• Journal of Chest Surgery
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• v.32 no.7
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• pp.621-627
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• 1999

Background: Sixty five cases with congenitally corrected transposition of the great arteries (CCTGA) indicated for biventricular repair were operated on between 1984 and september 1998. Comparison between the results of the conventional(classic) connection(LV-PA) and the anatomic repair was done. Material and Method: Retrospective review was carried out based on the medical records of the patients. Operative procedures, complications and the long-term results accoding to the combining anomalies were analysed. Result: Mean age was 5.5$\pm$4.8 years(range, 2 months to 18years). Thirty nine were male and 26 were female. Situs solitus {S,L,L} was in 53 and situs inversus{I,D,D} in 12. There was no left ventricular outflow tract obstruction(LVOTO) in 13(20%) cases. The LVOTO was resulted from pulmonary stenosis(PS) in 26(40%)patients and from pulmonary atresia(PA) in 26(40%) patients. Twenty-five(38.5%) patients had tricuspid valve regurgitation(TR) greater than the mild degree that was present preoperatively. Twenty two patients previously underwent 24 systemic- pulmonary shunts previously. In the 13 patients without LVOTO, 7 simple closure of VSD or ASD, 3 tricuspid valve replacements(TVR), and 3 anatomic corrections(3 double switch operations: 1 Senning+ Rastelli, 1 Senning+REV-type, and 1 Senning+Arterial switch opera tion) were performed. As to the 26 patients with CCTGA+VSD or ASD+LVOTO(PS), 24 classic repairs and 2 double switch operations(1 Senning+Rastelli, 1 Mustard+REV-type) were done. In the 26 cases with CCTGA+VSD+LVOTO(PA), 19 classic repairs(18 Rastelli, 1 REV-type), and 7 double switch operations(7 Senning+Rastelli) were done. The degree of tricuspid regurgitation increased during the follow-up periods from 1.3$\pm$1.4 to 2.2$\pm$1.0 in the classic repair group(p<0.05), but not in the double switch group. Two patients had complete AV block preoperatively, and additional 7(10.8%) had newly developed complete AV block after the operation. Other complications were recurrent LVOTO(10), thromboembolism(4), persistent chest tube drainage over 2 weeks(4), chylothorax(3), bleeding(3), acute renal failure(2), and mediastinitis(2). Mean follow-up was 54$\pm$49 months(0-177 months). Thirteen patients died after the operation(operative mortality rate: 20.0%(13/65)), and there were 3 additional deaths during the follow up period(overall mortality: 24.6%(16/65)). The operative mortality in patients underwent anatomic repair was 33.3%(4/12). The actuarial survival rates at 1, 5, and 10 years were 75.0$\pm$5.6%, 75.0$\pm$5.6%, and 69.2$\pm$7.6%. Common causes of death were low cardiac output syndrome(8) and heart failure from TR(5). Conclusion: Although our study could not demonstrate the superiority of each classic or anatomic repair, we found that the anatomic repair has a merit of preventing the deterioration of tricuspid valve regurgitations. Meticulous selection of the patients and longer follow-up terms are mandatory to establish the selective advantages of both strategies.

• Journal of Veterinary Clinics
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• v.22 no.4
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• pp.328-335
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• 2005

The objective of this study was to evaluate tire effects of modified triple pelvic osteotomy(TPO). The procedures of modified TPO were composed of two iliac osteotomies and a pubic symphysiotomy at a tittle. Medical records of modified TPO treatment on 36 dogs and of unilateral TPO on 7 dogs were reviewed on the basis of signalment, body weight, operation time, Healing time of osteotomy sites and complications from October 2002 to September 2004. The values of clinical status and hip dysplasia, Norberg angle, percentage of femoral head coverage and pelvic diameter from radiographs taken preoperative, immediately postoperative, 2, 4, 8, 12 and 24 weeks after operation, respectively, were measured. In .unilateral TPO, the dogs could start standing without assistance from $3.0\pm1.0days$ and walking from $8.3\pm0.6days$ (n=3). Mean clinical grade before and 24 weeks after surgery were $2.2\pm0.42$(n=6) and $3.5\pm0.7$ (n=2), respectively. Mean operation time was $107.3\pm38.9$ minutes (n=4). In modified TPO, the dogs were seen to staff standing without assistance from $4.9\pm3.7$ days and walking from $7.3\pm4.8days$ (n=25). Mean clinical grade before surgery and 24 weeks after surgery were $2.3\pm1.5$ (n=27) and $3.2\pm0.7$)(n=9), respectively. Postoperative clinical grade significantly improved against preoperative clinical grade (P<0.01). Mean operation time was $143\pm42.8$ minutes (n=24). This was shorter than time f3r twice unilateral TPO. By comparison with preoperative values, postoperative mean radiographic grade, percentage of femoral head coverage and Norberg angle measured at the recheck time point significantly increased (P<0.01). Mean postoperative pelvic diameter was significantly larger than preoperative pelvic diameter in modified TPO (P<0.01) but not in unilateral TPO. These results indicated that modified TPO was effective technique for the treatment of hip dysplasia in dogs.

• Journal of Korean Society of Archives and Records Management
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• v.1 no.1
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• pp.201-230
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• 2001

Conserving the recored cultural inheritance is actually the duty of all of us. Above all, the management and conservation of archives and documents is up to archivists who have technical knowledge about archival science. Archivists have to not only conserve archives and documents but also carry out classifying and appraising them in order to define them as current historic ones. The fundamental education about archival science is made up of history and law. Because Archive is the organisation which manage archives and documents produced by legal and administrative actions. Although there are still arguments about technical knowledge and degree archivists have to acquire, most of them prefer the studies related with history and emphasize legal studies to be the general boundary of archivits' ideology and trust. The training course about conservation of archives is conducted in about 9 National Archives of Torino, Milano, Venezia, Genova, Bologna, Parma, Roma, Napoli, Palermo. The training course in 19th was mostly based on the lectures of Phaleography, Diplomatics. There were not the education about archival science yet. Toward the end of 19th and 20th, people stressed the most basic subject in the training course of National Archive was not Phaleography and Diplomatics but archival science. The goal of archival science is to study the institution and organisation transferring archives and documents to Archive. And also it help archivists not wander about with ignorance of organisational and original procedures and divisions but know exactly theirs works. Like this, the studies on institution and organisation have got in the saddle as a branch of archival science since a few ten years. While archival science didn't evoke sympathy among people and experienced the tedious and difficult path in italy and other countries, Archive was managed by experts of other branches. As a result, there were a lot of faults in Archival Science. Specializing training course for Italian archivists came into being under the backdrop of Social Science Institute of Roma National University in 1925. The archival course of universities accomplished by the studies of history, law and economy. And such as Eugenio Casanova and Giorgio Cencetti were devoted archival science was abled to settle down in national archive. The training course for experts of 'archival science, 'Phaleography and Diplomatics' in National Archive of Bologna(Archivio di Stato di Bologna) is one of courses conducted in 17 National Archives in italy. This course is gratuitous and made up of 8 subjects(Archivistica, Paleografia, Diplomatica, Storia dell' Archivio, Notariato e documenti privati, istituzione medievale, istituzione moderna, istituzione contemporanea) students have to complete for two years. Students can receive the degree through passing twice written exam and once oral test. After department of Culture and education finally puts the marks of students, the chief Nationa Archive of Bologna confer the degree of 'archival science Phaleography and Diplomatics' on students passing the exams. This degree authenticates trainees' qualification which enables him to work at the archive in province, district and administrative capital city and archive of comunity and so on. Italian training course naturally leads archivists to keep in contact with valuable cultural inheritance through training in Archive. And it shows the intention to strengthen the affinity with each documents in the spot of archival management before training archivists. Also this is appraised as one of positive policies to conserve the local cultual inheritante in connection with the original qualitity of national archive with testify the history of each region. Traning course for archivist in Italy shows us the way how we have to prepare and proceed it. First, from producing documents to conserving than forever there has introduced 'original order that is to say a general rule to respect the first order given at the time producing documents'. Management of administrative documents is related consistently with one of historical documents. Second, the traning course for archivist is managing around 17 national archives. because italian national archive lay stress not or rducation of theory bus on train for archivest working in the first time of archival science. Third, diplomatics and phaleography for studies about historical document support archives. Forth, the studies on history id proceeding by cooperation between archivist and historian around archive. How our duties is non continuinf disputer who has to conserve and manage document and archives, but traing experts who having ability, vision and flexible thought, responsibility about archivals.

• Journal of Preventive Medicine and Public Health
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• v.20 no.1 s.21
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• pp.165-203
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• 1987

This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. The specific objectives were: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i)FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the inter-birth interval and/or open interval, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. Study design; The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum 'package' program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and 'before and after' surveys were conducted to measure the change. Service input; This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. Method of evaluation; a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed; b. Nevertheless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the 'integration process' itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltrurture, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable: Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. Summary of Findings; A) Program effects and impact 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 75% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) at delivery care(45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) Effects on Interactive Linkage 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in caring for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However, $85{\sim}90%$ of the services provided by the health workers were other than FP/MCH, mainly for immunizations such as the encephalitis campaign. In the control area, a similar pattern was observed. Over 75% of their service was other than FP/MCH. Therefore, the pattern shows the health workers are a long way from becoming multipurpose workers even though the government is pushing in this direction. 3. Villagers were much more likely to visit the health sub-center clinic in the study area than in the control area (58% vs.31%) and for more combined care (45% vs.23%). C) Organization factors (admistrative integrative issues) 1. When MW (new workers with higher qualification) were introduced to HSC, it was noted that there were conflicts between the existing HSC workers (Nurse aids with less qualification than MW) and the MW for the beginning period of the project. The cause of the conflict was studied by an anthropologist and it was pointed out that these functional integration problems stemmed from the structural inadequacies of the health subcenter organization as indicated below; i) There is still no general consensus about the objectives and goals of the project between the project staff and the existing health workers. ii) There is no formal linkage between the responsibility of each member's job in the health sub-center. iii) There is still little chance for midwives to play a catalytic role or to establish communicative networks between workers in order to link various knowledge and skills to provide better FP/MCH services in the health sub-center. 2. Based on the above findings the project recommended to the County Chief (who has power to control the administrative staff and the technical staff in his county) the following ; i) In order to solve the conflicts between the individual roles and functions in performing health care activities, there must be goals agreed upon by both. ii) The health sub·center must function as an autonomous organization to undertake the integration health project. In order to do that, it is necessary to support administrative considerations, and to establish a communication system for supervision and to control of the health sub-centers. iii) The administrative organization, tentatively, must be organized to bind the health worker's midwive's and director's jobs by an organic relationship in order to achieve the integrative system under the leadership of health sub-center director. After submitting this observation report, there has been better understanding from frequent meetings & communication between HW/MW in FP/MCH work as the program developed. Lessons learned from the Seosan Project (on issues of FP/MCH integration in Korea); 1) A majority or about 80% of the couples are now practicing FP. As indicated by the study, there is a growing demand from clients for the health system to provide more MCH services than FP in order to maintain the achieved small size of family through FP practice. It is fortunate to see that the government is now formulating a MCH policy for the year 2,000 and revising MCH laws and regulations to emphasize more MCH care for achieving a small size family through family planning practice. 2) Goal consensus in FP/MCH shouBd be made among the health workers It administrators, especially to emphasize the need of care of 'wanted' child. But there is a long way to go to realize the 'real' integration of FP into MCH in Korea, unless there is a structural integration FP/MCH because a categorical FP is still first priority to reduce the rate of population growth for economic reasons but not yet for health/welfare reasons in practice. 3) There should be more financial allocation: (i) a midwife should be made available to help to promote the MCH program and coordinate services, (in) there should be a health sub·center director who can provide leadership training for managing the integrated program. There is a need for 'organizational support', if the decision of integration is made to obtain benefit from both FP & MCH. In other words, costs should be paid equally to both FP/MCH. The integration slogan itself, without the commitment of paying such costs, is powerless to advocate it. 4) Need of management training for middle level health personnel is more acute as the Government has already constructed 90 MCH centers attached to the County Health Center but without adequate manpower, facilities, and guidelines for integrating the work of both FP and MCH. 5) The local government still considers these MCH centers only as delivery centers to take care only of those visiting maternity cases. The MCH center should be a center for the managment of all pregnancies occurring in the community and the promotion of FP with a systematic and effective linkage of resources available in the county such as i.e. Village Health Worker, Community Health Practitioner, Health Sub-center Physicians & Health workers, Doctors and Midwives in MCH center, OBGY Specialists in clinics & hospitals as practiced by the Seosan project at primary health care level.