• Journal of Home Health Care Nursing
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• v.6
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• pp.33-45
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• 1999

The purpose of this study was to develop a basic framework and criteria for evaluation of quality care provided to patients with the attributes of disease in the home care nursing field, and to provide measurement tools for home health care in the future. The study design was a developmental study for evaluation of hospital-based HCN(home care nursing) in Korea. The study process was as follows: a home care nursing study team of College of Nursing. Yonsei University reviewed the nursing records of 47 patients who were enrolled at Yonsei University Medical Center Home Care Center in March, 1995. Twenty-five patients were insured at that time, were selected from 47 patients receiving home care service for study feasibility with six disease groups; Caesarean Section (C/S), simple nephrectomy, Liver cirrhosis(LC), chronic obstructive pulmonary disease(COPD), Lung cancer or cerebrovascular accident(CVA). In this study, the following items were selected : First step : Preliminary study 1. Criteria and items were selected on the basis of related literature on each disease area. 2. Items were identified by home care nurses. 3. A physician in charge reviewed the criteria and content of selected items. 4. Items were revised through preliminary study offered to both HCN patients and discharged patients from the home care center. Second step : Pretest 1. To verify the content of the items, a pretest was conducted with 18 patients of which there were three patients in each of the six selected disease groups. Third step : Test of reliability and validity of tools 1. Using the collected data from 25 patients with either cis, Simple nephrectomy, LC, COPD, Lung cancer, or CVA. the final items were revised through a panel discussion among experts in medical care who were researchers, doctors, or nurses. 2. Reliability and validity of the completed tool were verified with both inpatients and HCN patients in each of field for researches. The study results are as follows: 1. Standard for discharge with HCN referral The referral standard for home care, which included criteria for discharge with HCN referral and criteria leaving the hospital were established. These were developed through content analysis from the results of an open-ended questionnaire to related doctors concerning characteristic for discharge with HCN referral for each of the disease groups. The final criteria was decided by discussion among the researchers. 2. Instrument for measurement of health statusPatient health status was measured pre and post home care by direct observation and interview with an open-ended questionnaire which consisted of 61 items based on Gorden's nursing diagnosis classification. These included seven items on health knowledge and health management, eight items on nutrition and metabolism, three items on elimination, five items on activity and exercise, seven items on perception and cognition, three items on sleep and rest, three items on self-perception, three items on role and interpersonal relations, five items on sexuality and reproduction, five items on coping and stress, four items on value and religion, three items on family. and three items on facilities and environment. 3. Instrument for measurement of self-care The instrument for self-care measurement was classified with scales according to the attributes of the disease. Each scale measured understanding level and practice level by a Yes or No scale. Understanding level was measured by interview but practice level was measured by both observation and interview. Items for self-care measurement included 14 for patients with a CVA, five for women who had a cis, ten for patients with lung cancer, 12 for patients with COPD, five for patients with a simple nephrectomy, and 11 for patients with LC. 4. Record for follow-up management This included (1) OPD visit sheet, (2) ER visit form, (3) complications problem form, (4) readmission sheet. and (5) visit note for others medical centers which included visit date, reason for visit, patient name, caregivers, sex, age, time and cost required for visit, and traffic expenses, that is, there were open-end items that investigated OPD visits, emergency room visits, the problem and solution of complications, readmissions and visits to other medical institution to measure health problems and expenditures during the follow up period. 5. Instrument to measure patients satisfaction The satisfaction measurement instrument by Reisseer(1975) was referred to for the development of a tool to measure patient home care satisfaction. The instrument was an open-ended questionnaire which consisted of 11 domains; treatment, nursing care, information, time consumption, accessibility, rapidity, treatment skill, service relevance, attitude, satisfaction factors, dissatisfaction factors, overall satisfaction about nursing care, and others. In conclusion, Five evaluation instruments were developed for home care nursing. These were (1)standard for discharge with HCN referral. (2)instrument for measurement of health status, (3)instrument for measurement of self-care. (4)record for follow-up management, and (5)instrument to measure patient satisfaction. Also, the five instruments can be used to evaluate the effectiveness of the service to assure quality. Further research is needed to increase the reliability and validity of instrument through a community-based HCN evaluation.

• Radiation Oncology Journal
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• v.27 no.3
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• pp.111-119
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• 2009

Purpose: This study aimed at assessing the value of fluorine-18 fluorodeoxyglucose positron emission tomography ($^{18}F$-FDG PET) for predicting the response of locally advanced rectal cancer to neoadjuvant CRT. Materials and Methods: Between August 2006 and January 2008, we prospectively enrolled 20 patients with locally advanced rectal cancer and who were treated with neoadjuvant CRT at the Korea Institute of Radiological and Medical Sciences. The treatment consisted of radiation therapy and chemotherapy, and this was followed by curative resection 6 weeks later. All the patients underwent $^{18}F$-FDG PET/CT both before CRT and 6 weeks after completing CRT. The measurements of the FDG uptake ($SUV_{max}$), the absolute difference (${\Delta}SUV_{max}$) and the percent $SUV_{max}$ difference (response index, $RI_{SUV}$) between the pre- and post-CRT $^{18}F$-FDG PET/CT scans were assessed. The measurements of the metabolic volume, the absolute difference (${\Delta}$metabolic volume) and the percent metabolic volume difference (response index, $RI_{metabolic\;volume}$) were also assessed. Results: Of the 20 patients who underwent surgery, 11 patients (55%) were classified as responders according to Dworak's classification. The post-CRT $SUV_{max}$ was significantly lower than the pre-CRT $SUV_{max}$. However, there were no significant differences in the $SUV_{max}$ and the metabolic volume reduction between the responders and non-responders. We used a minimum $SUV_{max}$ reduction of 67% as the cut-off value for defining a response, with a sensitivity of 45.5%, a specificity of 88.9%, a positive predictive value of 77% and a negative predictive value of 53.8%. Conclusion: Although there were no statistically significant results in this study, other studies have revealed that $^{18}F$-FDG PET/CT has the potential to assess the tumor response to neoadjuvant CRT in patients with locally advanced rectal cancer.

• The Korean Society of Law and Medicine
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• v.17 no.2
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• pp.85-124
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• 2016

The Human gene testing act (GenDG) in Germany starts from the characteristic features of gene testing, i.e. dualisting structure consisted of anlaysis on the one side and the interpretation on the other side. The linguistic distincion of 'testing', 'anlaysis' and 'judgment' in the act is a fine example. Another important basis of the regulation is the ideological purpose of the law, that is information autonomy. The normative texts as such and the founding principle are the basis of the classification of testing types. Especially in the case of gene testing for medical purpose is classified into testing for diagnostic purpose and predictive purpose. However, those two types are not always clearly differentiated because the predictive value of testing is common in both types. In the legal regulation of gene testing it is therefore important to manage the uncertainty and subjectivity which are inherent in the gene-analysis and the judgment. In GenDG the system ensuring the quality of analysis is set up and GEKO(Commity for gene tisting) based on the section 23 of GenDG concretes the criterium of validity through guidelines. It is also very important in the case of gene testing for medical purpose to set up the system for ensurement of procedural rationality of the interpretation. The interpretation of the results of analysis has a wide spectrum because of the consistent development of technology on the one side and different understandings of different subjects who performs gene testings. Therefore the process should include the communication process for patients in oder that he or she could understand the meaning of gene testing and make plans of life. In GenDG the process of genetic counselling and GEKO concretes the regulation very precisely. The regulation as such in GenDG seems to be very suggestive to Korean legal polic concerning the gene testing.

• The Journal of Dong Guk Oriental Medicine
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• v.4
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• pp.1-23
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• 1995

The aim of this study is to compare the diseases which are in the Sun Woo-Yees charts with the diseases which are in the medical books excavated in MA WANG TEI(馬王堆), "YOUNG COO(靈樞)" and "SO MUN(素問)", and to investigate their interactions. The results obtained are as follows : 1. JOE(疽) which is made in stomach and bowels is not found at the medical books excavated in MA WANG TUI(馬王堆), "YOUNG COO(靈樞)" and "SO MUN(素問)". JOE(疽) which is made on the breast is similar to JOE(疽) which is made on the chest of "YOUNG COO(靈樞)". 2. It is said in Sun Woo-Yee(淳于意)'s charts that mental depression blocks up the circulation of Kl(氣), and it is the same viewpoint of "YOUNG COO(靈樞)"and "SO MUN(素問)". 3. The POONG GYUL(風厥) and the YOUL GYUL(熱厥) that are found in the Sun Woo-Yee(淳于意)'s charts is similar to those of "SO MUN(素問)", but different from those of "YOUNG COO(靈樞)". 4. It is regarded that YONG SAN(涌疝) in the Sun Woo-Yee(淳于意)'s charts is similar to the COONG SAN(퇴산) in "SO MUN(素問)", KI SAN(氣疝) in the Sun Woo-Yee(淳于意)'s charts is related to the TUI SAN(癡疝) of the medical books excavated in MA WANG TUI(馬王堆), "YOUNG COO(靈樞)" and "SO MUN(素問)", MO SAN(牡疝) in the Sun Woo-Yee(淳于意)'s charts is considered PE SAN(肺疝) and PE POONG SAN(肺風疝) in "SO MUN(素問)", but more and deeper study is required. In the change of the terms ; from TUI SAN(癡疝) to TUI SAN(퇴산), from PYUN SAN(偏疝) to HO SAN(狐疝), it can be guessed that the terms changed, as new doctrines were introduced and reorganiged with the development of the medical theory. 5. POONG BI in the Sun Woo-Yee(淳于意)'s charts is not found in "YOUNG COO(靈樞)", but it is similar to DAN FEVER(단열) in "SO MUN(素問)". It is regareded that PE SO DAN(폐소단) in the Sun Woo-Yee(淳于意)'s charts is the same as that of "YOUNG COO(靈樞)". 6. DONG PUNG in Sun Woo-Yee(淳于意)'s charts is not found in "YOUNG COO(靈樞)"and "SO MUN(素問)", but it seems like DONG SOEL(洞泄) in "YOUNG COO(靈樞)". It is regareded that the DONC PUNG(동풍) in the Sun Woo-Yee(淳于意)'s charts was at first changed into DONG SOEL(洞泄), and later differentiated into DOHG SOEL(洞泄) and SON SOEL. 7. In the Sun Woo-Yee(淳于意)'s charts, the treatment of the decayed tooth had the classification of the right and left, seeing cauterization with moxa on SU YANG MYOUNG MAEK(手陽明脈), it is considered that the tooth was decayed in the lower right. region. A tooth was related to QI MAEK(齒脈) and BI YANG MYUNG MAEK(臂陽明脈) in the early stage, but gradually was related to not only SU YANG MYUNG MAEK(手陽明脈) but also JOK YANG MYUNG MAEK(足陽明脈), JOK SO YIN MAEK(足少陰脈), JOK TAE YIN MAEK(足太陰脈), and in regards to the tooth and KYUNG MAEK(經脈), "YOUNG COO(靈樞)" emphasised the course of the KYUNG MAEK(經脈), "SO MUN(素問)" emphasised the attachment of the five elements. 8. In regards to BI(痺), the importance of the five elements theory given in the Sun Woo-Yee(淳于意)'s charts is similar to that of "SO MUN(素問)", and "YOUNG COO(靈樞)" and the medical books excavated in MA WANG TUI(馬王堆) give the same importance to the Kyung MAEK(經脈) theory. 9. The explanation of the irregular menstruation in the Sun Woo-Yee(淳于意)'s charts was fundamentally similar to that of "SO MUN(素問)", but it shows the another theory that can not found in "SO MUN(素問)".

• Journal of Chest Surgery
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• v.29 no.2
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• pp.177-184
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• 1996

Between 1987 and 1994, 21 patients were treated surgically for aortic aneurysm involving the thoracoabdominal aorta. There were 11 males and 10 females, and their age ranged from 20 to 67 years old and mean age was 41.5 years. Many complained of back pain, chest pain or discomfort, and flank pain, but three patients were asymptomatic. 15 patients had chronic dissection (71.4%) and 6 had nondissecting fusiform or saccular aneurysm(28.5%), and of those 15 patients with chronic dissection, 6(28.5%) had atherosclerosis assniated with hypertension, 5 (23.8%) were Martian syndrome, and 2 (9.5%) were associated with pregnancy. The diameter of an aneurysm ranged from 6cm to 12cm, and their extent was classified as type I in 7(33.3%), type II in 8(38.1%), type III in 3(14.3%), and type IV in 3(14.3%) patients based on Crawford classification for TAA . Diseased aorta was replaced with artificial vascular graft in all but one patient. In whom the aortic tear site due to pseudoaneurysm was closed by primary suture. For the spinal cord protection during the operation, we used partial cardiopulmonary bypass (FV-FA or PA-FA bypass) in 12 patients (57.1%), Biopump (LA-FA bypass) in 4(19.0%), total circulartory arrest and CPB in 2 (9.5%), Gott's heparinized shunt in 1(4.7%), and simple aortic cross clamping in 2 (9.5%). The most common complication after the operation was hoarseness due to unilateral vocal cord palsy which onured in 5 patients (23.8%), and the next common complication was wound infection in 4 patients(19.0%), paraplegia in 2 patients (9.5%), chylothorax in 1 patient(4.7%). The hospital mortality rate was 9.5% (2deaths), and there was no late death. Our experience shows that the graft replacement of TAAA had reasonable rate of mortality, low rate of serious complication, and provided good post operative state of the pati nts, and since the thoracoabdominal aortic operation is not a high risky procedure anymore, we recommend a radical operation for the indicated patients.

• Clinical and Experimental Pediatrics
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• v.53 no.3
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• pp.314-322
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• 2010

Purpose : Through a clinical and retrospective analysis of pediatric patients who visited the Regional Emergency Medical Center of Masan Samsung Hospital from January 2007 to December 2008, we characterized pediatric and adolescent emergency patients to improve emergency care in future. Methods : We reviewed the medical records of 14,065 pediatric patients below 19 years of age. Results : The male to female ratio was 1.5:1, and the most common age group was less than 3 years (49.6%). The peak month was May (10.0%), the peak day of the week was Sunday (24.7%), and the peak time of day was 20:00-0:59 (8.5%). There was no difference in the number of visits per day based on weather (sunny, rain [below 10 mm per day], snow, and fog) or daily temperature difference; however, visits increased on sandy, dusty days and decreased on rainy days with more than 10 mm of rain per day. Based on the international classification of disease (ICD)-10 system, the most common disease code was code R (symptoms, sign, and abnormal clinical laboratory finding) (31.5%), and the most common symptom was fever (13.1%). Final outcomes were discharged (73.8%), admitted (25.7%), transferred (0.4%), and expired (0.1%). In adolescent patients aged 15-9 years, the most common disease code was Injury & Poisoning (code S&T, 36.9%); the most common symptom was abdominal pain (9.6%). Conclusion : Pediatric patients visiting the emergency center were most likely to be male and under 3 years of age and to visit between 20:00 and 21:00 on Sundays and in May, and the most common symptom was fever. Differences between adolescents and pediatric patients showed that adolescents had a higher visiting rate with abdominal pain and a larger temperature difference.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.5 no.1
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• pp.70-82
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• 1994

Present study was to evaluate the validity and the clinical utility of the Korean version of Luria-Nebraska Neuropsychological Battery for Children(LNNB-C) in various groups including normal, brain damaged attention deficit hyperactivity disordered(ADHD), and psychiatrically disordered. The Korean version of LNNB-C and BGT were administered to clinical groups consisted of 51 patients(19 brain damaged, 16 ADHD. and 16 psychiatric controls), and to normal group composed of 147 children between the age of 8 and It Also KEDI-WISC was administered D clinical groups as a part of comprehensive psychological assessment There were significant differences between the brain damaged and the normals on all scales of LNNB-C, and between the normals and the ADHD on 11 clinical scales and 3 summary scales, which indicate the clinical validity for the scales of the Korean version of LNNB-C. The significant differences between the ADHD and the brain damaged on 3 summary scales were found, suggesting that the summary scales might play an important role id discriminating between two groups. Multiple discriminant analysis showed that the Korean version of LNNB-C significantly discriminates 3 groups - normals, ADHD, and brain damaged. Percentages of correct classification were ranged from 62.5% in the ADHD to 98.6Ta in the normals. For further evaluating the discriminant validity of the LNNB-C, the discriminant power of each items were calculated, and 131 of the 147 items discriminated significantly between the brain damaged and the normals. The scales of LNNB-C significantly correlated with the error scores of BGT and the most of scales of KEDI-WISC. These results put together : strongly support the concurrent and the discriminant validity of the Korean version of LNNB-C in diagnosing brain damage. The limitations of present study and several issues for the luther study were discussed.

• The Korean Society of Law and Medicine
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• v.16 no.2
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• pp.263-291
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• 2015

In May, 2015, a 68 years old man, who has been Middle East Saudi Arabia and the United Arab Emirates, had high fever, muscle aches, cough and shortness of breath. he went two local hospital near his house and the S Medical Center emergency center. He was diagnosed MERS(Middle East respiratory syndrome) and the diseases had put South Korea the fear of epidemics for three months. Especially, this disease has firstly reported in Middle East Asia in September 2012 and spreaded to twenty-six countries. In 21, July, 2015, European Center for disease prevention and control reported 533 people were died and in South Korea, 186 people were infected, 36 people were died and 16,693 people were isolated from MERS. South Korea government were faced into epidemic control and blamed from public. Especially, hospital acquired infection, disease control chain, opening of information, ventilation, lack of isolation bed, the problem of function of local health center, the issue of reparation for hospital and insurance cover rate, the classification of disease, the role of Korea Centers for disease control and prevention, the culture of visiting hospital to see sick people, the issue of hospital multiple room and other related social support policy. it is time to study and discuss to solve these problems. South Korea citizens felt fear and fright from MERS. What is wore, they thought the dieses were out of their government control. It was unusual case for word except Middle East Asia. numerous tourists canceled visiting korea. South korea economic were severly damaged especially, tourism industry. South korea government should admit that they had failed initial action against MERS and take full reasonability from any damages. The government have to open information to public in terms of epidemic diseases and try to prevent any other epidemic diseases and try to work with local governments.

• The Korean Society of Law and Medicine
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• v.16 no.2
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• pp.197-225
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• 2015

The presentation of this paper was triggered by the spread of MERS in Korea in the year 2015. The analysis of the present acts related with MERS is necessary in order to cope efficiently with any probable spread of such infectious diseases as MERS in future. The acts that should be analyzed in this paper include 'Medical Service Act' and 'Infectious Disease Control And Prevention Act' (hereafter, IDCAPA). At first the classification of the infectious diseases in IDCAPA should be referred to. The Act does not properly classify them because the scope of concept of each group of the infectious diseases overlaps each other. This overlap should be removed. The present system in IDCAPA is not proper for the efficient notification and reporting of the infectious disease patients. This is so in some viewpoints including the persons obligated to make the notification and reporting, the persons to whom they should notify and report such patients, and the process of notification and reporting. The efficient approach to the information related with the infectious disease is necessary for the rapid prevention of its spread. Cohort isolation and quarantine of the infectious patients and exposed contacts are the strongest and most efficient steps for the prevention of spread of the infectious diseases. One of the great problems related with such steps would be the conflict of powers or attributions, the likelihood of which is inevitable under the present system of IDCAPA. The IDCAPA distributed the power or attribution to take the steps to the three governments including the central government, the metropolitan government and the primary local government. The power should be concentrated in the central government, which could afford financially to compensate for the huge amount of damages caused likely by the steps. The power to take the steps would be actually just a useless thing for its holder without such financial capacity. The remedy for the victims by the fault of spreader should be approached to in the sense of national wealth. The general principle of tort law could not supply the victims with the sufficient remedy because the damages would be likely too huge for the wealth of such spreader to cope with. In future another parliamentary inspection could reveal another problems in the administration by the government of the MERS event in the year 2015. Any problem caused by defect in the legal system of the control and prevention of the infectious diseases should be taken into consideration when the legal system would be reformed in future.

• Korean Journal of Psychosomatic Medicine
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• v.24 no.1
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• pp.28-42
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• 2016

Objectives : The author tried to find out reasons why and how hysteria(and conversion disorder) patient numbers, which were so prevalent even a few decades ago, have decreased and the phenotype of symptoms have changed. Methods : The number of visiting patients diagnosed with conversion disorder and their phenotype of symptoms were investigated through chart reviews in a psychiatric department of a University hospital for the last 12 years. Additionally, the characteristics of conversion disorder patients visiting the emergency room for last 2 years were also reviewed. Those results were compared with previous research results even if it seemed to be an indirect comparisons. The research relied on Briquet P. and Charcot JM's established factors of the vicissitudes of hysteria(and conversion disorder) which has been the framework for more than one hundred and fifty years since hysteria has been investigated. Results : The author found decreased numbers and changes of the phenotype of the hysteria patients(and conversion disorder) over the last several decades. The decreased numbers and changes of the symptoms of those seemed to be partly due to several issues. These issues include the development of the diagnostic techniques to identify organic causes of hysteria, repeated changes to the symptom descriptions and diagnostic classification, changes of the brain nervous functions in response to negative emotions, and the influence of human evolution. Conclusions : The author proposed that the evolutionary brain discord reaction theory explains the causes of disappearance of and changes to symptoms of hysteria(conversion disorder). Most patients with hysteria(conversion disorder) have been diagnosed in the neurological department. For providing more appropriate treatment and minimizing physical disabilities to those patients, psychiatrists should have a major role in cooperating not only with primary care physicians but with neurologists. The term 'hysteria' which had been used long ago should be revived and used as a term to describe diseases such as somatic symptom disorder, functional neurological symptoms, somatization, and somatoform disorders, all of which represent almost the same vague concept as hysteria.