• Health Policy and Management
• /
• v.25 no.4
• /
• pp.253-255
• /
• 2015

The concept of precision medicine-prevention and treatment strategies that take individual variability into account-is hot issue of US in the year 2015. Precision medicine is a new concept that approach patients individually by there characteristics, such as genome, life style, environmental exposure, etc. For developing the precision medicine, National Institute of Health of US has been prepared the Precision Medicine Initiative Cohort Program, at least 1 million people cohort. The US President Obama announced the Precision Medicine Initiative on 30th January 2015. He announced that he will pioneer a new model of patient-powered research that promises to accelerate biomedical discoveries and provide clinicians with new tools, knowledge, and therapies to select which treatments will work best for which patients. Most medical treatments have been designed for the 'average patient.' As a result of this 'one-size-fits-all-approach,' treatments can be very successful for some patients but not for others. This is changing with the emergence of precision medicine, an innovative approach to disease prevention and treatment that takes into account individual differences in people's genes, environments, and lifestyles. Precision medicine gives clinicians tools to better understand the complex mechanisms underlying a patient's health, disease, or condition, and to better predict which treatments will be most effective. The healthcare researcher should prepare the new medicine era such as bio-information technology convergence, big data study.

• The Korean Journal of Pain
• /
• v.10 no.1
• /
• pp.89-92
• /
• 1997

Neurolytic splanchnic nerve block is effective for treatment of intractable upper abdominal cancer pain. Conventional approach for splanchnic nerve block is conducted in the prone position to ensure proper orientation and to allow insertion of needles on each side of the vertebral body. However, the prone position has some technical disadvantages as this position is frequently poorly tolerated by a majority of patients with advanced cancer due to severe abdominal pain, ascites and so on. Male patient, 53-year old with transverse colon cancer, carcinomatosis peritonei and $L_1,\;L_2$ vertebral body metastasis, was admitted for treatment of severe right upper quadrant and right iliac crest pain. We performed neurolytic splanchnic nerve block with transdiscal technique in the lateral decubitus position under fluoroscopic guidance, and well noted the usefulness and the advantage of this technique. The benefits of this technique are safe, simple and effective because the lateral position is better tolerated by patients and makes bony landmarks more accessible during fluoroscopy.

• Journal of The Korean Society of Inherited Metabolic disease
• /
• v.14 no.1
• /
• pp.10-18
• /
• 2014

Recent advances in the diagnosis and treatment of inborn errors of metabolism have improved substantially the prognosis of many of these diseases, if diagnosed early enough before irreversible damage occurs. This makes it essential that the practicing pediatrician, especially neonatologists be familliar with the clinical presentations and systematic approaches of these disorders. Characteristic clinical presentations, methods of systematic approach and typing of various disorders is discussed in this review. The signs of neurological dysfunctions of many IEMs manifesting in the neonatal period is very nonspecific, such as poor feeding, poor sucking, apnea or tachypnea, vomiting, hypertonia, hypotonia, seizure, letharginess, consciousness change and coma. Many other non-metabolic severe disorders of neonatal period such as neonatal sepsis and intracerebral hemorrhage share these nonspecific symptoms. Hyperammonemia, metabolic acidosis, ketosis and hyperlatic acidemia are observed in many of these conditions but there are exceptions in which conditions all basal laboratory tests are normal, such as NKH, sulfite oxidase deficiency and peroxisomal disorders. According to the results of basal laboratory tests, IEMs in the neonatal period can be categorized in to 6 types. Grouping of IEMs into 6 types will make confirmatory tests and early emergency treatment more efficient.

• The Journal of Korean Physical Therapy
• /
• v.27 no.2
• /
• pp.118-123
• /
• 2015

Purpose: This study was conducted in order to present basic policy data for introduction of a home-based physical therapy (HBPT) policy. Methods: The study surveyed physical therapists and patients for six weeks, in order to identify satisfaction with physical therapy. The statistical significance of the management plan with regard to costs and cost estimation and payment methods was determined and managed according to the operating principals of HBPT, eligibility criteria, number of visits, treatment time, and team approach. Results: Through the survey all groups of patients and physical therapists recognized the need for HBPT. They felt that the most desirable methods for activation of physical therapy visits involve precise diagnosis and evaluation through a team approach. While making regular visits to the patient three times a week, an expert visiting physical therapist with 3 to 5 years of experience in the clinical field could provide central nerve developmental treatment in less than 60 minutes; this service could be provided at a reasonable cost, minimizing unnecessary hospital visits, reducing time, medical expenses and facilitating a quick recovery due to psychological satisfaction resulting from a decrease in the psychological anxiety patients often experience in medical institutions. Conclusion: Based on the study results provided above, if HBPT is to be introduced, appropriate pricing and programs should be based on the results of pilot projects.

• Nuclear Engineering and Technology
• /
• v.53 no.4
• /
• pp.1224-1235
• /
• 2021

An integrated waste management approach for irradiated graphite was developed during the European Commission project 'Treatment and Disposal of Irradiated Graphite and other Carbonaceous Waste'. This included the identification of potential options for the management of irradiated graphite, taking account of storage, retrieval, treatment and disposal methods. This paper describes how these options can be assessed using multi-criteria decision analysis (MCDA) for a case study relating to a generic power reactor. Criteria have been defined to account for safety, environmental, economic and socio-political factors, including radiological impact, resource usage, economic costs and risks. The impact of each option against each criterion has been assessed using data from the project and the wider literature. A linear additive approach has been used to convert the calculated impacts to scores. To account for the relative importance of the criteria, example weightings were allocated. This application has shown that MCDA approaches can be used to support complex decisions regarding irradiated graphite management, accounting for a wide range of criteria. Use of this approach by individual countries or organisations will need to account for the specific options, scores, weightings and constraints that apply, based on their national strategies, regulatory requirements and public acceptability.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.46 no.6
• /
• pp.373-378
• /
• 2020

The purpose of this review is to assess the surgical outcomes of two different treatment modalities, endoscopic and open resection, for the management of sinonasal malignancies by comparing the effectiveness of these two methods. A wide search was carried out considering various electronic databases for English language articles from 2013 to 2018 using keywords such as sinonasal malignancies, endoscopic surgery, open resection for sinonasal malignancies, and endoscopic versus open surgery. One thousand articles were identified from the literature for screening. After a thorough systematic assessment and based on the selection criteria, 10 articles with 4,642 patients were included in this quantitative analysis. With a total of 4,642 patients, 1,730 patients were operated on using endoscopic resection and 2,912 patients were operated on using open resection. The endoscopic approach was found to have a shorter hospital stay compared to open surgical resection (P<0.05). The rate of positive margins and the recurrence rate for open surgical resection were both smaller compared to those for endoscopic resection (P>0.05), and the endoscopic approach had smaller complication rates and a higher survival rate compared to open resection (P>0.05). Though endoscopic resection and open surgical resection have comparable postoperative benefits, preoperative evaluation of cases presenting with sinonasal malignancies is necessary for determining the right treatment method to obtain the best possible results postoperatively.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.48 no.5
• /
• pp.267-276
• /
• 2022

Objectives: Recently a modified high-submandibular approach (HSMA) has been introduced for treatment of condylar fracture. This approach involves an incision line close to the mandibular angle and transmasseteric transection, leading to a low incidence of facial palsy and allowing good visualization of the condyle area, especially the condylar neck and subcondyle positions. This study reports several cases managed with this modified HSMA technique for treating condylar fractures. Materials and Methods: Six cases of condylar fractures treated with modified HSMA technique were reviewed. Results: Three unilateral subcondylar fracture, 1 bilateral subcondylar fracture, 1 unilateral condylar neck fracture, 1 unlateral simultaneous condylar neck and subcondylar fracture cases were reviewed. All the cases were successfully treated without any major complication. Conclusion: Reduction, fixation, and osteosynthesis of condylar fractures via the modified HSMA technique enabled effective and stable treatment outcomes. Therefore, the described approach can be used especially for subcondylar and condylar neck fractures with minimal complications.

• Journal of Yeungnam Medical Science
• /
• v.40 no.2
• /
• pp.218-222
• /
• 2023

A holistic approach to diabetes considers patient preferences, emotional health, living conditions, and other contextual factors, in addition to medication selection. Human and social factors influence treatment adherence and clinical outcomes. Social issues, cost of care, out-of-pocket expenses, pill burden (number and frequency), and injectable drugs such as insulin, can affect adherence. Clinicians can ask about these contextual factors when discussing treatment options with patients. Patients' emotional health can also affect diabetes self-care. Social stressors such as family issues may impair self-care behaviors. Diabetes can also lead to emotional stress. Diabetes distress correlates with worse glycemic control and lower overall well-being. Patient-centered communication can build the foundation of a trusting relationship with the clinician. Respect for patient preferences and fears can build trust. Relevant communication skills include asking open-ended questions, expressing empathy, active listening, and exploring the patient's perspective. Glycemic goals must be personalized based on frailty, the risk of hypoglycemia, and healthy life expectancy. Lifestyle counseling requires a nonjudgmental approach and tactfulness. The art of diabetes care rests on clinicians perceiving a patient's emotional state. Tailoring the level of advice and diabetes targets based on a patient's personal and contextual factors requires mindfulness by clinicians.

• Hip & pelvis
• /
• v.34 no.2
• /
• pp.79-86
• /
• 2022

Purpose: The purpose of this study was to determine whether the direct anterior approach (DAA) can be applied to hemiarthroplasty for treatment of unstable femoral intertrochanteric fractures in elderly patients. Materials and Methods: We conducted a retrospective review of 34 cases (34 patients) who underwent bipolar hemiarthroplasty using a DAA from February 2019 to April 2020. The mean age of the patients was 82.68 years (range, 67-95 years). A cementless distal fixation hip system was used in all cases. Operation time, total amount of blood loss, intraoperative and postoperative fractures, infections, and reoperations were measured. The patients performed weight-bearing walking as tolerated immediately after surgery. Measurement of migration of the greater trochanter (GT) and progressive subsidence of the femoral stem was performed using follow-up radiographs. Results: The mean operative time was 83.50 minutes (range, 60-120 minutes). The mean amount of bleeding was 263.53 mL (range, 112-464 mL). Walking started a mean of 3.03 days (range, 3-4 days) after surgery. There was no case of progressive migration of the GT more than 5 mm even though it was not fixed. There were no cases of infection, dislocation, or reoperation. Conclusion: Bipolar hemiarthroplasty using the DAA for treatment of unstable femoral intertrochanteric fractures could be considered a useful option that provides many advantages in elderly patients.

• The Journal of the Korean dental association
• /
• v.54 no.12
• /
• pp.1045-1054
• /
• 2016

Purpose : Aim of this study is to describe and compare clinical results and complications epending on the surgical approaches for the mandibular subcondyle fracture Materials and methods : The patients who had been diagnosed as the mandibular subcondyle fracture and underwent open reduction and internal fixation from May 2009 to December 2014 were included. They were divided into two groups depending on the surgical approaches; endoscopically assisted transoral approach and retromandibular approach. Association between the preoperative fracture classification and post-operative results was reviewed depending on the surgical approaches. Results : The number of patients selected in this study was 33. Eighteen patients (male 7, female 11) underwent open reduction and internal fixation via retromandibular approach and fifteen patients (male 12, female 3) underwent open reduction and internal fixation via endoscopically assisted transoral approach. The mean age, follow up period, and operation time were $44.29{\pm}15.19years$, $9.97{\pm}7.82months$, and $161{\pm}89.44minutes$. Post-operative results were all "good" state in the retromandibular approach group regardless of the fracture classification but two patients in the endoscopically assisted transoral approach group underwent re-operation due to "poor" results. The fracture types of two were classified as displacement and lateral override at the same time. There was no statistically significant difference between two groups. Three patients in the retromandibular approach group had experienced facial nerve palsy (17%) temporarily. No one showed malocclusion in this study. There was no significant difference on the complications such as temporomandibular disorder, local infection, and condyle resorption depending on the surgical approaches. Conclusion : In this study, there was no significant difference on the complications between the two groups but retromandibular approach has advantage over endoscopically assisted transoral approach in case of the severely displaced subcondyle fracture.