• Journal of the Korean Society of Radiology
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• v.9 no.1
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• pp.1-7
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• 2015

Acute phase patients who are unconscious and are suffering from cerebral infarction, cranial nerve disorders, or cerebral apoplexy are susceptible to aspiration pneumonia due to dysphagia. In these cases, a nasogastric tube is inserted to supply nutrients. Although bedside screening tests are administered during recovery after rehabilitation, clinical examinations may not be able to ascertain asymptomatic aspiration. Therefore, a video fluoroscopy swallowing study (VFSS) was performed in 10 patients with dysphagia after rehabilitation therapy; these patients had nasogastric tubes inserted, and a rehabilitation specialist assessed the degree of swallowing based on the patients' diet and posture. If aspiration or swallowing difficulties were observed, dysphagia rehabilitation therapy was administered. The patients were reassessed approximately 30-50 days after administration of therapy, based on the patients' condition. If aspiration is not observed, the nasogastric tube was removed. A functional dysphagia scale was used to analyze the VFSS images, and the scores were statistically calculated. The mean score of patients with nasogastric tubes was $49.79{\pm}9.431$, thereby indicating aspiration risk, whereas the group without nasogastric tubes showed a mean score of $11.20{\pm}1.932$, which indicated low risk of aspiration. These results demonstrated that a significantly low score was associated with nasogastric tube removal. Mann-Whitney's test was performed to assess the significance of both the groups, and the results were statistically significant with a P value <0.001. In conclusion, VFSS can effectively assess the movements and structural abnormalities in the oral cavity, pharynx, and esophagus. It can also be used to determine the aspiration status and ascertain the appropriate diet or swallowing posture for the patient. Therefore, VFSS can potentially be used as a reliable standard test to assess swallowing in order to determine nasogastric tube removal.

• Journal of the Korean Applied Science and Technology
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• v.35 no.1
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• pp.1-11
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• 2018

The purposes of this study were to examine the depression level of sales workers at a cosmetics company in South Korea and investigate the effects of emotional labor, job stress, and resilience on their depression symptoms. A structured questionnaire was distributed to 189 workers at the cosmetics company to assess their general characteristics, diseases diagnosed by the doctor, depression, emotional labor, job stress, and resilience. Univariate analysis and multiple logistic regression analysis was conducted to examine connections among depression symptoms, emotional labor, job stress, and resilience. The findings show that the depression symptom rate of the cosmetics sales workers was 32.3%. The multiple logistic regression analysis results of the high risk group in depression symptoms show that depression had significant relations with resilience(OR : 3.84, CI : 1.68-8.77), diseases diagnosed by the doctor(OR : 3.82, CI : 1.73-8.47), emotional disharmony(OR : 2.51, CI : 1.06-5.96), and job demand(OR : 2.12, CI : 0.93-4.85). The low risk group of emotional labor was corrected in age, doctor's diagnosis, and job stress with the reference value to analyze connections with depression symptoms according to the degree of resilience. The analysis results show that depression symptoms increased by 2.35 times(CI : 0.73-7.53) when they had high emotional labor and good resilience, by 3.74 times(CI : 1.17-11.97) when they had low emotional labor and bad resilience, and by 10.39 times(CI : 3.34-32.28) when they had high emotional labor and bad resilience. These findings raise a need to run a program to increase resilience, reduce emotional disharmony through emotional labor management, and take health management measures to control physical illness and lower job stress so that cosmetics sales workers can manage their depression symptoms.

• The Korean Society of Law and Medicine
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• v.19 no.1
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• pp.113-142
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• 2018

In recent years, there have been opinions in which physicians are liable to the revocation of their medical license if they are sentenced to above a certain level for criminal charges regardless of the types of offenses. Accordingly, a revised bill of law was submitted in the National Assembly, and related discussions are thus expected to commence. Considering the morality and ethics or the level of the rule of law that the general public expects of physicians, as well as the license revocation system in other professional sectors, it is assessed that medical license revocation due to criminal convictions of physicians is appropriate to some degree. However, if a poorly devised system is established based on unrefined inferences or emotional judgements, unexpected side-effects are likely to arise. With regard to serious criminal acts that society generally perceives as unacceptable, it can be assessed that the revocation of physicians' licenses would appropriately protect the general public from threats. However, given the life-saving characteristics of high-risk medical practices, higher malpractice exposures, and social values, it is difficult to assess charges of professional negligence resulting in death(or in injury) and minor offences in the same manner as anti-social criminal offences are handled. Physicians need to be treated the same as any other professions. At the same time, they are engaged in administering medical treatment to patients in the face of great risks as professionals. Under the circumstances, a discussion on the introduction of a more specific and empirical system is needed by considering the intrinsic characteristics of medical treatment and the need for an equitable health and medical policy. Accordingly, based on the above judgment and perception, this study explores the code of ethics for physicians and medical license revocation related to criminal offences at home and abroad, and examines various legislative alternatives appropriate for the Republic of Korea. In doing so, the purpose of the study is to contribute to the development of a reasonable system for handling criminal offences by physicians.

• The Journal of the Korea Contents Association
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• v.16 no.1
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• pp.24-41
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• 2016

Study is about Bit Coin that is electronic cash that is received attention globally in recent. It is increasing domestically that uses bit coin for convenience of micro payment, and also bit coin is possible to exchange each countries' currency. In this point, we searched understanding degree and acceptance of bit coin. Also we applied transformed TAM(Technology Acceptance Model) to search factors that have an effect on consumers' intention to use it. In advance, we analyze features of bit coin, and extract factors through preceding researches for existing electronic cash, because studies for intention to use bit coin are weak in internal and external. First of results is that 'economic efficiency' which is a characteristic variable of bit coin influences 'intention to use,' a dependent variable through 'perceived usefulness,' a parameter. It was investigated that monetary and mental costs that was costed when we use bit coin were less than using other cash. Secondly, 'payment convenience' that is a characteristic variable affects 'intention to use', a dependent variable through 'perceived usefulness,' a parameter. It was measured that problems of inconvenience that include transaction process, cash management time shortage and exchange changes will be solved by using bit coin. Thirdly, 'reliability' that is a perceived risk variable of bit coin has a direct effect on 'intention to use,' a dependent variable. It was investigated that we could achieve purpose of payment because we weren't influenced by breakdown on system by processing distributed database in some computers. Fourthly, 'perceived usefulness,' a parameter of bit coin directly affects 'intention to use,' a dependent variable. Then consumers who want to use bit coin are fascinated bit coin for various usability. Moreover, we want to provide implications to all of finance corporations, companies related electronic cash and bit coin users based on these results.

• Korean Security Journal
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• no.37
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• pp.325-354
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• 2013

The concept of national security and the fundamental system for crisis management have departed from traditional methods and the importance of a national critical infrastructure crisis management has been emphasized. A national critical infrastructure crisis means a situation where human resource, material and functional system that may have a material effect on the critical functions of the government, the vitality and integrity of society, national economy and the safety of the public becomes disabled due to causes such as terrorism or major disasters. Although North Korea had been subject to numerous rounds of negotiations and sanctions as it continually developed nuclear weapons since the 1960s, it has also showed off its nuclear armaments through successful nuclear testings and missile launches. As the development and threat of North Korea's weapons of mass destruction becomes more noticeable and the range of its risk expands, this study focuses on the potential for an absence of leadership for national crisis management where the country's leadership, which should serve the critical role and function of handling national crises, becomes completely destroyed by the unexpected initial attacks by North Korea. As a result, the purpose of this study is to propose safety measures for the country's leadership in preparation for North Korea's threat of nuclear weapons by examining the concept and degree of risk of weapons of mass destruction with a focus on nuclear weapons, analyzing the substance of the threat of North Korean nuclear weapons and evaluating such threat. In conclusion, first, to ensure the normal functioning of a national crisis management system in the event of a national crisis, we must seek safety measures that conform to the scope and succession order of the leadership of the national crisis management for an Enduring Constitutional Government (ECG) and the Continuity Of Operations (COOP). Second, in the event of a national ceremony, the gathering of the country's leadership all together in an open place should be avoided. In unavoidable circumstances, the next in rank that will act on behalf of the current leader should be designated and relevant safety measures should be taken. Third, during time of peace, in preparation for national crises, the scope of protection for the country's leadership should be prescribed and specific security and safety measures should be implemented. Fourth, the succession order for acting president in the case of the death of the president pursuant to Articles 71 and 26(1) of the National Government Organization Act should reconsidered to see whether it is a reasonable provision that takes into consideration a national crisis management that corresponds to the threat of North Korean nuclear weapons and weapons of mass destruction. Pursuant to the Basic Guidelines for National Crisis Management set out under Presidential Directive No. 229, the Korean government is currently operating a case-by-case "crisis management standard manual" and its sub-manuals and has also prepared the Presidential Security Service's security and safety measure regulations regarding the acting president. Therefore, the Korean government should actualize the above points in the case-by-case crisis management standard manual and security and safety measure regulations regarding the acting president to implement and legislate them.

• KDI Journal of Economic Policy
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• v.32 no.2
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• pp.171-216
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• 2010

With the payment and settlement systems becoming more and more complex and interconnected, the issue of their interdependency rises as an important academic issue as well as a policy topic. This study examines causes, forms, and risk management of interdependencies of payment and settlement systems in Korea, and presents their current situation. By way of simulations using BOF-PSS2 developed by the Bank of Finland, we quantify the effects of an operational disruption on the payment and settlement systems so as to figure out the degree of interdependency. As a result, the secondary round effect reaches up to ￦13.6 trillion a day, which amounts to 7.8% of the daily settlement value. Furthermore, if we also consider the amount of direct operational disruption, the volume of operational disruption occupies 22.3% of total value of the daily settlement, evidencing that the interdependencies of the payment and settlement systems in Korea is enormously widespread. The secondary round effects are found to be more severe with security companies rather than with banks, and to be more depended upon when it is perceived rather than it actually happens. In case that we expand the liquidity to include cash holdings and deposits as assets, the secondary round effect dramatically decreases in all types of financial institutions while foreign banks account for more share of all the secondary round effects increases. Based on these results, we suggest various policy tasks and directions to improve the risk management of settlement systems: expansion of off-setting settlements, introduction of a new settlement system for securities transactions, rapid provision of liquidity to financial institutions, more effective monitoring on participant institutions, and intensified information sharing and cooperation among the systems.

• Radiation Oncology Journal
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• v.23 no.1
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• pp.32-42
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• 2005

Purpose : To evaluate the incidence of arm morbidity following breast cancer surgery including axillary dissection and to identify related factors. Materials and Methods : One hundred and fifty nine patients were studied using a self-report questionnaire and a clinical examination. Lymphedema, reduction of range of motion in shoulder joint and subjective symptoms (pain, impaired arm movement, numbness, stiffness) were evaluated. As related factors, demographic, oncologic characteristics and types of treatment were analysed. Results : The incidence of lymphedema ($\geqq$2 cm difference comparing to unaffected arm) was $6.3\%$, $10.7\%$, $22.5\%$ and $23.3\%$ at each 10 cm, 20 cm, 30 cm, and 40 cm from wrist. Reduction of range of motion in shoulder joint ($\geqq$ 20 degree difference comparing to unaffected arm) was noted In more than 1/3 patients for flexion, abduction and internal rotation. Especially the reduction of range of motion in internal rotation was severe ($>50\%$ reduction) in 1/3 patients. Approximately 50 to $60\%$ of patients complained impaired arm movement, numbness, stiffness and pain. Body mass index (BMI) was the significant risk factor for lymphedema. Conclusion : Lymphedema was present in 1/3 of patients and the common sites of edema were 30 cm 40 cm proximal from the wrist. Also most severe reduction of range of motion in shoulder joint was with internal rotation. There needs weight control for lymphedema because BMI was the significant risk factor for lymphedema. Also rehabilitation program for range of motion especially internal rotation In shoulder joint should be developed.

• Journal of Chest Surgery
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• v.34 no.12
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• pp.901-908
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• 2001

Background : Coronary artery bypass graft(CABG) in patients with advanced left ventricular dysfunction has often been regarded as having high mortality rate, despite the great improvement in operative result of CABG. With recent advances in surgical technique and myocardial protection, surgical revascularization improved the symptom and long-term survival of these high risk patients more than the medical conservative treatment. Material and Methold : Clinical data of 31(4.1％) patients with preoperative ejection fraction less than 30% among 864 CABGs performed between January 1995 and March 1999 were retrospectively analyzed and pre- and postoperative changes of the ejection fraction on echocardiography were analyzed. There were 26 men and 5 women. The mean age was 60.7 years(range 41 to 72 years). History of myocardial infarction(30 cases, 98％) was the most common preoperative risk factor. There were seven irreversible myocardial infarction on thallium scan. Most patients had triple vessel diseases(26 cases, 84％) and first degree of Rentrop classification(16 cases, 52％) on coronary angiography. The mean number of distal anastomosis during CABG was per patient was 4.9${\pm}$0.8 sites in each patient. In addition to long saphenous veins, the internal mammary artery was used in 20 patients. Total bypass time was 244.7${\pm}$3.7 minutes(range, 117 to 567 minutes), and mean aortic cross-clamp time was 77.9 ${\pm}$ 1.6 minutes(range, 30 to 178 minutes). There were five other reparative procedures such as two left ventricular aneurysrmectomy, two mitral repair, and one aortic valve replacement. There were twelve postoperative complications such as three cardiac arrhythmia, two bleeding(re-operation), one delayed sternal closure, eleven usage of intra-aortic balloon counterpulsation for low cardiac output. Two patients died, postoperative mortality was 6.5% . Twenty-nine patients were relieved of chest pain and left ventricular ejection fraction after operation was significantly higher(38.5${\pm}$11.6%, p 0.001) as compared with preoperative left ventricular ejection fraction(25.3${\pm}$2.3%). The follow up period of out patient was 25. 3 months. Conclusion: In patients with coronary artery disease and advanced left ventricular dysfunction, coronary artery bypass grafting can be performed relatively safely with improvement in left ventricular function, but it will be necessary to study long term results.

• Journal of Chest Surgery
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• v.37 no.5
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• pp.410-415
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• 2004

Background: In the operation for coronary artery stenosis, the procedures for mitral regurgitation are restricted to cases of more than moderate mitral regurgitation or for the lesions in leaflets. This is based on the belief that the less than mild regurgitation are a form of reversible change results from ischemia with coronary artery stenosis. We studied the changes and prognostic factors of mitral regurgitation in patients with coronary artery stenosis and mitral regurgitation who underwent coronary artery bypass surgery alone. Material and Method: We reviewed the medical records of 90 patients with coronary artery stenosis and mitral regurgitation who underwent coronary artery bypass surgery alone by a single surgeon from Jan. 1995 to Dec. 2002, We grouped the patients according to the postoperative changes of mitral regurgitation, and then we statistically compared the findings of echocardiogram between preoperative and last follow up. Result: There were 24 cases with progression of mitral regurgitation, 12 cases without changes, 54 cases with improvements of mitral regurgitation in total 90 patients. The bypass to LAD was proven as the significant prognostic factor of mitral regurgitation. The preoperative end diastolic left ventricular volume index were higher in aggravated group with 105.38$\pm$38.89 $m\ell$ compared to 71.75$\pm$28,45 $m\ell$ in improvement group, and 84.00$\pm$11.66 $m\ell$ in no change group. The grade of preoperative mitral regurgitation did not show significant differences among the groups. Conclusion: The mitral regurgitation in patient with coronary artery stenosis can be improved after the coronary artery bypass surgery alone. However, the expectation of improvements based on the degree of preparative mitral regurgitation can not be justified, therefore, the procedures for mitral regurgitation should be aggressively considered even in the cases of mild mitral regurgitation. Also, further study should be performed to identify the exact prognostic factors of mitral regurgitation including the left ventricular volume index, and whether the left anterior descending artery has been bypassed.

• The Korean Society of Law and Medicine
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• v.16 no.2
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• pp.55-84
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• 2015

The tuberculosis is the infectious disease. Generally, the active tuberculosis patient can infect the 10 persons for one year within the daily activities like casual conversation and singing together. The infectivity of tuberculosis can continue for a life time, and infected persons can remain at risk for developing active tuberculosis. To control this contagious disease, along with the active tuberculosis patients, non-infectious but non-compliant patients who can be infectious if their immune systems become impaired have to be managed. To control the non-complaint patients, medical treatment order should be combined with the public order. Because tuberculosis is the risk of community health, the human rights like liberty and freedom of movement can be restricted for public welfare under the article 37(2) of constitution. Even when such restriction is imposed, no essential aspect of the freedom or right shall be violated. The degree of restriction on the rights of citizens is different what methods are chosen to non-complaint patients. For example, under the directly observed therapy program, the patients and medical staffs make an appointment and meet to confirm the drug intakes according to the schedule, which is the medical treatment combined with the mildest public order. If the patients break the appointments or have the history of disobedient, the involuntary detention can obtain the legitimate cause. The Tuberculosis Prevention Act has the two step programs on this involuntary detention, The admission order (Article 15) is issued when the patients are infectious. The quarantine order (Artle 15-2) is issued when the patients are infectious and non-complaint. The legal criteria for involuntary detention are discussed and published through the international conventions and covenants. For example, World Health Organization had made guidance on human rights and involuntary detention for tuberculosis control. The restrictions should be carried out in accordance with the our law and in the legitimate objective of public interest. And the restriction should be based on scientific evidence and not imposed in an unreasonable or discriminatory manner. We define and adopt these international criteria under our constitution and legal system. Least restrictive alternative principle, proportionality principle and the individual evaluation methods are explained through the reviews of United States court decisions. Habeas Corpus Act is reviewed and adopted as the procedural due process to protect the patient rights as a citizen. Along with that, what conditions and facilities which are needed to performed quarantine order are discussed.