• 대한치과보철학회지
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• 제57권1호
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• pp.31-36
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• 2019

고령인구의 수가 증가함에 따라 무치악 환자의 비율이 높아지고 있으며, 전통적인 방식의 의치의 수요 또한 증가할 것으로 분석된다. 전통적인 방식의 의치에서 만족 할 만한 의치를 제작하기 위해서는 상,하악 치조제의 관계 및 형태에 맞춰 치아를 배열하는 것이 중요하다. 본 증례는 79세 여자 환자로 환자의 심리 및 경제적인 이유로 급여 의치 제작을 희망하였다. 치조골이 심하게 위축된 상태로 치조제 간의 위치관계에 대한 정확한 평가를 위해 교합기에 부착한 주모형을 스캔하여 치과용 CAD 소프트웨어를 활용하였고, 프로그램 상에서 치조제 관계를 확인하여 치조정간선 법칙에 따라 구치부는 교차교합 형태로 배열하였다. 완성 후 정기적인 검사 및 치료 결과 의치는 적절한 안정과 유지를 보였으며 환자 역시 높은 만족감을 표현하였다. 본 증례에서는 완전 무치악 환자에서 치조제 간의 측방적 관계를 정확하게 분석하기 위해 디지털 기술을 활용하여 진단 및 치료의 효율성을 높일 수 있었기에 이를 보고하고자 한다.

• 한국기계가공학회지
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• 제18권2호
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• pp.1-6
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• 2019

With the increase in number of the athletic population and elderly demographic, the demand for orthopedic splints, which are used to support a damaged body, has rapidly increased. Current splints mainly consist of inner and outer parts, which are multiple fabrics covered with polyurethane and nonwoven fabrics, respectively. However, the laminated materials with directly applied pre-polymer coating lead to a high defect rate because of the uneven thickness on the surface. Thus, this study proposes an indirect coating method using a precise clearance controller, which enables the even application of the coating material on multiple inner parts while maintaining a constant thickness. In addition, a roll-to-roll (R2R) technique is applied instead of the sewing mechanism to bond the inner and outer materials together and enhance the productivity in the final stage. In the advanced methods, there is a storage tank that contains polyurethane, a clearance controller, and pairs of rollers in the upper and lower rows. To improve the quality of the products and optimize the equipment, three controllable factors are determined: the viscosity of polyurethane, angle of the gap controller and number of pairs of rollers in the R2R system.

• 대한임상검사과학회지
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• 제51권2호
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• pp.270-275
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• 2019

노령 인구의 기대 수명이 증가함에 따라 퇴행성 판막 질환이 많아지고 있다. 류마티스성 판막 질환인 승모판 협착증과 대동맥판 역류가 점차적으로 감소하고 석회화된 퇴행성 대동맥판 협착증, 승모판 탈출증 및 허혈성 심장 질환으로 인한 승모판막 폐쇄 부전의 빈도가 증가하고 있다. 심장초음파는 심장판막질환의 진단은 물론, 치료방법 및 수술 시기와 더불어 예후 평가에서도 매우 중요한 도구이며, 판막질환을 평가할 때 모든 판막을 자세하게 관찰하는 이면성 심장초음파가 우선해야 한다. 흔히 접하는 퇴행성 판막질환에 대한 이해와 함께 임상적 특성을 파악하여 심장초음파를 정확하게 시행하는 것이 가장 중요하다. 아울러 대동맥판 협착증의 중증도 평가가 수술적 적응증을 판단하는 데 꼭 필요한 검사인만큼 정확한 판단 기준에 따라 평가하여 환자의 정확한 진단 및 치료가 이루어지도록 해야 한다. 퇴행성 대동맥판 협착증 환자 3례를 통해 심장초음파 검사의 중증도 평가를 쉽게 이해할 수 있기를 바라며 퇴행성 판막 질환의 심초음파 소견을 숙지하는 것이 심장초음파검사를 정확하게 수행하는 것에 수반되어야할 것으로 사료된다.

• 교육녹색환경연구
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• 제18권1호
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• pp.17-26
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• 2019

무장애 설계는 사회적 약자 집단에 대한 관심을 반영한다. 중국은 인구가 가장 많으면서 노인 인구도 가장 많은 나라로서 무장애 설계에 많은 진전을 이루었다. 본 논문의 범위는 1980년대부터 2012년까지로 설정하였으며 현재까지 시행된 두 개의 무장애 설계 기준을 비교함으로써 중국 무장애 설계 표준의 발전 과정을 연구하는 것을 목적으로 한다. 본 논문에서는 두 개 규범의 번호, 장절, 적용범위, 적용대상, 목적 등의 내용을 비교하였다. 분석결과, 2001년 규범이 비해 2012년 규범에서 무장애 발전의 가속화, 규범 적용 범위의 확대, 규범 내용의 보강, 조항의 완화 등의 특징이 있다는 점을 도출할 수 있었다.

• 융합정보논문지
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• 제11권4호
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• pp.146-152
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• 2021

본 연구는 그림책을 활용한 시각화 기억훈련 프로그램의 프로토콜을 개발하고 임상에 적용하기 위하여 유용성을 확인하고자 한다. 경도치매 환자 5명을 대상으로 총 5회기의 시각화 기억훈련 프로그램을 진행하였다. 프로그램 진행 전후 단어 기억력, 전반적 기억력검사, 및 우울감검사를 시행하여 그 변화를 관찰하였다. 그 결과 프로그램 시행 후 전반적 기억력의 향상이 있었으나 통계적으로 유의하지 않았다. 반면 우울감에는 통계적으로 유의미한 긍정적인 효과가 있는 것으로 나타났다. 단어 기억력에 있어 일부 대상자는 인출 및 재인의 향상을 보였고 일부 대상자는 변화가 없거나 더 나빠진 것으로 나타났다. 본 프로그램은 일부 경도치매 환자의 기억력 향상에 도움이 되며 우울감이 감소하는 정서적 효과가 있는 것으로 판단된다. 향후 그룹 인지치료 모델로 널리 활용되길 바라며 더 많은 대상자 수의 연구가 필요할 것으로 사료된다.

• 한국임상약학회지
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• 제31권1호
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• pp.61-78
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• 2021

Background and Objective: The use of potentially inappropriate medications (PIMs) increases the risk of negative health outcomes, including drug-related admissions. Tools for structured medication review have been developed to ensure optimal medication use and safety. Here, we aimed to evaluate medication use review (MUR) tools for community-dwelling older patients. Methods: We performed a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA). We searched PubMed, Embase, and the Cochrane Library from 1991 to 2020, excluding tools that are specifically applied to hospitalized patients or nursing home residents. We identified the most common inappropriate medications, drug-disease interactions, drug-drug interactions and prescribing omissions presented among tools. Results: From among 9,788 identified reports screened, 60 met our inclusion criteria; finally, 27 were eligible for data analysis considering originality and up-to-dateness. Most tools presented explicit criteria (93%), and only one was specific to community-dwelling elderly. The most common PIM was tricyclic antidepressants. Use of diltiazem and verapamil in patients with heart failure and the combination of nonsteroidal anti-inflammatory analgesics and warfarin were the most frequent disease-specific PIM and drug-interaction, respectively. Conclusions: Although several medication review tools have been developed for older adults, specific guidelines for community-dwelling populations remain limited. Furthermore, the list of PIMs differed among available tools. In future, specific but integrating MUR tools need to be developed for clinical practice considering this population.

• 대한통합의학회지
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• 제8권4호
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• pp.79-92
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• 2020

Purpose : The purpose of this study was to evaluate the prescription pattern of NSAIDs and GPAs in the arthritis patients over 65 years old to prevent the GI adverse events. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used agents to treat arthritis, can cause gastrointestinal (GI) adverse effects. Recent guidelines recommend that moderate risk patients who have one or two risk factors, should be prescribed either combination of non-selective NSAID (nsNSAIDs) and gastroprotective agent (GPAs) or selective NSAID alone. Methods : Study population was National Patient Sample of 2011. Number of drugs used were 138 for NSAIDs and 21 for GPAs. Chi-square test was used to compare prescribing patterns. Results : The appropriate prescription rate follows the guideline was 11.2%: co-prescription with nsNSAID and proton pump inhibitor (PPI) or misoprostol was 1.6% and selective NSAID alone was 9.6%. Inappropriate prescription rates were as follows: co-prescription with nsNSAID and Histamine-2 receptor antagonist (H2RA) or antiacid was 53.8% and nsNSAID alone was 35.0%. The appropriate prescription rate among the types of medical institute was 54.4% in tertiary hospital, 31.2% in secondary hospital, and 6.0% in primary hospital. The appropriate prescription rate among the regions was 19.4%, highest in Seoul and 4.2%, lowest in Jeju. The appropriate prescription rate among the medical departments was as follow: 12.2% in orthopaedic surgery, 11.0% in internal medicine, and 7.7% in other departments. Conclusion : This finding suggests the needs to revise the national medical insurance imbursement policy, provide continuing medical education about the guideline of medical doctors.

• 보건행정학회지
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• 제30권4호
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• pp.522-530
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• 2020

Background: In 2008, Korea implemented a new type of social insurance known as "long-term care insurance". We examined the association between ownership of long-term care facilities and the incidence of pressure ulcers after the implementation of "long-term care insurance". This study is a population-based retrospective cohort study from 2006 to 2013. Methods: We used medical claims data from the Korean National Health Insurance Corporate Elderly Cohort Database from 2006 to 2013. These data comprise a nationally representative sample. To avoid confounders, only patients admitted to one long-term care facility and who stayed for >70% of the follow-up time were included; as a result, 3,107 individuals were enrolled. The main independent variable was the operating entity of the long-term care facility (local government, corporate bodies, and private for-profit owners), and the dependent variable was the 1-year incidence of pressure-ulcers. Survival analysis (Cox proportional hazard model) was used as an analysis method. Results: Compared to patients admitted to local government long-term care facilities, patients admitted to private long-term care facilities had a significantly higher 1-year risk of pressure ulcers (hazard ratio [HR], 1.94; 95% confidence interval [CI], 1.29-2.91); the risk was especially high among patients who were cognitively dependent (HR, 2.34; 95% CI, 1.25-4.37). Conclusion: Patients admitted to private for-profit long-term care facilities were more likely to have pressure ulcers compared to those in local government and corporate body long-term care facilities. Appropriate assessment tools and publicly available information, as well as more restricted legal requirements, are needed to improve the care quality and outcomes of patients in long-term care facilities.

• 대한예방한의학회지
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• 제25권2호
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• pp.1-11
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• 2021

Objective : The purpose of this study is to analyze Korean patients' characteristics, who were concurrently treated with both Korean herbal medicines and Western chemical medicines using nation-wide database. Method : Using the patients sample data (HIRA-NPS 2018) provided by Health Insurance Review and Assessment Service, a group of patients who co-administered Korean herbal and Western medicines was selected, and their basic characteristics, diagnosis, and prescribed chemical medicines were analyzed. Results : Out of the 1,481,921 sample population, 17,629 patients (1.2%) were selected as a concurrent medication group. Compared to the whole sample, the concurrent medication group was composed of more women (65.8% vs. 51.1%), the more elderly people (65 or older years old) (44.5% vs. 14.6%), and the higher prevalence of chronic diseases (49.1% vs. 22.2%). The most frequent diagnosis treated with Western medicines was mental and behavioral disorders, musculoskeletal and circulatory disorders. Frequently used drugs among concurrent medication group were anti-anxiety drugs, gastric ulcer treatment drugs, and senile diseases treatment drugs. Conclusion : The evidence reported in this study is expected to provide herb-drug interaction researchers with important reference to set the priorities of research topics in the future.

• BMB Reports
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• 제54권12호
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• pp.592-600
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• 2021

Parkinson's disease (PD) is one of the most common neurodegenerative diseases in the elderly population and is caused by the loss of dopaminergic neurons. PD has been predominantly attributed to mitochondrial dysfunction. The structural alteration of α-synuclein triggers toxic oligomer formation in the neurons, which greatly contributes to PD. In this article, we discuss the role of several familial PD-related proteins, such as α-synuclein, DJ-1, LRRK2, PINK1, and parkin in mitophagy, which entails a selective degradation of mitochondria via autophagy. Defective changes in mitochondrial dynamics and their biochemical and functional interaction induce the formation of toxic α-synuclein-containing protein aggregates in PD. In addition, these gene products play an essential role in ubiquitin proteasome system (UPS)-mediated proteolysis as well as mitophagy. Interestingly, a few deubiquitinating enzymes (DUBs) additionally modulate these two pathways negatively or positively. Based on these findings, we summarize the close relationship between several DUBs and the precise modulation of mitophagy. For example, the USP8, USP10, and USP15, among many DUBs are reported to specifically regulate the K48- or K63-linked de-ubiquitination reactions of several target proteins associated with the mitophagic process, in turn upregulating the mitophagy and protecting neuronal cells from α-synuclein-derived toxicity. In contrast, USP30 inhibits mitophagy by opposing parkin-mediated ubiquitination of target proteins. Furthermore, the association between these changes and PD pathogenesis will be discussed. Taken together, although the functional roles of several PD-related genes have yet to be fully understood, they are substantially associated with mitochondrial quality control as well as UPS. Therefore, a better understanding of their relationship provides valuable therapeutic clues for appropriate management strategies.