• The Korean Society of Law and Medicine
• /
• v.18 no.2
• /
• pp.163-194
• /
• 2017

Coronary artery disease has increased in Korea as the country enters the aged society. It is well known that the incidence of coronary artery disease is related to aging, hypertension, diabetes, hyperlipidemia, and dietary habit. For effective treatment of significant coronary stenosis, close coordination between cardiac surgery and cardiology team is essential. Especially cardiologists' decision whether to do the stent placement or CABG is very important because the cardiologists usually start to consult the patients for their treatment. Recently, non-surgical interventions(that is stent placement) in cardiology field have dramatically increased as the national insurance system removed the limitation of the number of stents deployed. However, accidents are often caused by inappropriate use of stents, especially in patients with triple coronary disease or left main disease with heavy coronary calcifications. Another aspect of stent placement is to cope with an emergency case in the event of coronary rupture or pericardial tamponade during coronary interventions without cardiac surgeons. In the past two years, the Korea Consumer Agency (Consumer Dispute Coordination Committee) analyzed eight cases of medical dispute settlement. Only two hospitals were manned with both cardiologists and cardiac surgeons. Seven patients died of procedures of stenting and five patients died on the day of the procedure. Among the 8 cases, 5 cases showed 3 vessel disease and the rest of the cases had either severe calcification, complete occlusion or poor coronary antomies for stenting According to a 2017 national data registry of coronary stenting, less than 3 drug-eluting stents were implanted in 98% of all patients. In 2015, the number of stent procedures was 38,922, and approximately in 800 (2%) cases, more than four stents were used per patient. We emphasize that it is necessary to seriously consider the cost-benefit analysis between stent and CABG. The patient has the right to choose the right procedure by asking the liability of 'instruction explanation obligation'. He should be well informed of the pros and cons of both procedures to avoid overuse of stent. It can be solved by intimate discussion of individual cases with the cardiac surgeon and the patient. Unilateral dialogue with the patient, forceful restriction on the number of stenting, lack of surgeon's backup in difficult cases should all be avoided. It is also necessary to solve the problem not only at the hospital level, such as multidisciplinary integrated medical care, but also a nationwide solution such as expanding cardiac surgeons as essential personnel to public officials.

• Journal of dental hygiene science
• /
• v.15 no.3
• /
• pp.361-368
• /
• 2015

The study was conducted to provide data for the development of effective medical conflict prevention programs for dental hygiene by analyzing the dental experience conflicts. A self-administered questionnaire survey was conducted targeting dental hygienists who were performing dental assistance at university hospital, dental hospital and dental clinic in Busan and Gyeongnam regions from April 1 to 30, 2014. Collected questionnaires of 212 dental hygienists were then analyzed with IBM SPSS Statistics ver. 20.0 program. A total of 59.4% had experienced complaints, discontents and medical disputes and 24% of these had experienced a legal trouble developed from such and 95.3% were anxious and doubtful about a possible future medical dispute to some degree. Patient complaints, complaints of non-medical issues raised by 24.3% was the most common, notices, maps and descriptions in relation to the issues raised by 14.4%, is related to the impression issue was raised in the order of 13.5%. Occurrence of disputes did not show a significant difference by place of work, however, a possibility of development of dispute into a legal proceeding showed a significant difference depending on service career and it was investigated that the experienced group feels more pressures with regard to a medical dispute according to their experience of such. All respondents said that education on a prevention and countermeasures of medical disputes is necessary. Understanding of dental hygienists on medical related laws regarding the scope of duty is required to be enhanced and, in order to do so, opportunities to receive an education with regard to a prevention and countermeasures of medical disputes are to be expanded.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.7 no.2
• /
• pp.228-238
• /
• 2004

Purpose: Obesity is rapidly increasing in Korean children. Obesity is a risk factor for cardiovascular morbidity and is frequently associated with hypertension, diabetes mellitus and coronary artery disease. This study was designed to evaluate risk factors of the metabolic syndrome in obese children. Methods: From February 2000 to June 2004, eighty eight obese (body mass index ${\geq}95th$ percentile) children aged 4 to 15 years were included. We measured serum lipid levels (total cholesterol, triglyceride, HDL cholesterol, LDL cholesterol), fasting sugar levels and insulin levels. Insulin resistance was determined by homeostasis model assessment, fasting insulin/glucose ratio and quantitative insulin sensitivity check index. Results: Clustering of risk factors for the metabolic syndrome in obese children demonstrated that 60.2% had more than one risk factors. Hypertension (14.8%), hypertriglyceridemia (14.8%), HDL-hypocholesterolemia (14.8%), LDL-hypercholesterolemia (12.5%) and hyperinsulinemia (12.5%) were observed. As BMI increased, there was statistically significant increase in systolic blood pressure, insulin and insulin resistance values. Insulin resistance was correlated to systolic blood pressure, serum lipid and insulin levels. The more risk factors for the metabolic syndrome obese children had, the higher was their insulin resistance. Conclusion: The increase in insulin resistance and clustering of risk factors for the metabolic syndrome are already apparent in obese children. Monitoring these risk factors for the metabolic syndrome should become a part of routine medical care for obese children.