• 제목/요약/키워드: Trial Results

검색결과 4,419건 처리시간 0.034초

산란말기 사료 내 Bacillus subtilis와 오레가노 오일 첨가가 산란계의 계란 생산성, 계란품질 및 장의 형태학적 특성에 미치는 영향 (Effects of Dietary Bacillus subtilis and Oregano Oil Supplementation on Performance, Egg Quality, and Intestinal Morphology in Late-Phase Laying Hens)

  • 김현수;김희진;윤연서;이우도;신혜경;손지선;홍의철;전익수;강환구
    • 한국가금학회지
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    • 제50권4호
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    • pp.311-323
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    • 2023
  • 본 연구는 생균제인 Bacillus subtilis(BS) 및 Oregano essential oil(OEO)이 산란말기 산란계의 계란 생산성, 계란 품질, 그리고 회장 내 융모의 조직학적 특성에 미치는 영향을 조사하였다. 산란말기(69주령) 산란계 총 150마리를 공시하였으며, 시험 전 산란율 차이에 따라 산란율 100%(H), 평균(A, 88%~89%) 총 두 그룹으로 나눈 다음, 각 그룹별로 BS 또는 OEO을 처리하였다. 산란율 차이에 따른 두 그룹에서 각각 대조군(CON)은 상업용 시판사료를 급여하였으며, BS군은 대조군 사료에 3 × 108 CFU/kg Bacillus subtilis를 첨가하였고, OEO은 대조군 사료에 사료용 Oregano essential oil 0.3 g/kg을 첨가하였다. 총 6처리로 하여 처리당 5반복, 반복당 5수를 완전 임의 배치하여 5주간 사양 시험을 수행하였다. 시험 종료 후 계란 생산성, 계란 품질, 그리고 회장내융모의 조직학적 특성을 조사하였다. 산란율 평균인 처리구에서 BS(91.69%) 및 OEO(91.94%)에서 CON(86.80%)과 비교하여 유의적으로 증가하였다. 혈구 및 혈청 생화학 분석 결과, 산란말기 산란율 및 BS과 OEO 첨가 급여에 따른 유의적인 차이는 나타나지 않았다. 난각강도는 OEO(3.31~3.49 kg/cm2)에서 CON(2.96~3.17 kg/cm2)과 비교하여 유의적으로 개선되었다(P<0.05). 장 건강지표인 융모높이(villi height; VH)와 장샘깊이(crypt depth: CD)에 대한 분석결과, CON보다 BS와 OEO를 급여한 처리구에서 높은 VH/CD의 비율을 나타내었다(P<0.05). 본 연구 결과는 산란말기 산란계 사료에 Bacillus subtilis와 Oregano essential oil을 첨가 급여하는 것이 산란율, 계란품질 및 장 건강을 향상시키는 사료 첨가제로서 활용될 수 있을 것으로 사료된다.

사료 내 조단백질 및 칼슘 수준에 따른 비육후기 거세한우의 성장성적 및 도체특성에 미치는 영향 (Effects of Crude Protein and Calcium Levels in Feed on Growth Performance and Carcass Characteristic of Hanwoo Steers)

  • 류채화;이성대;이슬;백열창
    • 한국유기농업학회지
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    • 제31권4호
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    • pp.453-460
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    • 2023
  • 본 연구는 사료 내 조단백질 및 칼슘 수준이 한우 거세우의 성장성적 및 도체특성에 미치는 영향을 확인하고자 수행되었다. 실험은 CP 2수준과 칼슘 2수준을 2×2 완전요인설계법에 따라 총 4개의 실험구로 구성하였다: HPHC (CP 15%, Ca 1.2%), HPLC (CP 15%, Ca 0.6%), LPHC (CP 12.5%, Ca 1.2%), LPLC (CP 12.5%, Ca 0.6%). 실험동물은 24개월령 한우 거세우(650.8±16.27 kg)를 실험구별 8두씩(총 32두) 공시하여 28개월령 출하 시까지 진행되었다. 실험동물은 개시체중에서 실험구간 차이가 없도록 배치되었으며 사료는 볏짚과 배합 사료를 1:9 비율로 급여하였다. 성장성적에서는 일당증체량, 사료 요구율, 종료체중을 측정하였고, 도체특성에서는 도체중, 등심 단면적, 등지방 두께, 육량 등급, 근내지방도 및 육질 등급을 확인하였다. 성장성적은 일당증체량, 사료 요구율 및 종료체중에서 실험구간 유의적 차이가 없었다. 도체특성의 도체중, 등심 단면적, 등지방 두께 및 근내지방도에서도 실험구간 유의적 차이가 없었으나, 육질 등급은 LPLC에서 1+ 등급 이상 비율이 76%로 다른 실험구(HPHC, 63%; HPLC, 63% 및 LPHC, 50%)보다 높은 결과를 보였다. 따라서, 사료 내 조단백질을 낮추어도 성장 및 도체특성에 영향을 미치지 않았다. 또한 비육후기 거세한우의 칼슘 조절이 성장성적에 영향을 미치지 않았으나, 혈액 내 인의 함량에서 차이를 나타냈다. LPLC에서 육질 1+ 이상의 비율이 가장 높게 나타나, 사료 내 칼슘조절에 대한 추가 연구가 필요할 것으로 생각된다. 그러나 사료 내 단백질과 칼슘수준은 모든 연구결과에서 상호관계에서 유의적 차이가 없어, 두 요인이 서로에게 미치는 영향은 낮을 것으로 생각된다.

Prospective Multi-Center Korean Registry of Transcatheter Arterial Chemoembolization with Drug-Eluting Embolics for Nodular Hepatocellular Carcinoma: A Two-Year Outcome Analysis

  • Myungsu Lee;Jin Wook Chung;Kwang-Hun Lee;Jong Yun Won;Ho Jong Chun;Han Chu Lee;Jin Hyoung Kim;In Joon Lee;Saebeom Hur;Hyo-Cheol Kim;Yoon Jun Kim;Gyoung Min Kim;Seung-Moon Joo;Jung Suk Oh
    • Korean Journal of Radiology
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    • 제22권10호
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    • pp.1658-1670
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    • 2021
  • Objective: To assess the two-year treatment outcomes of chemoembolization with drug-eluting embolics (DEE) for nodular hepatocellular carcinoma (HCC). Materials and Methods: This study was a prospective, multicenter, registry-based, single-arm trial conducted at five university hospitals in Korea. Patients were recruited between May 2011 and April 2013, with a target population of 200. A DC Bead loaded with doxorubicin was used as the DEE agent. Patients were followed up for two years. Per-patient and per-lesion tumor response analysis, per-patient overall survival (OS) and progression-free survival (PFS) analysis, and per-lesion tumor control analysis were performed. Results: The final study population included 152 patients, with 207 target lesions for the per-lesion analysis. At one-month, six-month, one-year, and two-year per-patient assessments, complete response (CR) rates were 40.1%, 43.0%, 33.3%, and 19.6%, respectively. The objective response (OR) rates were 91.4%, 55.4%, 35.1%, and 19.6%, respectively. The cumulative two-year OS rate was 79.7%. The cumulative two-year PFS rate was 22.4% and the median survival was 9.3 months. In multivariable analysis, the Child-Pugh score (p = 0.019) was an independent predictor of OS, and tumor multiplicity (p < 0.001), tumor size (p = 0.020), and Child-Pugh score (p = 0.006) were independent predictors of PFS. In per-lesion analysis, one-month, six-month, one-year and two-year CR rates were 57.5%, 58.5%, 45.2%, and 33.3%, respectively, and the OR rates were 84.1%, 65.2%, 46.6%, and 33.3%, respectively. The cumulative two-year per-lesion tumor control rate was 36.2%, and the median time was 14.1 months. The Child-Pugh score (p < 0.001) was the only independent predictor of tumor control. Serious adverse events were reported in 11 patients (7.2%). Conclusion: DEE chemoembolization for nodular HCCs in the Korean population showed acceptable survival, tumor response, and safety profiles after a two-year follow-up. Good liver function (Child-Pugh score A5) was a key predictor of per-patient OS, PFS, and per-lesion tumor control.

소아승낙 현황조사와 소아청소년과/소아신경과 전문의를 대상으로 면담조사를 통한 소아승낙서 공통기준 수립 연구 (Research to Establish a Common Standard for Assent by Assessing the Current State of the Assent Process and Conducting Interviews with Pediatrician/Pediatric Neurologist)

  • 이윤진;이선주;강수진;이대호;배균섭;정종우;김병수;김진석;이명아
    • 대한기관윤리심의기구협의회지
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    • 제6권1호
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    • pp.5-16
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    • 2024
  • Purpose: The purpose of this study is to investigate the current status of pediatric assent in nationwide hospitals and to assess the children's comprehension for pediatric assent by interviewing pediatricians/pediatric neurologists to determine whether children of the age (elementary and middle school students) can understand the purpose, risks, benefits, and concepts of voluntary participation in clinical research described in the assent form, and to help improve the administrative efficiency of multicenter clinical trials. Methods: The status of pediatric assent was surveyed online using Google Forms at 141 university hospitals with administrative staff who are members of the Institutional Review Board (IRB) administrative staff subcommittee with in Korean Association of Institutional Review Boards (KAIRB). Additionally, face-to-face interviews were conducted with 7 pediatricians/pediatric neurologists. Survey and interview responses were summarized using descriptive statistics. Results: Out of the 141 institutions surveyed, 35 institutions (24.8%) responded. Among them, 30 institutions (85.7%) reported having age criteria for acquiring pediatric assent forms in the case of children. The age range for pediatric assent acquisition have been from 7 years old to 12 years old (15 institutions, 50%), and from 7 years old to 15 years old (7 institutions, 23.3%). Nine institutions (25.7%) have had criteria for obtaining both parents' consent in cases involving the participation of children. Nineteen institutions (54.3%) have had checklists or guidelines available for use by IRB members in study protocols involving vulnerable research subjects. Three pediatricians/pediatric neurologists have believed that upper-grade elementary school students (5th-6th grade) could comprehensively understand informed consent forms. Two have believed that middle school students would be able to understand them if they included personal information. Two pediatricians/pediatric neurologists have believed that even lower-grade elementary school students (1st-4th grade) could understand the explanations if they were made simpler. Conclusion: It is suggested that not only elementary school students (7-12 years old) but also middle school students (13-15 years old) should receive pediatric assent forms, as it would facilitate a comprehensive understanding of the forms. To enhance the comprehension of assent form content, it is necessary to use age-appropriate words, language, and expressions in the forms hospital. It is also recommended to create comics or videos to make the content of the assent forms more accessible for children.

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평년기상을 활용한 우리나라의 콩 재배지역 구분 (Classification of Cultivation Region for Soybean (Glycine max [L.]) in South Korea Based on 30 Years of Weather Indices)

  • 윤동경;박재성;서진희;원옥재;최만수;이현수;이채원
    • 한국작물학회지
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    • 제69권1호
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    • pp.49-60
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    • 2024
  • 우리나라 주요 밭작물의 하나인 콩 재배에서 기상에 맞는 재배 양식 개발이 필요함에 따라 콩 작황시험 생육 및 수량 조사 데이터를 이용해 콩에 영향을 끼치는 기상요소를 추출하고 재배지역을 구분하였다. 1. 밀양과 수원지역의 콩 10년 동안의 작황시험 결과와 기상자료 간의 상관분석을 통해 콩에 영향을 미치는 기상요소를 분석한 결과, 생육 특성과 영양생장기 기상과의 상관관계는 일교차, 강수량과 최저온도에서 높게 나타났으며, 수량특성과 생식생장기 기상과는 일교차, 강수량, 최고온도에서 유의한 상관관계를 보였다. 2. 추출한 기상요소와 위도, 해발고도를 포함해 콩의 재배지역 구분을 위해 k-means clustering을 실시한 결과, 지역은 세 가지로 나누어졌으며, zone 1은 중부내륙지역과 경기도 남부지역, zone 2는 서해안 남부지역, 동해안 남부지역과 남해지역, zone 3은 경기도 동부 일부지역과 강원도 및 해발고도가 높은 지역이 포함되었다. 3. 세 가지 지역 중 위도의 범위가 넓은 zone 1을 세 가지 지역으로 세분한 결과, Zone 1-1은 다른 두 지역에 비해 위도가 낮았으며, 강수량이 적은 특징을 가진다. Zone 1-2는 다른 두 지역에 비해 짧은 일조시간과 높은 기온이 특징적이었다. Zone 1-3은 위도 상으로는 두 지역의 중앙에 위치해 있으며, 일조 시간이 길면서 일교차가 큰 특징이었다. 4. 본 연구에서 콩 재배를 위한 한국의 재배지역은 크게 3가지로 구분되었으며, 작게는 5가지 지역으로 구분되었다. 기상 요소 및 생육 정보를 기반으로 한 재배지역을 구분함으로써 국내 콩 생산에 기여할 수 있는 새로운 정보를 제공하였다.

The Association of CHADS-P2A2RC Risk Score With Clinical Outcomes in Patients Taking P2Y12 Inhibitor Monotherapy After 3 Months of Dual Antiplatelet Therapy Following Percutaneous Coronary Intervention

  • Pil Sang Song;Seok-Woo Seong;Ji-Yeon Kim;Soo Yeon An;Mi Joo Kim;Kye Taek Ahn;Seon-Ah Jin;Jin-Ok Jeong;Jeong Hoon Yang;Joo-Yong Hahn;Hyeon-Cheol Gwon;Woo Jin Jang;Hyuck Jun Yoon;Jang-Whan Bae;Woong Gil Choi;Young Bin Song
    • Korean Circulation Journal
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    • 제54권4호
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    • pp.189-200
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    • 2024
  • Background and Objectives: Concerns remain that early aspirin cessation may be associated with potential harm in subsets at high risk of ischemic events. This study aimed to assess the effects of P2Y12 inhibitor monotherapy after 3-month dual antiplatelet therapy (DAPT) vs. prolonged DAPT (12-month or longer) based on the ischemic risk stratification, the CHADS-P2A2RC, after percutaneous coronary intervention (PCI). Methods: This was a sub-study of the SMART-CHOICE trial. The effect of the randomized antiplatelet strategies was assessed across 3 CHADS-P2A2RC risk score categories. The primary outcome was a major adverse cardiac and cerebral event (MACCE), a composite of all-cause death, myocardial infarction, or stroke. Results: Up to 3 years, the high CHADS-P2A2RC risk score group had the highest incidence of MACCE (105 [12.1%], adjusted hazard ratio [HR], 2.927; 95% confidence interval [CI], 1.358-6.309; p=0.006) followed by moderate-risk (40 [1.4%], adjusted HR, 1.786; 95% CI, 0.868-3.674; p=0.115) and low-risk (9 [0.5%], reference). In secondary analyses, P2Y12 inhibitor monotherapy reduced the Bleeding Academic Research Consortium (BARC) types 2, 3, or 5 bleeding without increasing the risk of MACCE as compared with prolonged DAPT across the 3 CHADS-P2A2RC risk strata without significant interaction term (interaction p for MACCE=0.705 and interaction p for BARC types 2, 3, or 5 bleeding=0.055). Conclusions: The CHADS-P2A2RC risk score is valuable in discriminating high-ischemic-risk patients. Even in such patients with a high risk of ischemic events, P2Y12 inhibitor monotherapy was associated with a lower incidence of bleeding without increased risk of ischemic events compared with prolonged DAPT.

Clinical Usefulness of Virtual Ablation Guided Catheter Ablation of Atrial Fibrillation Targeting Restitution Parameter-Guided Catheter Ablation: CUVIA-REGAB Prospective Randomized Study

  • Young Choi;Byounghyun Lim;Song-Yi Yang;So-Hyun Yang;Oh-Seok Kwon;Daehoon Kim;Yun Gi Kim;Je-Wook Park;Hee Tae Yu;Tae-Hoon Kim;Pil-Sung Yang;Jae-Sun Uhm;Jamin Shim;Sung Hwan Kim;Jung-Hoon Sung;Jong-il Choi;Boyoung Joung;Moon-Hyoung Lee;Young-Hoon Kim;Yong-Seog Oh;Hui-Nam Pak;CUVIA-REGAB Investigators
    • Korean Circulation Journal
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    • 제52권9호
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    • pp.699-711
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    • 2022
  • Background and Objectives: We investigated whether extra-pulmonary vein (PV) ablation targeting a high maximal slope of the action potential duration restitution curve (Smax) improves the rhythm outcome of persistent atrial fibrillation (PeAF) ablation. Methods: In this open-label, multi-center, randomized, and controlled trial, 178 PeAF patients were randomized with 1:1 ratio to computational modeling-guided virtual Smax ablation (V-Smax) or empirical ablation (E-ABL) groups. Smax maps were generated by computational modeling based on atrial substrate maps acquired during clinical procedures in sinus rhythm. Smax maps were generated during the clinical PV isolation (PVI). The V-Smax group underwent an additional extra-PV ablation after PVI targeting the virtual high Smax sites. Results: After a mean follow-up period of 12.3±5.2 months, the clinical recurrence rates (25.6% vs. 23.9% in the V-Smax and the E-ABL group, p=0.880) or recurrence appearing as atrial tachycardia (11.1% vs. 5.7%, p=0.169) did not differ between the 2 groups. The post-ablation cardioversion rate was higher in the V-Smax group than E-ABL group (14.4% vs. 5.7%, p=0.027). Among antiarrhythmic drug-free patients (n=129), the AF freedom rate was 78.7% in the V-Smax group and 80.9% in the E-ABL group (p=0.776). The total procedure time was longer in the V-Smax group (p=0.008), but no significant difference was found in the major complication rates (p=0.497) between the groups. Conclusions: Unlike a dominant frequency ablation, the computational modeling-guided V-Smax ablation did not improve the rhythm outcome of the PeAF ablation and had a longer procedure time.

Discordance Between Angiographic Assessment and Fractional Flow Reserve or Intravascular Ultrasound in Intermediate Coronary Lesions: A Post-hoc Analysis of the FLAVOUR Trial

  • Jung-Hee Lee;Sung Gyun Ahn;Ho Sung Jeon;Jun-Won Lee;Young Jin Youn;Jinlong Zhang;Xinyang Hu;Jian'an Wang;Joo Myung Lee;Joo-Yong Hahn;Chang-Wook Nam;Joon-Hyung Doh;Bong-Ki Lee;Weon Kim;Jinyu Huang;Fan Jiang;Hao Zhou;Peng Chen;Lijiang Tang;Wenbing Jiang;Xiaomin Chen;Wenming He;Myeong-Ho Yoon;Seung-Jea Tahk;Ung Kim;You-Jeong Ki;Eun-Seok Shin;Doyeon Hwang;Jeehoon Kang;Hyo-Soo Kim;Bon-Kwon Koo
    • Korean Circulation Journal
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    • 제54권8호
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    • pp.485-496
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    • 2024
  • Background and Objectives: Angiographic assessment of coronary stenosis severity using quantitative coronary angiography (QCA) is often inconsistent with that based on fractional flow reserve (FFR) or intravascular ultrasound (IVUS). We investigated the incidence of discrepancies between QCA and FFR or IVUS, and the outcomes of FFR- and IVUS-guided strategies in discordant coronary lesions. Methods: This study was a post-hoc analysis of the FLAVOUR study. We used a QCA-derived diameter stenosis (DS) of 60% or greater, the highest tertile, to classify coronary lesions as concordant or discordant with FFR or IVUS criteria for percutaneous coronary intervention (PCI). The patient-oriented composite outcome (POCO) was defined as a composite of death, myocardial infarction, or revascularization at 24 months. Results: The discordance rate between QCA and FFR or IVUS was 30.2% (n=551). The QCA-FFR discordance rate was numerically lower than the QCA-IVUS discordance rate (28.2% vs. 32.4%, p=0.050). In 200 patients with ≥60% DS, PCI was deferred according to negative FFR (n=141) and negative IVUS (n=59) (15.3% vs. 6.5%, p<0.001). The POCO incidence was comparable between the FFR- and IVUS-guided deferral strategies (5.9% vs. 3.4%, p=0.479). Conversely, 351 patients with DS <60% underwent PCI according to positive FFR (n=118) and positive IVUS (n=233) (12.8% vs. 25.9%, p<0.001). FFR- and IVUS-guided PCI did not differ in the incidence of POCO (9.5% vs. 6.5%, p=0.294). Conclusions: The proportion of QCA-FFR or IVUS discordance was approximately one third for intermediate coronary lesions. FFR- or IVUS-guided strategies for these lesions were comparable with respect to POCO at 24 months.

한국농촌보건(韓國農村保健)의 문제점(問題點)과 개선방안(改善方案) (Innovative approaches to the health problems of rural Korea)

  • 노인규
    • 농촌의학ㆍ지역보건
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    • 제1권1호
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    • pp.5-9
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    • 1976
  • The categories of national health problems may be mainly divided into health promotion, problems of diseases, and population-economic problems which are indirectly related to health. Of them, the problems of diseases will be exclusively dealt with this speech. Rurality and Disease Problems There are many differences between rural and urban areas. In general, indicators of rurality are small size of towns, dispersion of the population, remoteness from urban centers, inadequacy of public transportation, poor communication, inadequate sanitation, poor housing, poverty, little education lack of health personnels and facilities, and in-accessibility to health services. The influence of such conditions creates, directly or indirectly, many problems of diseases in the rural areas. Those art the occurrence of preventable diseases, deterioration and prolongation of illness due to loss of chance to get early treatment, decreased or prolonged labour force loss, unnecessary death, doubling of medical cost, and economic loss. Some Considerations of Innovative Approach The followings art some considerations of innovative approaches to the problems of diseases in the rural Korea. 1. It would be essential goal of the innovative approaches that the damage and economic loss due to diseases will be maintained to minimum level by minimizing the absolute amount of the diseases, and by moderating the fee for medical cares. The goal of the minimization of the disease amount may be achieved by preventive services and early treatment, and the goal of moderating the medical fee may be achieved by lowering the prime cost and by adjusting the medical fees to reasonable level. 2. Community health service or community medicine will be adopted as a innovative means to disease problems. In this case, a community is defined as an unit area where supply and utilization of primary service activities can be accomplished within a day. The essential nature o the community health service should be such activities as health promotion, preventive measures, medical care, and rehabilitation performing efficiently through the organized efforts of the residents in a community. Each service activity should cover all members of the residents in a community in its plan and performance. The cooperation of the community peoples in one of the essential elements for success of the service program, The motivations of their cooperative mood may be activated through several ways: when the participation of the residents in service program of especially the direct participation of organized cooperation of the area leaders art achieved through a means of health education: when the residents get actual experience of having received the benefit of good quality services; and when the health personnels being armed with an idealism that they art working in the areas to help health problems of the residents, maintain good human relationships with them. For the success of a community health service program, a personnel who is in charge of leadership and has an able, a sincere and a steady characters seems to be required in a community. The government should lead and support the community health service programs of the nation under the basis of results appeared in the demonstrative programs so as to be carried out the programs efficiently. Moss of the health problems may be treated properly in the community levels through suitable community health service programs but there might be some problems which art beyond their abilities to be dealt with. To solve such problems each community health service program should be under the referral systems which are connected with health centers, hospitals, and so forth. 3. An approach should be intensively groped to have a physician in each community. The shortage of physicians in rural areas is world-wide problem and so is the Korean situation. In the past the government has initiated a system of area-limited physician, coercion, and a small scale of scholarship program with unsatisfactory results. But there might be ways of achieving the goal by intervice, broadened, and continuous approaches. There will be several ways of approach to motivate the physicians to be settled in a rural community. They are, for examples, to expos the students to the community health service programs during training, to be run community health service programs by every health or medical schools and other main medical facilities, communication activities and advertisement, desire of community peoples to invite a physician, scholarship program, payment of satisfactory level, fulfilment of military obligation in case of a future draft, economic growth and development of rural communities, sufficiency of health and medical facilities, provision of proper medical care system, coercion, and so forth. And, hopefully, more useful reference data on the motivations may be available when a survey be conducted to the physicians who are presently engaging in the rural community levels. 4. In communities where the availability of a physician is difficult, a trial to use physician extenders, under certain conditions, may be considered. The reason is that it would be beneficial for the health of the residents to give them the remedies of primary medical care through the extenders rather than to leave their medical problems out of management. The followings are the conditions to be considered when the physician extenders are used: their positions will be prescribed as a temporary one instead of permanent one so as to allow easy replacement of the position with a physician applicant; the extender will be under periodic direction and supervision of a physician, and also referral channel will be provided: legal constraints will be placed upon the extenders primary care practice, and the physician extenders will used only under the public medical care system. 5. For the balanced health care delivery, a greater investment to the rural areas is needed to compensate weak points of a rurality. The characteristics of a rurality has been already mentioned. The objective of balanced service for rural communities to level up that of urban areas will be hard to achieve without greater efforts and supports. For example, rural communities need mobile powers more than urban areas, communication network is extremely necessary at health delivery facilities in rural areas as well as the need of urban areas, health and medical facilities in rural areas should be provided more substantially than those of urban areas to minimize, in a sense, the amount of patient consultation and request of laboratory specimens through referral system of which procedures are more troublesome in rural areas, and more intensive control measures against communicable diseases are needed in rural areas where greater numbers of cases are occurred under the poor sanitary conditions.

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비인강암의 병합요법 (Combined Modality Treatment in Nasopharyngeal Carcinoma)

  • 윤상모;김재철;박인규
    • Radiation Oncology Journal
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    • 제19권2호
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    • pp.100-106
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    • 2001
  • 목적 : 국소 진행된 비인강암으로 유도 화학요법 혹은 동시 화학요법 및 방사선 치료를 받은 환자들의 부작용 및 단기 생존율을 비교하기 위하여 본 연구를 시행하였다. 대상 및 방법 : 1989년 10월부터 1998년 5월까지, 비인강암으로 진단받고 유도 화학요법 혹은 동시 화학요법 및 방사선 치료를 받은 62명의 환자들을 대상으로 후향적 분석을 시행하였다. 유도 화학요법군은 50명, 동시 화학요법군은 12명이었다. 나이, 성, 전신 수행능력, 조직학적 유형 등은 양군에서 비교적 고르게 분포하였다. 병기 분포는, 유도 화학요법군의 경우 IIB가 $32\%$, III가 $30\%$, 그리고 IV가 $38\%$였으며, 동시 화학요법군은 각각 50, 33.3, $16.7\%$였다. 양군에서 화학요법 약제는 CF (cisplatin and 5-FU)였고, 약제 투여 방법은 동일하였다. Cisplatin $100\;mg/m^2$을 day 1에, 5-FU $1,000\;mg/m^2$을 day $2\~6$에 각각 정맥투여하였으며 3주 간격으로 반복하였다. 방사선 치료 종료시까지 시행된 화학요법의 횟수는 양군 모두 테$1\~3$회(중앙값 2회)였다. 방사선 치료는 양군 모두 일일선량 $1.8\~2.0\;Gy$를 주 5회 조사하였다. 총 방사선량은, 유도 화학요법군의 경우 $69.4\~86\;Gy$ (중앙 선량 73.4 Gy), 동시 화학요법군은 $69.4\~75.4\;Gy$ (중앙 선량 70.8 Gy)였다. 추적기간은, 유도 화학요법군의 경우 $9\~l16$개월(중앙값 40.5개월), 동시 화학요법군은 $14\~29$개월(중앙값 21개월)이었다. 결과 : 전체 환자에서 2년 생존율은 $78.7\%$였다. 치료 방법별 2년 전체 생존율은, 유도 화학요법군이 $77\%$, 동시 화학요법군은 $87\%$였으며(p>0.05), 2년 무병 생존율은 각각 $56\%$$81\%$였다(p>0.05). 최종 치료에 대한 완전 관해율은 $75.5\%$$91.7\%$로 동시 화학요법군에서 높았으나 통계학적 유의성은 없었다. 방사선 치료시 grade $3\~4$의 혈액학적 독성은 양군에서 차이가 없었고, grade 2의 백혈구 감소가 동시 화학요법군에서 많았다 $(18\%\;vs\;66.7\%)$. Grade $3\~4$의 점막염은 동시 화학요법군에서 많았다$(4.0\%\;vs\;33.3\%)$. 전체적으로 grade $3\~4$의 급성 부작용이 동시 화학요법군에서 빈번하였고$(6.0\%\;vs\;41.7\%,\;p=0.005)$, 부작용으로 사망한 경우는 없었다. 결론 : 국소 진행된 비인강암에서 동시 화학요법을 시행함으로써 치료의 반응율과 2년 무병 생존율이 향상되는 경향을 보였으나, 통계학적 의의는 없었다. 따라서, 좀더 많은 대조군과 장기 추적관찰이 요구된다.

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