• Journal of Hospice and Palliative Care
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• 제23권2호
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• pp.93-102
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• 2020

Purpose: The Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life came into force in February 2018 in Korea. This study reviews the practices of end-of-life care for patients who withdrew or withheld life-sustaining treatment at a tertiary care hospital, addresses the limitations of the law, and discusses necessary steps to promote patient-centered self-determination. Methods: We retrospectively analyzed the medical records of patients who died after agreeing to withhold life-sustaining treatment in 2018 at our university hospital. The cause of death, the intensity of end-of-life care, and other characteristics were reviewed and statistically analyzed. Results: Of a total of 334 patients, 231 (69%) died from cancer. The decision to stop life-sustaining treatment was made by family members for 178 patients overall (53.3%) and for 101 (43.7%) cancer patients, regardless of the patient's wishes. When the patient decided to stop life-sustaining treatment, the time from the authorization to withhold life-sustaining treatment to death was longer than when the decision was made by family members (28.7±41.3 vs 10.5±23.2 days, P<0.001). Conclusion: In many cases, the decision to discontinue life-sustaining treatment was made by the family, not by the patient. In order to protect human dignity based on the patients' self-determination, it is necessary for patients to understand their disease based on careful explanations from physicians. Ongoing survey-based research will be necessary in the future.

• 한국환경보건학회지
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• 제19권3호
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• pp.1-16
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• 1993

This paper describes an investigation to determine whether the activated sludge (AS) process could be used for the treatment of wastewater at the Union Carbide Coporation (UCC) plant in Seadrift, Texas. This plant presently utilizes a waste stabilization pond (WSP) system for treatment of the wastewater. The treatment system consists of an in-plant primary WSP and two off-plant WSPs (secondary and tertiary WSPs), run in series. The total hydraulic detention time of the WSP system is approximately 150 days. Several laboratory-based treatability studies have been conducted to evaluate the performace of the WSP system and the degradability of specific chemical compounds. From an additional study, it was determined that the WSP system was stressed and occasionally operating near the limit of its treatment capacity. The existing primary WSP plays an important role in the overall treatmemt system, because it not only functions as a pH and organic-strength equalization basin, but also serves as a "preconditioning" basin by fermenting high strength organic wastes to volatile organic acids for subsequent degradation in the escondary WSP. However, in view of pending RCRA legislatin conerning the "proposed organic toxicity characteristics limits" (40 CFR Part261: Federal Register, July, 1988), it is possible that the primary WSP will have to be abandoned in favor of alternative treatment options. Therefore the main purpose of this study was to perform activated sludge treatability evaluations for the development of an alternative to the existing primary WSP treatment ststem. In addition, another purpose was to determine the degradability of bis(2-chloroethyl)ether (Chlorex or CX) and benzene(BZ) in the activated sludge process. The presence of these two chemicals in the wastewater of the plant prompted the question of whatedether they could be degraded in an activated sludge system.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제47권5호
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• pp.351-359
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• 2021

Objectives: Despite treatment, the pre-traumatic facial appearance of patients with maxillofacial fractures might not be able to be restored, and this difference can affect the person's quality of life (QoL). This study was designed to evaluate changes in QoL of people with maxillofacial fractures. Materials and Methods: The study population was comprised of participants with maxillofacial fracture and age- and sex-matched healthy controls without history of such fracture. QoL was measured using the World Health Organization Quality of Life BREF (WHOQOL-BREF) questionnaire, which was administered to the patients before treatment (Time 1), at 6 weeks post-treatment (Time 2), and at 12 weeks postoperatively (Time 3). The values were compared with those of healthy controls. The QoL was compared between closed reduction group and open reduction and internal fixation group. Results: The QoL scores of people with maxillofacial fracture before treatment were significantly lower (P=0.001) than those of healthy controls in all domains of the WHOQOL-BREF. The QoL scores in the psychological and social domains of patients with maxillofacial fracture at Time 3 were still lower than those of healthy controls (P=0.001). Conclusion: The QoL of patients with maxillofacial fracture was significantly reduced before treatment in all domains and remained reduced in both psychological and social domains weeks after treatment. Therefore, clinicians must be aware of and manage the residual psychosocial issues that can accompany the post-treatment period of maxillofacial injury.

• 한국환경보건학회지
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• 제20권3호
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• pp.1-12
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• 1994

Wastewaters being treated and final effluents were collected from 3 wastewater treatment plants of petrochemical industries, from August 31 to October 4, 1993 in an interval of 10 days, and further analysed by GC/FID to investigate discharge situation and removal efficiency on polycyclic aromatic hydrocarbons. The results were as follows: 1. The PAHs 294.57 $\mu$g/l were discharged in primary treatment effluent of plant A to manufacture vinyl acetate resin and acryl, and removed 54.51% by aeration and totally 84.71%. 2. The PAHs of the highest concentration were discharged in primary treatment effluent of plant B to manufacture PS resin and ABS resin, but removed 91.65% by activated sludge process and 98.19% by activated carbon to discharge PAHs of the lowest concentration comparing to another treatment operations. 3. The PAHs 99.96 $\mu$g/l of the lowest concentration were discharged in wastewater of plant C to manufacture epoxy resin, and removed 80.48% by activated sludge process. 4. B treatment system including activated carbon showed up the best removal efficiency of PAHs. Activated carbon therefore, seems to be effective as tertiary treatment. 5. Correlation coefficient of components to total PAHs was generally low, and correlation coefficients of phenanthrene, pyrene and acenaphthylene to total PAHs were each 0.98, 0.97 and 0.80, respectively. Correlation coefficient of the sum of phenanthrene, pyrene and acenaphthylene to total PAHs was 0.99, so that the sum of phenanthrene, pyrene and acenaphthylene was available as index to estimated total PAHs. 6. Phenanthrene and Chrysene were very well treated biologically and acenaphthylene and fluoranthene were untreated biologically. 7. Considering EPA standards, it seems that the concentration of phenanthrene, pyrene, fluoranthene, and benzo(k)fluoranthene is high level.

• 성인간호학회지
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• 제22권3호
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• pp.229-238
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• 2010

Purpose: The purpose of this study was to examine the effect of maximal sterile barrier precaution on the central venous catheter-related infection and subsequent cost savings. Methods: Study subjects were 462 hospitalized patients with central venous, catheter of more than 48 hours duration. Data collection period was from April 2008 to February 2009 at a tertiary university hospital in Seoul. Subjects were randomly assigned to either the treatment or the usual care group. Patients in the treatment group (n=209) were treated by staff using maximal sterile barrier precautions and the comparison group(n=253) received traditional care. Results: Central venous catheter-days was2,821 in treatment group and 3,515 in comparison group. The incidence density of central venous catheter-related infection was 2.1 times higher in the comparison group (8.2 per 1,000 catheter-days) compared with the treatment group (3.9 per 1,000 catheter-days). The incidence density of central venous catheter-related bloodstream infection was 4.54 times higher than in the comparison group (3.2 per 1,000 catheter-days) compared with the treatment group (0.7 per 1,000 catheter-days). The attributable cost of central venous catheter-related infection in the treatment group was 10,174,197 won and that of the comparison group was 22,224,554 won. Attributable cost by area was also significantly lower compared with that of the comparisons. Conclusion: The maximal sterile barrier precaution during central venous catheter insertion was an effective intervention to reduce central venous catheter-related infection rate and provides a significant cost savings.

• 한국환경농학회지
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• 제23권4호
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• pp.228-233
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• 2004

Nitrate removal was examined from May to October 2003 of a surface flow treatment wetland cell, which was a part of a treatment wetland system composed of four wetland cells and a distribution pond The system was established on rice paddy near the Kohung Estuarine Lake located in the southern part of the Korean Peninsula. Effluent from a secondary-level night soil treatment plant was funneled into the system. The investigated cell, 87 m in length and 14 m in width, was created in April 2003. An open water was designed at its center, which was equivalent to 10 percent of its total area. Cattails (Typha angustifolia) were transplanted from natural wetlands into the cell and their stems were cut at about 40cm height from their bottom ends. Average $25.0\;m^3/day$ of effluent from the treatment plant was funneled into the cell by gravity flow and average $24.1\;m^3/day$ of its treated effluent was discharged into the Sinyang Stream flowing into the lake. Its water depth was maintained about 0.2 m and its hydraulic detention time averaged 5.2 days. Average height of the cattail stems was 42.5 cm in May 2M3 and 117.7 cm in September 2003. The number of stems averaged $9.5\;stems/m^2$ in May 2003 and $16.4\;stems/m^2$ in September 2003. The growth of cattails was good. Temperature of influent and effluent averaged 25.9 and $26.7^{\circ}C$, respectively. $NO_3$-N loading rate of influent and effluent averaged 176.67 and $88.09\;mg/m^2\;day$, respectively. Removal of rf03-N averaged $89.58\;mg/m^2\;day$ and its removal rate by mass was about 50%. Considering its initial operating stage in which cattail rhizomes and litter layer on the bottom were not Idly established, the $NO_3$-N removal rate of the cell was rather good.

• 대한간호학회지
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• 제49권3호
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• pp.329-339
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• 2019

Purpose: The purpose of this study was to investigate the frequency, patterns, and factors of reversals in decisions about life-sustaining treatment (LST) among older patients with terminal-stage chronic cardiopulmonary disease. Methods: This was a retrospective correlational descriptive study based on medical chart review. De-identified patient electronic medical record data were collected from 124 deceased older patients with terminal-stage cardiopulmonary disease who had made reversals of LST decisions in an academic tertiary hospital in 2015. Data were extracted about the reversed LST decisions, LST treatments applied before death, and patients' demographic and clinical factors. Multivariate logistic regression analysis was used to identify the factors associated with the reversal to higher intensity of LST treatment. Results: The use of inotropic agents was the most frequently reversed LST treatment, followed by cardiopulmonary resuscitation, intubation, ventilator therapy, and hemodialysis. Inconsistency between the last LST decisions and actual treatments occurred most often in hemodialysis. One-third of the reversals in LST decisions were made toward higher intensity of LST treatment. Patients who had lung diseases (vs. heart diseases); were single, divorced, or bereaved (vs. married); and had an acquaintance as a primary decision maker (vs. the patients themselves) were significantly more likely to reverse the LST decisions to higher intensity of LST treatment. Conclusion: This study demonstrated the complex and turmoil situation of the LST decision-making process among older patients with terminal-stage cardiopulmonary disease and suggests the importance of support for patients and families in their LST decision-making process.

• 융합정보논문지
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• 제12권2호
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• pp.184-191
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• 2022

본 연구는 자동차보험 이용환자들의 효율적 관리방안을 모색하는데 필요한 기초정보를 제공하고자 보건의료빅데이터개방시스템에 등록된 2016년부터 2020년까지 5개년 자동차보험 진료비 심사자료를 대상으로 분석하였다. 분석결과, 자동차보험 입원진료비 내역 구성비율 1순위는 상급종합병원은 처치 및 수술료, 종합병원·병원·의원은 입원료, 한방의료기관(한방병원, 한의원)은 처치 및 수술료, 치과병원은 처치 및 수술료 이었다. 외래진료비 내역 구성비율 1순위는 양방의료기관(상급종합병원, 종합병원, 병원, 의원)은 진찰료, 한방의료기관(한방병원, 한의원)과 치과의료기관(치과병원, 치과의원)은 처치 및 수술료 이었다. 자동차보험 입원 건당 진료비에는 투약료, 마취료, 특수장비 비율이 영향요인이었으며, 외래 건당 진료비에는 이학요법료 비율이 영향요인으로 확인되었다.

• Hip & pelvis
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• 제36권1호
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• pp.62-69
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• 2024

Purpose: To assess current practice in the treatment of osteoporosis in patients who underwent treatment for hip fracture in South Korea. Materials and Methods: A survey of 97 members of the Korean Hip Society, orthopedic hip surgeons who administer treatment for hip fractures in South Korea, was conducted. The survey was conducted for assessment of demographic data and perceptions regarding the management of osteoporosis in patients who have undergone treatment for hip fracture. Analysis of the data was performed using descriptive statistical methods. Results: The majority of participants were between the age of 41 and 50 years, and 74% were practicing in tertiary hospitals. Testing for serum vitamin D levels (82%) was the most commonly performed laboratory test. Calcium and vitamin D were prescribed for more than 80% of patients by 47% and 52% of participants, respectively. Denosumab was the most commonly used first-line treatment option for osteoporosis in hip fracture patients. Bisphosphonate was most often perceived as the cause of atypical femoral fractures, and the most appropriate time for reoperation was postoperative 12 months. Teriparatide was most preferred after cessation of bisphosphonate and only prescribing calcium and vitamin D was most common in high-risk patients for prevention of atypical femoral fracture. Conclusion: The results of this study that surveyed orthopedic hip surgeons showed that most participants followed the current strategy for management of osteoporosis. Because the end result of osteoporosis is a bone fracture, active involvement of orthopedic surgeons is important in treating this condition.

• Journal of Trauma and Injury
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• 제24권2호
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• pp.129-135
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• 2011

Purpose: During August 2010, a natural gas fuel cylinder on a bus exploded in downtown Seoul, injuring 20 citizens. This kind of blast injury has never been reported in Korea before. Thus, the goal of this study was to review the clinical features of these victims to help physicians manage similar cases and to understand the risk factors associated with blast injuries in everyday life. Methods: Twenty (20) victims who visited nearby emergency departments, and 3 peoples left hospital without care. Seventeen (17) victims were included in this study, and the following factors were investigated: age, sex, type of hospital, diagnosis of injury, injury mechanism, position of victim (in-bus/out of bus), classification of injury severity with START (simple triage and rapid treatment), and classification of injury according to the mechanism of the blast injury. Results: The victims included 8 males (47%), 9 females (53%). The mean age was $37.5{\pm}12$. Thirteen (13) victims were transferred to two tertiary hospitals, and 4 were transferred to two secondary hospitals. The types of injury were 3 fractures, 2 ligaments injuries, 6 contusions, 4 abrasions, and 3 open wounds (one of them was combined fracture). According to START classification, 17 victims were 1 immediate, 11 minor, 5 delayed, and no death. Classifications according to the mechanism of the blast injury were 1 primary injury, 6 secondary injuries (2 of them combined other mechanism), 3 tertiary injuries and 9 quaternary injuries. Conclusion: Trauma care physicians should be familiar with not only the specific types of injuries from blast accidents, but also the potential accidents that may occur in public facilities.