• The Journal of Korean Academic Society of Nursing Education
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• v.9 no.1
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• pp.144-154
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• 2003

Recently, in the academic disciplines critical thinking has been emphasized as the new evolution in education. Problem-based learning is suggested as the evolutionary learning method in developing critical thinking. In the nursing education, PBL is offered as an appropriate teaching method to prepare nurse student for professional. PBL is a student-centered learning strategy aimed at developing critical thinking, motivating self-directed study and attaining autonomy. The purpose of this study was to develop the communication curriculum of nursing education based on PBL and implementing of it. PBL module was developed focused on five communication situations. And learning strategies to facilitate the learning process and the guided questions to stimulate student inquiry were also developed. This PBL education was conducted for six students in the master's course during the 14 weeks from March, 2000 to June, 2000. The outcomes of the PBL education were examined based on the content analysis of the students reflective journal. As a result, it was found that students experienced the effect of it focused on self-oriented, group-oriented, and practice-oriented domain. In the self-oriented domain, the findings indicate that there were 5 kinds of concepts including 'motivation for self-directed study', 'transition toward certainty in knowledge acquisition', 'attempt to apply their prior knowledge into new situation', 'enhancement of self-image in real situation', 'self-growth with self reflection'. In the group-oriented domain, there were 3 kinds of concepts including 'cognitive work in group', 'perception of co-responsibility in attaining learning objectives', 'socialization with group members'. In the practice-oriented domain, there were 3 kinds of concepts including 'linkage theoretical knowledge with real situation', 'attempt to apply in real situation', 'development problem solving skill in real situation'. In conclusion, PBL had a significant effect on self, group, and clinical domain. And assessing PBL outcomes is challenging because standardized instrument do not develop yet. So the findings of this study can suggest the basic data for examining the PBL outcome.

• The korean journal of orthodontics
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• v.29 no.6 s.77
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• pp.663-672
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• 1999

A case is described, where an adolescent boy developed alopecia areata and alopecia totalis during the course of routine orthodontic treatment for the resolution of a dentoalveolar Class II division 1 malocclusion. The orthodontic treatment lasted 22 months, with a successful outcome. However, within eight months of the onset of treatment the patient lost all his hair Exhaustive medical tests and differential diagnosis determined that the etiolgy of the patient's alopecia was psychological stress evoked by the orthodontic treatment. Numerous reports suggest that psychological stress can cause alopecia by affecting the immune system. Therefore, it appears reasonable to assume that in the case of this patient, alopecia had resulted from stress effects on the immune system, leading to autoimmune disease-like conditions in tissues surrounding the scalp hair follicles. The alopecia condition was successfully reversed by daily oral and topical applications of vitamin D. It is concluded that the immune system plays a pivotal role in tissue remodeling around the teeth and elsewhere in the body, and that any conditions capable of affecting this system may cause unfavorable outcomes, such as alopecia.

• Clinics in Shoulder and Elbow
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• v.11 no.2
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• pp.131-136
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• 2008

Purpose: Parsonage-Turner syndrome is a rare disorder with sudden onset of severe pain around the shoulder girdle, followed by weakness of the shoulder muscles. The purpose of the current study was to describe the clinical features associated with this condition and to review the literature. Materials and methods: A retrospective study of the Parsonage-Turner syndrome was carried out for 6 patients seen from December 2005 to July 2008. The clinical and radiographic data was collected by medical records and telephone interviews. Five patients were males and one was female with ages ranging between 20-68 years (mean, 43.5). The mean follow-up period was 19.1 months (range, 14-27 months). Results: The intense pain around shoulder continued for 1 day to 3 weeks and decreased spontaneously at a mean of 3.3 weeks (range, 2-5 weeks) after onset of pain. Weakness in the involved muscles had developed at a mean of four weeks (range, 2-7 weeks). At the end of follow-up, five patients had an improvement of their strength and one patient had regained full strength. Electromyography was the most helpful in diagnosis. Conclusion: Parsonage-Turner syndrome is a self-limited disorder with a good outcome. Understanding of the course will assist in the diagnosis and treatment.

• Childhood Kidney Diseases
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• v.19 no.2
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• pp.98-104
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• 2015

Objective: To find out clinical features and long-term outcomes of idiopathic childhood nephrotic syndrome(NS) patients with late steroid resistance(LSR)/late steroid sensitiveness(LSS). Patients and Methods: A retrospective chart review was performed on 480 patients diagnosed with idiopathic childhood NS at Asan Medical Center Children's Hospital from 1990 to 2013. Twenty-four patients whose responsiveness to steroids changed over a minimum 2 year follow-up period (2-17.5 years) were investigated. All patients had undergone a renal biopsy. Results: Among 480 nephrotic children, 428 (89%) were sensitive to the first steroid course. Of those who initially responded, 11 (2.5%) developed resistance to steroid therapy after relapses. LSR mostly developed between 1 month and 1 year after the initial episode. Six patients showed a minimal change and five showed focal segmental glomerulosclerosis (FSGS). Nine (82%) responded to cyclosporine or methylprednisolone pulse therapy. Of these, two had no further relapse, whereas the other seven experienced several relapses that ranged in length from 1.1 to 13.9 years. Three of the nine who initially responded to immunosuppression went on to experience several changes in steroid responsiveness. Two (18%) with resistance to immunosuppressants, including steroids, eventually progressed to end stage renal disease. Among the 52 patients (11%) who were initially steroid resistant, 13 (23%) were converted to steroid sensitive at relapses. Among these, 9 showed minimal change and 4 showed FSGS. Two had no further relapse and the other 11 responded to steroids on subsequent relapses ranging in length from 1.3 to 9.4 years. All these patients have had no further changes in steroid responsiveness with normal renal function. Conclusions: In this study, 2.5% of initial steroid responders and 25% of initial steroid non-responders changed their responsiveness to steroids at subsequent relapses. Eighteen percent of LSR patients developed end stage renal disease. All of the LSS patients showed preserved normal renal function. Responsiveness to immunosuppressants seemed to be the most important factor determining longterm outcomes in LSR/LSS patients.

• Journal of Korean Neurosurgical Society
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• v.61 no.1
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• pp.81-88
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• 2018

Objective : Spondylitis is often chemotherapy resistant and requires long-term treatment. Without adequate chemotherapy, the outcome can be fatal or result in severe neurologic damage. Therefore, differentiating the etiology of spondylitis is very important, particularly in spontaneous cases. As the prevalence of tuberculosis in Korea has decreased in recent years, updated clinical research about spondylitis is warranted. Methods : From April 2010 to March 2016, data from spondylitis patients were collected retrospectively. In total, 69 patients (51 with pyogenic spondylitis and 18 with tuberculous spondylitis) were included. Clinical data, laboratory findings including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level, measurements of Cobb angles at the initial and final follow-up, and radiologic features on magnetic resonance imaging (MRI) scans were evaluated. To test differences between the pyogenic and tuberculous groups, numerical data were compared using the student's t-test and Mann-Whitney U test, and categorical data were compared using the chi-square test and Fisher's exact test. Results : The patients' mean age was 60.0 years. Male sex was slightly predominant (56.5%). There was no difference in mean age and sex between the two groups. The pyogenic group had a relatively higher proportion of immunocompromised patients. The peak CRP value was higher in the pyogenic group than in the tuberculous group (14.08 mg/dL and 8.50 mg/dL, respectively, p=0.009), whereas the ESR was not significantly different between the groups (81.5 mm/h and 75.6 mm/h, respectively, p=0.442). Radiologically, the presence of disc space sparing and vertebral body collapse differed between the groups. In the tuberculous group, the disc was more commonly preserved on contrast-enhanced MRI (50% and 23.5%, respectively, p=0.044), and vertebral body collapse was more common (66.6% and 15.7%, respectively, p<0.001). The mean length of hospitalization was longer in the pyogenic group (56.5 days and 41.2 days, respectively, p=0.001). Four mortality cases were observed only in the pyogenic group. The most commonly isolated microorganism in the pyogenic group was Staphylococcus aureus(S. aureus) (methicillin susceptible S. aureus and methicillin resistant S. aureus [MRSA] in 8 and 4 cases, respectively). Conclusion : The clinical and radiological manifestations of spontaneous spondylitis differ based on the causative organism. Pyogenic spondylitis patients tend to have a higher CRP level and a more severe clinical course, whereas tuberculous spondylitis patients present with destruction of the vertebral body with disc sparing more frequently. The presence of MRSA is increasing in community-acquired spondylitis cases.

• Archives of Plastic Surgery
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• v.36 no.3
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• pp.351-355
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• 2009

Purpose: Cervical necrotizing fasciitis tends to involve the deep soft tissues and spread caudally to the anterior chest and mediastinum, often resulting in major complications and death. It may rapidly spread into the thorax along fascial planes, and the associated diagnostic delay results in this descending necrotizing mediastinitis. So, aggressive multidisciplinary therapy with surgical drainage is mandatory. We present a very rare case of descending necrotizing mediastinitis with literature review. Methods: A 53 years old male visited our department 7 days after trauma in neck. His premorbid conditions and risk factors of necrotizing fasciitis were concealed hepatoma, trauma history, chronic liver disease, and nutrition deficit. Computed tomographic scans of the head and neck region were performed in this patient : signs of necrotizing fasciitis, were seen in the platysma, sternocleidomastoid, trapezius muscle and strap muscles of the neck. Fluid accumulations involved multiple neck spaces and mediastinum. At the time, he diagnosed as necrotizing fasciitis on his neck and anterior chest. Necrotic wound was excised serially and we treated this with the Vacuum - assisted closure(VAC, Kinetics Concepts International, San Antonio, Texas) system device. After appropriately shaping the sponge and achieving additional 3 pieces drainage tubes in the pockets, continuous negative pressure of 125 mmHg was applied. The VAC therapy was utilized for a period of 12 days. Results: We obtained satisfactory results from wide excision, abscess drainage with the VAC system, and then split thickness skin graft. The postoperative course was uneventful. Conclusion: The refined technique using the VAC system can provide a means of simple and effective management for the descending necrotizing mediastinitis, with better cosmetic and functional results. Finally, the VAC system has been adopted as the standard treatment for deep cervical and mediastinal wound infections as a result of the excellent clinical outcome.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.19 no.2
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• pp.77-85
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• 2018

Recently, many people have attempted to combine the 4th industry in various fields. Citizen participation has also become more important in the policy making and decision making process. Therefore, this study examined ways to encourage citizen participation by integrating the 4th industry in the field of urban planning and design. The research method was to design street space using virtual reality, and to examine the preference of design and the satisfaction of using a virtual reality device for Cheongju citizens and residents. The main result is that the use of VR in the design process of street space can achieve a sufficient outcome in terms of inducing resident participation. The opinions of the respondents before and after the VR experience were different from each other. After the VR experience, understanding, participation and interest in design were improved. On the other hand, during the course of the study, there are many difficulties in obtaining a place that satisfied the conditions of the PC-VR equipment. Although it can be used by connecting a smart phone and a VR device, the constraint of free movement and degradation of the graphic quality are inevitable. In addition, it is difficult to operate simple interfaces because VR devices are not yet popularized. Accordingly, it will be necessary to popularize and commercialize VR equipment and establish a legal basis.

• Journal of Korean Physical Therapy Science
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• v.15 no.2
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• pp.33-40
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• 2008

Background: The purpose of this study is to examine the effect of resistance exercise on static and dynamic proprioception by applying elastic bands to the knee flexor, which can be performed earlier than proprioception, a weight bearing pattern. Proprioceptive training may be applied to the early period of recuperation training along with resistance exercise to prevent damage to the knees and the joints in the lower body, as well as the reoccurrence of injury, which is expected to improve the effect of static and dynamic proprioceptive training. Methods: The subjects of this study were 32 men and women in their 20s who volunteered to participate in the experiment which was carried out over the course of 6 weeks from March 14 to April 24 at K Hospital located in Yongin City. They were tested in two groups: the elastic band resistance exercise group (RE: Resistance Excercise Group, n＝17) and the joint motion range exercise group(ROM: Range of Motion Group, n＝15). In this experiment, static and dynamic proprioceptive tests were given to both groups before and after the test. In this study, SPSS Win ver.12.0 was utilized to perform a T-test on the independent samples in order to validate the identical features of subjects in the RE and ROM Group and substantiate the significance as to the difference between both groups before and after the test. Also, a paired T-test was conducted to compare the static and dynamic proprioception of both groups before and after the test. The statistical significance levels were ${\alpha}$＝.05. Results: 1.The static proprioception in both groups, RE and ROM, increased in a statistically significant way after the test(p<.05). 2.The static propriocetion of the RE group increased in a statistically significant way after the test(p<.05). However, the increase of the static proprioception in the ROM group was not statistically significant. 3.Static and dynamic proprioception of the RE group increased significantly more than that of the ROM group after the test(p<.05). Conclusion: The resistance exercise using elastic bands improved the static and dynamic proprioception more than the joint motion range exercise did, reducing the risk of injury by enhancing the location sense of the joints and the sense of motion and shortening the period of recovery from injury. The outcome of the experiment may provide basic data for developing an effective way to reduce the risk of injury among ordinary people and athletes.

• Tuberculosis and Respiratory Diseases
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• v.78 no.3
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• pp.196-202
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• 2015

Background: Viridans streptococci (VS) are a large group of streptococcal bacteria that are causative agents of community-acquired respiratory tract infection. However, data regarding their clinical characteristics are limited. The purpose of the present study was to investigate the clinical and radiologic features of community-acquired pneumonia (CAP) with or without parapneumonic effusion caused by VS. Methods: Of 455 consecutive CAP patients with or without parapneumonic effusion, VS were isolated from the blood or pleural fluid in 27 (VS group, 5.9%) patients. Streptococcus pneumoniae was identified as a single etiologic agent in 70 (control group) patients. We compared various clinical parameters between the VS group and the control group. Results: In univariate analysis, the VS group was characterized by more frequent complicated parapneumonic effusion or empyema and bed-ridden status, lower incidences of productive cough, elevated procalcitonin (>0.5 ng/mL), lower age-adjusted Charlson comorbidity index score, and more frequent ground glass opacity (GGO) or consolidation on computed tomography (CT) scans. Multivariate analysis demonstrated that complicated parapneumonic effusion or empyema, productive cough, bed-ridden status, and GGO or consolidation on CT scans were independent predictors of community-acquired respiratory tract infection caused by VS. Conclusion: CAP caused by VS commonly presents as complicated parapneumonic effusion or empyema. It is characterized by less frequent productive cough, more frequent bed-ridden status, and less common CT pulmonary parenchymal lesions. However, its treatment outcome and clinical course are similar to those of pneumococcal pneumonia.

• Tuberculosis and Respiratory Diseases
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• v.80 no.3
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• pp.296-303
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• 2017

Background: Acute respiratory distress syndrome (ARDS) is related to high mortality and morbidity. There are no proven therapeutic measures however, to improve the clinical course of ARDS, except using low tidal volume ventilation. Metformin is known to have pleiotropic effects including anti-inflammatory activity. We hypothesized that pre-admission metformin might alter the progress of ARDS among intensive care unit (ICU) patients with diabetes mellitus (DM). Methods: We performed a retrospective cohort study from January 1, 2005, to April 30, 2005 of patients who were admitted to the medical ICU at Seoul National University Hospital because of ARDS, and reviewed ARDS patients with DM. Metformin use was defined as prescribed within 3-month pre-admission. Results: Of 558 patients diagnosed with ARDS, 128 (23.3%) patients had diabetes and 33 patients were treated with metformin monotherapy or in combination with other antidiabetic medications. Demographic characteristics, cause of ARDS, and comorbid conditions (except chronic kidney disease) were not different between metformin users and nonusers. Several severity indexes of ARDS were similar in both groups. The 30-day mortality was 42.42% in metformin users and 55.32% in metformin nonusers. On multivariable regression analysis, use of metformin was not significantly related to a reduced 30-day mortality (adjusted ${\beta}-coefficient$, -0.19; 95% confidence interval, -1.76 to 1.39; p=0.816). Propensity score-matched analyses showed similar results. Conclusion: Pre-admission metformin use was not associated with reduced 30-day mortality among ARDS patients with DM in our medical ICU.