• 보건행정학회지
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• 제14권4호
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• pp.48-74
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• 2004

Considering the existence of asymmetric information between doctor and patient, the doctor's reimbursement method has been considered as a desirable policy device of improving efficiency of patient's use of medical care in terms of its affecting doctor's practice pattern by determining doctor's practice revenue. By using the Community Tracking Study (CTS) physician data set, which includes not only various information on doctors practice arrangements and sources of practice revenue, but also vignettes of various clinical presentations, this paper investigates doctor's reaction to the financial incentive under the control of patient's specific medical situation. Under the econometric model for exploring the effect of doctor's reimbursement method on his/her practice patterns; referring patients, recommend doctor-visit or medical tests, the Hausman's specification test was used for checking out the possibility of the doctor's reimbursement method being endogeneized explanatory variable. In the case where the endogeneity problem of doctor's reimbursement method exists, the 2SLS method was used for correcting that problem, and the multiple regression method was used in the case where the problem is found to be nonexistent. Based on the empirical results, this paper finds that doctors do appear to respond to financial incentive. The empirical results show that the doctor's reimbursement method statistically significantly affects doctor's practice pattern and are coincident with the theoretical result proposed by previous researches, This results suggest, as doctor's practice revenues are mainly determined by prospective method, such as capitation, doctors would more refer their patients to specialists, and hesitate in recommending doctor-visit or medical exam.

• 대한정형외과스포츠의학회지
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• 제2권1호
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• pp.56-61
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• 2003

본연구는슬관절과견관절의초기재활과정에서관절운동범위와스트레칭, 그리고유산소성운동프로그램에대한논문이다. 만약관절이손상후장기간동안고정된다면관절이굳어지고 근육은위축이 될것이다. 그러므로본 프로그램은다양한운동기술을포함하고있다. 즉관절의경직을예방하기위한운동범위확보와근육의이완을위한스트레칭, 심폐기능의감소를예방하기위한심혈관훈련(수영, 상체자전거, 고정식자전거)을포함하고있다. 초기재활과정에서는임상운동전문가와환자사이의상호관계를형성하는것이매우중요하다. 또한임상운동전문가는환자의통증과운동적응도, 체력수준, 프로그램의진행등에관해스포츠의학전문의와상의하는것이권장된다.

• Journal of Korean Neurosurgical Society
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• 제60권6호
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• pp.684-690
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• 2017

Objective : As increasing the size of the geriatric population, the number of elderly patients, who need the surgery for painful degenerative spinal stenosis has been increasing. The geriatric population may be relatively high complications, because of age and age-associated medical conditions. However, there is a lack of studies addressing the perioperative complications and outcomes in elderly patients with posterior lumbar inter body fusion with screw augmentation (PLIF). Methods : We retrospectively reviewed the medical records and radiographic studies of geriatric patients who had spine surgery of PLIF due to spinal stenosis for 11 years. We divided into 2 groups (A; 70-75 years, B; over then 76 years) according to the age. Surgical level of each groups, hospital day and postoperative day, co-morbidities, complications, clinical outcomes were analyzed. Operative reports, hospital and outpatient clinic charts, and radiographic studies were reviewed. Results : Group A was composed of 80 patients, their mean age was 72.21 and female dominant (n=46), and their mean surgically fused level was 1.52 level. Group B was 36 patients, their mean age was 78.83 and female dominant (n=20), and their mean surgically fused level was 1.36 level. Comparing between two groups, complications, postoperative hospital stay were slightly increase in group B and co-morbidity was statistically high in group B, however clinical outcomes were similar between two groups. Conclusion : Increasing age might be an important risk factor for complications in patients undergoing PLIF, however, we would like to recommend that if the situation of spine of extreme geriatric patients need PLIF, it should be in the surgeon's consideration after careful selection and clinical judgement.

• Journal of Korean Neurosurgical Society
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• 제50권4호
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• pp.377-380
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• 2011

Objective : The purpose of this study was to determine the anatomic relationships between neurovascular structures and the transverse carpal ligament so as to avoid complications during endoscopic carpal tunnel surgery. Methods : Twenty-eight patients (age range, 35-69 years) with carpal tunnel syndrome were entered into the study. We examined through wrist magnetic resonance imaging in three different positions (neutral, radial flexion, and ulnar flexion) and determined several anatomic landmark (distance from the hamate hook to the median nerve, ulnar nerve, and ulnar vessel) based on the lateral margin of the hook of the hamate. The median nerve and ulnar neurovascular structure were studied with the wrist in the neutral, ulnar, and radial flexion positions. Results : The ulnar neurovascular structures usually passed just over or ulnar to the hook of the hamate. However, in 12 hands, a looped ulnar artery coursed 0.6-3.3 mm radial to the hook of the hamate and continued to the superficial palmar arch. The looped ulnar artery migrates on the ulnar side of Guyon's canal (-5.2-1.8 mm radial to the hook of the hamate) with the wrist in radial flexion. During ulnar flexion of the wrist, the ulnar artery shifts more radially beyond the hook of the hamate (-2.5-5.7 mm). Conclusion : It is appropriate to transect the ligament greater than 4 mm apart from the lateral margin of the hook of the hamate without placing the edge of the scalpel toward the ulnar side. We would also recommend not transecting the transverse carpal ligament in the ulnar flexed wrist position to protect the ulnar neurovascular structure.

• 기본간호학회지
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• 제4권1호
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• pp.119-131
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• 1997

This study was conducted to analyze the nursing diagnoses applied for case studies of nursing students through their clinical practices, and to provide the educational basis of nursing diagnoses with its results. The data were collected for two years(1995 and 1996) from 70 case studies reported by the 2nd and 3rd year nursing junior college students. The students made 259 nursing diagnoses among which 230 diagnoses qualified NANDA classification and were taken for analysis. The results of the analysis were as follows : 1. The number of diagnoses indicating response patterns was 35(35.7%), whereas 98 diagnoses in NANDA table. Among the 35 diagnoses, the pattern of exchange was most frequent, then feeling, moving, knowing in rank. 2. The diagnoses were analyzed in the categories of response patterns. For Instance, 'Altered in Nutrition' was most frequent in exhange, then Risk for Infection', 'Ineffective Airway Clearance', in rank. 3. Among 230 diagnoses, 'Knowle Deficit' was most frequently mentioned, then 'Activity Intolerance' 'Anxiety', 'Pain', 'Altered in Nutrition', 'Risk for Infection', 'Ineffective airway clearance', in rank. 4. The types of word expression of each diagnoses were various. 'Activity Intolerance' was expressed in 6 types. 5. The relating factors applied to each diagnosis were analyzed. For Instance, the relating factor of 'Knowledge Deficit' were illness, and therapeutic process, lack of motivation, occurrance of complication, short experience, operation, and so on. From the above study, the researcher would like to recommend as follows : 1) The current diagnoses need to be verified its content validity, when they are applied to our culture. 2) The most effective educational method for applying nursing diagnoses should be explored. 3) Further study could be focused on not only 'relating factors' but also 'sign and symptoms'.

• 한국전문물리치료학회지
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• 제23권4호
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• pp.55-62
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• 2016

Background: The functioning of the serratus anterior (SA) muscle is essential to normal scapulohumeral rhythm during forward flexion (FF) of the shoulder. Also, SA weakness and overuse of the upper trapezius (UT) is observed in patients with shoulder dysfunction and trapezius myalgia. We designed a combination exercise involving FF and scapular protraction with resistance (CFFSP) to activate the SA muscle and to deactivate the UT muscle. Objects: The purpose of this study was to determine whether or not CFFSP would be more effective in activating the SA muscle than FF alone and FF with scapular protraction (FFP). Methods: Nineteen subjects (12 men and 7 women) participated in this study and performed FF, FFP, and CFFSP at $120^{\circ}$. Surface electromyography was applied to the SA, UT, and pectoralis major (PM) muscles, as was one-way analysis of variance (ANOVA) with repeated measures. Statistical significance was set at .05. Bonferroni adjustment was used to counteract the problem of multiple comparisons, with a statistical level of significance of .017 (.05/3). Results: A statistically significant difference was found in relation to the three positions for the SA muscle (p<.001) and the SA/UT ratio (p=.005) using ANOVA. Significantly different results, depending on the position, were also demonstrated using the Bonferroni post-hoc test for the SA muscle ($FF=28.27{\pm}16.20$, $FFP=45.66{\pm}15.81$, and $CFFSP=62.4{\pm}27.21$) and for the SA/UT ratio ($FF=3.04{\pm}2.14$, $FFP=3.61{\pm}2.38$, and $CFFSP=5.95{\pm}3.01$). Significant differences between the three positions was not found regarding the average amplitude of SA/PM muscle ratio (SA/PM: p=.060). Conclusion: We recommend the use of CFFSP to strengthen the SA muscle at $120^{\circ}$.

• 대한두개안면성형외과학회지
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• 제21권4호
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• pp.225-228
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• 2020

Background: The aim of this study is to develop a two-stage training module using radish and swine scapular cartilage for carving ear cartilage. Methods: In the first stage, white radish was cut in 3-6 mm thick slices. The ear cartilage framework was carved using a graver and the helix and antihelix were fixed with pins. In the second stage, swine scapular cartilage was obtained. The thickness varied 3-6 mm. The ear cartilage framework was made. And triangular fossa and scaphoid fossa were carved with graver. A curvilinear cartilage for helix was assembled to the framework by pin fixing. Six participants were recruited for an ear reconstruction training workshop and figures of the cartilage framework were provided. Participants were asked answer the pre-workshop questionnaire and post-workshop questionnaire on a Likert scale to rate their satisfaction with the outcome. Results: On the pre-workshop questionnaire, participants indicated that they did not have sufficient knowledge and skill for fabricating the ear cartilage framework (1.5±0.5 using white radish; 1.3±0.5 using swine scapular cartilage). On the post-workshop questionnaire, participants responded that they had learned useful knowledge from this workshop, reflecting a significant improvement (3.8±1.0 using white radish; 4.0±1.1 using swine scapular cartilage). They also indicated that they had become somewhat confident in this skill (4.2±0.8 using white radish; 4.3±0.5 using swine scapular cartilage. The participants generally found the workshop satisfactory (practically helpful, 4.7±0.5; knowledge improved, 4.8±0.4; satisfied with course, 4.5±0.5; would recommend to others, 4.8±0.4). Conclusion: This model can be useful for ear reconstruction training for medical personnel.

• 정보교육학회논문지
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• 제21권2호
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• pp.209-217
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• 2017

최근 SW교육이 강조되고 있으나 아직 많은 학생들이 컴퓨터과학을 접할 기회는 많지 않다. 이 논문에서 연구자는 컴퓨터과학에 대한 관심과 이해를 증대시키기 위해 컴퓨터과학 쇼를 구성하였다. 컴퓨터과학 쇼는 이진체계의 이해, 문자 전달하기, 패리티비트 마술, 숫자 카드 찾기, 색깔 모으기(오렌지 게임)들로 구성하였다. 컴퓨터과학 쇼를 초등학생들에게 적용하고 결과를 살펴보았다. 컴퓨터과학 쇼에 참여한 대부분의 학생들은 "컴퓨터과학 쇼에 대한 경험"이 없었다. 컴퓨터과학 쇼 후의 설문조사에서 많은 학생이 "쇼에 대해 재미있다", "컴퓨터과학에 관심이 생겼다", "주변 친구에게 추천 하겠다"라고 응답했다. 연구를 통해 컴퓨터과학 쇼는 초등학생들에게 컴퓨터과학에 대한 흥미를 이끌어 낼 수 있고, 컴퓨터과학에 대한 호기심과 관심을 일으킬 수 있는 방법임을 알게 되었다.

• Childhood Kidney Diseases
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• 제24권1호
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• pp.1-13
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• 2020

Immunoglobulin (Ig)A vasculitis nephritis (IgAVN), also referred to as Henoch-Schönlein purpura nephritis, is a relatively benign disease in children. However, two 24-year European cohort studies have reported high sustained rates of hypertension, severe proteinuria, and renal dysfunction in patients with IgAVN. Notably, the incidence and exacerbation rates of proteinuria, hypertension, and renal dysfunction during pregnancy were high even in women who recovered from IgAVN before pregnancy. Patients with IgAVN need lifelong care. Trials have been performed to investigate early biomarkers and genes associated with poor prognosis to identify high-risk patients in whom IgAVN may progress to severe renal disease. Urinary IgA/cr, IgM/cr levels, and HLAB35 and angiotensinogen gene expression were shown to be predictors of progression of IgAVN to severe renal dysfunction. The 2019 Single Hub and Access point for paediatric Rheumatology in Europe (SHARE) initiative group published guidelines for pediatric IgAVN, following the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines established in 2012. Compared with the KDIGO guidelines, the SHARE guidelines recommend earlier corticosteroid administration in cases of mild proteinuria (>0.5 g/d). Clinical trials of targeted budesonide delivery to the distal ileum, monoclonal antibody targeting C5, eculizumab and anti-CD20 monoclonal antibody administration, among others are currently underway in patients with IgA nephropathy. It is expected that newer therapeutic agents would become available for IgAVN in the near future. This review summarizes IgAVN with emphasis on recently published literature, including possible preventive strategies, predictive biomarkers for progression of IgAVN, and various treatments.

• Asian Pacific Journal of Cancer Prevention
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• 제16권17호
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• pp.7819-7824
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• 2015

Purpose: To subtype breast cancer (BC) in Saudi women according to the recent molecular classification and to correlate these subtypes with available clinicopathological parameters. Materials and Methods: Estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor (Her2/neu) immunostaining was semi-quantitatively assessed to define molecular subtypes of luminal A and B, HER-2 and triple negative (basal-like) in BC paraffin embedded sections from 115 Saudi female patients diagnosed between 2005 to 2015 at the Department of Pathology, King Fahd Hospital, Almadinah, Saudi Arabia. Results: The most common subtypes were luminal A (47%), followed by luminal B (27.8%) and basal like subtypes (18.3%), whereas HER-2 was the least common subtype (6.9%). Luminal A was predominantly found in the old age group, with low tumor grade (p<0.001) and small tumor size, whereas HER-2 and basal-like subtypes were significantly associated with young age, high tumor grade, lymph node metastasis and lymphovascular invasion (p<0.03, 0.004, 0.05 and 0.04 respectively). All subtypes showed advanced clinical stage at the time of presentation. Conclusions: Molecular subtypes of Saudi BC patients in Almadinah region are consistent with most of the worldwide subtyping. The biological behaviour of each molecular subtype could be expected based on its characteristic clinicopathological features. Along with other prognostic indicators, molecular subtyping would be helpful in predicting prognosis and management of our BC patients. We recommend screening and early diagnosis of BC in our population.