• Journal of Hospice and Palliative Care
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• v.13 no.4
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• pp.216-224
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• 2010

Purpose: The purpose of this study was to evaluate a community-based cancer patient management program (CBPCMP) which was collaborated between a hospice center and public health centers. Methods: The CBPCMP proceeded on four steps; 1) Signing agreements with three public health centers, 2) Enrolling the domiciliary terminal cancer patients, 3) Providing home hospice service, and 4) Inquiring patient's level of satisfaction. From February 1 to December 31 in 2009, 43 terminal cancer patients were referred and provided with home hospice service. The hospice team made a total of 605 visits. Medical records for each visit and data from satisfaction surveys were analyzed. Results: 76.7% of patients were older than 60 years, and 90.7% of the patients were alert. The level of functional status for 76.7% of patients rated as lower than ECOG grade 1. 62.8% of the patients or their caregivers signed hospice service agreements. On the initial evaluation, the most frequent reasons for referral were general weakness (86.0%), followed by anorexia (72.1%). Nurses visited the patients' most frequently (371 visits), followed by volunteers (216 visits). Nurses provided emotional support and health promotion counseling on 95.1% and 22.9% of visits, respectively. The mean satisfaction score rated by patients and their family was 4.45 out of 5. Conclusion: This study tested CBPCMP in collaboration with hospice centers and public health centers. CBPCMP showed a possibility to improve the quality of end of life care. To insure the quality care, however, the guidelines for home hospice service should be developed.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.19 no.6
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• pp.500-506
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• 2018

This study analyzed current prehospital emergency care for severe trauma patients administered by different number of 119 EMS (emergency medical services) teams. Out of 1,067 severe trauma patients transferred by 119 EMS teams in J province from January 1st to December 31st 2015, 438 were evaluated in this study. IBM SPSS Statistics 21.0 was used to analyze collected data. The number of patients with severe trauma during the period of study was higher in male with two and three ambulance crews of 119 EMS teams with 242 patients (70.6%) and 66 patients (69.5%) respectively. The percentage of transfers made to local emergency medical centers was highest in those two groups, being 44.0% (151 patients) and 49.5% (47 patients), respectively. Total time spent at the scene did not differ between ambulance crews of two and three, nor did the frequency of practicing advanced airway management and IV (intravenous) cannulation, or the success rate of IV cannulation (p=0.253, p=0.362, p=1.000). Overall, the results indicated that merely increasing the number of paramedics does not improve the quality of prehospital care for severe trauma patients. Measures such as securing professional paramedics, simplifying direct medical oversights, activating indirect medical oversights, and expanding the legally allowed work scope are required.

• The Korean Society of Law and Medicine
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• v.18 no.2
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• pp.163-194
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• 2017

Coronary artery disease has increased in Korea as the country enters the aged society. It is well known that the incidence of coronary artery disease is related to aging, hypertension, diabetes, hyperlipidemia, and dietary habit. For effective treatment of significant coronary stenosis, close coordination between cardiac surgery and cardiology team is essential. Especially cardiologists' decision whether to do the stent placement or CABG is very important because the cardiologists usually start to consult the patients for their treatment. Recently, non-surgical interventions(that is stent placement) in cardiology field have dramatically increased as the national insurance system removed the limitation of the number of stents deployed. However, accidents are often caused by inappropriate use of stents, especially in patients with triple coronary disease or left main disease with heavy coronary calcifications. Another aspect of stent placement is to cope with an emergency case in the event of coronary rupture or pericardial tamponade during coronary interventions without cardiac surgeons. In the past two years, the Korea Consumer Agency (Consumer Dispute Coordination Committee) analyzed eight cases of medical dispute settlement. Only two hospitals were manned with both cardiologists and cardiac surgeons. Seven patients died of procedures of stenting and five patients died on the day of the procedure. Among the 8 cases, 5 cases showed 3 vessel disease and the rest of the cases had either severe calcification, complete occlusion or poor coronary antomies for stenting According to a 2017 national data registry of coronary stenting, less than 3 drug-eluting stents were implanted in 98% of all patients. In 2015, the number of stent procedures was 38,922, and approximately in 800 (2%) cases, more than four stents were used per patient. We emphasize that it is necessary to seriously consider the cost-benefit analysis between stent and CABG. The patient has the right to choose the right procedure by asking the liability of 'instruction explanation obligation'. He should be well informed of the pros and cons of both procedures to avoid overuse of stent. It can be solved by intimate discussion of individual cases with the cardiac surgeon and the patient. Unilateral dialogue with the patient, forceful restriction on the number of stenting, lack of surgeon's backup in difficult cases should all be avoided. It is also necessary to solve the problem not only at the hospital level, such as multidisciplinary integrated medical care, but also a nationwide solution such as expanding cardiac surgeons as essential personnel to public officials.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.19 no.1
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• pp.121-126
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• 2018

The oral hygiene of patients admitted to the ICU (Intensive Care Unit) is very important. Critically ill patients are basically immunocompromised ones because of the high risk of infection by various pathogenic bacteria. The mouth is not only the primary site of infection, but also the site of systemic infections. The purpose of this study was to design a mouthpiece type vacuum oral cleaner for the oral care of seriously ill patients. A 3D CAD modeling and flow analysis model were established for a double structure type cleaner and standard tooth model, and their pressure and flow characteristics were analyzed. The pressure inside the oral cleaner was almost constant, but the velocity distribution showed a large difference between the inside and outside of the teeth. The velocity at the center region inside of the teeth was the highest, and the speed decreased as the distance from the center increased. In the analysis of the case where the suction tube was replaced by the drainage tube, the velocity at the center of the outer portion of the teeth was the highest. In order to increase the effectiveness of the oral cleaner, alternating between suction and drainage is proposed, and a design complement to increase the speed of the molar region is required.

• Journal of Korean Academy of Nursing
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• v.2 no.1
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• pp.35-47
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• 1971

This is a research on general evaluation of the nursing profession which is a professional job, a suitable calling to women and is developing academically day by day. The author gave some questions to the patients, doctors, people, student nurses-themselves and got the following results; (A) General concept about nursing profession A nurse is a member, of a medical team who works for people′s health promotion(50.8%). The reason that the nursing profession is a good one is that it is a rewarding job to care for sick patients(78.9%). The spirit is the most important factor for the nurse(84.8%) and the nursing profession is a suitable calling to women (76%). The description of nurses as "The angels in white dress" is an appropriate one (44.6%) or only a beautiful expression(47.4%) (B) Nurses as actually seen by doctors and patients. They work only obligatorily (47.8%)-Doctors They try to relieve, the patient′s physical discomforts in all sincerity (65.6%), also they to decrease the patient′s mental apprehension (56.7%). (C) Satisfaction in the nursing profession. Nurses satisfaction in the nursing profession is general(68.8%) and student nurses satisfaction in selecting nursing is fulfilled (50.9%). One reason for dissatisfaction among nurses and student nurses is people's failure to understanding the nursing profession(40.1%), One reason for satisfaction is that it is a rewarding job caring for sick patients(35%). (D) Is the nursing professional job? People think the nursing profession is a professional job like doctors or lawyers (60.2%). (E) Are they academic? People think the nurses are academic(37.8%) but nurses read only interesting items in the "Journal of Korean Nurse"(67.7%). (F) Opinions about nurses′going out of the country. Doctors and nurses agree that after 1-2 years′experience in this country(78.5%) and student nurses want to go out where there is on opportunity(73.1%). Student's purpose of going out is to enrich their stock of information(71.3%), doctors think, it is for training in nursing knowledge and skills (47.8%). (G) Opinions about nurse′s social affairs. They want nurses to be controlled(44.4%) and also think that the nurse's demonstration in the National Conte. was reasonable (36.3%). (H) Would you make your daughter a nurse? They favour their daughter′s becoming a nurse(17.4%) because they think it is a rewarding job to care for sick patients(42.5%).

• The Korean Journal of Pain
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• v.9 no.1
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• pp.75-82
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• 1996

Background: Nerve blocks, including epidural analgesia, can be risky for terminal cancer pain patients in generally poor conditions. We performed this study to evaluate the efficacy of intravenous patient-controlled analgesia(PCA) to treat severe pain of terminally ill cancer patients during the last days of life. Methods: We explained the patient's poor general condition to relatives and received a written consent to administer PCA. The starting dose of opioid for PCA in cancer pain management was based on previous 24-hour dose. Previous 24-hour opioid dose was converted to intramuscular morphine equivalent. The concentration of opioid mixed into Basal Bolus $Infusor^{(R)}$ was controlled to allow for one half of the previous 24-hour equianalgesic dose to infuse continuously. Patients controlled their pain by pushing the PCA module themselves. Patients were observed by pain service team. Some discharged patients were treated at home until death. Results: Forty eight patients received PCA for last two years. The most common reason receiving a PCA was the patient's poor general condition(52.0%). The mean starting dose of PCA was $20.6{\pm}16.2$ mg of morphine. Over eighty percents of the patients were in good or tolerable state of analgesia. Half of the patients expired within one week. The mean duration of PCA was $8.7{\pm}7.0$ days. The problems during PCA were: difficulty in maintaining intravenous routes, early loss of mentality after starting PCA, hypotension and nausea. Conclusion: We concluded that PCA, if correctly, is an effective, relatively safe and readily controllable method of pain management in terminally ill cancer patients during the last days of life. For future considerations, terminal patients may expire at the comfort of their own homes after the resolution of legal problems regarding using opioid in home care.

• Journal of Hospice and Palliative Care
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• v.3 no.1
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• pp.39-48
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• 2000

Purpose : The purpose of the study is to disclose the spiritual needs of hospice patients. Method : The questionaire survey was carried out on 49 hospice patients and 40 caregivers who were in the 9 hospice institutions from lune to August in 1999. Results : In the patients, mean scores of the spiritual needs were significantly higher in the group with stomach cancer, college education, christians, $8{\sim}14$ days of hospice care and the group thinking that religion was important, and in the caregivers in the group of religions besides christianity and lives under $3{\sim}5$ years of medical treatment. In the total average of the spiritual needs, the patients's average was significantly lower than the caregiver's. Among the different categories, the patient's needs were highest in the area of meaning of life and the hope, the caregiver's needs in the love and the concern. However, both groups were low in the religion area. In the items of the love and the concern, the patient was highly responding to the 'wanting someone to give warm concern in conversation' and the caregiver was highly responding to the 'giving a warm response to questions on the sad and hard time'. And also, the patient was lowly responding to the 'wanting more concerns to him than other patients', and the caregiver was low responding to the 'patients wanting warm response in conversation'. In the categories of religious area both group were highly responding to the 'wanting to be helped to relax out of all'. And they gave lowest response to the 'wanting to introduce a book to know God'. In the area of meaning of life and hope, the both groups gave highest response to the 'wanting to be guided to have the hope' and lowest to the 'wanting to have opportunity to reconcile the person with bad relationship'. Conclusion : Summing up the above results, personal in-depth conversation is necessary to understand more deeply the spiritual needs of hospice patient. Moreover the hospice team needs to have more systematic approach to find out the spiritual needs of hospice patients.

• Journal of the Korean Society of Radiology
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• v.12 no.7
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• pp.895-908
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• 2018

As modern science is developed and advanced, examination and number of times using radiation are increasing daily. General diagnostic X-ray generator is installed on stationary form, But X-ray generator was developed because patient who is in the intensive care unit, operation room, emergency room can not move to general x-ray room. What we examine patient by x-ray generator is certainly necessary, So patient exposure is inevitable. but reducing radiation exposure is highly important matter about radiation technology, guardian, patient in the same hospital room, nurse etc. For this reason, rule regarding safety control of diagnostic x-ray generator revised for radiation worker, patient and protector proclaim that mobile diagnostic x-ray shield must placed in case of examine different location excluding operation room, emergency room, intensive care unit. But, radiogical technologist is having a lot of difficulties to examine with mobile x-ray generator, diagnostic x-ray shield partition, image plate and lead apron. So, when we use x-ray generator, we manufacture shield tools can be attached to the mobile x-ray generator On behalf of x-ray shield partition and conduct analysis and in comparison to part of body and distribution of dose rate and find way to reduce radiation exposure through distribution of dose rate of patient within the radiogical technologist, medical team. Mobile x-ray generator aimed at SHIMADZU inc. R-20, We manufactured equipment for shielding x-ray scattered x-ray by installing shielding wall from side to side based on support beam on the mobile x-ray generator. Shielding wall when moving can be folded and designed to expand when examine. Experiment measured five times in each by an angle for dose rate of eyes, thyroid, breast, abdomen and gonad on exposure condition of upper and lower extremity, chest, abdomen which is examined many times by mobile x-ray generator. We used dosimeter RSM-100 made by IJRAD and measured a horizontal dose rate by body part. The result of an experiment, shielding decreasing rate of the front and the rear showed 77 ~ 98.7%. Therefore using self-production shielding wall reduce scattered x-ray occurrence rate and confirm can decrease exposure dose consequently. Therefore, through this study, reduction result which is used shielding wall of self-production will be a role of shielding optimization and it could be answer about reduction of medical exposure recommended by ICRP 103.

• Quality Improvement in Health Care
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• v.8 no.1
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• pp.10-21
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• 2001

Background : The Clostridium difficile is the most important identifiable cause of nosocomial infectious diarrhea and colitis, which lengthens hospital stay. Recently incidence of C. difficile has been increasing in an university hospital, and an intervention for prevention and control of C. difficile associated diarrhea (CDAD) was in prompt need. Methods : Subjects were the patients in the neurosurgical intensive care unit(NCU) where C. difficile was most frequently isolated. To increase participation of various departments, we used the CQI method, because management of CDAD requires a wholistic approach including control of antibiotics, barrier precaution and environmental cleaning and disinfection. Duration of the CQI activities was 9 months from April to December 1999. Results : The identified problems were misuse and overuse of antibiotics, lack of consciousness of medical personnels and the possibility of transmission from the contaminated environment and tube feeding. Education for proper use of antibiotics and management of C. difficile infection, use of precaution stickers, supplement of handwashing equipments, emphasis on environmental disinfection, and the change of the process of tube feeding were done. The CDAD rate in NCU was significantly decreased after the CQI program (8.6 case per 1,000 patient days from January to April 1999 vs 4.8 from May to December 1999). The distribution of neurosurgical wards including NCU among the total number of isolated C. difficile from the clinical specimens dropped from 49.4% in January to April to 33,7% in May to December. The average hospital stay of the neurosurgical department changed from 19.6 days to 15.2 days. Also, the effect of the CQI activities for C. difficile may have affected the incidence of vancomycin resistant enterococci (VRE). Duration and dosage of certain antibiotics used in the NS department were decreased. The distribution of neurosurgical department in the number of VRE isolated patients declined from 18.4% to 11.1%. Conclusion : Infection control of resistant organisms such as C. difficile is likely to be successful when management of environmental contamination an collaborative efforts of decreasing the patients' risk factors such as antibiotics management and decreasing the length of hospital stay come simultaneously. For this work, related departments need to actively participate in the entire process under a common target through discussions for identifying problems and bringing up solutions. In this respect, making use of a CQI team is an efficient method of infection control for gathering participation and cooperation of related departments.

• Journal of the korean academy of Pediatric Dentistry
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• v.36 no.4
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• pp.607-612
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• 2009

The malignant tumor in childhood is one of the main causes of children s death due to disease. The traditional treatment for the malignancy is known for the radiation therapy and the chemical therapy or both. However, the treatments tend to induce intraoral complications. Different from adults, almost all children on cancer therapy are expected to have dental complications, because their permanent teeth are on the developmental stage. The degree of dental complication depends on the patient's age, type of chemical and other factors-radiation dose and frequency. In this report, 3 children who had experienced the anti-cancer therapy on their age between 1 and 4 years were selected and dental complications were examined. The children have chance for the various oral complications including the developmental problems such as agenesis, microdontia and hypoplasia of the teeth. Therefore, it's important to understand the side-effects of anticancer therapy during the permanent teeth had been developmental stage in young patients. Also, oral health care specialists, including pediatric and hospital dentist can support the oncology team by providing basic oral care, implementing oral care protocols, delivering emergency dental treatment undergoing anticancer treatment.