Objectives: Skin cancer is a prevalent type of malignancy, necessitating efficient diagnostic tools. This study aimed to develop an automated skin lesion classification model using the dynamically expandable representation (DER) incremental learning algorithm. This algorithm adapts to new data and expands its classification capabilities, with the goal of creating a scalable and efficient system for diagnosing skin cancer. Methods: The DER model with incremental learning was applied to the HAM10000 and ISIC 2019 datasets. Validation involved two steps: initially, training and evaluating the HAM10000 dataset against a fixed ResNet-50; subsequently, performing external validation of the trained model using the ISIC 2019 dataset. The model’s performance was assessed using precision, recall, the F1-score, and area under the precision-recall curve. Results: The developed skin lesion classification model demonstrated high accuracy and reliability across various types of skin lesions, achieving a weighted-average precision, recall, and F1-score of 0.918, 0.808, and 0.847, respectively. The model’s discrimination performance was reflected in an average area under the curve (AUC) value of 0.943. Further external validation with the ISIC 2019 dataset confirmed the model’s effectiveness, as shown by an AUC of 0.911. Conclusions This study presents an optimized skin lesion classification model based on the DER algorithm, which shows high performance in disease classification with the potential to expand its classification range. The model demonstrated robust results in external validation, indicating its adaptability to new disease classes.

PURPOSE: The purpose of this study was to identify the influence of posttraumatic growth and meaning in life on health promotion behavior in cancer patients. METHODS: The participants were 124 cancer patients who were treated at a general hospital in Pusan. Data were collected for posttraumatic growth, meaning in life, and health promotion behavior. The data were analyzed using descriptive statistics, t-tests, ANOVA, Pearson correlation coefficients and stepwise multiple regression with SPSS 21.0. RESULTS: The mean scores were health promotion behavior 2.72+/-0.47, posttraumatic growth 3.38+/-0.89, and meaning in life 3.29+/-0.59. The scores of health promotion behavior were significantly different by gender, perceived economic status, and economic difficulties due to diagnosis. Health promotion behavior had a significant correlation with posttraumatic growth and meaning in life. In multiple regression analysis, meaning in life and posttraumatic growth accounted for 26.0% of health promotion behavior. CONCLUSION: Posttraumatic growth and meaning in life were important factors that could be used to improve the health promotion behavior of cancer patients.
Busan ; Diagnosis ; Health Promotion* ; Hospitals, General ; Humans

PURPOSE: The aim of this study was to evaluate the process and outcome of a mobile computerized system for individual home visiting healthcare. METHODS: A nonequivalent control group non-synchronized design was employed for this study. The newly constructed system was administered to 80 healthcare providers in the experimental group for 8 weeks. Data were analyzed using descriptive analysis, t-test, and ANCOVA with the SPSS 18.0 program. RESULTS: In the process stage, the difference in the frequency of computerized information usage between the experimental and control groups was significant as 8.88+/-3.20 and 7.08+/-2.92, respectively (t=3.90, p<.001). In the outcome evaluation stage, all kinds of healthy lifestyle such as alcohol use, nutrition, weight management and mental health were not improved. CONCLUSION: The findings of this study showed that the revised mobile computerized system was an effective device for individual visiting healthcare providers. Further advanced strategies for using this system should be developed and applied in a broad range of community healthcare.
Community Health Services ; Health Personnel ; Home Care Services ; House Calls ; Humans ; Life Style ; Mental Health ; Mobile Health Units ; Program Evaluation

This study was conducted as a part of project developing the standards of the national board test for dietitian's licences. The purpose of this study was to define the job specification for dietitian's job description based on the knowledge, skill, attitude and related to the curriculum. The study team established the research team which composed of 11 person(7 professor in the university and 4 dietitians in hospitals, schools and private firms). The job description composed of 17 duties, 99 tasks and 576 task elements. For each element, the job specifications are written, which composed of introduction, process, required equipments, and required ability. Required ability included knowledge, skill and attitudes. The relations of the knowledge, skill and attitudes with the possible curriculum currently operated in the college or university were analyzed, also. Job specifications for 576 task elements are analyzed and framed.
Curriculum ; Humans ; Job Description* ; Nutritionists

This study was conducted a part of the project developing the standards of national board test for the dietitian's licence. The purpose of this study was to verify the dietitian's job description. To do this the survey was carried out for the frequency, criticality and difficulty of each job description with 4 point scales. The subjects was 521 dietitians, who have been working over 3 years at their position. The results are following ; 1. The each duty, task and task elements are verified with survey results. 2. Duties with high frequency and criticality were menu management, purchasing, storage and stock management, operational management for cooking, system management for distribution and sanitation management. 3. Duties with middle frequency and high criticality were managing equipment and facility, food service management, human resources management and self-development. 4. Duties with low frequency and high criticality were nutritional assessment for life cycles, nutrition therapy, nutrition education and disease management. 5. For difficulty, food service area show lower than of nutrition service area.
Cooking ; Disease Management ; Education ; Food Services ; Humans ; Job Description* ; Life Cycle Stages ; Nutrition Assessment ; Nutrition Therapy ; Nutritionists ; Sanitation ; Weights and Measures

This study was conducted as a part of the project developing the standards of national board test for the dietitian's licence. The purpose of this study was to define the job description of dietitians, and to describe the task elements based on the detailed analysis of the dietitians' work. This study team established the research team which was composed of food and nutrition experts, 7 of registered dietitians and 3 of university professors. Draft job description form was made to fully explain the dietitians' task elements, process and sequence by the research team. Final job description form was confirmed after the validity of 576 task elements was reevaluated upon 4 point scale test based on the frequency, importance, and difficulty by 21 field registered dietitian by the study team. It was also confirmed by the university. This form was formated by following DACUM method which analyzed the job description containing duty, task and task elements. It was organized to include every dietitians' work and to describe the every detailed process of work. Duty was defined as the specific and independent work as a dietitian, and was composed of 17 parts, i.e 10 parts in food supply management area and 6 parts in nutritional care service area and self promotion area. Duties were also divided into 99 tasks containing the 576 detailed task elements to describe definite action, steps and decisions. Seventeen parts are following; menu planning, storage and inventory control, food production, meal service, waste management, sanitation, equipment and facility management, human resource management, financial management, nutrition assessment of life cycle, nutritional assessment of several disease, nutritional assessment in specific condition, medical nutrition therapy, nutritional education, public health nutrition and self promotion. If these protocols are properly performed and presented, they can provide the likelihood that dietetics professionals work as a primary contributors in promoting health care and preventing disease nationally.
Delivery of Health Care ; Dietetics ; Education ; Financial Management ; Food Supply ; Humans ; Job Description ; Life Cycle Stages ; Meals ; Menu Planning ; Nutrition Assessment ; Nutrition Therapy ; Nutritionists ; Public Health ; Sanitation ; Waste Management

To investigate the change of perception after weight management education in elementary, middle and high school students, a survey was conducted. Same questionnaire was administered twice, before and after weight management education, to 426 students at 9 schools in Seoul area. The mean height, weight and body mass index were 145.5+/-8.0cm, 40.0+/-8.3kg, 18.6+/-3.0 for elementary school students, 160.1+/-5.2cm, 50.2+/-7.3kg, 19.5+/-2.4 for middle school students, and 162.2+/-5.0cm, 52.2+/-6.4kg, 19.8+/-2.3 for high school students, respectively. Before education, their preferred weight and perceived healthy weight was 35.4kg and 37.0kg among elementary school students, 44.8kg and 46.5kg among middle school students, and 47.3kg and 48.9kg among high school students, respectively. Differences between their present body weight and their preferred weight and/or perceived healthy weight appeared to be 4.5kg and 2.9kg in elementary school students, 5.6kg and 4.0kg in middle school students, and 5.1kg and 3.3kg in high school students, respectively. After administering education, the differences decreased to 2.5kg and -0.2kg in elementary school students, 4.2kg and 2.7kg in middle school students, and 4.3kg and 2.0kg in high school students, respectively (p<0.01). And their perception on own body shape was investigated using 5 point scale ('too lean' to 'too fat', 1 to 5) before and after education. The mean values changed from 3.1 to 2.8 in elementary school students, from 3.3 to 3.0 in middle school students, and from 3.4 to 3.2 in high school students (p<0.01). Their satisfaction with own body weight was monitored using 5 point scale ('very satisfied' to 'very unsatisfied', 1 to 5), also. The mean values changed from 3.0 to 2.7 in elementary school students, from 3.6 to 3.2, in middle school students, and from 3.8 to 3.4 in high school students (p<0.01). In the evaluation of their nutrition knowledge about weight control using 10 item quiz, before and after education, the mean quiz score was changed from 6.3 to 7.0 in elementary school students, from 7.0 to 7.9 in middle school students, and from 7.5 to 8.1 in high school students (p<0.01). In summary, nutrition education on weight management improved the subject's perception on perceived healthy weight and own body shape, and satisfaction with present body weight. This result suggests that nutrition education program should incorporate strategies to change incorrect beliefs and knowledge regarding weight control. Onto this, weight control education for students should start from their early age, be repeated periodically and consistently, and focus on the harmful effects of excessive weight loss and information on the practical and scientific ways of weight management.
Body Mass Index ; Body Weight ; Education* ; Humans ; Surveys and Questionnaires ; Seoul* ; Weight Loss

PURPOSE: The TNM classification for carcinoma of the colon and the rectum provides more detail than other staging systems. This study was performed to evaluate the effectiveness of AJCC staging system (5th ed., 1997) for the colorectal cancer in predicting prognosis. METHODS: We analyzed a data base of 1,233 colorectal cancer patients (M:F=673:560) who underwent surgery in Asan Medical Center during July 1989-December 1996. Survival analysis was performed between the stages and the subgroups in same stage by using Kaplan-Meier method and log rank test. Borderline subgroup comparison between the stages was performed, also. Significance was assigned to a P value of <0.05. RESULTS: Mean age of the patients was 57 (19-90) years old. Median follow-up period was 42 (6-129) months. The number of patients in each stage were 0: 15, I: 152, II: 390, III: 465, IV: 199. The 5 year overall & disease free survival rates of each stage were 100%, 100% (in stage 0), 96.4%, 93.6% (in stage I), 82.7%, 82.2% (in stage II), 59.9%, 55.3% (in stage III), and 7.3%, 24.9% (in stage IV), respectively (P=0.000). Subgroup analysis in stage I (T1N0 vs. T2N0) and II (T3N0 vs. T4N0) revealed no differences. However, in stage III, N1 (n=246) group showed better survival than N2 (n=219) group (70.3%, 65.5% vs. 49.2%, 44.6%: P=0.000). Borderline survival analysis between stage I and II (T2N0 vs. T3N0) was significantly different (96.6%, 95.7% vs 82.7%, 82.3%: P=0.006). However, between stage II and III (T4N0 vs. T1N1), appropriate analysis was impossible due to small number of cases. CONCLUSIONS: AJCC staging system for colorectal cancer was reliable and effective in predicting prognosis. However, substages are needed in stage III.
Chungcheongnam-do ; Classification ; Colon ; Colorectal Neoplasms* ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Prognosis ; Rectum

BACKGROUND: Women with end-stage renal disease have low fertility. Following renal transplantation, the reproductive function returns to normal, and pregnancy becomes possible. METHOD: At our medical center, between June 1990 and February 1998, 263 female patients underwent renal transplantations, and 14 of them later became pregnant. The outcomes from 23 pregnancies in these 14 kidney transplant recipients were analyzed. RESULT: Forty-three percent (43%) of the pregnancies ended in artificial (9 cases) or spontaneous abortion (1 case), and 11 of 13 deliveries were successful. A vaginal delivery was performed in 9 cases (69%) and a cesarian section was done in 4 cases (31%). All of the 11 pregnancies that continued over 30 weeks ended successfully. The mean age of the recipients at the first pregnancy was 29.4 +/- 4.6 years (23-37). The mean time to first pregnancy since renal transplantation was 22.6 +/- 12.3 months (1-50). Thirteen (13) recipients were maintained on cyclosporin-based immunosuppressive regimens before and during pregnancy. One recipient, who was considered to have developed immune tolerance later, stopped the immunosuppressive drug at 3 months prior to the first pregnancy. The renal function remained stable and unchanged in all the recipients, and no rejection episodes occurred during and after pregnancy in any of the recipients. Preeclamsia occurred in 8 cases (35%) and a previous rupture of membrane in 1 case (4%). Of the 11 live births, 4 (36%) were premature (<37 weeks), 1 (9%) had a lowbirth-weight (<2500 gm), 1 (9%) had transient apnea, and 3 (27%) had transient neutropenia. The mean Apgar score at 1 minute was 7.8 (7-9), with only 2 children having a score below 7. No congenital anomalies were documented. The later development and health of all of the children were good during a mean follow-up of 16.6 +/- 10 (1-38) months. Two (2) recipients who had a successful first pregnancy had a second baby. CONCLUSION: From these results, we can conclude that pregnancy does not adversely affect graft function and fetal development, provided that the graft function was stable at the time of conception and prudent fetal monitoring could be done.
Abortion, Spontaneous ; Apgar Score ; Apnea ; Child ; Female ; Fertility ; Fertilization ; Fetal Development ; Fetal Monitoring ; Follow-Up Studies ; Humans ; Immune Tolerance ; Kidney ; Kidney Failure, Chronic ; Kidney Transplantation ; Live Birth ; Membranes ; Neutropenia ; Pregnancy* ; Rupture ; Transplantation ; Transplants

BACKGROUNDS/AIMS: In hepatocellular carcinoma (HCC), bile duct invasion occurs far more rarely than vascular invasion and is not well characterized. In addition, the pathologic finding of bile duct invasion is not considered an independent prognostic factor for HCC following surgery. In this study, we determined the characteristics of HCC with bile duct invasion, and assessed the clinical significance of bile duct invasion. METHODS: We retrospectively reviewed the medical records of 363 patients who underwent hepatic resection for HCC at Seoul National University Hospital (SNUH) from January 2009 to December 2011. Preoperative, operative, and pathological data were collected. The risk factors for recurrence and survival were analyzed. Subsequently, the patients were divided into 2 groups according to disease stage (American Joint Committee on Cancer/International Union Against Cancer 7th edition): early stage (T1 and 2) and advanced stage (T3 and 4) group; and risk factors in the sub-groups were analyzed. RESULTS: Among 363 patients, 13 showed bile duct invasion on pathology. Patients with bile duct invasion had higher preoperative total bilirubin levels, greater microvascular invasion, and a higher death rate than those without bile duct invasion. In multivariate analysis, bile duct invasion was not an independent prognostic factor for survival for the entire cohort, but, was an independent prognostic factor for early stage. CONCLUSIONS: Bile duct invasion accompanied microvascular invasion in most cases, and could be used as an independent prognostic factor for survival especially in early stage HCC (T1 and T2).
Bile Ducts* ; Bile* ; Bilirubin ; Carcinoma, Hepatocellular* ; Cohort Studies ; Humans ; Joints ; Medical Records ; Mortality ; Multivariate Analysis ; Pathology ; Recurrence ; Retrospective Studies ; Risk Factors ; Seoul