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Purpose: Discontinuation of hormone therapy is known to lead to a poorer prognosis in breast cancer patients. We aimed to investigate the prescription gap as a prompt index of medication adherence by using prescription data extracted from patient electronic medical records. Methods: A total of 5,928 patients diagnosed with invasive, non-metastatic breast cancer, who underwent surgery from January 1, 1997 to December 31, 2009, were enrolled retrospectively. The prescription data for 4.5 years of hormonal treatment and breast cancer-related events after treatment completion were analyzed. We examined the characteristics and prognoses of breast cancer in patients with and without a 4-week gap. Results: Patients with a gap showed a significantly higher risk of breast cancer recurrence, distant metastasis, breast cancer-specific death, and overall death after adjustment (hazard ratio [HR], 1.389; 95% confidence interval [CI], 1.089–1.772; HR, 1.568; 95% CI, 1.158–2.123; HR, 2.108; 95% CI, 1.298–3.423; and HR, 2.102; 95% CI, 1.456–3.034, respectively). When patients were categorized based on gap summation, the lower third (160 days) and fourth (391 days) quartiles showed a significantly higher risk of distant metastasis (HR, 1.758; 95% CI, 1.186–2.606 and HR, 1.844; 95% CI, 1.262–2.693, respectively). Conclusion: A gap of > 4 weeks in hormonal treatment has negative effects on breast cancer prognosis, and can hence be used as a sentinel index of higher risk due to treatment non-adherence. Further evaluation is needed to determine whether the gap can be used as a universal index for monitoring the adherence to hormonal treatment.
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Depression is a common psychiatric disorder, but accurate recognition of depression is somewhat difficult because of different symptom presentation by age. The consequence of not recognizing to depression is that clinically significant and potentially treatable depression might be overlooked, misdiagnosed, and mistreated in depressive patients. The overlap of somatic symptoms of depression and physical illness and minimal expression of sadness is common in old age. Because of that reasons, alternative approach to identifying depression should be provided by proper screening instruments.
Objectives: The usability of clinical information systems (CISs) is known to be an essential consideration in ensuring patient safety as well as integrating clinical flow. This study aimed to determine how usability and safety guidelines of CIS consider clinical workflow through a systematic review in terms of the target systems, methodology, and guideline components of relevant articles. Methods: A literature search was conducted for articles published from 2000 to 2015 in PubMed, Cochrane, EMBASE, Web of Science, and CINAHL. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement method was employed. Articles containing recommendations, principles, and evaluation items for CIS usability and safety were included. The selected articles were classified according to article type, methodology, and target systems. Taking clinical workflow into consideration, the components of guidelines were extracted and classified. Results: A total of 7,401 articles were identified by keyword search. From the 76 articles remaining after abstract screening, 15 were selected through full-text review. Literature review (n = 7) was the most common methodology, followed by expert opinions (n = 6). Computerized physician order entry (n = 6) was the most frequent system. Four articles considered the entire process of clinical tasks, and two articles considered the principles of the entire process of user interface affecting clinical workflow. Only two articles performed heuristic evaluations of CISs. Conclusions: The usability and safety guidelines of CISs need improvement in guideline development methodology and with consideration of clinical workflow.
Jakata story based on the folk tales of ancient India features Buddha's distributing charity and perseverance in his previous life. Among them, the self-sacrificing stories show us the extreme sacrifice of one's body. The Jakata stories about giving someone one's flesh are a big part of the whole Jakata stories. When it entered in China, in contact with Confucian culture, it created a new and interesting aspect. This paper examined the narrative features of the self-sacrificing jakata tales, and grasped the underlying desire and the nature of human beings, futhermore looked at the process in which Shāma jakata and Sujāti jakata were appropriated in the Confucian context. As a result, the flesh-sacrificing story, through describing a cruelly damaged body and cannibalism, stimulates the original fears as a human being and the desires for violating a taboo on cannibalism. However, because of this feature, the stories attracted attention for its charm as a story, but those elements do not fit with Confucian sentiment, so they change into different forms. The cruel contents are purified, and the ideal relations between father and son are emphasized. In this process 割股 filial piety stories, which is about cutting thigh flesh for curing parents, are produced. As 割股 stories get popular, in reality there are many filial piety to practice 割股, and 割股 soon becomes essential behavior as a filial son. Finally, 割股 pandemic has expanded to the medical field, so human flesh was officially recognized as the best medicine in the Tang dynasty. This series of streams means that the ancient Chinese perception of cannibalism has changed. The cannibal, which was basically savage, naturally transformed into a civilization. 고대 인도의 민간설화를 바탕으로 구성된 본생담은 전생의 석가를 주인공으로 하여 보시와 인내를 통해 菩薩行을 실천하는 것을 주제로 한다. 그 중 신체를 보시하는 본생담은 자신의 몸을 희생하여 타인을 돕는, 극단적인 자기희생의 이야기를 다루고 있다. 살(flesh)을 내어주는 본생고사는 전체 본생담에서 차지하는 비중이 크고 중국으로 전래되는 과정에서 유교 문화와 접촉하면서 흥미로운 양상을 보이게 된다. 본고는 대표적인 신체보시 본생담인 睒子本生과 須闍提本生을 중심으로 주요 신체보시 본생담의 서사적 특징에 대해 살펴보고 나아가 이들 본생담이 유교적으로 전유된 과정을 분석했다. 그 결과 신체보시 본생담은 고유의 잔인한 신체 훼손과 식인에 대한 묘사를 통해 인간의 근원적인 공포심과 식인 금기에 대한 위반의 욕망을 자극하고 이러한 이야기로서의 매력을 통해 주목받지만 유교적 정서와 맞지 않는 요소들로 인해 다른 형태로 변화하게 된다. 잔혹한 내용은 순화되고 이상적인 부자관계는 강조된다. 그 과정에서 자신의 허벅지 살을 베어 부모의 병을 치유하는 割股故事가 생산된다. 할고고사의 인기로 실제 할고를 행하는 효자들이 생겨나기 시작하고 곧 할고는 효자라면 당연히 행해야 할 필수적인 행위로 고정된다. 할고의 대유행은 의약학적 지식의 영역으로까지 확대되며 唐代에 이르러서 人肉은 최고의 약재로 공식적으로 평가받게 된다. 이러한 일련의 흐름은 곧 식인에 대한 고대 중국인들의 인식에 변화가 생겼음을 의미한다. 이렇게 기본적으로 야만의 것이었던 식인은 이제 문명의 것이 되었다.