• Journal of Korean Biological Nursing Science
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• v.20 no.4
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• pp.228-235
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• 2018

Purpose: This study aimed to investigate the clinical alarm occurrence and management of nurses toward clinical alarms in the intensive care unit (ICU). Methods: This observational study was conducted with 40 patients and nurses cases in two ICUs of a university hospital. This study divided 24 hours into the unit of an hour and conducted two times of direct observation per unit hour for 48 hours targeting the medical devices applied to 40 patients. Data were analyzed using IBM SPSS Statistics 23. Results: On average, 3.8 units of medical devices were applied for each patient and the ranges of alarm settings were wide. During 48 hours, 184 cases of clinical alarm were occurred by four types of medical devices including physiological monitors, mechanical ventilators, infusion pumps, and continuous renal replacement therapy. Among them, false alarm was 110 cases (59.8%). As for the alarm management by ICU nurses, two-minute alarm mute took up most at 38.0% (70 cases), and no response was second most at 32.6% (60 cases). When valid alarm sounded, nurses showed no response at 43.2%. Conclusion: The findings suggest that a standard protocol for alarm management should be developed for Korean ICU settings. Based on the protocol, continuous training and education should be provided to nurses for appropriate alarm management.

• Tuberculosis and Respiratory Diseases
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• v.82 no.2
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• pp.151-157
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• 2019

Background: Tuberculosis (TB) is the most important disease screened for upon patient history review during preimmigration medical examinations as performed in South Korea in prospective immigrants to certain Western countries. In 2007, the U.S. Centers for Disease Control and Prevention (CDC) changed the TB screening protocol from a smear-based test to the complete Culture and Directly Observed Therapy Tuberculosis Technical Instructions (CDOT TB TI) for reducing the incidence of TB in foreign-born immigrants. Methods: This study evaluated the effect of the revised (as compared with the old) protocol in South Korea. Results: Of the 40,558 visa applicants, 365 exhibited chest radiographic results suggestive of active or inactive TB, and 351 underwent sputum tests (acid-fast bacilli smear and Mycobacterium tuberculosis culture). To this end, using the CDOT TB TI, 36 subjects (88.8 per $10^5$ of the population) were found to have TB, compared with only seven using the older U.S. CDC technical instruction (TI) (p<0.001). In addition, there were six drug-resistant cases which were identified (16.7 per $10^5$ of the population), two of whom had multidrug-resistance (5.6 per $10^5$ of the population). Conclusion: The culture-based 2007 TI identified a great deal of TB cases current to the individuals tested, as compared to older U.S. CDC TI.

• Progress in Medical Physics
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• v.31 no.3
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• pp.63-70
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• 2020

Stereotactic radiosurgery is one of the most sophisticated forms of modern advanced radiation therapy. Unlike conventional fractionated radiotherapy, stereotactic radiosurgery uses a high dose of radiation with steep gradient precisely delivered to target lesions. Lars Leksell presented the principle of radiosurgery in 1951. Gamma Knife^® (GK) is the first radiosurgery device used in clinics, and the first patient was treated in the winter of 1967. The first GK unit had 179 cobalt 60 sources distributed on a hemispherical surface. A patient could move only in a single direction. Treatment planning was performed manually and took more than a day. The latest model, Gamma Knife^® Icon^TM, shares the same principle but has many new dazzling characteristics. In this article, first, a brief history of radiosurgery was described. Then, the physical properties of modern radiosurgery machines and physicists' endeavors to assure the quality of radiosurgery were described. Intrinsic characteristics of modern radiosurgery devices such as small fields, steep dose distribution producing sharp penumbra, and multi-directionality of the beam were reviewed together with the techniques to assess the accuracy of these devices. The reference conditions and principles of GK dosimetry given in the most recent international standard protocol, International Atomic Energy Agency TRS 483, were shortly reviewed, and several points needing careful revisions were highlighted. Understanding the principles and physics of radiosurgery will be helpful for modern medical physicists.

• The Journal of Korean society of community based occupational therapy
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• v.7 no.1
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• pp.25-35
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• 2017

Objective : The aims of this study was to investigate the effects of modified constraint induced movement therapy(CIMT) on upper extremities function of children with hemiplegic cerebral palsy. Methods : The participants of this study are 4 children with hemiplegic cerebral palsy aged between 8 to 11 years old. During the modified CIMT period, the unaffected hand of the subjects was restrained by a hand splint for 8 weeks, five days per week, five hours a day. And the affected upper extremity was strongly trained by performing functional tasks, which were individually structured use of the affected arm. Measurements used to assess hand function are Jebsen Hand Function Test, and 3D Motion Analysis. The Jebsen Hand Function Test was performed repeatedly every two weeks. The 3D Motion Analysis was performed before and after the 8 weeks of modified constraint induced movement therapy. Results : After the modified CIMT, there was a significant improvement in completed time for the 6 tasks of Jebsen Hand Function Test(p<.05). 3D Motion Analysis was that the finger tapping and the hand tapping has been significantly decreased (p<.05), and the pronation-supination movement has been significantly increased as well(p<.05). Conclusion : In the results of this study, it is evidenced that modified CIMT is effective treatment for upper extremities function of children with hemiplegic cerebral palsy. For future research, it is recommended to examine various periods and protocol of modified CIMT including impact of long periods application.

• The Journal of Korean society of community based occupational therapy
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• v.8 no.3
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• pp.77-89
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• 2018

Objective : The purpose of this study was to analyze occupational therapy intervention on the community mobility for stroke patients, and to provide evidence of intervention in the clinical fields. Methods : A systematic review was executed according to the PRISMA checklist. The accessed database was PubMed, EMBASE, Cochrane Library (CENTRAL), ProQuest Dissertations & thesis (PQDT), RISS, and KoreaMed. We included the articles published from 2005 to September 2018. RoBANS checklist was used to evaluate the quality of the articles. Included articles, totally eight, were categorized according to the type of intervention. Results : The study design of the literature was varied from two-group randomized trial, quasi-experimental study, case-control trial, one group pre-post comparison study, and cross-sectional study. In the evidence level, 6 articles were included in level II (75%). The percentage of low risk of bias in each article ranged from 52.5%~87.5%. Four studies (50%) provided intervention based on virtual reality or virtual environment. The three (37.5%) provided intervention based on the protocol, and the other (12.5%) did wheelchair training. All studies reported significant effects of the intervention. Conclusion : This systematic review provided evidences to use proper intervention in the clinical fields. Various type of studies should be conducted to prove the effect of occupational therapy intervention for community mobility.

• Progress in Medical Physics
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• v.28 no.4
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• pp.190-196
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• 2017

For the $ViewRay^{(R)}$ system (ViewRay Inc., Cleveland, OH, USA) which is representative of magnetic resonance (MR) guided radiotherapy machine, it is important to evaluate effectiveness of AAPM's TG-51 protocol and the effect of the magnetic field on absolute dosimetry. In order to measure the absolute dose, MR-compatible chamber and water phantom system manufactured in this study were used. The materials of the water phantom system were plastic of polymethyl methacrylate (PMMA) and non-ferrous materials. Due to the inherent feature of the $ViewRay^{(R)}$, all Co-60 sources are not located at gantry angle of $0^{\circ}$ while being located at gantry angle of $90^{\circ}$. For this reason, absolute dosimetry was performed based on the measurements in solid water phantom (SWP) and water which determine the SWP to water correction factor. For evaluation of output constancy with gantry angle, measurements were made with ionization chamber inserted in cylindrical water-equivalent phantom. For measured doses in water, the values of dose deviation according to a reference dose of 200 cGy for Head 1, Head 2 and Head 3 were -0.27%, -0.45% and -0.22%, respectively. For measured doses in SWP, the values of dose deviation according to a reference dose of 200 cGy for Head 1, Head 2 and Head 3 were -1.91%, -2.07% and -1.84%, respectively. All values of dose measured in SWP tended to be less than those measured in water by -1.63%. With the reference gantry angles of $0^{\circ}$ and $90^{\circ}$, the maximum values of deviation for Head 1, Head 2 and Head 3 were 0.48%, 1.06% and 0.40%, respectively. The measurement agreement is within the range of results obtainable for conventional treatment machines. The low strength of the magnetic field does not affect dose measurements. Using the SWP to water correction factor, absolute doses for $ViewRay^{(R)}$ system can be measured.

• Progress in Medical Physics
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• v.16 no.3
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• pp.116-124
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• 2005

Absorbed dose dosimetry protocols of high energy photon and electron beams, which are widely used and based on an air kerma calibration factors, have somewhat complex formalism and limitations for improving dosimetric accuracy due to uncertainty of the physical parameters used. Recently the IAEA and the AAPM published the absorbed dose to water-based dosimetry protocol. In this work web-based dose calibration program for IAEA TRS-398 and AAPM TG-51 protocols were developed. This program developed using the Visual C$\#$ language can be used in the internet. User selectable dosimetry protocol on the web allows the absorbed dose to water data of the two protocols at a reference point to be easily compared, and enables to conveniently manage and understand the current status of the dosimetry calibration performed at participating institutions in korea. This program and the resultant database from the web-based calibration can be useful in developing new dosimetry protocols in Korea.

• Journal of Periodontal and Implant Science
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• v.52 no.1
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• pp.77-87
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• 2022

Purpose: This pilot study assessed the immediate in vivo effect of high peak pulse power neodymium-doped yttrium aluminum garnet (Nd:YAG) laser monotherapy on selected red/orange complex periodontal pathogens in deep human periodontal pockets. Methods: Twelve adults with severe periodontitis were treated with the Laser-Assisted New Attachment Procedure (LANAP®) surgical protocol, wherein a free-running, digitally pulsed, Nd:YAG dental laser was used as the initial therapeutic step before mechanical root debridement. Using a flexible optical fiber in a handpiece, Nd:YAG laser energy, at a density of 196 J/cm² and a high peak pulse power of 1,333 W/pulse, was directed parallel to untreated tooth root surfaces in sequential coronal-apical passes to clinical periodontal probing depths, for a total applied energy dose of approximately 8-12 joules per millimeter of periodontal probing depth at each periodontal site. Subgingival biofilm specimens were collected from each patient before and immediately after Nd:YAG laser monotherapy from periodontal pockets exhibiting ≥6 mm probing depths and bleeding on probing. Selected red/orange complex periodontal pathogens (Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia/nigrescens, Fusobacterium nucleatum, Parvimonas micra, and Campylobacter species) were quantified in the subgingival samples using established anaerobic culture techniques. Results: All immediate post-treatment subgingival biofilm specimens continued to yield microbial growth after Nd:YAG laser monotherapy. The mean levels of total cultivable red/orange complex periodontal pathogens per patient significantly decreased from 12.0% pretreatment to 4.9% (a 59.2% decrease) immediately after Nd:YAG laser monotherapy, with 3 (25%) patients rendered culture-negative for all evaluated red/orange complex periodontal pathogens. Conclusions: High peak pulse power Nd:YAG laser monotherapy, used as the initial step in the LANAP® surgical protocol on mature subgingival biofilms, immediately induced significant reductions of nearly 60% in the mean total cultivable red/orange complex periodontal pathogen proportions per patient prior to mechanical root instrumentation and the rest of the LANAP® surgical protocol.

• The Journal of Korean Society for Radiation Therapy
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• v.31 no.2
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• pp.13-24
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• 2019

Purpose: CT scan range is insufficient for various reasons in head and neck Tomotherapy^®. To solve that problem, Re-CT simulation is good because CT scan range affects accurate dose calculations, but there are problems such as increased exposure dose, inconvenience, and a change in treatment schedule. We would like to evaluate the minimum CT scan range required by changing the plan setup parameter of the existing CT scan range. Materials and methods: CT Simulator(Discovery CT590 RT, GE, USA) and In House Head & Neck Phantom are used, CT image was acquired by increasing the image range from 0.25cm to 3.0cm at the end of the target. The target and normal organs were registered in the Head & Neck Phantom and the treatment plan was designed using ACCURAY Precision^®. Prescription doses are Daily 2.2Gy, 27 Fxs, Total Dose 59.4Gy. Target is designed to 95%~107% of prescription dose and normal organ dose is designed according to SMC Protocol. Under the same treatment plan conditions, Treatment plans were designed by using five methods(Fixed-1cm, Fixed-2.5cm, Fixed-5cm, Dynamic-2.5cm Dynamic-5cm) and two pitches(0.43, 0.287). The accuracy of dose delivery for each treatment plan was analyzed by using EBT3 film and RIT(Complete Version 6.7, RIT, USA). Results: The accurate treatment plan that satisfying the prescribed dose of Target and the tolerance dose in normal organs(SMC Protocol) require scan range of at least 0.25cm for Fixed-1cm, 0.75cm for Fixed-2.5cm, 1cm for Dynamic-2.5cm, and 1.75cm for Fixed-5cm and Dynamic-5cm. As a result of AnalysisAnalysis by RIT. The accuracy of dose delivery was less than 3% error in the treatment plan that satisfied the SMC Protocol. Conclusion: In case of insufficient CT scan range in head and neck Tomotherapy^®, It was possible to make an accurate treatment plan by adjusting the FW among the setup parameter. If the parameter recommended by this author is applied according to CT scan range and is decide whether to re-CT or not, the efficiency of the task and the exposure dose of the patient are reduced.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.11 no.1
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• pp.153-170
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• 1989

Recently, frequently using hyperbaric oxygen therapy is known for its effectiveness on the healing of problem wounds such as osteomyelitis, osteoradionecrosis and gas gangrenous wound etc. The main objectives of this study was to determine the best protocol of its application of hyperbaric oxygen therapy. Author used 238 rats (Sprague-Dawley strain) deviding into 2 Groups, experimental I group for skin and experimental II group for palatal mucosal ischemic wounds, and observed its effects by microscopically. The obtained results summarized as follows; 1. Severe infiltration of inflammatory cells was observed in initial stages of both control and experimental I group. The infiltration showed decreasing tendency at 5th day of experimental D, E, F group while at 8th day in control group In d, f of experimental II group showed decreasing tendency at 8th experimental day while at 12th day in control group. 2. Macrophages appeared at 2nd day in D of experimental I group while at 6th day in control group. In d, f of experimental II group appeared at 6th day while at 10th day in control group. 3. As to the proliferation of capillary blood vessels showed at 3-4 day in most of experimental I group severely while at 8th day in control group. In experimental II group, it was at 8th day and 12th day respectively. 4. The proliferation of fibroblasts showed rather rapider in experimental I group, at 4-6th day, while at 8th day in control group. In experimental II group, it was at 8th day and 12th day respectively. 5. As to the collagen formations, it was at 4th day in experimental I group while at 8th day in control group. In experimental II group, it was at 6th day and 10th day respectively. 6. 5 rats (2.0 %) in E group and 8 rats (3.4 %) in f group showed oxygen toxic reaction, such as unstable attitude and tremor, during the experiments. This hyperbaric oxygen animal experiments disclosed excellent effects on the ischemic wound healing and it is thought to be the best protocol of its application was on D group (2.5 ATM. and 2 hrs, exposure).