• Title/Summary/Keyword: Treatment Decide

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Closed Interlocking Intrmedullary Nailing of Metastatic Diaphyseal Fractures of the Humerus (상완골 간부 악성 병적골절의 비관혈적 고합성 골수강내 금속정 고정술)

  • Bahk, Won-Jong;Rhee, Seung-Koo;Kang, Yong-Koo
    • The Journal of the Korean bone and joint tumor society
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    • v.9 no.1
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    • pp.1-11
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    • 2003
  • Purpose: To analysis of the result of the treatment of metastatic diaphyseal fracture of the humerus with closed interlocking intrameduallry nailing. Materials and Methods: Among surgically treated 29 patients with pathologic or impending fracture of diaphysis of the humeurs, 13 patients (16 cases) treated with closed intramedullary interlocking nail were selected for the study. The final result of pain relief and functional recovery was evaluated by modified rating system of Perez et al. Results: Primary cancer was diagnosed after fracture was developed in 2 patients and pathologic or impending fracture was occurred average period of 28.9 months after primary cancer was diagnosed. The main primary malignancies were multiple myeloma, lung cancer and breast cancer. Mean survival after humeral metastasis was 11.7 months. The final result was superior to fair in 13 of 16 cases, and poor in 3 cases with progression of tumor spread or distant dissemination to the ipsilateral fingers. Except the latter 3 patients and other 3 patients, who died before 3 months postoperatively, bony union was achieved in 10 cases. There were no complications related to surgery. Conclusion: Closed interlocking intrameduallry nailing is accomplished with brief operative time, small amount of bleeding and provides immediate stability with resultant early return of function to the arm. Additionally it allows early postoperative irradiation. However, some of our cases shows that intramedullary nailing can accelerate tumor spread and metastases elsewhere, so that serious consideration must be given in planning this treatment. In conclusion, the functional status before fracture, life expectancy, type of tumor and extent of involvement should be carefully considered to decide operative treatment of metastatic disease.

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Whether to put on Criminal convictions on the medical examination records prepared by medical personnels - Sentenced by November 24, 2005, by The Supreme Court, Precedent case no. 2002DO4758 - (의료인의 진료기록부 등 허위작성시 형사처벌 가부 - 대법원 2005. 11. 24. 선고 2002도4758 판결 -)

  • Park, Kyong-Chun
    • The Korean Society of Law and Medicine
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    • v.8 no.1
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    • pp.107-135
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    • 2007
  • In preparation of the medical examination records, the failure to correctly write the taken medical behaviors on the medical examination records, is subject to criminal conviction due to the breach of the Article 21-1. The false or overstated writings on the medical examination records is subject to the same punishment due to the Article 21-1, which $\underline{additionally}$ may lead to the administrative measures such as the suspension of license according to Article 53-1. The interpretation is considered as proper in light of the function of the medical examination records, hazard to the patients, and the doctors' ethics. In light of the attitude of The Supreme Court for the preparation obligation of the medical examination records specified in the medical law Article 21-1(Purport : The doctors may continue to use their opinions on the patient's status and treatment process on the medical examination records, may provide the proper information to other medical staff, and ought to specify the details enough to decide the appropriateness of such medical behaviors after the recent treatment.), the false writings of the doctors on the medical examination records of the non-treated patient as faithfully treated one during the entire period before the present hospitalization, will be regarded as the fulfillment obligation of the preparation of the medical examination records in the medical law Article 21-1.

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Development of Model Plans in Three Dimensional Conformal Radiotherapy for Brain Tumors (뇌종양 환자의 3차원 입체조형 치료를 위한 뇌내 주요 부위의 모델치료계획의 개발)

  • Pyo Hongryull;Lee Sanghoon;Kim GwiEon;Keum Kichang;Chang Sekyung;Suh Chang-Ok
    • Radiation Oncology Journal
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    • v.20 no.1
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    • pp.1-16
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    • 2002
  • Purpose : Three dimensional conformal radiotherapy planning is being used widely for the treatment of patients with brain tumor. However, it takes much time to develop an optimal treatment plan, therefore, it is difficult to apply this technique to all patients. To increase the efficiency of this technique, we need to develop standard radiotherapy plant for each site of the brain. Therefore we developed several 3 dimensional conformal radiotherapy plans (3D plans) for tumors at each site of brain, compared them with each other, and with 2 dimensional radiotherapy plans. Finally model plans for each site of the brain were decide. Materials and Methods : Imaginary tumors, with sizes commonly observed in the clinic, were designed for each site of the brain and drawn on CT images. The planning target volumes (PTVs) were as follows; temporal $tumor-5.7\times8.2\times7.6\;cm$, suprasellar $tumor-3\times4\times4.1\;cm$, thalamic $tumor-3.1\times5.9\times3.7\;cm$, frontoparietal $tumor-5.5\times7\times5.5\;cm$, and occipitoparietal $tumor-5\times5.5\times5\;cm$. Plans using paralled opposed 2 portals and/or 3 portals including fronto-vertex and 2 lateral fields were developed manually as the conventional 2D plans, and 3D noncoplanar conformal plans were developed using beam's eye view and the automatic block drawing tool. Total tumor dose was 54 Gy for a suprasellar tumor, 59.4 Gy and 72 Gy for the other tumors. All dose plans (including 2D plans) were calculated using 3D plan software. Developed plans were compared with each other using dose-volume histograms (DVH), normal tissue complication probabilities (NTCP) and variable dose statistic values (minimum, maximum and mean dose, D5, V83, V85 and V95). Finally a best radiotherapy plan for each site of brain was selected. Results : 1) Temporal tumor; NTCPs and DVHs of the normal tissue of all 3D plans were superior to 2D plans and this trend was more definite when total dose was escalated to 72 Gy (NTCPs of normal brain 2D $plans:27\%,\;8\%\rightarrow\;3D\;plans:1\%,\;1\%$). Various dose statistic values did not show any consistent trend. A 3D plan using 3 noncoplanar portals was selected as a model radiotherapy plan. 2) Suprasellar tumor; NTCPs of all 3D plans and 2D plans did not show significant difference because the total dose of this tumor was only 54 Gy. DVHs of normal brain and brainstem were significantly different for different plans. D5, V85, V95 and mean values showed some consistent trend that was compatible with DVH. All 3D plans were superior to 2D plans even when 3 portals (fronto-vertex and 2 lateral fields) were used for 2D plans. A 3D plan using 7 portals was worse than plans using fewer portals. A 3D plan using 5 noncoplanar portals was selected as a model plan. 3) Thalamic tumor; NTCPs of all 3D plans were lower than the 2D plans when the total dose was elevated to 72 Gy. DVHs of normal tissues showed similar results. V83, V85, V95 showed some consistent differences between plans but not between 3D plans. 3D plans using 5 noncoplanar portals were selected as a model plan. 4) Parietal (fronto- and occipito-) tumors; all NTCPs of the normal brain in 3D plans were lower than in 2D plans. DVH also showed the same results. V83, V85, V95 showed consistent trends with NTCP and DVH. 3D plans using 5 portals for frontoparietal tumor and 6 portals for occipitoparietal tumor were selected as model plans. Conclusion : NTCP and DVH showed reasonable differences between plans and were through to be useful for comparing plans. All 3D plans were superior to 2D plans. Best 3D plans were selected for tumors in each site of brain using NTCP, DVH and finally by the planner's decision.

A Theoretical Model for the Analysis of Residual Motion Artifacts in 4D CT Scans (이론적 모델을 이용한 4DCT에서의 Motion Artifact 분석)

  • Kim, Tae-Ho;Yoon, Jai-Woong;Kang, Seong-Hee;Suh, Tae-Suk
    • Progress in Medical Physics
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    • v.23 no.3
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    • pp.145-153
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    • 2012
  • In this study, we quantify the residual motion artifact in 4D-CT scan using the dynamic lung phantom which could simulate respiratory target motion and suggest a simple one-dimension theoretical model to explain and characterize the source of motion artifacts in 4DCT scanning. We set-up regular 1D sine motion and adjusted three level of amplitude (10, 20, 30 mm) with fixed period (4s). The 4DCT scans are acquired in helical mode and phase information provided by the belt type respiratory monitoring system. The images were sorted into ten phase bins ranging from 0% to 90%. The reconstructed images were subsequently imported into the Treatment Planning System (CorePLAN, SC&J) for target delineation using a fixed contour window and dimensions of the three targets are measured along the direction of motion. Target dimension of each phase image have same changing trend. The error is minimum at 50% phase in all case (10, 20, 30 mm) and we found that ${\Delta}S$ (target dimension change) of 10, 20 and 30 mm amplitude were 0 (0%), 0.1 (5%), 0.1 (5%) cm respectively compare to the static image of target diameter (2 cm). while the error is maximum at 30% and 80% phase ${\Delta}S$ of 10, 20 and 30 mm amplitude were 0.2 (10%), 0.7 (35%), 0.9 (45%) cm respectively. Based on these result, we try to analysis the residual motion artifact in 4D-CT scan using a simple one-dimension theoretical model and also we developed a simulation program. Our results explain the effect of residual motion on each phase target displacement and also shown that residual motion artifact was affected that the target velocity at each phase. In this study, we focus on provides a more intuitive understanding about the residual motion artifact and try to explain the relationship motion parameters of the scanner, treatment couch and tumor. In conclusion, our results could help to decide the appropriate reconstruction phase and CT parameters which reduce the residual motion artifact in 4DCT.

The Effect of Application Levels of Slurry Composting and Bio-filtration Liquid Fertilizer on Soil Chemical Properties and Growth of Radish and Corn (총각무와 옥수수 재배시 SCB액비 시용수준이 토양화학성과 생육에 미치는 영향)

  • Kang, Seong-Soo;Kim, Min-Kyeong;Kwon, Soon-Ik;Kim, Myong-Suk;Yoon, Sung-Won;Ha, Sang-Gun;Kim, Yoo-Hak
    • Korean Journal of Soil Science and Fertilizer
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    • v.44 no.6
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    • pp.1306-1313
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    • 2011
  • A liquid fertilizer treated with slurry composting and biofiltration (SCB) process has been applied increasingly on agricultural field but the effects on the soil properties and crop production has not been throughly evaluated. This study was conducted to investigate the effect of the SCB application on soil chemical properties and the growth of radish and corn. SCB liquid fertilizer as a basal fertilization was treated with five levels based on $6kg\;10a^{-1}$ for radish and $10kg\;10a^{-1}$ for corn. The experimental design was the completely randomized block design with five levels and three replicates. Electrical conductivity (EC), $NO_3$-N, Exch. K and Exch. Na increased depending on the treatment levels of SCB. There were no changes in soil organic matter, Avail. $P_2O_5$, Exch. Ca and Exch. Mg. EC, $NO_3$-N and Exch. Na content decreased as precipitation increased. Especially, they decreased up to the initial condition before the treatment after the heavy rainy season in 2008. Although Exch. K decreased at the rainy season, they remained relatively higher content after the experiment on August, 2008. Fresh weight and the amount of N uptake of radish increased due to the levels of SCB, but corn did not present any significant increase. It is recommended that we need to decide the proper amount of SCB as well as the application method on the field to increase the productivity and decrease environmental stress. Additional experiments also need to clarify the effect of the trace element and heavy metal accumulations due to long term application of SCB.

A Study on the Work of Dental Hygienists by Service Area (치과위생사의 근무지별 업무실태에 관한 조사 연구)

  • Moon, Kyung-Sook;Hwang, Yoon-Sook;Kim, Young-Kyung;Jung, Jae-Yeon
    • Journal of Korean society of Dental Hygiene
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    • v.2 no.1
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    • pp.63-83
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    • 2002
  • The purpose of this study was to serve as a basis for more efficient dental hygienist human resources utilization and for determining some of the right directions for supplementary education for dental hygienists, by examining how they actually worked and what they thought of job-related things. The subjects in this study were 537 dental hygienists who participated in a seminar by the Korea Dental Hygienist Association. After a survey was conducted, the following findings were given: 1. 50.2% of the dental hygienists investigated completed legally required eight-class education. Those who worked in clinics took less supplementary education classes than the others in the other types of dental institutions. The main reason they didn't receive supplementary education was financial burden and uncooperative employers. 73.2% took supplementary education at the association or its branches. The association was most favored by those in clinical sector as a place that provides supplementary education, followed by its branch and university in the order named. And the dental hygienists in public health sector preferred university most, and the next best favored one was the association and its branch in the order named. Those in clinical sector hoped to acquire clinical information on patient management, implant or aesthetics, and the dental hygienists in public health sector wanted to learn about health administration, public oral health operations and oral health education, which were different from what those in clinical sector wanted. 2. Regarding the period of service, 492% had worked for three years or more. This fact suggested that their service term and average age continued to grow. And they thought they would decide the retirement time on their own. 3. The most common yearly income ranged from 12 million won to 16 million won(40.7%). For-those in clinics, yearly income was 14.36 million won, and that of the dental hygienists who had worked for less than 3 years was 12.90 million won. 4. The Korea Dental Hygienist Association was most required to protect the rights and interests of the members and offer new knowledge and technology. 5. The largest group of them were engaged in patient management, and this type of job also was the most favored one for them to do. The greatest number of the dental hygienists in public health sector were in charge of dental treatment. 6. Concerning their turnover rate, 492% had never changed their occupation. Specifically, 70.0% of the respondents who had worked for less than 3 years had have no experience to do that. The time constraints for self-development and conflicts with other workers were the cause of their turnover. Those in dental hospital and general hospital changed their occupation chiefly due to the lack of time for self-development, and for the dental hygienists in clinics, the conflicts with other workers were the main reason. The above-mentioned findings suggested that the way the dental hygienists looked at things was undergoing change. The service area made a difference to their preference for the type of supplementary education and institution in charge of it, as those in public health and clinical sectors had a different opinion. And the dental hygienists in clinical sector had a different opinion as well, according to service area, about salaries, reason of not taking supplementary education, preferred type of supplementary education, cause of turnover, and type of occupation to which they hoped to change employment. To utilize and supply human resources in a more stabilized manner, job description should be more segmented, standardized and classified clearly, and dental hygienists should be motivated to perform their substantial jobs, including oral disease prevention, oral prophylaxis and oral health education. To make it happen, it seems that dentists are required to have a clear understanding of dental hygienist job and to change the way they look at it.

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Relationship between the Economical Defects of Broiler Meat Carcass and Quality Grade A with a Meat Grader (경제성 관련 계육 도체 결함과 축산물등급사에 의한 품질 A등급의 상관관계)

  • Choe, Jun-Ho;Lee, Jae-Cheong;Jo, Cheor-Un
    • Food Science of Animal Resources
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    • v.29 no.4
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    • pp.494-499
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    • 2009
  • To investigate the relationship between the carcass defects considered by a meat grader and quality grade A, a total of 59,700 broiler carcasses, which were reared from September 1, 2007 to August 31, 2008 and randomly selected from 597 broiler farms with 100 broilers in each farm, were graded by a meat grader using the Korean meat grading system. The average slaughter weight of the broilers increased at the 31- to 33-d age but decreased after the 37-d age. The average daily gain to grade A ratio of the broilers was highest in autumn, and the bruises, flesh blemishes, and abnormalities of the carcasses were found to have been most frequent in winter (p<0.05). The number of economical defects (EDs) increased with the increase in the slaughter age, and the correlation coefficients of the EDs and grade A were -0.88, -0.48, and -0.12 in terms of the conformation, exposed flesh/cuts/tears, and skin discolorations of the carcasses, respectively. The correlation coefficients of the non-economical defects (NEDs) and the grade A of the broiler carcasses were -0.16, -0.22, and -0.32 in terms of the feathers, alien substances, and carcass treatment, respectively. The total number of defects (EDs + NEDs) and the grade A were highly correlated (-0.93), and in particular, the correlation between the grade A and the EDs was -0.91. It can be deemed that the grade A from a meat grader is highly correlated with the EDs. Therefore, the results suggest that broiler carcass grade evaluation using a meat grading system can provide direct information on profits in the market. The resulting carcass grade of broilers can also provide the information needed to decide on a proper incentive for a farm that has attained a good quality grade.

The investigation of the degree of the request of the education about the claim for the medical expenses in the dentistry health insurance - mainly in the Daejeon, Chungcheong area - (치과건강보험 요양급여비용 청구에 관한 교육요구도 조사 -대전·충청지역을 중심으로-)

  • Nam, Yong-Ok;Kim, Sung-Hee;Kim, Min-Ja
    • Journal of Korean society of Dental Hygiene
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    • v.11 no.3
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    • pp.325-341
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    • 2011
  • Objectives : This research has investigated the reality of the education of the claim and the degree of the education for the claimed of the dentistry recuperation organization in the Daejeon and Chuncheong are for the improvement of the problem in the medical expenses. Methods : It use as a basic data for the vitalizations of the education and performed the survey in the dentistry recuperation organization in the Daejeon and ChungCheong Nam BukDo which are registered in the evaluating organization for judging the health insurance in the present May 2010, and concluded just like the below. Results : 1. The education of the claim in the requirer in the dentistry recuperation organization, and the education of the claim was especially lacking when the dentist was studying in the university, and the dental hygienist had the similar educational experience in the school and the clinic (p<0.05) 2. Most of the requirer in the dental recuperation organization was hoping to get the education related to the claim work, but the dentist and the nurse's aid was relatively low (p<0.05) 3. For fixing the error of the claim, the participation and the extension of the judging standard of the insurance was the highest among the university subordinate dental hospital/dental hospital, but the health center was relatively low (p<0.05). 4. The dentist feels the economic burden in employing the special employee because the raising of the special judging people, compared to others, but the staffs such as the dental hygienist preferred it as one of ways to fix the error of the claim of the dental insurance (p<0.05) 5. Both dentists and the dental hygienist said proper time to teach the insurance was all needed in the school, and the clinic, but other workers relatively believed it should be held in the clinic (p<0.05). 6. The important factors to decide the participation of the lecture was in order of the contents of the lecture, the place of the lecture, the amount for the lecture, the superintendent of the lecture, whether it has gone through the educational score, and whether it has passed the conserving educational score was relatively less important in the university subordinate dentist/dentist, but the medical center was very effective as 4.50 (p<0.05) 7. Health Insurance Review and assessment service was very high as the managing department for supplying the lecture and the information, 70.5%, and the next was the Korean Dental Association/ Korean dental hygiene association, but dentists were preferring the association to manage in than the Health Insurance Review and assessment service to manage (p<0.05) 8. In preferring lecture for the inquiring the insurance, periodontal surgery was the highest as 4.51, the diagnosis standard for injection was high in the university subordinate hospital/dentists, and the more the year of the insurance inquiry, the less the doctor who was hoping for the lecture about the basic treatment. Conclusions : Taken together, it is decided that the inquiry education about the medical expense in the dentist, so the consistent and systematic education should be held to the related people, and from this, it is thought to reduce the problem of the inquiry of the medical expenses by fostering the knowledge and supplying the information which are related to the inquiry of the dentists.

Child Abuse Experience, perception of the Cause of the Child Abuse and Need for counseling among Day Care Center Teachers (어린이집 아동학대에 대한 보육교사의 경험, 인식 및 상담 요구도 실태조사)

  • Kyung-Sook Lee;Jin-Ah Park;Myung-Hee Choi
    • Korean Journal of Culture and Social Issue
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    • v.21 no.2
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    • pp.227-252
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    • 2015
  • This study was intended to examine child abuse experience, response to child abuse, perception of the cause of child abuse, and need for counseling to prevent and eliminate child abuse among 514 day care center teachers across the country. First, 17.9% (92) of the teachers had experience of witnessing child abuse at day care centers. After such witness, the teachers mostly "paid attention to abused children and provided them with warm treatment" when they were abused by other teachers and "took no actions" when they were abused by directors of the day care centers. The biggest reason of not taking any actions was: they "had no authority to intervene in child care of other teachers" in case of child abuse by other teachers and "were afraid of responsibilities or roles that could be placed on them after reporting" in case of child abuse by day care center directors. Second, the biggest reason of child abuse by teachers was job stress followed by excessive work and mental health of teachers. Third, necessary actions when child abuse cases were found and confirmed were suspension of involved teachers and psychological evaluation for involved children and parents. Fourth, 88.9% (457) of the teachers responded that they would use an organization specialized in child abuse if such organization was built and that the organization would help them to decide on whether to report child abuse and prevention of and intervention in child abuse. They also said that such organization should be installed in the Counseling Center in the Comprehensive Child Care Support Center. Fifth, 95.3% (490) of the teachers answered professional counselors specialized in development and counseling of infants and toddlers were needed to address child abuse at day care centers. They demanded that such counselors should be able to administer psychological evaluation for young children and assess child abuse cases. Qualification of the counselors was at least college graduates who majored in psychology and child care, three to five years of experience in the field, and appropriate certificates or licenses. Finally, the teachers said that training and professional counseling about child abuse were required to prevent and eliminate child abuse at day care centers. Implications and follow-up studies were provided and suggested based on these findings.

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