• 대한물리의학회지
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• 제14권1호
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• pp.75-89
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• 2019

PURPOSE: This study measured the impact of a 12-week fall-prevention exercise program on balance, ambulatory ability, lower limb strength, and psychosocial characteristics in older adults diagnosed with dementia. METHODS: The participants comprised 31 older adults (9 men, 22 women) diagnosed with Alzheimer's or vascular dementia at a long-term care hospital located in Gunsan City. A fall-prevention exercise program was provided to the experimental group, while the control group was only provided with instruction and materials related to the fall-prevention exercise program. The participants were evaluated before the intervention, 6 weeks after the intervention, and 12 weeks after the intervention on static and dynamic balance abilities (using Timed Up and Go test: TUG, Tinetti-balance scale, one-leg standing test: OLS), gait (Tinetti-balance scale, 6-minute walk test: 6MWT), lower limb strength (sit to stand test; STS), and psychosocial characteristics (Short Form 36 Health Survey-Korean version, Korean Mini-Mental State Exam). RESULTS: An independent samples t-test and repeated measures analysis of variance were used for the statistical analysis. There were statistically significant improvements after the intervention (p<.05) in dynamic balance abilities (TUG and OLS using the left foot), gait (6MWT), and lower limb strength (STS) for the experimental group, but not for the control group. No difference was seen in psychosocial characteristics. CONCLUSION: Older adults with dementia who participated in the fall-prevention exercise program showed significant improvements in their static and dynamic balance abilities, lower limb strength, and ambulatory ability after the intervention.

• 대한디지털의료영상학회논문지
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• 제5권1호
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• pp.32-44
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• 2002

The role of radiology department has been greatly increased in the past few years as the technology in the medical imaging devices improved and the introduction of PACS (Picture Archiving and Communications System) to the conventional film-based diagnostic structure is a truly remarkable factor to the medical history. In addition, the value of using digital information in medical imaging is highly expected to grow as the technology over the computer and the network improves. However, the current medical practice, using PACS is somewhat limited compared to the film-based conventional one due to a poor image quality. The image quality is the most important and inevitable factor in the PACS environment and it is one of the most necessary steps to more wide practice of digital imaging. The existing image quality control tools are limited in controlling images produced from the medical modalities, because they cannot display the real image changing status. Thus, the image quality is distorted and the ability to diagnosis becomes hindered compared to the one of the film-based practice. In addition, the workflow of the radiologist greatly increases; as every doctor has to perform his or her own image quality control every time they view images produced from the medical modalities. To resolve these kinds of problems and enhance current medical practice under the PACS environment, we have developed a program to display a better image quality by using the ROI optical density of the existing gray level values. When the LUT is used properly, small detailed regions, which cannot be seen by using the existing image quality controls are easily displayed and thus, greatly improves digital medical practice. The purpose of this study is to provide an easier medical practice to physicians, by applying the technology of converting the H-D curves of the analog film screen to the digital imaging technology and to preset image quality control values to each exposed body part, modality and group of physicians for a better and easier medical practice. We have asked to 5 well known professional physicians to compare image quality of the same set of exam by using the two different methods: existing image quality control and the LUT technology. As the result, the LUT technology was enormously favored over the existing image quality control method. All the physicians have pointed out the far more superiority of the LUT over the existing image quality control method and highly praised its ability to display small detailed regions, which cannot be displayed by existing image quality control tools. Two physicians expressed the necessity of presetting the LUT values for each exposed body part. Overall, the LUT technology yielded a great interest among the physicians and highly praised for its ability to overcome currently embedded problems of PACS. We strongly believe that the LUT technology can enhance the current medical practice and open a new beginning in the future medical imaging.

• 보험의학회지
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• 제24권
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• pp.97-117
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• 2005

Internally Korean insurance market is that whole life products' growth are becoming slowdown that's why new insurance products have appeared on the market in consideration of consumer's needs recently. Externally domestic insurance market competitions has drifted from insurance industry to whole financial industry since bankasurance started. Life insurance companies should open up a new market to survive from severe competitions. Worksite marketing can be an alternative. An insurer make arrangements with an employer about an insurance terms which an insurer offers in Worksite marketing. Then eligible individuals enroll in the plans at their own discretion and pay 100 percent of the premium for coverage through payroll deductions. An employer doesn't need to pay extra money for additional benefit but can raise employee's loyalty and satisfaction of company through worksite marketing. An employee can be covered at discounted premium rate and less strict underwriting guidelines to an insurer compared to individual insurance. In developed countries specially U.S insurance market, Worksite marketing is getting very popular and growing rapidly due to the advantages. Worksite marketing has both individual insurance characters and group insurance characters. Individual insurance characters are that employees enroll in the plans at their own discretion and pay 100 percent of the premium for coverage. Group insurance characters are that actively at work and participation etc. An insurer have to reflect these two characters on Worksite marketing when an insurance company work out a plan for developing products and underwriting guidelines. When an insurer devise worksite products, one should consider participation level which means percentage of eligible employees participating. Participation is related to anti-selection. As we know underwriting is essential for every kind of insurance, especially underwriting plays major role in worksite marketing. We can see that in the below. Firstly, it has a function in calculation of premium rate. When calculate premium rate for worksite products underwriters have to estimate expected participation level and risk factors. So underwriters and acturies keep in close contact with each other. Secondly, underwriting methods are important. When an insurer underwrite worksite products, there are three kinds of underwriting methods. These are Simplified issue underwriting, Full underwriting and Guaranteed issue underwriting. Simplified issue underwriting typically requires no medical examination, but usually requires supplying satisfactory answers to one or several health and/or lifestyle questions. Full underwriting requires a complete medical history questionnaire that may further require an exam. Guaranteed issue underwriting means that coverage is issued without the employee having to provide evidence of insurability. When insurer set the GI limit are usually based on the type of industry, number of eligible employees, the average amount of coverage and participation level. In addition to insurer should have a clear definition of eligible employee on the insurance provision and application form. It will minimize possibility of trouble claims and anti-selection. An insurer also establish preexisting condition exclusion and special guidelines for late entrants. When an insurer introduce Worksite marketing to Korean insurance market, an insurer has to examine market research to analyze potential market and strategy of sales most of all. Also an insurer should review real situation of the U.S, England and Japanese market etc. There are a lot of new technologies about worksite marketing process that an insurer should learn. When an insurer consider many things which we explained it can be a real alternative.

• 한국전문물리치료학회지
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• 제30권4호
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• pp.306-313
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• 2023

Background: As social problems due to the acceleration of the aging era and the increase in the elderly population are becoming serious, virtual reality (VR)-based healthcare is emerging as an approach for preventing and managing health issues. Objects: This study used validity and reliability analyses to examine the clinical efficacy that is, the clinical value and usability of a novel VR cognitive evaluation system index that we developed. Methods: We developed a VR cognitive evaluation system based on motion recognition analysis evaluation for individuals aged 65 to 85. After conducting the Korean version of the Mini-Mental State Exam (K-MMSE) cognitive evaluation, the evaluation score was verified through correlation analysis in the VR cognitive evaluation system. To verify the construct validity of the two groups, the Global Deterioration Scale (GDS) grades were categorized into a normal cognitive group (GDS grade 1) and a cognitive impairment group (GDS grades 2 and 3). The data were measured twice to determine the reliability between the two measurements and assess the stability and clinical value of the evaluation system. Results: Our evaluation system had a high correlation of 0.85 with the widely used K-MMSE cognitive evaluation. The system had strong criterion-related validity at the 95% confidence interval. Compared to the average score of GDS grade 1 in the VR cognitive evaluation system, the average score of GDS grades 2 and 3 in the VR cognitive evaluation system was statistically significantly lower while also having strong construct validity at the 95% confidence interval. To measure the reliability of the VR cognitive evaluation system, tests-retests were conducted using the intraclass correlation coefficient (3,1), which equaled 0.923 and was statistically significant. Conclusion: The VR cognitive evaluation system we developed is a valid and reliable clinical tool to distinguish between normal cognitive status and mild cognitive impairment.

• 한국임상약학회지
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• 제32권4호
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• pp.328-335
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• 2022

Background: Case-based learning (CBL) is becoming an important approach for improving interprofessional collaboration education. Previous studies have examined learners' satisfaction with interprofessional education (IPE) in medical institutions. However, there are few studies on the implementation of university-led CBL interventions and their direct effects on learning outcomes. The aim of this study was to evaluate the effectiveness of CBL interventions on changes in the participants' perception and knowledge acquisition ability. Methods: The CBL approach consisted of team-based case-based learning, self-directed learning, and post-feedback. It was conducted as a single course for pharmacy students in their 5th year in a university setting. Changes in the participants' perceptions and self-assessments of competence levels were evaluated using survey responses. The effect of the CBL intervention on knowledge acquisition ability was directly evaluated using the exam score. Results: The majority agreed or strongly agreed that team-based case-based learning, and self-directed learning helped them to improve their knowledge and skills to a higher level and to increase the self-assessment of competency level. The average score of knowledge acquisition ability (average score of 75.0, p=0.0098) was significantly higher in the CBL intervention group than the lecture-based learning intervention group (average score of 52.0). Conclusion: The participants positively perceived that CBL intervention helped them to effectively improve their knowledge and the self-assessment of competency level. It also enhanced knowledge acquisition ability. These data, based on the survey responses, suggest that it is necessary to implement CBL interventions in a university-led single professional education.

• 한국전문물리치료학회지
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• 제14권1호
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• pp.74-81
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• 2007

The purpose of this study was to investigate effect of hospital-based physical and occupational therapy on Modified Barthel Index (MBI) score in stroke inpatients at least 3 months after stroke, to predict MBI score at discharge from subscales of MBI, and determine the characteristics of stroke at admission. Forty-five stroke inpatients participated and received physical and occupational therapy for two months. All participants were assessed on MBI at admission and discharge. The collected data was analyzed by dependency level (MBI${\leq}$74 and MBI${\geq}$75) at admission. The results revealed that the MBI score at discharge was significantly improved compared to the MBI score at admission in the group with more than moderate dependency level (MBI${\leq}$74). In particular, personal hygiene, dressing, ambulation, and chair/bed transfer were improved. But only ambulation was improved significantly in the group with a less than mild dependency level (MBI${\geq}$75). The chair/bed transfer, dressing, ambulation, and Mini-Mental State Exam-Korea score at admission were important factors in the MBI score at discharge. Eighty-six percent of the variation in MBI score function at discharge can be explained. Therefore, it is suggested that hospital-based physical and occupational therapy in subacute stroke improve independent living status, especially for patients with a more than moderate dependency level.

• Journal of Preventive Medicine and Public Health
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• 제15권1호
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• pp.57-73
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• 1982

Questionaires on symptoms of respiratory disease have been used in Korea to elicit the probable health effects of air pollution in epidemiologic studies: The objectives of such studies often include comparing prevalence of symptoms of respiratory system between different population groups or between the same population groups, at different times. Unfortunately, little attention has, been paid to standardization of those questionaires, whether those are Korean. versions or not. Furthermore, no attempt to develop Korean ,questionaire on respiratory symptoms and relevant information has been made. Followed by 'a comparative study on responses to Korean version questionaires(English origin) of CMI, MRC, and ATS-DLD-78' two types of questionaires on respiratory symptoms and relevant information for Korean adult, which are short form (SUN-81-AS) and long forms (optional questions are added to the short one, SUN-81-AL), have been designed suitable to Korean background by authors (see Annex). The self-administered and closed-question questionaire were tested their validity and reliability by administration to l80 normal adults (medical and nursing students) and 60 clinical patients of Seoul National University Hospital, with spirometric exam. The results obtained and conclusions drawn are as follow: 1. It took less than 10 minutes to complete the questionaire SNU-81-AS and SNU-81-AL. 2. The test-retest reliability of each questions in AS and AL ,were observed as 92.7% and 92.1%, respectively. And all of the level of agreement are statistically significant with kappa statistic. 3. In addition to higher prevalence rate of symptoms in patients group compared, with, normal. group, the correlations between FEV 1.0/FVC predictive value(%) and number of symptoms were statistically significant inpatients group (See Fig. 1 and, Table 7). 4. The answer rate to optional questions in AL form among those who are not to do was about 10%, while the no-answer rate among who are to do was about 15% in Normal (medical and nursing students) group. 5. From the viewpoints of validity and reliability, the new Korean questionaire (SNU-81-AS and AL) developed by authors are to be recommendable to use in epidemiologic studies on respiratory illness in Korea. The self-administration, however, of optional questions in AL form may not assure the quality of data gathered.

• Journal of Preventive Medicine and Public Health
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• 제36권2호
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• pp.101-107
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• 2003

Objectives : Dementia has emerged as a leading public health problem in elderly persons, and its early detection is important for the treatment of curable cases, and in the educational support for other family members. Although dementia screening tests are available, they have not gained widespread use in community or primary care settings. Our goal was to validate the Tine and Change (T&C) Test, -including its validity and reliability in patients, and to assess it as a simple, standardized method for the screening of dementia in the rural elderly. Methods : The participants in this study comprised of 59 patients from an urban hospital and 405 persons from a rural community aged 65 years or older. The time test evaluated the understanding of clock hands indicating 11:10, and the change test the ability to make 1,000 Won from a group of coins, consisting of one 500, seven 100, and seven 50 Won coins. The T&C ratings were validated against a reference standard based on the physician's diagnosis of the patients. The convergent validity in relation to other cognitive measure, test-retest agreement, and inter-observer reliability were assessed. To assess the relationship between the Korean Mini-Mental State Exam (K-MMSE) and the T&C Test, the mean K-MMSE scores were compared with the results of the T&C Test in the elderly from a rural community. Results The T&C Test had a sensitivity and specificity of 73.0, and 90.9%, and positive and negative predictive values of 93.1, and 66.7%, respectively. The test-retest and inter-observer agreement rates were both 95%. The K-MMSE scores and T&C Test were significantly related in the elderly from a rural community (p<0.01), The T&C Test was not influenced by the educational status. The Time and Change Tests took a mean of 6.3 and 12.7 seconds, respectively, to complete Conclusion : The T&C Test is a simple, accurate and reliable, performance-based tool in the screening for dementia. Because it is quick, and easy-to-use, it is hoped the T&C Test will be used for the widespread cognitive screening of aging populations.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제43권1호
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• pp.16-22
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• 2017

Objectives: Bisphosphonate is the primary cause of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Bisphosphonates are eliminated from the human body by the kidneys. It is anticipated that bisphosphonate levels in the body will increase if the kidney is in a weak state or if there is systemic disease that affects kidney function. The aim of this study was to analyze the relevance of renal function in the severity of BRONJ. Materials and Methods: Ninety-three patients diagnosed with BRONJ in Pusan National University Dental Hospital from January 2012 to December 2014 were included in this study. All patients underwent a clinical exam, radiographs, and serologic lab test, including urine analysis. The patient's medical history was also taken, including the type of bisphosphonate drug, the duration of administration and drug holiday, route of administration, and other systemic diseases. In accordance with the guidelines of the 2009 position paper of American Association of Oral and Maxillofacial Surgeons, the BRONJ stage was divided into 4 groups, from stage 0 to 3, according to the severity of disease. IBM SPSS Statistics version 21.0 (IBM Co., USA) was used to perform regression analysis with a 0.05% significance level. Results: BRONJ stage and renal factor (estimated glomerular filtration rate) showed a moderate statistically significant correlation. In the group with higher BRONJ stage, the creatinine level was higher, but the increase was not statistically significant. Other factors showed no significant correlation with BRONJ stage. There was a high statistically significant correlation between BRONJ stage and 'responder group' and 'non-responder group,' but there was no significant difference with the 'worsened group.' In addition, the age of the patients was a relative factor with BRONJ stage. Conclusion: With older age and lower renal function, BRONJ is more severe, and there may be a decrease in patient response to treatment.

• 대한핵의학회지
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• 제26권2호
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• pp.280-289
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• 1992

The 20-minute $^{99m}Tc-pertechnetate$ uptake became readily available for routine use and it replaced $^{131}I$ for thyroid imaging. However measuring thyroid uptake during a 5-minute minimizes pertechnetate uptake by the salivary glands and presence of contaminated saliva from those glands in to the pharynx and esophagus. A study was carried out to determine the suitability of the utility of a S-minute and 20-minute interval from administration of $^{99m}Tc-pertechnetate$ to imaging and uptake measurement as a replacement for the 24 hour standard originally established with $^{131}I$, and to evaluate the relationship between 5-minute $^{99m}Tc-pertechnetate$ uptake and other thyroid functions. A 5-minute and 20-minute uptake of $^{99m}Tc-pertechnetate$ were measured in 70 patients with thyroid disease at Yeungnam University Hospital from March 1, 1991 to Feb. 29, 1992. The results were as follows. 1) The 5-minute $^{99m}Tc-pertechnetate$ uptake in Graves' disease, Hashimoto's thyroiditis, simple goiter, non toxic nodular goiter, subacute thyroiditis and euthyroid were 18.2%, 14.6%, 2.8%, 3.2%, 1.2% and 1.1%, respectively. There was a significant difference between the mean of the euthyroid group and the mean of the Graves' disease. So differenciation between them can be easily made. 2) The 5 minute $^{99m}Tc-pertechnetate$ thyroid uptake was well correlated with 24 hour $^{131}I$ thyroid uptake (r=0.75, p<0.001). These data provided an equation for estimating the 24 hour uptake of iodide given the 5 minute pertechnetate uptake: Estimated 24-hour $^{131}I$ thyroid Uptake= 7.188*ln (5 minute $^{99m}Tc-pertechnetate$ uptake)+16.94 3) The 20-minute $^{99m}Tc-pertechnetate$ thyroid uptake was well correlated with 24-hour $^{131}I$ uptake (r=0.72, p<0.001) and 5-minute $^{99m}Tc-pertechnetate$ thyroid uptake (r=0.96, p<0.001). 4) In the Graves' disease, The 5-minute $^{99m}Tc-pertechnetate$ thyroid uptake was well correlated with serum $T_3-resin$ uptake (r=0.46, p<0.01), serum total $T_3$ (r=0.55, p<0.05), serum total $T_4$ (r=0.46, p<0.05). These results suggest that 5-minute ${99m}Tc-pertechnetate$ thyroid uptake has been found at least as useful as 24-hour $^{131}I$ uptake for diagnostic confirmation at our hospital, the logistical advantages of completing the diagnosis. The exam in 5-minutes led us to abandon the 24-hour study in the majority of patients, but the 24-hour $^{131}I$ uptake is still obtained in patients with planned or potential radioiodine therapy.