• 의료법학
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• 제18권2호
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• pp.105-138
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• 2017

이 글은 환자의 자기결정권에 관한 몇몇 대표적인 판례들을 연혁적으로 검토한 논문이다. 대법원은 과거 음주상태에서 농약을 음독하여 자살을 시도한 환자가 치료를 거부하자 치료를 포기한 의료진에게 특정 의학적 상태(응급상황)에서 의사의 생명보호의무가 환자의 자기결정권 존중보다 우선한다고 판단하여 의료과실을 인정하였다. 이후 대법원은 가족들의 요청에 의해 지속적 식물인간 상태인 환자에게 해당 환자의 의학적 상태(회복불가능한 사망의 단계 등)를 고려하고 환자의 의사를 추정하여 연명의료를 중단하게 하였다. 최근 대법원은 종교적 신념과 관련하여 수혈과 같은 필수적인 치료를 거부한 환자에 대하여 대법원은 환자의 생명 보호에 못지않게 환자의 자기결정권을 존중하여야 할 의무가 대등한 가치를 가지는 것으로 평가할 수 있는 판단 기준을 제시하였다. 인간의 존엄성에 근거한 환자의 자기결정권과 의사의 생명보호의무가 충돌하는 상황에 대하여 연혁적 판례 검토를 통해 법원의 입장이 우리 사회에서 환자의 주체적 역할과 자율성을 존중하는 방향을 반영하여 함께 변화되어 왔음을 확인할 수 있었다. 법원이 생명권이라는 최고의 가치만을 환자의 의사보다 더욱 우선하여 판단해오다가 적어도 명시적인 환자의 의사 또는 그렇지 못할 경우에 추정적 의사까지도 고려한 치료의 유보나 중단에 대하여 고려하기 시작한 것, 종교적 신념에 근거한 자기결정권의 행사로서의 수혈거부와 같은 치료거부에 대하여 충분한 정보에 근거한 치료거부의 몇 가지 적법한 요건들을 인정하기 시작했다는 것은 이후 우리나라 의료 환경에 적잖은 영향을 줄 것이고 의료현장에서 의료행위를 하는 의사들에게도 직 간접적인 지침이 될 것이다.

• Journal of Hospice and Palliative Care
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• 제20권2호
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• pp.93-99
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• 2017

목적: 본 연구는 심폐소생술금지에 동의한 암환자를 대상으로 연명치료 변화를 확인하기 위해 시도된 후향적 조사연구이다. 방법: 연구대상자는 S시에 소재한 A종합병원에서 2013년 1월 1일부터 12월 31일까지 종양내과 병동에 입원치료하고 사망한 암환자로 심폐소생술금지에 동의한 250명이 선정되었으며, 이중 심폐소생술금지를 입원당일 동의하였거나(N=40) 동의 후 3일 이내 사망한(N=10) 경우는 제외하였다. 대상자의 특성과 연명치료의 변화를 의무기록을 통해 조사하였으며, 심폐소생술금지 지시 동의 전 1일과 심폐소생술금지 지시 동의 후 3일 혹은 사망시점까지 조사하여 유지, 중단, 추가로 연명의료 변화를 판정하였다. 수집된 자료는 SPSS Win 21.0 프로그램을 이용하여 분석하였다. 결과: 연구대상자는 총 200명으로, 50~59세 나이 군이 36.0%로 가장 많이 차지하였고 남자가 62%였다. 재원일은 15일이었고, 입원하여 10일되는 시점에서 심폐소생술금지에 동의하였다. 심폐소생술금지에 동의 후 35.7~100%에서 연명치료가 계속 유지되었다. 인공호흡기 치료는 중단되지 않고 100% 유지되었으며, 수혈(37%), 혈액검사(37.4%), 산소요법(23.5%) 순으로 추가되었다. 중단된 연명치료 중 가장 빈도가 높은 것은 수혈(13.5%)이었고, 다음으로 혈액검사(11.5%), 비경구성 영양제투여(8.5%) 순이었다. 결론: 심폐소생술 지시 동의 후에 대부분 연명치료는 계속되었고 중단되는 경우는 드물었다. 의료진과 가족들 간의 연명치료 범위에 대한 이견을 좁히고, 무의미한 연명치료 중단에 대한 결정을 합의하기 위한 적극적인 논의가 요구된다.

• 한국융합학회논문지
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• 제8권2호
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• pp.63-72
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• 2017

본 연구는 간호대학생의 DNR에 대한 융합적 인식 및 윤리적 태도를 파악하여 DNR 환자간호에 도움이 되는 기초자료로 활용하고자 시도하였다. G광역시 4년제 간호대학생 306명을 대상으로 2016년 6월 1일부터 2016년 7월 10일까지 설문조사하였고, SPSS 23.0 Program을 이용하여 최종 분석하였다. 분석결과 DNR에 대한 인식은 DNR의 필요성, 환자와 가족의 의지에 의한 DNR 결정, 문서화된 지침서의 필요성에 찬성하였다. 윤리적 태도는 환자의 의지에 의한 결정, 치료범위, 설명 여부, 지침에 따른 결정에 찬성하였고, 주치의에 의한 결정, 기본간호 제공 감소에는 반대하였다. 일반적 특성에 따른 윤리적 태도는 학년, 임상실습경험, 윤리가치관에 대한 교육경험, DNR에 대한 교육경험, 삶에 대한 만족도, 죽음에 대한 가치관에 따라 유의한 차이가 있었다. 본 연구결과를 토대로 DNR 결정에 관한 기준 및 지침을 마련하기 위한 지속적인 후속연구가 필요하다고 사료된다.

• 수산경영론집
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• 제46권2호
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• pp.13-29
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• 2015

The abalone aquaculture has been very rapidly developed in Korea. Annual production quantity was less 200 tons before 2000th, it have been increased to over 9,000 tons in 2014. Also Abalone export amounts have been over 20 million dollars. The reason of rapid growth of Abalone aquaculture in Korea is due to high level profit ratio. Then now many fishing officers and other aquaculture fishers want to participate with abalone aquaculture newly. However Recent Abalone aquaculture in Korea is faced some problems. Aspects of production environmental status of fishing grounds are more aggravate, and then abalone aquaculture is exposed to various disease, and death rate of young abalone is higher. And aspect of management, the aquaculture cost is more increase. The demand of abalone also is depressing recently, this cause to come down the production price. In this viewpoint, Management analysis of abalone aquaculture in Korea is helpful for decision making of general aquaculture fisher want to participate newly. The analysis is practiced two aspects. One is index analysis, and the other is Break-even-point(BEP) analysis. The result of index analysis, average net profit rate has shown 28.0%, however the Regional difference has excessive. That is, Wando(major) has shown 39.4%, and Haenam province has shown 14.2%. On the other hand, the more scale has shown higher profit rate by aquaculture scale. And the result of BEP analysis, average has shown 93 cage number per abalone aquaculture household, and Wando(major) has shown 56 cage number, Haenam province has shown 131 cage number. The lower production abalone price of recent means higher BEP level.

• Journal of Korean Neurosurgical Society
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• 제61권4호
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• pp.474-477
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• 2018

Objective : From November 30, 2016, the Korean Government carried the revised Medical Dispute Mediation and Arbitration Act into effect. Mediation will start automatically without agreements of the defendant, when the outcome of the patient was death, coma more than a month or severe disability. Cerebral aneurysm has a definite risk of bad outcome, especially in the worst condition. Any surgical intervention to this lesion has its own high risk of complications. Recently, Seoul central district court decided 50% responsibility of the doctors who made a rupture of the aneurysm during coiling (2015Ga-Dan5243104). We reviewed judicial precedents related to cerebral aneurysms in lawsuit using a web search. Methods : We searched judicial precedents at a web search of the Supreme Court, using the key words, "cerebral aneurysm". Results : There were 15 precedents, six from the Supreme Court, seven from the High Court, and two from district courts. Seven precedents were related to the causation analysis, such as work-relationship. Five precedents were malpractice suits related bad results or complications. Remaining three precedents were related to the insurance payment. In five malpractice precedents, two precedents of the Supreme Court reversed former two precedents of the High Court. Conclusion : Judicial precedents on the cerebral aneurysm included not only malpractice suits, but also causation analysis or insurance payment. Attention to these subjects is needed. We also need education of the independent medical examination. To avoid medical disputes, shared decision making seems to be useful, especially in cases of high risk condition or procedures.

• Toxicological Research
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• 제34권2호
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• pp.163-172
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• 2018

Air pollution is increasing, along with consumption of fossil fuels such as coal and diesel gas. Air pollutants are known to be a major cause of respiratory-related illness and death, however, there are few reports on the genotoxic characterization of diverse air pollutants in Korea. In this study, we investigated the mutagenic activity of various particles such as diesel exhaust particles (DEP), combustion of rice straw (RSC), pine stem (PSC), and coal (CC), tunnel dust (TD), and road side dust (RD). Ultra-fine particles (UFPs) were collected by the glass fiber filter pad. Then, we performed a chemical analysis to see each of the component features of each particulate matter. The mutagenicity of various UFPs was determined by the Ames test with four Salmonella typhimurium strains with or without metabolic activation. The optimal concentrations of UFPs were selected based on result of a concentration decision test. Moreover, in order to compare relative mutagenicity among UFPs, we selected and tested DEP as mutation reference. DEP, RSC, and PSC induced concentration-dependent increases in revertant colony numbers with TA98, TA100, and TA1537 strains in the absence and presence of metabolic activation. DEP showed the highest specific activity among the particulate matters. In this study, we conclude that DEP, RSC, PSC, and TD displayed varying degrees of mutagenicity, and these results suggest that the mutagenicity of these air pollutants is associated with the presence of polycyclic aromatic hydrocarbons (PAHs) in these particulate matters.

• 환경영향평가
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• 제15권6호
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• pp.373-383
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• 2006

The spatial mapping of risk is very useful data in planning for disaster preparedness. This research presents a methodology for making the landslide life risk map in the Boeun area which had considerable landslide damage following heavy rain in August, 1998. We have developed a three-stage procedure in spatial data analysis not only to estimate the probability of the occurrence of the natural hazardous events but also to evaluate the uncertainty of the estimators of that probability. The three-stage procedure consists of: (i)construction of a hazard prediction map of "future" hazardous events; (ii) validation of prediction results and estimation of the probability of occurrence for each predicted hazard level; and (iii) generation of risk maps with the introduction of human life factors representing assumed or established vulnerability levels by combining the prediction map in the first stage and the estimated probabilities in the second stage with human life data. The significance of the landslide susceptibility map was evaluated by computing a prediction rate curve. It is used that the Bayesian prediction model and the case study results (the landslide susceptibility map and prediction rate curve) can be prepared for prevention of future landslide life risk map. Data from the Bayesian model-based landslide susceptibility map and prediction ratio curves were used together with human rife data to draft future landslide life risk maps. Results reveal that individual pixels had low risks, but the total risk death toll was estimated at 3.14 people. In particular, the dangerous areas involving an estimated 1/100 people were shown to have the highest risk among all research-target areas. Three people were killed in this area when landslides occurred in 1998. Thus, this risk map can deliver factual damage situation prediction to policy decision-makers, and subsequently can be used as useful data in preventing disasters. In particular, drafting of maps on landslide risk in various steps will enable one to forecast the occurrence of disasters.

• 대한기관식도과학회지
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• 제8권2호
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• pp.36-42
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• 2002

Aspirated and ingested foreign bodies continue to present challenges to otolaryngologists. The major discussions were the accurate diagnosis and speedy, safe removal of foreign body. Many diagnostic tools have been tried and removal of foreign bodies has been facilitated by technical improvements with rod lens telescope, video endoscope, flexible fiberoendoscope and safer anesthesia. In spite of these advances, more than 3000 children's death occur per year in the world because of foreign bodies and untold number of parients survive with variable sequelae. In these study, 59 consecutive cases of children and adults with tracheobronchial foreign bodies were reviewed from 1992 to 2001. We studied the history, symptoms, ausculatory radiologic, bronchoscopic finding and post operative complications. 71% (42 cases in 59 cases) of patients had foreign body aspiration history or choking crisis. In 64% (38cases) cough was observed. 81% (48cases) had abnormal finding in chest auscultation and 78% in chest X-ray. Computed tomography was done in 12 cases, all were founded foreign body shadow. Main site of foreign body was right main bronchus (41%, 24cases) and most frequent foreign body was peanut (36% , 21cases) . 4 experienced ICU(intensive care unit) care. 2 cases were failed to remove foreign. In these cases 1 cases was improved by steroid therapy and physical therapy and the other was treated with thoracotomy. We concluded the morbidity and motality were much correlated with speedy decision making and experienced skill of operator.

• Asian Pacific Journal of Cancer Prevention
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• 제14권1호
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• pp.595-598
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• 2013

Background: Lung cancer is the leading cause of cancer death worldwide Therefore, identification of genetic as well as environmental factors is very important in developing novel methods of lung cancer prevention. However, this is a multi-layered problem. Therefore a lung cancer risk prediction system is here proposed which is easy, cost effective and time saving. Materials and Methods: Initially 400 cancer and non-cancer patients' data were collected from different diagnostic centres, pre-processed and clustered using a K-means clustering algorithm for identifying relevant and non-relevant data. Next significant frequent patterns are discovered using AprioriTid and a decision tree algorithm. Results: Finally using the significant pattern prediction tools for a lung cancer prediction system were developed. This lung cancer risk prediction system should prove helpful in detection of a person's predisposition for lung cancer. Conclusions: Most of people of Bangladesh do not even know they have lung cancer and the majority of cases are diagnosed at late stages when cure is impossible. Therefore early prediction of lung cancer should play a pivotal role in the diagnosis process and for an effective preventive strategy.

• 디지털융복합연구
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• 제11권4호
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• pp.311-320
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• 2013

본 연구는 일 대학 간호과와 비 간호과 학생의 생명의료윤리 의식을 파악하여 대학생들의 올바른 생명윤리 의식 함양에 필요한 윤리교육의 방향과 교육과정 내용을 위한 기초자료를 제공하고자 시도하였다. 생명의료윤리 의식은 4점 만점에 간호과 학생들이 평균 3.04점으로 비 간호과 학생들의 2.88점보다 높았고 이들 간에 유의한 차이가 있었다(t=6.79, p<.001). 두 그룹간에 태아의 생명권, 태아진단, 신생아 생명권, 안락사, 장기이식, 뇌사영역에서 통계적으로 유의한 차이를 나타내었다. 대상자들의 생명의료윤리 의식에 영향을 미치는 주요 요인은 간호과에서는 한 학기 이상 윤리관련 수업 경험 유무, 생명윤리 관련 문제로 고민한 경험 유무, 윤리적 가치관이었고, 비 간호과는 학년으로 나타났다. 결과적으로 대상자들의 낮은 생명의료윤리 의식은 각 학과별로 기본적인 생명윤리 교육부터 고학년으로 올라갈수록 체계적이고 복합적인 윤리적 사고 판단과 의사결정 능력, 가치관 고취를 위한 교육과정을 통해 충족되어야 할 것이다. 추후 생명의료윤리 의식의 하위영역별 집중연구나 질적 연구를 제언한다.