• Journal of Korean Academy of Fundamentals of Nursing
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• v.4 no.2
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• pp.245-265
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• 1997

The purpose of this study was to promote the effectiveness in managing disease or injury, by examining the length of stay in hospital according to characteristics concerned before and after operation, and by serving as a basis for reducing that length. As a result of investigating the length of stay in hospital according to inpatient's personal characteristics, clinical features and other characteristics concerned, the following characteristics appeared significant. The characteristics that showed a significant difference about the length of stay in hospital before and after operation were the age and the fact whether one was married or not among inpatient's personal characteristics. The significant ones among clinical features were the route to be taken to hospital, the form of insurance, the experience of re-hospitalization, whether another disease coexisted, the experiment of changing department, whether a diagnosis was determined by consultation, whether an intensive care unit was used, whether re-operation was performed, the total number of case of the experience of re-hospitalization, inpatient who were again sent to hospital under the same diagnosis was not included in the investigation, which was pointed out as a limit in this study. The significant ones among other characteristics concerned were the date and season when the patients were taken to hospital and the doctor in attendance. The doctor in attendance appeared to give a significant impact on the length of stay in hospital before operation, but no significant difference was noted in the mean among the doctors in attendance. And those characteristics were not found regularly among the selected departments. As stated above, one way to reduce the length of stay In hospital was to diminish the length of stay in hospital before operation. The term of hospitalization before operation shall be reduced by grasping the factors that affected that length before operation and by conducting examination as many as possible in the out-patient department. Also, the efforts should be put on that length after operation. The management of hospital seemed to be successfully carried out if those factors affected that length were effectively controlled.

• Korean Journal of Adult Nursing
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• v.13 no.1
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• pp.123-135
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• 2001

The purpose of this study is to analyze the structural pattern of nurses' pain management with patients who experience pain. As a research method, the Q methodology, which is useful for an objective view of a highly abstract concept, was applied. The data collecting activity of this study was from August, 21st, 2000 to November, 24th 2000. The Q-population, the previous thesis and a literature review were done. Questions about pain management by the nurse on the patients, caregivers, nursing students, doctors, nurses, and others were asked in documentary work and in-depth interviews. In all, 223 units of the Q-population were formed, and the last 35 units of the Q-population were extracted. The data on the P-sample was collected from 41 nurses who worked in the medical and surgical units of a hospital that belonges to C university in Seoul. The research results were constituted in 3 types. Type I was the 'pattern of judging by objectivity'. The statement on which most of the people highly agreed for those patterns was shown by 'If patients said that they are suffering from pain, we sufficiently performed an assessment about the etiology, location, duration and degree'. For type I, the same pain was found in different locations according to the patients, so the etiology of the pain should be identified first place. Since ways of coping are different according to pain etiology, it was thought that it is important to assess sufficiently the pain etiology, location, duration, and degree. Therefore, when patients complain of pain, the pain etiology should be identified and assessed; according to the result, pain management should be performed systematically. Type II was the 'pattern of accepting by subjectivity'. The statement on which most of the people highly agreed for those patterns was shown as 'If patients said that they are suffering from pain, the medical treatment should be performed rapidly and speedily.' For type II, when the patient complains of pain, treatment should be performed quickly in order to prevent the condition getting worse, and it is thought that activity is a reasonable duty. Further, by trying to show empathy after pain is admitted and by understanding and coping rapidly with the pain of patients, an attitude which matched the altruistic morals of nurses is being shown. Type III was the 'pattern of worrying about', and the statement on which most of the people highly agreed for those patterns was shown is 'When there is a pain, to help patients to tolerate the pain to the highest degree.' In type III, the pain is a subjective expression, so there is a difference according to every individual. Therefore, actually if there is no measurement of pain, it could be exaggerated so nurses should help patients to tolerate it to the utmost. Even if there is a way to remove pain without an analgesic drug, nurses were reluctant to perform pain management as they possibly could. Through these research results, pain management of nurses was classified in 3 types, and structural characteristics in each type were discovered. Based upon the characteristics according to the type, an individualized pain management intervention strategy should be established and the follow up work performed.

• The Korean Society of Law and Medicine
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• v.12 no.1
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• pp.177-225
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• 2011

Verdicts related to major medical litigation given by the Seoul Central District Court, the Seoul High Court and the Supreme Court in 2010 were analyzed. It's shown that in cases of the medical negligence regarding the occurrence of neonatal cerebral palsy, the plaintiff claims were dismissed using criteria proposed by associations of Obstetrics and Gynecology and Pediatrics in US, and thereof the burden of plaintiffs to prove the medical negligence has increased. In addition, in case of that the expected survival period of infants gets longer, payments for treatment and nursing after survival period determined by judges are made and it was judged to compensate it as a periodical indemnity. In case for the explanation obligation the most frequently mentioned in the medical litigation, in addition to cases of invoking the existing theory of explanation obligation, verdicts to mention the instructions of theory regarding instruction explanation obligation and the possibility of compensation for damages on property are given. Particularly, in cases for a liability of reparation by exaggerating the effects and not disclosing the risks related to treatment with stem cells, even if the treatment not approved by Food and Drug Administration is in violation of the Pharmaceutical Affairs Law, it's not illegal as violation in Pharmaceutical Affairs Law itself. But there is a certain verdict to present the possibility of an extension of the theory of explanation obligation by acknowledging the liability of reparation caused by illegal acts with no explanations of effects and risks of treatment with stem cell by doctors and pharmaceutical companies. In an incident in which a mental patient fell and died through the opened door of the roof at the hospital, a liability of reparation was acknowledged due to defects in structure installation management and this verdict drew an attention since the overall management responsibility about patients including structures was acknowledged to the hospital besides the obligations on medical practice. In case of the verdict without giving the opportunity to state the opinion with respect to the main legal issues, the responsibility of the court was emphasized since the court did not fulfill the explanation obligations. There were some cases in which payments for nursing and caring to a patient in vegetative state during the plastic surgery was admitted. However, in dental-related incidents, the proportion of cases in which plaintiff won was low since the difficulty of proving may be reflected. In the area of administrative litigation, unlike the existing position regarding arbitrary medical charge cover collected from patients in hospital, the verdict to admit the legitimacy of collection of medical treatment was given and attracted the attention of people. Verdict in which the expression related to medical advertisement was not exaggerated disposed the original verdict and pointed out the problem of excessive regulations on medical advertisement. The effort to analyze the trend of verdicts of court through reviewing the decisions and to organize should be continued, but the full decision should be disclosed as a base, and people and systems to enable the all time monitoring should be prepared.

• The Korean Society of Law and Medicine
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• v.22 no.2
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• pp.81-109
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• 2021

This paper review about the relationship between the prohibition against medical refusal and the principle of private autonomy in medical contracts. The obligation to this Prohibition in Medical Law does not restrict the liberty of contracting a medical contract. On the other hand, the prohibition limits the freedom to terminate medical contracts. Medical contracts can be terminated if the trust between doctors and patients is vanished. However certain restrictions should be placed on termination of the medical contract, because termination of the contract should not be detrimental to patients' health. According to the current medical law the medical contract is to be enforced in principle and can be revoked only with justifiable reason. At the Civil Code on Medical Contracts the freedom to terminate the medical contract is permitted, but this paper suggests the restrictions of the revocation under certain conditions. The Criminal Punishment Regulations against medical refusal should be removed. Refusal the provide medical service should be regulated by administrative sanctions under the National Health Insurance Act's obligation.

• The Korean Society of Law and Medicine
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• v.23 no.2
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• pp.67-96
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• 2022

"Aid in Dying" means that when a decision-making patient suffers from an incurable disease, a drug that can speed up death is prescribed by a doctor and used to lead to death. Since the suspension of life-sustaining treatment was institutionalized based on human dignity and patient autonomy, the question of whether assisted death can be legally justified in relation to the right to receive medical help to shorten one's life to die with dignity has recently been actively discussed. In Korea, since the suspension of life-sustaining treatment was institutionalized by the enactment of the Life-sustaining Treatment Decision Act in 2016, an amendment to the Life-sustaining Treatment Act was recently proposed to legalize Aid in Dying. The global trend is that human "Right to Die" is discussed in the division of life and death, from the suspension of life-sustaining treatment to assisted death, and again in the order of euthanasia. In this paper, we started discussing dignified death and institutionalized patients' right to self-determination, looked at the controversy in the United States, which legislated assisted death in many states since the 2000s, and analyzed the main contents of California's End of Life Option Act and the data after enforcement. The strict requirements for Aid in Dying, such as voluntary confirmation of patients' intentions and doctors' obligation to provide information, and the results of California's Aid in dying system, composed of relatively diverse races, were reviewed.

• The Korean Society of Law and Medicine
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• v.25 no.1
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• pp.117-148
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• 2024

This study attempted to examine the ambiguity of work from the legal, social perspective, and actual performance differences in domestic nursing work compared to foreign countries. We compared the historical background of nurses' expanded work through overseas situations, compare and analyze the legal basis for nurses' qualifications and work in each country, and what changes they have undergone to clarify their work. Through this, we would like to consider the current status of the absence of a legal basis for professional work of domestic nurses and seek a direction for the development of domestic medical care. This study applied the case study method as one of the comparative institutional research methods. Among OECD countries, developed countries such as the United States, Australia, and Japan were selected and compared among developed countries that are solving medical gaps using nurses. In the United States, Australia, Japan, and Korea, nurses' professional work has been created by changes in the medical environment due to an aging society, chronic diseases, and lack of doctors. We looked at the start of their professional work, the establishment of legal grounds, the timing of qualification recognition, the development of the credential system and scope of work. Foreign countries have legal grounds for their roles and tasks, but domestic countries are before legislation. The country still has not narrowed the gap between the position of the legislative and judicial branches and actual work, and the current status of the domestic healthcare system has been measured through overseas development cases.

• Korean Journal of Radiology
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• v.25 no.5
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• pp.414-425
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• 2024

Objective: This study aims to explore the opinions on the insurance coverage of artificial intelligence (AI), as categorized based on the distinct value elements offered by AI, with a specific focus on patient-centered outcomes (PCOs). PCOs are distinguished from traditional clinical outcomes and focus on patient-reported experiences and values such as quality of life, functionality, well-being, physical or emotional status, and convenience. Materials and Methods: We classified the value elements provided by AI into four dimensions: clinical outcomes, economic aspects, organizational aspects, and non-clinical PCOs. The survey comprised three sections: 1) experiences with PCOs in evaluating AI, 2) opinions on the coverage of AI by the National Health Insurance of the Republic of Korea when AI demonstrated benefits across the four value elements, and 3) respondent characteristics. The opinions regarding AI insurance coverage were assessed dichotomously and semi-quantitatively: non-approval (0) vs. approval (on a 1-10 weight scale, with 10 indicating the strongest approval). The survey was conducted from July 4 to 26, 2023, using a web-based method. Responses to PCOs and other value elements were compared. Results: Among 200 respondents, 44 (22%) were patients/patient representatives, 64 (32%) were industry/developers, 60 (30%) were medical practitioners/doctors, and 32 (16%) were government health personnel. The level of experience with PCOs regarding AI was low, with only 7% (14/200) having direct experience and 10% (20/200) having any experience (either direct or indirect). The approval rate for insurance coverage for PCOs was 74% (148/200), significantly lower than the corresponding rates for other value elements (82.5%-93.5%; P ≤ 0.034). The approval strength was significantly lower for PCOs, with a mean weight ± standard deviation of 5.1 ± 3.5, compared to other value elements (P ≤ 0.036). Conclusion: There is currently limited demand for insurance coverage for AI that demonstrates benefits in terms of non-clinical PCOs.

• Herbal Formula Science
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• v.15 no.1
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• pp.49-105
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• 2007

Objectives : Select and analyze the case record of dyspnea and wheezing asthma recorded in Xu Ming Yi Lei An that is the most abundant and wide in contents in existing case records that are systematic, comprehending relatively modern Traditional Chinese Medicine to secure more deep and objective basis of Traditional Chinese Medicine approach for dyspnea and wheezing asthma to analyze and review possibility for clinical application in this study. Methods: The study was conducted with the case records of dyspnea and wheezing asthma in whole Xu Ming Yi Lei An. Pattern identify and classify selected case records and again classified with deficiency syndrome and excess syndrome. Also analyzed prescriptions and herbs used in the case records. Nature of herbs and properties and flavors that were used in the case records were classified and frequency of each nature of herbs were analyzed. Applicable case records were interpreted and suggested prescriptions, pulse feelings, pattern classification were analyzed and described. Results : Among the 5254 case records stated on the complete collection, it is researched that there are 63 case records for the symptom complex of dyspnea as 1.2% of the whole case records, and the case records on the symptom complex of wheezing asthma are 14 as the 0.27% of the total examples. 63 case record examples related with symptom complex of dyspnea were pattern identified and classified. As a result, deficiency syndrome of the Kidney(33 %), deficiency syndrome of the Spleen(26.0%), Wind-Cold(12.3%), phlegm turbidity(12.3%), Heat in the Lung(8.2%), asthenia of the Lung(8.2%) were investigated as above order. 14 case record examples related with wheezing asthma were pattern identified and classified. As a result, phlegm-Heat(26.3%), upper excess and lower deficiency(26.3%), external affections Wind-Cold(15.8%), Dampness-phlegm(10.5%), Lung asthenia(10.5%), Cold phlegm(5.3%), mutual deficiency and detriment of Heart and Kidneys(5.3%) were investigated as above order. Symptom complex of dyspnea has 67.1% of deficiency syndrome, 32.9% of excess syndrome resulting more deficiency syndrome than excess syndrome. Symptom complex of wheezing asthma has 42.1 % of deficiency syndrome and 57.9% of excess syndrome resulting more excess syndrome than deficiency syndrome. In case of symptom complex of dyspnea prescription used in the case record, the order of frequency is as following. Palmijihwang-tang, Bojung-ikgitang, Yungmijihwang-tang, Ijintang, Sojaganggitang, Igongsan. In case of symptom complex of wheezing asthma prescription in the case record, Yungmijihwang-tang, Ohotang, Dodamtang were mostly used. Herbs used in case records of symptom complex of dyspnea are Ginseng Radix, Poria, Glycyrrhizae Radix, Aconiti Iateralis Preparata Radix, Atractylodis Macrocephalae Rhizoma, Dioscoreae Rhizoma, Angelicae Gigantis Radix, Rehmanniae Radix Preparat, Pinelliae Rhizoma, Zingiberis Rhizoma Recens are mostly used. Nature of herb properties used for symptom complex of dyspnea and symptom complex of wheezing asthma are herbs that are warm properties. When the symptom complex of dyspnea and the symptom complex of wheezing asthma were treated. if the patient felt tenderness at Pyesu, doctors conducted pricking blood around the opposite Pyesu or Sipseon acupoint. when the patient didn't have tenderness at Pyesu by soft press, pricking blood was performed both sidees, right and left Pyesu. In case of the treatment of symptom complex of dyspnea and symptom complex of wheezing asthma, when they got treatment, when the symptom complex of disease is severe, a doctor cauterized the opposite Pyesu while the other Pyesu felt tenderness, and decided how the above treatment is performed whether the degree of the symptom compolex of disease is severe or not. In case of the treatment of symptom complex of dyspnea and symptom complex of wheezing asthma, if the person felt tenderness at Pyesu and is caught by the Wind-Cold pathogen, slight acupuncture is treated at relevant Pyesu with Fire needling. When patient with symptom complex of dyspnea and symptom complex of wheezing asthma cannot hawk sputum up from the oral and laryngopharynx, suction method is treated. Conclusion : With this study, actual traditional and clinical pattern identification form and characteristics of symptom complex of dyspnea and symptom complex of wheezing asthma were recognized. Modern case report utilizing in clinical application need to be secured and an incurable disease asthma need to be diagnosed and improvement for treatments have to be searched through other case records.

• Journal of Hospice and Palliative Care
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• v.10 no.2
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• pp.78-84
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• 2007

Purpose: The prevalence of lung cancer is increasing continuously these days. We studied clinical characters of the terminal lung cancer patients who had died in hospice units and our study is the basic report for efficient hospice and palliative care to the lung cancer patients. Methods: We retrospectively reviewed the medical records of 129 terminal lung cancer patients who had died in Sam Anyang Hospice Unit from March 2003 to December 2006. The survival days during the hospice and palliative care were analyzed using Kaplan-Meier method of SPSS 13.0. Results: There were 93 males (72%) and 36 females (28%), and median age of patients was 68 years (range $37{\sim}93$). Eighty two patients (64%) took analgesics, the others 47 (36%) not. The most prevalent reason for admission was dyspnea (47 patients, 36%) and it was different from the terminally ill cancer patients being hospitalized because of pain. And the most common symptom was general weakness (103 patients, 80%). One hundred twenty of the paitents (93%) were administered opioid analgesics, and IV morphine shots were mostly used (103 patients, 80%). Sedation was used in 87 patients (67%), and midazolam was mostly used (68 patients, 53%). The median survival in hospice and palliative care was 35 days and the median hospitalization was 24 days. Conclusion: It is very important to manage dyspnea in terminal lung cancer patients. The length of hospice and palliative care for the terminal lung cancer patients is still short. Therefore continuous education and promotion of hospice and palliative care is needed for an effective care for the patients, their families and doctors.

• Journal of Hospice and Palliative Care
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• v.20 no.3
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• pp.167-172
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• 2017

End-stage liver disease (ESLD) is a terminal condition of cirrhosis which cannot be treated without liver transplantation. Thus, it is natural for patients to consider hospice/palliative care (HPC). Since the recent legislation of the Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life (Act No. 14013) in Korea, the practicality of this law has become an issue. The criteria for HPC should be defined with consideration to how the severity of each ESLD complication may vary by individual patients. Generally, patients qualify if they have an intractable condition despite aggressive treatment such as the hepatorenal syndrome, hepatic encephalopathy or variceal hemorrhage. However, the option of liver transplantation should be sufficiently discussed with patients and their families before making a decision on HPC. The evaluation of which ESLD patients should receive HPC should be based on a long-term doctor-patient relationship and sufficient objective data. Therefore, a multidisciplinary approach and mutual consultation among cirrhosis specialists and doctors with other expertise are essential to offer optimal and balanced treatments between liver-specific treatment and HPC. Discussed in this review are adequate criteria for HPC and special considerations for ESLD at the point of HPC.