• Tuberculosis and Respiratory Diseases
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• v.46 no.3
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• pp.350-362
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• 1999

Background: Acute Respiratory failure which is developed after extubation in the weaning process from mechanical ventilation is an important cause of weaning failure. Once it was developed, endotracheal reintubation has been done for respiratory support. Noninvasive Positive Pressure Ventilation (NIPPV) has been used in the management of acute or chronic respiratory failure, as an alternative to endotracheal intubation, using via nasal or facial mask. In this study, we evaluated the usefulness of NIPPV as an alternative method of reintubation in patients who developed acute respiratory failure after extubation. Method: We retrospectively analyzed thirty one patients(eighteen males and thirteen females, mean ages $63\pm13.2$ years) who were developed acute respiratory failure within forty eight hours after extubation, or were extubated unintentionally at medical intensive care unit(MICU) of Asan Medical Center. NIPPV was applied to the patients. Ventilatory mode of NIPPV, level of ventilatory support and inspiratory oxygen concentration were adjusted according to the patient condition and results of blood gas analysis by the attending doctors at MICU. NIPPV was completely weaned when the patients maintained stable clinical condition under 8 $cmH_2O$ of pressure support level. Weaning success was defined as maintenance of stable spontaneous breathing more than forty eight hours after discontinuation of NIPPV. Respiratory rate, heart rate, arterial blood gas analysis, level of pressure support, and level of PEEP were monitored just before extubation, at thirty minutes, six hours, twenty four hours after initiation of NIPPV. They were also measured at just before weaning from NIPPV in success group, and just before reintubation in failure group. Results: NIPPV was successfully applied to thirty-one patients of thirty-two trials and one patient could not tolerated NIPPV longer than thirty minutes. Endotracheal reintubation was successfully obviated in fourteen patients (45%) among them. There was no difference in age, sex, APACHE III score on admission at MICU, duration of intubation, interval from extubation to initiation of NIPPV, baseline heart rate, respiratory rate, arterial blood gas, and $PaO_2/FiO_2$ between the success and the failure group. Heart rate and respiration rate were significantly decreased with increase $SaO_2$ after thirty minutes of NIPPV in both groups(p<0.05). However, in the patients of failure group, heart rate and respiratory rate were increased again with decrease in $SaO_2$ leading to endotracheal reintubation. The success rate of NIPPV treatment was significantly higher in the patients with COPD compared to other diseases(62% vs 39%) (p=0.007). The causes of failure were deterioration of arterial blood gas without aggravation of underlying disease(n=9), aggravation of undelying disease(n=5), mask intolerance(n=2), and retained airway secretion(n=l). Conclusion: NIPPV would be a useful therapeutic alternative which can avoid reintubation in patient who developed acute respiratory failure after extubation.

• Journal of Korean society of Dental Hygiene
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• v.16 no.2
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• pp.233-240
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• 2016

Objectives: The aim of this study was to evaluate the oral health status and behavior in Korean diabetic adults. Methods: The study subjects were 11,840 adults who participated in the fifth Korea National Health and Nutrition Examination Survey(2010-2012). Diabetic status was defined by doctors and fasting blood sugar(FBS) level. Oral health status was assessed by decayed-missing-filled teeth(DMFT), community periodontal index(CPI), periodontal disease, denture needs, limitation of oral function, and chewing difficulty. The oral health behavior was evaluated by oral examination within a year, brushing times a day, and use of auxiliary oral product. The data were analyzed by descriptive analysis, chi-square tests and multiple logistic regression analyses. Results: The prevalence rate of diabetes mellitus diagnosed by doctor and FBS was 8.3% and 10.2%, respectively. The prevalence rate of periodontitis was 25.4%. The proportions of $DMFT{\geq}20$, $CPI{\geq}3$, periodontal disease, denture needs, oral function limitation and chewing difficulty in the confirmed diabetic group by doctor were significantly higher than those of the non-diabetic group(p<0.05). In multiple logistic regression analysis, the adjusted odds ratio(aOR) for periodontal disease(aOR=1.73, 95% CI=1.41-2.12), presence of denture needs(aOR=1.40, 95% CI=1.06-1.84), limited oral function(aOR=1.43, 95% CI=1.15-1.78) and chewing difficulty(aOR=1.41 95% CI=1.13-1.77) in diabetic subjects were significantly higher than those of the non-diabetic subjects. There were similar associations between diabetes defined with FBS and oral health. In oral health behavior, diabetic subjects had significantly lower odds ratios for oral examination(aOR=0.76, 95% CI=0.60-0.98), brushing time ${\geq}2$ times(aOR=0.73, 95% CI=0.57-0.93), and auxiliary oral products(aOR=0.74, 95% CI=0.59-0.94). Conclusions: There was a significant relationship between oral health status and behavior in Korean diabetic adults. Further study is needed to evaluate the underlying mechanisms between diabetes mellitus and oral health status.

• Journal of agricultural medicine and community health
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• v.45 no.4
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• pp.194-207
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• 2020

Purpose: The purpose of this study is to develop and evaluate the curriculum, that was the continuing professional development program, for cultivating physician's competencies in public health. Methods: This study was conducted through in-depth interview and survey in the frame of ADDIE, from 2 May to 30 June in 2019. Participants were 7 physicians by in-depth interview and Respondents were 46 physicians worked in public health by survey. Results: The results were analyzed and described in the frame of ADDIE model. In the stage of Analysis, physician's core competencies in public health was presented to practical education, management of organization and labor force, communication with community, and director' role of public health center in the community as core competencies by in-depth interview. The skill - knowledge-attitude competencies were highest in order in the survey for placing priority (by Borich score) of 29 core competencies. In design stage, the educational objective of curriculum was established, that is to develop the competencies of knowledge, skills, and attitude needed for physician of public health in 21th century. In development and implementation stage, it is important to decide to lecturer, to get in advance educational materials to do the maintenance and management of curriculum. In the stage of evaluation, the educational satisfaction was high on the whole and educational effect was statistically significant. Conclusions: This study was an initial study of Korean doctors, and it aims to pursue competency-based education as a continuing professional development (CPD) beyond continuing medical education (CME) including knowledge, skills, and attitudes.

• The Korean Society of Law and Medicine
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• v.7 no.2
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• pp.9-74
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• 2006

Due to the awareness of their rights for medical liability and the advancement of legal principles, it becomes also not hard to find those who seek damages against hospitals, doctors and nurses for the suicide committed under the protection of psychiatric institute in Korea these days. Judgements on these kinds of cases are not enough yet, so that it may be too early to try to find principles used in these cases, however it is hardly wrong to read following things from above cases. That is, to gain the case, plaintiffs should show (1) there exists an obligation of "due care"(there is a special relation between patients and hospitals), (2) the duty is violated on the basis of the applicable standard of care, (3) whatever injures or damages are sustained are proximately caused by the breach of duty and (4) the plaintiff suffers compensable damages. To specific, whether a psychiatric institute was liable for wrong death or not depends upon the patients conditions, circumstances and the extent of the danger the patients poses to himself or herself; in short, the foreseeability of self-inflicted harm(the doctor should have or could reasonably have foreseen the patient's suicide and the doctor's negligence actually caused the suicide). In this context if a patient exhibit strong suicidal tendencies, constant observation should be required. Negligence has been found not exist, however, when a patient abruptly and unexpectedly dashes from an attendant and jumps out a window or otherwise attempts to injure himself or herself. And the standard of conduct that is required to meet the obligation of "due care" is based on what the "reasonable practitioner" would do in like circumstances. The standard is not one of excellence or superior practice; it only re quires that the physician exercise that degree of skill and care that would be expected of the average qualified practitioner practicing under like circumstances. Most of these principles have been established at cases of the U.S.A and Japan. In this article you can also find the legal organizations of medical liability and medical contacts on the suicide of patients who have psychiatric diseases under Korean negligence law.

• The Korean Society of Law and Medicine
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• v.21 no.1
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• pp.33-67
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• 2020

The hospitals that are owned by non-medical personnel result when non-medical personnel with resources conspire with newly graduated medical doctors who cannot afford the enormous amount of capital required at the beginning of the establishment of a medical institution. Such hospitals, though they may have met the external requirements as medical institutions, disrupt the medical market as it should be centered by medical personnels, In addition, such hospitals are causing a huge social problem as it is illegally receiving and reducing various benefits such as medical care benefits and subsidies from the government, resulting in a significant financial leak in the national health insurance. The illegality of the opening of a non-medical personnel hospital is so high that it nullifies the contractual arrangement for the establishment, imposes criminal penalties on all persons involved in the establishment under the Korean Medical Law, and imposes administrative sanctions on medical personnel. In case the hospital was aware of the illegality of its opening, but had applied to receive medical care benefits from the National Health Insurance Act and the Medical Care Act, such actions will result in the return of the benefits under the National Health Insurance Act and the Medical Care Assistance Act, subject to the penalty for the crime of fraud, and aggravated punishment for specific economic crimes based on the amount of gain, as well as civil liability for torts. In this study, we will examine the current status of the regulations on the non-medical personnel hospital and present the basis for future legislative directions by looking at the legal regulations and the attitude of the precedents.

• The Korean Society of Law and Medicine
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• v.22 no.2
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• pp.3-48
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• 2021

Among the major rulings handed down in 2020, there were cases involving anaphylaxis, which is timely as a side effect of coronavirus and flu vaccine. And as a rare case, a ruling was handed down that if medical treatment was done so unfaithfully beyond the limit of patience of ordinary people, it can be an independent illegal act and a cause of compensation for emotional distress. Also, there was a ruling in the appellate court that evaluated disability rate applying the Korean Academy of Medical Sciences Guides for the Evaluation of Permanent Impairment, not McBride system. And the supreme court made it clear that telemedicine is illegitimate. In relation to duty of explanation, it is in the process of adding detail criterion on the firm principles in the individual cases. In regard of medical records, there was a case that even when a medical record is strongly suspected to be tampered with, it is not considered to be an obstruction of proof. There were cases that resulted in different conclusion between the court of first instance and the appellate court rulings. Lastly, in the face of a growing number of cases in which doctors are sentenced to prison for malpractice, we reviewed a ruling that sentenced a doctor to prison.

• The Korean Society of Law and Medicine
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• v.22 no.2
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• pp.49-79
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• 2021

Due to defendant's wrongful act by implant surgery, plaintiff has been suffered serious damages to his face and teeth, and pain caused by establishing implanted teeth. Jeonju Appellate Court sentenced to pay future medical expenses and alimony to the plaintiff in compensation for breach of duty or torts. The ruling is designed to relieve the burden of proof because it is extremely difficult for non-experts to determine whether dentists violated their 'duty of care' or whether there was a causal relationship between damages to medial treatment. It was judged that if symptoms that contributed to the patient's significant outcome occurred during or after surgery, such symptoms could be presumed to have been caused by medical negligence if indirect facts were proven to be other than medical negligence. Originally, the shifting of burden of proof in Germany, has already been developed in medical malpractice case since 1940s. In order to guarantee the patients' right, §630h German Civil Code (BGB) - presumption of negligence in the realization of controllable risk- has been also legislated. BGH (Bundesgerichtshof) has been interested in ensuring that the principle of equality between patients and doctors. So, in this study, we wanted to refer to German precedent cases to analyzing Korean medical malpractice lawsuit. In particular, the decision could be significant in that it approaches closer to allows the shifting burden of proof in drastically growing dental malpractice cases. This is clearly confirmed in the judgment of the dentist's "fault" that "if indirect facts about the symptom or occurrence are proven to be cause other than medical negligence, such symptoms can be presumed to be due to medical negligence."

• The Korean Society of Law and Medicine
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• v.25 no.1
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• pp.193-222
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• 2024

From a global trend, discussions on the patient's death with dignity are gradually progressing from the issue of withdrawal of life-sustaining treatment to the issue of whether to allow assisted death and its requirements. Several states in the United States and Western European countries such as Canada, Belgium, and the Netherlands have institutionalized treatment to accelerate the time of death through the assistance of doctors. In France, after a long period of raising and reviewing issues, discussions on related legislation are taking place at a slower pace than in other European countries. In France, social discussions and legislative attempts on death with dignity have been actively conducted since the late 20th century. The Leonetti Act of 2005 prohibited the continuation of meaningless treatment against the will of patients, and after the Clay-Leonetti Act of 2016, it was legalized to administer intensive and continuous sedatives to patients until death. However, unlike many neighboring European countries, treatment that speeds up the time of death itself is still prohibited in France, even if the patient wants. As the existential and universal question of whether to allow dying patients to die painlessly with the help of a doctor has recently emerged as an important issue, a number of lawmakers have submitted legislation to legalize assisted death. This paper examines the legislative process developed in relation to patients' rights to dignified death in France, and compares and reviews French legislation that attempts to legalize assisted death with the amendment to the Korean Life-Sustaining Treatment Act.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.9 no.2
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• pp.233-241
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• 2006

Purpose: This study was carried out to investigate the awareness of the weaning of food using questionnaires, and the relationship with the weight gain in young infants. Methods: From September 2005 to December 2005, we performed a survey on 141 guardians of young infants aged from 6 to 18 months, who visited the pediatric out-patient department at Dongguk University Medical Center. We calculated the total score for each responder from ten questions on the weaning of food and assessed the body weight percentile of each of the young infants. Results: The most commonly reported information source for weaning food was 'the friends around' by 62 respondents (44.0%); 54 (38.3%) responded that the definition of weaning food was the preparatory step before starting a solid diet. Most used a spoon (90.8%) to feed when weaning food with a thin gruel of rice (78.7%). The time for weaning of food was before breast or infant formula feeding (55.3%). Addition of cow's milk was around 12 months (77.3%). The mean score was 6.21; however this did not show a statistically significant correlation with weight gain in young infants. Conclusion: The overall awareness of weaning of food has improved; however, information from doctors has decreased. Although the relationship between the awareness of weaning of food and the growth of young infants was not statistically significant, further studies on weaning of food, with larger and controlled sample sizes may provide important information.

• Journal of Hospice and Palliative Care
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• v.5 no.1
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• pp.24-30
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• 2002

Background : Pain is one of the most feared consequences of cancer. $65{\sim}85%$ of cancer patients experienced severe pain, and sometimes high dose morphine is used to these patients. But many doctors still have 'opioid-phobia' and hesitate to use high dose morphine. We investigated the morphine therapy in terminal cancer patients during the last 1 week to death, and found any differences according to the morphine dosage. Methods : 93 patients admitted to National Health Insurance Corporation Ilsan Hospital, department of family medicine for hospice care between September 2000 and the end of October 2001 and lived more than 1 week entered in the study. We investigated the demographic data, laboratory tests and sufficient dosage of morphine for pain control. According to the calculated dosage by OME(oral morphine equivalent), patients were divided into low dosage group (${\leq}150mg/day$) and high dosage group (>150 mg/day). The chi-squared test were used to evaluate the influence of age, gender, tumor sites, metastasis and adverse effects of morphine. Results : Mean age was $65.0{\pm}13.1year$ in low dosage group and $59.9{\pm}11.6year$ in high dosage group. 32 men (50.0%) and 32 women (50.0%) were included in low dosage group and 15 men (51.7%) and 14 women (48.3%) in high dosage group. Stomach was the most frequent tumor site and lung was the next. Metastasis were found 58 (90.6%) in low dosage group and 28 (96.6%) in high dosage group. In other palliative radiotherapy and adverse effects, there were no differences in both group. Conclusion : During the last 1 week to death in cancer patients, there were no difference according to the morphine dosage. So we don't have to have 'opioid-phobia' in treating the terminal cancer patients.