• The Korean Society of Law and Medicine
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• v.16 no.2
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• pp.27-53
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• 2015

Recently, a plastic surgery hospital in Seoul, has been raided following suspicions that ghost surgery was performed by an unauthorized substitute surgeon on a chinese woman who lapsed into a death. Following the incident, an organization to eradicate ghost surgery was created in March by Consumers Korea, founded to protect consumer rights, and the Korea Alliance of Patients Organization. The organization has received reports of illegal medical practices. To substitute another physician without the patient's consent and without his knowledge of the substitution is fraud and deceit and a violation of a basic ethical concept. The patient as a human being is entitled to choose his own physician and he should be permitted to acquiesce in or refuse to accept the substitution. It should be noted that it is the operating surgeon to whom the patient grants his consent to perform the operation. The patient is entitled to the services of the particular surgeon with whom he contracts. The surgeon, in accepting the patient, obligates himself to utilize his personal talents in the performance of the operation to the extent required by the agreement creating the physician-patient relationship. He cannot properly delegate to another the duties which the patient authorizes him to perform personally. 'Ghost surgery' comes under Article 257(Inflicting Bodily Injury on Other or on Lineal Ascendant) of the Criminal Code. Substitution another physician without the patient's consent and without his knowledge of the substitution shall be performed Inflicting Bodily Injury. This is a controversial issue that'ghost surgery' comes under Article 347(Fraud) of the Criminal Code. It maybe controversial that operation substituted by another physician without the patient's consent and without his knowledge of the substitution becomes the component of Fraud. Also, Ghost surgery' comes under Article 27 (Prohibition of Unlicensed Medical Practice, etc.), Article 22 (Medical Records, etc.), Article 33 (Establishment) of the Medical Service Act. The surgeon's obligation to the patient requires him to perform the surgical operation: (1) within the scope of authority granted him by the consent to the operation; (2) in accordance with the terms of the contractual relationship; (3) with complete disclosure of all facts relevant to the need and the performance of the operation; and (4) to utilize his best skill in performing the operation.

• Clinical and Experimental Reproductive Medicine
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• v.2 no.2
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• pp.27-36
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• 1975

The success of the family planning program in Korea is reflected in the decrease in the growth rate from 3.0% in 1962 to 2.0% in 1971, and in the decrease in the fertility rate from 43/1,000 in 1960 to 29/1,000 in 1970. However, it would be erroneous to attribute these reductions entirely to the family planning program. Other socio-economic factors, such as the increasing age at marriage and the increasing use of induced abortions, definitely had an impact on the lowered growth and fertility rate. Despite the relative success of the program to data in meeting its goals, there is no room for complacency. Meeting the goal of a further reduction in the population growth rate to 1.3% by 1981 is a much more difficult task than any one faced in the past. Not only must fertility be lowered further, but the size of the target population itself will expand tremendously in the late seventies; due to the post-war baby boom of the 1950's reaching reproductive ages. Furthermore, it is doubtful that the age at marriage will continue to rise as in the past or that the incidence of induced abortion will continue to increase. Consequently, future reductions in fertility will be more dependent on the performance of the national family planning program, with less assistance from these non-program factors. This paper will describe various approaches to help to the solution of these current problems. 1. PRACTICE RATE IN FAMILY PLANNING In 1973, the attitude (approval) and knowledge rates were quite high; 94% and 98% respectively. But a large gap exists between that and the actual practice rate, which is only 3695. Two factors must be considered in attempting to close the KAP-gap. The first is to change social norms, which still favor a larger family, increasing the practice rate cannot be done very quickly. The second point to consider is that the family planning program has not yet reached all the eligible women. A 1973 study determineded that a large portion, 3096 in fact, of all eligible women do not want more children, but are not practicing family planning. Thus, future efforts to help close the KAP-gap must focus attention and services on this important large group of potential acceptors. 2. CONTINUATION RATES Dissatisfaction with the loop and pill has resulted in high discontinuation rates. For example, a 1973 survey revealed that within the first six months initial loop acceptance. nearly 50% were dropouts, and that within the first four months of inital pill acceptance. nearly 50% were dropouts. These discontinuation rates have risen over the past few years. The high rate of discontinuance obviously decreases the contraceptive effectiveness. and has resulted in many unwanted births which is directly related to the increase of induced abortions. In the future, the family planning program must emphasize the improved quality of initial and follow-up services. rather than more quantity, in order to insure higher continuation rates and thus more effective contraceptive protection. 3. INDUCED ABORTION As noted earlier. the use of induced abortions has been increase yearly. For example, in 1960, the average number of abortions was 0.6 abortions per women in the 15-44 age range. By 1970. that had increased to 2 abortions per women. In 1966. 13% of all women between 15-44 had experienced at least one abortion. By 1971, that figure jumped to 28%. In 1973 alone, the total number of abortions was 400,000. Besides the ever incre.sing number of induced abortions, another change has that those who use abortions have shifted since 1965 to include- not. only the middle class, but also rural and low-income women. In the future. in response to the demand for abortion services among rural and low-income w~men, the government must provide and support abortion services for these women as a part of the national family planning program. 4. TARGET SYSTIi:M Since 1962, the nationwide target system has been used to set a target for each method, and the target number of acceptors is then apportioned out to various sub-areas according to the number of eligible couples in each area. Because these targets are set without consideration for demographic factors, particular tastes, prejudices, and previous patterns of acceptance in the area, a high discontinuation rate for all methods and a high wastage rate for the oral pill and condom results. In the future. to alleviate these problems of the methodbased target system. an alternative. such as the weighted-credit system, should be adopted on a nation wide basis. In this system. each contraceptive method is. assigned a specific number of points based upon the couple-years of protection (CYP) provided by the method. and no specific targets for each method are given. 5. INCREASE OF STERILIZA.TION TARGET Two special projects. the hospital-based family planning program and the armed forces program, has greatly contributed to the increasing acceptance in female and male sterilization respectively. From January-September 1974, 28,773 sterilizations were performed. During the same time in 1975, 46,894 were performed; a 63% increase. If this trend continues, by the end of 1975. approximately 70,000 sterilizations will have been performed. Sterilization is a much better method than both the loop and pill, in terms of more effective contraceptive protection and the almost zero dropout rate. In the future, the. family planning program should continue to stress the special programs which make more sterilizations possible. In particular, it should seek to add the laparoscope techniques to facilitate female sterilization acceptance rates. 6. INCREASE NUMBER OF PRIVATE ACCEPTORS Among the current family planning users, approximately 1/3 are in the private sector and thus do not- require government subsidy. The number of private acceptors increases with increasing urbanization and economic growth. To speed this process, the government initiated the special hospital based family planning program which is utilized mostly by the private sector. However, in the future, to further hasten the increase of private acceptors, the government should encourage doctors in private practice to provide family planning services, and provide the contraceptive supplies. This way, those do utilize the private medical system will also be able to receive family planning services and pay for it. Another means of increasing the number of private acceptors, IS to greatly expand the commercial outlets for pills and condoms beyond the existing service points of drugstores, hospitals, and health centers. 7. IE&C PROGRAM The current preferred family size is nearly twice as high as needed to achieve a stable poplation. Also, a strong boy preference hinders a small family size as nearly all couples fuel they must have at least one or more sons. The IE&C program must, in the future, strive to emphasize the values of the small family and equality of the sexes. A second problem for the IE&C program to work. with in the: future is the large group of people who approves family planning, want no more children, but do not practice. The IE&C program must work to motivate these people to accept family planning And finally, for those who already practice, an IE&C program in the future must stress continuation of use. The IE&C campaign, to insure highest effectiveness, should be based on a detailed factor analysis of contraceptive discontinuance. In conclusion, Korea faces a serious unfavorable sociodemographic situation- in the future unless the population growth rate can be curtailed. And in the future, the decrease in fertility will depend solely on the family planning program, as the effect of other socio-economic factors has already been maximumally felt. A second serious factor to consider is the increasing number of eligible women due to the 1950's baby boom. Thus, to meet these challenges, the program target must be increased and the program must improve the effectiveness of its current activities and develop new programs.

• The Korean Journal of Emergency Medical Services
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• v.8 no.1
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• pp.87-104
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• 2004

This study selected the fifth and sixth graders of elementary school in Jeollanamdo who can express their opinions of safety consciousness and understand the items of questionnaire as the population. It selected 10 elementary schools under the supervision of Jeonnam Board of Education and sampled 700 students randomly from 2-3 classes in the 5th and the 6th grade. One preliminary survey was conducted to revise and complement the contents and forms of questionnaire with 70 students of a school from Apr. 1 to 6, 2004 and this study was conducted from Apr. 10 to 30, 2004. Data of this study were collected by explaining the purport of study to subjects after obtaining approval of principal and teacher of the school and distributing questionnaires. Total 700 questionnaires were distributed and 681 were collected (97%) and 602 were used for final analysis except 79 lacking responses. The results of this study are as follows. According to demographical characteristics of subjects, 'male' students were 302(50.%) and 'female' students were 300(49.8%) by sex and 'the 5th graders' were 285(47.3%) and 'the 6th graders' were 317(52.7%) in grade distribution. Residents at 'apartment house' were 406(67.4%) in residence type, 'going to school by foot' was 477 students(79.2%), 'high school graduates' were 297(49.3%) in fathers' education, 'high school graduates' were 366 (60.8%) in mothers' education, 'professional and office workers' were 231(38.4%) in fathers' job, 'full-time workers' were 283(47.0%) in mothers' job, and the number of siblings was one except myself in 343 students(57.0%). Respondents on the level of class showing 'good' were 340(56.5%) and those on the degree of adaptation to school life showing 'active' were 349(58.0%). On the characteristics related to safety education, 360(59.8%) responded it was 'very necessary', on the frequency of safety education at school for last one year, 339(56.3%) responded they had 'once or twice', on the frequency of safety education by parents, 279(46.3%) responded they 'often' had it, on the level of safety practice by parents, 347(57.6%) responded they practiced it 'frequently', on the source of knowledge of safety, 223(37.0%) responded they got it from 'parents, siblings and relatives', on the degree of recognizing the need of safety education textbooks, 295(38.5%) responded 'it was needed', on the recognition of necessity of teacher for safety education, 271(45.0%) answered it was very necessary', and on the recognition of qualification of teacher for safety education, 370(61.5%) answered it was 'paramedic'. The mean score of safety consciousness of subjects was 2.72 (SD. 21) of full score 3, having high score over mean score. According to each area, the area showing the highest safety consciousness was safety of fire(2.83), followed by home safety(2.76) and first-aid treatment(2.76), traffic safety(2.71), play and leisure safety(2.66) and school safety(2.56). Items showing statistical differences in the degree of safety consciousness according to demographical characteristics were sex(t=-3.11, p=.002), education(t=2.33, p=.021) and number of siblings(F=3.729, p=.011). In the difference of safety consciousness between both sexes, 'female' students(2.75) showed higher safety consciousness than 'male' students (2.69), and the former also showed higher safety consciousness than the latter in all six areas of school safety, play and leisure safety, traffic safety, fire safety, home safety and first-aid treatment, and there were statistical differences in the areas of play and leisure safety, traffic safety, fire safety and first-aid treatment. According to the differences of safety consciousness by grade, 'the fifth graders'(2.74) showed higher safety consciousness than 'the sixth graders'(2.70) and the former also showed higher safety consciousness than the latter in all six areas of school safety, play and leisure safety, traffic safety, fire safety, home safety and first-aid treatment, and there were statistical differences in the areas of fire safety and home safety. In the safety consciousness by the number of siblings, 'single son or daughter' (2.78) was highest and their safety consciousness was also highest in all six areas of school safety, play and leisure safety, traffic safety, fire safety, home safety and first-aid treatment, and there were statistical differences in the areas of school safety, fire safety and home safety, There were statistically remarkable differences in degree of adaptation to school life (F=15.349, p=.000) and perceived schooling level(F=9.552, p=.000). According to the degree of safety consciousness related to characteristics of safety education, there were statistical differences at the degree of recognizing the need of safety education(F=9.797, p=.000), degree of safety education at school(F=2.595, p=.006), degree of safety education by parents(F=12.709, p=.000), degree of practicing safety by parents(F=17.579, p=.000), source of knowledge of safety education (F=2,715, p=.044), necessity of safety education textbooks(F=3.972, p=.008), need of safety teacher(F=4.137, p=.006) and qualification standard of safety teacher(F=3.016, p=.029).

• Journal of Genetic Medicine
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• v.8 no.1
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• pp.1-16
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• 2011

Owing to the risk of fetal loss associated with prenatal diagnostic procedures (amniocentesis, chorionic villus sampling), noninvasive prenatal diagnosis (NIPD) is ultimate goal of prenatal diagnosis. The discovery of circulating cell-free fetal DNA (cffDNA) in maternal plasma in 1997 has opened up new probabilities for NIPD by Dr. Lo et al. The last decade has seen great development in NIPD. Fetal sex and fetal RhD status determination by cffDNA analysis is already in clinical use in certain countries. For routine use, this test is limited by the amount of cell-free maternal DNA in blood sample, the lack of universal fetal markers, and appropriate reference materials. To improve the accuracy of detection of fetal specific sequences in maternal plasma, internal positive controls to confirm to presence of fetal DNA should be analyzed. We have developed strategies for noninvasive determination of fetal gender, and fetal RhD genotyping using cffDNA in maternal plasma, using real-time quantitative polymerase chain reaction (RT-PCR) including RASSF1A epigenetic fetal DNA marker (gender-independent) as internal positive controls, which is to be first successful study of this kind in Korea. In our study, accurate detection of fetal gender through gestational age, and fetal RhD genotyping in RhD-negative pregnant women was achieved. In this assay, we show that the assay is sensitive, easy, fast, and reliable. These developments improve the reliability of the applications of circulating fetal DNA when used in clinical practice to manage sex-linked disorders (e.g., hemophilia, Duchenne muscular dystrophy), congenital adrenal hyperplasia (CAH), RhD incompatibility, and the other noninvasive pregnant diagnostic tests on the coming soon. The study was the first successful case in Korea using cffDNA in maternal plasma, which has created a new avenue for clinical applications of NIPD.

• The Korean Journal of Emergency Medical Services
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• v.12 no.3
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• pp.87-98
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• 2008

Purpose : This study was designed to figure out the necessity of continuing basic CPR education for the higher grade students of elementary school. The assessment contents were knowledge, practice ability, precision level of CPR skills and continuation of the educational efficiency. Methods : Twenty two students of 4th and 5th grade of elementary school in K city in Chungcheongnam-do were recruited for this study. The study method was a control group of non-synchronized design. A preliminary study was done on October 27 in 2006. The main study was performed from February 14 to May 11 in 2007. The researcher adopted the method of Kyung-hui, Kang (1998) such as awareness, attitude and knowledge in control group, emergency medical technician test protocol, Anne/SkillReporter$^{(R)}$ in case of the basic CPR knowledge. Four times of measures were done in shortly after practicing CPR, 4 weeks after the education, 8 weeks after the education, and 12 weeks after the education. By using SPSS/PC+ (version 12.0), the researcher analyzed the collected data based on frequency, percentage, repeated measurement, ANOVA (analysis of variance), and sidak (multiple comparison - sidak). Results : 1) The confidence of people in the control group in terms of practicing CPR showed a statistically meaningful difference (t = 10.230, p = .000) before/after CPR education. Therefore, hypothesis No.1-1 was accepted. 2) The educational necessity of people in the control group showed no statistically meaningful difference (t = -1.695, p = 0.105) before/after CPR education. Therefore, hypothesis No.1-2 was rejected. 3) The knowledge points of people in the control group showed a statistically meaningful difference (t = -7.731, p = .000) before/after CPR education. Therefore, hypothesis No.2 was accepted. 4) The confidence of people in the control group in terms of practicing CRP showed no meaningful difference (F = 2.789, p = 0.072) as time passed. Therefore, hypothesis No.3 was rejected. 5) The knowledge of people in the control group showed a meaningful difference (F = 9.090, p = .000) as time passed. Therefore, hypothesis No.4 was accepted. 6) The capability of people in the control group in terms of practicing CPR showed a statistically meaningful difference (F = 42.795, p = .000) as time passed. Therefore, hypothesis No.5 was accepted. 7) The precision level of CPR skill of people in the control group showed a statistically meaningful difference (F = 25.198, p = .000) as time passed. Therefore, hypothesis No.6-1 was accepted. 8) The precision level of chest compression skill of people in the control group showed a statistically meaningful difference (F = 5.188, p = .003). Therefore, hypothesis No.6-2 was accepted. Conclusion : In a nutshell, CPR education for the 4th and 5th graders of elementary schools had an influence on their confidence in practicing CPR and on their knowledge. This study showed that as time passed. the educational effect declined in terms of knowledge point, capability of practicing CPR, and the precision level of CRP skill. The results of the study could be postulated into the fact that re-education within 8 weeks after the first education was essential to retaining the educational effect. Therefore, we need to vitalize the CPR education for elementary school students repeatedly on a regular basis in order to continue the educational effect after they were grown-ups and to make them play their roles as a first aider.

• Radiation Oncology Journal
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• v.23 no.3
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• pp.143-156
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• 2005

Background: The best dose-fractionation regimen of the definitive radiotherapy for cervix cancer remains to be clearly determined. It seems to be partially attributed to the complexity of the affecting factors and the lack of detailed information on external and intra-cavitary fractionation. To find optimal practice guidelines, our experiences of the combination of external beam radiotherapy (EBRT) and high-dose-rate intracavitary brachytherapy (HDR-ICBT) were reviewed with detailed information of the various treatment parameters obtained from a large cohort of women treated homogeneously at a single institute. Materials and Methods: The subjects were 743 cervical cancer patients (Stage IB 198, IIA 77, IIB 364, IIIA 7, IIIB 89 and IVA 8) treated by radiotherapy alone, between 1990 and 1996. A total external beam radiotherapy (EBRT) dose of $23.4\~59.4$ Gy (Median 45.0) was delivered to the whole pelvis. High-dose-rate intracavitary brachytherapy (HDR-IBT) was also peformed using various fractionation schemes. A Midline block (MLB) was initiated after the delivery of $14.4\~43.2$ Gy (Median 36.0) of EBRT in 495 patients, while In the other 248 patients EBRT could not be used due to slow tumor regression or the huge initial bulk of tumor. The point A, actual bladder & rectal doses were individually assessed in all patients. The biologically effective dose (BED) to the tumor ($\alpha/\beta$=10) and late-responding tissues ($\alpha/\beta$=3) for both EBRT and HDR-ICBT were calculated. The total BED values to point A, the actual bladder and rectal reference points were the summation of the EBRT and HDR-ICBT. In addition to all the details on dose-fractionation, the other factors (i.e. the overall treatment time, physicians preference) that can affect the schedule of the definitive radiotherapy were also thoroughly analyzed. The association between MD-BED $Gy_3$ and the risk of complication was assessed using serial multiple logistic regression models. The associations between R-BED $Gy_3$ and rectal complications and between V-BED $Gy_3$ and bladder complications were assessed using multiple logistic regression models after adjustment for age, stage, tumor size and treatment duration. Serial Coxs proportional hazard regression models were used to estimate the relative risks of recurrence due to MD-BED $Gy_{10}$, and the treatment duration. Results: The overall complication rate for RTOG Grades $1\~4$ toxicities was $33.1\%$. The 5-year actuarial pelvic control rate for ail 743 patients was $83\%$. The midline cumulative BED dose, which is the sum of external midline BED and HDR-ICBT point A BED, ranged from 62.0 to 121.9 $Gy_{10}$ (median 93.0) for tumors and from 93.6 to 187.3 $Gy_3$ (median 137.6) for late responding tissues. The median cumulative values of actual rectal (R-BED $Gy_3$) and bladder Point BED (V-BED $Gy_3$) were 118.7 $Gy_3$ (range $48.8\~265.2$) and 126.1 $Gy_3$ (range: $54.9\~267.5$), respectively. MD-BED $Gy_3$ showed a good correlation with rectal (p=0.003), but not with bladder complications (p=0.095). R-BED $Gy_3$ had a very strong association (p=<0.0001), and was more predictive of rectal complications than A-BED $Gy_3$. B-BED $Gy_3$ also showed significance in the prediction of bladder complications in a trend test (p=0.0298). No statistically significant dose-response relationship for pelvic control was observed. The Sandwich and Continuous techniques, which differ according to when the ICR was inserted during the EBRT and due to the physicians preference, showed no differences in the local control and complication rates; there were also no differences in the 3 vs. 5 Gy fraction size of HDR-ICBT. Conclusion: The main reasons optimal dose-fractionation guidelines are not easily established is due to the absence of a dose-response relationship for tumor control as a result of the high-dose gradient of HDR-ICBT, individual differences In tumor responses to radiation therapy and the complexity of affecting factors. Therefore, in our opinion, there is a necessity for individualized tailored therapy, along with general guidelines, in the definitive radiation treatment for cervix cancer. This study also demonstrated the strong predictive value of actual rectal and bladder reference dosing therefore, vaginal gauze packing might be very Important. To maintain the BED dose to less than the threshold resulting in complication, early midline shielding, the HDR-ICBT total dose and fractional dose reduction should be considered.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.19 no.3 s.31
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• pp.134-145
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• 2006

Objective : This study was carried out to investigate what type of assumption and conditions are needed for the application of various statistical techniques such as descriptive statistics, t-test, analysis of variance, correlation analysis, regression analysis and chi-square test and to evaluate that they are used correctly in the research process. Methods : One more methods of statistical analysis were used in 91 papers among 162 papers selected from the journal of Korean oriental medical Ophthalmology & Otolaryngology & Dermatology from April 2003 to December 2005. So we analysed the type of statistical analysis method in 91 papers(clinical and experimental study) and assessed the their validity of statistical techniques by the check list consisting of 34 items(3 items for validity assessment of descriptive statistics, 6 items for t-test, 7 items for analysis of variance, correlation analysis and regression analysis, respectively, 4 items for chi-square test) Results : 1. The type of 65(40%) cases is experimental trial, the type of 55(34%) cases is case report, the type of 26(16%) cases is clinical trial and the type of 16(10%) cases is review, in 91 papers using statistical techniques among 162 papers selected from the journal of Korean oriental medical Ophthalmology & Otolaryngology & Dermatol-ogy from April 2003 to December 2005. 2. One more methods of statistical analysis were used in the experimental and clinical study. When we classified 125 units using statistical analysis methods in 91 papers according to statistical techniques such as descriptive statistics, t-test, analysis of variance, correlation analysis, regression analysis and chi-square test, the number of independent sample t-test is 33(26%), the number of only descriptive statistics is 28(22%), the number of independent sample t-test is 33(26%), the number of only descriptive statistics is 28(22%), the number of one way ANOVA is 15(12%), the number of non-parametric test 10(8%). 3. After carrying out one way ANOVA, the number of using multiple comparison methods is 15(Scheffe:6(26%), Duncan:4(17%), Dunnett:3(13%), Tukey:2(9%)) out of 23 (total case carrying out one way ANOVA). 8(35%) out of 23 did not enforce multiple comparison methods after carrying out one way ANOVA. 4. From the assessment of validity about 63 cases using statistical techniques(except descriptive statistics), 5(8%) cases are proper, the other 58(92%) are improper, so we recognized a serious misuse of statistical application in our journal. 5. The number of case below 10 sample size in experimental and clinical study(except descriptive statistics) is 31(34%) and frequent. Also the number of case containing no mention of sample size is 41(45%, including culture study). 6. For example of statistical error, there are wrong choice of statistical technique, lack of check on standard assumption(such as standard distribution, equivariance, independence), and so on. Conclusions : We investigated the validity of statistical analysis methods in our journal by check list consisting of 34 items and suggested correct statistical analysis methods. We should practice the spread of education about statistical analysis methods and precis application, enhance objectivity and reliability of our thesis and further correspond with purpose of scientific study.

• The Journal of Internal Korean Medicine
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• v.44 no.3
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• pp.439-454
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• 2023

Objectives: As Korea transitions into an aging society, the incidence of cerebrovascular disease is expected to increase. Herbal medicine is commonly used in Oriental medicine to treat cerebrovascular disease. However, there is insufficient clinical evidence to actively support the safety of herbal medicine in clinical practice. Therefore, the aim of this study was to determine the toxicity and safety of four herbal medicines (Cheongsimyeonja-tang, Dodam-tang, Hyeolbuchukso-tang, and Boshiniknai-tang) in patients with cerebrovascular disease. Methods: This study used electronic medical records to analyze patients admitted to an oriental medicine hospital from April 1, 2017, to December 31, 2020. Liver and renal function values at the time of admission and discharge were compared. Results: A total of 25 patients were included in this study. We found no significant differences in various variables, such as complete blood count, liver-renal function test, and urine, before and after the administration of the four herbal medicines. Additionally, no significant adverse events related to herbal medicine were observed. Conclusions: This study confirmed the safety of the four herbal medicines in patients with cerebrovascular disease who were hospitalized in a single Oriental medicine hospital.

• The Journal of Korean Society for Radiation Therapy
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• v.12 no.1
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• pp.91-104
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• 2000

Recently linear accelerator in radiation therapy in asymmetric field has been easily used since the improvement and capability of asymmetrical field adjustment attached to the machine. It has been thought there have been some significant errors in dose calculation when asymmetrical radiation fields have been utilized in practice of radiation treatments if the fundamental data for dose calculation have been measured in symmetrical standard fields. This study investigated how much the measured data of dose distributions and their isodose curves are different between in asymmetrical and symmetrical standard fields, and how much there difference affect the error in dose calculation in conventional method measured in symmetrical standard field. The distributions of radiation dose were measured by photon diode detector in the water phantom (RFA-300P, Scanditronix, Sweden) as tissue equivalent material on utilization of 6 MV linear accelerator with source surface distance (SSD) 1000 mm. The photon diode detector has the velocity of 1 mm per second from water surface to 250 mm depth in the field size of $40mm{\times}40mm\;to\;250mm{\times}250mm\;symmetric\;field\;and\;40mm{\times}20mm\;to\;250mm{\times}125mm$ asymmetrical fields. The measurements of percent depth dose (PDD) and subsequent plotting of their isodose curves were performed from water surface to 250mm dmm from Y-center axis in $100mm{\times}50mm$ field in order to absence the variability of depth dose according to increasing field sizes and their affects to plotted isodose curves. The difference of PDD between symmetric and asymmetric field was maximum $4.1\%\;decrease\;in\;40mm{\times}20mm\;field,\;maximum\;6.6\%\;decrease\;in\;100mm{\times}50mm\;and\;maximum\;10.2\%\;decrease\;200mm{\times}100mm$, the larger decrease difference of PDD as the greater field size and as greater the depth, The difference of PDD between asymmetrical field and equivalent square field showed maximum $2.4\%\;decrease\;in\;60mm{\times}30mm\;field,\;maximum\;4.8\%\;decrease\;in\;150mm{\times}75mm\;and\;maximum\;6.1\%\;decrease\;in\;250mm{\times}125mm$, and the larger decreased differenced PDD as the greater field size and as greater the depth, these differences of PDD were out of $5\%$ of dose calculation as defined by international Commission on radiation unit and Measurements(ICRU). In the dose distribution of asymmetrical field (half beam) the plotted isodose curves were observed to have deviations by decreased PDD as greater as the blocking of the beam moved closer to the central axis, and as the asymmetrical field increased by moving the block 10 mm keeping away from the central axis, the PDD increased and plotted isodose curves were gradually more flattened, due to reduced amount of the primary beam and the fraction of low energy soft radiations by passing thougepth in asymmetrical field by moving independent jaw each 10 h beam flattening filter. As asymmetrical radiation field as half beam radiation technique is used, the radiation dosimetry calculated in utilizing the fundamental data which measured in standard symmetrical field should be converted on bases of nearly measured data in asymmetrical field, measured beam data flies of various asymmetrical field in various energy and be necessary in each institution.

• Journal of Korean Academy of Nursing
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• v.10 no.1
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• pp.41-55
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• 1980

The medical care insurance system, being put into practice nearly for three years, seem to have brought about some considerable problems as serious for the government as to consider a revision of that system. As one of the most serious problems of present system, the treatment cost of insurance patients is so remarkably low in comparison with than of non-insurance cases that normal operation of hospitals is threatened and care services of low quality are induced. The researcher carried out this survey to analyze and bring to light several aspects of treatment cost of non-insurance patients as a material for a re-assessment of the cost of insurance cases which shows a a considerable difference in amount at the standpoint of hospitals with than of non-insurance cases and further, hoping the significant blind spot of present insurance system(that is, the absence of regulations' for cost assessment by patterns or types of health care treatment) will be mended in near future. The survey was carried out with the treatment invoice sheets of total 902 in-hospital Patients of a general hospital in Seoul during the period of the 2 nd quarter of the year(1979). Among total 902 patients, 694 cases were used for analysis, because those disease or syndromes shared by less than 10% of the patients were put aside before procession. The data were analyzed by kinds or types of diseases, demographic characteristics of patients, hospitalization patterns, types of nursing treatment, etc. The result of analysis was as follows 1. Among all the non-insurance cases, those who received one or more kinds of nursing treatment mounted up to 96. 7 ％. The invoice issue frequency per person was 7.2 times, while that frequency per day for a person was 0.8, : the treatment cosr per person was ￦22,650 while its daily average was ￦2,430, due to the average 9.3 in-hospital days per person. 2. As to the nursing treatment types by the demographic characteristics of patients and hospitalization patterns. a. The unit cost female patients was generally more expensive them that of males, and independent nursing service was more given than other types of treatment. As to age, higher age groups received independent nursing service most, while the youngest group received instrumental and integrated nursing services. b. As to room grade, the unit cost of I.C.U. cases was the highest : and the cast of private room patients was higher than that of public room patients. By in-hospital days, the curve of function showed L. type : that is, the longer stay, the lower function. 3. State of treatment types by kinds of disease were ; a. Dependent nursing service showed comparatively high availability in surgical and neurologic disease and independent nursing service was most received by medical, obstetrical and urological patients, while instrumental and integrated services were most available for respiratory disease and obstetrical and neurologic diseases next. b. The invoice issue frequency per day for a patient was highest in obstetrical disease 3.8 times, and the unit cost(per one invoice sheet) was also highest in obstertrical disease(￦10,880) and next in neurologic cases(￦ 4,690 ). 4. As to the pertained departments. a. Cost amount per person was highest in department of Psychiatries daily cost was highest in obstetrical cases : while the invoice issue frequency was highest in obstetrics and next in pediatrics. b. In departments in need of surgical operation, dependent nursing care was highly availabl : while in internal medicine and obstetrics, independent service was higher. Psychiatrics showed the highest the of integrate nursing while pediatrics and obstetrics higher of instrumental services. The variation co-efficien of treatment cost came out to be relatively in high in special surgery, opthalmology and internal medicine. 5. State of treatment cost by types of nursing behavior was. a. The average frequency of invoice issue was 3.5 (times). Among the type four types of treatment, instrumetal service (4.3) and independent nursing behavior(3.9) showed higher frequency than average respectively. But as to unit cost (per invoice). dependent (￦5,200) and integrated (￦5,340) nursing care services were higher than average and considerably higher than the other two types. b. In repect patient distribution. independent nursing behavior(80.3% ) was the highest and depend ent nursing (31.7% ) the lowest. The variation co-efficient of treatment cost appeared highest in dependent nursing be havior as a whole, and among that, doctor's diagnosis showed the highest coefficient value (100.7). In conclusion, the variaty of treatment cost(treatment itself ) by various characteristics and treatment types pro- that treatment various sort of patients and treatment cost of various types of nursing behavior cannot be uniform. Therefore, to attain the equalization of health care service and its cost both for insurant and non-insurant patients, a more specific provision for assessment of cost should be added to the present medical care insurance system and, in addition, the cost of nursing treatment is desired to be inserted into the treatment invoice.