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강성희,제경숙,김현주 한국생애학회 2017 생애학회지 Vol.7 No.3
The purpose of this research was to provide data to help foster expertise for consultants as well as to improve quality of care by identifying areas of improvement in daycare evaluation and accreditation consulting based on experiences of consultants. Participants in this research were eight daycare center directors who were appointed by the support center for childcare in area A and B to serve as evaluation and accreditation consultants. Semi-structured interviews based on a discussion guide were conducted twice with each participant. Materials from interview sessions and summary of results were collected, transcribed, classified, and analyzed. This research found that consultants regularly participate in various consultant education and training sessions. They are also making efforts on their own to develop and strengthen their skills and competencies. They provide individual support to daycare centers by providing specific examples or guidance on updates to evaluation criteria, and providing emotional support to childcare providers facing challenges at work. They try to use discretion in word choice when writing the report. Although consulting compensation is considered appropriate as volunteer service given specified hours required, they express the need to adjust the compensation based on required level of expertise, time, effort, and distance to travel. In conclusion, systematic and specialized training sessions to develop their expertise are needed to resolve challenges faced by them. Centralized development and deployment of standardized consulting materials are needed to minimize challenges during consulting and to provide professional and objective consulting.
Preparation and Patient Evaluation for Safe Gastrointestinal Endoscopy
강성희,현종진 대한소화기내시경학회 2013 Clinical Endoscopy Vol.46 No.3
Patient evaluation and preparation is the first and mandatory step to ensure safety and quality of endoscopic procedures. This begins and ends with identifying the patient, procedure type, and indication. Every patient has the right to be fully informed about risks and benefits of what is to be performed on them, and the medical personnel should respect the decision made by the patients. Thoroughly performed history taking and physical examination will guide the endoscopists to better stratify risk and plan sedation. Special attention should be given to higher-risk patients with higher-risk condition undergoing higher-risk procedures. Making preparations to monitor the patients and being ready to handle emergency situations throughout the endoscopic procedure are sine qua non to warrant safe endoscopy.
Efficacy of Sorafenib for the Treatment of Post-Transplant Hepatocellular Carcinoma Recurrence
강성희,조혜기,조은주,이정훈,유수종,김윤준,이남준,이광웅,서경석,윤정환 대한의학회 2018 Journal of Korean medical science Vol.33 No.45
Background: The role of sorafenib in patients with hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) has been rarely studied. The aim of this study was to evaluate the efficacy of sorafenib in post-LT era. Methods: Consecutive patients with post-transplant HCC recurrence not eligible to resection or locoregional therapy were included. Patients receiving best supportive care (BSC) until 2007 were compared with those treated by sorafenib thereafter. Results: Of a total of 65 patients, 20 patients received BSC and 45 received sorafenib. Clinical characteristics were similar between two groups except that sorafenib group received tacrolimus and mammalian target-of-rapamycin inhibitors more frequently than BSC group. Treatment with sorafenib conferred a survival advantage as compared with BSC for survival after recurrence (median, 14.2 vs. 6.8 months; P = 0.01). In multivariate analyses, high serum α-fetoprotein level, synchronous intrahepatic recurrence and distant metastasis at the time of recurrence, and BSC were independently associated with poorer survival after recurrence. Sorafenib treatment was associated with better survival after recurrence as compared with BSC (hazard ratio, 0.25; 95% confidence interval, 0.10–0.62; P = 0.002). In addition, sorafenib group showed tolerable toxicity in the post-transplant setting. Conclusion: Sorafenib may be beneficial in patients with post-transplant HCC recurrence.