It is well known that a physician's personal characteristic affects his practice pattern. Furthermore, a physician's specialty has powerful influences on his practice pattern. However, despite the fact specialization has received the most attention for its influence on physician's service behavior, few studies have been conducted on the variations of contents and volume of physician's services. This study has intended to identify factors influencing the practice variations according to various physician characteristics. There are some other evidences that medical care providers are different in using of health services and resources in Korea. Four physician characteristics were selected for the analysis, two demographical factors, age and sex, and two practice factors, place of practice and medical specialty. Also, three indicators of service amount(total amount of insurance claim bill, number of visits per case, number of prescriptions per case) were selected. From the pool of insurance claims for ambulatory care received by the Korean National Federation of Medical Insurance(NFMI), 84,898 cases were randomly sampled. In the meantime using physician database of NFMI, 613 general practitioners(GP), 107 regular family physicians(FP), 483 'grandfather' family physicians(GFP), and 1,157 specialist practitioners(SP) were randomly sampled. Their different practice contents were compared concerning the specialty, age groups, sex, and practice sites(urban-rural). Specialist physicians tend to provide more costly care than do generalists. General practitioners and family physicians usually make fewer following visits and prescriptions. Age is also the important factor in determining the amount of services, which is highest at the physician's age group of 40's. Female doctors and urban practitioners use much more resources than their counterparts respectively. Research findings suggest that physician's characteristics particularly the specialty can affect practice patterns and resource utilizations. Other characteristics such as age and sex are not controllable but physician's specialty is relatively easily controllable during the entire phases of policy implementation. This is all the more true in the individual's initial decision of his specialty. Specialization therefore should receive policymaker's attention for its potential influence on medical care utilization and health care expenditure.
Age Factors ; Ambulatory Care ; Delivery of Health Care ; Female ; General Practitioners ; Health Expenditures ; Health Services ; Humans ; Insurance ; Korea ; Physicians, Family ; Prescriptions ; Specialization

In an attempt to know the nature of the pupils in neonates, the authors studied the pupil diameter and net miosis to the light stimulation of 70 neonates ranging from 27.3 weeks to 42.0 weeks of gestational age. The mean corneal diameter was 9.3mm. The mean pupil diameters of awakening infants (200 1ux) and in bright light stimulation were 3.1mm and 2.1mm respectively. All the cases had the response to light stimulation and the mean net miosis was 1.0mm. Anisocoria of 0.5mm to 1.0mm was detected in 11 infants (16%). Thus it may be warranted that the careful investigation to search for neurologic abnormalities is necessary if the pupil size of the neonate is more than 2 standard deviation from the mean (smaller than 1.7mm or larger than 4.5mm in dim illummation), or if their pupils do not respond to light challenge.
Anisocoria ; Gestational Age ; Humans ; Infant ; Infant, Newborn* ; Miosis ; Pupil*

In an attempt to know the nature of the pupils in neonates, the authors studied the pupil diameter and net miosis to the light stimulation of 70 neonates ranging from 27.3 weeks to 42.0 weeks of gestational age. The mean corneal diameter was 9.3mm. The mean pupil diameters of awakening infants (200 1ux) and in bright light stimulation were 3.1mm and 2.1mm respectively. All the cases had the response to light stimulation and the mean net miosis was 1.0mm. Anisocoria of 0.5mm to 1.0mm was detected in 11 infants (16%). Thus it may be warranted that the careful investigation to search for neurologic abnormalities is necessary if the pupil size of the neonate is more than 2 standard deviation from the mean (smaller than 1.7mm or larger than 4.5mm in dim illummation), or if their pupils do not respond to light challenge.
Anisocoria ; Gestational Age ; Humans ; Infant ; Infant, Newborn* ; Miosis ; Pupil*

Abrupt reoxygenation (or reperfusion) after anoxia (or ischemia)-induced injury resulted in the loss of contractile property, destruction of cell organelles, and ultimately, cell death in cardiac myocytes. This phenomenon has been called 'oxygen paradox' or 'reperfusion injury'. The purpose of this study was to investigate the changes of fine structures and enzyme activities associated with oxygen paradox during 60 min. of anoxia, followed by a 30 min. of reoxygenation. Cardiac myocytes were dissociated from neonatal rat ventricles and cultured for three days. While they were exposed to anoxia and reoxygenation, the cardiac myocytes were investigated through beating counts, enzyme cytochemistry, immunofluorescence, electron microscopy for morphological study. Activity staining and Western blot for Cu, Zn-SOD, NADPH-diaphorase stain and nitrite concentration mesurement for nitric oxide synthase, and catalase activity measurement were performed. After 60 min. of anoxia, the beating rate increased remarkably. Swollen mitochondria with amorphous dense clumps, mild contracture of myofibrils and retraction of cytoplasmic processes were observed in cardiac myocytes. Under confocal microscope, weak reaction of Mn-SOD and myosin were observed, whereas reaction of Cu, Zn-SOD was enhanced in perinuclear region. Cu, Zn-SOD and catalase activity in cardiac myocytes increased markedly. Nitric oxide synthase activity increased gradually with time. After 30 min. of reoxygenation following 60 min anoxia, structural changes of myocardial cells was more pronounced than in the cells of anoxic group. Beating rate was variable but decreased gradually. Myocardial cells showed evidence of severe structural alterations, including marginal clumping of chromatids, varying-sized bleb formation, many vacuoles, mitochondrial matrix exposed to cytoplasm and fragmen-tation of cristae, myofibrillar hypercontracture. Decline of immunocytochemical reaction of Mn-SOD, myosin and Cu, Zn-SOD were observed under confocal microscope. The declines of activity and quantity of Cu, Zn-SOD were severe compared to control. In contrast, nitric oxide synthase activity significantly increased. Catalase activity was lower than in anoxic group, but still higher than in control activity. These results suggested that there were two possible mechanisms for the drastic morphological changes induced by anoxia-reoxygenation; 1) direct effect of oxygen free radicals, and 2) reaction of nitric oxide with superoxide radicals, which resulted in generation of toxic metabolites of nitric oxide, exacerbated myocardial cellular damages.
Animals ; Anoxia ; Blister ; Blotting, Western ; Catalase ; Cell Death ; Chromatids ; Contracture ; Cytoplasm ; Fluorescent Antibody Technique ; Free Radicals ; Histocytochemistry ; Microscopy, Electron ; Mitochondria ; Myocytes, Cardiac* ; Myofibrils ; Myosins ; Nitric Oxide ; Nitric Oxide Synthase ; Organelles ; Oxygen ; Rats ; Superoxide Dismutase ; Superoxides ; Vacuoles

OBJECTIVE: To evaluate the effects of heel-opened ankle foot orthosis (HOAFO) on hemiparetic gait after stroke, especially on external foot rotation, and to compare the effects of HOAFO with conventional plastic-AFO (pAFO) and barefoot during gait. METHODS: This cross-over observational study involved 15 hemiparetic patients with external rotation of the affected foot. All subjects were able to walk independently, regardless of their usual use of a single cane, and had a less than fair-grade in ankle dorsiflexion power. Each patient was asked to walk in three conditions with randomized sequences: 1) barefoot, 2) with a pAFO, and 3) with an HOAFO. Their gait patterns were analyzed using a motion analysis system. RESULTS: Fifteen patients consisted of nine males and six females. On gait analysis, hip and foot external rotation were significantly greater in pAFO (-3.35degrees and -23.68degrees) than in barefoot and HOAFO conditions (p<0.05). Wearing an HOAFO resulted in significant decreases in hip (0.78degrees, p=0.04) and foot (-17.99degrees, p<0.01) external rotation compared with pAFO; although there was no significant difference between HOAFO and barefoot walking. Walking speed and percentage of single limb support were significantly greater for HOAFO than in barefoot walking. CONCLUSION: HOAFO was superior to pAFO in reducing hip and foot external rotation during the stance phase in patients with post-stroke hemiparesis. HOAFO may, therefore, be useful in patients with excessive external rotation of the foot during conventional pAFO.
Animals ; Ankle ; Canes ; Extremities ; Female ; Foot ; Foot Orthoses ; Foot Rot ; Gait ; Hip ; Humans ; Male ; Orthotic Devices ; Paresis ; Stroke ; Walking

It has been reported that ischernia causes changes in the concentration and tumover of monoamine neurotransmitters in brain. For the mechanism of cellular death in brain ischernia it is suggested that accumulation of intracellular calcium during ischemia is one of the main causes. Present study was undertaken to investigate the influence of ischemia on the contents and tumover of the biogenic anines in rat brain and further to investigate the effects of nimodipine, a calcium channel blocker, and cromakalim, a potassium channel opener, on them. Brain ischemia was induced by partial ligation of bilateral common carotid artery. Nimodipine (36 ,ug/kg, I.p.) or cromakalim (0.5mg/kg, I.p.) was administered 20 minutes before ligation. Nimodipine was administered every 4 hours in 24-hour ischemic group. Rats were sacrificed by decapitation 3 or 24 hours after induction of ischemia and whole brains were excised. The brain was divided into follow ing regions; cerebral cortex, corpus striatum, hippocampus, thalamus, hypothalamus, substantia nigra and cerebellum. The concentrations of biogenic amines and their metabolites were measured by high performance liquid chromatography-electrochemical detector (HPLC-ECD).
Animals ; Biogenic Amines* ; Brain Ischemia ; Brain* ; Calcium ; Calcium Channels ; Carotid Artery, Common ; Cerebellum ; Cerebral Cortex ; Corpus Striatum ; Cromakalim ; Decapitation ; Hippocampus ; Hypothalamus ; Ischemia ; Ligation ; Neurotransmitter Agents ; Nimodipine* ; Potassium Channels ; Rats* ; Substantia Nigra ; Thalamus

PURPOSE: This was to describe the emotions that patients face when diagnosed with cancer to know the problems and coping styles that cancer patients experience during the treatment. METHOD: The qualitative method was used for this study. The participants were 90 cancer patients at five general hospital in Pusan, Korea. Data were collected by interviews with a semi-structured questionnaire from November 2000 to June 2001, and were analyzed using the modified constant comparative method. RESULT: The most common emotions on the diagnosis of cancer were shock(36.7%), followed by despair(25.6%), acceptance(24.4%), denial(18.9%), complaint(16.7%), and fear(8.9%). The problems identified were the unpleasantness and physical discomfort related with the treatment(50.0%), the feelings of burden(41.1%), finance/occupation(38.8%), and fear of the future(26.6%). Coping styles to problems that the subjects have faced on the course of the treatment were compliance(36.6%), health care(31.1%), positive thinking(22.2%), despair/avoidance(15.5%), seeking social support(6.6%), information seeking(3.3%) and self-control(2.2%). CONCLUSION: It is very important to develop nursing interventions which can mitigate shock that patients experience, can help cancer patients to have hope for the future and to positively cope with cancer.

OBJECTIVES: To investigate the number of leiomyoma patients-exposed to bisphenol A (BPA) and to observe whether the serum concentration of BPA is related to leiomyoma growth. METHODS: A total of 158 patients were recruited for this study. Leiomyoma patients were divided into three groups, mild (n = 48), moderate (n = 32) and severe (n = 28), according to the size of leiomyomas. The control (n = 30) group was defined as having no leiomyomas. Transvaginal ultrasonography was used to identify and measure the leiomyomas. Serum BPA concentrations were measured by enzyme-linked immunosorbent assay. RESULTS: BPA was detected in 87.0% out of a total of 158 samples, and in 86.0% out of 108 leiomyoma patients. In detail, the detection rates of serum BPA were 88.0% in the control group, 77.2% in the mild group, 90.0% in the moderate group and 96.0% in the severe group. The mean BPA concentration in the control group was 0.558 +/- 0.097 ng/mL, the leiomyoma groups, the mean BPA concentrations were 0.274 +/- 0.063 ng/mL (mild), 0.346 +/- 0.064 ng/mL (moderate) and 0.647 +/- 0.039 ng/mL (severe) (P = 0.0003). Values represent the mean +/- standard error. CONCLUSION: The detection rates of serum BPA in the control and leiomyoma groups were 88.0% and 86.0%, respectively. However, there was no significant difference in the serum BPA concentrations between the control and leiomyoma groups. To verify the effect of BPA on leiomyoma growth, a close and sequential monitoring is recommended for people who are at risk for uterine leiomyoma.
Endocrine Disruptors ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Leiomyoma* ; Ultrasonography ; Uterus

PURPOSE: This study was conducted to develop a nurse-learning program for the pain management of cancer patients. METHODS: In this methodological study, a learning program was developed between January and June 2011, following the methodological procedure based on the ADDIE Instructional System Design. RESULTS: The learning program consists of 4 parts: learning goal, learning outcomes, learning method, and evaluation method. Learner-centered learning goal and learning outcomes were established, and lecture-based group learning and self-directed study were combined as the learning method. For the evaluation, we developed a written test, a nursing skill checklist, and a case report evaluation tool. After a pilot test, the learning program was assessed by an expert group for its construct validity and content-related conformance. Moreover, the effectiveness of the program was validated by the results of the learning outcomes evaluation and the achievement levels of 40 trainees who participated in the program. CONCLUSION: On the basis of the results of this study, we suggest that this unit-based core nursing practice learning program, comprising 202 nursing units developed by a research institute nursing department since 2010, be shared by all nurses in clinical nursing care settings to improve their practical performance and ensure necessary specialization.
Academies and Institutes ; Checklist ; Humans ; Learning* ; Methods ; Nursing Care ; Nursing* ; Oncologic Nursing ; Pain Management* ; Programmed Instruction as Topic

Primary transitional cell carcinoma of the ovary is recently recognized, as one of the main types of ovarian carcinoma. Histologically, it is distinguished from malignant Brenner tumor only in the abscence of benign or proliferative Brenner tumor component. primary transitional cell carcinomas are more aggressive than malignant Brenner tumors. However, Primary transitional cell carcinomas have a better response to chemotherapy than other types of ovarian carcinomas. We report a case of primary transitional cell carcinoma presenting as both ovarian masses that developed in a 60-year-old woman with a brief review of literature.
Brenner Tumor ; Carcinoma, Transitional Cell* ; Drug Therapy ; Female ; Humans ; Middle Aged ; Ovary*