• Quality Improvement in Health Care
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• v.2 no.2
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• pp.32-45
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• 1996

Background : A critical path defines an optimal sequencing and timing of interventions by physicians, nurses, and other staff for a particular diagnosis or procedure, designed to better utilize resources, maximize quality of care, and minimize delays. It can be thought of as a visualization of the patient care process. In this study, a review of appendectomy patient records was undertaken to identify a critical path for the management of this treatment. Methods: For this study, records of patients under 15 or over 65 years of age were excluded ; cases where the patient was pregnant, or where complications developed were also excluded. The remaining 21 cases were divided into two categories according to the indication for appendectomy : for acute appendicitis, and for perforated appendix or drainage of periappendical abscess. The time frame for the review was from patient examination immediately prior to operation, through discharge. The study team was composed of a surgeon, research head nurse, education head nurse, surgical part head nurse, and medical recorder. Following their review of the 21 charts, the team determined an appropriate progression and schedule for an appendectomy. Result : Through the chart and literature review, the following aspects of the care process were identified as typical and tracked : monitoring/assessment, treatment, lines/drains, medication, activity, diet, tests and patient education. Conclusion : From this study, the design team determined two separate critical paths : one for appendectomy only, and one for appendectomy plus drainage. Next, these paths must be validated and fine-tuned through clinical implementation. In addition, a comparison of our design with the critical paths determined at other hospitals would be extremely valuable for advancing research in this area. Lastly, the critical path approach to improving patient care and maximizing hospital resources should be applied to other procedures.

• Radiation Oncology Journal
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• v.35 no.2
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• pp.153-162
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• 2017

Purpose: To evaluate intracranial control after surgical resection according to the adjuvant treatment received in order to assess the optimal radiotherapy (RT) dose and volume. Materials and Methods: Between 2003 and 2015, a total of 53 patients with brain oligometastases from non-small cell lung cancer (NSCLC) underwent metastasectomy. The patients were divided into three groups according to the adjuvant treatment received: whole brain radiotherapy (WBRT) ${\pm}$ boost (WBRT ${\pm}$ boost group, n = 26), local RT/Gamma Knife surgery (local RT group, n = 14), and the observation group (n = 13). The most commonly used dose schedule was WBRT (25 Gy in 10 fractions, equivalent dose in 2 Gy fractions [EQD2] 26.04 Gy) with tumor bed boost (15 Gy in 5 fractions, EQD2 16.25 Gy). Results: The WBRT ${\pm}$ boost group showed the lowest 1-year intracranial recurrence rate of 30.4%, followed by the local RT and observation groups, at 66.7%, and 76.9%, respectively (p = 0.006). In the WBRT ${\pm}$ boost group, there was no significant increase in the 1-year new site recurrence rate of patients receiving a lower dose of WBRT (EQD2) <27 Gy compared to that in patients receiving a higher WBRT dose (p = 0.553). The 1-year initial tumor site recurrence rate was lower in patients receiving tumor bed dose (EQD2) of ${\geq}42.3Gy$ compared to those receiving <42.3 Gy, although the difference was not significant (p = 0.347). Conclusions: Adding WBRT after resection of brain oligometastases from NSCLC seems to enhance intracranial control. Furthermore, combining lower-dose WBRT with a tumor bed boost may be an attractive option.

• The Journal of Korean Academy of Prosthodontics
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• v.30 no.2
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• pp.191-202
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• 1992

The purpose of the present study is to inspect the satisfied degree of each oral function in geriatric patients with the shortened dental arch and when their prosthetic treatment is on schedule, provide some references to such treatment. For the approach to such study, 521 subjects were reviewed by grouping them according to the number of their remaining teeth, and masticatory function, phonetic function, facial change, and TMJ disorders were inspected and clarified through some questionnaires. Also through the questionnaires, the correlations between the geriatiric patients with the shortened dental arch and dentition and between the geriatiric patients with the Free-end RDP at the shortened dental arch and their oral function were found out with their satisfied degree of oral function. Results or findings from such study are as follows : 1. With regard to their satisfied degree of oral function, there was a significant difference of satisfaction between or among the group having only the anterior teeth and the group having the part of premolars and the group having even the part of molars, however no significant difference of satisfaction appeard between the group having 1st molars and the group having 2nd molars. 2. With regard to their satisfied degree of phonetic function, no significant difference appeared between or among the group having only the anterior part of teeth and the group having even the part of premolars and the group having even the part of molars, and with regard to their satisfied degree of facial change, no significant difference of satisfaction appeared between the group having the part of premolars and the group having even the part of molars. 3. With regard to their satisfied degree of masticatory function, phonetic function, TMJ disorders, and facial change, no significant difference appeared between the group having both the anterior part of teeth and the part of premolars and the group attached with the Free-end RPD on the same conditions of the afore-said group.

• Journal of Periodontal and Implant Science
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• v.44 no.2
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• pp.65-70
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• 2014

Purpose: The purpose of this retrospective study was to evaluate the effect of patient compliance with supportive periodontal therapy (SPT) on tooth loss in Korean adults. Methods: The periodontal records of 134 patients were reviewed for this study. They completed active periodontal treatment from 1999 to 2001 and were placed on a schedule of periodic follow-up visits for SPT. Patient compliance was classified into complete compliance (CC), erratic compliance (EC), and noncompliance (NC) groups. Re-examinations were carried out $11.0{{\pm}}0.8$ years after the active periodontal treatment. The prognosis for each tooth was determined as good, questionable, or hopeless according to the bone loss observed in pretreatment radiographs. Results: The rate of tooth loss of the CC group was significantly lower than that of the NC group. The tooth loss/patient and the tooth loss/patient/year were not significantly different between the three groups. The rates of tooth loss in the good, questionable, and hopeless prognosis groups were 6.7%, 9.5%, and 13.2%, respectively. For the teeth with a good prognosis, the rate of tooth loss of the CC group was significantly lower than that of the NC group (0.4% vs. 5.1%). For the teeth with a questionable prognosis, the CC group showed a significantly lower rate of tooth loss than did the EC group (4.1% vs. 30.7%) or the NC group (4.1% vs. 25.6%). For the teeth with a hopeless prognosis, the rates of tooth loss were not significantly different among the three groups. Conclusions: Within the limits of this study, the patients who showed a poor compliance with SPT were more likely to lose teeth than were the regularly compliant patients. However, the risk of tooth loss with a hopeless prognosis was high irrespective of the compliance.

• Anxiety and mood
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• v.2 no.2
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• pp.108-114
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• 2006

Objectives : Only a few prospective studies of panic disorder are available. This study investigated naturalistic outcome of panic disorder patients at twelve months after the initial diagnosis. Methods : A total of 84 subjects were diagnosed with panic disorder by diagnostic interview, Structured Clinical Interview for DSM-IV (SCID-IV) and Anxiety Disorder Interview Schedule for DSM-IV (ADISIV). Among them, 80 subjects could be evaluated by means of Panic Disorder Severity Scale (PDSS) at follow-up interview after twelve months. Treatment continuation was also examined at follow-up interview. Results : At initial intake, 80 patients were classified into 22% with mild, 33% with moderate-to-marked, and 45% with severe symptoms on the basis of their PDSS total score. At twelve months, 20% of patients reached remission, 65% had mild and 15% had moderate-to-marked symptoms. Initial panic symptom severity, presence of agoraphobia, panic symptom duration before diagnosis, number of comorbid Axis I disorders were associated with significantly higher PDSS total score at twelve months. Forty six percent of total patients continued medication and 23% have stopped treatment by clinician's recommendation and 31% have selfdiscontinued their medication. At twelve months, all three groups were improved but self-discontinuation group had significantly higher PDSS total score. Conclusion : In the one-year naturalistic outcome study of panic disorder patients, high percentage of patients achieved remission or had mild symptoms.

• Advances in Traditional Medicine
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• v.7 no.3
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• pp.261-273
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• 2007

We investigated the antihypertensive effect of Pet ether extract (PE) of ginger rhizome; its toluene fraction (TF) and Korean ginseng extract (KGE) in deoxycorticosterone acetate (DOCA) - salt induced and fructose induced hypertensive rats. In DOCA model, DOCA (25 mg/kg, once a week; s.c) was administered in uninephrectomised animals for 4 w. PE (50 mg/kg/day; p.o), TF (10 mg/kg/day; p.o) and KGE (30 mg/kg/day; p.o) were evaluated for their antihypertensive effect. In the fructose model, drinking water was replaced with fructose (10%) for five weeks to induce hypertension. PE (50 mg/kg/day; p.o) and KGE (30 mg/kg/day; p.o) were assessed for its antihypertensive effect in fructose model. After completion of the treatment schedule, vascular reactivity to various agonists like 5-HT, noradrenaline, adrenaline, phenylbiguanide and acetylcholine were recorded in rats of both the models. A cumulative dose response curve (CDRC) of 5-HT was carried out in isolated rat fundus strip of the fructose induced hypertensive rats. Chronic administration of PE (50 mg/kg/day; p.o), TF (10 mg/kg/day; p.o), and KGE (30 mg/kg/day; p.o) significantly reduced the blood pressure in DOCA salt whereas PE (50 mg/kg/day; p.o) and KGE (30 mg/kg/day; p.o) reduced the blood pressure in fructose induced hypertensive rats. Treatment with PE (50 mg/kg/day; p.o) and KGE (30 mg/kg/day; p.o) in fructose model for five weeks shifted the CDRC towards the right on rat fundus. The mechanism of action may partly involve the serotonergic antagonistic property.

• Journal of the Korean Ceramic Society
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• v.38 no.12
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• pp.1137-1143
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• 2001

In this study, glass-ceramics containing cordierite(2MgO$.$2Al$_2$O$_3$5SiO$_2$) as a major crystalline phase was prepared from MAS (MgO-Al$_2$O$_3$-SiO$_2$) glass system for the application to reflector. Glasses prepared with addition of TiO$_2$as a nucleating agent were crystallized by two-step heat treatment of nucleation and crystal growth. Then nucleation and crystal growth behavior were investigated and the influence of heat treatment schedule on the nature of crystal phases and the diffuse reflectance spectrum was investigated. As a result, cordierite and rutile were precipitated as a major crystalline phases for the glass-ceramics with the nucleation at 750$^{\circ}C$ for 3 hours and then crystallization at 1100$^{\circ}C$ for 5 hours, and this glass-ceramics showed the reflectance over 90% in 570∼2500nm specturm region.

• Journal of Korean Neurosurgical Society
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• v.66 no.5
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• pp.562-572
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• 2023

Objective : Bevacizumab is a feasible option for treating cerebral radiation necrosis (RN). We investigated the clinical outcome of RN after treatment with bevacizumab and factors related to the initial response and the sustained effect. Methods : Clinical data of 45 patients treated for symptomatic RN between September 2019 and February 2021 were retrospectively collected. Bevacizumab (7.5 mg/kg) was administered at 3-week intervals with a maximum four-cycle schedule. Changes in the lesions magnetic resonance image (MRI) scans were examined for the response evaluation. The subgroup analysis was performed based on the initial response and the long-term maintenance of the effect. Results : Of the 45 patients, 36 patients (80.0%) showed an initial response, and eight patients (17.8%) showed delayed worsening of the corresponding lesion. The non-responders showed a significantly higher incidence of diffusion restriction on MRI than the responders (100.0% vs. 25.0%, p<0.001). The delayed worsening group showed a significantly higher proportion of glioma pathology than the maintenance group (87.5% vs. 28.6%, p=0.005). Cumulative survival rates with sustained effect were significantly higher in the groups with non-glioma pathology (p=0.019) and the absence of diffusion restriction (p<0.001). Pathology of glioma and diffusion restriction in MRI were the independent risk factors for non-response or delayed worsening after initial response. Conclusion : The initial response of RN to bevacizumab was favorable, with improvement in four-fifths of the patients. However, a certain proportion of patients showed non-responsiveness or delayed exacerbations. Bevacizumab may be more effective in treating RN in patients with non-glioma pathology and without diffusion restriction in the MRI.

• The Journal of Korean Academy of Prosthodontics
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• v.36 no.5
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• pp.772-785
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• 1998

This study was undertaken to clarify the microstructure of the different IPS Empress ingots by etching and to observe the change of leucite crystal structure according to subsequent heat treatment and the crystal distribution according to sprue types(${\phi}2.8mm$, single sprue; ${\phi}1.8mm$, double sprue) by scanning electron microscopy. IPS Empress T1, O1 ingots used for staining technique, and Dentin(A2) ingots used for layering technique were selected for this study. To observe the microstructures of these ingots before pressing, the specimens were prepared in splinters($3{\times}3{\times}3mm$) taken from the original ingots. And to estimate crystal distribution and microstructural change by sprue type and subsequent heat treatment. the specimens($3{\times}3{\times}3mm$) were heat-pressed through the two types of sprues with different diameters and numbers, and all specimens were fired according to the recommended firing schedule. The observed surface was ground with waterproof papers($#800{\sim}#1800$) on the grind polisher and was cleaned ultrasonically. All specimen were etched with 0.5% hydrofluoric acid. After etching, the surface was treated by ion sputter coating for SEM observation at an accelerating voltage of 20kV. In all specimens, the central area of ground surface was observed because there was less difference in microstructure between the peripheral area and the central area. The results were as follows ; 1. In the microstructure according to the ingot type, there was a wide difference between the staining (T1,O1) and layering(Dentin A2) ingots, but there was not a considerable difference between the T1 ingot and the O1 ingot for staining technique. 2. In all specimens, the crystal dispersion of IPS Empress ceramic using double sprue was significantly more scattered than that of IPS Empress ceramic using single sprue. The degree of scattering was strongest in the Dentin(A2) specimen and weakest in the O1 ingot. 3. In the microstructural change according to the subsequent heat treatment, all of ingots had some microcracks in the inside of the leucite crystal and the glass matrix after pressing. The inner splinters of the leucite crystal became smaller, and more microcracks occurred in the glass matrix due to increasing heat treatment times. 4. The size of leucite crystals varied from $1{\mu}m\;to\;5{\mu}m$. The mean size of mature crystals was about $5{\mu}m$. The form of the crystal was similar to a circle when it was smaller and similar to an ellipse when it was larger.

• The Journal of Korean Society for Radiation Therapy
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• v.7 no.1
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• pp.156-166
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• 1995

Total body irradiation (TBI) requires large radiation field and extended source to axis distance (SAD), therefore in needs large size treatment room and it needs compensators which components. Appropriate thickness beam spoiler should be used to raise skin dose. Treatment machine, photon energy, total dose, dose rate, dose fractionation, patient position, shield of normal tissues and organs were known to important parameters for TBI. TBI disturbes regular daily treatment schedule and significantly overloads Radiation on oncology departments and during the treatment session it requires accurate reproduction of radiation field and patient position. We were enable to TBI in small size treatment room and short SAD with parallel opposing lateral fields technique and achieved homogenious whole body dose distribution using pb compensators and controled lung dose by lung shield blocks. Drawing a patient shadow on the wall, we could shortened set up time and possible to accurate reproduction of radiation field and patient position.