• Title/Summary/Keyword: Prevention System

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An Effect of Muscle Strength Training Program on Muscle Strength, Muscle Endurance, Instrumental Activities of Daily Living and Quality of Life in the Institutionalized Elderly (노인의 근력강화운동이 일상생활기능 및 삶의 질에 미치는 효과)

  • Kim, Hee-Ja;Hong, Yeo-Shin
    • Research in Community and Public Health Nursing
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    • v.6 no.1
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    • pp.55-73
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    • 1995
  • An Effect of Muscle Strength Training Program on Muscle Strength, Muscle Endurance, Instrumental Activities of Daily Living and Quality of Life in the Institutionalized Elderly Recent statistics shows that the aged are the fastest growing segment of our population by increasing life span. The age group of over 60 shows multiple health problems and the most serious handicapping problem of these. are related to the changes in muscular skeletal system. With aging, people lose. their muscle mass and muscle strength resulting from biological changes and physical inactivity. Studies documented a 30-50% loss of muscle mass in an advanced age and thus, ordinary life activities can be seriously affected due to weakened muscle strength. Preservation of muscle strength of lower limb is especially important in the aged. Since it is readily affected from reduced physical activity in old age, sometimes to the detriment of moving or walking. So muscle strength exercise program designed for the elderly to improve leg muscle strength and leg muscle endurance. The research design used was nonequivalent control group pretest - protest design. The purposes of this study were to test the effect of muscle strength exercise program utilizing Leg Press on muscle strength, muscle endurance, instrumental activities of daily living(IADL), cognitive perceptual variables and quality of life. Forty nine subjects participating in this study consisted of twenty four male and twenty five female. Twenty four experimental group subjects were selected from C-institution in Chung Buk province, and twenty five control group subjects were selected from O-institution in Chung Nam province. The mean age of subjects was 72.8 years. Muscle strength training program utilizing Leg Press for the experimental group was carried out three times a week for 9 weeks. The data was collected from August, 1993 to October, 1993. Data were analyzed with $X^2-test$, t-test, ANCOVA test, Kruskal Wallis 1-Way ANOVA test using SPSS PC program. Results were obtained as follows : 1) The experimental group showed significantly higher scores on muscle strength (leg lift strength, back lift strength and grip strength) and muscle endurance than control group after the experiment $\ulcorner$F=52.35(p=.001), F=54.07(p=.001), F=6.97(p=.011), F=18.17(p=.001)$\lrcorner$ 2) Experimental group were significantly higher scores on IADL than control group(F=7.51, p=.009). 3) Experimental group showed significantly higher scores on economical state and self esteem aspects of the quality of life scale than control group $\ulcorner$F=10.59(p=.002), F=6.97(p=.011)$\lrcorner$. But there were no differences in emotional state, physical and functional state and relationship with reatives in the quality of life between groups. 4) Scores on IADL showed a significant difference with the level of muscle strength and muscle endurance $\ulcornerx^2=7.73(p=.025),\;x^2=8.86\;(p=.011)\lrcorner$ 5) Scores on self esteem and physical and functional state aspects of the quality of life scale showed a significant difference with the level of IADL $\ulcornerx^2=11.39(p=.003),\;x^2=9.02(p=.011)\lrcorner$. 6) Scores of experimental group after the experiment in cognitive perceptual variables (perceived benefit on exercise, perceived health status, self efficacy, emotion on exercise) were significantly higher than those of control group $\ulcorner$F=32.09(p=.001), F=5.07(p=.029), F=20.63 (p=.001), F=30.38(p=.001)$\lrcorner$. As a result of this study, the effect of strength training exercise program with Leg. Press had improved muscle strength, muscle endurance, IADL, and the perception of self esteem, physical and funtional state, and economical state. Thus strength training program could be beneficially applied for the prevention of disablity and promotion of health and wellbeing in the aged easily and safely. The subjects in the experimental group have maintained their exercises till six months after the cessation of the experiment. This seem to illustrate that changes in cognitive perceptual variables and the improvement in health status have reinforced motivation for the continuation of voluntary exercises. A further study is necessary to determine the factors affecting maintainance of muscle strength exercise and to assess the effect of weight training program on bone density.

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A Study on Satisfaction level with Herbal Public Health Services and its Improvement Plans (한방공중보건서비스 만족도와 개선방안)

  • Lee, Jae-Won;Koo, Jin-Suk;Seo, Bu-Il
    • Korean Journal of Oriental Medicine
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    • v.18 no.2
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    • pp.65-89
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    • 2012
  • Objective : In order to investigate and improve public Korean medical health service satisfaction level, this study was designed. Method : A questionnaire has been conducted on 212 patients who received treatments at six public health centers in the northern part of Gyeongbuk during 15 days between Sep. 24 and Oct. 8, 2011. Result : 1. An Investigation on the usage of herbal clinics in public health centers reveals that 63.7% have received three times or more medical treatments previously and 61.8% have had their illness treated at other medical institutions. In regard to illness 32.1% have had arthritis or muscle aches. 50.9% have taken insurance medication after having had treatments at the public health centers. 66% have assessed acupuncture and moxa cautery the most satisfying. 2. To a question regarding whether herbal health treatment costs higher than that of physician's, the highest response at 31.6% is 'No'. And to a question regarding whether herbal medicines administered at public health centers have more side effects than that of physician's, the highest response at 39.6% is 'No'. 3. To a question regarding whether herbal treatment of public health centers has little effect against acute disease, 48.1% of responses are 'Fair'. To a question regarding whether herbal treatments, when compared with physician's treatments, boost better recovery of patients, 48.1% of responses are 'Fair'. To a question regarding whether herbal medicine is unscientific, when compared with that of western medicine, 38.2% of responses are 'Fair', To a question regarding whether herbal medicine has faster effect on disease than western medicine, 41.0% of responses are 'Fair'. To a question regarding whether herbal medicine is more effective on disease prevention and promotion of health than disease treatment, 38.2% of responses are 'Fair'. And to a question regarding whether the lack of various types of physical therapy devices in herbal medicine, when compared with western medicine causes inconvenience in herbal treatment, 42.0% of responses are 'Fair'. Those responses take up highest portion at each questionnaire. 4. A comparative study between herbal treatments and physician's treatments has also been conducted. To questions regarding which one of the two considering types of disease is the better, responses are the latter accounted for 43.9% against 'Cancer', the latter accounted for 45.3% against 'Endocrine disorders', the former accounted for 30.7% against 'Psychiatric disorders', the latter accounted for 38.2% gainst 'Otolaryngological(ENT) disease', the former accounted for 47.6% against 'Post traumatic stress disorder', and the former accounted for 52.4% against 'Muscle-skeletal disease'. 5. An investigation on frequency of patients' visits via (p<0.05) of subjects show a statistically significant difference. 6. First, an investigation on frequency of reasons of medical treatments reveal that age, occupation, monthly income, and insurance type (p<0.05) of subjects show a statistically significant difference. Secondly, an investigation on frequency of subjects taking insurance medicines after herbal health treatments reveal that monthly income (p<0.05) of subject shows a statistically significant difference. 7. First, an investigation on frequency of a claim that herbal treatments of public health center does not have great effect on acute disease reveals that age, education, and insurance type (p<0.05) of subjects show a statistically significant difference. Secondly, an investigation on frequency of analysis that herbal treatments has faster effect on disease compared with western treatments reveals that education level, religion, monthly income, and insurance type (p<0.05) of subjects show a statistically significant difference. 8. When herbal clinics of public health centers and general herbal medicine institutions are compared, a survey on additional treatments that herbal clinics need the most reveals that education level, monthly income, and insurance type (p<0.05) of subjects show a statistically significant difference. Secondly, an investigation on frequency of subjects who want various forms of herbal medicines reveals that occupation and insurance type (p<0.05) of subjects show a statistically significant difference. Conclusion : In order to improve efficiency of treatments and enhance patient's satisfaction level, this study suggests measures such as providing a differentiated acupuncture treatments as a whole, streamlining an reception procedure, adopting more elaborated computer system for a patient to get proper medical attention, standardizing a treatment duration in order for a maximum result, keeping regular office hours, and optimizing a consultation time for a patient.

The Optimum of Respiratory Phase Using the Motion Range of the Diaphragm: Focus on Respiratory Gated Radiotherapy of Lung Cancer (횡격막의 움직임을 이용한 최적화된 호흡 위상의 선택: 폐암의 호흡 동기 방사선치료 중심)

  • Kim, Myoungju;Im, Inchul;Lee, Jaeseung;Kang, Suman
    • Journal of the Korean Society of Radiology
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    • v.7 no.2
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    • pp.157-163
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    • 2013
  • This study was to analyze quantitatively movement of planning target volume (PTV) and change of PTV volume through movement of diaphragm according to breathing phase. The purpose of present study was to investigate optimized respiration phase for radiation therapy of lung cancer. Simulated breathing training was performed in order to minimize systematic errors which is caused non-specific or irregular breathing. We performed 4-dimensional computed tomography (4DCTi) in accordance with each respiratory phase in the normalized respiratory gated radiation therapy procedures, then not only defined PTVi in 0 ~ 90%, 30 ~ 70% and 40 ~ 60% in the reconstructed 4DCTi images but analyzed quantitatively movement and changes of volume in PTVi. As a results, average respiratory cycle was $3.4{\pm}0.5$ seconds by simulated breathing training. R2-value which is expressed as concordance between clinically induced expected value and actual measured value, was almost 1. There was a statistically significant. And also movement of PTVi according to each respiration phase 0 ~ 90%, 30 ~ 70% and 40 ~ 60% were $13.4{\pm}6.4mm$, $6.1{\pm}2.9mm$ and $4.0{\pm}2.1mm$ respectively. Change of volume in PTVi of respiration phase 30 ~ 70% was decreased by $32.6{\pm}8.7%$ and 40 ~ 60% was decreased by $41.6{\pm}6.2%$. In conclusion, PTVi movement and volume change was reduced, when we apply a short breathing phase (40 ~ 60%: 30% duty cycle) range. Furthermore, PTVi margin considered respiration was not only within 4mm but able to get uniformity of dose.

A review of Deepwater Horizon Oil Budget Calculator for its Application to Korea (딥워터 호라이즌호 유출유 수지분석 모델의 국내 적용성 검토)

  • Kim, Choong-Ki;Oh, Jeong-Hwan;Kang, Seong-Gil
    • Journal of the Korean Society for Marine Environment & Energy
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    • v.19 no.4
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    • pp.322-331
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    • 2016
  • Oil budget calculator identifies the removal pathways of spilled oil by both natural and response methods, and estimates the remaining oil required response activities. A oil budget calculator was newly developed as a response tool for Deepwater Horizon oil spill incident in Gulf of Mexico in 2010 to inform clean up decisions for Incident Comment System, which was also successfully utilized to media and general public promotion of oil spill response activities. This study analyzed the theoretical background of the oil budget calculator and explored its future application to Korea. The oil budge calculation of four catastrophic marine pollution incidents indicates that 3~8% of spilled oil was removed mechanically by skimmers, 1~5% by in-situ burning, 4.8~16% by chemical dispersion due to dispersant operation, and 37~56% by weathering processes such as evaporation, dissolution, and natural dispersion. The results show that in-situ burning and chemical dispersion effectively remove spilled oil more than the mechanical removal by skimming, and natural weathering processes are also very effective to remove spilled oil. To apply the oil budget calculator in Korea, its parameters need to be optimized in response to the seasonal characteristics of marine environment, the characteristics of spilled oil and response technologies. A new algorithm also needs to be developed to estimate the oil budget due to shoreline cleanup activities. An oil budget calculator optimized in Korea can play a critical role in informing decisions for oil spill response activities and communicating spill prevention and response activities with the media and general public.

A Preliminary Analysis on the International Management System for the Ocean fertilization with Iron at High Seas (해양 철분 시비(施肥)사업의 국제 관리체제 예비 분석)

  • Hong, Gi-Hoon;Sohn, Hyo-Jin
    • Journal of the Korean Society for Marine Environment & Energy
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    • v.11 no.3
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    • pp.138-149
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    • 2008
  • Rapid accumulation of carbon dioxide in the atmosphere for the past century leads to acidify the surface ocean and contributes to the global warming as it forms acid in the ocean and it is a green house gas. In order to curb the green house gas emissions, in particular carbon dioxide, various multilateral agreements and programs have been established including UN Convention of Climate Change and its Kyoto Protocol for the last decades. Also a number of geo-engineering projects to manipulate the radiation balance of the earth have been proposed both from the science and industrial community worldwide. One of them is ocean fertilization to sequester carbon dioxide from the atmosphere through the photosynthesis of phytoplankton in the sea. Deliberate fertilization of the ocean with iron or nitrogen to large areas of the ocean has been proposed by commercial sector recently. Unfortunately the environmental consequences of the large scale ocean iron fertilization are not known and the current scientific information is still not sufcient to predict. In 2007, the joint meeting of parties of the Convention on the Prevention of Marine Pollution by Dumping of Wastes and Other Matter, 1972 and 1996 Protocol (London Convention/Protocol) has started considering the purposes and circumstances of proposed large-scale ocean iron fertilization operations and examined whether these activities are compatible with the aims of the Convention and Protocol and explore the need, and the potential mechanisms for regulation of such operations. The aim of this paper is to review the current development on the commercial ocean fertilization activities and management regimes in the potential ocean fertilization activities in the territorial sea, exclusive economic zone, and high seas, respectively, and further to have a view on the emerging international management regime to be London Convention/Protocol in conjunction with a support from the United Nations General Assembly through The United Nations Open-ended Informal Consultative Process on Oceans and the Law of the Sea.

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A Study on the Utilization of Private Security for Park Safety (공원안전관리를 위한 민간경비 활용방안 연구)

  • Kang, Yong-Gil
    • Korean Security Journal
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    • no.34
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    • pp.7-32
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    • 2013
  • The idea of this study was derived from awareness of local governments and police's limitation on attempts to 'creating safe park'. The purpose of this study is to examine current political measures of preventing various types of possible crimes in the park and the limitation of those policies. Furthermore, this study aims to suggest possible explanations to utilize Private Security Sector for the effective and continuous way of managing park safety by considering legal and practical solutions and its expectations. The methods of analysis used in this study are, first, literature review of current park safety management policies. Second, this article examined implications of strategies of those policies throughout the case study of the USA's park safety policy. Third, this study suggested plans of action and role of Private Security Sector to improve park safety. The results present several arguments for the park safety. First, legislation of mandatory crime preventing programme in the early stages of designing park is required. Introducing the 'park special judicial police system' to the major parks for a immediate response to the crime can be one of suggestions. Moreover, proactive police response systems, such as one of the Seoul Metropolitan Police's policies- 'returning safe parks to a citizen' are required. Second, the case study of the USA regarding park safety confirmed that major parks in the USA have rigorous and detailed park regulations. It also showed that those parks take not only preventing measures, but also follow-up measures against crimes. Third, the results suggest creating human resources by contracting out Park Managers and Private Security Sector that have specialized experiences and techniques to prevent crimes and public disorders. Overall in this study, increased citizen's satisfaction level, control of continuous and systematic crimes, the spread of joint-production of public safety, and increased fields of the Private Security Sector are expected from the findings.

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Clinical Study of Vascular Injuries (혈관 손상의 임상적 고찰)

  • Chung, Sung-Woon;Kim, Young-Kyu
    • Journal of Chest Surgery
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    • v.40 no.7 s.276
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    • pp.480-484
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    • 2007
  • Background: Major vascular injuries can jeopardize a patient's life or imperil limb survival. We performed this study to establish an optimal management plan for vascular injuries. Material and Method: We retrospectively reviewed 26 cases of vascular injury that were treated at Pusan National University Hospital from May, 1999 to September, 2004. The age and sex distribution, the locations and causes of vascular injury, the diagnostic tools, the degree of injuries, clinical manifestations, the treatment modality and complications were reviewed. Result: The mean age was 39.5 years (range: $12{\sim}86$) and the male to female ratio was 22 : 4. The injuries were in 6 descending thoracic aortas, 4 femoral arteries, 4 popliteal veins and so on. The causes of injury were iatrogenic in 8 cases, traffic accident in 7, stab injury in 6 and industrial accident in 5. The most commonly used diagnostic tools were CT and angiography. The degrees of arterial injury were pseudoaneurysm in 10 cases, partial severance in 5, complete severance in 3 and thrombosis in 3. The degrees of venous injury were partial severance in 6 cases, complete severance in 2 and arteriovenous fistula in 2. The clinical manifestations were absence of pulse in 8 cases, coldness in 7, chest pain in 6, swelling in 5, bleeding in 5 and so on. The most frequently used type of revascularization was graft interposition in 11 cases. Two arteriovenous fistulae were repaired by endovascular procedure. There was one case of mortality due to multi-organ failure after hemorrhagic shock, There were three major amputations, and two of them were due to delayed diagnosis and treatment. Conclusion: A system for the early diagnosis and treatment is essential for improving limb salvage and patient mortality. As a consequence of the widespread application of endovascular procedures, the incidence of iatrogenic injuries has recently increased. Educating physicians is important for the prevention of iatrogenic injury. Easy communication and cooperation for earlier involvement of a vascular surgeon is also an important factor.

An Analysis of Referrals, Nursing Diagnosis, and Nursing Interventions in Home Care - Wonju Christian Hospital Community Health Nursing Service - (가정간호 기록지 분석 - 원주기독병원 가정간호 보건활동을 중심으로 -)

  • Suh, Mi-Hae;Huh, Hae-Kyung
    • Journal of Home Health Care Nursing
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    • v.3
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    • pp.53-66
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    • 1996
  • Home Health Care is one part of the total health care system. It includes health care services that link the hospital to the community. While it is important for early discharge patients, home care is also important for people with chronic illnesses or handicapping conditions. In 1989 the Korean government passed a law that opened the way for formal development of home health care services beginning with education programs to certify nurses for home care, and then demonstration home care services. Part of the mandate of the demonstration projects was evaluation of home care services. This study was done in order to provide basic data that would contribute to the development of records that could be used for evaluation through a retrospective audit and to examine the care that had been given in Home Care at Wonju Christian Hospital over a twenty year period from 1974 to 1994. The purposes of the study were : to identify to characteristics of the clients who had received home care, to identify the reasons for client referrals, to identify the nursing problems of these clients, to identify the nursing care provided to these clients, and to identify differences in these areas over the twenty year period. The study was a descriptive study involving a retrospective audit of the client records. Demographic data on all clients were included : 4,171 clients from 2,564 families. Data on referrals, nursing diagnosis and nursing interventions were from even numbered records which had a patient problem list included in the record, 2,801 clients, Frequencies and ANOVA were used in the analysis. The results of the study showed that the majority of the clients were from Wonju city /county. There were more women than men related to the high number of postpartum clients(1,300). The high number of postparttum clients and newborns was also evident in the age distribution. An the number of maternal-child clients decreased over the 20 years, the mean age of the clients increased significantly. Other factors also contributed to this change ; as increasing number of clients with brain injuries or with cancer, and fewer children with burns, osteomyelitis and tuberculosis. There was a decrease in the mean number of visits and mean length of coverage, reflecting a movement towards a short term acute care model. The number of new clents dropped sharply after 1985. The reasons for this are : the development of other treatment alternatives for clients, the establishment of an active wellbaby clinic, many more options plus a decreasing number of new cases of Hansen's Disase, and insurance that allows people with burns to be kept in hospital until skin grafts are healed. Socioeconomic changes have resulted in an increase in the number of cases of cancer, stroke, head injuries following car accidents, and of diabetes. Of the 2,801 client records, 2,541(60.9%) contained a written referral but for 1,802 it contained only the medical diagnosis. The number of records with a referral requesting specific nursing care was 739(29.1%). Many family members who were identified as in need of nursing care had no written referral. Analysis of the patient problem list showed that 41.9% of the enteries were nursing diagnoses. Others incuded medical diagnosis, symptoms, and plans. The most frequently used diagnoses were alteration in nutrition, less than body requirements(115 entries), alteration in skin integrity(114), knowledge deficit(111), pain(78), self-care deficit(66), and alteration in pattern of urinary elimination(50). These are reflected in the NANDA categories for which the highest number of diagnosis was in the Exchanging pattern(446), followed by Moving(178), Feeling(136) and Knowing (115). Analysis of the frequency of interventions showed that exercise and teaching about exercise was the most frequent intervention, followed by teaching concering the need for follow-up care, checking vital signs, managing nutritional problems, managing catheters, giving emotional support, changing dressings, teaching about medication, teaching (subject not specified), teaching about diet, IM and IV medications or fluid, and skin care, in that order. Recommendations included: development of a record that would allow for efficient recording of frequently used nursing diagnoses and nursing interventions: expansion of the catchment area for Home Care at Wonju Christian Hospital ; expansion of the service to provide complication prevention, rehabilitation services, and support to increase the health maintenance /health promotion of the people being served as well as providing client dentered care ; and development of a clinical record that will allow efficient data collection from records, even though the recording is done by a variety of health care providers.

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Development of a Failure Probability Model based on Operation Data of Thermal Piping Network in District Heating System (지역난방 열배관망 운영데이터 기반의 파손확률 모델 개발)

  • Kim, Hyoung Seok;Kim, Gye Beom;Kim, Lae Hyun
    • Korean Chemical Engineering Research
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    • v.55 no.3
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    • pp.322-331
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    • 2017
  • District heating was first introduced in Korea in 1985. As the service life of the underground thermal piping network has increased for more than 30 years, the maintenance of the underground thermal pipe has become an important issue. A variety of complex technologies are required for periodic inspection and operation management for the maintenance of the aged thermal piping network. Especially, it is required to develop a model that can be used for decision making in order to derive optimal maintenance and replacement point from the economic viewpoint in the field. In this study, the analysis was carried out based on the repair history and accident data at the operation of the thermal pipe network of five districts in the Korea District Heating Corporation. A failure probability model was developed by introducing statistical techniques of qualitative analysis and binomial logistic regression analysis. As a result of qualitative analysis of maintenance history and accident data, the most important cause of pipeline damage was construction erosion, corrosion of pipe and bad material accounted for about 82%. In the statistical model analysis, by setting the separation point of the classification to 0.25, the accuracy of the thermal pipe breakage and non-breakage classification improved to 73.5%. In order to establish the failure probability model, the fitness of the model was verified through the Hosmer and Lemeshow test, the independent test of the independent variables, and the Chi-Square test of the model. According to the results of analysis of the risk of thermal pipe network damage, the highest probability of failure was analyzed as the thermal pipeline constructed by the F construction company in the reducer pipe of less than 250mm, which is more than 10 years on the Seoul area motorway in winter. The results of this study can be used to prioritize maintenance, preventive inspection, and replacement of thermal piping systems. In addition, it will be possible to reduce the frequency of thermal pipeline damage and to use it more aggressively to manage thermal piping network by establishing and coping with accident prevention plan in advance such as inspection and maintenance.

Cardiac Intracoronary Stenting vs CABG: Prevention of Medical Accident (심장 스텐트 시술과 의료사고 예방)

  • Kim, Kyoung Reay;Park, Kook Yang
    • 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.

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