• Title/Summary/Keyword: 의료인지지

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Analysis of Risk Factors and Effect of Vancomycin for Sternal Infection after Coronary Artery Bypass Graft (관상동맥우회술 후 흉골감염의 위험인자분석 및 반코마이신의 효과)

  • Baek, Jong-Hyun;Jung, Tae-Eun;Lee, Dong-Hyup;Lee, Jang-Hoon;Kim, Jung-Hee
    • Journal of Chest Surgery
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    • v.43 no.4
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    • pp.381-386
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    • 2010
  • Background: Sternal wound infection (SWI) is an important complication after cardiac surgery. The aim of this study was to investigate the predictors affecting sternal wound infection and preventive factors including short term Vancomycin therapy in patients who underwent coronary artery bypass grafting (CABG). Material and Method: A retrospective study was done using data collected from January 2001 through December 2007. This included 219 patients who had isolated CABG. The definition of SWI was documentation from a microbiological study and a requirement for simple closure or other surgical revision. Result: The overall incidence of SWI was 7.8% (n=17). The causative organisms were methicillin resistant Staphylococcus aureus (MRSA, n=13), methicillin resistant Staphylococcus epidermidis (n=2), Pseudomonas aeruginosa (n=1), and Candida albicans (n=1). Ten cases had deep sternal wound infection with mediastinitis; 7 cases had a superficial wound infection. Infection-related mortality was low (1/17; 6%). Diabetes mellitus (p=0.006) and smoking history (p=0.020) were factors that predicted high risk. Short term use of vancomycin decreased the incidence of MRSA-associated SWI (p=0.009). For treatment, curettage and rewiring or flap were needed in most cases (88%, n=14). Conclusion: Patients who had diabetes mellitus and a smoking history need careful management. Short term use of vancomycin is effective for prevention of SWI with MRSA.

Comparison of Innovation Efficiency of Pre-IPO and Post-IPO in Korea: Case of Pharmaceutical Industry (IPO 전후 혁신의 효율성 비교 연구: 의약산업 중심으로)

  • Kim, Eunhee
    • Journal of Technology Innovation
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    • v.24 no.1
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    • pp.143-167
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    • 2016
  • The purpose of this study is to analyze changes of innovation activities and their performance in pre-IPO and post-IPO of KOSDAQ IPO listed companies in medical and pharmaceutical fields, which require high R&D investment, from 2000 to 2005 in Korea. The innovation efficiencies of the IPO companies were measured before and after three years based on the DEA model. The financial data and patent information of the listed company during total 6 years, which were 3 years before IPO and 3 years after IPO, were collected. The main results of this research are as follows. First, it took an average 12.86 years until IPO in the start-up of the IPO companies in the pharmaceutical sector, and innovation was on average more active than the IPO before. R&D investment was higher than the IPO before, and the number of the applied patent during 3 years after IPO was 16.67 which was increased from 8.43 during 3 years before IPO. In addition, the average scope of technology of the IPO companies was expanded from 11 to 22 technology fields during previous 3 year and after 3 year each, and financial growth after IPO was lower than the previous IPO. Second, the financial performance of R&D investment and the performance of patent activity were weakened in the efficiency after the IPO, and the integrated performance from the patenting activities and the R&D investment was decreased after the IPO. Finally, the efficiency of the financial performance of the patenting activity was lower than the efficiency of the financial performance of the patent and R&D investment and patent activities under the R&D investment. In particular, the inefficiency of the firms' patenting activities performance after the IPO was caused by the decreasing return to scale, according to the results of this study. This results implicate that the expansion of R&D investments through the IPO had not lead to the financial performance of the market, and that the overall inefficiency since the IPO is due to the inefficiencies at the stage for the outcome of innovation activity rather than the output obtained through the R&D investments that appear to lead the performance of the market.

Radiation Results and Survival Rate of Small Cell Lung Cancer (소세포폐암의 방사선치료 성적 및 생존율)

  • Oh, Won-Yong;Song, Mi-Hee;Whang, In-Soon
    • Radiation Oncology Journal
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    • v.14 no.2
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    • pp.105-113
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    • 1996
  • Purpose : To improve treatment modality and results by analysis of clinical characteristics, local control, survival and recurrence rate in limited stage small cell lung cancer. Materials and Methods : patients with limited stage small cell lung cancer were treated with combined radiation and chemotherapy from Feb. 1986 to Dec. 1992 at the National Medical Center We followed up on 21 patients ($81\%$), who were mostly irradiated with 4,000-5.000cGy ($75\%$ of all Patients) in the results by the analysis retrospectively. Survival rate was evaluated by the Kaplan-Meier method Results : Mean survival of irradiated patients with limited small cell lung cancer was 12 months. 1-rear and 2-rear survival rate were $65.3\%$ and $15.4\%$ Tumor response rate and median survival after combined chemotherapy and irradiation were the following: $50\%$ and 15 months of complete response, and $23\%$ and 11 months of partial response respectively. Response rates by radiation dose were $66\%$ for below 4,000cGy $69\%$ for between 4,000-5,000cGy and $86\%$ for above 5,000cGy. 21 of all patients showed treatment failure($81\%$) which as appeared 9 of local failure.9 of distant failure and 3 of local and distant failure. Conclusion : Local response rate after induction chemotherapy alone in limited stage of small cell lung cancer was $54\%$. Furthermore it was increased to $73\%$ after adding of radiation. We have to increase radiation dose above 5,000cGy and need to try new effective chemotherapy agents for the improvement of local control and survival rate and also will try concurrent chemoradiotherapy in near time.

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The Results of Radiation Therapv for Adenocarcinoma of the Uterine Cervix (자궁경부 선암 환자에 대한 생존율과 실패양상 분석)

  • Lee, Ho-Jun;Kim, Jin-Hee;Kim, Ok-Bae
    • Radiation Oncology Journal
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    • v.17 no.1
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    • pp.16-22
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    • 1999
  • Purpose : This study was done to analyze prognostic factors and patterns of failure of patients with histologically confirmed adenocarcinoma of the uterine cervix. Materials and Methods : From June 1988 to December 1990, a retrospective analysis was undertaken for 45 patients who were treated with curative radiation therapy for adenocarcinoma of the uterine cervix at the department of Therapeutic Radiology of Keimyung University Hospital. According to FIGO staging classification, f2 patients were stage Ib, 9 patients were lla, 19 patients were IIB, and 5 patients were lIIb. Median age of the patients was 54 years. The radiation therapy consisted of a combination of external and intracavitary irradiation. Only the pelvis was treated for external irradiation, but 6 patients were treated with extended field irradiation including paraaortic nodes. Intracavitary irradiation was performed with high dose rate sources (Co-60). Neoadiuvant chemotherapy was undertaken for 10 patients. Median and maximum follow-up duration was 64 and 116 months, respectively. Results : The overall 5-year survival rate was 55.2$\%$, and the 5-year survival rates for stage Ib, IIa, IIb, and IIIb were 100$\%$, 50.8$\%$, 46.8$\%$, and 40$\%$ (3-year survival rate), respectively. Of the many clinicopathologic variables evaluated for prognosis, only the stage and the tumor size were significant prognostic factors. Statistically, pelvic failure rates for stage Ib, IIa, IIb, and IIIb were 0$\%$, 33.3$\%$, 57.9$\%$, and 60$\%$, respectively. Distant metastasis rates were 0$\%$, 33.3$\%$, 21.1$\%$, and 40$\%$ for stage Ib, IIa, IIb, and IIIb, respectively. Especially the 6 patients who were irradiated with extended field to treat the paraaortic nodes were free of distant metastasis all. But, 9 patients (23.1$\%$) of the 39 patients who were not irradiated the paraaortic nodes were suffered and expired from uncontrolled distant metastasis. Conclusions : As compared with other studies, the survival rates were similar, but distant metastasis rates including paraaortic nodes metastasis were likely somewhat higher than expected, especially for patients with stage II. So, we think that the effect of prophylactic paraaortic nodes irradiation should be studied prospectively, especially for patients with pelvic nodes involvement or advanced stage of disease.

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Radiosurgery with Linac Based Photon Knife in Cerebral Arteriovenous Malformation (선형가속기를 이용한 Photon Knife 방사선수술에 의한 뇌동정맥기형의 치료)

  • Kim, Jin-Hee;Choi, Tae-Jin
    • Radiation Oncology Journal
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    • v.21 no.1
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    • pp.1-9
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    • 2003
  • Purpose : The purpose of this study was to analyze the effect of a Linear accelerator based Photon Knife Radiosurgery System developed by the staff of Keimyung University Dongsan Medical Center for the treatment of cerebral arterlovenous malformation Material and Methods : Between December 1993 and October 2000, 30 patients with cerebral arteriovenous malformation (AVM) were treated with the Linac based Photon knife Radlosurgery System In the Department of Therapeutlc Radiology at Keimyung University Dongsan Medical Center. The median age was 34, ranging from 7 to 63 years, with a 2 : 1 male to female ratio. The locations of the AVM nidi were the frontal lobe (motor cortex), parletal lobe, and the thalamus, In that order. The diameters of the AVM nidi ranged 1.2 to 5.5 cm with a mean on 2.9 cm, and target volumes of between 0.5 and 20.5 cc, with a mean of 5.8 cc. The majority of patients received radiation doses of between 1,500 and 2,500 cGy, w14h a mean of 2,000 cGy, at 80% the isodose line. Twenty-five patients were treated with one isocenter, 4 with two, and 1 with four. The follow-up radiological evaluations were peformed with cranial computed tomogram (CT) or MRI between 6 month and one year interval, and if the AVM nidus had completely disappeared in the CT or MRI, we confirmed thls was a complete obliteration, with a cerebral or magnetic resonance angiogram (MRA). The median iollow-up period was 39 months with a range of 10 to 103 months. Results : Twenty patients were radloiogicaiiy followed up ior over 20 months, with complete obliteration observed in 14 (70%). According to the maximal diameter, all four of the small AVM (<2 cm) completely obliterated, 8 of the 10 patients with a medium AVW (2~3 cm) showed a complete obliteration, and two showed partial obliteration. Among the patients with a large AVM (>3 cm), only one showed complete obliteration, and S showed partial obliteration, but 3 oT these underwent further radiosurgery 3 years later. One who followed up for 20 months fellowing further radiosurgery eventually showed complete obliteration. Ten patients with seizure symptoms had no recurrent seizure due to radiosurgery and medication. One of the eleven patients who suffered intracranlal bleeding developed further bleeding at 9 and 51 months fellowing the radiosurgery although complete obliteration was eventually observed and the patient was managed in hospital then recovered. No patient suffered severe complications fellowing the radiosurgery. Conclusion : The radiosurgery with Linac-based Photon knife radiosurgery system, developed by the staff at our hospital, is a safe and effective treatment for AVM patients having diameters or volumes of less than 3 cm or 10 cm$^{3}$, respectively, located In Inoperable areas or who refused neurosurgery. We suggest that staged AVM radiosurgery may initially be considered, if the AVM target volume is above 10 cm$^{3}$

Mortality Change of North Korean People and its Association with State Production and Welfare System (경제 위기 전후 북한 주민의 사망률 동태의 특성과 변화)

  • Park, Keong-Suk
    • Korea journal of population studies
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    • v.35 no.1
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    • pp.101-130
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    • 2012
  • This study examines mortality change in North Korea and its association with state production and welfare systems. Two main subjects are analyzed. The first theme is to examine the reliability of mortality related data released by North Korea government authorities. Examining inner consistencies among mortality related statistics and comparing with mortality trends in other socialist societies, the study finds that mortality rate was under estimated. Under-estimation of mortality by North Korean authorities is regarded to result not only from political purpose which aims to propagate the regime's superiority but also from enumeration errors of vital statistics based on the residence registration. The second theme is to estimate the change in mortality of North Korean people since the establishment of DPRK, correcting errors of mortality data. Mortality of North Korean people is estimated to have improved largely by the early 1970s, to have been sluggish hereafter, and finally to have increased during the economic hardship period between 1993 and 2008. While large people died during the food crisis in the late 1990s, however the population loss caused by mortality increase was not so great as the proposition of the huge starvation was expected. It is partly because population turbulence occurred not just by mortality increase, rather it has progressed in the joint effects of fertility decline and exodus of North Korean people for food. It is also due to North Korean people's voluntary activities of informal economy. It is also worth noting the high mortality rate of North Korean men. The high mortality of North Korean men is likely due to men's mobilization for long time in army and labor with high risk of accident and their life styles.

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지역사회 건강관리담당자의 만성질환 관리실태:전라남도를 중심으로

  • Kim, Hye-Sook;Park, Jong;Jeong, Eun
    • Journal of agricultural medicine and community health
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    • v.34 no.3
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    • pp.334-345
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    • 2009
  • Objectives: This study was performed to investigate the management status of chronic disease at community health centers. Methods: The study subjects were 450 employed persons at community health centers in Jeonlanamdo. General characteristics, status of chronic disease management and health education were collected for statistical analysis. The differences on management status among working areas were assessed with chi-square test and ANOVA. Results: The mean values of work duration were 18.7 years in rural, 14.4 years in fishing village, and 17.4 years in urban-rural, respectively. The number of management registration was highest in hypertension. The ways of disease management were medication check-up, diet stopping smoking. The contents of group health education were exercise, diet and prohibition of smoking. The place of health education was town assembling hall. The fields which officials wanted to be educated were symptom, diagnosis, treatment and complication. The most important field was early detection of chronic disease patients and health education. Finally, the field requiring support was work standardization. Conclusions: Community health workers have worked positively in chronic disease management. The barriers to work were the lack of professional and preliminary data. The support system with other health organ and health education were needed for the improvement of working ability.

Association between Dental Fear and Anxious Thoughts and Tendencies and Dental Experience of Dental Patients (치과내원 환자의 불안취약사고 경향 및 치과경험과 치과공포의 관련성)

  • Hwang, Hye-Rim;Choi, Ha-Na;Cho, Young-Sik
    • Journal of dental hygiene science
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    • v.11 no.1
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    • pp.15-21
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    • 2011
  • Introduction The aim of this study, personal trait and their dental care based on experience level of dental fear is to analyze the differences. Catastrophizing is an irrational belief that something is far worse than it actually is. Because it makes it possible to analyze patients' anxious thoughts and tendencies. Methods The Dental Fear Survey(DFS) and Anxious Thoughts and Tendencies(AT&T) were used as measuring tools, and the independent sample t-test and ANOVA were performed on the basis of the mean value of the summated scale scores and the standard deviation. On the factors to dental anxiety, the multiple regression analysis was performed. Results Demographically, the total DFS score was higher in women($25.73{\pm}8.27$) than in men. Also, AT&T was higher in women($31.01{\pm}7.05$) (p<0.05). Dental fear was intense in the group of patients who visited dental clinics only problems($25.29{\pm}8.57$) than in those regular visited($22.29{\pm}7.78$). In relation to dental experiences, the DFS score was significantly higher in children. In many cases, patients experienced therapeutic pains in children($26.40{\pm}9.54$) (p=0.004). Also in many patients, dental anxiety began to occur in adolescence(44.3%). The multiple regression analysis result, it was found that dental treatment pain and their AT&T wielded great influence upon dental fear.

A Cross-Sectional Study on Job Training Course of the Dental Hygienists at the Public Health (sub)Centers (보건(지)소 치과위생사의 구강보건직무교육실태에 관한 단면적 조사연구)

  • Kim, Seung-Hee;Kim, Soon-Bog
    • Journal of dental hygiene science
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    • v.9 no.1
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    • pp.83-89
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    • 2009
  • About 380 dental hygienists who were working in public health centers in 2004 joined this study with questionnaires about the evaluation of job training programs regarding oral health care. The findings are as follows. 1. As for the general characteristics of subjects including location, age and career, the dental hygienists in Public Health Subcenters outnumbered the dental hygienists in Public Health Centers, as the former accounted for 61.1 and the latter 35.3 percent. And the dental hygienists in their 36~40s made up the largest age group. The group in their 11~15 years career revealed 48.4, over 16 years career 35.7, under 10 years career group 15.9 percent, respectively. 2. The portion of certification in the respondents was 28.9 percent, as compared to the 71.1percent of non-certification. The major reasons of non-certification were not-applying(44.6%), participation rejected (29.3%). 3. Freqently requested curriculums were school based oral health program(4.42, the highest by Linkert 5 point scale), followed by oral health education(4.41), public oral health services for the toddler and for the elderly(4.04), for the disabled(3.92), oral health planning evaluation(3.85) and oral health survey& investigation(3.69). The gap between Dental hygienists at Public Health Center and Public Health Subcenter was statistically significant different(p < 0.001) in oral health survey& investigation and oral health planning evaluation.

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Effect of Mediating Variable on the Relationship between Job Stress and Stress Response among Clinical Dental Hygienists (임상치과위생사에서 직무스트레스와 스트레스 반응에 있어 매개요인의 영향)

  • Choi, Ja-Hyeong;Choi, Jun-Seon
    • Journal of dental hygiene science
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    • v.14 no.2
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    • pp.114-122
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    • 2014
  • The purpose of this study was to analyze the effect of mediating variables on the relationship between job stress and stress response. A survey was conducted to 243 clinical dental hygienists from January 15, 2013 to March 20, 2013 and the data were analyzed using t-test, one-way ANOVA, Pearson's correlation analysis, and hierarchical multiple regression analysis. The subjects who worked in poor working environment, had high level of role conflict and overload and aggressive nature showed high stress responsivity (p<0.01). The variable that showed mediation effect on the relationship between job stress and physical discomfort, depression was shown to be personality type (p<0.05). Also, the variable that showed mediation effect on the relationship between job stress and turnover intention was social support (p<0.05). According to the results, personality type and social support were shown to be important parameters when it came to the relationship between job stress and stress response. Therefore, in order to reduce negative outcomes caused by stress, it is suggested to provide an educational opportunity on self-control management while increasing social support from the organizational and structural level. Especially, it is asked to expand the system that provides encouragement and recognition to feel the sense of achievement in the course of their duty execution.