• Title/Summary/Keyword: medical collaboration

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Evaluation of a Community-Based Cancer Patient Management Program: Collaboration between a Hospice Center and Public Health Centers (병원 호스피스센터-보건소 연계를 통한 지역사회 재가암환자 관리 프로그램 평가)

  • Lee, Hae-Sook;Park, Sun-Hee;Chung, Young-Soon;Lee, Boo-Kyung;Kwon, So-Hi
    • Journal of Hospice and Palliative Care
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    • v.13 no.4
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    • pp.216-224
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    • 2010
  • Purpose: The purpose of this study was to evaluate a community-based cancer patient management program (CBPCMP) which was collaborated between a hospice center and public health centers. Methods: The CBPCMP proceeded on four steps; 1) Signing agreements with three public health centers, 2) Enrolling the domiciliary terminal cancer patients, 3) Providing home hospice service, and 4) Inquiring patient's level of satisfaction. From February 1 to December 31 in 2009, 43 terminal cancer patients were referred and provided with home hospice service. The hospice team made a total of 605 visits. Medical records for each visit and data from satisfaction surveys were analyzed. Results: 76.7% of patients were older than 60 years, and 90.7% of the patients were alert. The level of functional status for 76.7% of patients rated as lower than ECOG grade 1. 62.8% of the patients or their caregivers signed hospice service agreements. On the initial evaluation, the most frequent reasons for referral were general weakness (86.0%), followed by anorexia (72.1%). Nurses visited the patients' most frequently (371 visits), followed by volunteers (216 visits). Nurses provided emotional support and health promotion counseling on 95.1% and 22.9% of visits, respectively. The mean satisfaction score rated by patients and their family was 4.45 out of 5. Conclusion: This study tested CBPCMP in collaboration with hospice centers and public health centers. CBPCMP showed a possibility to improve the quality of end of life care. To insure the quality care, however, the guidelines for home hospice service should be developed.

Development of User Based Recommender System using Social Network for u-Healthcare (사회 네트워크를 이용한 사용자 기반 유헬스케어 서비스 추천 시스템 개발)

  • Kim, Hyea-Kyeong;Choi, Il-Young;Ha, Ki-Mok;Kim, Jae-Kyeong
    • Journal of Intelligence and Information Systems
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    • v.16 no.3
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    • pp.181-199
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    • 2010
  • As rapid progress of population aging and strong interest in health, the demand for new healthcare service is increasing. Until now healthcare service has provided post treatment by face-to-face manner. But according to related researches, proactive treatment is resulted to be more effective for preventing diseases. Particularly, the existing healthcare services have limitations in preventing and managing metabolic syndrome such a lifestyle disease, because the cause of metabolic syndrome is related to life habit. As the advent of ubiquitous technology, patients with the metabolic syndrome can improve life habit such as poor eating habits and physical inactivity without the constraints of time and space through u-healthcare service. Therefore, lots of researches for u-healthcare service focus on providing the personalized healthcare service for preventing and managing metabolic syndrome. For example, Kim et al.(2010) have proposed a healthcare model for providing the customized calories and rates of nutrition factors by analyzing the user's preference in foods. Lee et al.(2010) have suggested the customized diet recommendation service considering the basic information, vital signs, family history of diseases and food preferences to prevent and manage coronary heart disease. And, Kim and Han(2004) have demonstrated that the web-based nutrition counseling has effects on food intake and lipids of patients with hyperlipidemia. However, the existing researches for u-healthcare service focus on providing the predefined one-way u-healthcare service. Thus, users have a tendency to easily lose interest in improving life habit. To solve such a problem of u-healthcare service, this research suggests a u-healthcare recommender system which is based on collaborative filtering principle and social network. This research follows the principle of collaborative filtering, but preserves local networks (consisting of small group of similar neighbors) for target users to recommend context aware healthcare services. Our research is consisted of the following five steps. In the first step, user profile is created using the usage history data for improvement in life habit. And then, a set of users known as neighbors is formed by the degree of similarity between the users, which is calculated by Pearson correlation coefficient. In the second step, the target user obtains service information from his/her neighbors. In the third step, recommendation list of top-N service is generated for the target user. Making the list, we use the multi-filtering based on user's psychological context information and body mass index (BMI) information for the detailed recommendation. In the fourth step, the personal information, which is the history of the usage service, is updated when the target user uses the recommended service. In the final step, a social network is reformed to continually provide qualified recommendation. For example, the neighbors may be excluded from the social network if the target user doesn't like the recommendation list received from them. That is, this step updates each user's neighbors locally, so maintains the updated local neighbors always to give context aware recommendation in real time. The characteristics of our research as follows. First, we develop the u-healthcare recommender system for improving life habit such as poor eating habits and physical inactivity. Second, the proposed recommender system uses autonomous collaboration, which enables users to prevent dropping and not to lose user's interest in improving life habit. Third, the reformation of the social network is automated to maintain the quality of recommendation. Finally, this research has implemented a mobile prototype system using JAVA and Microsoft Access2007 to recommend the prescribed foods and exercises for chronic disease prevention, which are provided by A university medical center. This research intends to prevent diseases such as chronic illnesses and to improve user's lifestyle through providing context aware and personalized food and exercise services with the help of similar users'experience and knowledge. We expect that the user of this system can improve their life habit with the help of handheld mobile smart phone, because it uses autonomous collaboration to arouse interest in healthcare.

A Study of the Effect of Structured Rehabilitation Education on the Stress of the Family with Stroke Patients (구조화된 재활교육이 뇌졸중환자 가족의 스트레스에 미치는 영향)

  • Kim, Byung-Eun;Lee, Jung-Min;Lee, Hyang-Yeon
    • Journal of East-West Nursing Research
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    • v.1 no.1
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    • pp.22-39
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    • 1997
  • Purpose: The purpose of this study is to evaluate the effect of rehabilitation education on the reduction of the stress of family members who have patients suffering from stroke and to find a new way to nurse the patients and their family. Subjects & Methods: The subjects were sixty-one family members with the patients who had been hospotalized in K hospital of oriental medicine from september the 9th, 1996 to september the fourteen, 1996. This study was performed by simulated control group pretest-posttest design; pretest was done on the control group through a questionnaire, counselling and observation while posttest was done on the experimental group 1-2 days after systemic rehabilitation education. To teach the patients and their family, the amended version of a book written by Lee Hae-jin was used as a tool for systemic rehabilitation education. As a method to estimate ADL score, modified Kang's method was applied and ADL score was measured by well-trained technician. As for the tool to estimate the degree of family stress, Choi's method adjusted to this study was applied. In the analysis of the data, social property of the patient and the characteristic of the disease were surveyed in $X^2$ examination to confirm the consistency between the experimental group and the control group. The diffrence in the degree of the stress, which is a dependent factor, was examined by t-test. The difference in ADL score between the experimental group and the control group was examined by t-test. The difference in the degree of the stress according to the general feature of the family with stroke patient, social property of the patients and the characteristic of the disease were surveyed by F examination. The difference in family stress according to the degree of ADL was surveyed by F examination. RESULTS: 1. After hypothetically-examined systemic rehabilitation education, the total of the score of family stress surveyed in 34 items of three domains was compared between the experimental group and the control group. There was no statistically significant difference between two groups; mean score of experimental group=2.28, that of control group=2.93(t=.17, df=59, p=. 66). 2. In the survey on family stress in 34 items, the items over mean score 3.0 were firstly the anxiety of possible disability and relapse of the disease and secondly to watch the patient's suffering without doing anything in the domain of the change of the disease and the difficulty in caring. And the items of the lowest stress with less than mean 2.0 score were little chance to meet the relative and friends, inconsistent treatment and attitude of the medical workers and the change of the attitude of the relative due to the patient orderly in the domain of social and personal relation and the responsibility as the family. The items which showed the difference between two groups were aggravation of neighboring patient(t=3.36, df= 59, p=.001) and the possibility of patient's death(t=2.19, df=58.38, p=.033) in the domain of the change of the disease and the difficulty in caring. 3. In the study on the stress difference according to general features of the family with the stroke patient, the score of family stress with the occupation was higher with mean 2.49 than that of the family stress without occupation with mean 2.16, but there was no significant difference. (F=5.21, df=1/59, p=.026). 4. In the study on the stress difference according to social property of the patient and the characteristic of the disease, there was significant difference in the age of the patients (F=2.98, df=3/57, p=.039). These results show that even if there is no statistically significant difference between two groups, sixteen of the experimental group are less than 3.0 in ADL score(standard 6 score)while eight of the control group are less than 3.0 and that ten of the experimental group are in the year range of 39-49 while four of the control group are in the year range of 39-49 which showed significant difference in family stress. These imply that there is a possibility that the experimental group have serious and fundamental stress resulting in high pretest stress compared with the control group. It might be due to the characteristic of simulated control group pretest-posttest design that the psychologic-supportive effect by the education was not observed. On the basis of these results, the followings are suggested. 1) A study on the nursing-mediated method to reduce the stress in the items which are not resolved by rehabilitation education, a study on nursing according to the patient's age and a study on the supportive nursing toward the family with occupation are required. 2) More than two times consecutive nursing-mediated rehabilitation education to measure the family stress is required. 3) Comprehensive and multilateral systemic education program including the instruction on western-eastern medicine, physical therapy, exercise and diet through collaboration of the experts in each field is required. 4) Family stress at home as well as in the hospital needs to be estimated and home rehabilitation and home-nursing needs to be continued.

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Wearable Computers

  • Cho, Gil-Soo;Barfield, Woodrow;Baird, Kevin
    • Fiber Technology and Industry
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    • v.2 no.4
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    • pp.490-508
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    • 1998
  • One of the latest fields of research in the area of output devices is tactual display devices [13,31]. These tactual or haptic devices allow the user to receive haptic feedback output from a variety of sources. This allows the user to actually feel virtual objects and manipulate them by touch. This is an emerging technology and will be instrumental in enhancing the realism of wearable augmented environments for certain applications. Tactual displays have previously been used for scientific visualization in virtual environments by chemists and engineers to improve perception and understanding of force fields and of world models populated with the impenetrable. In addition to tactual displays, the use of wearable audio displays that allow sound to be spatialized are being developed. With wearable computers, designers will soon be able to pair spatialized sound to virtual representations of objects when appropriate to make the wearable computer experience even more realistic to the user. Furthermore, as the number and complexity of wearable computing applications continues to grow, there will be increasing needs for systems that are faster, lighter, and have higher resolution displays. Better networking technology will also need to be developed to allow all users of wearable computers to have high bandwidth connections for real time information gathering and collaboration. In addition to the technology advances that make users need to wear computers in everyday life, there is also the desire to have users want to wear their computers. In order to do this, wearable computing needs to be unobtrusive and socially acceptable. By making wearables smaller and lighter, or actually embedding them in clothing, users can conceal them easily and wear them comfortably. The military is currently working on the development of the Personal Information Carrier (PIC) or digital dog tag. The PIC is a small electronic storage device containing medical information about the wearer. While old military dog tags contained only 5 lines of information, the digital tags may contain volumes of multi-media information including medical history, X-rays, and cardiograms. Using hand held devices in the field, medics would be able to call this information up in real time for better treatment. A fully functional transmittable device is still years off, but this technology once developed in the military, could be adapted tp civilian users and provide ant information, medical or otherwise, in a portable, not obstructive, and fashionable way. Another future device that could increase safety and well being of its users is the nose on-a-chip developed by the Oak Ridge National Lab in Tennessee. This tiny digital silicon chip about the size of a dime, is capable of 'smelling' natural gas leaks in stoves, heaters, and other appliances. It can also detect dangerous levels of carbon monoxide. This device can also be configured to notify the fire department when a leak is detected. This nose chip should be commercially available within 2 years, and is inexpensive, requires low power, and is very sensitive. Along with gas detection capabilities, this device may someday also be configured to detect smoke and other harmful gases. By embedding this chip into workers uniforms, name tags, etc., this could be a lifesaving computational accessory. In addition to the future safety technology soon to be available as accessories are devices that are for entertainment and security. The LCI computer group is developing a Smartpen, that electronically verifies a user's signature. With the increase in credit card use and the rise in forgeries, is the need for commercial industries to constantly verify signatures. This Smartpen writes like a normal pen but uses sensors to detect the motion of the pen as the user signs their name to authenticate the signature. This computational accessory should be available in 1999, and would bring increased peace of mind to consumers and vendors alike. In the entertainment domain, Panasonic is creating the first portable hand-held DVD player. This device weight less than 3 pounds and has a screen about 6' across. The color LCD has the same 16:9 aspect ratio of a cinema screen and supports a high resolution of 280,000 pixels and stereo sound. The player can play standard DVD movies and has a hour battery life for mobile use. To summarize, in this paper we presented concepts related to the design and use of wearable computers with extensions to smart spaces. For some time, researchers in telerobotics have used computer graphics to enhance remote scenes. Recent advances in augmented reality displays make it possible to enhance the user's local environment with 'information'. As shown in this paper, there are many application areas for this technology such as medicine, manufacturing, training, and recreation. Wearable computers allow a much closer association of information with the user. By embedding sensors in the wearable to allow it to see what the user sees, hear what the user hears, sense the user's physical state, and analyze what the user is typing, an intelligent agent may be able to analyze what the user is doing and try to predict the resources he will need next or in the near future. Using this information, the agent may download files, reserve communications bandwidth, post reminders, or automatically send updates to colleagues to help facilitate the user's daily interactions. This intelligent wearable computer would be able to act as a personal assistant, who is always around, knows the user's personal preferences and tastes, and tries to streamline interactions with the rest of the world.

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Ginseng Research in Natural Products Research Institute (NPRI) and the Pharmaceutical Industry Complex in Gaesong (생약연구소의 인삼연구와 약도개성)

  • Park, Ju-young
    • Journal of Ginseng Culture
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    • v.3
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    • pp.54-73
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    • 2021
  • The Natural Products Research Institute (NPRI, 生藥硏究所), an institution affiliated with Keijo Imperial University (京城帝國大學), was the predecessor of the NPRI at Seoul National University and a comprehensive research institute that focused on ginseng research during the Japanese colonial era. It was established under the leadership of Noriyuki Sugihara (杉原德行), a professor of the second lecture in pharmacology at the College of Medicine in Keijo Imperial University. Prof. Sugihara concentrated on studying Korean ginseng and herbal medicine beginning in 1926 when the second lecture of pharmacology was established. In addition to Prof. Sugihara, who majored in medicine and pharmacology, Kaku Tenmin (加來天民), an assistant professor who majored in pharmacy; Tsutomu Ishidoya (石戶谷勉), a lecturer who majored in agriculture and forestry; and about 36 researchers actively worked in the laboratory before the establishment of the NPRI in 1939. Among these personnel, approximately 14 Korean researchers had basic medical knowledge, derived mostly from specialized schools, such as medical, dental, and pharmaceutical institutions. As part of the initiative to explore the medicinal herbs of Joseon, the number of Korean researchers increased beginning in 1930. This increase started with Min Byung-Ki (閔丙祺) and Kim Ha-sik (金夏植). The second lecture of pharmacology presented various research results in areas covering medicinal plants in Joseon as well as pharmacological actions and component analyses of herbal medicines. It also conducted joint research with variousinstitutions. Meanwhile, in Gaesong (開城), the largest ginseng-producing area in Korea, the plan for the Pharmaceutical Industry Complex was established in 1935. This was a large-scale project aimed at generating profits through research on and the mass production of drugs and the reformation of the ginseng industry under collaboration among the Gaesong Ministry, Kwandong (關東) military forces, Keijo Imperial University, and private organizations. In 1936 and 1938, the Gyeonggi Provincial Medicinal Plant Research Institute (京畿道立 藥用植物硏究所) and the Herb Garden of Keijo Imperial University (京城帝國大學 藥草園) and Pharmaceutical Factory were established, respectively. These institutions merged to become Keijo Imperial University's NPRI, which wasthen overseen by Prof. Sugihara as director. Aside from conducting pharmacological research on ginseng, the NPRI devoted efforts to the development and sale of ginseng-based drugs, such as Sunryosam (鮮麗蔘), and the cultivation of ginseng. In 1941, the Jeju Urban Test Center (濟州島試驗場) was established, and an insecticide called Pancy (パンシ) was produced using Jeju-do medicinal herbs. However, even before research results were published in earnest, Japanese researchers, including Prof. Sugihara, hurriedly returned to Japan in 1945 because of the surrender of Japanese forces and the liberation of Korea. The NPRI was handed over to Seoul National University and led by Prof. Oh Jin-Sup (吳鎭燮), a former medical student at Keijo Imperial University. Scholars such as Woo Lin-Keun (禹麟根) and Seok Joo-Myung (石宙明) worked diligently to deal with the Korean pharmaceutical industry.

An Exploratory Study on the Care Farm Governance: Focusing on the Netherlands and Belgium Cases (케어팜 거버넌스에 대한 탐색적 연구: 네덜란드와 벨기에 사례를 중심으로)

  • Hwang, Jeong Seop;Hwang, Yoon Min
    • The Journal of the Korea Contents Association
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    • v.20 no.4
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    • pp.358-372
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    • 2020
  • Recently, there has been growing social interest in the use of care farms as part of therapy for neurological or mental patients and regional innovation for rural areas. Care farm, which combines the health treatment and rural innovation perspectives, is important to establish a proper governance system for mutual collaboration with various stakeholders. However, there is still a lack of research on this. Therefore, this study designed the care farm governance framework and comparatively analyzed the governance between Netherlands paradise care farm and Belgium blue farm, which are major successful care farm cases. The results showed different governance system between Netherlands and Belgium care farm in terms of institutional and financial support, regional characteristics, structure, operation, and strategy. In Netherlands, as the central government-initiated therapy-centric, care farm governance is concentrated in treatment of patient mainly supported by Ministry of Health, Welfare and Sports under the law on social support. Whereas, in Belgium, as local government-initiated agriculture-centric, care farm governance is mainly focused to lead voluntary participation of agricultural cooperatives and medical institutions in regional area. This study provides a theoretical foundation of governance type and system for the care farm research and suggests guidelines of care farm governance for the governments like South Korea consider activating care farm.

Mediating effect of perceived stigma against epilepsy on quality of life among parents with epileptic child (간질아동 부모의 삶의 질에 대한 지각된 낙인의 매개효과)

  • Kim, Nho Eun;Cho, Sung Min;Kim, Dong Wook
    • Clinical and Experimental Pediatrics
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    • v.52 no.9
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    • pp.1005-1014
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    • 2009
  • Purpose:Epilepsy of child may cause high level of psychosocial difficulties for parents including stigmatization and stress and therefore worsen their quality of life (QOL). The purpose of this study was to evaluate the mediating effect of perceived stigma against epilepsy on QOL among parents with epileptic child. Methods:Two hundred and sixty parents of epileptic child recruited from five separated university hospital child neurology clinics specializing in epilepsy completed a demographic questionnaire, a medical questionnaire, a perceived stigma questionnaire and the Ro's Quality of Life Inventory, a popular tool for evaluating QOL of adults in Korea which is composed of 6 domains and 47 questions. Data was analyzed with SPSS 14.0 program using frequency analysis and descriptive analysis and with AMOS 7.0 program using Structural Equation Model (SEM) analysis. Results:The level of parents' QOL was relatively fair. SEM analysis on the quality of life level of parents showed that all variables (especially having religion, the monthly income, employment state, age of child, the leisure time, the perceived stigma level against epilepsy, and seizure frequency) directly affect the quality of life level of parents and that disease-related variables also affect the quality of life level of parents indirectly through the mediating factor (the perceived stigma), where the indirect effect is large with the existence of combined disabilities. The total effect on the quality of life level of parents is large with the existence of combined disabilities, the perceived stigma level, the leisure time, having religion, and the monthly income. Conclusion:The results of this study indicated that many factors including parents' perceived stigma may affect the quality of life of parents with epileptic children directly, and that some disease-related factors may affect indirectly through a mediating factor, the perceived stigma. Multidisciplinary collaboration would be imperative for their welfare.

Reports on 'Meeting on the Revision of Guidelines for Clinical Research on Acupuncture' (WHO 침구임상 지침서 개정을 위한 국제회의 보고)

  • Park, Hi-Joon;Seo, Jung-Chul;Kim, Se-Hyun;Kim, Sang-Woo;An, Kyung-Eh;Lim, Sabina;Kim, Yong-Suk;Choi, Do-Young;Kang, Sung-Keel
    • Journal of Acupuncture Research
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    • v.22 no.5
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    • pp.195-199
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    • 2005
  • The Working Group on the revision of Clinical Research Methodology for Acupuncture met in Seoul, Republic of Korea from 24 to 26 August 2005. The main objectives of the meeting were to review the regional publication guidelines for Clinical Research on Acupuncture, to make necessary revisions in the guidelines, to make recommendations on further collaboration and activities in the field of research on acupuncture, and to discuss scientific evidence-based approaches in the clinical research on acupuncture. Fourteen members from the eight Member States, one secretariat staff from the WHO Regional Office for the Western Pacific and ten observers from the Republic of Korea attended the meeting. The members presented their papers to review the current status of clinical research on acupuncture. The drafts of proposed revision to the previous guidelines for clinical research methodology on acupuncture were discussed extensively. The issues covered during the discussion included: the definition of the new terms; reorganization of clinical research design; revision and update of contents (e.g., control group); introduction of Institutional Review Board (IRB) on the section of ethical approval; additional outcomes including health-related quality of life (HRQOL), qualitative measures, etc. In the course of these discussions, the working group developed the revised guidelines for clinical research on acupuncture and made recommendations for promoting the dissemination of the revised guidelines.

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Analysis and Application Methods of Patent Map for Performance Diffusion of Translational Research in Health Technology Research and Development (보건의료 R&D 연구성과 활용·확산을 위한 특허맵 분석 및 활용방안 연구)

  • Cheon, Su-Hwan;Lee, Kyung-Min;Kim, Mi-Kyoung;Je, Young-Tae;Shin, Sang-Hun;Kim, Myung-Hwan;Kim, Dong-Seok;Park, Seong-Ho;Kim, Gi-Tae;Kwak, Jung-Ae;Jeon, Hye-Kyoung;Kwon, Jun-Young;Kim, Dong-Il;Kim, Byung-Soo;Park, Noh-Hyun
    • KSBB Journal
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    • v.28 no.6
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    • pp.339-348
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    • 2013
  • Translational research (TR) as high quality research can accelerate collaboration strongly between biotechnology-based researchers and clinical-research experts for overcoming diseases. TR facilitates basic science translated to clinical efficacy and effectiveness from bench (basic science) to bedside (clinical practice) for the enhancement of human health. Disease-oriented TR programs were defined as unilateral, bilateral and multilateral TR in this patent performance analysis. Patent performance was measured in a R&D project on Health and Medical Technology to enhance the productivity of R&D investment on disease-oriented TR in Health Technology (HT). Patent Map (PM) analysis and Bibliometrics were conducted to collect information for the assessment of research patents of TR programs. Futhermore, PIAS (Patent Information Analysis System) and Thinklear programs were applied for quantitative and qualitative analysis successfully. These indicate that multi-dimensional analysis of patent performance for disease-oriented TR could promote the connection of R&D-IP (Research and Development-Intellectural Property) and R&BD (Research and Business Development) supporting system significantly.

Dental Treatment of Children with CATCH 22 Syndrome: Case Report (CATCH 22 증후군을 가진 어린이의 치과치료)

  • Kim, Mi Sun;Lee, Soo Eon;Ahn, Hyo Jung;Park, Jae-Hong;Choi, Sung Chul
    • Journal of The Korean Dental Society of Anesthesiology
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    • v.13 no.1
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    • pp.13-18
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    • 2013
  • CATCH 22 syndrome is a one of the most common chromosome microdeletion syndrome with multiple organ anomalies in humans, with an incidence of approximately 1:4,000 to 1:5,000 live births. It is caused by a microdeletion of 1.5 to 3.0 megabases on the long arm of chromosome 22. The phenotypic spectrum of this disorder is wide and various. A 19-year-old patient who showed delayed growth and development (Height; 110 cm, Weight; 18 kg) was referred to our department for the treatment of dental cavities. She was diagnosed as CATCH 22 syndrome in 2004. Physical examination revealed hypertelorism, a short philtrum, thick reflected lips and a small mouth. She underwent cleft palate surgery at 1 year of age and heart valve surgery due to the cardiovascular abnormality at 13 years of age. Convulsive seizures had persisted until 5 years ago but are well controlled at present. Oral examination showed poor oral hygiene, crowding, prolonged retention on #65, 75 and dental cavities on #16, 21, 65, 26, 36, and 46. Cavity treatment and prophylaxis were performed under general anesthesia. Also continuous follow-up checks have been carrying out with the periodic prophylaxis and dental home education. Problems with numerous cavities and gingivitis which can lead to specific risks are common for CATCH 22 syndrome patients. It is therefore of great importance that these patients are referred to foremost physician and dental specialist for the oral care. In addition, preventive treatment targeting the risk of dental cavities and gingivitis is especially important and, as the syndrome involves many different medical problems, the dental treatment should be carried out in collaboration with the patient's physician.