• Journal of Korean Medical Science
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• v.33 no.49
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• pp.327.1-327.10
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• 2018

Background: It is difficult to decide whether to inform the child of the incurable illness. We investigated attitudes of the general population and physicians toward prognosis disclosure to children and associated factors in Korea. Methods: Physicians working in one of 13 university hospitals or the National Cancer Center and members of the general public responded to the questionnaire. The questionnaire consisted of the age appropriate for informing children about the prognosis and the reason why children should not be informed. This survey was conducted as part of research to identify perceptions of physicians and general public on the end-of-life care in Korea. Results: A total of 928 physicians and 1,241 members of the general public in Korea completed the questionnaire. Whereas 92.7% of physicians said that children should be informed of their incurable illness, only 50.7% of the general population agreed. Physicians were also more likely to think that younger children should know about their poor prognosis compared with the general population. Physicians who opposed incurable illness disclosure suggested that children might not understand the situation, whereas the general public was primarily concerned that disclosure would exacerbate the disease. Physicians who were women or religious were more likely to want to inform children of their poor prognosis. In the general population, gender, education, comorbidity, and caregiver experience were related to attitude toward poor prognosis disclosure to children. Conclusion: Our findings indicate that physicians and the general public in Korea differ in their perceptions about informing children of poor prognosis.

• Journal of Hospice and Palliative Care
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• v.18 no.3
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• pp.208-218
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• 2015

Purpose: Although a Do-Not-Resuscitate (DNR) order is widely in use, it is one of the challenging issues in end-of-life care. This study was conducted to investigate attitudes toward DNR according to education and clinical experience. Methods: Data were collected using a structured questionnaire comprising 30 items in a tertiary hospital in Seoul, Korea. Results: Participants were 238 nurses and 72 physicians. Most participants (99%) agreed to the necessity of DNR for reasons such as dignified death (52%), irreversible medical condition (23%) and patients' autonomy in decision making (19%). Among all, 33% participants had received education about DNR and 87% had DNR experience. According to participants' clinical DNR experience, their attitudes toward DNR significantly differed in terms of the necessity of DNR, timing of the DNR consent and post-DNR treatments including antibiotics. However, when participants were grouped by the level of DNR education, no significant difference was observed except in the timing of the DNR consent. Conclusion: This study suggests that the attitudes toward DNR were more affected by clinical experience of DNR rather than education. Therefore, DNR education programs should involve clinical settings.

• Journal of Hospice and Palliative Care
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• v.17 no.1
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• pp.10-17
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• 2014

Purpose: This study was conducted to examine understanding of the meaning of well-dying and types of such views held by medical practitioners and nursing students. Methods: The Q-methodology was used to analyze the subjectivity of each item. The P-sample was made up of 22 medical practitioners or nursing students. The P-sample was instructed to rate 33 statements using a 7-point scale to obtain forced normal distribution. They were asked to make extra comments on the statements that were placed on both ends of the distribution curve. The PC-QUANL Program was used for the factor analysis of the collected data. Results: The participants had three types of meaning of well-dying. Total variance explained by these types was 57.97%" where type 1 was "reality-oriented", type 2 "relationship-oriented" and type 3 "obeying-the-nature". Conclusion: The participants' subjective views on well-dying influences their medical practice on patients who are facing death. Therefore, medical practitioners should have profound insights concerning life and death. To that end, a training program is needed to help medical practitioners develop a proper view on well-dying by subjectivity type.

• The Korean Society of Law and Medicine
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• v.24 no.4
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• pp.103-128
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• 2023

According to the current act of Decision-Marking in Life-Sustaining Medicine, the decision to withhold or discontinue life-sustaining treatment is primarily based on the wishes of a patient in the dying process. Decision-making regarding life-sustaining treatment for these patients is made by the patient, if he or she is conscious, directly expressing his/her intention for life-sustaining treatment in writing or verbally or by writing an advance medical directive and physician orders for life-sustaining treatment. It can be exercised. On the other hand, if the patient has not written an advance medical directive or physician orders for life-sustaining treatment, the patient's intention can be confirmed with a statement from the patient's family, or a decision to discontinue life-sustaining treatment can be made with the consent of all members of the patient's family. However, in the case of an unrelated patient who has no family or whose family is unknown, if an advance medical directive or physician orders for life-sustaining treatment are not written before hospitalization and a medical condition prevents the patient from expressing his or her opinion, the patient's will cannot be known and the patient cannot be informed. A situation arises where a decision must be made as to whether to continue or discontinue life-sustaining treatment. This study reviewed discussions and measures for unbefriended patients under the current law in order to suggest policy measures for deciding on life-sustaining treatment in the case of unbefriended patients. First, we looked at the application of the adult guardian system, but although an adult guardian can replace consent for medical treatment that infringes on the body, permission from the family court is required in cases where death may occur as a direct result of medical treatment. It cannot be said to be an appropriate solution for patients in the process of dying. Second, in accordance with Article 14 of the Life-Sustaining Treatment Decision Act, we looked at the deliberation of medical institution ethics committees on decisions to discontinue life-sustaining treatment for patients without family ties.Under the current law, the medical institution ethics committee cannot make decisions on discontinuation of life-sustaining treatment for unbefriended patients, so through revision, matters regarding decisions on discontinuation of life-sustaining treatment for unbefriended patients are reflected in Article 14 of the same Act or separate provisions for unbefriended patients are made. It is necessary to establish and amend new provisions. In addition, the medical institution ethics committee must make a decision on unbefriended patients, but if the medical institution cannot make such a decision, there is a need to revise the law so that the public ethics committee can make decisions, such as discontinuing life-sustaining treatment for unbefriended patients.

• 한국노년학
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• v.30 no.4
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• pp.1197-1211
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• 2010

This research was concucted to present a model of advance directives(AD) when a patient, who is in consciousness, shows a preference for an end of life care as an act of preparing for an uncertain situation that may arise in the forseeable future. The subjects of the research are 383 doctors/nurese and adults, who live in six cities and provinces, to investigate the status of AD, attitude regarding a meaningless life-prolonging treatment, and moreover, an understanding of and a preference for AD. The research was done by the well-structured questionnaire. Also, SPSS 14.0 is used to analyse the collected data, focused on frequency analysis, avearage and standard deviation, X2 test. As the results of the study, the most of the surveyed doctors/nurese knew DNR orders and AD and a few of them used DNR orders and AD practically. Also, the result shows that there is a negative conception of meaningless life-prolonging treatment among the responents, in addition, most of them agreed upon the idea of introducing AD to Korea, filling it out and making it legally effective. As a method of making AD out, the respondents wanted to use a form that mixed living will with an Power of Attorney in a document. Also, considering the appropriate time, respondents prefered when they are diagnosed with terminal illness. At the moment, the introductory model for AD, which is suitable for the Korean culture and current situation is presented based on the result of this research. In the future, other researches should deal with specific measures that can lead to a social consensus to adopt AD in Korea.

• Journal of Life Science
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• v.20 no.12
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• pp.1844-1850
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• 2010

Body fat reducing and physical-activity enhancing effects, along with artherosclerosis improving effects, of conjugated linoleic acid (CLA) were elucidated on obese male middle school students with more than 30% body fat. Twenty-four volunteers were randomly divided into control (placebo, n=12) and CLA treatment (n=12) groups. Subjects were daily fed 6 g CLA (6 capsules, twice a day) or a placebo for 12 weeks. At the end of the experiment, body composition, blood lipid composition and exercise capacities of subjects were measured. CLA significantly reduced body fat content and body mass index (BMI) along with body weight, while the placebo did not have any such effects. Similarly, CLA significantly reduced low-density lipoprotein (LDL)-cholesterol, total cholesterol, and triglyceride, but elevated high-density lipoprotein (HDL)-cholesterol content in blood. Meanwhile, in terms of exercise capacity, there were significant enhancements of trunk flexion, closed-eyes foot balance, standing long jump, shuttle run, and sit-up activities in the CLA treatment group. These results indicate that CLA consumption reduced body fats, improved atherosclerosis factors in blood and improved physical activity of young male obese middle school students, and suggest that CLA could be a useful material for the heath care of obese young men.

• Journal of Hospice and Palliative Care
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• v.7 no.2
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• pp.232-237
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• 2004

Purpose: DNR order is generally accepted for cancer patients near the end of life at Hospice Ward. It means not only no CPR when cardiopulmonary arrest develops but no aggressive meaningless medical interventions. Usually on admission, we discuss with the patients' family about DNR order at the Hospice Ward. Recently, we experienced a terminal lung cancer patient who had been on the ventilator for two months after pulmonary arrest. CPR and artificial ventilation were performed because patient's family refused DNR order. There is no consensus when, who, and how DNR order could be written for terminal cancer patients in Korea, yet. Methods: Hospice charts of 60 patients who admitted between Jan and Jun 2003 to Hospice Ward were reviewed retrospectively. Results: The median age was 66(range $31{\sim}93$) and there were 31 males and 29 females. Their underlying cancers were lung (12), stomach (12), biliary tract (7), colon (6), pancreas (4) and others (19). The persons who signed DNR order were son (22), spouse(19), daughter (16) and others (3). But, there was no patients who signed DNR order by oneself. Thirty families of 60 patients signed on day of admission and 30 signed during hospitalization when there were symptom aggravation (19), vital sign change (4), organ failure (3) and others (4). There were 13 patients who died within 5 days after DNR order. Most of patients died at our hospice ward, except in 1 patient. The level of care was mostly 1, except in 2 patients. (We set level of care as 3 categories. Level 1 is general medical care: 2 is general nursing care: 3 is terminal care.) Conclusion: We have to consider carefully discussing DNR order with terminal cancer patients in the future & values on withholding futile intervention.

• International Area Studies Review
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• v.22 no.1
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• pp.215-235
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• 2018

Policy concerns related to raising fertility rates are not only common interests among the OECD countries, but they are also issues of great concern to South Korea whose fertility rate is the lowest in the world. The fertility rate in South Korea continues to decline, even though most of the national budget has been spent on measures to address this and many studies have been conducted on the increase in the fertility rates. In this regard, this study aims to verify the effectiveness of the detailed factors affecting the fertility rate that have been discussed in the previous studies on fertility rates, and to investigate the overall trend toward enhancing the quality of life and increasing the fertility rate through macroscopic and structural studies under the recognition of problems related to the policy approaches through the case studies of the European countries. Toward this end, this study investigated if a high quality of life in advanced countries contributes to the increase in the fertility rate, which country serves as a state model that has a high quality of life and a high fertility rate, and what kind of social and policy environment does the country have with regard to childbirth. The analysis of the OECD Better Life Index (BLI) and CIA fertility rate data showed that the countries whose people enjoy a high quality of life do not necessarily have high fertility rates. In addition, under the recognition that a country with a high quality of life and a high birth rate serves as a state model that South Korea should aim for, the social characteristics of Iceland, Ireland, and New Zealand, which turned out to have both a high quality of life and a high fertility rate, were compared with those of Germany, which showed a high quality of life but a low fertility rate. According to the comparison results, the three countries that were mentioned showed higher awareness of gender equality; therefore, the gender wage gap was small. It was also confirmed that the governments of these countries support various policies that promote both parents sharing the care of their children. In Germany, on the other hand, the gender wage gap was large and the fertility rate was low. In a related move, however, the German government has made active efforts to a paradigm shift toward gender equality. The fertility rate increases when the synergy lies in the relationship between parents and children; therefore, awareness about gender equality should be firmly established both at home and in the labor market. For this reason, the government is required to provide support for the childbirth and rearing environment through appropriate family policies, and exert greater efforts to enhance the effectiveness of the relevant systems rather than simply promoting a system construction. Furthermore, it is necessary to help people in making their own childbearing decisions during the process of creating a better society by changing the national goal from 'raising the fertility rate' to 'creating a healthy society made of happy families'

• Safety and Health at Work
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• v.10 no.4
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• pp.393-399
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• 2019

Objective: This study investigates the impact of multimorbidity on work through a literature review of longitudinal studies. Methods: A systematic review was carried out in the databases Lilacs, SciELO, PAHO, PubMed/Medline, Scopus, Web of Science, and Cochrane. There were no restrictions regarding the year of publication or language to maximize the identification of relevant literature. The quality of studies was assessed by the protocol STrengthening the Reporting of OBservational studies in Epidemiology (STROBE). Results: An initial database search identified 7522 registries, and at the end of the analysis, 7 manuscripts were included in the review. Several studies have demonstrated direct and indirect impacts of multimorbidity on the health of workers. For this, the number of missed days due to health-related issues was evaluated, as well as the reduction in work productivity of the unhealthy worker, vulnerability of the worker with multimorbidity regarding higher indices of dismissal and recruitment difficulties, and incidence of early retirement and/or receipt of benefits due to disabilities. Conclusions: Multimorbidity has a negative impact on work, with damages to quality of life and work productivity, worsening the absenteeism/presenteeism indices, enhancing the chances of temporary or permanent leaves, and lowering employability and admission of individuals with multimorbidity.

• Journal of Chest Surgery
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• v.57 no.3
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• pp.315-318
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• 2024

The HeartWare Ventricular Assist Device (HVAD) was widely used for mechanical circulatory support in patients with end-stage heart failure. However, there have been reports of a critical issue with HVAD pumps failing to restart, or experiencing delays in restarting, after being stopped. This case report describes 2 instances of HVAD failure-to-restart during heart transplantation surgery and routine outpatient care. Despite multiple attempts to restart the pump using various controllers and extensions, the HVAD failed to restart, triggering a hazard alarm for pump stoppage. In one case, the patient survived after receiving a heart transplantation, while in the other, the patient died immediately following the controller exchange. These cases highlight the rare but life-threatening complication of HVAD failure-to-restart, underscoring the importance of awareness among clinicians, patients, and caregivers, and adherence to the manufacturer's guidelines and recommendations for HVAD management.