• 제목/요약/키워드: Medical refusal

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How to Improve Eating Behaviour during Early Childhood

  • Green, Robin John;Samy, Gamal;Miqdady, Mohamad Saleh;Salah, Mohamed;Sleiman, Rola;Abdelrahman, Hatim Mohamed Ahmed;Al Haddad, Fatima;Reda, Mona M.;Lewis, Humphrey;Ekanem, Emmanuel E.;Vandenplas, Yvan
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • 제18권1호
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    • pp.1-9
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    • 2015
  • Eating behaviour disorder during early childhood is a common pediatric problem. Many terminologies have been used interchangeably to describe this condition, hindering implementation of therapy and confusing a common problem. The definition suggests an eating behaviour which has consequences for family harmony and growth. The recent Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition does not cover the entire spectrum seen by pediatricians. Publications are substantive but level of evidence is most of the time low. This purpose of this review is to clarify terminology of eating behaviour problems during early childhood; including benign picky eating, limited diets, sensory food aversion, selective eating, food avoidance emotional disorder, pervasive refusal syndrome, tactile defensiveness, functional dysphagia, neophobia and toddler anorexia. This tool is proposed only to ease the clinical management for child care providers. Diagnostic criteria are set and management tools are suggested. The role of dietary counselling and, where necessary, behavioural therapy is clarified. It is hoped that the condition will make its way into mainstream pediatrics to allow these children, and their families, to receive the help they deserve.

의료분쟁조정제도 운영에 따른 문제점 및 개선 방안 (The Problems in the Medical Dispute Mediation Process According to the "Act on Remedies for Injuries from Medical Malpractice and Mediation of Medical Disputes" and the Alternative Propsal)

  • 황승연
    • 의료법학
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    • 제14권1호
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    • pp.85-116
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    • 2013
  • Korea Medical Dispute Mediation and Arbitration Agency, "K-MEDI" in abbr. herein-after, is established on Apr. 9, 2012 according to the law cited in the title above for the purpose of settling medical disputes in a prompt, fair and efficient manner. Two special professional organizations are established in K-MEDI, one of them is Medical Dispute Mediation and Arbitration Committee(hereinafter referred to as the "Mediation Committee") and the other Medical Malpractice Appraisal Board(hereinaf-ter referred to as the "Appraisal Board"), the mission of the latter is to investigate the facts concerning the disputed medical conduct and to research as to and apprai-se whether the medical conduct was negligent and whether a causal relationship exists. Each panel organized in the Mediation Committee or the Appraisal Board shall be comprised of five mediators or appraisers, including necessarily a judge or a prose-cutor respectively and any disputed case regardless of the scale, the importance or the complicacy shall be handled by a panel. As the system is not thought efficient or economic, the number of the members comprising a panel or total members com-prising the Mediation Committee or the Appraisal Board shoud be adjusted, and the process shoud be versified, including the "Rapid Process," for instance. A petition for the mediation of a medical dispute shall be rejected if the respondent fails to notify K-MEDI of his/her intention to accede to the mediation within 14days from the day on which the petition for the mediation was served(Art. 27 Cl. 7). As the option of an arbitrary decision whether the mediation proceedings shall be commenced or not given to the respondent by the clause is thought unfair, making the process unstable, and moreover, diminishing the purpose of the system established by the law cited above for solving the medical disputes, the clause shoud be amended not to allow the respondent the option of such an arbitrary deci-sion. K-MEDI shall conduct the "Program for Compensation of Medical Accidents"(Art 46) according to which unavoidable injuries caused by the medical accidents in the cour-se of childbirth and the "Advances for Damages"(Art. 47) that are the compensating moneys paid to victims in medical malpractice cases who fail to receive money at all or partly from the operator or the professional of a public health or medical institution although he/she has a final and conclusive right to be paid by them. Some operators or professionals of such institutions claim that both the programs violate their fundamental rights assured by the constitution, and that it be a justifica-tion of refusal to accede to the mediation. As any of the programs needs not to be conducted by K-MEDI, it may be a proper solution to change the conductor of the programs to avoid the unproductive controversy.

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119구급대원의 응급구급활동과 관련한 형법적 책임 (A Criminal Responsibility of Aid by 119 Rescuer)

  • 윤상민
    • 한국화재소방학회논문지
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    • 제20권4호
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    • pp.77-90
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    • 2006
  • 119구급대원의 응급구급활동과 관련하여 형사법적으로 문제되는 영역은 크게 세 가지이다. 첫째는 구급 요청을 거절하는 행위이며, 둘째는 요구호자를 이송하지 않는 미이송 행위이고, 셋째는 응급처치행위이다. 이러한 일련의 구급대원의 행위들이 '응급의료에 관한 법률'이나 관련 법규의 규정에 위반되어 이루어진 경우에는 이들 법률들에 규정된 범죄행위가 성립한다. 특히 정당한 이유 없이 구급요청을 거절한 행위는 응급의료법상 응급의료거부죄가 성립하고, 적법한 절차에 의하지 아니한 응급처치는 무단 응급처치죄가 성립한다. 또한 구급요청거절과 미이송 행위 그리고 응급처치나 미응급처치 등으로 인해 요구호자가 사망하거나 상태가 악화된 경우에는 형법상 살인죄나 업무상과실치사죄 또는 중상해죄가 성립할 수 있다. 이처럼 구급대원의 경우에는 구급활동과 관련하여 형사적 책임으로부터 자유로울 수가 없다. 즉 구급대원들도 직무의 소홀과 과실로 인해 발생하는 법익침해적 결과에 대해서는 당연히 형사적 책임을 져야 한다. 그러나 긴급상황에서 불가피하게 국민의 생명과 건강을 침해한 경우에는 이들을 보호할 수 있는 법적 방안도 마련되어야 하며, 특히 열악한 근무환경에서 구급대원에게만 그 책임을 전가할 수 없는 게 현실이다. 현재 구호자보호법 제정문제가 논의되고 있는데, 이 법률에 구급대원의 형사면책부분이 합리적으로 규정되어 궁극적으로 구급대원들이 국민의 생명과 건강을 지키는 파수꾼으로서 그 역할에 충실할 수 있도록 하여야 한다.

Causes of Failure during the Management Process from Identification of Brain-Dead Potential Organ Donors to Actual Donation in Korea: a 5-Year Data Analysis (2012-2016)

  • Kim, Mi-im;Oh, Jaesook;Cho, Won Hyun;Kim, Dong-Sik;Jung, Cheol Woong;You, Young-Dong;Gwon, Jun-Gyo;Lee, Jae-myeong
    • Journal of Korean Medical Science
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    • 제33권50호
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    • pp.326.1-326.10
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    • 2018
  • Background: This retrospective study analyzed the causes of failure in the management process from the identification of brain-dead potential organ donors to actual donation in Korea over the past 5 years. Methods: Data of 8,120 potential brain deaths reported to the Korea Organ Donation Agency were used, including information received at the time of reporting, donation suitability evaluation performed by the coordinator after the report, and data obtained from interviews of hospital medical staff and the donor's family. Results: From January 2012 to December 2016, the total number of brain-dead potential organ donors in Korea was 8,120, of which 2,348 (28.9%) underwent organ procurement surgery with designated recipients. While the number of transplant donors has increased over time, the ratio of transplant donors to medically suitable brain-dead donors has decreased. The common causes of donation failure included donation refusal (27.6%), non-brain death (15.5%), and incompatible donation (11.6%); 104 potential donors (7.8%) were unable to donate their organs because they were not pronounced brain dead. Conclusion: The rate of successful organ donation may be increased by analyzing the major causes of failure in the brain-dead organ donation management process and engaging in various efforts to prevent such failures.

여대생의 음주행위 영향요인 (Factors Influencing Alcohol Consuming behavior of the Female University Students)

  • 김희경;최은숙;안정선
    • Child Health Nursing Research
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    • 제10권2호
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    • pp.205-216
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    • 2004
  • Purpose: The purpose was to investigate the factors influencing alcohol consuming behavior of the female university students to provide the basic data for a nursing intervention program to improve health and prohibit of alcohol consuming behavior. Method: The subjects were 134 female university students, studying at K university and K educational university in Chungnam province from April 1 to 20, 2002. The instruments were the alcohol consuming behavior scale, that is drinking intensity score, and alcohol problem developed by Shin(1998), refusal self-efficacy scale by Aas et. al.(1995), alcohol expectancy by Goldman at. al.(1989), TPQ scale by Cloninger(1991), depression scale modified by Shin(1977) using Zung(1965)' tool, family cohesion scale by Olson at. al.(1983). The data were analyzed using descriptive statistics, Pearson correlation coefficient, canonical correlation and stepwise multiple regression. Result: The most powerful predictor of alcohol consuming behavior was influence of friends-drinking(21.0%). A combination of economic status(8.0%), and personality of novelty seeking(3.0%), accounted for 32.0% of the variance in alcohol consuming behavior. Conclusion: I recommended that economic status, influence of friends drinking frequently, and personality of novelty seeking were contained of the developing nursing intervention program for decreasing the alcohol consuming behavior in female university students.

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Endoscopic Balloon Dilation for Treatment of Congenital Antral Web

  • Peck, Jacquelin;Khalaf, Racha;Marth, Ryan;Phen, Claudia;Sosa, Roberto;Cordero, Francisco Balsells;Wilsey, Michael
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • 제21권4호
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    • pp.351-354
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    • 2018
  • Congenital antral webs are a rare but relevant cause of gastric outlet obstruction in infants and children. The condition may lead to feeding refusal, vomiting, and poor growth. Due to the relative rarity of the disease, cases of congenital antral web are frequently misdiagnosed or diagnosed with significant delay as physicians favorably pursue diagnoses of pyloric stenosis and gastric ulcer disease, which are more prevalent. We report a case of an eight-month-old female who presented with persistent non-bilious emesis, feeding difficulties, and failure to thrive and was discovered to have an antral web. The web was successfully treated with endoscopic balloon dilation, which resolved her symptoms. Two years later, the patient remains asymptomatic and is thriving with weight at the 75th percentile for her age.

Adolescents' Perceptions Regarding Effective Tobacco Use Prevention Strategies for their Younger Counterparts: A Qualitative Study in Malaysia

  • Zin, Faridah Mohd;Hillaluddin, Azlin Hilma;Mustaffa, Jamaludin
    • Asian Pacific Journal of Cancer Prevention
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    • 제17권12호
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    • pp.5113-5119
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    • 2016
  • Purpose:The present qualitative study explored adolescents' perceptions regarding effective strategies to prevent adolescents from using tobacco products (TP). Apart from the commercial TPs, there has been emerging use of alternatives such as vapes, e-cigarettes and shisha. This unfortunate phenomenon continues despite the currently available preventive strategies. Thus, understanding of the perceptions of the current generation would be valuable to provide new insights. Methods: Purposive sampling was utilized to recruit 40 adolescents between the age of 15 and 16 years old attending public daily secondary schools. Eight focus group discussions were conducted among the TP users, ex-users and non-users. Data were analyzed using a thematic content analysis procedure with NVivo. Results: Among barriers with the currently available strategies were having teachers who smoke tobacco, addiction to nicotine and self-perceptions of being healthy. The content of any program should include knowledge on negative outcomes of using tobacco products and awareness of the legislation together with ways to overcome peer and family influence including improving self-efficacy and refusal skills. Strategies were suggested to be delivered using information technology which provides interactive learning and visual effects. Conclusions: Adolescents agreed that the content and delivery of tobacco use prevention strategies need to be revised to suit the current generation to ensure sustainability.

Study on Nursing College Students' Subjectivity in Their Attitude Toward Jobs

  • Kim Yoon Soak;Kim Boon Han
    • 대한간호학회지
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    • 제35권4호
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    • pp.680-685
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    • 2005
  • Purpose. The purpose of the study was to categorize nursing students' subjectivity in their attitude toward their jobs, and thereby understand the differences among these attitude types. Methods. The study used a Q-method to measure nursing students' attitude toward jobs identity types. In-depth and objective interviews and literature review formed Q sample. The P sample consisted of 25 nursing students. Results. The results of the study show that nursing students can be categorized into three types, depending on their attitudes toward their jobs. The firs type, 'interest-oriented' students, strongly disagree to the follow-ing: giving priority to job over marriage, standing unfair treatment in the workplace, the importance of pro-motion opportunity, irresponsibility, and uncertainty. The 'reward-oriented' students, on the other hand, strongly disagree to the following: indifference to career prospects, employment-related relocation of residence, irresponsibility, standing difficulties, and compromises with others. The third type of nursing students is the possession-oriented students, who strongly disapprove of irresponsibility, refusal to compromise with reality, standing unfair job allocation or promotion and career uncertainty. Conclusions. The study on nursing college students' attitude toward their jobs is meaningful in the following aspects: First, the study clarifies nursing college students' attitudes toward their job by categorizing it. Second, the study confirms the changing attitudes of nursing students toward jobs with the change of times and calls for proper educational programs to foster healthy career attitudes. Third, proper decision-making as regards jobs and job allocation for nurses, or their career attitudes, is beneficial to individuals, the medical industry, and society.

불완전 방사선치료 환자의 분석 (Why Do Patients Drop Out During Radiation Therapy? - Analyses of Incompletely Treated Patients -)

  • 허승재;우홍균;안용찬;김대용;신경환;이규찬;정원아;김현주
    • Radiation Oncology Journal
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    • 제16권3호
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    • pp.347-350
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    • 1998
  • 목적 : 본 연구는 계획된 방사선치료의 과정 도중에 방사선치료를 완료하지 못하는 환자들의 빈도를 조사하고 그 이유를 분석하고자 하였다. 대상 및 방법 :삼성서울병원 치료방사선과에서 방사선치료를 받은 환자 중에서 1996년 4월부터 1997년 5월까지 방사선치료를 시행 받은 1,100명의 환자들을 대상으로 하였다. 대상 환자들 중에서 최초 계획 방사선량의 95$\%$ 이하를 받은 경우를 불완전 방사선치료로 정의하여 그 빈도와 이유를 조사하였다. 결과 : 불완전 방사선치료의 빈도는 1,100명 중 128명으로 12$\%$였다. 불완전 방사선치료 환자들의 운동수행능력은 전체 환자들에 비하여 불량하였으며, 방사선치료의 목적은 고식적 목적이 많았다. 불완전 방사선치료의 가장 흔한 이유는 환자의 거부였으며 이는 주로 환자의 방사선치료에 대한 불신과 경제적 부담 때문이었다. 결론 : 불완전 방사선치료의 빈도를 줄이기 위해서는 방사선치료의 임상적 적응 여부는 물론 환자의 사회 경제적인 여건을 잘 고려하여 방사선치료의 대상 환자를 선정하는 것이 요망되며 이는 특히 고식적 방사선치료의 경우에 더욱 중요하다고 할 수 있겠다.

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의료관련감염 예방을 위한 마스크 미착용 장애인의 의료기관 출입제한과 인권차별 결정에 대한 검토 (A Study on Restriction of Access to Medical Institutions and Discrimination on Human Rights of Persons with Disabilities Not Wearing Masks to Prevent Healthcare-Associated Infections)

  • 문상혁;김제선
    • 의료법학
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    • 제24권1호
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    • pp.67-98
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    • 2023
  • 코로나19 발생 이후 우리의 모든 생활 영역에서 많은 변화가 있었는데, 그 중 하나가 마스크 착용 의무화였다. 팬데믹 등 상황 초기에 우리나라는 다른 국가들보다 선도적으로 '사회적 거리두기' 정책 등을 강하게 시행하면서 개인 공간을 제외한 거의 모든 공간을 이용할 경우 누구나 할 것 없이 마스크 착용은 의무였다. 물론, 의료기관을 이용하기 위해서는 무엇보다 마스크 착용이 먼저였고, 마스크 착용을 안 할 경우 출입이 거부 또는 제한되었다. 즉, HAI 예방 등을 위해 모든 의료기관 이용 환자는 코로나19 검사를 실시한 후, 음성 확인이 된 환자에 한해 대면에 의한 의료행위가 이루어지는 규제가 실시되었다. 이 과정에서 마스크를 착용하기 곤란한 장애인 등의 상황은 고려되지 못하였고, 응급환자가 제때 치료 또는 수술 등을 의료인으로부터 받지 못하는 상황이 벌어졌다. 이에 국가인권위원회는 마스크 착용을 모든 사람에게 강제하고 의료기관 출입을 허용하지 않는 것은 장애인 인권차별이라는 결정을 내렸다. 따라서 이 연구는 코로나19 상황에서 장애인의 특성을 고려하지 않은 감염병 전염 예방조치로 인해 장애인에 대한 차별이 발생한 사례와 국가인권위원회 결정에 대해 쟁점이 되는 사안을 검토하는 한편, 마스크 착용이 어려운 장애인에 대한 의료기관의 진료 거부 방지 대책의 필요성과 합리적인 방안을 모색하는 것을 목적으로 하였다.