• 한국콘텐츠학회논문지
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• 제15권8호
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• pp.416-423
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• 2015

본 연구에서는 내부표적체적을 통한 방사선치료계획을 분석하여 호흡연동방사선치료에 주로 이용되는 호기상태의 치료계획체적과 비교 분석하여 정상조직이 받은 선량을 알아보았다. 2013년 12월부터 2014년 6월까지 모 대학교병원 방사선종양학과에서 복부부위에 호흡연동방사선치료를 받은 환자 25명을 대상으로 하였으며, 암의 종류는 liver(64%), CBD(8%), gastric(8%), GB(8%), pancreas(8%), SMA(4%)이었다. ITV와 PTV 체적의 평균치는 $471.44cm^3$, $425.48cm^3$ 로 체적의 증가를 알 수 있었고, PTV구간에서 ITV구간으로 선택한 구간의 증가로 인해 정상조직체적 또한 증가함을 알 수 있었다. 그리고 정상조직체적의 증가, target volume 증가, 치료조사야 면적증가의 차이와 정상조직이 받은 선량평균치의 차이에서는 right kidney가 유의한 증가를 보였다. 호흡평균치에 따른 정상조직이 받은 선량평균치의 차이는 없었고 target moving과 정상조직의 선량평균치의 차이에서는 both kidney가 유의한 차이를 나타내었다. 결론적으로 PTV구간과 ITV구간 체적 설정을 통한 치료방법이 모두 정상조직의 보호선량에 적합하였으며, 처방선량의 95% 이상이 분포하였으므로 환자의 치료목적에 따라 선택적으로 사용되어도 무방할 것이라 사료된다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권6호
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• pp.2505-2510
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• 2014

Background: The standard radiotherapy (RT) fractionation practiced in India and worldwide is 50Gy in 25 fractions over 5 weeks to the chest wall or whole breast followed by tumour bed boost in case of breast conservation (BCS). A body of validated data exists regarding hypofractionation in breast cancer. We here report initial results for 135 patients treated at our center with the START-B type of fractionation. Materials and Methods: From May 2011 till July 2012, women with all stages of breast cancer (excluding metastatic), who had undergone BCS or mastectomy were planned for 40Gy in 15 fractions over 3weeks to chest wall/whole breast and supraclavicular fossa (where indicated) followed by tumour bed boost in BCS patients. Planning was done using Casebow's technique. The primary end point was to assess the acute toxicity and the cosmetic outcomes. Using cosmetic scales; patients were assessed during radiotherapy and at subsequent follow up visits with the radiation oncologist. Results: Of the 135 patients, 62 had undergone BCS and 73 mastectomy. Median age of the population was 52 years. Some 80% were T1&T2 tumours in BCS whereas most patients in mastectomy group were T3&T4 tumours (60%). 45% were node negative in BCS group whilst it was 23% in the mastectomy group. Average NPI scores were 3.9 and 4.9, respectively. Most frequently reported histopathology report was infiltrating ductal carcinoma (87%), grade III being most common (58%), and 69% were ER positive tumours, and 30% were Her 2 Neu positive. Triple negative tumours accounted for 13% and their mean age was young (43 yrs.) The maximum acute skin toxicity at the end of treatment was Grade 1 in 94% of the mastectomy grouppatients and 71% in BCS patients. Grade 2 toxicity was 6% in mast group and 23% in BCS group. Grade 3 was 6% in BCS group, no grade 3 toxicity in mastectomy patients and there was no grade 4 skin toxicity in any case. Post RT at 1 month; 39% of BCS patients had persisting Grade I skin reaction which was only 2% in mastectomy patients. At 3 months post RT, 18% patients had persisting hyperpigmentation. At 6 months 8% patients had persisting erythema in the BCS group only. Some 3% BCS and 8% mastectomy patients had lymph edema till the date of evaluation. Cosmetic outcome in BCS patients remained good to excellent 6 months post surgery and radiotherapy. 1 patient of BCS and 3 patients of mast had developed metastatic disease at the time of evaluation. Conclusions: Hypofractionated RT is well tolerated in Indian population with reduced acute skin toxicity and good cosmetic outcome. Regimens such as these should be encouraged in other centers to increase machine output time. The study is on-going to assess long term results.

• 농촌의학ㆍ지역보건
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• 제7권1호
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• pp.74-79
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• 1982

Recently in Korea, integration of F.P. & MCH programs for effective and efficient implementation of the health programs has been discussed actively. In fact, categorical health workers in fields have been trained and changed as an integrated health workers by government. But one of the most important problems that had to be solved for successful integration of F.P. and MCH programs, is that there must be a common indicator for the evaluation of the two health services (integrated indicator). We regarded reproductive efficiency (=R.E.) that had been proposed by Charlotter M$\ddot{u}$ller et al, as the good integrated indicator. The object of this brief article is to introduce the meaning of reproductive efficiency and to illustrate the usefulnesses of R.E. as the integrated health indicator by applying this indicator to the data from preliminary survey of Seosan demonstration project for integration of F.P. & MCH service supported by WHO. The results and conclusions are as follows 1) Definition of R.E. is the percentage of pregnancies that succeed in production normal, surving children after taking into account the frequency of all measurable types of adverse outcomes (End point for evaluation of survival is one year of age). 2) On the basis of the past pregnant history, reproductive efficiency of the 2,484 eligible women (15-44 years) was roughly 75% (But, in the concept of good births, it is not regarded whether the survived infant is normal health or not). 3) Compared with the results of the other two surveys of the rural area in Korea, reproductive efficiency has been slightly decreased than before, in spite of family planning and MCH services for past 20 years. Because the quantity of increased abortion rate overwhelmed that of the decreased infant mortality rate. 4) Reproductive efficiency has the object for measure many events during the period from the conception (Wanted pregnancy) to an normal surviving children as an 1 year of age. So these heterogenous adversities, ie, induced abortion, still births, spontaneous abortion, neonate & infant death, are aggregated as R.E. However, if the information of these important events and reproductive efficiency were given, R.E. is used as the comprehensive evaluation indicator for F.P. and M.C.H. after meticulous analysis the various components of R.E. 5) Economic loss for adverse outcomes of preg were pregnancy were calculated applying the medical cost at the relatively small sized hospital of small city. Economic loss for 100 cases of adverse outcome is 10,420,000 won, and economic loss for infant death is 46.1% of the total loss. So, it is rational to invest much more effort and than before to MCH programs.

• 농촌의학ㆍ지역보건
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• 제21권2호
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• pp.231-241
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• 1996

The estimation of medical care status and the planning of health service program should be done according to each community resident's socio-medical background and public health service. In this point, it is most necessary to be set the exact and new socio-economic statistics data in Nepal, one of the worst countries in national health status. We surveyed 668 house, 3,425 residents in Dolka area, Nepal from January 25th to February 1st, 1995. 1. In personal characteristics, the ratio of men and women was similar, the person who were below 19 years old were 28.1% and the single were 52.4%. The illeterate person were 50.3% and the lower group in economic status which had been estimated by interviewers were 46.9%. 2. In sanitational characteristics, the person who used stream water or rainwater to drink were 42.2% and the person who always boiled water to drink were only 8.3%. The person who had not toilet in their house were 67.3% and the lower group in sanitational status which had been estimated by interviewers were 61.8%. 3. The prevalence rate of illness during the last one month were 8.6% and the chronic were 26.1% and the acute were 72.5%. The distribution of sickness symptom were headache, fever and joint pain in order and the person who took no medical treatment among the sick were 37.0%. The patterns of medical utilization were public health center, hospital and pharmacy in order. 4. Illness prevalence was significantly related to sex, age, merital status and educational experience. The residents who were women, 40 years old or more, married and had not educational experience were apt to take illness. 5. Medical utilization was significantly related to educational experience, job, distance from home to medical facilities and economic status. The person who had educational experience, were officer workers or merchants, lived near by medical facilities and had higher economic status took medical treatment very well.

• 한국간호교육학회지
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• 제5권1호
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• pp.97-105
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• 1999

Based on literature, status and role of the NP in America was reviewed. The process of developing NP program in America suggests us many things. In America, nurse practitioners have sustained a mutually beneficial status with their patients for over thirty years. Excel fence in academic education and clinical training will enable nurse practitioners to continue to provide quality health care. The magnitude changes in the health care system of the United States, the challange of providing real access of health care continues. Lack of access to adequate primary care was the driving force in the initial 1965 Federal Involvement in developing the NP role. In 1993 President Bill Clinton's health care reform initiative provided policy support for NPs as primary care providers. The Institute of Medicine explicitly recognized NPs as an integral part of the primary care team. In addition, several national reports recognized NPs as affordable, accessible, high-quality care providers. The recent passage of direct Medicare reimbursement for NPs reflected public policy statements coincided with and likely contributed to a growth spurt in the NP workforce. From 1965 to 1977 NP programs offered traditional primary care clinical tracks(adult, family, woman's health, and pediatrics) for relatively small clusters of students in a variety of institutional settings. From 1978 to 1990 these educational programs were incorporated into graduate schools of nursing. By 1990 the majority of NPs received educational preparation in master's-level nursing programs. A new emphases was placed on postmaster's NP programs designed for master's prepared clinical nurse specialists and nurse managers. he the health care system shifted hospital nursing resources toward community-based care, these master's -level nurses sought additional NP preparation. NP educational programs are defined as the educational structure in which one or more NP clinical tracks are offered. NP clinical tracks, in turn, offer curriculum and supervised clinical experiences that match standards in specific practice areas such as family(FNP), adult(AUP), geriatrics(GNP), pediatrics(PNP), women's health (WHNP), neonatal (NNP), and acute care(ACNP). There were indications that NP practice was expanding into new clinical areas as evidenced by new types of tracks, particularly in acute care and psychiatry. The increase in acute care NP students likely reflects the increased demand from hospitals and other acute care settings. In Korea, change of nurse's role into nurse practitioner's role may have many difficulties. The need of health consumer, policy support of government, approval of medical care team are all essential component. Every nursing personnel make effort to planning the new health care delivery system.

• 대한치과의사협회지
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• 제51권6호
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• pp.346-354
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• 2013

Early identification of maxillary canine impaction is very important, because of treatment duration time. Analysis used by 3-dimensional computed tomography is more important than before in treatment planning. The aim of this study was to analysis of factors associated with the treatment during time of forced eruption of the impacted maxillary canine using 3-dimensional computed tomography. 17 patients were analysed in Daejeon dental hospital of Wonkwang university(16 patients with unilateral impactions and 1 patient with bilateral impaction). In total, 18 maxillary impacted cannines were analysed by 3-dimensional computed tomography. The results obtained were as follow; 1. There was positive correlation between the age of patient and treatment duration time. 2. There was positive correlation between the distance of occlusal plane to cusp of maxillary impacted canine and treatment duration time, and negative correlation between the length of maxillary impacted canine and treatment duration time. 3. There was positive correlation between the angulation of midsagittal plane to axis of maxillary impacted canine and treatment duration time, and negative correlation between occlusal plane to axis of maxillary impacted canine and treatment duration time. In conclusion, age, tooth length, distance from the canine cusp tip to the occlusal plane, angulation of tooth axis to occlusal plane and midsagittal plane allow that we can predict treatment duration time.

• 대한간호학회지
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• 제20권3호
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• pp.357-367
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• 1990

This descriptive study was done to identify factors influencing sexual satisfaction in women who had had a hysterectomy and to compare these with women who had not had a hysterectomy. The purpose was to contribute theoretical understanding on which to base nursing care planning. One group of subjects were 156 women who had had a hysterectomy, between one and 18 months post surgery, living with their spouse, having no complications, and menstruating before surgery. The other group of subjects were 282 healthy women who were living with their husbands and menstruating. The study tool consisted of 108 items including item concerning personal characteristics, characteristics related to the hysterectomy, husband's support, body image, emotions, attitude toward the sexual relationship, knowledge of sexuality, sexual behavior, and sexual satisfaction. Sexual satisfaction was measured by a tool based on Derogatis Sexual Function Inventory. The range of the internal level of the study tool was from. 5208 to .9462. Data collection was done during the period from June 20 to Aug.20, 1989. The same questionnaire was used of data collection for both groups, but a mail survey method was used for the women who had had a hysterectomy, and an interview method was used for the women who had not had a hysterectomy. Data analysis was done using frequency, ratio, mean and S.D. for the characterstics of the subjects and level of sexual satisfaction. t - test or ANOVA was used for the differences between the groups with regard to the general and hysterectomy related characteristics. The relationship between the score for sex life related factors and the level of sexual satisfaction was analyzed using the Pearson Correlation, and the influencing factors on sexual satisfaction were analyzed by stepwise multiple regression. The results of this study were as follows ; 1. Mean age and income level were the only general characteristics for the two groups that were significantly different. The mean age, and income level of the group who had had a hysterectomy were 45years, and 1,150,000 won respectively, and for those who had not had a hysterectomy, 41 years and 999,000 won. 2. There was no statistical difference of the sexual satisfaction score between the two groups. 3. There was differences in the factors influencing sexual satisfaction between the two groups. Factors influencing sexual satisfaction for the group who had had a hysterectomy were husband's support (R＝.5793, P＝.000) and the women's Knowledge of sexuality(R＝.6670, P＝.000) (total variance : 33.56). On the other hand, emotional status(R＝.4294, P＝.000), sexual behavior(R＝.4294, P＝.000), husband's support(R＝.5274, P＝.000) and attitude towards sexual relations (R＝.5412, P＝.000) (total variance : 54.12) were the factors influencing sexual satisfaction in the group who had not had a hysterectomy. Since husband's support and sexuality knowledge were identified as factors influencing sexual satisfaction of women who have had a hysterectomy, it can be concluded that, before a woman who has had a hysterectomy is discharged from hospital, nurses should include strategies in the nursing care plan that will promote husband's support and the women's knowledge of sexuality.

• 대한간호학회지
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• 제12권2호
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• pp.57-66
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• 1982

This study was undertaken to delineate the relationship between numerical score and the amount of nursing hours required in the nursing process. Score was a numerical description of the patients functional nursing needs. Therefore this study focused on standard nursing hours required by patient's self-care status. This study observed the 62 patients and 15 R.N. in H. university hospital from Aug. 7, 1982 to Aug. 13, 1982. 1. For the first time, each head nurse assessed self-care status by Schoening's self-care score-Minimal care patient (self-care score: 23, 24) was placed in Group Ⅰ, intermediate care patient (self-care score: 11∼22) was Group Ⅱ, and special care score: 0∼10) was Group Ⅲ. 2. We observed and recorded the nursing care received from nurses according to patient's group. (8AM∼4PM) 3. And, We observed and recorded the activities of nurses in order to determine standard nursing hours required. (8AM∼4PM) 4. If we apply the content of paragraph 3 to paragraph 2, we will predict the number of patient that nurse can care during day time by self-care status. The following results were obtained: 1) Patient's mean self-care score were Group I : 23.9 score Group Ⅱ：17.8 score Group Ⅲ : 1.6 score 2) Nursing hours required by patient's physical function(self-care status) status were Group I : 35 min. Group Ⅱ: 47.5 min. Group Ⅲ : 104.6 min. 3) Nurse's nursing time and distribution required in nursing activities during day duty were A.D.L. : 84.3min. (17.56％) Functional nursing activities : 279.9min. (58.31 ％) Education ＆ Emotional support : 11.3min. (2.35%) Task unrelated patients : 54min. (11.25%) Non Productive nursing care : 50. 5min. (10.52％) 4) Mean nursing hours required by each patient and the number of patient that nurse can rare during day duty by self-care status were Group I : 38.6min. 11.1 patients/1 nurse Group Ⅱ : 51.1min: 8.4 patients/1 nurse Group Ⅲ： 108.2min. 4 patients/1 nurse It seems reasonable that this could be done effectively as each-unit has an established standard for hours required, This not only allows time for planning of staff but helps to avoid the very human inclination to predict excessive staffing requirements by placing the majority of patients in high care group.

• 대한치과교정학회지
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• 제50권5호
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• pp.336-345
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• 2020

Objective: To investigate the treatment modalities (Tx-Mods) for patients with unilateral hemifacial microsomia (UHFM) according to Pruzansky-Kaban types and growth stages. Methods: The samples consisted of 82 Korean UHFM patients. Tx-Mods were defined as follows: Tx-Mod-1, growth observation due to mild facial asymmetry; Tx-Mod-2, unilateral functional appliance; Tx-Mod-3, fixed orthodontic treatment; Tx-Mod-4, growth observation due to a definite need for surgical intervention; Tx-Mod-5, unilateral mandibular or bimaxillary distraction osteogenesis (DO); Tx-Mod-6, maxillary fixation using LeFort I osteotomy and mandibular DO/sagittal split ramus osteotomy; Tx-Mod-7, orthognathic surgery; and Tx-Mod-8, costochondral grafting. The type and frequency of Tx-Mod, the number of patients who underwent surgical procedures, and the number of surgeries that each patient underwent, were investigated. Results: The degree of invasiveness and complexity of Tx-Mod increased, with an increase in treatment stage and Pruzansky-Kaban type (initial < final; [I, IIa] < [IIb, III], all p < 0.001). The percentage of patients who underwent surgical procedures increased up to 4.2 times, with an increase in the Pruzansky-Kaban type (I, 24.1%; IIa, 47.1%; IIb, 84.4%; III, 100%; p < 0.001). However, the mean number of surgical procedures that each patient underwent showed a tendency of increase according to the Pruzansky-Kaban types (I, n = 1.1; IIa, n = 1.5; IIb, n = 1.6; III, n = 2.3; p > 0.05). Conclusions: These findings might be used as basic guidelines for successful treatment planning and prognosis prediction in UHFM patients.

• 대한치과보철학회지
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• 제51권3호
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• pp.214-220
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• 2013

무치악 환자의 임플란트 보철 치료는 지지, 유지, 안정성, 발음 등의 측면에서 더 우수한 결과를 보인다. 임플란트를 이용한 무치악 환자의 치료는 다양하며, 크게 가철성과 고정성으로 나눌 수 있다. 가철성 치료에는 임플란트 유지 및 지지 피개의치가 있으며, 고정성 보철치료에는 ceramo-metal 보철물과 임플란트 하이브리드 보철물(implant hybrid prosthesis)이있다. 치료계획의 수립은 잔존 치조제, 연조직, 악간 관계, 환자의 경제적 상황 등을 종합적으로 고려하여 수립해야 한다. 임플란트를 이용한 하이브리드 보철물은 고정성 치료를 통해 환자에게 적절한 교합력을 제공하고 심리적인 안정감을 주는 동시에 적절한 연조직의 회복을 통한 심미적인 결과를 얻을 수 있다. 본 증례는 73세 여환으로 상악 Kennedy Class I 부분 무치악과 하악 무치악 상태로 내원하였다. 상악에는 우측 견치부터 좌측 제1소구치까지 7개의 잔존치를 이용한 가철성 국소의치, 하악은 양측 측절치와 제1소구치 부위에 4개의 임플란트 고정체를 이용한 하이브리드 보철물로 최종 치료 진행하였으며 치료 후 기능적, 심미적으로 만족스러운 결과를 얻었기에 이를 보고하고자 한다.