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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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A study on Establishment and Management of the CCTV in Operating Room (수술실 CCTV 설치 및 운영에 대한 고찰)

  • Kim, Minji
    • The Korean Society of Law and Medicine
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    • v.20 no.1
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    • pp.109-132
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    • 2019
  • Recently, medical accidents related to surgical procedures have increased. In addition, the media reported that some of these accidents were involved in health crimes. Patient-advocate groups have called for mandatory establishment and management of CCTV in operating rooms. There is a lot of discussion among the interested parties, so it is necessary to review the relevant laws and regulations. The purpose of this study is to identify the characteristics of CCTV in operating rooms and to review legislations related to establishment and management of the CCTV in operating rooms. Medical institutions use CCTV for management of facilities and patient safety and install it in operating rooms optionally. The Constitution guarantees the privacy and the privacy of correspondence of every citizen, but it can be limited by the law for public welfare. Currently, however, there is no existing law about establishment and management of the CCTV in operating rooms and it can be defect of legal system. Under the current legislations, it is likely that the Self-determination can be violated due to the characteristic of healthcare provider when CCTV is mandatorily installed in operating room. In addition, the regulations on access and leakage of confidential information known by operator are insufficient. So that, the safety of the visual data might be threatened. Furthermore, unless the period and the place of storage of the visual data are clearly defined, it is highly unlikely to meet the original purpose of patient safety and prevention of medical accidents. This study is meaningful as there is few previous study on this topic although the need for legal review about this is growing and several bills are being proposed. It is expected that the results of this study can be utilized as basic data for enactment or amendment of the laws and regulations about establishment and management of CCTV in operating rooms.

The Influence of the repeated learning of moving picture materials applying 'the development of mathematical power' program on The Self-Directed Learning (수학적 힘의 신장 프로그램을 적용한 교실 수업 동영상 자료 반복 학습이 자기 주도적 학습에 미치는 영향 - 수학 I 을 중심으로 -)

  • Byun Kyung-Hae
    • Communications of Mathematical Education
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    • v.20 no.2 s.26
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    • pp.295-326
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    • 2006
  • Despite the importance of mathematics education, many students in high school have lost their interests and felt difficulties and they don't have 'mathematical' experience with meanings attached because of the entrance examination. This paper attempted to resolve these problems and find the teaching-method with which students can study by themselves with more confidence. Nowadays students' use of Internet is very popular. After develop 'the development of mathematical power' program based on mathematics history, history, science, the application of problems in real world, and self-evaluation, I made students repeat them after making teaching lessons in classroom as moving pictures. Through this processes, I attempted to develop the Self-Directed Learning' ability by making public education substantial. First of all I analyzed the actual conditions on 'Self-Directed Learning' ability in mathematics subject, the conditions of seeing and hearing in Internet learning program, and students' and their parents' interests in Internet education. By analyzing the records, I observed the significance of the introducing mathematics history in mathematics subject in early stager, cooperative-learning, leveled-learning, self-directed learning, and Internet learning. Actually in aspect of applying 'the development of mathematical power' program, at first I made up the educational conditions to fix the program, collected the teaching materials, established the system of teaching-learning model, developed materials for the learning applying Internet mail and instruments of classroom, and carried out instruction to establish and practice mathematics learning plan. Then I applied the teaching-learning model of leveled cooperation and presentation loaming and at the same time constructed and used the leveled learning materials of complementary, average, and advanced process and instructed to watch teaching moving pictures through Internet mail and in the classroom. After that I observed how effective this program was through the interest arid attitude toward mathematics subject, learning accomplishment, and the change of self-directed learning. Finally, I wrote the conclusion and suggestion on the preparation of conditions fur the students' voluntary participation in mathematics learning and the project and application on 'the development of mathematical power' program and repeated learning with the materials of moving pictures in classroom.

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On­farm Survey on Deer Farming Situation and Environment in Korea (우리나라 양록업 현황 및 환경 실태 조사)

  • 성시흥;문상호;전병태;이승기
    • Journal of Animal Environmental Science
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    • v.9 no.2
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    • pp.123-130
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    • 2003
  • In this study, current status of domestic deer farms and its feeding were surveyed. The information of supply and demand of feed f3r deers including its industry were also examined and then analyzed to make fundamental data for deer farms and government policy. The results are as follows. 1. Over 40 years old farmers were about 63% of total deer farms while 20­30 years olds were less than 1% indicating that young people still evade agriculture. Moreover, considering education, over 52% of the farmers have bachelor degree showing much higher rates compared to the other agricultural fields. The reason can be assumed that the labor burden is not serious in deer farming while it is not dirty job compared to the other livestock management. Those high­educated people can be easily trained as experts of deer farming to improve its international competition. 2. Most of investigated farms raise Korean spotted deers and Elk showing that the percentage of Elk has greatly increased(However, many farmers have complained about purchasing methods and they insisted that the sales organization should be controlled by government). 3. 57% of total cost of production is for feed while most of feeds are imported from abroad. It indicated that it is urgent to make counterplan for saving feed cost. 4. It is necessary to develop feeds for deers in the near future while most of the examined farmers currently use normal assorted feed. Typical roughage sources feeds are rice straw, alfalfa hay, browses feed, and so on. Most of them are currently imported except the rice straw indicating urgently needed to develop domestic bulky feed. 5. The present questions are development of processed goods of velvet antler, establishment of reasonable management system, difficulty of velvet antler selling, feed supply, and so on. It is necessary for government and academic world to develop reasonable policy and scientific research program.

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The Health Status of Rural Farming Women (농촌여성(農村女性)의 건강실태(健康實態)에 관한 연구(硏究))

  • Park, Jung-Eun
    • Journal of agricultural medicine and community health
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    • v.15 no.2
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    • pp.97-106
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    • 1990
  • 1. Background Women's health and their involvement in health care are essential to health for everyone. If they are ignorant, malnourished or over-worked, the health &-their families as well as their own health will suffer. Women's health depends on broad considerations beyond medicine. Among other things, it depends upon their work in farming. their subordination to their families, their accepted roles, and poor hygiene with poorly equipped housing and environmental sanitation. 2. Objectives and Contents a. The health status of rural women : physical and mental complaints, experience of pesticides intoxication, Farmer's syndrome, experiences of reproductive health problems. b. participation in and attitudes towards housework and farming c. accessibility of medical care d. status of maternal health : fertility, family planning practice. induced abortion, and maternal care 3. Research method A nationwide field survey, based on stratified random sampling, was conducted during July, 1986. Revised Cornell Medical index(68 out of 195 items). Kawagai's Farmers Syndrome Scale, and self-developed structured questionnaires were used to rural farming wives(n=2.028). aged between 26-55. 4. Characteristics of the respondents mean age : 40.2 marital status : 90.8% married mean no. of household : 4.9 average years of education : 4.7 yrs. average income of household : \235,000 average years of residence in rural area : 36.4 yrs average Working hours(household and farming) : 11 hrs. 23 min 5. Health Status of rural women a. The average number of physical and mental symptoms were 12.4, 4.7, and the rate of complaints were 22.1%, 38.8% each. revealing complaints of mental symptomes higher than physical ones. b. 65.4% of rural women complained of more than 4 symptoms out of 9, indicating farmer's syndrome. 11.9 % experienced pesticide overdue syndrome c. 57.6% of respondents experienced women-specific health problems. d. Age and education of respondents were the variables which affect on the level of their health 6. Utilization of medical services a. The number of symptoms and complaints of respondents were dependent on the distance to where the health-care service is given b. Drug store was the most commonly utilized due to low price and the distance to reach. while nurse practitioners were well utilized when there were nurse practitioner's office in their villages. c. Rural women were internalized their subordination to husbands and children, revealing they are positive(93%) in health-care demand for-them but negative(30%) for themselves d. 33.0% of respondents were habitual drug users, 4.5% were smokers and 32.3% were alcohol drinkers. and 86.3% experienced induced-abortion. But most of them(77.6%) knew that those had negative effects on health. 7. Maternal Health Care a. Practice rate of contraception was 48.1% : female users were 90.9% in permanent and 89.6% in temporary contraception b. Induced abortions were taken mostly at hospital(86.3%), while health centers(4.7%), midwiferies(4.3%). and others(4.5%) including drug stores were listed a few. The repeated numbers of induced abortion seemed affected on the increasing numbers of symptoms and complaints. c. The first pre-natal check-up during first trimester was 41.8%, safe delivery rate was 15.6%, post-natal check-up during two months after delivery. Rural women had no enough rest after delivery revealing average days of rest from home work and farming 8.3 and 17.2. d. 86.6% practised breast feeding, showing younger and more educated mothers depending on artificial milk 8. Recommendations a. To lessen the multiple role over burden housing and sanitary conditions should be improved, and are needed farming machiner es for women and training on the use of them b. Health education should begin at primary school including health behavior and living environment. c. Women should be encouraged to become policy-makers as well as administrators in the field of women specific health affairs. d. Women's health indicators should be developed and women's health surveillance system too.

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A Study of Textured Image Segmentation using Phase Information (페이즈 정보를 이용한 텍스처 영상 분할 연구)

  • Oh, Suk
    • Journal of the Korea Society of Computer and Information
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    • v.16 no.2
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    • pp.249-256
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    • 2011
  • Finding a new set of features representing textured images is one of the most important studies in textured image analysis. This is because it is impossible to construct a perfect set of features representing every textured image, and it is inevitable to choose some relevant features which are efficient to on-going image processing jobs. This paper intends to find relevant features which are efficient to textured image segmentation. In this regards, this paper presents a different method for the segmentation of textured images based on the Gabor filter. Gabor filter is known to be a very efficient and effective tool which represents human visual system for texture analysis. Filtering a real-valued input image by the Gabor filter results in complex-valued output data defined in the spatial frequency domain. This complex value, as usual, gives the module and the phase. This paper focused its attention on the phase information, rather than the module information. In fact, the module information is considered very useful at region analysis in texture, while the phase information was considered almost of no use. But this paper shows that the phase information can also be fully useful and effective at region analysis in texture, once a good method introduced. We now propose "phase derivated method", which is an efficient and effective way to compute the useful phase information directly from the filtered value. This new method reduces effectively computing burden and widen applicable textured images.

A Study on Relationship between Physical Elements and Tennis/Golf Elbow

  • Choi, Jungmin;Park, Jungwoo;Kim, Hyunseung
    • Journal of the Ergonomics Society of Korea
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    • v.36 no.3
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    • pp.183-196
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    • 2017
  • Objective: The purpose of this research was to assess the agreement between job physical risk factor analysis by ergonomists using ergonomic methods and physical examinations made by occupational physicians on the presence of musculoskeletal disorders of the upper extremities. Background: Ergonomics is the systematic application of principles concerned with the design of devices and working conditions for enhancing human capabilities and optimizing working and living conditions. Proper ergonomic design is necessary to prevent injuries and physical and emotional stress. The major types of ergonomic injuries and incidents are cumulative trauma disorders (CTDs), acute strains, sprains, and system failures. Minimization of use of excessive force and awkward postures can help to prevent such injuries Method: Initial data were collected as part of a larger study by the University of Utah Ergonomics and Safety program field data collection teams and medical data collection teams from the Rocky Mountain Center for Occupational and Environmental Health (RMCOEH). Subjects included 173 male and female workers, 83 at Beehive Clothing (a clothing plant), 74 at Autoliv (a plant making air bags for vehicles), and 16 at Deseret Meat (a meat-processing plant). Posture and effort levels were analyzed using a software program developed at the University of Utah (Utah Ergonomic Analysis Tool). The Ergonomic Epicondylitis Model (EEM) was developed to assess the risk of epicondylitis from observable job physical factors. The model considers five job risk factors: (1) intensity of exertion, (2) forearm rotation, (3) wrist posture, (4) elbow compression, and (5) speed of work. Qualitative ratings of these physical factors were determined during video analysis. Personal variables were also investigated to study their relationship with epicondylitis. Logistic regression models were used to determine the association between risk factors and symptoms of epicondyle pain. Results: Results of this study indicate that gender, smoking status, and BMI do have an effect on the risk of epicondylitis but there is not a statistically significant relationship between EEM and epicondylitis. Conclusion: This research studied the relationship between an Ergonomic Epicondylitis Model (EEM) and the occurrence of epicondylitis. The model was not predictive for epicondylitis. However, it is clear that epicondylitis was associated with some individual risk factors such as smoking status, gender, and BMI. Based on the results, future research may discover risk factors that seem to increase the risk of epicondylitis. Application: Although this research used a combination of questionnaire, ergonomic job analysis, and medical job analysis to specifically verify risk factors related to epicondylitis, there are limitations. This research did not have a very large sample size because only 173 subjects were available for this study. Also, it was conducted in only 3 facilities, a plant making air bags for vehicles, a meat-processing plant, and a clothing plant in Utah. If working conditions in other kinds of facilities are considered, results may improve. Therefore, future research should perform analysis with additional subjects in different kinds of facilities. Repetition and duration of a task were not considered as risk factors in this research. These two factors could be associated with epicondylitis so it could be important to include these factors in future research. Psychosocial data and workplace conditions (e.g., low temperature) were also noted during data collection, and could be used to further study the prevalence of epicondylitis. Univariate analysis methods could be used for each variable of EEM. This research was performed using multivariate analysis. Therefore, it was difficult to recognize the different effect of each variable. Basically, the difference between univariate and multivariate analysis is that univariate analysis deals with one predictor variable at a time, whereas multivariate analysis deals with multiple predictor variables combined in a predetermined manner. The univariate analysis could show how each variable is associated with epicondyle pain. This may allow more appropriate weighting factors to be determined and therefore improve the performance of the EEM.

Effect of Di(2-ethyl hexyl)phthalate(DEHP) on the Onset of Puberty in Female Rat (암컷 흰쥐의 사춘기 개시에 미치는 di(2-ethyl hexyl)phthalate(DEHP)의 효과)

  • Lee, Kyeung-Yeup;Lee, Sung-Ho
    • Development and Reproduction
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    • v.10 no.2
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    • pp.147-154
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    • 2006
  • Phthalates such as di(2-ethyl hexyl)phthalate(DEHP) are industrial chemicals with wide-ranging human exposures because of their use in plastics and other common consumer products. Consequently, their adverse effects as endocrine disruptor in the reproductive physiology of both laboratory rodents and human have been studied extensively. The present study was undertaken to examine whether prepubertal exposure to DEHP affects on the onset of puberty and the associated reproductive parameters such as hormone receptor expressions in female rats. DEHP(100mg/kg/day) was administered daily from postnatal day 25(PND 25) through the day when the first vaginal opening(VO) was observed, and the animals were sacrificed on the next day. Gross anatomy and weight of reproductive tissues were compared to test the DEHP's effects on the cell proliferation. Furthermore, histological studies were performed to assess the structural alterations in the tissues. Specific radioimmunoassay was carried out to measure serum LH levels. To determine the transcriptional changes in progesterone receptor(PR), total RNAs were extracted and applied to the semi-quantitative reverse transcription polymerase chain reaction(RT-PCR). As a result, delayed VO was shown in the DEHP group(PND $37.3{\pm}0.7$) compared to the control group(PND $35.3{\pm}0.7$; p<0.05). DEHP treatment significantly decreased the wet weight of ovaries and uteri compared to the control group(p<0.05). Interestingly, elevation of serum LH levels was shown in the DEHP group(p<0.05). Graafian follicles and corpora lutea were observed only in the ovaries from the control animals. Numerous primary, secondary follicles and small atretic follicles were observed in the ovaries from DEHP-treated animals. Similarly, hypotrophy of luminal and glandular uterine epithelium was found in the DEHP-treated group. These effects were probably due to the inhibitory effects of DEHP on the synthesis and secretion of estrogen from granulosa cells. In the semiquantitative RT-PCR studies, the transcriptional activities of PR in both ovary(p<0.05) and uterus(p<0.01) from DEHP-treated animals were significantly lower than those from the control animals. The present studies demonstrated that the acute exposure to DEHP during the critical period of prepubertal stage could inactivate the reproductive system resulting delayed puberty in female rats.

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Effects of Light Sources, Light Quality on the Growth Response of Leafy Vegetables in Closed-type Plant Factory System (완전제어형 식물공장에서 광원, 광질에 따른 엽채류 6종의 생육반응)

  • Kim, Sang Bum;Lee, Kyung Mi;Kim, Hae Ran;You, Young Han
    • Korean Journal of Ecology and Environment
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    • v.47 no.1
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    • pp.32-40
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    • 2014
  • This study was conducted to evaluate the growth response of economical six leafy vegetables that are crown daisy, pak-choi and four kinds of lettuce (Red leaf lettuce, Green leaf lettuce, Head lettuce, Romaine lettuce) by light treatment of LED in plant factory. The light treatments were composed of red, blue, red+farred, red+blue, red+blue+white LEDs, irradiation time ratio of the red and blue LED per minute (1 : 1, 2 : 1, 5 : 1, 10 : 1), and duty ratio of mixed light (100%, 99%, 97%). The following results were obtained in different LED light sources treatments: Shoot biomass and S/R ratio of romaine lettuce were the highest under mixed red+blue LEDs. S/R ratio of head lettuce was higher under mixed red+blue+white LEDs than red+blue LEDs. The others showed no difference in LED light treatment. Shoot biomass, total biomass and S/R ratio of green lettuce, head lettuce and pak-choi were highest in the higher red ratio (5 : 1) on irradiation time of red : blue LED ratios. By the different duty ratio (red+blue and red+blue+white LEDs), Under the mixed light of red+blue, shoot and root biomass of crown daisy and romaine lettuce were high in duty ratio of 100% and 99%, and S/R ratio was highest in all the 6 kinds in duty ratio of 97%. All the 6 kinds showed a fine growth state in low duty ratio (97%). Green lettuce, romaine lettuce and pak-choi showed relatively high shoot biomass and total biomass in low duty ratio of 97% under the mixed light of red+blue+white. S/R ratio of romaine lettuce and head lettuce were highest in the duty ratio of 97% with red+blue+white LEDs. Thus, we can cultivate stably without reference to external factors, if we use appropriate light sources and light quality in closed-type plant factory.

The Study on Risk Factors Analysis and Improvement of VDT Syndrome in Nuclear Medicine (핵의학과 Video Display Terminals Syndrome 유해 요인 조사 및 개선에 관한 연구)

  • Kim, Jung-Soo;Kim, Seung-Jeong;Lee, Hong-Jae;Kim, Jin-Eui;Kim, Hyun-Joo;Han, In-Im;Joo, Yung-Soo
    • The Korean Journal of Nuclear Medicine Technology
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    • v.14 no.1
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    • pp.61-66
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    • 2010
  • Purpose: Recently, Department of Nuclear Medicine have an interest in Video Display Terminals (VDT) syndrome including musculoskeletal disorders, ophthalmologic disorders, trouble of electromagnetic waves and stress disorders occur to VDT workers as the growing number of users and rapid pace of service period supply in large amount. This study research on the actual condition for VDT syndrome in Nuclear Medicine, Seoul National University Hospital (SNUH), discover the problem and draw a plan of upcoming improvement. The aim of this study establish awareness about VDT syndrome and is to prevent for it in the long run. Materials and Methods: Department of Nuclear Medicine, SNUH is composed Principle part, Pediatric part and PET center. We estimated risk factors visit in each part directly. Estimation method use "Check list for VDT work" of Wonjin working environment health laboratory and check list is condition of VDT work, condition of work tables, condition of chairs, condition of keyboards, condition of monitors, working position, character of health management and other working environment. Analysis result is verified in Department of Occupational and Environment, Hallym University Sacred Heard Hospital. Results: As a result of analysis, VDT condition of Department of Nuclear Medicine, SNUH is rule good. In case of work tables, recent of things are suitable to users upon the ergonomical planning, but 15% of existing work tables are below the standard value. In case of chairs are suitable, but 5% of theirs lost optimum capacity become superannuated. The keyboards are suitable for 98% of standard value. In case of monitors, angle control of screen is possible of all, but positioning control is impossible for 38%. In case of working position, 10% is fixed positioning for long time and some of the items researched unsuitable things for standard. At health management point, needed capable of improvement. Also, other working condition as lighting, temperature, noise and ventilation, discovered the problem, but is sufficient to advice value. Conclusion: VDT syndrome is occurrences of possibility continuously, come economical expensive about improvement, is inherent in various causes and originate without your knowledge. So, there is need systematic management system. In Nuclear Medicine, VDT syndrome make it better that constant interest and effort as improvement of ergonomical working environment, improvement of working procedure, regular exercise and steady stretching, and can be prevented fairly. This promote physical and mental condition of worker in top form in comfortable working environment, so this is judged by enlargement of operations efficiency and rising of satisfaction ratings of the inside client.

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