• Korean Journal of Clinical Laboratory Science
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• v.48 no.2
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• pp.158-167
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• 2016

The requirements for medical laboratories ISO 15189 is examined in organization and a quality management system, stressing the importance of evidence, document control, and control of records and clinical material. Medical services are provided from the areas of resource management, and pre-examination, examination and post-examination processes. The main goal of ISO 15189 accreditation is to improve the quality of laboratory services provided for patients and clinical users not only through compliance with consensually developed and harmonized requirements but also by adopting the philosophy of continual improvement using the Plan-Do-Check-Act cycle. Laboratory quality should be evaluated and improved in all steps of the testing process as the state-of-the art indicates that the pre- and post-analytical phases are more vulnerable to errors than the intra-analytical phase. The Korea Laboratory Accreditation Scheme (KOLAS), a national accreditation body, provides medical laboratory accreditations for appropriate approaches to evaluating the competence of a medical laboratory in providing effective services to its customers and clinical users. Adoption of ISO 15189 in 2010s as a government policy has been delayed, and only 5 laboratories have been accredited to date in Korea. The medical laboratories should seek the adoption of ISO 15189 with a positive attitude for quality improvement and strengthening of international competitiveness.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.10 no.1
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• pp.28-35
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• 2007

Purpose: The aim of this study was to evaluate the clinical usefulness of ultrasound examination of children performed by a pediatrician. Methods: One thousand children who presented with symptoms of a gastrointestinal disorder and underwent abdominal ultrasound evaluation in the Department of Pediatrics, between January 2003 and June 2006, were included in this study. We analyzed the patient's medical records and ultrasound results retrospectively. Results: Among the 1,000 patients, 58.4% were male and 41.6% were female. The mean age of the patients was $4.7{\pm}4.0$ years. The main reasons for ultrasound were abdominal pain (43.9%), vomiting (17.3%), elevated liver enzymes (11.8%), and jaundice (9.8%). Abnormal ultrasound findings were present in 57.9% of cases. The major abnormal findings were mesenteric lymphadenitis (29.2%), fatty liver (12.1%), hepatitis (6.4%), hepatosplenomegaly (6.2%), and acute appendicitis (4.8%). The time interval between the initial medical evaluation and the ultrasound evaluation was within 24 hours in most cases (78.5%). The main findings in children with abdominal pain were mesenteric lymphadenitis (32.6%), fatty liver (5.9%), intussusception (2.7%), and acute appendicitis (2.7%). The main findings in children with vomiting were mesenteric lymphadenitis (12.7%), hypertrophic pyloric stenosis (10.4%), and acute appendicitis (3.5%). The major ultrasound findings in children with urinary tract diseases were hydronephrosis (45.4%), urolithiasis (21.5%) and cystic renal disease (18.1%). Conclusion: Ultrasound examination played an important role as a non-invasive and prompt screening examination for detection of abdominal diseases. Ultrasound was an important tool for pediatricians to determine timely information for patient management.

• Childhood Kidney Diseases
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• v.12 no.2
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• pp.194-201
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• 2008

Purpose : Voiding cystourethrography(VCUG) is required to detect vesicoureteral reflux(VUR), which may manifest as urinary tract infection(UTI) in children. It is well known that VCUG can cause UTI(post-VCUG UTI). In this study, risk factors for post-VCUG UTI and the preventive effect of antibiotics against this complication of VCUG were explored. Methods : Medical records of 284 patients who underwent VCUG at our hospital in 2007 were reviewed retrospectively. The incidence of post-VCUG UTI and risk factors for post-VCUG UTI, and the impact of antibiotic use on prevention of post-VCUG UTI were evaluated. According to antibiotics usage, we divided the enrolled patients into 4 groups of noantibiotics group, prophylactic antibiotics group(prophylactic antibiotics having been used before), antibiotics-for-VCUG group(antibiotics added for VCUG) and antibiotics-for-treatment group(treatment dose of antibiotics). Results : Seven of 284 children(2.5%) developed UTI after they underwent VCUG. Highgrade(grade$\geq$III) VUR was the only statistically significant risk factor(odds ratio[OR] 6.266, P=0.026) for post-VCUG UTI, while sex, age, and other anomalies of urinary system were not significant. Five post-VCUG UTI cases belonged to prophylactic antibiotics group. Antibiotics use (three groups using antibiotics vs. no-antibiotics group) or addition of antibiotics for VCUG (antibiotics-for-VCUG vs. other groups) did not have any effect on prevention of post-VCUG UTI. Conclusion : The risk factor for post-VCUG UTI was high-grade VUR. Antibiotics use did not prevent post-VCUG UTI in this study.

• Journal of Korean Society of Transportation
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• v.24 no.2 s.88
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• pp.65-78
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• 2006

This paper investigates the cost structure ot the Korea and Japan railroad industry with respect to density, scale and scope economies as well as productivity growth rate using a generalized trans)og multiproduct cost function model. The paper then assumes that the Korea and Japan railway companies pi·educe three outputs (incumbent railway passenger-kilometers. Shinkansen passenger-kilometers, ton-kilometers of freight) using four input factors (labor, fuel, maintenance, rolling stock and capital). The specified cost function includes foul other independent variables: track lengths to reflect network effects, two dummies to reflect nation and ownership effects, and time trend as a proxy for technical change. The simultaneous equation system consisting of a cost function and three input share equations is estimated with the Zellner's iterative seemingly unrelated regression. The unbalanced panel data used in the paper, a total of 154 observations. are collected from the annual records of the Korea National Railroad (KNR) for the yews $1977{\sim}2003$, Japan National Railways (JNR) for the years $1977{\sim}1984$. seven Japan Railways (JR's) for the years $1987{\sim}2003$. The findings show that the Korean and Japanese railways exhibit product-specific and overall economies of density but product-specific diseconomies of scale with respect to incumbent railway passenger-kilometers, Shinkansen-kilometers and ton-kilometers. However, the railways experience mild overall economies of scale which result from economies of scope associated with the joint production of incumbent railway/Shinkansen and feight, freight/incumbent railway and Shinkansen except Shinkansen/incumbent railway and freight. In addition, the economies of density and scale in the KNR, JR east, JR central, and JR west companies at the point of the years $1990{\sim}2003$ average is generally analogous to the above results at the point of sample average. There also appear to be economies of ssope associated with the joint Production of the incumbent railway and Shinkansen in JR central but diseconomies of scope in JR East and JR West. The findings also indicate that the productivity growth rate of the privately-owned JR's is larger than that of the government-owned KNR.

• Journal of Hospice and Palliative Care
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• v.21 no.2
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• pp.51-57
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• 2018

Purpose: End-of-life (EoL) decisions are challenging and multifaceted for patients and physicians. This study was aimed to explore how EoL care is practiced for patients with a do-not-resuscitate (DNR) order. Methods: We retrospectively analyzed medical records of patients who died after agreeing to a DNR order in 2016 at a university hospital. Characteristics including cause of death, intensity of EoL care, and other factors were reviewed and statistically analyzed. Results: Of total 375 patients, 170 patients (45.3%) died with malignancies, and 205 patients (54.6%) with other causes involving the central nervous system (19.2%), pulmonary (14.7%), cardiologic (6.7%) and infectious (6.4%) conditions. Both the cancer and non-cancer patient groups showed a short duration from DNR to death (median 3 days vs 2 days, P=0.629). An intensive care group comprising patients who received one or more intensive treatments such as ventilator (n=205) showed a higher number of non-cancer patients and a shorter duration from DNR to death than a group that withheld treatment before DNR (P<0.05). Conclusion: EoL decisions were made very late by both cancer and non-cancer patients. About half of the patients did not have cancer, and two-thirds of them decided DNR during intensive treatment. To make a good EoL decision, a shared decision making with patients should be done at an earlier stage.

• Korean Journal of Head & Neck Oncology
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• v.15 no.2
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• pp.149-155
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• 1999

Objectives: To study the clinical features of the primary nasal/nasopharyngeal non-Hodgkin's lymphomas and to evaluate the implication of immunophenotyping as a prognostic factor. Patients and Methods: From January 1990 to December 1997,41 patients(median age, 41 years) of primary nasal/nasopharyngeal non-Hodgkin's lymphoma were studied. The clinical records and paraffin-embedded tissue blocks were reviewed retrospectively. The histologic features, immunophenotypic findings(pan-T, pan-B, CD3, CD56) and Epstein-Barr virus in situ hybridizatios were examined. The prognostic factors for clinical outcome were evaluated in these patients. According to Ann-Arbor system, there were 30 patiets(73%) with stage IE, 4(10%) with stage IIE, 3(7%) with stage IIIE, 4(10%) with stage IVE lymphoma. Among the patients with stage IE/IIE, 4 patients received local radiation alone, 4 received chemotherapy alone, 25 received combination chemotherapy and radiotherapy and 1 refused treatment. The patients with stage IIIE/IVE were given combination chemotherapy and radiotherapy. Results: Immunophenotyping were performed in 40 patients and staining results were as follows: 3(7%) patients with B cell, 17(42%) with T cell, 18(44%) with NK/T cell(CD56 positive), and two patients with unclassifiable result. Epstein-Barr(EB) virus in situ hybridization were performed in 28 patients and 23(82%) patients had positive EBV-encoded RNAs(EBERs). 21(55%) patients achieved a complete remission. There was no difference in complete remission between radiation alone and combination therapy. With median follow-up of 30 months, 5-years disease free survival of complete responders was 60% and 5-years overall survival rate was 36%. Multivariate analysis showed that better overall survival was related with absence of B symptoms, ECOG performance${\leq}1$ and non-NK cells. Conclusion: Most of all cases were positive for EBER. Since NK/T phenotype carried the worst prognosis, analysis for CD56 expression should be done. Further prospective studies were warranted to evaluate the role of chemotherapy in stage IE/IIE.

• Journal of Hospice and Palliative Care
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• v.7 no.2
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• pp.200-213
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• 2004

Purpose: The purpose of this study was to create an electronic nursing record form to build a hospice nursing process database to be used in the u-hospital EMR system. Specific aims of the study were: 1. To generate a complete, accurate, and simple electronic nursing record form. 2. To verify its appropriateness following documentation with the standardized hospice protocol. 3. To verify its validity and finalize the hospice nursing process database through discussion among hospice professionals. Methods: Nursing records from three independent hospice organizations were collected and analyzed by five expert hospice nurses with more than 10 years of experience, and a nursing record database was developed. This database was applied to 81 hospice patients at three hospice organizations to verify its completeness. Results: 1. An electronic nursing record form with completeness, accuracy, and simplicity was developed. 2. The completeness of the standardized home hospice service protocol was 95.86 percent. 3. The hospice nursing process database contains 18 items on health problems, 79 items on related causes and major symptoms, and 229 items on nursing interventions. Conclusion: The new nursing record form and database will reduce documentation time and articulate and streamline the working process among team members. They can also improve the quality of hospice services, and ultimately enable us to estimate hospice service costs.

• Clinical and Experimental Pediatrics
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• v.53 no.3
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• pp.314-322
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• 2010

Purpose : Through a clinical and retrospective analysis of pediatric patients who visited the Regional Emergency Medical Center of Masan Samsung Hospital from January 2007 to December 2008, we characterized pediatric and adolescent emergency patients to improve emergency care in future. Methods : We reviewed the medical records of 14,065 pediatric patients below 19 years of age. Results : The male to female ratio was 1.5:1, and the most common age group was less than 3 years (49.6%). The peak month was May (10.0%), the peak day of the week was Sunday (24.7%), and the peak time of day was 20:00-0:59 (8.5%). There was no difference in the number of visits per day based on weather (sunny, rain [below 10 mm per day], snow, and fog) or daily temperature difference; however, visits increased on sandy, dusty days and decreased on rainy days with more than 10 mm of rain per day. Based on the international classification of disease (ICD)-10 system, the most common disease code was code R (symptoms, sign, and abnormal clinical laboratory finding) (31.5%), and the most common symptom was fever (13.1%). Final outcomes were discharged (73.8%), admitted (25.7%), transferred (0.4%), and expired (0.1%). In adolescent patients aged 15-9 years, the most common disease code was Injury & Poisoning (code S&T, 36.9%); the most common symptom was abdominal pain (9.6%). Conclusion : Pediatric patients visiting the emergency center were most likely to be male and under 3 years of age and to visit between 20:00 and 21:00 on Sundays and in May, and the most common symptom was fever. Differences between adolescents and pediatric patients showed that adolescents had a higher visiting rate with abdominal pain and a larger temperature difference.

• Cartoon and Animation Studies
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• s.28
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• pp.27-53
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• 2012

American superhero comics are being produced in numerous different forms for multiple, and cross-platform media. In cinema, films based on superhero comics top the list of all time box office records. The same phenomenon of the 'Invasion of Superhero' is duplicated in Korean box office 2012, however, the korean fans are not familiar with the superheroes from the publication which provides the original source of characters and stories for other superhero related media products. Based on observing the multiple and vastness of world building characteristics of superhero comic, this paper attempts to associate the continuous creative nature and the infinite repetition of superheroes and comic texts with the identity of superhero on ontological level. First, chapter 2 examines how one superhero exists in multiple and different worlds individually by utilizing the concept of 'multi-universe' or 'multiverse' in comic texts. Initially, duplicating a superhero on multiple settings and series destroyed continuity and allowed contradiction and paradox confused narrative as a whole, but it also gave chances for comics to be more vibrant and experimental with their stories and characters. Chapter 3 analyzes the superhero comic texts in the light of repetition, concept developed by french philosopher Gilles Deleuze, and make the argument that the superheroes and texts are not repeated to generate surplus of source for economic utilitarian purposes, but it is, first and foremost, a repetition of creativeness and capability. Many concepts introduced by Deleuze in his early masterpiece, $\acute{e}$rence et R$\acute{e}$p$\acute{e}$tition> are taken to support this argument. Mainly, his critical views on generality of the identity and his effort to replace the Plato's system of representation with vibrant creative, and renewal energy of r$\acute{e}$p$\acute{e}$tition. According to Deleuze, repetition is similar concept, if not identical, to what Nietzsche called the 'eternal return' which allows the return of the Overhuman or the Superhuman, and he extends his idea that the returning Overhuman is the singular simulacre which opposes the generalization of identity, in the likes of Plato's Idea. Thus, the superhero's identity is ever changing, ever returning, and ever renewing Overhuman. The superhero must be repeated to fully actualize his/her existence. Also, based on Deleuze's reading of Bergson's texts on the Virtual, the superhero, for example Superman, is actualization of his/her multiplisit$\acute{e}$, the internally multiple, and differentiated variations from itself. These every Supermans' multiplisit$\acute{e}$ shares common memory, past, and duration, thus the Virtual of Superman. Superman becomes himself only by actualizing the movement and differentiation from these multiplisit$\acute{e}$ in his virtual on the surface of reality. On chapter 4, a popular Korean comic book character Oh, Hae-Sung's r$\acute{e}$p$\acute{e}$tition and multiplist$\acute{e}$ are analyzed, and makes comparison to that of Superman to distinguish the repetition from r$\acute{e}$p$\acute{e}$tition, and multiplicit$\acute{e}$ from diversity.

• Journal of Acupuncture Research
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• v.30 no.4
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• pp.55-68
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• 2013

Objectives : The purpose of this study is to analyze the distribution, relationship, prognosis and improvement score of idiopathic facial palsy inpatients according to constitutional differentiation ; Sasang constition, Hyungsang classification, Sasang constition combined with Hyungsang classification. Methods : A study was done on 102 patients who were diagnosed and treated as idiopathic facial palsy from April 2012 to Nomember 2012 at the Department of Acupuncture and Moxibution Medicine, Dong-eui Oriental University Hospital. Medical records of inpatinets who underwent facial ENoG, NET test were analyzed. Changes of HBGS grade and Yanagihara's score were also evaluated. We classified inpaients acording to Sasang constitution by consulting to Department of Sasang constitutinal medicine, and to Hyungsang classification(Dam-body, Bangkwang-body) by measuring under medical system of 3D facial shapes(RS-400FL). The constitutional differentiation and general characteristics were initially analyzed, and valuse on ENoG, NET were correlated with constitutinal differentiation. Results of HBGS and Yanagihara's score were also correlated with constitutinal differentiation. Results : 1. Each 39.2 percent of idiopathic facial palsy inpatients were the Taeeumin and Soyangin, 21.6 percent were the Soeumin. 2. 75.5 percent of idiopathic facial palsy inpatients were the Bangkwang-body, 24.5 percent were the Dam-body. 3. 34.3 percent of idiopathic facial palsy inpatinets were the Taeeum-Bangkwang, 21.6 percent were the Soyang-Bangkwang, 19.6 percent were the Soeum-Bangkwang, 17.6 percent were the Soyang-Dam, 4.9 percent were the Taeem-Dam, 2 percent were the Soeum-Dam. 4. By sex, the each ratio of Taeeumin, Soeumin, Bangkwang-body, Taeeum-Bangkwang, Soeum-Bangkwang, Soyang-Bangkwang was higher in female, that of Dam-body, Taeeum-Dam, Soyang-Dam was higher in male. 5. By relations between Sasang constitution and Hyungsang classification, the each ratio of Taeeumin and Soeumin was higher in Bangkwang-body. 6. By values on ENoG and NET, evaluations of HBGS's grade and Yanagihara's score, there were no significant difference. Conclusions : In idiopathic facial palsy inpatients, the proportion of Taeeum and Soyang among the Sasang constitution was higher, that of Dam among the Hyungsang classification was higher, that of Taeeum-Bangkwang among the Sasang combined with Hyungsang was the highest. It would seem that Bangkwang-body, female were closely related to Taeeumin, Soeumin. Also, Dam-body were closely related to male. But when comparing groups, there was no statistically significant difference in prognosis and improvement.