• 구강회복응용과학지
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• 제16권2호
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• pp.149-159
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• 2000

Occlusal disease is comparable to periodontitis in that it is generally not reversible. Occlusal disease, however, like periodontitis, often maintainable. It does itself to treatment and when restorative dentistry is utilized it becomes, in that sense, reversible. Moreover, a systematized and integrated approach will lead to a prognosis that is favorable and predictable. This approach facilitates development of optimum oral function, comfort, and esthetics, resulting in a satisfied patient. Such a systematized approach consists of four logical phase : (1) patient evaluation, (2) comprehensive analysis and treatment planning, (3) integrated and systematic reconstruction, and (4) postoperative maintenance. An integrated treatment plan is first developed on one set of diagnostic casts, properly mounted on a semiadjustable articulator using jaw relationship records. This is accomplished by using wax to make reconstructive modifications to the casts. These modified casts become the blueprint for planned occlusal changes and the fabrication of provisional restorations. The treatment goals are : (1) comfortably functioning temporomandibular joints and stomatognathic musculature, (2) adherence to the basic principle of occlusion advocated by Schuyler, (3) anterior guidance that is in harmony with the envelope of function, (4) restorations that will not violate the patient's neutral zone. This report shows the treatment procedures for a patient whose mandibular position has been altered due to posterior bite collapse. Migration of the maxillary anterior teeth had occurred, and the posterior occlusal contacts showed pathologic interference. Precise diagnosis using mounted casts was executed and prosthodontic reconstruction by the aid of an unconventional orthodontic correction on maxillary flaring was planned. An unconventional orthodontic correction can be accomplished by using preexisting natural teeth, which can be modified for use in active tooth movement or splinted together for orthodontic anchorage. This technique has an advantage over conventional fixed appliance orthodontic therapy because it can accomplish tooth movement concurrently with restorative and periodontal therapy. On occasion, minor tooth movement can be necessary to achieve the optimum occlusal scheme, crown form, and tooth position for the forces of occlusion to be displaced down the long axis of the periodontally compromised teeth. Once the occlusion, periodontal health, and crown contours for the provisional splinted restoration are acceptable, the final splinted restoration can be similarly fabricated, and it becomes an excellent orthodontic retainer.

• 한국콘텐츠학회논문지
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• 제17권6호
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• pp.415-423
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• 2017

환자가 의사를 신뢰한다는 의미를 살펴보는 것은 의료서비스를 바탕으로 이루어지는 환자-의사 관계관리 뿐만 아니라 진료만족도, 병원재방문 등 마케팅 측면에서도 중요하다. 이 연구에서는 의사-환자 관계에서 신뢰의 의미가 무엇인지를 병원방문경험이 6개월 이내인 20대 이상 성인들을 대상으로 설문조사한 328명의 응답결과를 분석자료로 활용하여 살펴보았다. 연구결과, 환자가 의사를 신뢰한다는 의미는 한마디로 정의하기는 힘들지만 적어도 네 가지 의미를 담고 있음을 알 수 있었다. 환자가 신뢰하는 의사는 첫째, 환자의 이야기를 주의깊게 경청하며 관심을 표현하는 대화 분위기를 형성하는 커뮤니케이션 행위를 보여야 한다. 둘째, 환자의 건강을 먼저 생각하고 환자를 이해하려고 하며 공감할 수 있도록 해야 한다. 셋째, 기술적인 능력뿐만 아니라, 치료와 관련한 검사와 절차에 있어서 솔직하여야 한다. 마지막으로 환자와 협력을 자아내고자 노력해야 한다.

• The Korean Journal of Physiology and Pharmacology
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• 제21권3호
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• pp.301-308
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• 2017

27-Hydroxycholesterol induces differentiation of monocytic cells into mature dendritic cells, mDCs. In the current study we sought to determine roles of the PI3K and the ERK pathways in the 27OHChol-induced differentiation. Up-regulation of mDC-specific markers like CD80, CD83 and CD88 induced by stimulation with 27OHChol was significantly reduced in the presence of LY294002, an inhibitor of PI3K, and U0126, an inhibitor of ERK. Surface expression of MHC class I and II molecules elevated by 27OHChol was decreased to basal levels in the presence of the inhibitors. Treatment with LY294002 or U0126 resulted in recovery of endocytic activity which was reduced by 27OHChol. CD197 expression and cell adherence enhanced by 27OHChol were attenuated in the presence of the inhibitors. Transcription and surface expression of CD molecules involved in atherosclerosis such as CD105, CD137 and CD166 were also significantly decreased by treatment with LY294002 and U0126. These results mean that the PI3K and the ERK signaling pathways are necessary for differentiation of monocytic cells into mDCs and involved in over-expression of atherosclerosis-associated molecules in response to 27OHChol.

• 한국임상약학회지
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• 제28권3호
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• pp.216-223
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• 2018

Objective: This study aimed to assess treatment persistence in Korean children and adolescents with attention deficit hyperactivity disorder (ADHD) and the factors influencing their adherence to ADHD pharmacotherapy. Methods: The study included patients between 6 and 18 years of age with ADHD who were taking various formulations of methylphenidate and atomoxetine on June 1, 2014. Patients were dichotomized as "persistent" or "non-persistent", depending on whether they continued ADHD therapy for 6 months (therapy persistence). We also investigated if the patients were taking the same medication(s) as before and also classified the patients as "medication persistent" or "non-persistent". Patient' characteristics were correlated with therapy persistence and medication persistence. Multiple logistic regression analyses were performed to assess potential risk factors for treatment persistence. Results: Overall, 3,317 patients were included in the analysis. A majority of patients were taking stimulants (82.0%), 16.2% were taking non-stimulants and 1.8% were taking a combination therapy of stimulants and non-stimulants. After 6 months, 2,290 patients (69.0%) continued to take medication for ADHD with 1,953 patients taking the same medication(s) as 6 months previously. Common positive factors for therapy persistence and medication persistence were identified as younger age, retardation, and developmental delay, and long-acting formulations of methylphenidate as either monotherapy or in a combination therapy may be used. Conclusion: ADHD medications were proven to improve academic performance and social skills of children. Collaboration between patients, parents, school staffs, and prescribers is required to improve the persistent use of ADHD medications.

• Asian Pacific Journal of Cancer Prevention
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• 제17권7호
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• pp.3179-3183
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• 2016

The aim of this study was to assess the rate of uptake of a customised annual Colorectal Cancer Awareness, Screening and Treatment Project (CCASTP) using faecal immunohistochemical test (FIT) kits in low income communities in Malaysia. The immediate objectives were (1) to evaluate the level of adherence of CRC screening among low-income groups, (2) to assess the knowledge and awareness of the screened population and (3) to assess the accuracy of FIT kits. A total of 1,581 FIT kits were distributed between years 2010 to 2015 to healthy asymptomatic participants of the annual CCASTP organized by Empowered - the Cancer Advocacy Society of Malaysia. Data for socio-demographic characteristics, critical health and lifestyle information of the registered subjects were collected. Findings for use of the FIT kits were collected when they were returned for stool analyses. Those testingd positive were invited to undergo a colonoscopy examination. A total of 1,436 (90.8%) of the subjects retuned the FIT-kits, showing high compliance. Among the 129 subjects with positive FIT results, 92 (71.3%) underwent colonoscopy. Six cases (6.5%) of CRC were found. Based on the data collected, the level of awareness of stool examination and knowledge about CRC was poor amongst the participants. Gender, age group, ethnicity and risk factors (i.e. smoking, lack of exercise and low consumption of fresh fruits) were associated with positive FIT-kit results. In conclusion, CRC screening can be performed in the community with a single FIT-kit. Although CRC knowledge and awareness is poor in low-income communities, the average return rate of the FIT kits and rate of colonoscopy examination were 91.2% and 70.3%, respectively.

• The Korean Journal of Pain
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• 제30권2호
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• pp.86-92
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• 2017

Osteoblasts, originating from mesenchymal cells, make the receptor activator of the nuclear factor kappa B ligand (RANKL) and osteoprotegerin (OPG) in order to control differentiation of activated osteoclasts, originating from hematopoietic stem cells. When the RANKL binds to the RANK of the pre-osteoclasts or mature osteoclasts, bone resorption increases. On the contrary, when OPG binds to the RANK, bone resorption decreases. Denosumab (AMG 162), like OPG (a decoy receptor), binds to the RANKL, and reduces binding between the RANK and the RANKL resulting in inhibition of osteoclastogenesis and reduction of bone resorption. Bisphosphonates (BPs), which bind to the bone mineral and occupy the site of resorption performed by activated osteoclasts, are still the drugs of choice to prevent and treat osteoporosis. The merits of denosumab are reversibility targeting the RANKL, lack of adverse gastrointestinal events, improved adherence due to convenient biannual subcutaneous administration, and potential use with impaired renal function. The known adverse reactions are musculoskeletal pain, increased infections with adverse dermatologic reactions, osteonecrosis of the jaw, hypersensitivity reaction, and hypocalcemia. Treatment with 60 mg of denosumab reduces the bone resorption marker, serum type 1 C-telopeptide, by 3 days, with maximum reduction occurring by 1 month. The mean time to maximum denosumab concentration is 10 days with a mean half-life of 25.4 days. In conclusion, the convenient biannual subcutaneous administration of 60 mg of denosumab can be considered as a first-line treatment for osteoporosis in cases of low compliance with BPs due to gastrointestinal trouble and impaired renal function.

• 정보교육학회논문지
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• 제17권4호
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• pp.475-486
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• 2013

환자의 입원전후, 입원생활, 수술전후, 퇴원후 정보교육 및 식사 영양지도 등 의료 기관에서의 적재 적시적 환자교육 정보의 부재, 지연과 오류는 임상적 예후는 물론 의료의 질 저하와 의료분쟁 등 심각한 문제를 야기시키고 있다. 따라서 최근 의료선진국을 중심으로 의료의 질 관리, 상호소통 및 의료분쟁의 화두와 함께 맞춤형 환자교육 체계의 중요성이 크게 부각되고 있다. 의료진, 원무행정 및 임상 실험실들을 중심으로 환자교육이 네트워크기반으로 활발하게 이뤄질 때 의료 질이 향상되고, 궁극적으로 병원의 경영이익창출에도 도움이 되는 것으로 S병원 사례에서 유의미하게 나타났다. 이러한 동기에서 본 논문에서는 CPES 개념의 연구를 바탕으로 웹기반 맞춤형 환자교육 시스템을 제안하고 S 병원을 대상으로 설계와 구현을 진행하였다. 더불어 S병원에서의 실증적 계량분석을 통해 ?춤형 환자 중심 교육 시스템의 도입 효율성과 효과성을 분석하였다.

• 한국임상약학회지
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• 제24권4호
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• pp.255-264
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• 2014

Objective: The aims of this study are to investigate the total volume of prescribed medicines against Alzheimer's disease (AD) and the trends of usage by analyzing the claims-data from the Korea National Health Insurance Service. Method: The demographic and claims-data were included the major AD treating medicines such as donepezil, galantamine, rivastigmine and memantine, and analyzed during the period of 2010~2012. The assessing criteria were gender, age, habitation, types of medical institution, code of ingredients, outcomes of treatment, volume and amount of claims, and the numbers of patients with dementias. After trimming the data, it were analyzed by the market size, demographic traits, characteristics of medical service, characteristics of each anti-AD medicine, etc. Results: Among the chosen 4 medicines, donepezil had the top prescription volumes. Most prevalent prescribing preparations of donepezil were conventional types. However, among the non-conventional types, oro-dispersible formulation is the fast increasing one in both volume and growth rate. This specialized preparations to improve both toleration and adherence, tend to being prescribed generally at the tertiary medical institutions. While the younger patients with mild-to-moderate AD mostly treated by expensive medicines in resident at the tertiary hospitals, the rest older patients with severe AD have been treated non-expensive one at long-term care facilities. Conclusion: AD is a chronic illness therefore, long-term use of therapeutic medications are highly important. If an anti-AD treatment was applied steadily in the earlier stages, it would be achieved not only improving the quality of life of patient but also reducing the expenses in the medical and nursing cares. As the socioeconomical impacts of AD is expanding, healthcare professionals need to aware the importance of pharmacotherapy and to improve sociopolitical fundamentals.

• The Korean Journal of Physiology and Pharmacology
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• 제10권2호
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• pp.85-94
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• 2006

A splanchic artery occlusion for 90 min followed by reperfusion of the mesenteric circulation resulted in a severe form of circulatory shock, characterized by endothelial dysfunction, severe hypotension, marked intestinal tissue injury, and a high mortality rate. The effect of defibrotide, a complex of single-stranded polydeoxyribonucleotides having antithrombotic effect, was investigated in a model of splanchnic artery occlusion (SAO) shock in urethane anesthetized rats. Occlusion of the superior mesenteric artery for 90 min produced a severe shock state, resulting in a fatal outcome within 120 min of reperfusion in many rats. Defibrotide (10 mg/kg body weight) 10 min prior to reperfusion significantly improved mean arterial blood pressure in comparison to vehicle treated rats (p＜0.05). Defibrotide treatment also significantly attenuated in the increase of plasma amino nitrogen concentration, intestinal myeloperoxidase activity, intestinal lipid peroxidation, infiltration of neutrophils in intestine and thrombin induced adherence of neutrophils to superior mesentric artery segments. Superoxide anion and hydrogen peroxide production in $1{\mu}M$ formylmethionylleucylphenylalanine (fMLP)-activated PMNs was inhibited by defibrotide in a dose-dependent fashion. Defibrotide effectively scavenged hydrogen peroxide, but not hydroxyl radical. Treatment of SAO rats with defibrotide inhibited tumor necrosis factor-${\alpha}$, and interleukin-1${\beta}$ productions in blood in comparison with untreated rats. These results suggest that defibrotide partly provides beneficial effects by preserving endothelial function, attenuating neutrophil accumulation, and antioxidant in the ischemic reperfused splanchnic circulation

• 지역사회간호학회지
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• 제32권3호
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• pp.312-324
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• 2021

Purpose: Tuberculosis is an infectious condition with a high disease burden, and the stigma in patients with tuberculosis causes negative health outcomes. The purpose of this study was to define and clarify the concept of self-stigma among patients with tuberculosis. Methods: The analysis was conducted using Walker and Avant's conceptual approach. Twenty-seven studies met the selection criteria. Results: Self-stigma in patients with tuberculosis can be defined by the following attributes: 1) self-esteem decrement; 2) fear; 3) negative emotions to oneself; 4) social withdrawal; and 5) discrimination. The antecedents identified were 1) inappropriate knowledge of tuberculosis, 2) spread of improper health information through media and social communications, 3) stereotypes and prejudices, 4) visibility due to symptoms appearing, 5) recognizing the risk of infection, and 6) low financial status. The consequences were 1) concealing the disease, 2) treatment delay, 3) poor treatment adherence, 4) poor quality of life, and 5) deterioration in or lack of social activities. Conclusion: The definition and attributes of self-stigma identified by this study can be applied to enhance the understanding of stigma in tuberculosis patients and to improve communications between healthcare providers and researchers. It can also be used to develop theories and measurements related to stigma in patients with tuberculosis.