• Korean Journal of Adult Nursing
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• v.12 no.1
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• pp.52-63
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• 2000

In Korea, most of the patients with chronic liver diseases have been using some kind of alternative therapies at home. however, the question is why do people turn to alternative therapy and how the patients are able to use the alternative therapies widely, though the effects have not been proven scientifically. Therefore, it is necessary to explore the process of the patients' experiences using the alternative therapies. The 16 participants were from internalmedical departments in hospital and the permission was received to participate in this study from the subjects. The data were collected with interviews and participants observations, analyzed by the grounded theory methodology of Strauss and Corbin(1990). With the analysis of the data, 15 categories were generated such as psychological pressures, barriers of role performances, distrusts of western medicine, blind obediences to the treatments, attitudes towards alternative therapies, supportive systems, obstacles to taking alternative therapies, financial burdens, collecting informations, pursuing alternative modalities, efforting diversities, analyzing by themselves, managing the body, accepting the disease, and ambivalence. The paradigm model was developed to identify the relationships of categories. The central phenomenon of the experiences of seeking alternative therapies was named jagi momdasrim. The central concept of jagi momdasrim is a mind-set to desire to wellness and to take more responsibility for one's own healing by pursuing alternate healing modalities rather than the western medical system. The process of jagi momdasrim evolved several stages such as seeking, finding, struggling, overcoming, fulfilling, and governing the diseases. Four patterns of taking alternative therapies were found as follows: the bulsin-chujong-hyung, the suyoung-hyung, the yangdari-gulchiki-hyung, the chamjae-hyung. In conclusion, the phenomenon of alternative therapies as consumer-driven force to heal the chronic liver diseases of the patients could be explained as an adaptive behavior through the process of jagi momdasrim. However, since most of the participants practicing some kind of alternative therapies had no evidences of its effects and never tried to consult with their medical doctors about alternative therapies, we should approach more actively. Therefore, it is recommended for nurses to listen and watch the patients behaviors of using alternative therapies and find out how to educate the patients about the proper and safe way to take the alternative therapies.

• Journal of the Korean Society of Radiology
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• v.4 no.3
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• pp.19-25
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• 2010

Dysphagia is common and serious problems in post-stroke patients. The post-stroke dysphagia with aspiration is associated with dehydration, malnutrition, pneumonia, sepsis and death. Up to date, gag reflex and choking history used to decide the aspiration in clinical. The purpose of this study was to evaluate the aspiration and to choice the proper meal formation using by video fluoroscpic swallowing study(VFSS) with post-stroke dysphagia patients. 58 post-stroke patients and ten normal person participated to perform the VFSS with liquid type, puding, yoplait, rice mixed with barium(Ba). Two rehabilitation medicine doctors and a radiological technologist analysed the phase(oral, pharyngeal, esophageal phase)with video film, and checked the pharyngeal transition time(PTT). 38 patients showed abnormality in pharyngeal phase, 13 patients in oral and pharyngeal phase, 3 patients in oral phase, and 2 patients in pharyngeal and esophageal phase. 43 patients(65.2%) occured the aspiration, but 23 of 43 patients improved by the chin tuck position. Aspiration occured 34 patients in liquid type, 2patients in rice gruel and nothing in boiled rice. After VFSS, 13 of 23 patients change the intaking pathway from nasogastric tube(NGT) to oral, On the contrary with 3 of 42 patients from oral to NGT. Consequently VFSS is clearly effective to evaluate the aspiration with post-stroke dysphagia patients.

• The Journal of Korean Medical History
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• v.14 no.2
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• pp.189-248
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• 2001

In this essay, following final conclusions have been drawn by analyzing medical ideology and research system of Yi cheon in Yi hak yip mun("醫學入門"). Firstly, even though the existing medical history researchers are not noting the system of Yi-cheon's medical ideology, this essay has proved the man as a doctor who succeeded the (main system) based on the content of Yi-hak-yip-mun("醫學入門") by Ju-Dan-Gae(朱丹溪). The outline of this proof is as follows. 1. Those doctors who had actively researched in Myung era(明代), were basically taking over the medical studies and result of Gum-Won era(金元代). However, depending on whose theory is to be followed, the followers are largely divided into two groups of Ju-Dan-Gae Academics(丹溪學派) and On-Boe Academics(溫補學派). In addition, both Ju-Dan-Gae Academics(丹溪學派) and On-Boe Academics(溫補學派) hold contradictory ideologies to that of the main medical system. In Yi-hak-yip-mun("醫學入門"), Yi-cheon(李?) ties The Text of Whang-Jae-Nae-Kyung("黃帝內經"), Jang-Jung-Kyung(張仲景), Yu-Ha-Gun(劉河間), Yi-Dong-Won(李東垣), Ju-Dan-Gae(朱丹溪) into one pedigree. With regard to the main system, he especially marks Ju-Dan-Gae(朱丹溪) for his efforts in gathering various medical theories into a large compilement. 2. When Yi-Cheon(李?) was writing Yi-Hak-Yip-Mun("醫學入門"), he made references to various medical publishings, among those book which he had utilized, books by Ju-Dan-Gae Academics(丹溪學派) had affected him more than anything else in terms of both quality and quantity. 3. Yi-Cheon(李?)'s "Congested Phlegm Theory(痰鬱論)" had succeeded "Congested Phlegm Theory(痰鬱論) of Ju-Dan-Gae Academics(丹溪學派). His Yi-Hak-Yip-Mun("醫學入門"), carries a more complete form of "Congested Phlegm Theroy(痰鬱論) which was made into a more systemic and widely applicable method which was by Ju-Dan-Gae Academics(丹溪學派). Secondly, Yi-Hak-Yip-Mun("醫學入門"), is a medical book which was written in the process of systemic reorganization of medical theories of various academic parties in Myung 명 era. Since this process was hearing its completion in the period of Yi-Cheon(李?), he chose specific ways of reshuffling, whilst seeking ways to efficiently utilizing existing medical information . He provided a standard to specific ways. He rearranged the existing medical theories based upon these standards. He also contributed to clinical medicine by providing description of symptoms focused upon the symptoms differentiated In Conclusion, Yi-Hak-Yip-Mun("醫學入門") holds systematic medical information which was developed by Ju-Dan-Gae Academics(丹溪學派). Also, Yi-Cheon(李?) uniformly classified the clinical experiences of existing Ju-Dan-Gae Academics(丹溪學派). He had contributed in the clinical use of Ju-Dan-Gae Academic(丹溪學派)'s clinical experience by providing main points from differentiation of symptoms.

• Journal of Preventive Medicine and Public Health
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• v.4 no.1
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• pp.77-87
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• 1971

A study of the knowledge, attitude and practices about the maternal and child health of 305 married women residing in apartments at the Yonsei Community Health area was conducted during the period from November to December 1970 using designed questionnaire with well trained interviewers. The results and findings obtained from the study are summarized as follows: A. Pregnancy and Birth Questions were asked about their last child. 1. 16.4% of the women were pregnant. 2. Among 281 women who had experienced delivery, 48.0% were assisted by doctor or midwisves for their last delivery, while the rest of women delivered their last baby at home without any professional's assistance. The higher the level of education or the greater exposure to mass communication, the more the deliveries were assisted by doctors or midwives. Those women who were born and raised in cities had more deliveries assisted by doctors and midwives than those who were not. 3. Kinds of delivery sheets used. Among 141 cases of home delivery 68% used cement bag paper or vinyl sheets. Three% used nothing and remained used unsterile materials. 4. Among 141 cases of home delivery, 70.2% used scissors. The rest of them used other methods. 5. 47.3% of the women had a rest for one month or more after birth. The higher the level of education, the longer the period of rest was observed. 6. 52.4% of the women fed the colostrum to their babies. This was not related to the mother's education. 7 About half(42.9%) of the women had poor knowledge about a proper diet for the pre and post natal period. B. Child Health 1. Knowledge and practice regarding to the immunization for their children: Most of the women (93.2%) could name at least one kind of immunization. 20.3% could name 6 kinds of immunization. Mothers education level did not influence their ability to name immunizations. 85.2% of children had been immunized at least once. 2. Morbidity of last born children: 48.1% of their last born children were found to have been sick during the last year. Less than half(41.5%) of the sick children were seen by doctor. 3. Counselling at well baby clinic: Most of the women(76.5%) had no counselling for their children. Registration rate at the well baby clinic at the Severance Hospital was 13.2%. 45.9% wanted to visit to the well baby clinic at the Severance Hospital. 4. Weaning Period: 44.6% said that the beginning of the weaning for their last born children was from 6 months to twelve months of age. The most important reason of weaning was the health of both mothers and children. 5. Knowledge and Practice regarding birth and death Registration: 64.6% of the women could name correctly the Ku-office as the place for the registration. Only 29.2% registered the birth of their last born children within 14 days. C. Knowledge, Attitude and Practice regarding to family planning Most: of the women accepted the idea of family planning. 97.7% could name at least one contraceptive method. 35.4% were found to be current users of contraceptive methods. The ideal number of children was 3.1 in average.

• Journal of Hospice and Palliative Care
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• v.6 no.1
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• pp.51-57
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• 2003

Purpose : Anorexia-cachexia syndrome is one of the most common symptoms and main cause of death in terminal cancer patients. This symptom is due to the enlarged cancer mass as well as tumor released cytokines. Some doctors have suggested that vitamin C was preferentially toxic to tumor cells in vitro and in vivo, and improved clinical symptoms in terminal cancer patients. Therefore, we measured cytokines in serum of terminal cancer patients to determine whether vitamin C treatment improved the anorexia-cachexia syndrome. Methods : We investigated that 49 terminal cancer patients admitted to the department of family medicine, National Health Insurance Corporation Ilsan hospital from March 1, 2002 to August 31, 2002. The study was done on 22 patients who were given 10 g/day of vitamin C infusions during 1 week and 27 patients who were not infused. We measured the cytokines levels ($IL-1{\beta}$, IL-6, and $TNF-{\alpha}$) before and after 1 week between terminal cancer patients treated vitamin C and without vitamin C. Results : Out of 49 patients, patents treated with vitamin C infusions were 22 (12 male, 10 female), and these without vitamin C were 27 (18 male, 9 female). In patients treated with vitamin C, $IL-1{\beta}\;were\;6.19{\pm}5.17$ before day and $8.76{\pm}5.72$ after 1 week, IL-6 were $3.07{\pm}8.09$ before day and $1.31{\pm}2.36$ after 1 week, and $TNF-{\alpha}\;were\;2.74{\pm}14.24$ before day and $0.50{\pm}2.00$ after 1 week. In patients treated without vitamin C, $IL-1{\beta}\;were\;2.50{\pm}3.58$ before day and $6.49{\pm}12.01$ after 1 week, IL-6 were $1.00{\pm}2.19$ before day and $17.16{\pm}81.55$ after 1 week, and $TNF-{\alpha}\;were\;1.19{\pm}2.98$ before day and $1.27{\pm}1.52$ after 1 week. The level of cytokines in patients treated with vitamin C decreased more than those without vitamin C. However, this represented no statistical value (P=0.0598 in $IL-1{\beta}$, P=0.1664 in IL-6, and P=0.5395 in $TNF-{\alpha}$). Conclusion : In terminal cancer, even if there was no statistical difference in the cytokines levels between patients treated with vitamin C and those not treated, those who were treated had a decrease all cytokines levels. Vitamin C is very safe with almost no side effects. Therefore, vitamin C treatment in terminal cancer patients can be seen as beneficial and helpful for clinical symptoms.

• Journal of Hospice and Palliative Care
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• v.19 no.1
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• pp.11-25
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• 2016

Purpose: The purpose of this study was to determine the factors that influence healthcare providers' attitude towards end-of-life care (EOLC) in the emergency department (ED) in hospital settings. Methods: From June 1 through June 30, 2014, a descriptive correlational study was performed with 41 doctors and 105 nurses stationed in the ED. Results: According to a regression model on the factors affecting healthcare providers' professional attitude towards EOLC, 28.1% of variance (F=15.185, P=0.000) was explained by awareness of death, gender and personal attitude towards EOLC. And 34.1% of the healthcare providers' personal attitude was related with awareness of death, experience of hospice education, occupations and professional attitude towards EOLC. Conclusion: This study demonstrated that attitude towards EOLC was influenced by awareness of death and personal characteristics. Healthcare providers in the ED should be provided with tailored training to improve their understanding of death. Also an educational program should be developed and provided to ED healthcare providers to improve their awareness of death.

• Health Policy and Management
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• v.3 no.2
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• pp.100-129
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• 1993

This study is designed to find out some intra-clinic factors affecting the content of practice provided by primary care physicians in Korea, and proposed factors in this study are characteristcs of each private clinc --- physician-related variables(age, sex, specialty), bfed-related variables for inpatient care, laboratory-related variables for precise diagnosis. We have tried to estimate the difference of disease entities cared by each primary care physician according to above factors by analyzin gdisease data claimed during one month(April, 1992) to National Federation of Medical Insurance. The diagnosis codes by ICD-9 in the research disease data were reclassified to 'diagnosis clusters' by virtue of clinical similarities for effective analyses. We have converted frequent-tsing ICD-9 codes to 86 diagnosis clusters, which incorporated 97.4 percents of all ambulatory visits to private clinics. This result means proposed diagnosis-cluster method is effective tool for analysis of the content of ambulatory medical care carried out by primary care physicians. Comparisons and analyses of multiple diagnosis-clusters made on the basis of presented factors were done and the results were as follows; - Major factors affecting the difference between diagnosis-cluster pattern by each variables were phyusician's age, sex, specialty and bed counts of each private clinic for inpatient care and the size of laboratories of each clinic. - Middle aged(30th to 40th) group physicians are providing more comprehensive care than 20th or above 50th aged groups. Male physicians are more adequate for comprehensive care than female physicians, because woman-doctors are providing narrow-spectrum care. The content of practice of obstetricians and gynecologists shows much difference from primary medical practice, and they cannot be included in primary care physician, this study suggested. Pediatricians are also providing short-spectum acre, and nearly all visits to pediatricians were incorporated only 2-3 diagnosis-clusters. General surgeons' practices are very similar to general practioners' or family physicians' practices, the means they are providing primary care rather than special surgical care. And small number of beds(under 5 beds) and only basic(2-3 sorts of)diagnostic apparatuses are sufficient for primary physicians' clinic to carry out primary care. In conclusion, to reinforce primary care department in Korea, there must be support with health policy to expand office-based primary care practice-- with small number of beds for inpatient care and only basic laboratories-- provided by general practitioner of family physician.

• Journal of Hospice and Palliative Care
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• v.4 no.2
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• pp.154-160
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• 2001

Purpose : This study, as the first year project of setting up a community based management system, was attempted for the cancer patients and their family to improve their quality of life; investigating and managing the cancer patients, educating volunteers and connecting the patients with the volunteers were performed. Method and result : The education of managing cancer patients for the volunteers was done once in lune for 2 days to the 80 volunteers. Questions about education effect, volunteer motivation and so on were made up. The survey showed, generally, education satisfaction level was high and a longer education and an intensive course were needed and was suggested that organizing a volunteer community be needed for the continuous further education and systematic management. As the result, after the public health center and volunteers deliberated, a volunteer community consisting of 4 teams, 28 members was organized, launched in Oct. and operated for the cancer patients and their family. For investigating and enrolling the patients, advertising on a local information paper, recommending of local doctors, publicizing by educating the heads of a subdivision of the city, the heads of a neighborhood association and the people in charge of the related local communities such as women's society, and surveying the community by volunteers were performed and the total, 41 patients were registered. Management of cancer patients was carried out by volunteers in a community and in a nursing school. A regional volunteers' community is composed of 23 members and they have worked 87 times, that is 3.8 times per capita on an average. The content of duties is attending the education (41.1%) the most. A volunteers' community of nursing students composed of 12 members have worked 135 times, that is 11.3 times per capita on an average. The content of duties - consulting with patients and home visiting (37.8 %) were the most and survey for investigating the cancer patients was the second. Conclusion : This study has the meaning that this is the guiding attempt in building a community based management system, and especially the achievement of this study is that a regional society organized a volunteer community for the cancer patients by itself and went into action for the cancer patients and their family. Furthermore, to activate this volunteering, it is necessary to keep managing volunteers and running continuing education or the intensive course of the volunteers. Indeed we should let the patients have good impression on this program through publicity and education for the residents to keep track of more cancer patients. For that, systematic and powerful cooperation of a self-administrative organization is required.

• The Korean Journal of Emergency Medical Services
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• v.15 no.2
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• pp.67-84
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• 2011

Purpose: The aim of this study is to present the basic data for qualitative improvement of emergency care for emergency patient by paramedic in fire station by understanding the level of awareness and practice in prehospital and transfer step, and understanding the level of emergency care and improvement of clinical knowledge through hospital clinical training. Methods: The researchers explained the objective for 143 persons who completed hospital clinical training from June 2nd, 2006 to October 23rd, 2009 among paramedic in fire station. The questionnaire in this research consisted of 80 questions. In the reliability for the awareness of emergency patient assessment, cronbach's $\alpha$ was 0.95, and in the reliability for emergency care fulfillment, cronbach's $\alpha$ was 0.93. reliability for clinical knowledge improvement is cronbach's $\alpha=.95$, and reliability for emergency care fulfillment is cronbach's $\alpha=.82$. Collected data was analyzed through SPSS 18.0 statistics program for frequency, percentage, average, standard deviation, Paired t-test, t-test, Correlation Coefficient, and internal consistency reliability was analyzed by cronbach's $\alpha$. Results: 1) The paramedic awareness and practice difference for emergency patient is statistically signification for general patient assessment(t=14.159, p=.000), trauma patient assessment(t=11.288, p=.000), internal medicine patient assessment(t=10.898, p=.000), and it shows the level of practice is lower than the level of awareness. 2) The paramedic difference between the level of awareness and practice according to whether or not they have clinical career is not signification on awareness(t=3.119, p=.125), and is high on practice(t=3.119, p=.002). 3) The correlation between paramedic awareness and the level of practice shows positive correlation(r=.61, p=.000). The higher the awareness of emergency patient assessment is, the higher the level of practice is. 4) The difference between paramedic clinical knowledge improvement and the level of emergency care practice is statistically significant(t=3.351, p=.001). 5) 89.6%(128 persons) of paramedic replied hospital clinical training experiences are helpful for field activity. 92.3%(133 persons) replied they apply well for clinical knowledge learned during hospital clinical training and emergency care skills in the field. Conclusion: Paramedic in fire station must evaluate the patient's initial assessment and activate the transfer system to the emergency department. It is necessary to develop and implement the effective education program continuously. The education program should systemize currently operated hospital clinical training. emergency disease and symptoms emergency care method, and practice mainly skill education should be progressed. In the prehospital and transfer management, high quality of medical assessment is required to the emergency medical service system. Medical direction from the doctors can feedback the paramedic continuously and continuing education must be provided to the paramedic in fire station.

• Quality Improvement in Health Care
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• v.9 no.2
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• pp.176-197
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• 2002

Backgound : This study is to suggest the standardized format of the clinical sheets and the standardized items of every clinical sheet. The standardization of the medical records will increase the faithfullnes of the contents in them and it will contribute to construct the good health information system. Method : From Jan. 1st. 2001 to March 31st 2001, we gathered as many paper clinical sheets as possible by every class of institutions to review the faithfulness of the clinical contents in them. Clinical sheets of 9 tertiary care hospitals, 6 general hospitals and 56 clinics were gathered. Two experienced medical record administrators reviewed them. The review focus was to check whether the items recommend by the hospital standardization review criteria and hospital service evaluation organization were appeared in the clinical sheets and whether the contents of every item were written. Results : Tertiary care hospitals; In case of administrative data, the contents were filled well if the items were fixed. The clinical data like C.C, history,physical examiniation were filled well, but if the items were not fixed, some items were omitted. The result is that more items are to be filled if they are fixed. General hospitals Administrative data were filled more than 50%. Final diagnosis was filled about 66.7%.But other clinical data were not filled well and not many clinical related items were appeared in the sheets.In the legal point of view, the reason for visiting hosptals or the right diagnosis, patient condition at discharge could not be confirmed well.In surgery cases, surgical procedures could not be confirmed well as many surgical related information(surgery time, fluids and blood, number of sponges, biopsy, etc) were omitted. Clinics More than 70% administrative data were filled and fixed as items. Among the clinical related data, laboratory result was the most credible data. But without the right diagnosis, drug orders were given and doctors' written signatures were not appeared over 96.4%. So the clinical sheets cannot be used as a legal document. Conculusion : There was a tendency that the contents were filled well if the items were fixed in the documents, We also suggest a clinical check list to review the completeness and faithfulness of the clinical sheets. If many hospitals use the suggested clincal check list and if they make the necessary items fixed in the clinical sheets, the quality of the medical record will increase dramatically.