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The Thoughts of Patients on Medical Accidents and Disputes in Korea (의료사고와 의료분쟁에 대한 의료이용자들의 의식 조사)

  • Rhee, Hyun-Sill;Lee, Jun-Hyup;Rhim, Kook-Hwan;Choi, Man-Kyu
    • Korea Journal of Hospital Management
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    • v.11 no.1
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    • pp.1-30
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    • 2006
  • According to the available data, in these days, the number of medical accidents and disputes have significantly increased since 1990 in Korea. From this aspect, a variety of approaches and efforts to solve these problems is needed before it is too late. This study intended to identify the thoughts of patients who are directly connected with medical accidents and disputes and then to consider reasonable settlement methods of the increasing disputes. For achieving the purpose of this study, the self-administerd questionnaire was conducted with 450 out-patients who visited three university hospitals, five small and medium-sized hospitals, and ten clinics in Seoul from June 13 to 17, 2005. Incomplete questionnaires were omitted and 410 respondents(91%) were included for the analysis of this study. Each section of the survey was composed of six categories such as the recognition of malpractice, a compensation system about no-fault medical accidents, the recognition of the judgement of medical accidents in court, reasonable settlement of medical accidents, reasons of lawsuit, and the need of the medical dispute settlement organization. The major results of this study were as follows. First, more than half of the respondents, 51.9 percent, worry about malpractice. And many respondents think malpractice causes their symptoms to persist or become worse, and also some respondents think that the doctor's prescription changed too frequently. Second, as for a compensation system about no-fault medical accident, 55.7 percent of the respondents insist that a proper compensation for suffering patients or their families should be provided. And also as for the responsibility of compensation, respondents think joint compensation of both the medical institution and the government is needed foremost, followed by the medical insurance company and finally by the medical institution. The government as well as the related institutions should take responsibility for malpractice accidents for which the doctor is not responsible. Third, as for the acknowledgment of medical accident judgements by the court, 32.8 percent of respondents think that it is best to compromise with a medical institution, followed by lawsuit(26.2%), the assistance of civil organization(23.2%), and a powerful physical protest(7.6%). Fourth, as for the lawsuit of medical accidents, 62.9 percent of respondents think that patients and their families would be in a disadvantageous position in relation to medical institutions and doctors mentioning the lack of professional medical and lawful knowledge, experience and know-how as the reason. So many people have given up appeals owing to the difficulties involved in defending themselves through evidence. Fifth, about a half share of the respondents indicated that the medical institution's neglect of the responsibility of medical accidents is one of the most important reasons of lawsuit. And next respondents mentioned the lack of the medical dispute settlement organization and a general distrust of medical institutions and doctors. Sixth, a majority of respondents consented to the introduction of the need of the medical dispute settlement organization, And about a half of the respondents mentioned a readiness to accept the mediation of the organization, but the rest did not express a clear opinion. It seems that conflict among the parties concerned have existed in relation to the medical dispute settlement organization and related legislation for many years. But as this study has shown, the needs of the medical dispute settlement organization is in desperate demand. Therefore, more negotiation efforts from all interest groups should be considered for the birth of the medical dispute settlement organization and related legislation.

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The Content Analysis of the Textbooks of Dental Clinical Course (치과임상교과목 교재에 대한 내용분석)

  • Lee, Sun-Mi;Yoo, Jung-Sook;Ahn, Se-Youn;Lim, Mi-Hee;Han, Ji-Youn;Jun, Mi-Kyoung;Lee, Hyun-Ok;Won, Young-Soon
    • Journal of dental hygiene science
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    • v.15 no.3
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    • pp.272-279
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    • 2015
  • This study was conducted to provide baseline data which could suggest a direction of role based efficient integrated clinical education by avoiding duplicate of contents through analyzing clinical courses. Among the 7 clinical courses, orthodontics and periodontology were the most published subjects which were published in 5 kinds of books and dental materials was the least published subject which was published in 2 kinds of books on investigation of overlapping contents based on titles that appeared on chapters and verses of all textbooks for clinical courses. Dental implant was covered in 4 subjects such as oral maxillofacial surgery, prosthodontics, periodontology and dental materials which was the most number. Other overlapping contents were restoration treatment, occlusion and malocclusion, temporomandibular joint diseases, anesthesia sedation, tooth trauma, systemic disease and dental treatment, dental casting, isolation techniques, tooth bleaching, pulp protection, gingivitis periodontitis, tooth development, etc. Reviews of textbooks of clinical courses should be conducted in a detailed manner by systematic, various studies in order to improve quality of the textbooks.

Brief Observation on Arbitration Agreement and Arbitral Award - Focusing on Construction Disputes - (중재합의와 중재판정에 관한 소고 -건설분쟁을 중심으로-)

  • Cho Dae-Yun
    • Journal of Arbitration Studies
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    • v.14 no.1
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    • pp.273-314
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    • 2004
  • There is a belief in the construction industry that the traditional court system may not be an ideal forum to effectively and efficiently resolve construction disputes due to the protracted proceedings and the three tier appeal system resulting in a long delay in the final and conclusive settlement of the dispute, relatively high costs involved, the lack of requisite knowledge and experience in the relevant industry, etc. Hence, they assert that certain alternative dispute resolution ('ADR') methods, such as mediation, conciliation, arbitration or a new system for dispute settlement in the form of any combination thereof should be developed and employed for construction disputes so as to resolve them more promptly and efficiently to the satisfaction of all the disputants concerned. This paper discusses certain merits of such assertions and the need for additional considerations for effective resolution of the construction disputes in light of the complexity of the case, importance of expert witnesses, parties' relationship and non-level playing field of the construction industry and so on. At the same time, however, given the inherent nature of disputes rendering the parties involved in an adversarial position, it would rather be difficult, if not practically impossible, to satisfy all the parties concerned in the dispute. Accordingly, in this study, it is also purported to address the demerits of such assertions by studying the situation from a more balanced perspective, in particular, in relation to the operation of such ADRs. In fact, most of such ADRs as stipulated by special acts, such as the Construction Industry Basic Act of Korea, in the form of mediation or conciliation, have failed to get support from the industry, and as a result, such ADRs are seldom used in practice. Tn contrast, the court system has been greatly improved by implementing a new concentrated review system and establishing several tribunals designed to specialize in the review and resolution of specific types of disputes, including the construction disputes. These improvements of the court system have been warmly received by the industry. Arbitration is another forum for settlement of construction disputes, which has grown and is expected to grow as the most effective ADR with the support from the construction industry. In this regard, the Korean Commercial Arbitration Board ('KCAB') has established a set of internal rules end procedures in operation to efficiently handle construction disputes. Considering the foregoing, this paper addresses the most important elements of the arbitration, i.e., arbitration agreement and arbitral award, primarily focusing on the domestic arbitrations before the KCAB. However, since this parer is prepared for presentation at the construction disputes seminar for the public audience, it is not intended for academic purposes, nor does it delve into any specific acadcmic issues. Likewise, although this paper addresses certain controversial issues by way of introduction, it mainly purports to facilitate the understanding of the general public, including the prospective arbitrators on the KCAB roster without the relevant legal education and background, concerning the importance of the integrity of the arbitration agreement and the arbitral award. In sum, what is purported in this study is simply to note that there are still many outstanding issues with mediation, conciliation and arbitration, as a matter of system, institutional operation or otherwise, for further study and consideration so as to enhance them as effective means for settlement of construction disputes, in replacement of or in conjunction with the court proceeding. For this purpose, it is essential for all the relevant parties, including lawyers, engineers, owners, contractors and social activists aiming to protect consumers' and subcontractors' interests, to conduct joint efforts to study the complicated nature of construction works and to develop effective means for examination and handling of the disputes of a technical nature, including the accumulation of the relevant industrial data. Based on the foregoing, the parties may be in a better position to select the appropriate dispute resolution mechanism, a court proceeding or in its stead, an effective ADR, considering the relevant factors of the subject construction works or the contract structure, such as the bargaining position of the parties, their financial status, confidentiality requirements, technical or commercial complexity of the case at hand, urgency for settlements, etc.

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Diagnostic Value of MRI in Schwannoma (신경초종 진단에 있어 자기공명영상촬영(MRI)의 진단적 가치)

  • Kim, Jeung Il;Kim, Um Ji;Moon, Tae Yong;Lee, In Sook;Song, You Seon;Choi, Kyung Un
    • The Journal of the Korean bone and joint tumor society
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    • v.20 no.2
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    • pp.60-65
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    • 2014
  • Purpose: To diagnose soft tissue tumor, such as lipoma and Schwannoma, magnetic resonance imaging (MRI) is sufficient in most cases. However, various characteristics are found in MRI images of Schwannoma, thus other type of tumors are often misdiagnosed as Schwannoma with MRI images. In this study, we evaluate the diagnostic value of specific MRI findings of Schwannoma. Materials and Methods: From January 2002 to May 2013, 104 patients who are suspected as Schwannoma rith MRI images are included in data, and the final diagnosis is confirmed with biopsy. Patients are divided into group 1 and group 2 who are confirmed as Schwannoma and other disease with biopsy, respectively. Results: 92 patients were diagnosed as Schwannoma (group 1) and 12 patients were diagnosed as other disease (group 2). We investigate the diagnostic value of specific MRI findings of Schwannoma. 41 patients of group 1 (45%) and 0 patients of group 2 (0%) showed target sign, 47 patients of group 1 (51%) and 2 patients of group 2 (17%) showed fascicular sign, 44 patients of group 1 (48%) and 5 patients of group 2 (42%) showed fat split sign, 28 patients of group 1 (30%) and 1 patients of group 2(9%) showed nerve entering and exiting sign, and 8 patients of group 1 (9%) and 6 patients of group 2 (50%) showed none of four specific findings on their MRI images. 52 patients of group 1 (57%) and 5 patients of group 2 (42%) have tumors on the pathway of nerve. Target sign could be considered as the best diagnostic value of the sign we investigate (p<0.05). Conclusion: Although specific MRI findings have powerful diagnostic value, patients are often misdiagnosed as Schwannoma with MRI findings. Therefore, if patients who are suspected as Schwannoma based on MRI findings have no target sign on their MRI images, we should consider the possibility of other disease.

The Analysis of Visiting Patterns for the Top of Seoseokdae in Mudeungsan National Park (무등산국립공원 서석대 정상부의 탐방패턴 분석)

  • Shim, Seok-Yeong;Park, Seok-Gon
    • Korean Journal of Environment and Ecology
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    • v.31 no.2
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    • pp.266-274
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    • 2017
  • The purpose of this study was to analyze the number of visitors to the top of Seoseokdae in Mudeungsan National Park, in which visitors are concentrated, and their visiting patterns, thereby suggesting measures to manage the visitors. The number of annual visitors and the numbers of regional and seasonal visitors to Mudeungsan National Park, which affect the concentration of visits to Seoseokdae were analyzed using the data produced by an automatic digitizing device. A field study was conducted to examine the number of seasonal and periodic visitors to Seoseokdae and their visiting patterns. In 2015, the number of visitors was 2,563,651 and 83.9% of the visitors visited via the Jeungsimsa and Wonhyosa area that is near Gwangju City. This area is close to the Seoseokdae area and it is easy to hike between the areas. Therefore, there was an influx of most visitors to Seoseokdae into the Jeungsimsa and Wonhyosa area. In terms of seasonal visitors, the largest number of visitors came in the fall, followed by the summer, spring, and winter in order. However, the seasonal differences were not notable. There was no statistically significant correlation between the number of visitors and meteorological factors. This result may have been because Gwangju citizens frequently visit Mudeungsan regardless of period and weather. Visitors can get to Seoseokdae via the trails into Wonhyosa and Jangbuljae. A slightly larger number of visitors used the trail into Jangbuljae in the fall and winter, whereas a larger number of visitors used the trail into Wonhyosa in the summer. In general, there is a large influx of visitors into Jangbuljae, a strategic visiting point. However, a slightly larger number of visitors may have chosen the trail into Wonhyosa in the summer because they could hike under the shade of trees. In the summer, visitors stayed in Seoseokdae for a short time with a low level of crowdedness. On the other hand, in the fall and winter, visitors stayed in the area longer because they had lunch and rested. During the time, the number of momentary maximum visitors peaked, causing extreme crowdedness. Therefore, some visitors showed the visiting pattern of entering the grassland outside the designate zone. Because this behavior can damage the grassland on the top of Seoseokdae, which can lead to soil erosion, intensive visitor management may be necessary.

Department of Preventive Medicine and public Health, College of Medicine, Chungnam National University (일부 농촌지역 주민들의 사지 부자유 실태 및 우울과의 관련성)

  • Song, Sun-Hui;Cho, Young-Chae
    • Journal of agricultural medicine and community health
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    • v.30 no.1
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    • pp.63-74
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    • 2005
  • Objectives: The present study aimed to provide the fundamental data for guiding establishment of measures among the rural elderly population with physical disabilities. The specific goals of this report are to reveal the prevalence of their disabilities, its tendency according to their increasing age, and to assess the background explanations. Methods: The self-administered questionnaires have been performed 432 persons of rural residents age 40 and greater in Kumsan-Gun and Chongyang-Gun, Chungchongnamdo Province. The questionnaire items included presence or not. of disabilities. specific causes for disabilities, anthropometric measures, and amount of physical activities. Results: The proportion of disabilities was higher in women than men, and the functional degree of their limbs decreased with the increasing age. The proportion of disabling extremities was higher in the lower extremities than in the upper ones. Joint diseases were the most prevalent causes for disabilities of extremities. Concerning the degree of depression, 41.2% of study subjects were normal, 47.5% had mild depression, 6.3% moderate, and 5.1% severe depression, with no statistical difference based on age and sex. The worse are the functional degree of both extremities, the greater the degree of depression the subjects had. The odds ratio for presence of disabilities of extremities was 2.6 times higher in women than in men for sex and for age, 50's were 3.5 times, 60's 4.3 times, 70's 4.9 times than 40's, respectively, with increasing tendency with increasing age. The odds ratio for depression was 1.2 times greater in subjects with disabilities than in normal population with no statistical difference. Conclusions: More efforts are needed to establish elderly specific measures for providing proper public health services centering on maintenance of physical functioning among elderly population.

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Safety Assessment of Estimated Daily Intakes of Antioxidants in Korean Using Dietary Survey Approach and Food Supply Survey Approach (식이를 통한 평가방법과 공급량 평가방법을 이용한 산화방지제 일일 추정 섭취량 안전성 평가)

  • Suh, Hee-Jae;Choi, Sung-Hee
    • Korean Journal of Food Science and Technology
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    • v.42 no.6
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    • pp.762-767
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    • 2010
  • This study evaluated daily intakes of BHT, BHA, and TBHQ in Korean. The daily intakes were estimated using both a dietary survey approach and food supply survey approach. In the dietary survey approach, individual dietary intake data from the Korea National Health and Nutrition Survey in 2005, as well as analytical results of BHT in 131 samples, BHA in 134 samples, and TBHQ in 104 samples, were used to assess daily intakes of the antioxidants. In the food supply survey approach, both total production amounts of BHT, BHA and TBHQ and maximum permitted levels of the antioxidants were used to calculate daily intakes. In the dietary survey results, the average daily intakes of BHT, BHA and TBHQ were 0.8, 0.5, and 0.3 ${\mu}g$/kg body weight/day, respectively, and below 0.2% of the ADI (acceptable daily intake) set by JECFA (Joint FAO/WHO Expert committee on Food Additives). In the food supply survey approach, the average daily intakes of BHT, BHA,and TBHQ were all 0.3 mg/kg body weight/day. The ratios of ADI were 97, 60, and 40%, respectively. According to these results, daily intakes of BHT, BHA, and TBHQ in Korean are lower than the ADI.

The Effectiveness of Buprenorphine Transdermal Patch on Patients with Shoulder Pain: Short-Term Follow-up Study (견관절 통증을 동반한 동결견 환자에게서 Buprenorphine transdermal patch의 효과: 단기 추시 결과)

  • Hong, Jin Ho;Park, Yong Bok;Ryu, Ho Young;Jeon, Sang Jun;Park, Won Ha;Yoo, Jae Chul
    • The Journal of Korean Orthopaedic Ultrasound Society
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    • v.7 no.1
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    • pp.7-12
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    • 2014
  • Purpose:The effectiveness of transdermal buprenorphine patch on the patients with frozen state of frozen shoulder was evaluated. Materials and Methods: Between March and September in 2013, 127 patients with pain and limited range of motion in shoulder joint over 6 months were included. Every patient was confirmed the diagnosis through MRI or ultrasonogram and each patient received intra-articular injection of steroid once. After 2~4 weeks, every patient was interviewed via telephone survey and finally 105 patients were included, 54 patients received only oral NSAIDs (NP group) while 51 patients received additional transdermal buprenorphine patch (BP group). Pain and functional visual analog scale (PVAS, FVAS), American Shoulder Elbow Society (ASES) score was checked. Results: Generally, every outcome variables showed improvements in both groups (p<0.001). PVAS score after treatment showed superior result in NP group but it was not significant (p=0.088). In ASES score, NP group had superior result than BP group and it had significant difference. Similarly in FVAS, NP group showed superior result but the data before treatment was significantly different (p=0.028) Conclusion: Transdermal buprenorphine patch didn't show superior treatment result in the patient with frozen state of frozen shoulder which was applied with oral NSAIDs after single intra-articular glenohumeral steroid injection in short-term follow-up.

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Understanding the Relationship between Value Co-Creation Mechanism and Firm's Performance based on the Service-Dominant Logic (서비스지배논리하에서 가치공동창출 매커니즘과 기업성과간의 관계에 대한 연구)

  • Nam, Ki-Chan;Kim, Yong-Jin;Yim, Myung-Seong;Lee, Nam-Hee;Jo, Ah-Rha
    • Asia pacific journal of information systems
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    • v.19 no.4
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    • pp.177-200
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    • 2009
  • AIn the advanced - economy, the services industry hasbecome a dominant sector. Evidently, the services sector has grown at a much faster rate than any other. For instance, in such developed countries as the U.S., the proportion of the services sector in its GDP is greater than 75%. Even in the developing countries including India and China, the magnitude of the services sector in their GDPs is rapidly growing. The increasing dependence on service gives rise to new initiatives including service science and service-dominant logic. These new initiatives propose a new theoretical prism to promote the better understanding of the changing economic structure. From the new perspectives, service is no longer regarded as a transaction or exchange, but rather co-creation of value through the interaction among service users, providers, and other stakeholders including partners, external environments, and customer communities. The purpose of this study is the following. First, we review previous literature on service, service innovation, and service systems and integrate the studies based on service dominant logic. Second, we categorize the ten propositions of service dominant logic into conceptual propositions and the ones that are directly related to service provision. Conceptual propositions are left out to form the research model. With the selected propositions, we define the research constructs for this study. Third, we develop measurement items for the new service concepts including service provider network, customer network, value co-creation, and convergence of service with product. We then propose a research model to explain the relationship among the factors that affect the value creation mechanism. Finally, we empirically investigate the effects of the factors on firm performance. Through the process of this research study, we want to show the value creation mechanism of service systems in which various participants in service provision interact with related parties in a joint effort to create values. To test the proposed hypotheses, we developed measurement items and distributed survey questionnaires to domestic companies. 500 survey questionnaires were distributed and 180 were returned among which 171 were usable. The results of the empirical test can be summarized as the following. First, service providers' network which is to help offer required services to customers is found to affect customer network, while it does not have a significant effect on value co-creation and product-service convergence. Second, customer network, on the other hand, appears to influence both value co-creation and product-service convergence. Third, value co-creation accomplished through the collaboration of service providers and customers is found to have a significant effect on both product-service convergence and firm performance. Finally, product-service convergence appears to affect firm performance. To interpret the results from the value creation mechanism perspective, service provider network well established to support customer network is found to have significant effect on customer network which in turn facilitates value co-creation in service provision and product-service convergence to lead to greater firm performance. The results have some enlightening implications for practitioners. If companies want to transform themselves into service-centered business enterprises, they have to consider the four factors suggested in this study: service provider network, customer network, value co-creation, and product-service convergence. That is, companies becoming a service-oriented organization need to understand what the four factors are and how the factors interact with one another in their business context. They then may want to devise a better tool to analyze the value creation mechanism and apply the four factors to their own environment. This research study contributes to the literature in following ways. First, this study is one of the very first empirical studies on the service dominant logic as it has categorized the fundamental propositions into conceptual and empirically testable ones and tested the proposed hypotheses against the data collected through the survey method. Most of the propositions are found to work as Vargo and Lusch have suggested. Second, by providing a testable set of relationships among the research variables, this study may provide policy makers and decision makers with some theoretical grounds for their decision making on what to do with service innovation and management. Finally, this study incorporates the concepts of value co-creation through the interaction between customers and service providers into the proposed research model and empirically tests the validity of the concepts. The results of this study will help establish a value creation mechanism in the service-based economy, which can be used to develop and implement new service provision.

The Death Orientation of nursing students in Korea and China (한국과 중국 간호대학생의 죽음에 대한 의식)

  • Li, Zhen-Shu;Choe, Wha-Sook
    • Korean Journal of Hospice Care
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    • v.8 no.1
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    • pp.1-12
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    • 2008
  • Perpose: The purpose of this study was to investigate the perception of death between Korean and Chinese nursing students. And it will help develop curriculum for preparing death, the quality of hospice care, as well as nursing education and practice. Methods: Data was collected from 492 nursing students participated(248 Korean and 244 Chinese) by questionnaire designed for examining Death Orientation (Thorson & Powell, 1988). They were analyzed using Cronbach's Alpha coefficients, factor analysis, t-test, ANOVA and regression analysis (SPSS; win 12.0 version) Results: More than half of the Korean nursing students followed a religion (58.5%) while the majority of Chinese nursing students did not follow a religion (93.9%). In the view of the afterlife, nursing students in China had two views. 'I really don't know what happens after a person dies (30.3%)' and ‘There is no afterlife and death is the end (29.5%)’. On the other hand the Korean nursing students’ answer were, 'After dying, a person goes to heaven or hell (27.3%)' and 'I really don't know what happens after a person dies. (22.9%)' The study also found that the average of 25 items in Death Orientation is 2.36points of nursing students in Korea and 2.50points of nursing students in China. This means that the concern, anxiety and fear were of the middle level for the Chinese Students and were higher than Korean students (t=3.51, p=.000). In the low factor of death orientation, those in Korea had higher 'anxiety of burden to family' than those in China (t=-3.50, p=.001). The nursing students in China had higher 'anxiety of the unknown (t=4.96, p=.000)', 'fear of suffering (t=6.88, p=.000), 'fear of extinction body and life (t=5.20, p=.000), 'fear of lost self-control(t=2.12, p=.034)', and 'anxiety of future existence and nonexistence (t=2.33, p=.020)' than those in Korea. There was no statistically significant difference for the 'concern of body and fear of identity lost' category. The death orientation of Korean nursing students had statistically significant differences according to age (t=3.20, p=.002), religion (t=2.56, p=.011), and afterlife (F=4.64, p=.000). The contribution of Death Orientation had a statistically significant difference, the afterlife variable (0.735, p=0.001). The death orientation of Chinese nursing students did not have any statistically significant differences. Conclusion: In conclusion, there were differences in death orientation between Korean and Chinese nursing students. In particular, those who believed in afterlife showed acceptance of death. The results of this study suggest that nursing curricula should include education program on death and spiritual nursing. Additional studies are needed to establish death education in China with careful considerations on Chinese policies, cultures and social systems.

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