• Clinical and Experimental Pediatrics
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• v.46 no.7
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• pp.635-641
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• 2003

Purpose : To investigate the success rate and factors that influence breast-feeding among women having antenatal breast-feeding plans. Methods : Questionnaires included items on success in breast-feeding, reasons for failure and perinatal factors. It was done by telephone calls to 152 randomly selected women having antenatal breast-feeding plans at 4 months after delivery. The questionnaires were analysed by bivariate ${\chi}^2$-analysis. Results : The breast-feeding rate for the first four months among women having antenatal breast-feeding plans was 37.5%. The major reason for breast-feeding failure was insufficient amount of breast milk(66.3%). The breast-feeding rate was 2.3(95% CI 1.15-4.62) times higher in women having antenatal breast-feeding plans for longer than 4 months(P<0.05), but maternal age, breast-feeding for previous baby, person advocating breast-feeding, and family size were not significant factors of success in breast-feeding. The breast-feeding rate of graduates of college was 0.43(95% CI 0.21-0.86) times lower than that of graduates of high school. The breast-feeding rate of employed mothers was 0.37(95% CI 0.17-0.83) times lower than that of housewives(P<0.05). Maternal disease, smoking, alcohol drinking, and understanding and knowledge about breast-feeding were not significant determinant factors of success in breast-feeding. Breast-feeding rate of infant born at local obstetric clinics was 3.97(95% CI 11-14.23) times higher than that of infant at general hospital(P<0.05). Conclusion : To increase the breast-feeding, medical personnel should educate mothers on problems during breast-feeding. Hospital polices that facilitate breast-feeding such as rooming-in must be promoted. For employed mothers, strategies for breast-feeding within companies must be encouraged.

• Journal of Korean Academy of Nursing
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• v.24 no.4
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• pp.584-596
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• 1994

The objective of the study is to explore the relationships between the variables of nursing productivity on the framework of system del in the tertiary university based care hospital in Korea. Productivity is basically defined as the relation-ship between inputs and outputs. Under the proposition that the nursing unit is a system that produces nursing care output using personal and material resources through the nursing intervention and nursing care management. And this major conception of nursing productivity system comproises input, process and output and feed-back. These categorized variables are essential parts to produce desirable and meaningful out-put. While nursing personnel from head nurse to staff nurses cooperate with each other, the head nurse directs her subordinates to achieve the goal of nursing care unit. In this procedure, the head nurse uses the leadership of authority and benevolence. Meantime nursing productivity will be greatly influenced by environment and surrounding organizational structures, and by also the operational objectives, the policy and standards of procedures. For the study of nursing productivity one sample hospital with 15 general nursing care units was selected. Research data were collected for 3 weeks from May 31 to June 20 in 1993. Input variables were measured in terms of both the served and the server. And patient classification scores were measured drily by degree of nursing care needs that indicated patent case-mix. And also nurses' educational period for profession and clinical experience and the score of nurses' personality were measured as producer input variables by the questionnaires. The process varialbes act necessarily on leading input resources and result in desirable nursing outputs. Thus the head nurse's leadership perceived by her followers is defined as process variable. The output variables were defined as length of stay, average nursing care hours per patient a day the score of quality of nursing care, the score of patient satisfaction, the score of nurse's job satis-faction. The nursing unit was the basis of analysis, and various statistical analyses were used : Reliability analysis(Cronbach's alpha) for 5 measurement tools and Pearson-correlation analysis, multiple regression analysis, and canonical correlation analysis for the test of the relationship among the variables. The results were as follows : 1. Significant positive relationship between the score of patient classification and length of stay was found(r=.6095, p.008). 2. Regression coefficient between the score of patient classification and length of stay was significant (β=.6245, p=.0128), and variance explained was 39%. 3. Significant positive relationship between nurses’ educational period and length of stay was found(r=-.4546, p=.044). 5. Regression coefficient between nurses' educational period and the score of quality of nursing care was significant (β=.5600, p=.029), and variance explained was 31.4%. 6. Significant positive relationship between the score of head nurse's leadership of authoritic characteristics and the length of stay was found (r=.5869, p=.011). 7. Significant negative relationship between the score of head nurse's leadership of benevolent characteristics and average nursing care hours was found(r=-.4578, p=.043). 8. Regression coefficient between the score of head nurse's leadership of benevolent characteristics and average nursing care hours was significant(β=-.6912, p=.0043), variance explained was 47.8%. 9. Significant positive relationship between the score of the head nurse's leadership of benevolent characteristics and the score of nurses' job satis-faction was found(r=.4499, p=050). 10. A significant canonical correlation was found between the group of the independent variables consisted of the score of the nurses' personality, the score of the head nurse's leadership of authoritic characteristics and the group of the dependent variables consisted of the length of stay, average nursing care hours(Rc²=.4771, p=.041). Through these results, the assumed relationships between input variables, process variable, output variables were partly supported. In addition it is also considered necessary that-further study on the relationships between nurses' personality and nurses' educational period, between nurses' clinical experience including skill level and output variables in many research samples should be made.

• Journal of Hospice and Palliative Care
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• v.17 no.2
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• pp.66-74
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• 2014

Purpose: This study is aimed to investigate perceptions of caregivers and medical staff toward do not resuscitate (DNR) and advance directives (AD). Methods: Participants were 141 caregivers and 272 medical staff members from five general hospitals. A questionnaire used for the study consisted of 20 items: 14 about DNR perceptions, three about AD, one each for age, gender and employment. Results: Both medical staff and caregivers strongly recognized the need for DNR and AD, and the level of recognition was higher with medical staff than caregivers (DNR ${\chi}^2=44.56$, P=0.001; AD ${\chi}^2=16.23$, P=0.001). The main reason for the recognition was to alleviate sufferings of patients in the terminal phase. In most cases, DNR and AD were filled out when patients with terminal conditions were admitted, and patients made the decisions by consulting with their guardians. Medical staff better recognized the need and for growing demand for guidelines for the DNR and AD decision making process than caregivers (${\chi}^2=7.41$, P=0.0025). Conclusion: This study showed that patients highly rely on their caregivers when making decisions for DNR and AD. Thus, it is important that patients and caregivers are provided with objective information about the decisions. Since participants' strong support for DNR and AD was mainly aimed at alleviating patients' suffering, further study is needed in the association with hospice care. Medical staff also needs to understand the different views held by caregivers and fully consider the disparity when informing patients/caregivers to make the DNR and AD decisions.

• The Korean Society of Law and Medicine
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• v.18 no.1
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• pp.297-341
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• 2017

We searched out court rulings on medical affairs through court library search sites and specialized articles on medically relevant judgments sentenced in 2016. And we selected and analyzed the judgements of the court we considered important as follows. In relation to the medical civil judgements, (1) In the case of applying surgery for female infertility during cesarean section operation but it has not been done, we expressed the regret for the lack of judgment in the process of entering the medical contract, introducing the rights infringed and the scope of compensation, (2) We pointed out that the ruling on the medical malpractice estimation goes out of limit of negligence estimation doctrine, and that the court asked very high degree duty of the traditional Korean medicine doctors to cooperate with Western medicine doctors. (3) In the case of admitting hospital's 100% responsibility, we pointed out the court overlooked the uncertainty and good intention of the medical practice. (4) Additionally, We introduced the cases admitted the hospital's responsibility in the accident related to the psychiatric patients in closed ward. Relating to a medical criminal ruling, we analyzed the supreme court decision about whether the dentist's Botox injection on the patient's face is a medical practice within the scope of the license from the viewpoint whether it is within the possible range of the word. And, concerning decisions on healthcare administration, (1) we analyzed the case about when medical personnel operate multiple medical institutions, whether it is possible to get back medical care costs under the National Health Insurance Law, (2) We commented on the ruling regarding explanation obligation in terms of object, degree, subject of explanation as a prerequisite for permissible arbitrary uninsured benefits. Finally, we reviewed the decision of the Constitutional Court about the Article 24 of the Mental Health Law, which it had allowed for a mental patient to be hospitalized forcibly by the consent of two guardians and a diagnosis of a psychiatrist. Also we indicated the problems of the revised Mental Health Law.

• Journal of dental hygiene science
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• v.1 no.1
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• pp.46-52
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• 2001

The purpose of this study was to examine dental personnels' concern for health, their personal protection manner, and whether or not they were inoculated against hepatitis B and made an inquiry of patients about that. It's ultimately meant to serve as a basis for the preparation of an anti-infection guide for the protection of dental personnels against all sorts of infectious diseases. After a survey was conducted from March 29 through May 9, 2001, the following findings were obtained: (1) The dental personnel group that had worked for 5 to less than 7 years took health examination the most, with 71.4%, before joining the hospital, and 61.5% of those who had served for 9 years or more, the greatest percentage, took medical checkup after joining the hospital(P<0.05). (2) The largest percentage of being inoculated against the anti-B type hepatitis after employment was 71.4% of the dental personnels over 35, and 57.7% of those with 9-year or more working experiences. Therefore, their age and service term made a significant difference(P<0.05). (3) There was no significant gap in personal protection practices between the dental hygienists and nurse aids(P>0.05). But the use of safety goggles for treatment was not properly done, with just 1.48 on the basis of 3 points, whereas the use of mask was scored 2.40 and the use of gloves was scored 1.96. (4) After a narcotic was used once, the leftovers were wasted by 89.7% of the dental hygienists and 70.0% of the nurse aids. More dental hygienists wasted them(P<0.05). (5) For hand washing, antibiotic liquid soap was used by 19.3% of the dental hygienists and 10.0% of the nurse aids, which were both very low percentage. And just 37.2% of the dental hygienists utilized a disposable paper towel to dry their hands, and only 36.0% of the nurse aids used the same(P<0.05).

• Journal of Korean Public Health Nursing
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• v.1 no.1
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• pp.45-61
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• 1987

This Study was an attempt to estimate the optimum numbers of Operating Room Nursing Manpower by measuring the amount of service hours required by the patients in Operating Room in relation to the service amount actually provided by the nurses. The major concern of this study was placed on the measurement of Nursing Service Requirements by using the Operating Room (O. R) Patient Acuity System recently developed by M. M. Hart to classify the O. R. patients into four groups according to the degree of the complexity of operative procedure and some other elements which increase nursing activities in respect of patient care; Acuity IV group is the one requires nursing services most, on the other hand Acuity I requires least. nu sing The objectives of this study were as follows; 1. To analyze functions of the nursing personnel in O. R. by time unit and to estimate the average time a nurse can activate for productive functions. 2. To measure the actual amount of nursing times provided by nurses to the surgical patients. 3. To develop a patient classification system in order to measure the amount of Nursing services required by the patients. 4. To calculate an appropriate number of nursing manpower to meet the needs of the patients. In order to conduct the research both selected nurses and patients in 'S' University Hospital were Studied by utilizing the O. R. Patient Acuity System as well as the Classification Chart developed by Association of Operating Room Nurses (A. O. R. N) as a means of classifying functions of O. R. nurses. That is; Functions of the 10 selected O. R. nurses observed during the period of June 30 to July 4, 1986, whereas the amount of nursing services required by or provided to the 974 patients who had received surgeries during the period of June 9 to July 4, 1986. The results of this study were as follows; 1) The actual working hours per a nurse averaged 6.7 hours a day. 2) Each nurse's daily routine schedule consists of $71.4\%$ for Technical Functions, $16.1\%$ for Nonprodective Functions, $6.6\%$ for Assessment and Evaluation, $3.9\%$ for Overseeing and Supervision and the rest $2.0\%$ for Patient Preparation respectively. 3) Preoperative waiting time per a patient was 24.1 minutes on the average; for the first case was 10.7 minutes, whereas for the following cases was 32.0 minutes. 4) Total Operation time for the 974 patients during the period of observation for this study amounted to 2759.6 hours, weekly hour was equivalent to 689.9 hours, Whereas daily operation time averaged 130 hours. Meanwhile the average operation time per patient was 2.8 hours ; for the case of Acuity IV was 5.6 hours, 5. 1 hours for the case of Acuity III, 2.3 hours for Acuity II and 1.1 hours for Acuity I. 5) According to the O. R. Patient Acuity System, $64.5\%$ of the whole patients belonged to Acuity II, $23.7\%$ to Acuity III, 11. $3\%$ to Acuity IV and $0.7\%$ to Acuity I respectively. 6) Required amount of nursing times based on the preoperative waiting time and operation time was 7167.8 person hours, which showed that $5.5\%$ of them needed for preoperative nursing care, whereas the rest $94.5\%$ for intraoperative nursing care. In terms of the O. R. Patient Acuity System, $49.7\%$ of total nursing service requirements was needed for Acuity II patients, $27.4\%$ for Acuity III patients, $17.2\%$ for Acuity IV patients and $0.2\%$ for Acuity I patients. 7) The rate of the nursing services provided against the required nursing times was about $81.4\%$ on the average; some departments, like those of Plastic Surgery, Otolaryngology and Ophthalmology whose patients mostly belonged to Acuity II recorded hegher provision rate than average, whereas other departments of Thoracic Surgery. Neurosurgery and Orthopedic Surgery whose patients belonged to Acuity III and Acuity IV as well as Acuity II recorded lower provision rate than average. 8) Subsequently, required numbers of nursing manpower was 10.7 nurses additionally. Based on the above findings the following recommendations will be made; 1) this study recommends, develops. and adopts an accurate and realistic O. R. Patient Acuity System which can help measure the nursing service requirements objectively to elicit the rationales of allocation of nursing personnels. 2) this study proposes storongly place nurses who take the role of preoperative nursing care exclusively for the waiting patients in O. R. and shortening their waiting time by close communication between the designated O. R. and the ward.

• Journal of Korean Academy of Nursing
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• v.25 no.2
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• pp.372-389
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• 1995

The frequency with which administration of chemotherapy for gynecological cancer treatment is used has increased along with the use of surgery and radiotherapy Among the various side effects of chemotherapy, stomatitis causes a problem of function and sensation in the oral cavity. This oral discomfort can be categorized into two components ; perceived oral symptoms and observed oral symptoms. If the oral problem continues, it may cause infection, bleeding and nutritional deficiencies. As a result of this condition, compliance with the treatment process can be affected as well as the prognosis for the cancer patients. But as the oral discorrfort usually appears after chemotherapy, it is often not reported to the health care personnel as a patient problem. Without problem identification of the oral discomfort and ability to assess the problem, effective intervention cannot be planned. Therefore, this study was conducted to identify the pattern and the degree of oral discomfort due to cancer chemotherapy and thus to provide data for identification of the patient problem and for nursing assessment. The design of this study was a longitudinal de-scriptive study The subjects were in - patients who received chemotherapy under the diagnosis of gynecological cancer between Mar. 15, 1994 and May 15, 1994 at a general hospital in Seoul, Korea. The number of subjects was 64 and they were divided into two groups, one of 41 (A : 5FU & Neoplatin), the other of 23(B : Neoplatin, Cytoxan, Adriamycin), according to the treatment regimen. The data were collected for 24 days using self-re-port instruments. The instruments were the 「Perceived Oral Symptom Assessment Tool」 and 「Observed Oral Symptom Assessment Tool」 developed by this researcher. Data were analyzed using the SPSS-PC program, ANOVA, t-test, paired t-test and the Pearson Correlation Coefficient were applied. The results of this study are as follows : 1. In A regimen the peak time for perceived oral symptom scores was the fifth day after chemotherapy, and the tenth day for observed oral symptom scores. Both of the problems started on first day of chemotherapy and were not resolved completely until the 24th day after treatment. 2. In B regimen, the peak time for perceived oral symptom scores was on the seventh day after chemotherapy, and the eighth day for observed oral symptom scores. It was noted that perceived oral symptom scores were higher than observed oral symptom scores consistently for 24 days. Both also started on first day of chemotherapy, and were not resolved completely until the 24th day after chemotherapy. 3. There were no differences statistically in perceived oral symptom scores between A and B regimen. The loss of appetite and xerostomia caused the most severe discomfort in both of these two groups. 4. The were no differences statistically in observed oral symptom scores between the A and B regi moil. In the A regimen, the highest observed symptom scores were the lips, gingiva, tongue and buccal membrane in that order. But in the B regimen, the highest observed symptom scores were tongue, lips, buccal membrane and gingiva in that order. 5. In A regimen, the patients who had gingival edema and dentures had significantly higher perceived oral symptom scores. And those who had gingival edema and bleeding, foul odor and aphthous stomatitis had significantly higher observed oral symptom scores. 6. In B regimen, the patients who had the experience of stomatitis in the last course of chemotherapy had significantly higher perceived oral symptom scores. Those who had gingival edema had significantly higher observed oral symptom scores. 7. In the A regimen there was no correlation between lab values for lymphocytes and albumin with perceived oral symptom scores and observed oral symptom scores. In the B regimen, there was a significant negative correlation between lymphocytes and albumin with the observed oral symptom scores, but not between perceived oral symptom scores and lymphocytes and albumin values. In conclusion, the nurse should expect that the patient undergoing chemotherapy will complain severely about subjective discomfort and before objective physical change is observed. Also the patients who have chronic oral problems such as dentures, gingival edema and bleeding, foul odor, aphthous stomatitis will complain of severe oral discomfort due to chemotherapy.

• Journal of agricultural medicine and community health
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• v.11 no.1
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• pp.44-54
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• 1986

This study was aimed at investigating the health seeking behaviors of patients; For the purpose of analyzing the research theme we classified the study into two phase. First, the types of patients' health seeking behavior were categorized into a scheme according to what medical care resources were utilized in patients' coping process. Second, from patients' first visits to third visits to medical resources, we analyzed variations of factors which noted as crucial elements in constituting the patients' sickness career. To grasp the generalized characteristics from complicated empirical data, we limited the scope of our analysis to third stage of health seeking. A total of 121 persons who had beer suffering from chronic diseases more than 3 months was sampled among the residents of Banwol-Eup, the target Area of Korea University Health Project. The findings are as follows ; 1) In the course of visiting medical care resources, 34 different types of health seeking Behavior were found. From this result we inferred the idea that patients in Banwol-Eup had not any stable norms to cope with their pains. Clinics, hospital, pharmacy, Herb-doctors', folkways (self-treatment) were accessed by patients in orders. But more than half of patients who had utilized clinics or hospitals from their first to third visits, changed medical care resources to others, for example herb doctors or folkways, which had fundamentally different treatment models. Upon these two facts, the diversified types and capricious patterns in the health seeking behavior of Banwol patients, we observed a typical Shopping-Around phenomenon. 2) Factors which influenced patients' to their sickness career were changed along the courses of health seeking, from first to third visits as follows ; $\cdot$ Perceived seriousness of diseases were tended to decrease. $\cdot$ Professional medical personnel tended to be influencial in the patients' sickness career, (5.0%, 25.0% and 65.7%). The influence of the primary interaction groups such as parents, friends, neighbours, tended to decrease ; (90.9%, 71.2% and 30.0%). $\cdot$ The subjective reasons why to choose such a medical care resource were related to economic affordability and disease-itself as main motives. Credibility of health resources tended to increase 14.9%, 24.0% and 31.4 sequently. $\cdot$ Geographic accessibility factors did not change significantly. Most of patients had utilized health resources in Banwol and Anyang area. 3) Cultural inclination in the shopping-around phenomenon has shown difference among age groups. The age group' over 50 years' preferred traditional health resources to modern health resources. 4) Consistency of health seeking behavior on the shopping around phenomenon has shown difference according to the degrees of patients' economic affordability and those of psychological satisfaction toward modern health services. However, there were some restrictions in this thesis ; a) the study was limited to the 3rd health seeking career so it did not allow us to collect more informations after that, b) the study was not able to carry out causal analysis on patients health behavior determinated by explanatory model of health resources, and c) the study was not able to take into consideration of factors connected with social structural circumstances. Despite of restrictions described above, we are sure that this thesis would promote health providers' understanding toward patients' inclinations, through which they could provide efficient and accurate medical service.

• The Korean Society of Law and Medicine
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• v.18 no.2
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• pp.163-194
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• 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 the Korean Society of Radiology
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• v.14 no.6
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• pp.773-780
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• 2020

With the development of the 4th industrial, research is being conducted to prevent diseases and reduce damage in various fields of science and technology such as medicine, health, and bio. As a result, artificial intelligence technology has been introduced and researched for image analysis of radiological examinations. In this paper, we will directly apply a deep learning model for classification and detection of pneumonia using chest X-ray images, and evaluate whether the deep learning model of the Inception series is a useful model for detecting pneumonia. As the experimental material, a chest X-ray image data set provided and shared free of charge by Kaggle was used, and out of the total 3,470 chest X-ray image data, it was classified into 1,870 training data sets, 1,100 validation data sets, and 500 test data sets. I did. As a result of the experiment, the result of metric evaluation of the Inception V3 deep learning model was 94.80% for accuracy, 97.24% for precision, 94.00% for recall, and 95.59 for F1 score. In addition, the accuracy of the final epoch for Inception V3 deep learning modeling was 94.91% for learning modeling and 89.68% for verification modeling for pneumonia detection and classification of chest X-ray images. For the evaluation of the loss function value, the learning modeling was 1.127% and the validation modeling was 4.603%. As a result, it was evaluated that the Inception V3 deep learning model is a very excellent deep learning model in extracting and classifying features of chest image data, and its learning state is also very good. As a result of matrix accuracy evaluation for test modeling, the accuracy of 96% for normal chest X-ray image data and 97% for pneumonia chest X-ray image data was proven. The deep learning model of the Inception series is considered to be a useful deep learning model for classification of chest diseases, and it is expected that it can also play an auxiliary role of human resources, so it is considered that it will be a solution to the problem of insufficient medical personnel. In the future, this study is expected to be presented as basic data for similar studies in the case of similar studies on the diagnosis of pneumonia using deep learning.