• Journal of Chest Surgery
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• v.39 no.6 s.263
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• pp.475-478
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• 2006

Background: The simultaneous bilateral spontaneous pneumothorax is a rare clinical event. Contrary to the unilateral pneumothorax, the patients with simultaneous bilateral spontaneous pneumothorax sometimes complains of severe respiratory distress, cyanosis and chest pain without tention pneumothorax. It is often dangerous; therefore, the chest drain should be inserted immediately. Material and Method: Between March 1994 and February 2004, 802 patients were treated in our department for spontaneous pneumothorax. Among these, the simultaneous bilateral spontaneous pneumothorax developed in 14 patients (1.7%). Result: Out of fourteen patients, two females and twelve males presented with simultaneous bilateral spontaneous pneumothorax. The patient age ranged between 0 and 79 years with mean age of 31.2 years. In eleven patients, this was the first episode of pneumothorax. One patient had combined hemopneumothorax and two patients had combined pyopneurnothorax. Six patients had smoking history (42.8%, average 17.3 p-y). Five patients had pulmonary tuberculosis history and among these, two patients had active pulmonary tuberculosis. Three patients were died due to meconium-aspiration pneumonia (1 patient) and ARDS (Acute Respiratory Distress Syndrome) with pneumonia (2 patients). We treated these patients with nasal oxygen inhalation, chest drain insertion, thoracotomy, VATS (Video-Assisted Thoracoscopic Surgery) and chemical pleurodesis. Conclusion: The simultaneous bilateral spontaneous pneumothorax developed in 14 patients (1.7%) among 802 patients. Prompt insertion of chest drain is needed for a relief of severe symptoms, and to reduce the risk of recurrence, early thoracotomy or VATS should be performed rather than chest drain insertion only.

• Journal of the Economic Geographical Society of Korea
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• v.22 no.4
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• pp.405-421
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• 2019

International aid to North Korea remains far below the humanitarian needs of vulnerable people. This paper examines the trajectory of international humanitarian assistance to North Korea over the last two decades with the focus on its decline in the context of the country's nuclear standoff and corresponding stringent sanctions. In so doing, the paper addresses major problems associated with North Korea's reception of foreign aid and operational constraints placed on humanitarian activities in the country. It shows that humanitarian assistance to North Korea has been largely shaped by geopolitical dynamics. A survey of UN reports and statistics also suggests a shifting trend in recent international aid to North Korea. The decline of aid and multiple operational obstacles faced by humanitarian organizations, for instance, have led to a fall in agricultural support and a proportional rise in health and related services. While UN Security Council resolutions include an exemption provision, humanitarian assistance to North Korea has been constrained by stringent sanctions, which have led to adverse consequences for the civilian population. In this regard, the paper suggests some policy directions for international aid to North Korea amidst negotiations over denuclearization, while stressing an urgent need to address the negative impact of sanctions on vulnerable groups in the country.

• Korean Journal of Hospice Care
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• v.7 no.1
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• pp.15-28
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• 2007

This study was focused on figure out what kinds of elements are influencing on job satisfaction with approach of the educational system. It was also to figure out how work characteristics and role conflicts of employees influence on job satisfaction. Objects of study were employeeswho had been working in Hospice and Palliative medical center at least for 6 months, and they were doctors, nurses, ministers, and welfare workers. Collected materials were analyzed by Frequency Analysis, One-way ANOVA, Correlation Analysis, and SimpleRegression Analysis. Results from study can be summarized like below. The first, job satisfaction of workers in Hospice and Palliative medical center were 3.36, and this numerical value is pretty high over all. For saying from the higher to the lower satisfaction level, there were satisfaction with job itself, satisfaction with co-workers, satisfaction with seniors (superiors), and satisfaction with organizations, on the other hands, satisfaction with salaries was turned out as the lowest level among those. The second, role conflict was 2.63, and it is considered as the medium level. after inquiring into it by elements of role conflict, they felt many environmental difficulties compared to other workers in different fields such as environmental difficulty, role ambiguity, insufficient ability, process obscurity, etc. The third, work environment influencing on job satisfaction are as follows. Professional environment among characteristics of work environment was significant statistically. Job satisfaction of ministers was the highest; others were in the order of doctors, welfare workers, and nurses. For employment history, job satisfaction was higher as they have more and longer job experience including whole professional experience both in hospice and palliative medical center. In addition, participating in hospice and palliative programs, intensive training regularly was significantly. Job Motivation was also significant statistically. Especially, job satisfaction was higher when people decided to work in hospice and palliative medical center because of individual desire (self-realization). Lastly, influence of role conflict on job satisfaction is as follows. Environmental difficulty, role ambiguity, insufficient ability, process obscurity, etc showed the significant meaning statistically, and the lower role conflict was related with the higher job satisfaction. Suggestions for next study based on such results are as follows in order to improve or increase job satisfaction of employees in hospice/palliative medical centers. The first, to expand education opportunity of employees is needed to increase job satisfactionof hospice/palliatives medical centers. Participating in intensive programs and seminars by types of occupation and acquiring professional knowledge are very important since employees are motivated by those activities. For that, developing and activating intensive education/programs by professional occupations are suggested. The second, dividing roles of employees and determining each job's limit clearly in hospice/palliative medical centers are required. For that, study developing standard job regulations is suggested for each professional job. Lastly, developing and providing reasonable salaries is needed because low salaries of hospice/palliative medical centers are the absolute reason lowering job satisfaction. Therefore, this paper suggests improving the salary level of employees of hospice/palliative medical centers and developing practical plan for it.

• Journal of Hospice and Palliative Care
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• v.9 no.1
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• pp.30-34
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• 2006

Purpose: This study is to report the operating result of the Hospice Cyber Counselling Program for improving quality of lift for terminal patients and their families. Methods: This study was performed followed by counsellor training, building strategy of public relations, management, and evaluation of the effect in order. Results: 72 subjects visited our cyber homepage and became members for approximately 9 months from Oct. 2004 to July 2005; 17 subjects in their 20s (23.6%), 12 subjects in their 30s (16.7%), 17 subjects in their 40s (23.6%), and 13 subjects above 50s (18%). Classified by diagnose related group, cancer related disease consist of 90%. As for the relationship between contents of counselling and counselling applicants, families consist of 90% and self-applicants only 10%. Only 30 members used on-line counselling and their counselling frequency was just 35 times. Although counselling frequency and the number of members who used the counselling site were not high, they tend to contact with a counsellor continuously and use the site actively after the first counselling. Conclusion: Cyber counselling program for hospice was practically managed to improve quality of life for terminal patients and their families as a basic activity for hospice business activation. Basic public relations with regard to hospice business by mass media and the press should be performed continuously and the hospice training program is required for medical personnel to be continue.

• Journal of Hospice and Palliative Care
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• v.19 no.2
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• pp.145-153
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• 2016

Purpose: This study was conducted to investigate patients' characteristics and actual conditions of home-based services offered by a free-standing hospice center. Methods: A retrospective review was performed with the medical records of 75 patients who received home-based hospice care from a free-standing hospice center from January 2014 through December 2014. Results: Most patients (54.7%) were enrolled via self-directed referral. The reason for the service termination was death at home 25.3%, admission to a hospice ward 50.7%, hospitalization 22.6% and patients' refusal 2.7%. Seventy three patients had cancer, and two patients had ALS. Among all, 58.7% were in a dying phase, and 34.7% were almost completely bedfast at the time of their enrollment in this study. When they enrolled, the patients' physical symptoms were characterized as pain (89.4%), sleep disturbance (71.2%), urinary difficulties (35.8%) and defecation difficulties (47.8%). Among all, 77.4% terminated the home visit service within one month. The mean frequency of the home visits was 3.25 (${\pm}3.98$), and less than five in 82.7% of patients. The mean frequency of the phone service was 3.40 (${\pm}3.12$). The frequency of doctor's home visits was $1.21{\pm}0.79$ on average, and the figure increased when patients' conditions turned unstable. Conclusion: It is necessary to develop a home-based hospice care model with consideration of patients' characteristics and the actual service conditions delivered by free-standing hospice facilities.

• Journal of Hospice and Palliative Care
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• v.19 no.2
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• pp.136-144
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• 2016

Purpose: To provide practical data for bioethics education, we identified correlations between recognition of good death, attitude towards withdrawal of meaningless life-sustaining treatment, and attitude towards euthanasia in nurses. Methods: Using convenience sampling, we recruited 218 nurses who had at least six-month work experience in one of the six general hospitals with 500 or more beds in Seoul, Busan, and Gyeongsang province. All participants understood the purpose of the study and agreed to take part in the study. The research tools used included the Concept of Good Death Measure (CoGD), the measurement tool for attitudes towards withdrawal of meaningless life-sustaining treatment (WoMLST), and the measurement tool for attitudes towards euthanasia. Data were analyzed using an Independent t-test, one-way ANOVA, and Pearson's correlation coefficient using SPSS 21 for Windows. Results: Nurses had normal levels on CoGD, WoMLST, and attitudes towards euthanasia. Nurses' CoGD, WoMLST, and euthanasia scores significantly differed depending on their education level, working period, and the importance of religion to them. A negative correlation was found between the CoGD and WoMLST scores, and WoMLST and euthanasia scores were positively correlated. Conclusion: Nurses should be trained to deal with ethical issues that may arise while caring for terminal patients. It is necessary for nurses to understand the concepts related to CoGD, WoMLST, and euthanasia, and to promote bioethics education with focus on decision-making and problem-solving ability in ethically conflicting situations.

• Journal of Hospice and Palliative Care
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• v.12 no.3
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• pp.147-156
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• 2009

The purpose of this study was to assess the level of resilience to burnout and work satisfaction of hospice volunteers. Methods: Participants included 235 regular volunteers at hospice facilities of two university hospitals and four general hospitals located in Busan. The study instruments were the scale of resilience to burnout and work satisfaction. The scale of resilience to burnout consisted of six dimensions (professional competency, accomplishment and worthiness, firm belief and value about their profession, good teamwork, support by their agency, and individual resources) and 31 items which were rated on a 5-point Likert scale, whereas the scale of work satisfaction consisted of 6 items which were rated on a 5-point Likert scale. Data were analyzed by descriptive statistics, t-test, ANOVA, Tukey and Pearson's correlation coefficient. Results: The mean score of resilience to burnout and work satisfaction of participants were 3.59 and 3.69, respectively. The highest and lowest scores of resilience to burnout were individual resources (3.81) and accomplishment and worthiness (3.36). There were significant differences in resilience to burnout scores, depending on religion, health status, type of hospice facilities, and period of volunteer experience. There were significant differences in work satisfaction scores, depending on gender, religion, education level, health status, and type of hospice facilities. Conclusions: Continuous education and efficient management need to be developed to improve the level of resilience to burnout and work satisfaction of hospice volunteers.

• Journal of Hospice and Palliative Care
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• v.12 no.3
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• pp.122-131
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• 2009

This study was performed to identify the importance and performance of hospice volunteer's activities perceived by hospice volunteers. Methods: The subjects were 259 hospice volunteers from six hospitals in Daegu and Gyeongsangbukdo areas. A list of hospice volunteer's activities was developed by authors, based on literature, and interviews with the hospice volunteers were used to measure the perception on the importance and performance of their activities. Data were analyzed by using Descriptive statistics, t-test, One-way ANOVA with Scheffe test, and Pearson's product-moment correlation in SPSS Win 12.0. Results: The average of the importance of hospice volunteer's activities was 3.09 and the performance was 2.31, which was lower than the importance. There was a significant correlation between the importance and the performance (r=.487, P=.000). There were significant differences in total score of the importance, depending on religion, education, and period of hospice volunteer activity of subjects. There were significant differences in total score of the performance, depending on age, religion, and period of hospice volunteer activity of subjects. Conclusion: The importance of hospice volunteer's activities, perceived by hospice volunteers, was relatively high, however their performance didn't reach the level of the importance. Some characteristics of the volunteers influenced the perception of the importance and performance of the hospice volunteer's activities. The findings of this study are expected to provide useful information for the development of educational and management programs the hospice volunteers.

• Journal of Hospice and Palliative Care
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• v.16 no.4
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• pp.232-241
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• 2013

Purpose: This study was conducted to do preliminary report of differences and similarities between Koreans residing in Korea and Korean Americans residing in America regarding their awareness of end-of-life care, attitudes toward advance care planning, truth telling, and preferred decision-making model. Methods: Two participating groups were selected: a) Koreans residing in Korea, and b) Koreans Americans who had resided in the United States for at least 20 years. 25 Koreans and 23 Korean Americans who were older than 65 years old participated in this study. They were asked via a self-administered questionnaire that contained demographic questions and questions about end-of-life decision making regarding awareness of end-of-life care, attitudes toward advance care planning, truth telling, and preferred decision-making model. A Chi-square was used to measure differences between Koreans' and Korean Americans planning. A P value of less than 0.5 was considered significant. Data analysis was performed using SPSS 18.0. Results: In some aspects of awareness of end of life care, attitudes toward advance care planning, and truth telling, both groups had similar opinions. However, there were significant differences between groups in the necessity of end of life documentation, preferential informing the truth, and preferred decision making model. Conclusion: There were similarities and differences regarding some end of life issues between the Koreans and the Korean Americans.

• Journal of Hospice and Palliative Care
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• v.16 no.2
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• pp.108-117
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• 2013

Purpose: The objectives of this study were to 1) explore nurses' attitudes toward death, coping with death, understanding and performance regarding end-of-life (EOL) care, 2) describe correlations among the above factors, and 3) determine the factors affecting nurses' EOL care performance. Methods: Study participants were 187 nurses stationed at departments that post higher mortality than others such as the oncology department, intensive care unit (ICU) and emergency department (ED). Data were collected from three urban university-affiliated hospitals. Multi-dimensional measure was performed for study instruments such as "attitude toward death", "coping with death" and "understanding and performance regarding EOL care". Data were analyzed by using descriptive statistics, correlation, and multiple regressions. Results: First, nurses showed significantly different attitudes toward death by age, religion, work unit and EOL care education. Younger nurses tend to score low on the understanding of EOL care, and ED nurses' score was lower than their peers at the oncology department and ICU. Second, EOL care performance was positively correlated with attitude toward death (P<0.001), coping with death (P=0.003) and understanding of EOL care (P<0.001). Third, nurses' EOL care performance was affected by work unit (P<0.001) and understanding of EOL care (P<0.001). Conclusion: Because nurses' performance was influenced by their work unit and understanding of EOL care, they should be provided with appropriate training to improve their understanding of death and EOL care according to work unit.