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A Study on Curriculum Development For Community Health Practitioners (보건진료원 직무교육 교과과정 개선을 위한 일 연구)

  • 조원정;이경자
    • Journal of Korean Academy of Nursing
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    • v.22 no.2
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    • pp.207-226
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    • 1992
  • This study was designed to develop a conceptual framework for the curriculum and develop the details of the learning content for the education of Community Health Practitioners (CHPs). Since education programs for CHPs started 10 years ago, concepts related to CHP services have changed because of changes in society. The objectives of the study were as follows : 1) to analyse the usefulness of the present education program for CHPs, 2) to analyse the Job performance and self -confidence of the CHPs, 3) to identify the health needs of the clients served by the CHPs and the community problems related to health. 4) to develop a conceptual framework for the curriculum, for the education of CHPs, 5) to develops details for the learning content of the education program for CHPs. Phase I of the study was conducted by questionnaires to 150 CHPs who have worked in remote rural areas for more than 2 years. Among them, 147 responded. Data was collected from August 16, to August 25, 1990. In order to identify the health needs of the community people, research within the last five years was reviewed and analyzed. The data on 1, 842 communities gathered by the WHO Nursing Collaborations Center of the College of Nursing, Yonsei University was utilized to identify community problems related to health and the self - confidence in job performance of the CHPs. Psase II of the study consisted of a workshop with 13 professionals including Community Health Practitioners to evaluate the existing education program and a conceptual framework of the curriculum for the job education of CHPs. The results of the study are Summariged below : 1. The only 26 among 45 content items of the education program related to job skills was used by 80% of the responding CHPs. The knowledge of $\ulcorner$Networking community organization$\lrcorner$ was used by only 53.7% of the respondents. Educational content about $\ulcorner$Mental disease$\lrcorner$ was used by less than 50% of CHPs because of a knowledge deficit. 2. The CHPs reported that their activities concentrated on clinical services during the last six months. The survey showed that they seemed to neglect the activities for health promotion and disease prevention. Thus, $\ulcorner$Education for community loaders$\lrcorner$(15.9%), $\ulcorner$Activity for eavironmental health$\lrcorner$(16.3%) and $\ulcorner$Social work for needey people$\lrcorner$(23.3%) were done by less than 30% of CHPs. 3. More than 90% of CHPs reported being self - confident for the activities of $\ulcorner$Health education and counselling$\lrcorner$, $\ulcorner$Medicine prescription$\lrcorner$ and $\ulcorner$Immunization$\lrcorner$. But 50% of CHPs reported that they were not have self - confident in $\ulcorner$Management of water and environmental health$\lrcorner$ and only 25.6% of CHPs could insert an IUD independently. 4. It was identified that respiratory diseases and the gastrointestinal diseases were most common problems for the community people, followed by musculoskeletal and skin problems. 5. The community problems were classified into eight categories : physical environmental problems, environmental hygiene, health problems, health behavior, social problem, lack of resources, financial problem and the problems of the cultural and value system. 6. The conceptual framework consisted of the target population and their health status, nursing process working site and primary health care services such as health promotion, disease prevention, treatment and rehabilitation. 7. The contents of curriculum of education program for CHPs were formulated from the results of this study.

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A study on the effects of Electrical stimulation by the miniature Electric device on the tooth movement and tissue remodeling (초소형 전기 장치에 의한 전기 자극이 치아 이동과 주위 조직 개조에 미치는 효과에 관한 연구)

  • Park, Soon-Jung;Lee, Young-Jun;Park, Young-Guk;Davidovitch, Zeev
    • The korean journal of orthodontics
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    • v.33 no.4 s.99
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    • pp.279-291
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    • 2003
  • Electric current is a highly probable way as a clinical tool for tooth movement. The purposes of this study were to determine the usefulness of exogenous electric currents in accelerating orthodontic tooth movement and to investigate the effects of electric-orthodontic treatment on the remodeling of the periodontal tissue histologically The study was performed with six male cats weighing around 3kg. The electric device wich is providing the direct electric current of $20{\mu}A$ was inserted to the removable appliance. The right and left maxillary canines were assigned as control and experimental sides respectively. The control canine was Provided with orthodontic force (75gm) oかy and the experimental side was given the same amount of force and electricity. The lingual buttons were bonded to the maxillary canines and both sides of canines were retracted with NiTi coil spring. The electric device was adjusted to provide 20uh direct current to the experimental canines S hours a day The amount of the canine movement was measured with electronic caliper every week. After 4 weeks of tooth movement, the animals were sacrificed and the histologic study was performed. The results of this study were as follows. 1. The application of a direct current to the experimental tooth significantly increased the final amount of orthodontic tooth movement. The amount of tooth movement after 28-day was 37% more in the experimental side. 2. The electrically stimulated tooth showed histologic evidence of significant increases in the amount of bones and matrix deposition in the area of tension. 3. In the compression side, the electric-orthodontic treatment stimulated bone resorption more extensively in the experimental canines. 4. After 28 days of electricity exposure and orthodontic force, the experimental side demonstrated significantly more osteoblasts, osteoclasts, capillaries and osteoid tissues, reflectinr an increase in the local tissue's cellular activity. 5. Intermittent electrical stimulation (five hours a day) had effects to enhance orthodontic tooth movement and tissue remodeling. These results suggested that the low-intensity exogenous electric current by the miniature electric device might accelerate orthodontic tooth movement and bone remodeling in vivo and have the possibility to reduce the orthodontic treatment duration.

Comparative Studies on Absorbed Dose by Geant4-based Simulation Using DICOM File and Gafchromic EBT2 Film (DICOM 파일을 사용한 Geant4 시뮬레이션과 Gafchromic EBT2 필름에 의한 인체 내 흡수선량 비교 연구)

  • Mo, Eun-Hui;Lee, Sang-Ho;Ahn, Sung-Hwan;Kim, Chong-Yeal
    • Progress in Medical Physics
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    • v.24 no.1
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    • pp.48-53
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    • 2013
  • Monte Carlo method has been known as the most accurate method for calculating absorbed dose in the human body, and an anthropomorphic phantom has been mainly used as a method of simulating internal organs for using such a calculation method. However, various efforts are made to extract data on several internal organs in the human body directly from CT DICOM files in recent Monte Carlo calculation using Geant4 code and to use by converting them into the geometry necessary for simulation. Such a function makes it possible to calculate the internal absorbed dose accurately while duplicating the actual human anatomical structure. Thus, this study calculated the absorbed dose in the human body by using Geant4 associating with DICOM files, and aimed to confirm the usefulness by compare the result with the measured dose using a Gafchromic EBT2 film. This study compared the dose calculated using simulation and the measured dose in beam central axis using the EBT2 film. The results showed that the range of difference was an average of 3.75% except for a build-up region, in which the dose rapidly changed from skin surface to the depth of maximum dose. In addition, this study made it easy to confirm the target absorbed dose by internal organ and organ through the output of the calculated value of dose by CT slice and the dose value of each voxel in each slice. Thus, the method that outputs dose value by slice and voxel through the use of CT DICOM, which is actual image data of human body, instead of the anthropomorphic phantom enables accurate dose calculations of various regions. Therefore, it is considered that it will be useful for dose calculation of radiotherapy planning system in the future. Moreover, it is applicable for currently-used several energy ranges in current use, so it is considered that it will be effectively used in order to check the radiation absorbed dose in the human body.

Differential Diagnosis of Bicornuate and Septate Uterus : Is Comparison of Septal Signal Intensity on MR Image Useful\ulcorner (양각 자궁과 중격 자궁의 감멸 진단: 자기공명영상에서 자궁 격막 신호 강도의 비교는 유용한가\ulcorner)

  • 김종철;변재영;백승연
    • Investigative Magnetic Resonance Imaging
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    • v.4 no.2
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    • pp.107-112
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    • 2000
  • Purpose : To evaluate the usefulness of comparison of the signal intensity of uterine septum in the differential diagnosis of bicornuate and septate uterus on magnetic resonance (MR) imaging. Materials and methods : Preoperative MR imaging findings of surgically proven 5 bicornuate and 6 septate uteri were retrospectively analyzed. Because preoperative differential diagnosis of both was possible in all cases in terms of the intercornual distance, external contour of uterine fungus, and divergent angle of two uterine cavities, these criteria were excluded in this study. The signal intensity of uterine septum in patients with bicornuate and septate uterus was analyzed on T1-weighted and fast spin echo T2-weighted images obtained in the axial and coronal planes, using a 1.5-T MR scanner. The signal intensity of uterine septum especially on T2-weighted images was compared with that of myometrium or junctional zone. Results : The signal intensity of uterine septum in patients with bicornuate uterus (n=5) and septate uterus (n=6) was similar to that of myometrium in all cases on T1-weighted images. The septum of bicornuate uterus (n=5) on fast spin echo T2-weighted images was isointense with myometrium in three and hypointense in two cases. The uterine septum of septate uterus (n=6) on T2-weighted images was isointense with myometrium in two, hypointense in two, and isointense with or more hypointense than junctional zone in two cases. No patient showed different signal intensity between upper and lower uterine septum. Conclusion : Because the MR signal intensity of the uterine septum in bicornuate or septate uterus is variable, it should not be used alone in the differential diagnosis of them. In these clinically important differentiation, therefore, comprehensive analysis of MR findings in terms of the external contour of uterine fundus, intercornual distance, divergent angle of two uterine cavities, in addition to the signal intensity of the uterine septum, should be considered.

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Measurement of Regional Cerebral Blood Volume in Normal Rabbits on Perfusion-weighted MR Image (MR 관류강조영상에서 정상 가토의 국소 뇌혈류량 측정)

  • 박병래;예수영;나상옥;김학진;이석홍;전계록
    • Investigative Magnetic Resonance Imaging
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    • v.4 no.2
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    • pp.100-106
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    • 2000
  • Purpose : To evaluate the usefulness of cerebral blood flow measurement applied to perfusion weighted image with short-scan time single shot gradient echo-planar technique in measuring cerebral blood volume(rCBV) of normal rabbits. Materials and methods : With 2.1-3.6 kg weighted rabbits, image is acquired when they are in supine position in children positioner. Perfusion weighted image is acquired to 44 seconds per 1 second successively. After 4 seconds later, Gd-DTPA 2ml are injected into int. jugular vein with 2 ml per second and normal saline is also injected after that. Same technique is applied 2 times per 30 minites in same rabbit. After Image is obtained in two part of cerebral cortex at vertex, convexity, in one of basal ganglia with choosing about $3-5{\textrm{mm}^2}$ areas. Curve of signal intensity changes in time sequence is drawn. After this images are transmitted by PC and software IDL, regional cerebral blood volume is measured with imaging processing program made by us. Results : With 22 of 24 rabbits, satisfactory 1-2 signal intensity versus time curve is made. Cerebral blood capacity and contrast media stay time (ST) is measured in two cerebral cortex and basal ganglia refering in parietal cerebral cortex. Mean focal cerebral blood flow capacity ratio in cortex was $0.97{\pm}0.35$ and in basal ganglia, $0.99{\pm}0.37$, mean contrast media stay time in cortex was $9.83{\pm}1.63$ sec and in basal gaiglia, $9.42{\pm}1.14$ sec, but there was no statistically significant difference between two areas ($\rho$=0.05). Conclusion : In cerebral cortex and basal ganglia, there is no difference in mean focal blood volume and mean contrast stay time. Therefore, PWI is useful in cerebral blood flow and early diagnosis, prognosis of cerebral ischemic disease. Hereafter, it is helpful in analysing cerebral blood flow changes with comparison difference in rCBV between normal tissue and ischemic tissue, and that with DWI finding in infarcted patient.

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Stereoscopic depth of surfaces lying in the same visual direction depends on the visual direction of surface features (표면 요소의 시선방향에 의한 동일시선 상에 놓여있는 표면의 입체시 깊이 변화)

  • Kham Keetaek
    • Korean Journal of Cognitive Science
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    • v.15 no.4
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    • pp.1-14
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    • 2004
  • When two objects are tying in the same visual direction there occurs abrupt depth change between two objects, which is against the assumption of the computational model for stereopsis on the surfaces in a natural scene. For this reason, this stimulus configuration is popularly used in the studies for the effectiveness of the constraints employed in the computational model. Contrary to the results from two nails (or objects) tying in the same visual direction, the two different surfaces from random-dot stereogram (RDS) in the same situation can be seen simultaneously in the different depth. The seemingly contradictory results between two situations my reflect the different strategies imposed by binocular mechanism for each situation during binocular matching process. Otherwise, the surfaces tying in the same visual direction is not equivalent situation to two objects tying in the same visual direction with regards to matching process. In order to examine above possibilities, the stereoscopic depth of the surface was measured after manipulating the visual direction of the surface elements. The visual direction of each dot pair from different surfaces in RDS (in Experiment 1) or the visual direction of line (hawing rectangle with regard to that of the vertical line (in Experiment 2) was manipulated. The stereoscopic depth of the surface was found to be varied depending on visual direction of the surface elements in both RDS and line hawing stimulus. Similar to the results from two nails situation depth of the surface was greatly reduced when each surface element was tying in the same visual direction as that of the other surface element or the other object. These results suggest that binocular mechanism imposes no different strategy in resolving correspondence problem in both two objects and two surfaces situation. And the results were discussed in the context of usefulness of the constraints employed in the computational model for stereopsis.

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Clinical application of D-dimer in Kawasaki Disease (가와사끼병에서 D-dimer의 임상적 응용)

  • Han, Jae Joon;Ko, Hong Ki;Yoo, Young;Lee, JungHwa;Lee, Kwang Chul;Son, Chang Sung;Lee, Joo Won
    • Clinical and Experimental Pediatrics
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    • v.50 no.2
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    • pp.205-208
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    • 2007
  • Purpose : Vascular endothelial cell damage and alteration of a fibrinolytic system was suggested to play a role in the development of coronary artery abnormalities in Kawasaki disease (KD). D-dimer is one of the markers of endothelial damage and fibrinolysis. We evaluated the clinical usefulness of D-dimer to differentiate KD from other febrile diseases and predict coronary artery abnormalities in KD. Methods : Sixty eight patients diagnosed as KD and twenty eight patients presented with acute febrile illnesses other than KD from September 2005 to July 2006 were included. Blood levels of D-dimer and various inflammatory markers were measured before treatment and the clinical course of KD was followed. Serial echocardiography was performed at the onset of disease and thereafter at a monthly interval for at least 2 months. Results : KD patients showed a higher D-dimer level than febrile controls, but the difference was not significant ($1.21{\pm}0.77{\mu}g/mL$ vs $0.92{\pm}0.71{\mu}g/mL$, P=0.083). Neither was the difference between KD patients who had coronary artery abnormalities and those who had not ($1.49{\pm}0.98{\mu}g/mL$ vs $1.15{\pm}0.71{\mu}g/mL$, P=0.169). D-dimer was significantly correlated with other inflammatory markers, such as C-reactive protein and erythrocyte sedimentation rate in both KD patients and febrile controls. Conclusion : D-dimer was not specific for KD. But it may be useful as an inflammatory marker to assess the severity of KD.

Multiple Binding Affinities for Muscarinic Acetylcholine Receptors in Rat Brain (흰쥐 뇌내(腦內)의 무수카린성 콜린 수용체의 이질성(異質性))

  • Lee, Jong-Hwa;El-Fakahany, Esam E.
    • The Korean Journal of Pharmacology
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    • v.23 no.2
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    • pp.101-111
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    • 1987
  • We investigated the binding properties of $(^3H)$ QNB and $(^3H)$ NMS to mAchR to elucidate the characterstics of mAchR in rat brain by using two different preparations (homogemates & intact brain cell aggregates). The binding properties of both ligands demonstrated high affinity and saturability in both experiments, however $(^3H)$ QNB showed a significantly higher maximal binding capacity than tha ot $(^3H)$ NMS 1. In rat brain homogenates; Displacement of both lignands with several mAchR antagonists resulted in competition curves in accoradnce with the law of massaction for QNB, atropine & scopolamine in thie preparation, also a similar profile was found for the quaternary ammonium analogs of atropine & scopolamine (methyl atropine & methylscopolamine) when $(^3H)$ NMS was used to label the receptors in rat brain. But when these hydrophillic antagonists were used to displace $(^3H)$ QNB, they showed interaction with high- and low-affinity binding sites in brain homogenates. Pirenzepine, the nonclassical mAchR antagonist, was able to displace both ligands from binding sites in this preparation. 2. In intact rat brain cell aggregates; Intact bain cell aggregates were used to elucidate the binding characteristics of $(^3H)$ NMS to mAchR in rat. The magnitude of binding of this ligand was related linearly to the amount of cell protein in the binding assay with a high ratio of total to nonspecific binding. mAchR antagonists displaced specific $(^3H)$ NMS binding according to the law of mass-action, while it was possible to resolve displacement curves using mAchR agonist into high-& low-affinity component. 3. Our results indicate that more hydrophilic receptor ligand $(^3H)$ QNB, displacement experiments in both tissues demonstrated that the lipid solubility of a particulr mAchR ligand might play an important role in determining its profile of binding to the mAchR, and the concentrations of mAchR in rat brain are both on the cell surface (membrane-bound receptor) and in the intracelluar membrane (intermembrane-bound receptor). 4. The results are discussed in terms of the usefulness of dissociated intact rat brain cells in studying mAchR in central nervous system.

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The evaluation of usefulness of Electronic Portal Imaging Device(EPID) (Electronic Portal Imaging Device(EPID)의 유용성 평가)

  • Lee, Yang-Hoon;Kim, Bo-Kyoum;Jung, Chi-Hoon;Lee, Je-Hee;Park, Heung-Deuk
    • The Journal of Korean Society for Radiation Therapy
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    • v.17 no.1
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    • pp.19-31
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    • 2005
  • Purpose : To supply the information of EPID system and to analyze the possibility of substitution EPID for film dosimetry. Materials & Methods : With amorphous silicon(aSi) type EPID and liquid filled lonization chamber(LC) type EPID, the reproducibility according to focus detector distance(FDD) change and gantry rotation was analyzed, and also the possible range of image acquisition was analyzed with Alderson Rando phantom. The resolution and the contrast of aSi type EPID image were analyzed through Las Vegas phantom and water phantom. DMLC image was analyzed with X-Omat V film and EPID to see wether it could be applied to the qualify assurance(QA) of IMRT. Results : The reproducibility of FDD position was within 1mm, but the reproducibility of gantry rotation was ${\pm}2,\;{\pm}3mm$ respectively. The resolution and the contrast of EPID image were affected by dose rate, image acquisition time, image acquisition method and frame number. According to the possible range of image acquisition of EPID, it is verified that the EPID is easier to use than film. There is no difference between X-Omat V film and EPID images for the QA of IMRT. Conclusion : Through various evaluation, we could obtain lots of useful information about the EPID. Because the EPID has digital data, also we found that the EPID is more useful than film dosimerty for the periodical Qualify Assurance of IMRT. Especially when it is difficult to do point dose measurement with diode or ionization chamber, the EPID could be very useful substitute. And we found that the diode and ionization chamber are difficult to evaluate the sliding window images of IMRT, but the EPID was more useful to do it.

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A comparative study of dose distribution for whole brain with field-in-field technique (전뇌(Whole Brain)치료 시 Field-in-Field Technique 적용에 관한 고찰)

  • Kim Bo Kyoum;Lee Je Hee;Jung Chi Hoon;Pack Heung Deuk
    • The Journal of Korean Society for Radiation Therapy
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    • v.17 no.1
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    • pp.9-17
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    • 2005
  • Purpose : Uniform dose distribution of the target volume is very important in the radiation treatment. We will evaluate the usefulness of Field-in-Field Technique use to get uniform dose distribution of the target volume and try to find Apply possibility out to a whole brain treatment patient of various thickness. Material and method : We compare the dose distribution when we applied Field-in-Field Technique and parallel opposed fields technique. establish the treatment plan to a phantom(acryl 16cm spheral phantom) and do the measurement, assessment use the TLD and Low sensitivity film. Also the assessment did Apply possibility of Field-in-Field Technique to 20 patient object of various thickness. Result : In the case to use the parallel opposed fields at the whole brain treatment $10-12\%$ high dose region appeared but reduce to $3-4\%$ lesses when we used the Field-in-Field technique. We could get similar numerical value the film and TLD measurement result also. The change of the dose distribution appeared to its ${\pm}1{\sim}2\%$ although it applied such Field-in-Field technique to various patient so that we were identical. Conclusion : We can get uniform dose distribution of in the treatment region if we apply the Field-in-Field technique at the whole brain treatment. Also alternate can play the role of the wedge filter and 3D compensator and We are thought by minimizing the obstacle to be happened due to the high dose region when radiation treatment.

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