• Korean Journal of Psychosomatic Medicine
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• v.26 no.1
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• pp.68-75
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• 2018

Objectives : Since pain in cancer patients is an important factor that greatly affects the quality of life and prognosis, many attempts have been actively made to reduce the pain. Despite continuous effort on reducing pain after Endoscopic submucosal dissection (ESD), research has not been done on psychological factors as much as on biological factors affecting pain. The objective of this study is to investigate the psychological factors affecting postoperative pain in gastric tumor patients who underwent gastric ESD. Methods : 91 gastric tumor patients who visited National Health Service Ilsan Hospital in Korean between May 2015 and June 2016, and received ESD were evaluated. Baseline characteristics including sociodemographic factors, anxiety, depression, and resilience were evaluated before the procedure. Multivariate logistic regression was done to analyze factors affecting postoperative pain. Results : The group with high postoperative pain showed lower alcohol consumption and higher depressive symptom scores than the group with low postoperative pain. Also, the group with high postoperative pain showed lower total resilience score with lower subtotal scores in self-control and positive item. Multivariate logistic regression analysis of the postoperative pain showed that patients with lower score in self-control of resilience [odd ratio (OR), 0.911 ; 95% CI, 0.854-0.971, p=0.004) reported more pain after ESD. Conclusions : This study showed that patients with lower self-control ability of resilience felt more pain after ESD. Among the psychological factors evaluated in this study, resilience of an individual seems to have effect on pain.

• Radiation Oncology Journal
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• v.21 no.1
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• pp.100-106
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• 2003

Purpose : To develop a patients' setup verification tool (PSVT) to verify the alignment of the machine and the target isocenters, and the reproduclbility of patients' setup for three dimensional conformal radiotherapy (3DCRT) and intensity modulated radiotherapy (IMRT). The utilization of this system is evaluated through phantom and patient case studies. Materials and methods : We developed and clinically tested a new method for patients' setup verification, using digitally reconstructed radiography (DRR), simulation, porial and digital images. The PSVT system was networked to a Pentium PC for the transmission of the acquired images to the PC for analysis. To verify the alignment of the machine and target isocenters, orthogonal pairs of simulation images were used as verification images. Errors in the isocenter alignment were measured by comparing the verification images with DRR of CT Images. Orthogonal films were taken of all the patients once a week. These verification films were compared with the DRR were used for the treatment setup. By performing this procedure every treatment, using humanoid phantom and patient cases, the errors of localization can be analyzed, with adjustments made from the translation. The reproducibility of the patients' setup was verified using portal and digital images. Results : The PSVT system was developed to verify the alignment of the machine and the target isocenters, and the reproducibility of the patients' setup for 3DCRT and IMRT. The results show that the localization errors are 0.8$\pm$0.2 mm (AP) and 1.0$\pm$0.3 mm (Lateral) in the cases relating to the brain and 1.1$\pm$0.5 mm (AP) and 1.0$\pm$0.6 mm (Lateral) in the cases relating to the pelvis. The reproducibility of the patients' setup was verified by visualization, using real-time image acquisition, leading to the practical utilization of our software Conclusions : A PSVT system was developed for the verification of the alignment between machine and the target isocenters, and the reproduclbility of the patients' setup in 3DCRT and IMRT. With adjustment of the completed GUI-based algorithm, and a good quality DRR image, our software may be used for clinical applications.

• Korean Journal of Food Science and Technology
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• v.31 no.4
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• pp.1115-1119
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• 1999

Chitosan was used to treat lavers during the production of dried lavers. In the procedure of washing the harvested lavers, the lavers were treated with various solutions of 0.1 and 0.01% of 30 cp chitosan and of 0.005 and 0.04% of 90 cp chitosan. Then treated lavers were processed as usual for the production of dried lavers. Significant differences between chitosan-treated and non-treated lavers were observed in flavor, in total microbial counts, and in the number of coliform microorganisms. Off-flavor of dried lavers was reduced significantly by treating with chitosan. Total microbial count was $3.7{\times}10^{4}$ cells/g in the non-treated dried lavers, but they were $5.7{\times}10^{3}$ cells/g and $2.1{\times}10^{3}$ cells/g, respectively, in the dried lavers treated with 0.01% and 0.1% of 30 cp chitosan. The number of coliform microorganisms was 240 cells/g in non-treated dried lavers. However, coliform microorganisms were not detected in the dried lavers treated with 0.1% of 30 cp chitosan. When the dried lavers were used to make Kimbab (rice rolled with laver), the number of total microorganisms increased very slowly during storage time at $20^{\circ}C$ in the Kimbab rolled with chitosan-treated dried lavers compared to that in the Kimbab rolled with non-treated dried lavers.

• Journal of Gastric Cancer
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• v.9 no.4
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• pp.231-237
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• 2009

Purpose: The aim of this study was to evaluate the significance of palliative gastrojejunostomy for treating patients with unresectable stage IV gastric cancer, and as compared with laparotomy for treating patients with incurable gastric cancer. Materials and Methods: We retrospectively studied 167 patients who could not undergo resection without obstruction at Korea University Hospital from 1984 to 2007. They were classified into two groups, one that underwent palliative gastrojejnostomy (the bypass group, n=62) and one that underwent explo-laparotomy (the O&C group, n=105), and the clinical data and operative outcomes were compared according to the groups. Results: For the clinical characteristics, there were no differences of age, gender and liver metastasis between the bypass group and the explo-laparotomy group, but there was a significant different for the presence of peritoneal metastasis (P=0.001). There was no difference between two groups for the postoperative mortality and morbidity. For the postoperative outcomes, the duration of the hospital stay (29.25 vs 16.67) and the frequency of re-admission were not different, but the median overall survival (4.3 months vs. 3.4 months, respectively) was significantly different. By multivariate analysis, the presence of peritoneal metastasis was identified as the independent prognostic factor for incurable gastric cancer. Conclusion: A prophylactic bypass procedure is not effective for improving the quality of life and prolonging the life expectancy of unresectable stage IV gastric cancer patients without obstruction.

• Journal of Gastric Cancer
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• v.13 no.3
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• pp.164-171
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• 2013

Purpose: Laparoscopy-assisted distal gastrectomy for early gastric cancer has gained acceptance and popularity worldwide. However, laparoscopy-assisted distal gastrectomy for advanced gastric cancer is still controversial. Therefore, we propose this prospective randomized controlled multi-center trial in order to evaluate the safety and feasibility of laparoscopy assisted D2-gastrectomy for advanced stage gastric cancer. Materials and Methods: Patients undergoing distal gastrectomy for advanced gastric cancer staged cT2/3/4 cN0/1/2/3a cM0 by endoscopy and computed tomography are eligible for enrollment after giving their informed consent. Patients will be randomized either to laparoscopyassisted distal gastrectomy or open distal gastrectomy. Sample size calculation revealed that 102 patients are to be included per treatment arm. The primary endpoint is the non-compliance rate of D2 dissection; relevant secondary endpoints are three-year disease free survival, surgical and postoperative complications, hospital stay and unanimity rate of D2 dissection evaluated by reviewing the intraoperative video documentation. Discussion: Oncologic safety is the major concern regarding laparoscopy-assisted distal gastrectomy for advanced gastric cancer. Therefore, the non-compliance rate of clearing the N2 area was chosen as the most important parameter for the technical feasibility of the laparoscopic procedure. Furthermore, surgical quality will be carefully reviewed, that is, three independent experts will review the video records and score with a check list. For a long-term result, disease free survival is considered a secondary endpoint for this trial. This study will offer promising evidence of the feasibility and safety of Laparoscopy-assisted distal gastrectomy for advanced gastric cancer. Trial Registration: NCT01088204 (international), NCCCTS-09-448 (Korea).

• Journal of National Security and Military Science
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• s.9
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• pp.313-340
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• 2011

The National Defense Reformation bill of "National Defense Reformation 2020" which have been constantly disputed and reformed by the government went through various levels of complementary measures after the North Korean sinking on the Republic of Korea (ROK) Naval Vessel "Cheonan". The final outcome of this reform is also known as the 307 Plan and this was announced on the 8th March. The reformed National Defense Reformation is to reduce the number of units and military personnel under the military structure reformation. However, in order for us to undertake successful National Defense Reformation, the use of privatized civilian resources are essential. Therefore according to this theory, the ROK Ministry of National Defense (MND) have selected the usage of privatized resources as one of the main core agenda for the National Defense Reformation management procedures, and under this agenda the MND plans to further expand the usage of private Especially the MND plans to minimize the personnel resources applied in non-combat areas and in turn use these supplemented personnel with optimization. In order to do this, the MND have initiated necessary appropriate analysis over the whole national defense section by understanding various projects and acquisition requests required by each militaries and civilian research institutions. However for efficient management of privatized civilian resources, first of all, those possible efficient private resources which can achieve optimization will need to be identified, and secondly continuous systematic reinforcements will need to be made in private resource usage legislations. Furthermore, we would need to consider the possibility of labor disputes because of privatization expansion. Therefore, full legal and systematic complementary measures are required in all possible issue arising areas which can affect the combat readiness posture. There is another problem of huge increase in operational expenses as reduction of standby forces are only reducing the number of soldiers and filling these numbers with more cost expensive commissioned officers. However, to overcome this problem, we would need to reduce the number of positions available for active officers and fill these positions with military reserve personnel who previously had working experiences with the related positions (thereby guaranteeing active officers re-employment after completing active service). This would in tum maintain the standards of combat readiness posture and reduce necessary financial budgets which may newly arise. The area of maintenance, supply, transportation, training & education duties which are highly efficient when using privatized resources, will need to be transformed from military management based to civilian management based system. For maintenance, this can be processed by integrating National Maintenance Support System. In order for us to undertake this procedure, we would need to develop maintenance units which are possible to be privatized and this will in turn reduce the military personnel executing job duties, improve service quality and prevent duplicate investments etc. For supply area, we will need to establish Integrated Military Logistics Center in-connection with national and civilian logistics system. This will in turn reduce the logistics time frame as well as required personnel and equipments. In terms of transportation, we will need to further expand the renting and leasing system. This will need to be executed by integrating the National Defense Transportation Information System which will in turn reduce the required personnel and financial budgets. Finally for training and education, retired military personnel can be employed as training instructors and at the military academy, further expansion in the number of civilian professors can be employed in-connection with National Defense Reformation. In other words, more active privatized civilian resources will need to be managed and used for National Defense Reformation.

• Progress in Medical Physics
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• v.25 no.1
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• pp.31-36
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• 2014

We aimed to evaluate the dosimetric characteristics of reproducibility, linearity and dose dependence of optical stimulated luminance dosimeter (OSLD) in the Co-60 Gamma-rays and to analyze with a precedent study in field of the diagnostic radiography and radiotherapy. The reproducibility was 0.76% of the coefficient of variation, the homogeneity was within 1.5% of the coefficient of variation and OSLD had supra-linear response more than 3 Gy. So the correlation between dose and count was fitted by quadratic function. The count depletion by repeated reading was 0.04% per reading regardless of the irradiated dose. And the half time of decay curve according to the irradiated dose was 0.68 min. with 1 Gy, 1.04 min. with 5 Gy, and 1.10 min. with 10 Gy, respectively. In case of annealing for 30 min, the removal rate was 88% with 1 Gy, 90% with 5 Gy, and 92% with 10 Gy, respectively and 99% in case of annealing time for 4 hour. It is feasible to use OSLDs for dose evaluation in Co-60 Gamma-rays when considering the uncertainty on the procedure according to the irradiated dose.

• Journal of muscle and joint health
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• v.8 no.1
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• pp.122-140
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• 2001

The aims of this study were to understand and to predict the determinent factors affecting the exercise behaviors and physical fitness by testing the Pender's revised health promotion model, and to help the patients with rheumatoid arthritis and osteoarthritis perform the continous exercise program, and to help them maximize the physical effect such as muscle strength, endurance, and functional status and mental effects including self efficacy and quality of life, and improve the physical and mental well being, and to provide a basis for the nursing intervention strategies. Of the selected variables in this study, the endogenous variables included the physical fitness, exercise score, exercise participation, perceived benefits of action, perceived barriers of action to exercise, activity-related affect(depression) and perceived self-efficacy, interpersonal influences(family support), situational factors(duration of arthritis, fatigue) and the exogenous variables included personal sociocultural factor(education level), personal biologic factor(body mass index), personal psychologic factor(perceived health status) and prior related behavior factors(previous participation in exercise, life-style). We analyzed the clinical records of 208 patients with rheumatoid arthritis and degenerative arthritis who visited the outpatient clinics at H university hospital in Seoul. Data were composed of self reported qustionnaire and good of fitness score which were obtained by padalling the ergometer of bicycle for 9 minutes. SPSS Win 8.0 and Window LISREL 8.12a were used for statistical analysis. Of 75 hypothetical paths that influence on physical fitness, exercise participation, exercise score, perceived benefits of action, perceived barriers of action to exercise, activity-related affect(depression) and perceived self-efficacy, interpersonal influences(family support), situational factors(duration of arthritis, fatigue), 40 were supported. The physical fitness was directly influenced by life-style, perceived health status, education level, family support, fatigue, which explained 12% of physical fitness. The exercise participation were directly influenced by life-style, education level, past exercise behavior, perceived benefits of action, perceived barriers of action, depression and duration of arthritis, which explained 47% of exercise participation. Exercise score were directly affected by perceived self efficacy. BMI, life-style, past exercise behavior, perceived benefits of action, family support, perceived health status. perceived barriers of action, and fatigue, which explained 70%. Perceived benefits of action was directly influenced by BMI, life-style, which explained 39%. Perceived barriers of action were directly influeced by past exercise behavior, perceived health status, which explained 7%. Perceived self efficacy were directly influeced by level of education, perceived health status, life-style, which explained 57%. Depression were directly influeced by past exercise behavior, BMI, life-style, which explained 27%. Family support were directly influeced by life-style, perceived health status, which explained 29%. Fatigue were directly influeced by BMI, life-style, perceived health status. which explained 41%. Duration of arthritis were directly influeced by life-style, past exercise behavior, BMI, which explained 6%. In conclusion, important variables for physical fitness were life-style, and variable affecting exercise participation were life-style. Perceived self-efficacy of exercise was a significant predictor of exercise score. BMI, Life-style, perceived benefits of action, family support, past exercise behavior showed direct effects on perceived self-efficacy. Therefore, disease related factor should be minimized for physical performance and well being in nursing intervention for patients with rheumatoid arthritis, and plans to promote and continue exercise should be seeked to reduce disability. In addition, Exercise program should be planned and performed by the exact evaluation of exercise according to the ability of the patients and the contents to improve the importance of exercise and self efficacy in self control program, dedicated educational program should be involved. This study suggest that the methods to reduce the disease related factors, the importance of daily life-style, recognition of benefit of exercise, and educational program to promote self efficacy should be considered in the exercise behavior promotion and nursing intervention for continous performance. The significance of this study is also thought to provide patients with chronic arthritis the specific data for maximal physical and mental well being through exercise, chronic therapeutic procedure, daily adaptation and confrontation in nursing intervention.

• Progress in Medical Physics
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• v.15 no.3
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• pp.161-166
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• 2004

A simplistic quality assurance (QA) method was designed for a Linac built-in enhanced dynamic wedge (EDW), which can be utilized to make wedged beam distributions. For the purpose of implementing the EDW symmetry QA, a film dosimetry system, low speedy dosimetry film, film densitometer and 3D RTP system were used, and the films irradiated by means of a 60$^{\circ}$ Reversed wedge pair (REWP) method. The profiles were then analyzed in terms of their symmetries, including partial treatment, which is the case of stopping it abruptly during EDW irradiation, and the measured and calculated values compared using the Cad Plan Golden Segmented Treatment Table (Golden STT). The result of this experiment was in good agreement, within 1 %, of the 'reversed wedge pair counterbalance effect'. For the QA of the effective wedge factor (EWF), the authors measured EWFs in relation to the 10$^{\circ}$, 15$^{\circ}$, 20$^{\circ}$, 25$^{\circ}$, 30$^{\circ}$, 45$^{\circ}$ and 60$^{\circ}$ EDW, which were compared with the calculated values using the correction factor derived from the Golden STT and the log files produced automatically during the process of EDW irradiation. By means of this method it was capable of check up the safety of effective wedge factor without any other dosimetry system. The EDW QA was able to be completed within 1 hour from irradiation to analysis as a consequence of the simplified QA procedure, with maximized effectiveness. Unlike the metal wedge system, the EDW system was heavily dependent on the dose rates and jaw movements; therefore, its features could potentially cause inaccuracy. The frequent simplistic QA for the EDW is essential, and could secure against the flaw of dynamic treatment that uses the EDW.

• The Korean Journal of Nuclear Medicine Technology
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• v.17 no.1
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• pp.30-35
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• 2013

Purpose: One of the current services, providing information to the patients and their guardians by using promotion materials induces positive responses and contributes to the improvement of the hospital reliability. Therefore, the objective of this study is to evaluate the effectiveness of audio visual materials, one of the means of promotion, as a way to give accurate medical information to resolve patient's curiosity about purpose and procedure of their examination and deplete complains about waiting which attributes negative effect to service quality assessment. Materials and Methods: 60 patients(mean age $53.97{\pm}12.24$, male : female = 26 : 34) who had $^{18}F-FDG PET/CT$ scan from July 2012 to August 2012 in Seoul Asan Medical Center were referred to the study. All of the patients having PET/CT scan were asked to watch an informative video material before the injection of radiopharmaceutical ($^{18}F-FDG$) and to fill in a questionnaire. Results: As a result of analyzing the contents of questionnaire, 52% of 60 patients had PET/CT scan for the first time and 72.4% of the patients read the PET/CT guidebook offered from their outpatient department or inpatient wards before their scan. After we searched the level of previous knowledge of the purpose and method of PET/CT scan, the patients answered 25.1% "know well", 34% "not sure", 40.9% "don't know" respectively. And 84.7% of the patients answered that watching the PET/CT guide video before the injection helps understanding what exam they were having and 15.3% of the patients did not. For the question asking ever the patients have experienced using our homepage or smart phone QR code to see the guide video before they visit out PET center, only 3.3% of them answered "yes". Lastly, the patients answered 60.1% "yes", 31.4% "so so" and 8.5% "no" respectively for the question asking whether watching the video makes the patients to fill the waiting time short. Conclusion: It is found that understanding of objective and method of the PET/CT scan and level of satisfaction was improved after the patients watched the guide video whether they had PET/CT scan before and read the PET/CT guidebook or not. Also, watching the video was effective for the reduction of perceptible waiting time. But while displaying the PET/CT guide video is useful for providing information about the scan and shortening the waiting time as one of the medical service, utilization of service was actually very poor because of the passive promotion and indifference of the patients about their examination. Therefore, from now on, it is necessary to construct the healthcare system which can be offered to more patients through the active promotion.