Kim, Chang Hyeun;Lee, Chi Hyung;Kim, Young Ha;Sung, Soon Ki;Son, Dong Wuk;Lee, Sang Weon;Song, Geun Sung
Journal of Korean Neurosurgical Society
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v.64
no.6
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pp.891-900
/
2021
Objective : Vertebral artery dissecting aneurysm (VADA) is a very rare subtype of intracranial aneurysms; when ruptured, it is associated with significantly high rates of morbidity and mortality. Despite several discussions and debates, the optimal treatment for VADA has not yet been established. In the last 10 years, flow diverter devices (FDD) have emerged as a challenging and new treatment method, and various clinical and radiological results have been reported about their safety and effectiveness. The aim of our study was to evaluate the clinical and radiological results with the use of FDD in the treatment of unruptured VADA. Methods : We retrospectively evaluated the data of all patients with unruptured VADA treated with FDD between January 2018 and February 2021 at our hybrid operating room. Nine patients with unruptured VADA, deemed hemodynamically unstable, were treated with FDD. Among other parameters, the technical feasibility of the procedure, procedure-related complications, angiographic results, and clinical outcomes were evaluated. Results : Successful FDD deployment was achieved in all cases, and the immediate follow-up angiography showed intra-aneurysmal contrast stasis with parent artery preservation. A temporary episode of facial numbness and palsy was noted in one patient; however, the symptoms had completely disappeared when followed up at the outpatient clinic 2 weeks after the procedure. The 3-6 months follow-up angiography (n=9) demonstrated complete/near-complete obliteration of the aneurysm in seven patients, and partial obliteration and segmental occlusion in one patient each. In the patient who achieved only partial obliteration, there was a sac 13 mm in size, and there was no change in the 1-year follow-up angiography. In the patient with segmental occlusion, the cause could not be determined. The clinical outcome was modified Rankin Scale 0 in all patients. Conclusion : Our preliminary study using FDD to treat hemodynamically unstable unruptured VADA showed that FDD is safe and effective. Our study has limitations in that the number of cases is small, and it is not a prospective study. However, we believe that the study contributes to evidence regarding the safety and effectiveness of FDD in the treatment of unruptured VADA.
This main purpose of this study was to assess the effects of two different types of ethics education on the moral judgement of clinical nurses. One type was free discussions among nurses with given specific moral issues and the other type was discussions guided by experts on specific moral issues. The study employed a quasi-experimental, nonequivalent pre test-post test design using two different control groups. The conceptual framework of the study was derived from the Kohlberg′s Moral Development Theory (1969) and the Greipp′s Ethical Decision-Making Model (1992). The data was collected during the period of October 14 through December 15, 1998. Sample consists of 32 nurses working in the ICU who met research criteria. 16 nurses were assigned to the free discussion group and 16 nurses to the group for the guided discussion with experts group. For the pre-test, the DIT which was developed by Rest (1984) and JAND by Ketefian (1998) were used with some modification by the author. After the education, only JAND was used to assess the changes in moral judgement. The collected data was analysed using SPSS PC program. The findings are as follows: 1. There was no significant difference between two groups in their general characteristics. Only difference which was statistically significant between two groups was that realistic score on Case 3/Medical Research and Autopsy was higher in the free discussion group. 2. Hypothesis 1: "There will be a difference on the moral judgement of nurses before and after they receive an ethics education". This hypothesis was supported partially. Those who had low scores on moral judgement before the education tended to have higher scores after the education on the same issues. And, after the education, the nurses tend to give lower scores on the dilemmas they had experienced frequently at work; while giving higher scores on those dilemmas they had no prior experience. 3. Hypothesis 2: "The effect of education may differ depended upon the moral development index [P(%)] score of nurses". The effect of education was different depend on moral development level. The group who′s P(%) scores was low at the pretest has higher scores in realistic moral judgement after the education, while the groups with middle or high P(%) scores went down after the education. These changes were statistically significant in some cases, thus, the Hypothesis 2 was partially supported 4. Hypothesis 3: "The method of ethics education will have different effects on the moral judgement of nurses". Even though several nurses attended the guided discussion stated that the education program broadend their perspectives the difference between two groups was not significant and this hypothesis was not supported. In conclusion, both types of ethics education had helped the nurses to acquire the skills to deal some nursing dilemmas. The effects of ethics education may differ according to the moral development index - P(%) score. However, because of some of the limitations of this study, mainly small sample size, short term education, unable to control other variables which may affect moral judgement of nurses, further research is warranted.er research is warranted.
Park, Eun Suk;Chang, Kyung Hee;Youn, Young Ok;Lee, Jung Sin;Kim, Tae Gon;Yea, Han Seung;Kim, Sun Ho;Shin, Jeong Won;Lee, Kyungwon;Kim, June Myung
Quality Improvement in Health Care
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v.8
no.1
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pp.10-21
/
2001
Background : The Clostridium difficile is the most important identifiable cause of nosocomial infectious diarrhea and colitis, which lengthens hospital stay. Recently incidence of C. difficile has been increasing in an university hospital, and an intervention for prevention and control of C. difficile associated diarrhea (CDAD) was in prompt need. Methods : Subjects were the patients in the neurosurgical intensive care unit(NCU) where C. difficile was most frequently isolated. To increase participation of various departments, we used the CQI method, because management of CDAD requires a wholistic approach including control of antibiotics, barrier precaution and environmental cleaning and disinfection. Duration of the CQI activities was 9 months from April to December 1999. Results : The identified problems were misuse and overuse of antibiotics, lack of consciousness of medical personnels and the possibility of transmission from the contaminated environment and tube feeding. Education for proper use of antibiotics and management of C. difficile infection, use of precaution stickers, supplement of handwashing equipments, emphasis on environmental disinfection, and the change of the process of tube feeding were done. The CDAD rate in NCU was significantly decreased after the CQI program (8.6 case per 1,000 patient days from January to April 1999 vs 4.8 from May to December 1999). The distribution of neurosurgical wards including NCU among the total number of isolated C. difficile from the clinical specimens dropped from 49.4% in January to April to 33,7% in May to December. The average hospital stay of the neurosurgical department changed from 19.6 days to 15.2 days. Also, the effect of the CQI activities for C. difficile may have affected the incidence of vancomycin resistant enterococci (VRE). Duration and dosage of certain antibiotics used in the NS department were decreased. The distribution of neurosurgical department in the number of VRE isolated patients declined from 18.4% to 11.1%. Conclusion : Infection control of resistant organisms such as C. difficile is likely to be successful when management of environmental contamination an collaborative efforts of decreasing the patients' risk factors such as antibiotics management and decreasing the length of hospital stay come simultaneously. For this work, related departments need to actively participate in the entire process under a common target through discussions for identifying problems and bringing up solutions. In this respect, making use of a CQI team is an efficient method of infection control for gathering participation and cooperation of related departments.
Objectives : According to the data from the 2016 Yearbook of Traditional Korean Medicine, 10 out of 12 medical schools of Korean medicine are offering medical ethics. Medical ethics has become essential in Korean medicine education, but there has been no agreement on the content of education yet, so initial discussions are necessary with respect to the content and methods of education. Methods : In this study, basic data were collected by searching papers, reports, books, and media articles on medical ethics related to Korean medicine education, and by studying the website of medical schools of Korean medicine nationwide. Based on the collected data, the status of medical ethics lectures were determined and compared with the current state of medical ethics lectures by western medical schools. The contents suitable for medical ethics education at medical schools of Korean medicine were discussed. Results : The topics of the medical ethics include: the basic concepts of medical ethics, the ethics of birth, the ethics associated with genetics, the ethics associated with death, and the ethics regarding doctor-patient interaction, the ethics of medical research, medical rationing ethics, ethics between medical staffs, medical law and ethics, philosophical base of medical ethics, ethics of doctor as professional, and moral personality formation of doctor. The contents of medical ethics in traditional Korean medicine reflected views on the human body and life based on "Huangdi's Internal Classic"and medical ethics from the viewpoints of Buddhism and Confucianism. Conclusions : Medical schools of Korean medicine are medical training institutions, and medical ethics education is essential to become a Korean medicine doctor as professional worker, medical practitioner, and biomedical researcher. There is no fundamental difference in the basic principles of medical ethics in both western and Korean medicine, and there are differences in contents depending on the clinical practice. The contents of medical ethics on clinical practice should be modified for Korean medicine doctors, and traditional Korean medicine ethics would be set up upon that. In the national licensing examination, medical ethics needs to be added as one part so that all the ethical problems related to the clinical situation can be solved.
Journal of the korean academy of Pediatric Dentistry
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v.26
no.3
/
pp.479-485
/
1999
Materials for posterior teeth includes amalgam, gold inlay and composite resin inlay. Amalgam and gold inlay have unsatisfyine esthetics. And because they simply obturate the cavity preparation, they do not strengthen the remaining tooth structure. Posterior composite resin has become established in recent years. However, its polymerization shrinkage and insufficient wear resistance were the most undesirable characteristic. The physical and mechanical properties of the composite resin inlay are further improved through heat treatment in an oven. The major part of polymerization contraction of the resin inlay takes place be fore cementation, and possible gap formation is only due to shrinkage of the thin layer of resin cement. With the semidirect technique, the inlay material is placed directly in the prepared tooth, and the primary polymerization is made by light activation with a handhold curing unit. Additional curing may take place extraorally with use of different curing ovens. It provides the patient with the benefits of luted restorations without the procedure of indirect lab-made inlay. I report three successfully treated cases by semidirect resin inlay technique. Entire clinical steps are described in detail with some discussions on the outcome.
Lee, Soo-Jin;Park, Su-Zanne H.;Shin, Sang-Woo;Chae, Han
The Journal of Korean Medicine
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v.29
no.1
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pp.25-38
/
2008
Objectives : Integrative medicine in Korea is the 21st century-style medical practice of two orthodox medical doctrines, traditional Korean medicine and western conventional medicine, as well as complementary and alternative medicine (CAM). CAM with scientific evidence should be incorporated in undergraduate curricula for the purpose of Korean integrative medicine. Methods : Items of detailed objectives, syllabi, textbooks, instructor's experiences, and effectiveness and reason for difficulty of the CAM curriculum for undergraduate students were analyzed and the preference of CAM therapies and others were also evaluated. Results and Discussion : The effectiveness of this CAM class curriculum was high (8.0$\pm$1.4) enough to be used in other Oriental medical colleges. Development of ability for self-study was rated as 7.0$\pm$1.7 and the helpfulness for clinical use was marked as 6.8$\pm$1.9. Students preferred placebo, Ayurveda, aromatherapy, yoga, functional food, bio-feedback and homeopathy. The difficulty degree was 7.2$\pm$1.6, and the amount of content was suggested as the major reason for it. We also found that this curriculum can be a model for self-oriented study and problem-based learning. Discussions were made for the improvement of the implemented CAM curriculum, which was shown to be very effective for the achievement of Korean integrative medicine. Conclusion : We have successfully installed a CAM curriculum for undergraduate students at the College of Oriental Medicine, and it can be used in others.
Objective: Although the government acknowledged Korean Medical Doctors as official health care providers since 1951, criticism regarding its modernity persisted. This paper focuses on the medical dispute between Korean and Western Medicine in 1950s risen from the problem of modernization of Korean Medicine. Method: This paper looked into the medical dispute between Korean and Western Medicine in 1950s through "EE LIM". "EE LIM" is a scholarly journal published by Korean Medical doctor Bae Won-Sik. Articles regarding the medical dispute between Korean and Western Medicine were selected, categorized and analyzed. Result: The main questions against Korean Medicine were: whether it was scientific or not, and whether there was a possibility of systematization. Several opinions were brought up on these issues. 1) Some people criticized Korean Medicine as being unscientific based on modern science. 2) Others emphasized the identity of Korean Medicine against the critics. 3) Another group of people wanted to study Korean Medicine using modern methods and obtain merits from both sides. Conclusion: The different understanding of the term 'science' led to diverse discussions on the direction of Korean Medicine's progression. The narrow meaning of science only considers Korean Medicine as an object of modern scientific and medical study. But if the meaning is broadened, containing empirical aspects, Korean Medicine can be included as a category of science based on its clinical utility.
Kling, Leslie;Cotugna, Nancy;Snider, Sue;Peterson, P. Michael
Nutrition Research and Practice
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v.3
no.3
/
pp.226-233
/
2009
Traditional nutrition education has not been shown to consistently produce behavior change. While it has been suggested that using emotion-based messages may be a better way to influence nutrition behavior change, this has not been well tested. Producing emotion-based messages is a multi-step process that begins with exploring subconscious barriers to behavior change rather than the more obvious and typically reported barriers. The purpose of this research was to uncover the emotional reasons, sometimes referred to as emotional pulse points, for mothers' choosing or not choosing to have more family meals. This would then serve as the first step to developing emotion-based messages promoting the benefits of family meals. Five focus group interviews were conducted with 51 low-income Black (n=28) and white (n=23) mothers. Metaphorical techniques were used to determine underlying feelings toward family and family meals. Discussions were video-taped, transcribed, and manually analyzed using a content-driven, immersion/crystallization approach to qualitative data analysis. Four themes emerged around the definition of family: acceptance, sharing, chaos, and protective/loyal. Some mothers felt mealtime was merely obligatory, and described it as stressful. Some reported a preference for attending to their own needs instead of sitting down with their children, while others felt that mealtime should be used to interact with and educate children and felt guilty when they were not able to provide family meals. Three themes emerged around feelings towards having or not having family meals: unimportant, important, and guilty. When explored further, mothers indicated that using the feeling of guilt to encourage family meals might be effective. Data obtained are being used to develop innovative, emotion-based messages that will be tested for effectiveness in promoting family meals.
This study was conducted to derive core and detailed competencies of dental hygienists to be utilized as educational targets to be reached by graduation as well as basic data that can be reflected in the development and improvement of dental hygiene curricula. This study analyzed publication reports from the Korean Dental Hygienists Association, the International Federation of Dental Hygienists, the Commission on Dental Accreditation, and the American Dental Education Association. Based on the academic classification system for dental hygiene studies, the components of core and detailed competencies of dental hygiene school at the time of graduation were extracted and developed through expert panel discussions. This study defined competencies at the graduation level of dental hygiene school and derived eight core competencies and their 52 detailed competencies to serve as educational objectives from four areas: professionalism, communication, clinical practice, and community and health promotion. In the future, it will be necessary to conduct self-assessments of competencies based on those developed in this study, at time of the graduation from dental hygiene school, as well as to continuously develop competency-based curricula according to entry level, knowledge level, and graduation level. Thus, it is urgently necessary to develop a system that can evaluate the competencies of dental hygienists after graduation and put this system into practical use.
There is no any reports on nation-wide nutrition survey since 1947 in Korea, During the period only the small scaled nutrition surveys have been reported by several investigators. Authors, under the financial support from the Ministry of Health and Social Affairs, Republic of Korea, had conducted a nation-wide nutrition survey, including dietary, clinical, and socio-economical aspects, during the period from 29th of July to 15th of August, 1969. Number of households surveyed and population distribution are shown in Table II-2 and age and sex distribution of the population surveyed are also in Table II-3 in this report. Average food and nutrient intakes are shown in Tables II-6, II-7 and II-8 respectively. For the detailed discussions on food and nutrient intakes, see the Tables II-9 through II-11 and Figures II-1 through II-10 in this report. Anthropometric data are shown in Tables III-1 through III-4 and in Figures III-1 through III-4. Data of deficiency diseases are shown in Table III-5 and in Figure III-5 in this report. Socio-economical data are shown in Tables IV-1 through IV-26 and in Figures IV-1 through IV-3 in this report.
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