• Title/Summary/Keyword: a frequency response

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Prognostically Significant Fusion Oncogenes in Pakistani Patients with Adult Acute Lymphoblastic Leukemia and their Association with Disease Biology and Outcome

  • Sabir, Noreen;Iqbal, Zafar;Aleem, Aamer;Awan, Tashfeen;Naeem, Tahir;Asad, Sultan;Tahir, Ammara H;Absar, Muhammad;Hasanato, Rana MW;Basit, Sulman;Chishti, Muhammad Azhar;Ul-Haque, Muhammad Faiyaz;Khalid, Ahmad Muktar;Sabar, Muhammad Farooq;Rasool, Mahmood;Karim, Sajjad;Khan, Mahwish;Samreen, Baila;Akram, Afia M;Siddiqi, Muhammad Hassan;Shahzadi, Saba;Shahbaz, Sana;Ali, Agha Shabbir
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.7
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    • pp.3349-3355
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    • 2012
  • Background and objectives: Chromosomal abnormalities play an important role in genesis of acute lymphoblastic leukemia (ALL) and have prognostic implications. Five major risk stratifying fusion genes in ALL are BCR-ABL, MLL-AF4, ETV6-RUNX11, E2A-PBX1 and SIL-TAL1. This work aimed to detect common chromosomal translocations and associated fusion oncogenes in adult ALL patients and study their relationship with clinical features and treatment outcome. Methods: We studied fusion oncogenes in 104 adult ALL patients using RT-PCR and interphase-FISH at diagnosis and their association with clinical characteristics and treatment outcome. Results: Five most common fusion genes i.e. BCR-ABL (t 9; 22), TCF3-PBX1 (t 1; 19), ETV6-RUNX1 (t 12; 21), MLL-AF4 (t 4; 11) and SIL-TAL1 (Del 1p32) were found in 82/104 (79%) patients. TCF3-PBX1 fusion gene was associated with lymphadenopathy, SIL-TAL1 positive patients had frequent organomegaly and usually presented with a platelets count of less than $50{\times}10^9/l$. Survival of patients with fusion gene ETV6-RUNX1 was better when compared to patients harboring other genes. MLL-AF4 and BCR-ABL positivity characterized a subset of adult ALL patients with aggressive clinical behaviour and a poor outcome. Conclusions: This is the first study from Pakistan which investigated the frequency of5 fusion oncogenes in adult ALL patients, and their association with clinical features, treatment response and outcome. Frequencies of some of the oncogenes were different from those reported elsewhere and they appear to be associated with distinct clinical characteristics and treatment outcome. This information will help in the prognostic stratification and risk adapted management of adult ALL patients.

Short Tenn Reactions to Acupuncture Treatment and Adverse Events Following Acupuncture in Korea a Cross-sectional Survey of Patient Reports (침치료 직 후 자가 설문지를 이용한 침반응(針感)과 부작용에 대한 단면적 연구)

  • Park, Seong-Uk;Jung, Woo-Sang;Moon, Sang-Kwan;Ko, Chang-Nam;Cho, Ki-Ho;Kim, Young-Suk;Bae, Hyung-Sup;Park, Jung-Mi
    • The Journal of Korean Medicine
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    • v.28 no.2 s.70
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    • pp.66-79
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    • 2007
  • Objectives : To explore the type and frequency of short term reactions, de Qi associated with acupuncture treatment and to determine the incidence of adverse events following acupuncture in Korea. Subjects and methods : This study is a retrospective and cross-sectional survey of patient reports. 1095 subjects, 585 of out-patients of the Oriental Medicine of Stroke & Neurological Disorders Center, East-West NEO Medical Center of Kyunghee University and 510 of out-patients of the Department of Cardiovascular & Neurologic Diseases (Stoke Center), Hospital of Oriental Medicine, Kyunghee Medical Center, from June through November of 2006, who had acupuncture, gave informed consent and completed one survey form. On this form, patients were asked to report short term acupuncture reactions, de Qi, patient satisfaction measurement (using VAS), and adverse events relating to acupuncture treatment. The acupuncturists of this study are Korean Medicine Doctors (KMD) who had worked as practitioners for 3-30 years or more. Results : The average age of the 1095 subjects was 58 years old. Positive short term acupuncture reactions after treatment were reported by 878 (80.2%), negative short term acupuncture reactions by 75 (6.8%) and no reactions were reported by 142 (13.0%). The most common positive short term acupuncture reactions were feeling 'relaxed', 472 (43.1%), followed by feeling 'less pain' 90 (8.2%), 'energized' 16 ( 1.5%), 'tingling' 16 (1.5%), 'heat feeling or Cold feeling' 10 (0.9%), and others 274 (25.0%), respectively. Negative short term acupuncture reactions were feeling 'pain' 37 (3.4%), tiredness 24 (2.2%), dizziness 9 (0.8%), and others 5 (0.2%), respectively. Traditionally described needling sensations of de Qi refer to a patient's response to distention, pulling, soreness, heaviness, numbness. 39.7% of subjects reported de Qi during needling, experiencing 'distention' 333 (30.4%), 'soreness' 52 (4.7%), 'pulling' 22 (2.0%), 'heaviness' 18 (1.6%), and 'numbness' 10 (0.9%) respectively. Positive short term acupuncture reactions and de Qi rate were the highest in the less than 40 years group (83/96 86.5%, 50/96 52.1%). No acupuncture reactions were highly seen in the over 70 years old group (31/187, 16.6%). Patient satisfaction level using VAS was a comparatively high $72.9{\pm}19.9$. Adverse events were only bleeding in 92 (8.4%) of the total subjects. High sensitive acupoints were 95 points as GV26 (54 times), LI4 (54 times), ST36 (53 times), GB20 (37 times), HT8(34 times), LV3 (29 times), SI3 (29 times), and LI11 (27 times) in order. Main impressions were stroke patients 430 (16.9%), headache 185 (16.9%), hypertension 97 (8.9%), and dizziness 85 (7.8%). Conclusions : Although 8 different Korean Medicine Doctors participated in this research, we obtained similar results from each. There were no significantly different results between the two hospitals. Short term acupuncture reactions and de Qi were most related to age. Except for bleeding there were no adverse events relating to acupuncture treatment in this study. We consider acupuncture treatment as very safe depending on practitioners. Positive short term acupuncture reactions after treatment were 12 times higher than negative short term acupuncture reactions. Subjects were comparatively satisfied with acupuncture treatment.

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The Analysis for Minimum Infective Dose of Foodborne Disease Pathogens by Meta-analysis (메타분석에 의한 식중독 원인 미생물들의 최소감염량 분석)

  • Park, Myoung Su;Cho, June Ill;Lee, Soon Ho;Bahk, Gyung Jin
    • Journal of Food Hygiene and Safety
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    • v.29 no.4
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    • pp.305-311
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    • 2014
  • Minimum infective dose (MID) data has been recognized as an important and absolutely needed in quantitative microbiological assessment (QMRA). In this study, we performed a comprehensive literature review and meta-analysis to better quantify this association. The meta-analysis applied a final selection of 82 published papers for total 12 species foodborne disease pathogens (bacteria 9, virus 2, and parasite 1 species) which were identified and classified based on the dose-response models related to QMRA studies from PubMed, ScienceDirect database and internet websites during 1980-2012. The main search keywords used the combination "food", "foodborne disease pathogen", "minimum infective dose", and "quantitative microbiological risk assessment". The appropriate minimum infective dose for B. cereus, C. jejuni, Cl. perfringens, Pathogenic E. coli (EHEC, ETEC, EPEC, EIEC), L. monocytogenes, Salmonella spp., Shigella spp., S. aureus, V. parahaemolyticus, Hepatitis A virus, Noro virus, and C. pavum were $10^5cells/g$ (fi = 0.32), 500 cells/g (fi = 0.57), $10^7cells/g$ (fi = 0.56), 10 cells/g (fi = 0.47) / $10^8cells/g$ (fi = 0.71) / $10^6cells/g$ (fi = 0.70) / $10^6cells/g$ (fi = 0.60), $10^2{\sim}10^3cells/g$ (fi = 0.23), 10 cells/g (fi = 0.30), 100 cells/g (fi = 0.32), $10^5cells/g$ (fi = 0.45), $10^6cells/g$ (fi = 0.64), $10{\sim}10^2particles/g$ (fi = 0.33), 10 particles/g (fi = 0.71), and $10{\sim}10^2oocyst/g$ (fi = 0.33), respectively. Therefore, these results provide the preliminary data necessary for the development of foodborne pathogens QMRA.

Treat-to-Target Strategy for Asian Patients with Early Rheumatoid Arthritis: Result of a Multicenter Trial in Korea

  • Song, Jason Jungsik;Song, Yeong Wook;Bae, Sang Cheol;Cha, Hoon-Suk;Choe, Jung-Yoon;Choi, Sung Jae;Kim, Hyun Ah;Kim, Jinseok;Kim, Sung-Soo;Lee, Choong-Ki;Lee, Jisoo;Lee, Sang-Heon;Lee, Shin-Seok;Lee, Soo-Kon;Lee, Sung Won;Park, Sung-Hwan;Park, Won;Shim, Seung Cheol;Suh, Chang-Hee;Yoo, Bin;Yoo, Dae-Hyun;Yoo, Wan-Hee
    • Journal of Korean Medical Science
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    • v.33 no.52
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    • pp.346.1-346.11
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    • 2018
  • Background: To evaluate the therapeutic benefits of the treat-to-target (T2T) strategy for Asian patients with early rheumatoid arthritis (RA) in Korea. Methods: In a 1-year, multicenter, open-label strategy trial, 346 patients with early RA were recruited from 20 institutions across Korea and stratified into 2 groups, depending on whether they were recruited by rheumatologists who have adopted the T2T strategy (T2T group) or by rheumatologists who provided usual care (non-T2T group). Data regarding demographics, rheumatoid factor titer, anti-cyclic citrullinated peptide antibody titer, disease activity score of 28 joints (DAS28), and Korean Health Assessment Questionnaire (KHAQ) score were obtained at baseline and after 1 year of treatment. In the T2T group, the prescription for disease-modifying antirheumatic drugs was tailored to the predefined treatment target in each patient, namely remission (DAS28 < 2.6) or low disease activity (LDA) ($2.6{\leq}DAS28$ < 3.2). Results: Data were available for 163 T2T patients and 162 non-T2T patients. At the end of the study period, clinical outcomes were better in the T2T group than in the non-T2T group (LDA or remission, 59.5% vs. 35.8%; P < 0.001; remission, 43.6% vs. 19.8%; P < 0.001). Compared with non-T2T, T2T was also associated with higher rate of good European League Against Rheumatism response (63.0% vs. 39.8%; P < 0.001), improved KHAQ scores (-0.38 vs. -0.13; P = 0.008), and higher frequency of follow-up visits (5.0 vs. 2.0 visits/year; P < 0.001). Conclusion: In Asian patients with early RA, T2T improves disease activity and physical function. Setting a pre-defined treatment target in terms of DAS28 is recommended.

On Securing Continuity of Long-Term Observational Eddy Flux Data: Field Intercomparison between Open- and Enclosed-Path Gas Analyzers (장기 관측 에디 플럭스 자료의 연속성 확보에 대하여: 개회로 및 봉폐회로 기체분석기의 야외 상호 비교)

  • Kang, Minseok;Kim, Joon;Yang, Hyunyoung;Lim, Jong-Hwan;Chun, Jung-Hwa;Moon, Minkyu
    • Korean Journal of Agricultural and Forest Meteorology
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    • v.21 no.3
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    • pp.135-145
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    • 2019
  • Analysis of a long cycle or a trend of time series data based on a long-term observation would require comparability between data observed in the past and the present. In the present study, we proposed an approach to ensure the compatibility among the instruments used for the long-term observation, which would allow to secure continuity of the data. An open-path gas analyzer (Model LI-7500, LI-COR, Inc., USA) has been used for eddy covariance flux measurement in the Gwangneung deciduous forest for more than 10 years. The open-path gas analyzer was replaced by an enclosed-path gas analyzer (Model EC155, Campbell Scientific, Inc., USA) in July 2015. Before completely replacing the gas analyzer, the carbon dioxide ($CO_2$) and latent heat fluxes were collected using both gas analyzers simultaneously during a five-month period from August to December in 2015. It was found that the $CO_2$ fluxes were not significantly different between the gas analyzers under the condition that the daily mean temperature was higher than $0^{\circ}C$. However, the $CO_2$ flux measured by the open-path gas analyzer was negatively biased (from positive sign, i.e., carbon source, to 0 or negative sign, i.e., carbon neutral or sink) due to the instrument surface heating under the condition that the daily mean temperature was lower than $0^{\circ}C$. Despite applying the frequency response correction associated with tube attenuation of water vapor, the latent heat flux measured by the enclosed-path gas analyzer was on average 9% smaller than that measured by the open-path gas analyzer, which resulted in >20% difference of the sums over the study period. These results indicated that application of the additional air density correction would be needed due to the instrument heat and analysis of the long-term observational flux data would be facilitated by understanding the underestimation tendency of latent heat flux measurements by an enclosed-path gas analyzer.

Nutritional Status and Health Risks of Low Income Elderly Women in Gwangju Area (광주지역 저소득층 여자노인의 영양상태와 건강위험요인에 관한 연구)

  • Yang, Eun-Ju;Bang, Hee-Myung
    • Journal of Nutrition and Health
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    • v.41 no.1
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    • pp.65-76
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    • 2008
  • This study was performed to identify association between nutritional status and health risks of the elderly. This was a cross-sectional study involving low income elderly women in Gwangju, Korea (${\geq}$65y, n = 92). Socio-demographics, life style characteristics, health conditions, dietary intakes based on 24h-recall method, anthropometric measures, and clinical biochemistry parameters were examined. Anthropometric and clinical parameters included wt, ht, waist, hip, body protein, body fat, abdominal fat, total cholesterol, HDL-cholesterol, triglyceride, total protein, albumin, hemoglobin, hematocrit, fasting blood glucose, ferritin, IL-2, IL-6, TNF-${\alpha}$, CRP, TAS, TBARS, systolic blood pressure, and diastolic blood pressure. The subjects were divided into three groups based on age (65-74y, 75-84y, 85y${\leq}$) and were divided into two groups according to the sum of the Nutrition Screening Initiative (NSI) checklist score (adequate nutritional status, NSI score ${\leq}$3; at risk of malnutrition, NSI score >3). Mean and frequency of variables were estimated. Analysis of Variance, Tukey test, Chi-square test, and Multiple linear regression analyses were performed. Mean BMI and body fat were 25.1 $kg/m^2$ and 40.0%, respectively. However, for over 80% of subjects, the intakes of energy, fiber, thiamin, riboflavin, niacin, folate, Ca, K, and Zn were less than the Korean DRI (EAR or AI). The subjects who had lower NSI score tended to have better health status, eat meals frequently, have less depression, and exercise regularly. The subjects who had higher NSI score tended to have tooth problems, to eat alone most of time, and to be physically unable to cook or feed. Serum IL-6 and TNF-${\alpha}$ were significantly related with nutritional status which suggested higher tendency of inflammatory response. Serum IL-2, TAS, and glucose were significantly correlated with body fat (%) or abdominal fat (%). These results suggest that improving the nutritional status, increasing regular exercise, maintaining normal weight are beneficial to health care of low income elderly women.

A Study on the Oral Health Behavior of High School Students in Jeolla-bukdo (전북지역 일부 고등학생의 구강보건형태에 관한 연구)

  • Yu, Mi-Sun;Goo, Kyong-Mi;Kim, Jeong-Suk
    • Journal of dental hygiene science
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    • v.9 no.2
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    • pp.225-230
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    • 2009
  • This study executed questionnaire 388 high school boy students in Jeolla-bukdo Namwon from June 9, 2008 to 20th prepares basic data about boy student's oral health behavior, and examines closely the connection factor and plans oral health promotion. Questionnaire distributed getting classroom teacher's cooperation and reclaimed through classroom teacher after make questionnaire by students. The collected data executed Chi-square test and descriptive statistics using SPSS program and the result is as following. 1. Response that responded that students of 61.1% are 2 times in toothbrushing number of times on 1 day, and appeared by thing which 69.1% does toothbrushing most much after way in the morning, and cleans up and down by toothbrushing method was the most by 36.6%. A student of only 8.5% was using auxiliary oral hygiene devices. 2. The oral medical examination and treatment engine use experience rate was 93.6%, and students of 82.9% do treatment as reason by last oral medical examination and treatment use purpose and did coming to help. The 1 year within use experience rate was 47.7%, and students of 77.1% were satisfied for medical examination and treatment. 3. Toothbrushing frequency of smoked students appeared low compared to students woo do not smoke, and students, who do drinking, was expose toothbrushing number by 3 limes compared to students who do not. 4. The activity limitation experience rate by oral disease was 16.0%, and the year absence experience rate was 5.2%, and the studies achievement hindrance experience rate appeared by 13. 1%. As a result, is considered to strengthen on-time oral medical examination and oral health education, and need prevention and policy of early treatment putting first.

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Behavioral Response of the Western Flower Thrips Frankliniella occidentalis (Thysanoptera: Thripidae) to Different Chrysanthemum Flower Colors (국화 화색별 꽃노랑총채벌레의 행동반응)

  • Choi, Yong-Seok;Whang, In-Su;Park, Deog-Gee;Lee, Jun-Seok;Ham, Eun-Hye;Choe, Kwang-Ryul
    • Korean journal of applied entomology
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    • v.53 no.1
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    • pp.65-71
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    • 2014
  • Frankliniella occidentalis is attracted to flowers and is a major pest of chrysanthemums. Even when some chrysanthemum plants are not flowering, the ones that have already flowered attract F. occidentalis. Therefore, we investigated the efficacy of chrysanthemum as a trap plant that attract F. occidentalis by using an olfactometer. The numbers of F. occidentalis collected from the flowers of pink, wihte and yellow standard chrysanthemums on a tray with wet paper during the flowering period were 18.4, 56.6, and 52.6 respectively; the numbers of F. occidentalis collected from leaves were 7.8, 16.6, and 15.4 respectively. the numbers of F. occidentalis collected from the buds of pink, white and yellow standard chrysanthemums were 15.2, 45.8, and 41.6 respectively; the numbers of F. occidentalis collected from the leaves were 2, 8.8 and 3.4 respectively. In the Y-tube olfactometer test, the number of F. occidentalis attracted to the 2-way arms of the Y-tube was not significantly different for the yellow, red, violet and white flowers. In the four-choice olfactometer test, when the same visual cues and odor cues were provided, the frequency of F. occidentalis was higher in the yellow (10.7) flowers than in the red (1.3), violet (3.7) and white (2.0) flowers. When visual cues with disturbed odor cues, F. occidentalis preferred yellow (10.0) color over red (3.3), violet (1.3) and white (3.0) colors. When the same visual and odor cues, except for yellow visual cues, were provided, F. occidentalis preferred white (8.3) color over red (4.7), violet (4.7) and yellow (2.0) colors. Therefore, F. occidentalis were attracted to buds before the flowering of chrysanthemum plants and attracted to yellow flowers after the flowering.

Comparison on Patterns of Conflicts in the South China Sea and the East China Sea through Analysis on Mechanism of Chinese Gray Zone Strategy (중국의 회색지대전략 메커니즘 분석을 통한 남중국해 및 동중국해 분쟁 양상 비교: 시계열 데이터에 근거한 경험적 연구를 중심으로)

  • Cho, Yongsu
    • Maritime Security
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    • v.1 no.1
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    • pp.273-310
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    • 2020
  • This study aims at empirically analyzing the overall mechanism of the "Gray Zone Strategy", which has begun to be used as one of Chinese major maritime security strategies in maritime conflicts surrounding the South China Sea and East China Sea since early 2010, and comparing the resulting conflict patterns in those reg ions. To this end, I made the following two hypotheses about Chinese gray zone strategy. The hypotheses that I have argued in this study are the first, "The marine gray zone strategy used by China shows different structures of implementation in the South China Sea and the East China Sea, which are major conflict areas.", the second, "Therefore, the patterns of disputes in the South China Sea and the East China Sea also show a difference." In order to examine this, I will classify Chinese gray zone strategy mechanisms multi-dimensionally in large order, 1) conflict trends and frequency of strategy execution, 2) types and strengths of strategy, 3) actors of strategy execution, and 4) response methods of counterparts. So, I tried to collect data related to this based on quantitative modeling to test these. After that, about 10 years of data pertaining to this topic were processed, and a research model was designed with a new categorization and operational definition of gray zone strategies. Based on this, I was able to successfully test all the hypotheses by successfully comparing the comprehensive mechanisms of the gray zone strategy used by China and the conflict patterns between the South China Sea and the East China Sea. In the conclusion, the verified results were rementioned with emphasizing the need to overcome the security vulnerabilities in East Asia that could be caused by China's marine gray zone strategy. This study, which has never been attempted so far, is of great significance in that it clarified the intrinsic structure in which China's gray zone strategy was implemented using empirical case studies, and the correlation between this and maritime conflict patterns was investigated.

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The Effect of Hospital Service Coordinator Education Curriculum on the Education Satisfaction and the Quality of Medical Service (병원서비스코디네이터 교육과정이 교육만족과 의료서비스 품질에 미치는 영향)

  • Choi, Eun-Kyoung;Park, Chang Sik;Seo, Jong-Bum
    • The Korean Journal of Health Service Management
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    • v.2 no.1
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    • pp.137-154
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    • 2008
  • The increase of the supply of medical service and the increase of hospitals have intensified the competition of hospitals, and the advancement towards internationalization in the opening of medical industry has triggered the infinite competition of medical profession. In addition, the high expectation of customers and quality improvement in the medical care in accordance with the improvement of overall income, and the change of active role of medical consumers according to the popularization and the improvement of rights awareness reflect the customer needs and choice in the medical service. Customers wanted to receive the kind and pleasant service under the up-to-date medical service. Therefore, as a solution, hospital coordinators were emerged for the purpose of smooth treatment and customer satisfaction by generalizing all service of hospital. Accordingly, this thesis attempted to investigate the effect of hospital coordinator education curriculum on the education satisfaction and the quality of medical service. In order to solve the purpose of this study, I, author reviewed the existing literatures, established hypothesis, and verified hypothesis by using the variety of statistics techniques such as reliability, validity, frequency analysis, and regression analysis. The verification of hypothesis is as followings: First, among education training factors of hospital coordinators, the quality of instructor significantly affects the satisfaction of hospital coordinator education training. Second, among training factors of hospital coordinator, the attitude of trainee significantly affects the training satisfaction of hospital coordinator. Third, among education training factors of hospital coordinator, education course significantly affects the training satisfaction of hospital coordinator education. As the qualities of instructor are better equipped, the satisfaction of education becomes higher. It indicates that the education method of instructors is important as an index to represent the qualities of instructor such as the appropriateness of education method, preparation, passion, visual materials, the adequacy of education procession, and specialized knowledge, and it has important effect on the satisfaction of education. In order to enhance the satisfaction of hospital coordinator education, the creation of education environment, making trainee concentrate on the education, is required by appropriately allocating programs, arousing interest in education, based on the attitude of trainee, discussion, and preliminary programs, preparation, ahead of enforcement of education. Fourth, the satisfaction of hospital coordinator education training significantly affects the reliability among the qualities of medical service. Fifth, satisfaction of hospital coordinator education training significantly affects hospitality I kindness among the qualities of medical service. If the education satisfaction of trainee is high, it is effective in the practical application such as dealing with complaints, the duty performance for the patients, and so on in offering the medical service, related to reliability and furthermore, we can find the positive change in the attitude change of medical professions related to the reliability of hospital coordinator. In addition, in the process of offering medical services such as the kind explanation on the duty, rapid response to the customers inquiry, and tidy uniform, practical effect was verified. Sixth, the education training factor of hospital coordinator significantly affects the reliability among the quality of medical service. Seventh, the education training factors of hospital coordinator significantly affect hospitality/kindness. In the education of hospital coordinator, the methods to attract the interest of trainee by emphasizing reliability should be sought and for gaining the practical effect of hospital coordinator education, the sufficient preparation and investigation on the education curriculum should be prerequisite and under this condition, intensified discussion on the instructor and education course is needed. In the design of education course, more education hours and subjects should be allocated in the part of hospitality in order to improve the practical application of hospitality. Therefore, it is meaningful in a sense that this study newly approached the components of hospital coordinator education and the need to modify the quality components of medical service in accordance with the study subjects was raised. This study also finds its meaning in that it provides basic materials for the study of future hospital coordinator education by suggesting the system development model of hospital coordinator education through preliminary study of education training. In addition, this study is meaningful in the aspect that it suggested the direction of education training by showing how the hospital coordinator education training would applied to the hospital coordinator course of the Continuing Education Center at Pusan and Kyungnam National University to some extent. Since all investigation of this study was approached from the side of hospital coordinator, the thoughts of patients who are beneficiaries of medical service, and care givers cannot be identified. Therefore, the satisfaction of patients and care givers through the experience of medical service, which is the essential prerequisite of medical service, should be importantly considered and investigated. Accordingly, The study of comparing and analyzing the views of both patients and care givers should be carried out in the future.

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