• 제목/요약/키워드: cooperative treatment

검색결과 348건 처리시간 0.032초

산학연계형 치위생학과 주문식 교육과정 연구 (A Study on Industry-University Cooperative Customized Curriculum of Dental Hygiene Study)

  • 박일순;최은미;이영석
    • 디지털융복합연구
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    • 제11권10호
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    • pp.537-547
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    • 2013
  • 최근 사회의 급격한 변화는 사회내 모든 부분에 반영되어 성과와 효율에 대한 무한 경쟁의 모습으로 나타나고 있다. 교육 분야도 이 같은 상황은 예외가 아니어서 수요자의 요구를 충족시키기 위한 형태로 대학간 전공간 경쟁이 심화되고 있다. 주문식 교육제도의 도입은 바로 이러한 특성을 반영한 대학의 생존전략 중에 하나이다. 치위생학의 주문식 교육과정에 대한 연구결과 치과병의원의 관리자들은 치과진료보조분야의 직무를 치과위생사의 주요업무라고 생각하는 것으로 나타났다. 반면 치과위생사들은 구강보건교육을 주요업무로 생각하고 있었으나 실제에 있어서는 본인의 의사와 달리 치과병의원 관리자의 의사를 따르는 것으로 나타나 1차적으로 산업체의 요구에 따른 산업체 현장실습강화가 필요한 것으로 분석되었다. 그리고 이와 함께 치과위생사의 주요 역할인 예방치과처치, 구강보건교육을 강화함으로써 병의원 내에서 치과위생사의 지위가 안정적으로 정착되게 하여 직장생활을 통해 자아실현의 기회를 제공할 필요도 있음을 알 수 있었다.

초음파를 이용한 유가공 슬러지의 가용화 (Solubilization of Dairy Sludge using Ultrasonic Pretreatment)

  • 문상재;전병철;최진택;남세용
    • Journal of Dairy Science and Biotechnology
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    • 제35권4호
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    • pp.244-248
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    • 2017
  • 본 연구는 유가공 슬러지의 경우 하수 슬러지, 기타 산업폐수 슬러지에 비해 중금속 등 유해한 성분을 함유하지 않고, 높은 유기물 함량으로 슬러지 가용화를 통한 재활용의 가능성을 충분히 가지고 있으나 활발히 연구가 되지 않고 있어 초음파 전처리를 이용하여 재활용 가능성을 실험하였다. 1. 유가공 슬러지와 축산 슬러지를 20 kHz의 주파수와 700 W, 500 W의 조사강도, 조사시간 90분간 초음파 처리하여 고형물 변화를 비교한 결과, 유가공 슬러지의 TS와 VS 제거율이 28%, 14% 감소하였으며, 축산 슬러지는 13%, 7% 감소하였다. 2. SCOD 변화는 동일한 조건의 초음파 처리 시 유가공 슬러지의 경우 7.1배, 5.9배의 증가율을 보였으며, 축산 슬러지의 경우 4.9배, 4.0배로 나타났다. 슬러지 가용화 효율은 유가공 슬러지의 14.5%, 12.1%의 가용화 효율을 보였으며, 축산 슬러지의 경우 10.6%, 8.6%로 나타났다. SCOD 증가속도 또한 유가공 슬러지의 경우 $0.022m^{-1}$, $0.020m^{-1}$, 축산슬러지의 경우 $0.021m^{-1}$, $0.018m^{-1}$의 증가속도를 나타내었다. 3. Soluble N 농도의 변화는 유가공 슬러지의 경우 90분간 초음파 처리 후 3.4배, 2.2배 증가한 것으로 측정되었으며, 축산 슬러지의 90분간 초음파 처리 후 3배, 2배 증가한 것으로 나타났다. C/N 비의 경우 유가공 슬러지가 7.5, 8.7을 나타냈고, 축산 슬러지는 5.7, 6.4로 나타났다. 유가공 슬러지의 경우 TS, VS 감량을 통한 슬러지 발생량을 감소시킬 수 있으며 SCOD의 증가량이 많아 C/N비가 더 높게 나타난 것을 알 수 있다. 따라서 유가공 슬러지의 가용화를 통한 외부탄소원으로의 활용 가능성을 확인하였고, 향후 전처리방법의 조합 및 최적 처리조건 도출 등 후속 연구의 필요성이 높다고 사료된다.

구기자술의 저장에 따른 성분변화 (Effect of storage condition on the quality of the wine and Yakju made by Lycium chinense Miller)

  • 최성현;이미현;신철승;성창근;오만진;김찬조
    • Applied Biological Chemistry
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    • 제39권5호
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    • pp.338-342
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    • 1996
  • 한방에서 강장과 보간 등에 효과가 있는 것으로 알려진 구기자를 원료로 술을 양조하여 그 일반성분, 유기산, 메탄올, ester, 휴젤유 및 $SO_2$ 등을 조사하였고, $20^{\circ}C$$30^{\circ}C$에서 20일 저장하면서 위의 성분분석과 관능 검사를 하였다. 보당형 구기자술 중의 유기산량은 젖산, 능금산, 주석산 및 초산 등이 주를 이루었으며 ester 및 휴젤유는 각각 $4.0{\sim}5.0\;mg%$$12{\sim}30\;mg%$ 그리고 methanol은 $25{\sim}27\;mg%$이었다. 약주형 구기자술의 ester 및 휴젤유는 보당형보다 많았다. 한편, 보당형 및 약주형 구기자술의 주질에 미치는 저장온도는 $30^{\circ}C$보다 $20^{\circ}C$가 좋았으며 살균 처리법은 $SO_2$ 100 ppm 첨가 또는 $60^{\circ}C/30$분의 처리가 좋았다.

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Prognostic Value of 18F-FDG PET/CT Radiomics in Extranodal Nasal-Type NK/T Cell Lymphoma

  • Yu Luo;Zhun Huang;Zihan Gao;Bingbing Wang;Yanwei Zhang;Yan Bai;Qingxia Wu;Meiyun Wang
    • Korean Journal of Radiology
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    • 제25권2호
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    • pp.189-198
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    • 2024
  • Objective: To investigate the prognostic utility of radiomics features extracted from 18F-fluorodeoxyglucose (FDG) PET/CT combined with clinical factors and metabolic parameters in predicting progression-free survival (PFS) and overall survival (OS) in individuals diagnosed with extranodal nasal-type NK/T cell lymphoma (ENKTCL). Materials and Methods: A total of 126 adults with ENKTCL who underwent 18F-FDG PET/CT examination before treatment were retrospectively included and randomly divided into training (n = 88) and validation cohorts (n = 38) at a ratio of 7:3. Least absolute shrinkage and selection operation Cox regression analysis was used to select the best radiomics features and calculate each patient's radiomics scores (RadPFS and RadOS). Kaplan-Meier curve and Log-rank test were used to compare survival between patient groups risk-stratified by the radiomics scores. Various models to predict PFS and OS were constructed, including clinical, metabolic, clinical + metabolic, and clinical + metabolic + radiomics models. The discriminative ability of each model was evaluated using Harrell's C index. The performance of each model in predicting PFS and OS for 1-, 3-, and 5-years was evaluated using the time-dependent receiver operating characteristic (ROC) curve. Results: Kaplan-Meier curve analysis demonstrated that the radiomics scores effectively identified high- and low-risk patients (all P < 0.05). Multivariable Cox analysis showed that the Ann Arbor stage, maximum standardized uptake value (SUVmax), and RadPFS were independent risk factors associated with PFS. Further, β2-microglobulin, Eastern Cooperative Oncology Group performance status score, SUVmax, and RadOS were independent risk factors for OS. The clinical + metabolic + radiomics model exhibited the greatest discriminative ability for both PFS (Harrell's C-index: 0.805 in the validation cohort) and OS (Harrell's C-index: 0.833 in the validation cohort). The time-dependent ROC analysis indicated that the clinical + metabolic + radiomics model had the best predictive performance. Conclusion: The PET/CT-based clinical + metabolic + radiomics model can enhance prognostication among patients with ENKTCL and may be a non-invasive and efficient risk stratification tool for clinical practice.

간호사(看護師)들의 간호사고(看護事故) 경험(經驗)과 사고원인(事故原因)에 관한 지각(知覺) (Perception on the Nursing Accident Experience of the Nurses and Its Cause)

  • 이순복;문희자
    • 간호행정학회지
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    • 제1권2호
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    • pp.246-267
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    • 1995
  • Recently the request of the patients to participate in the medical courses has been expanding due to the elevated sense of right on the people's health, merchandised medical treatment by mass supply, human right declaration of the patients, generalized medical informations by the mass media and the change of human relation between the medical personnels and the patients. Under these phenomena the patients have been in the thought of solving such accidents only by regulation of the laws which they think to be all powerful, Such trends are same in the area of nursing service. Also today the accident by the nurses have been increasing by the area of the nurses having been expanded and their independent roles having been increased. Such nursing accidents are the important subject which the professional occupation of the nurse has been facing but legal protective capability of the nurses has been very weak. Therefore this study has examined the degree of the experience of the nursing accident that happens in the clinical nursing scenes in the general hospital to provide the basic materials for the protection and the counter measures of the nursing accident. The following is the conclusion based by the above examination. 1) The experience degree of the whole nursing accidents has been appeared as 1.90 in average. And the degree according to service area has been 1.77 in the area of supervising management of patients, 1.54 in the area of the same management of patients by head-nurses, 1.84 in the area of doctors' treatment performances, 14 in the enforcement and education areas of the nursing technology, 2.04 in the area of observing patients and judgement and 2.07 in the area of nursing records and maintaining confidentials. Accordingly there has been higher degree of accidental experiences in the independent service areas of the patients than in the dependent ones directed by the doctors. 2) The perception of the nurses showed that the cause of the nursing accident has been due to the heavy work of the nurses with the 60.4% of the response rate, the highest rate. They report the accident to the head nurse first by 2/3 nurses after accident. And the hour of the accident has been frequently happened regardless of service hours with 48.1% in response rate, the highest rate, and the nursing accident happens in the night more than the daytime with the rate of 37.5% at night while 14. 4% daytime. 3) The nurses are in the perception that the patients are responsible for the accident with 48.2% response rate while 43.9% rate in response showed that it has been caused by many people. They are in the perception that 41.7% when the nursing power was lacking, 46.7% lower recognition of actual state about indivitual patient in the section of technical speciality and 35.8% when the patients were not cooperative and 37.8% when the wards were dirty and in disorder. 4) the attitude of the patients after the various nursing accidents has been violent words in 72.7%, violence in 17.4% and 3.9% in attending the court by the sue of the patient's side(18 nurses). 5) The action of the hospital has been : requesting the submission of the story of the accident in 22.8%, the report of the accidents in 14.4%, thus the written statement disposal was most, 4.5% was the transfer to the other departments when the accident was larger or the patients' guardians protested strongly and 0.6% of the dismissals of the nurses. 6) In regard to the responsiblity of the nurse accidents, 78.9% was the highest rate of supplying the nursing manpowers, 48.4% of mutual cooperation of the medical personnels, 37.2% of strengthening the education for the nurses and hospital facilities reformation in 32.7%. 7) The review of relation between the general characters of the object of the study and the degree of experience of nursing accidents showed the significant differences in ages (F=4.04, p=0.000).

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Eugenol과 1α,25-dihydroxyvitamin D3의 병합처리에 의한 HL-60 세포의 분화 유도 (Cooperative Induction of HL-60 Cell Differentiation by Combined Treatment with Eugenol and 1α,25-Dihydroxyvitamin D3)

  • 오미경;박선주;김남훈;조진경;진종률;김인숙
    • 생명과학회지
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    • 제17권9호통권89호
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    • pp.1191-1196
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    • 2007
  • Eugenol은 여러가지 향신료에 있는 필수 오일의 주요 성분으로서 악성 종양 세포의 성장을 저해하고 사멸을 유도한다고 보고되었다. 본 연구에서는 eugenol이 세포 분화 유도에 관여하는지를 조사하기 위하여 HL-60 전골 수성 백혈병 세포의 분화에 미치는 eugenol의 효과를 연구하였다. HL-60 세포에 eugenol (150 ${\mu}M$)을 가했을 때 세포성장이 저해되었으며 $1,25(OH)_{2}$ vit $D_{3}$ (3 nM)와 병합처리시에는 더 큰 저해효과를 보였다. 이 때, eugenol은 $1,25(OH)_{2}$ vit $D_{3}$에 의해 유도되는 세포주기의 $G_{0}/G_{1}$단계 정지를 더욱 증가시킴을 알 수 있었다. 또한, eugenol과 $1,25(OH)_{2}$ vit $D_{3}$를 병합처리 하였을 때에는 $G_{0}/G_{1}$단계의 정지와 관련된 세포주기 조절인자인 p27 level를 상호 협동적으로 증가시켰을 뿐만 아니라 cyclin A, cdk2, cdk4 level를 감소시켰다. 또한 유세포분석실험을 통하여, CD14 (단핵세포 표지 인자)의 발현이 eugenol과 $1,25(OH)_{2}$ vit $D_{3}$를 병합처리한 세포에서 단독처리시보다 더 증가함을 알 수 있었다. 이러한 결과들은 eugenol이 $1,25(OH)_{2}$ vit $D_{3}$와 상호협동적으로 작용하여 저농도의 $1,25(OH)_{2}$ vit $D_{3}$에 의해 자극된 세포 분화 신호를 더욱 더 증대 시킴을 나타낸다. 이러한 eugenol에 의한 세포 분화 유도 작용은 암의 화학적예방 효과에 유용하게 응용될 수 있을 것으로 기대된다.

한.미 간호 교육과정의 비교 연구 -간호대학과정을 중심으로- (A Comparative Study on the Curriculum of Nursing Education in America and Korea)

  • 김정자
    • 대한간호학회지
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    • 제7권2호
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    • pp.60-82
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    • 1977
  • The purpose of this study is first, to analyse the present nursing education and the curriculum in Korea in view of the changes and the new tendency of nursing education and second, to compare our curriculum with that of America, where nursing activities are actively earring on and, third, to try to find out what we should reconsider and improve in our nursing education. The object of this study is the educational program and the curriculum from 1973 to 1976 by selecting each five from colleges and department of nursing in Korea and America. The results of the study were as fellows : . 1. The aim of nursing education puts impassion the role of leader, knowledge and technology of nursing, welfare of society and service of community in both the America and Korea. In Korea nursing is mainly restricted to the treatment of diseases, while in the America the items of the aim of nursing are mainly extended to the capacity for Self- realization of nurse, in Korea they are restricted to the treatment of diseases. 2. In Korea the rate of credit of the curriculum of nursing education is the highest in professional education, next in general education, next in supporting science and educational subject, while in America the rate of the credit is the highest in general education, next professional education and then supporting Science and educational subject isn′t included in the curriculum. 3. In both Korea and America the role of the animal credit allotment in general education, is the highest in the first year and the rate in supporting science is the highest in the second year. In Korea professional subjects are concentrated in the third year while in America there is a tendency that they are increasing in number in the grade order. 4. There is a tendency that the rate of the credit allotment of the main professional subjects in curriculum is higher in Korea than in America : that is, in Korea the rate of the allotment of the credit is the highest in medical - surgical nursing, next maternal - child nursing, next community - health nursing and the psychiatric nursing and there in a great difference in the rate of the allotment of each credit. While in America the rate of the allotment of the credit is the highest in community - health nursing, next in medical- surgical nursing, next in maternal - child nursing, and then in psychiatric nursing and there is little difference in the rate of tile allotment of each credit. 5. From general education, supporting science and professional education, they have considered the continuity and sequence in the structure of nursing curriculum of Korea and America. While in Korea we have partly made integration in tile content of the subjects. Most of the school in America, they have made integration in the content of subjects especially in all subjects, but in Korea we haven't made it in all subjects. 6. In the system and form of nursing education Problem solving method, Dialectical method and operational method are introduced in some America schools and in others there is a tendency that the whole nursing education has the system based on Preventive frame - work or Health -illness frame work ; while only one college has an attempt for Health - Illness continue in Korea. 7. In Korea nursing education, as the importance of health- nursing and team nursing, the aim which is also comparatively emphasized is about health management and service of collective community. The subject pertaining to the aim is the studies of community health nursing, which are more in number in America. 8. When we consider the association between the social, general aims ?f the nursing education and the formation of the curriculum in Korean nursing school the courses of study concerning "the role of leadership and cooperative personal relation": "nursing care for the group": dynamic nursing care": and "the system of the public health nursing associated with the understanding of the regional community" are insufficient as compared with those of America. Especially, the lack of the behavioral science including the nursing care connected with the care for the group, the basic science on the clinical and developmental psychology, anthropology in known to be a prominent issue.

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Determination of optimum gamma ray range for radiation mutagenesis and hormesis in quinoa (Chenopodium quinoa Willd.)

  • Park, Chan Young;Song, Seon Hwa;Sin, Jong Mu;Lee, Hyeon Young;Kim, Jin Baek;Shim, Sang In
    • 한국작물학회:학술대회논문집
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    • 한국작물학회 2017년도 9th Asian Crop Science Association conference
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    • pp.240-240
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    • 2017
  • Quinoa (Chenopodium quinoa Willd.) is one of the ancient crops cultivated in the Andes region at an altitude of 3,500-4000m in Chile and Bolivia from 5000 BC. It contains a large amount of protein, minerals and vitamins in comparison with other crops. The cultivation area has been increasing worldwide because of its excellent resistance to various abiotic stress such as salinity, drought and low temperature. ${\gamma}$-Ray radiation of high dose is often used as a tool to induce mutations in plant breeding, but it has a deleterious effect on organisms. However, the radiation may have a positive stimulatory effect of 'hormesis' in the low dose range. This experiment was carried out to investigate the optimum dose range for creating the quinoa genetic resources and to investigate the hormesis effect at low dose on the quinoa. This experiment was performed for 120 days from November, 2016 to February, 2017 in the greenhouse of Gyeongsang National University. ${\gamma}$-Ray radiation was irradiated to seeds at 0 Gy, 50 Gy, 100 Gy, 200 Gy, 300 Gy, 400 Gy, 600 Gy, 800 Gy and 1000 Gy for 8 hours. (50 Gy) using the low level radiation facility ($Co^{60}$) of Cooperative Research Institute of Radiation Research Institute, KAERI. Fifty seeds were placed on each petri dish lined with wet filter paper and germination rate was measured at a time interval of 2 hours for 40 hrs. The length of the root length was measured one week after germination. Each treatment was carried out in 3 replicates. The growth of seedlings were investigated for 10 days after transplanting of 30 day-old seedlings. The plant height, NDVI, SPAD, Fv/Fm, and panicle weight were measured. The germination rate was highest at 50Gy and 0Gy and the rate of seeds treated with 400Gy or higher rate decreased to 25% of the seeds treated with 50Gy. The emergence rate of seedling in pot experiment was higher at the dose of 200 Gy, 300 Gy and 400 Gy than at 0 and 50Gy. However, the rate was lower at strong radiation higher than 600Gy at which $1^{st}$ leaf was not expanded fully and dead due to extreme overgrowth at 44 days after treatment (DAT). The highest value of panicle weight was observed at 50Gy (6.15g) and 100Gy (5.57g). On the other hand, the weight at high irradiated dose of 300Gy and 400Gy was decreased by about 55% compared to low dose (50 Gy). NDVI measurement also showed the highest value at 50 Gy as the growth progressed. SPAD was the highest at 400 Gy and showed positive correlation with irradiation dose except 0 Gy. Fv/Fm was high at 50 Gy up to 30 DAT and no difference between treatments was observed except for 400 Gy from 44 DAT. The plant height was the highest in 50Gy during the growing period and was higher in the order of 50Dy, 100Gy, 0Gy, 200Gy, 300Gy and 400Gy in 88 DAT. In this experiment, the optimal radiation dose for hormesis was 50Gy and 100Gy, and the optimal radiation dose for mutagenesis seems to be 400 Gy.

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The Tumor Control According to Radiation Dose of Gamma Knife Radiosurgery for Small and Medium-Sized Brain Metastases from Non-Small Cell Lung Cancer

  • Park, Sue Jee;Lim, Sa-Hoe;Kim, Young-Jin;Moon, Kyung-Sub;Kim, In-Young;Jung, Shin;Kim, Seul-Kee;Oh, In-Jae;Hong, Jong-Hwan;Jung, Tae-Young
    • Journal of Korean Neurosurgical Society
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    • 제64권6호
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    • pp.983-994
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    • 2021
  • Objective : The effectiveness of gamma knife radiosurgery (GKR) in the treatment of brain metastases is well established. The aim of this study was to evaluate the efficacy and safety of maximizing the radiation dose in GKR and the factors influencing tumor control in cases of small and medium-sized brain metastases from non-small cell lung cancer (NSCLC). Methods : We analyzed 230 metastatic brain tumors less than 5 mL in volume in 146 patients with NSCLC who underwent GKR. The patients had no previous radiation therapy for brain metastases. The pathologies of the tumors were adenocarcinoma (n=207), squamous cell carcinoma (n=18), and others (n=5). The radiation doses were classified as 18, 20, 22, and 24 Gy, and based on the tumor volume, the tumors were categorized as follows : small-sized (less than 1 mL) and medium-sized (1-3 and 3-5 mL). The progression-free survival (PFS) of the individual 230 tumors and 146 brain metastases was evaluated after GKR depending on the pathology, Eastern Cooperative Oncology Group (ECOG) performance score (PS), tumor volume, radiation dose, and anti-cancer regimens. The radiotoxicity after GKR was also evaluated. Results : After GKR, the restricted mean PFS of individual 230 tumors at 24 months was 15.6 months (14.0-17.1). In small-sized tumors, as the dose of radiation increased, the tumor control rates tended to increase (p=0.072). In medium-sized tumors, there was no statistically difference in PFS with an increase of radiation dose (p=0.783). On univariate analyses, a statistically significant increase in PFS was associated with adenocarcinomas (p=0.001), tumors with ECOG PS 0 (p=0.005), small-sized tumors (p=0.003), radiation dose of 24 Gy (p=0.014), synchronous lesions (p=0.002), and targeted therapy (p=0.004). On multivariate analyses, an improved PFS was seen with targeted therapy (hazard ratio, 0.356; 95% confidence interval, 0.150-0.842; p=0.019). After GKR, the restricted mean PFS of brain at 24 months was 9.8 months (8.5-11.1) in 146 patients, and the pattern of recurrence was mostly distant within the brain (66.4%). The small and medium-sized tumors treated with GKR showed radiotoxicitiy in five out of 230 tumors (2.2%), which were controlled with medical treatment. Conclusion : The small-sized tumors were effectively controlled without symptomatic radiation necrosis as the radiation dose was increased up to 24 Gy. The medium-sized tumors showed potential for symptomatic radiation necrosis without signifcant tumor control rate, when greater than 18 Gy. GKR combined targeted therapy improved the tumor control of GKR-treated tumors.

한국농촌보건(韓國農村保健)의 문제점(問題點)과 개선방안(改善方案) (Innovative approaches to the health problems of rural Korea)

  • 노인규
    • 농촌의학ㆍ지역보건
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    • 제1권1호
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    • pp.5-9
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    • 1976
  • The categories of national health problems may be mainly divided into health promotion, problems of diseases, and population-economic problems which are indirectly related to health. Of them, the problems of diseases will be exclusively dealt with this speech. Rurality and Disease Problems There are many differences between rural and urban areas. In general, indicators of rurality are small size of towns, dispersion of the population, remoteness from urban centers, inadequacy of public transportation, poor communication, inadequate sanitation, poor housing, poverty, little education lack of health personnels and facilities, and in-accessibility to health services. The influence of such conditions creates, directly or indirectly, many problems of diseases in the rural areas. Those art the occurrence of preventable diseases, deterioration and prolongation of illness due to loss of chance to get early treatment, decreased or prolonged labour force loss, unnecessary death, doubling of medical cost, and economic loss. Some Considerations of Innovative Approach The followings art some considerations of innovative approaches to the problems of diseases in the rural Korea. 1. It would be essential goal of the innovative approaches that the damage and economic loss due to diseases will be maintained to minimum level by minimizing the absolute amount of the diseases, and by moderating the fee for medical cares. The goal of the minimization of the disease amount may be achieved by preventive services and early treatment, and the goal of moderating the medical fee may be achieved by lowering the prime cost and by adjusting the medical fees to reasonable level. 2. Community health service or community medicine will be adopted as a innovative means to disease problems. In this case, a community is defined as an unit area where supply and utilization of primary service activities can be accomplished within a day. The essential nature o the community health service should be such activities as health promotion, preventive measures, medical care, and rehabilitation performing efficiently through the organized efforts of the residents in a community. Each service activity should cover all members of the residents in a community in its plan and performance. The cooperation of the community peoples in one of the essential elements for success of the service program, The motivations of their cooperative mood may be activated through several ways: when the participation of the residents in service program of especially the direct participation of organized cooperation of the area leaders art achieved through a means of health education: when the residents get actual experience of having received the benefit of good quality services; and when the health personnels being armed with an idealism that they art working in the areas to help health problems of the residents, maintain good human relationships with them. For the success of a community health service program, a personnel who is in charge of leadership and has an able, a sincere and a steady characters seems to be required in a community. The government should lead and support the community health service programs of the nation under the basis of results appeared in the demonstrative programs so as to be carried out the programs efficiently. Moss of the health problems may be treated properly in the community levels through suitable community health service programs but there might be some problems which art beyond their abilities to be dealt with. To solve such problems each community health service program should be under the referral systems which are connected with health centers, hospitals, and so forth. 3. An approach should be intensively groped to have a physician in each community. The shortage of physicians in rural areas is world-wide problem and so is the Korean situation. In the past the government has initiated a system of area-limited physician, coercion, and a small scale of scholarship program with unsatisfactory results. But there might be ways of achieving the goal by intervice, broadened, and continuous approaches. There will be several ways of approach to motivate the physicians to be settled in a rural community. They are, for examples, to expos the students to the community health service programs during training, to be run community health service programs by every health or medical schools and other main medical facilities, communication activities and advertisement, desire of community peoples to invite a physician, scholarship program, payment of satisfactory level, fulfilment of military obligation in case of a future draft, economic growth and development of rural communities, sufficiency of health and medical facilities, provision of proper medical care system, coercion, and so forth. And, hopefully, more useful reference data on the motivations may be available when a survey be conducted to the physicians who are presently engaging in the rural community levels. 4. In communities where the availability of a physician is difficult, a trial to use physician extenders, under certain conditions, may be considered. The reason is that it would be beneficial for the health of the residents to give them the remedies of primary medical care through the extenders rather than to leave their medical problems out of management. The followings are the conditions to be considered when the physician extenders are used: their positions will be prescribed as a temporary one instead of permanent one so as to allow easy replacement of the position with a physician applicant; the extender will be under periodic direction and supervision of a physician, and also referral channel will be provided: legal constraints will be placed upon the extenders primary care practice, and the physician extenders will used only under the public medical care system. 5. For the balanced health care delivery, a greater investment to the rural areas is needed to compensate weak points of a rurality. The characteristics of a rurality has been already mentioned. The objective of balanced service for rural communities to level up that of urban areas will be hard to achieve without greater efforts and supports. For example, rural communities need mobile powers more than urban areas, communication network is extremely necessary at health delivery facilities in rural areas as well as the need of urban areas, health and medical facilities in rural areas should be provided more substantially than those of urban areas to minimize, in a sense, the amount of patient consultation and request of laboratory specimens through referral system of which procedures are more troublesome in rural areas, and more intensive control measures against communicable diseases are needed in rural areas where greater numbers of cases are occurred under the poor sanitary conditions.

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