The causes of aviation accidents are not simple. Human error could possibly be caused by outside factors such as an environmental factor, laws and regulations, organizational, and national culture. An approach to an organizational factor on safety management and aircraft accident investigation is indispensable to improve aviation safety. Data collection from diversified sources is very important. Therefore, safety management focuses on safety inspections within the organization, and understanding the organization and employees' culture. Data from people who work in the aviation field must be merged with information technology to produce information and knowledge. Decision and policy making must be executed using knowledge-based aviation information. Policy makers must make it a priority to create an infrastructure for collecting data, transforming the data to information and the using information knowledge in amending aviation acts and regulations. The system that uses the infrastructure is composed of data collection from multi-channel, analysis and feedback to understand different culture organization-to-organization and country-to-country factors. Policy must be established and be enforced using this system to make it function positively. This study is a fundamental research to enhance aviation safety and to improve Korea's aviation acts and regulations.
Accidents, Aviation ; Administrative Personnel ; Aircraft ; Aviation* ; Data Collection ; Humans ; Jurisprudence ; Knowledge Management* ; Policy Making ; Safety Management* ; Social Control, Formal

BACGROUND: After amendment of the national health insurance law to enforce and reform primary health care, the number of family medicine out-patients was increased. Some patients requested referral. Therefore, this study was made to reveal family medicine residents'perception of attitude towards request for referral. METHODS: The self-administered questionnaires were collected by post mailing (July 1 to July 30, 2002) and by e-mailing (July 25 to August 10, 2002). The questionnaire contained the followings: general characteristics, issues of referral request, influence of referral request in training, and influence in private family clinics. RESULTS: The overall response rate was 22.2% (93/418). Patients need was the most common cause of referral (62.0%). Among the total, 46.2% of respondents gave answers that increasing number of patients at the family medicine out-patient clinic was beneficial in increasing their experience. Also, 55% of respondents replied that the present state of family medicine out-patient system influenced lowering of motivation in training. Overall, 63.4% of respondents replied that the present state of family medicine out-patient system led a trend of distrust to private family clinics. CONCLUSION: Patients request was the most common cause of referral in family medicine out-patient clinic. The present state of referral system in family medicine out-patient clinic influenced lowering of motivation in training and a trend of distrust to private family clinics.
Surveys and Questionnaires ; Electronic Mail ; Humans ; Jurisprudence ; Motivation ; National Health Programs ; Outpatients* ; Postal Service ; Primary Health Care ; Referral and Consultation*

OBJECTIVES: In our studies, we have made efforts to compare illness representation among the pathological gamblers, social gamblers, the family members of gambler, the gambling industry employees, and general adults and to investigate what kinds of illness representation make an estimate of therapy intention. METHODS: 222 gambling users, 125 family members of gambler, 95 employees in gambling industry, and 1383 general adults were included in this study. Symptom representation, negative characteristic representation, negative consequence representation, internal and external attribution representation, spontaneous recovery representation, recovery representation through therapeutic help of speciality, time lapse representation were constructed and included for illness representation of pathological gambling. RESULTS: 1) Pathological gamblers had lower symptoms, negative characteristics, negative consequences and therapeutic help seeking representation than other groups, on the other hand higher external attribution representation and spontaneous recovery representation. 2) Families of problem gambler have inconsistent characteristics higher external attribution and negative consequences and lower therapeutic help seeking representation. 3) It was founded that negative consequences representation and external representation were low in gambling industry employees. 4) The more symptom representation increased and external attribution decreased, the more therapeutic intention increased in case of problem gamblers and their families. CONCLUSION: Pathological gamblers have the lowest awareness and acceptance on mental problem caused by excessive gambling. However, suggested that family members of gambler and gambling industry employees also have partially self defensive and contradicted representations. It was suggested that awareness on severity of symptom and internal attribution representation needs to be increased in order to participate therapeutic place.
Adult ; Gambling* ; Hand ; Humans ; Intention

OBJECTIVE: Recently, the atypical antipsychotics such as quetiapine, olanzapine, risperidone, aripiprazole and ziprasidone are increasingly used in the management of acute manic patients as the monotherapy. But there are only a few reports on the use of these drugs in the treatment of bipolar disorder in Korea. The aim of this study was to evaluate the efficacy and tolerability of quetiapine monotherapy in patients with acute mania. METHOD: This study is multi-center, open-label, 6-week evaluation of the efficacy of quetiapine in bipolar mania. In this study, patients with a DSM-IV diagnosis of bipolar I disorder (manic or mixed episodes) were included to treatment with quetiapine (flexibly dosed up to 800 mg/day). Clinical improvements were rated by Young Mania Rating Scale (YMRS), Clinical Global Impression-Bipolar Version (CGI-BP), Brief Psychiatric Rating Scale (BPRS) and Montgomery-Asberg Depression Rating Scale (MADRS). Adverse events were measured using Simpson-Angus Rating Scale (SARS) and Barnes Akathisia Rating Scale (BARS), and subjective reports of patients were evaluated. Global Assessment Scale (GAS) was used to evaluate the general functioning of patients. All assessments were done at baseline and at days 7, 14, 21, and 42 except GAS (at days 21 and 42). Analyses were focused on change from baseline to day 42. RESULTS: Total 78 (male=30, female=48) patients were included and 59 patients (75.6%) completed the study. The mean initial dose of quetiapine was 268.0+/-223.2 mg/day and mean daily dose at day 42 was 585.3+/-244.5 mg/day. YMRS and CGI-BP were significantly improved at day 7, 14, 21, and 42 as compared to baseline. Mean scores of BPRS and MADRS were also significantly decreased at the each assessment points. Fifty-two patients (66.7%) showed response (more than 50% of decrease in YMRS score from baseline) and 35 patients (44.6%) reached remission (YMRS score < or =12) at day 21. GAS showed the improvements of patient's global functioning at days 21 and 42 of quetiapine monotherapy compared to baseline. There was no significant difference between baseline and any assessment points on SARS and BARS scores. CONCLUSIONS: The data showed that quetiapine monotherapy has favorable effects across a broad range of mood symptoms with minimal adverse events in addition to functional improvement in acute manic patients. This result suggests that quetiapine may be preferred for patients with acute mania as one of the first-line agents.
Antipsychotic Agents ; Bipolar Disorder* ; Brief Psychiatric Rating Scale ; Depression ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Korea ; Psychomotor Agitation ; Risperidone ; Aripiprazole ; Quetiapine Fumarate

OBJECTIVE: To evaluate the clinical effectiveness of minilaparotomy total hysterectomy compared with other methods of hysterectomy ever used. METHODS: Data of 300 women who had been done hysterectomy due to benign gynecologic disease were used for this thesis. Minilaparotomy hysterectomy was done for 40 women, classical transabdominal hysterectomy for 186 women, laparoscopic assisted vaginal total hysterectomy for 28 women and vaginal total hysterectomy for 46 women. Women's clinical data and clinical outcome were compared using Excel and SPSS. RESULTS: Minilaparotomy hysterectomy has no limitation in choosing patient and adnexal surgery like classical transabdominal hysterectomy, and postoperative clinical course is so rapid similar with laparosocopic assisted vaginal total hysterectomy. CONCLUSION: Minilaparotomy hysterecomy is good choice for treatment of benign gynecologic disease.
Female ; Genital Diseases, Female* ; Humans ; Hysterectomy* ; Laparotomy

OBJECTIVE: To investigate the relationship between umbilical plasma erythropoietin(epo) concentrations and umbilical cord pH in high risk pregnancies. METHODS: We measured epo concentrations and gas in 103 cases of cord blood obtained from 88 cesarean section (15 of twin) composed of 39 cases of normal control (12 of normal twins), 45 cases of high risk pregnancies and 4 cases of unclassified group using an RIA kit from december,1998 to December, 1999. Statistical analysis was performed using the student's t test and regression analysis. P values less than 0.05 were considered statistically significant. RESULTS: Umbilcal plasma epo concentrations revealed significant inverse correlation (P<0.05) with umbilical acidosis and cord blood epo levels, and it were significantly higher in GDM and IUGR than normal pregnancies (control: 1.60 1.15, n=39 versus GDM: 7.78 7.18, n=11 versus IUGR: 64.77 90.57 n=10, p<0.05), but 11 cases of fetal distress and 13 cases of preeclampsia did not differ significantly from umbilical plasma epo of normal control. CONCLUSIONS: Elevated epo concentrations in cord blood indicate fetal hypoxia and It is significantly increased in IUGR and GDM, these findings show that cord blood epo may serve as a clinically useful marker for chronic fetal hypoxia.
Acidosis ; Cesarean Section ; Erythropoietin* ; Female ; Fetal Blood* ; Fetal Distress ; Fetal Growth Retardation ; Fetal Hypoxia ; Hydrogen-Ion Concentration ; Plasma ; Pre-Eclampsia ; Pregnancy* ; Umbilical Cord

BACKGROUND AND OBJECTIVES: This study was designed to predict the development of severe mitral regurgitation (MR) following percutaneous mitral valvuloplasty (PMV) in patients with a favorable morphology of the mitral valve (MV). SUBJECTS AND METHODS: We prospectively examined 253 patients with severe mitral stenosis from 1997 to 2000. Echocardiographic evaluation of MV morphology was performed prior to PMV. We proposed commissural calcification, severe relative prolapse, and uneven thickening of MV as predictors of MR following PMV and defined the MR risk group as patients with any of these 3 features. The balloon size was expressed as the value of the effective balloon dilating area divided by the body surface area. The larger balloon group was defined as patients in whom balloon size>3.8 cm 2/m 2 was selected for PMV. The development of severe MR was defined as the presence of MR> or = 3 + on echocardiography following PMV. RESULTS: Severe MR developed in 14 (5.5%) patients. On multiple logistic regression analysis, the MR risk group (p<0.001) and balloon size (p=0.009) were the only significant independent predictors of severe MR following PMV. A sensitivity and specificity of a Padial MR score >8 and MR risk group was 43%, 88% and 71%, 86% respectively. In the MR risk group, severe MR developed in 8 (53.3%) of 15 patients of the larger balloon group as compared with 2 (6.9%) of 29 patients of the smaller balloon group (p=0.001). CONCLUSION: Echocardiography can identify patients with a high risk of developing MR after PMV and the use of a smaller Inoue balloon may prevent severe MR in selected patients.
Body Surface Area ; Echocardiography* ; Humans ; Logistic Models ; Mitral Valve ; Mitral Valve Insufficiency* ; Mitral Valve Stenosis ; Prolapse ; Prospective Studies ; Sensitivity and Specificity

We report here on two cases of a 48-year old woman and a 46-year-old man who both presented with broncholithiasis and obstructive pneumonitis. Removal of the broncholithiasis failed with bronchofibroscopy, and so right middle lobectomy of the lung were done in the 2 patients. The histopathologic diagnosis was thoracic actinomycosis associated with broncholithiasis. Thoracic actinomycosis associated with broncholithiasis is a very rare condition, so we report here on these two cases of thoracic actinomycosis associated with broncholithiasis.
Actinomycosis ; Bronchi ; Female ; Humans ; Lung ; Middle Aged ; Pneumonia

BACKGROUND: The heart transplantation is now accepted as a definite therapeutic modality in patients with terminal heart failure. With use of immunosuppressive agent, the incident of rejection deceased but risk of infection increased. Infection has been the most common cause of death in heart transplant patient, especially during the first year. The purpose of this study is to evaluate the infection of 91 patients who had heart transplantation at our hospital. METHODS: Of the total 91 patients, there were 75 males and 16 females, and the mean age was 39.8+/-14.1 years ranged from 14 to 62 years. All patients were in NYHA functional class III or IV preoperatively. The most common underlying heart diseases were dilated cardiomyopathy(72/91). The mean follow-up duration was 36.4 months (range; 0.6 ~ 103 months) and 10 patients died during this period. RESULT: There were 35 patients with infections (early infections in 4 and late infections in 32). The most common infection was skin infection of herpes virus (15 cases). Pneumonia occurred in 8 patients and responded well to antibiotics. But multiple empyema developed in one patient with bacterial pneumonia despite of antibiotics, chest tube insertion was needed. There were 4 patients with tuberculosis, 2 with tuberculous pericardial effusion, 1 with pulmonary tuberculosis and 1 with miliary tuberculosis. Sepsis was noted in 3 patients, 2 with bacterial sepsis and 1 with candidial sepsis. They all died despite of antibiotic treatment. There were 2 cases with wound infections and 1 with perianal abscess, and 1 with aortitis with paraaortic abscess due to Aerococcus viridans. Two patients with cryptococcal meningitis were successfully treated with liposomal amphotericin B and oral fluconazole, one of them also had invasive aspergillosis. There were 6 cases with cytomegalovirus (CMV) disease. Three of them had CMV viremia , 2 had CMV disease ( retinitis and colitis) and 1 had viremia and disease. CONCLUSION: There were 35 patients (38.5%) with infections and among then, 21 patients (23%) had one or more episodes of major infection. Infection was a major cause of death (30%) after heart transplantation. Careful control of infection is vital in the care of transplant recipients because infections result in increased morbidity and mortality.
Abscess ; Aerococcus ; Amphotericin B ; Anti-Bacterial Agents ; Aortitis ; Aspergillosis ; Cause of Death ; Chest Tubes ; Cytomegalovirus ; Empyema ; Female ; Fluconazole ; Follow-Up Studies ; Heart ; Heart Diseases ; Heart Failure ; Heart Transplantation* ; Humans ; Male ; Meningitis, Cryptococcal ; Mortality ; Pericardial Effusion ; Pneumonia ; Pneumonia, Bacterial ; Retinitis ; Sepsis ; Skin ; Transplantation ; Tuberculosis ; Tuberculosis, Miliary ; Tuberculosis, Pulmonary ; Viremia ; Wound Infection

An ampulla within a diverticulum is not rare especially in elderly patients with duct stones, but may pose a problem in identifying the papilla and properly orienting this structure for cannulation during endoscopic retrograde cholangiopancreatography. We therefore have used a new technique using the application of an additional catheter to keep the ampulla outside the diverticulum. When we pushed the duodenal fold downward and laterally with the first catheter, the ampulla was everted from the diverticulum and the hidden papilla was brought into view. Once the papilla was visible, the second catheter which was identical to the first, was advanced alongside it and inserted into the papillary orifice without difficulty. Eventually a successful cholangiogram was obtained. With the insertion of a guidewire through the second catheter, sphincterotomy and insertion of endoscopic nasobiliary drainage tube were also performed successfully.
Aged ; Catheterization* ; Catheters ; Cholangiopancreatography, Endoscopic Retrograde ; Diverticulum* ; Drainage ; Humans