% ; and stage IV, 2.6% and 0%. The 2-year survival rates for 84 patients who received chemotherapy(more than 2 cycles) with or without radiotherapy were as follows: stage I / II, 37.5% ; stage rna, 31.3% ; stage IIIb 13.5% ; and stage IV 0%. Overall outcome according to TNM staging was significantly different whether or not received treatment. However, there was no significant difference between stage IIIa and stage IIIb though median survival and 2-year survival rate were higher in stage IIIa than stage IIIb. Conclusion: These results suggest that the TNM staging system may be helpful for predicting the prognosis of patients with SCLC.

• Tuberculosis and Respiratory Diseases
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• v.45 no.5
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• pp.1058-1066
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• 1998

Background: Actinomycotic infection is uncommon and primary actinomycosis of the lung and chest wall has been less frequently reported. This disease may present as chronic debilitating illness with radiologic manifestation simulating lung tumor, pulmonary infiltrating lesion, or chronic suppuration. Diagnosis of choice was not definded yet and role of bronchoscopy on diagnosis was not described yet. Methods: From 1989 to 1998, we experienced 17 cases of thoracic actinomycosis. We have reviewed the case notes of 17 patients with thoracic actinomycosis. The mean age at presentation was $53{\pm}13$ years, 11 were male. Results: Cough, hemoptysis, sputum production, chest pain and weight loss were the commonest symptoms. The mean delay between presentation and diagnosis was $6.6{\pm}7.8$ months. There were six patients who presented with a clinical picture of a suppurative lesion and eleven patients were suspected of having primary lung tumor initially. In no cases was made an accurate diagnosis at the time of hospital admission. Associated diseases were emphysema (1 case), bronchiectasis (2 cases) and tuberculosis (2 cases). Bronchoscopic findings were mucosal swelling and stenosis(n=4), mucosal swelling, stenosis and necrotic covering (n=2), mass (n=3), mass and necrotic covering (n=1) and normal(n=6). Radiologic findings were mass lesion(n=8), pneumonitis(n=3), atelectasis(n=3), pleural effusion(n=2), and normal(n=3). Final diagnosis was based on percutaneous needle aspiration and biopsy (n=3), bronchoscopic biopsy specimens (n=9), mediastinoscopic biopsy (n=1) and histologic examination of resected tissue in the remaining patients(n=4) who received surgical excision. Among 17 patients, 13 were treated medically and the other 4 received surgical intervention followed by antibiotic treatment. Regarding the surgically treated patients, suspected malignancy is the most common indication for operation. However. both medically and surgically treated patients achieved good clinical results. Conclusion: Thoracic actinomycosis is rare. but should still be considered in the differential diagnosis of a chrinic, localized pulmonary lesion. Thoracic actinomycosis may co-exist with pulmonary tuberculosis or lung cancer. If the lesion is located in the central of the lung. the bronchoscopy is recommanded for the diagnosis.

• Tuberculosis and Respiratory Diseases
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• v.60 no.6
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• pp.653-662
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• 2006

Background: The changes in the pulmonary function observed in burn patients with an inhalation injury are probably the result of a combination of airway inflammation, chest wall and muscular abnormalities, and scar formation. In addition, it appears that prolonged ventilatory support and an episode of pneumonia contribute to the findings. This study investigated the changes in the pulmonary function in patients with inhalation injury at the early and late post-burn periods. Methods: From August 1, 2002, to August 30, 2005, surviving burn patients who had an inhalation injury were enrolled prospectively. An inhalation injury was identified by bronchoscopy within 48hours after admission. Spirometry was performed at the early phase during admission and the recovery phase after discharge, and the changes in the pulmonary function were compared. Results: 37 patients (M=28, F=9) with a total burn surface area (% TBSA), ranging from 0 to 18%, were included. The initial $PaO_2/$FiO_2$ratio and COHb were $286.4{\pm}129.6mmHg$ and $7.8{\pm}6.6%$. Nine cases (24.3%) underwent endotracheal intubation and 3 cases (8.1%) underwent mechanical ventilation. The initial X-ray findings revealed abnormalities in, 18 cases (48.6%) with 15 (83.3%) of these being completely resolved. However, 3 (16.7%) of these had residual sequela. The initial pulmonary function test, showed an obstructive pattern in 9 (24.3%) with 4 (44.4%) of these showing a positive bronchodilator response, A restrictive pattern was also observed in 9 (24.3%) patients. A lower DLco was observed in only 4 (17.4%) patients of which 23 had undergone DLco. In the follow-up study, an obstructive and restrictive pattern was observed in only one (2.7%) case each. All the decreased DLco returned to mormal. Conclusions: Most surviving burn patients with an inhalation injury but with a small burn size showed initial derangements in the pulmonary function test that was restored to a normal lung function during the follow up period.

• The Journal of Korean Academy of Prosthodontics
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• v.46 no.2
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• pp.157-168
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• 2008

Statement of problem: Over the past two decades, implant supported fixed prosthesis have been widely used. However, there are few studies conducted systematically and intensively on the splinting effect of implant systems in mandible. Purpose: The purpose of this study was to investigate the changes in stress distributions in the mandibular implants with splinting or non-splinting crowns by performing finite element analysis. Materials and methods: Cortical and cancellous bone were modeled as homogeneous, transversely isotropic, linearly elastic. Perfect bonding was assumed at all interfaces. Implant models were classified as follows. Group 1: $Br{{\aa}}nemark$ length 8.5mm 13mm splinting type Group 2: $Br{{\aa}}nemark$ length 8.5mm 13mm Non-splinting type Group 3: ITI length 8.5mm 13mm splinting type Group 4: ITI length 8.5mm 13mm Non-splinting type An load of 100N was applied vertically and horizontally. Stress levels were calculated using von Mises stresses values. Results: 1. The stress distribution and maximum von Mises stress of two-length implants (8.5mm, 13mm) was similar. 2. The stress of vertical load concentrated on mesial side of implant while the stress of horizontal load was distributed on both side of implant. 3. Stress of internal connection type was spreading through abutment screw but the stress of external connection type was concentrated on cortical bone level. 4. Degree of stress reduction was higher in the external connection type than in the internal connection type.

• The Korean Journal of Nuclear Medicine
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• v.38 no.6
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• pp.516-521
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• 2004

Background: Radioactive iodine (RAI) therapy and whole-body scanning are the fundamentals of treatment and follow-up of patients with differentiated thyroid cancer. It is generally accepted that a Thyroid-Stimulating Hormone (TSH) level of at least 30 ${\mu}U/ml$ is a prerequisite for the effective use of RAI, and that it requires 4-6 weeks of off-thyroxine to attain these levels. Because thyroxine withdrawal and the consequent hypothyroidism are often poorly tolerated, and occasionally might be hazardous, it is important to be certain that these assumptions are correct. We have measured serial changes in serum TSH after total thyroidectomy or withdrawl of thyroxine in patients with thyroid cancer. Subjects and Methods: Serum TSH levels were measured weekly after thyroidectomy in 10 patients (group A) and after the discontinuation of thyroxine in 12 patients (group B). Symptoms and signs of hypothyroidism were also evaluated weekly by modified Billewicz diagnostic index. Results: By the second week, 78% of group A patients and 17% of group B patients had serum TSH levels ${\geq}30{\mu}U/ml$. By the third week, 89% of group A patients and 90% of group B patients had serum TSH levels ${\geq}30{\mu}U/ml$. By the fourth week, all patients in two groups achieved target TSH levels and there were no overt hypothyroidism. Conclusion: in all patients, serum TSH elevated to the target concentration (${\geq}30{\mu}U/ml$) within 4 weeks without significant manifestation of hypothyroidism. The schedule of RAI administration could be adjusted to fit the needs and circumstances of individual patients with a shorter preparation period than the conventional.