• Title/Summary/Keyword: Withholding treatment

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Withdrawal of Life-Sustaining Treatment from Children: Experiences of Nurses Caring for the Children (간호사의 연명치료중단아동 돌봄경험)

  • Park, So Yeon;Ju, Hyeon Ok;Lee, Ga Eon
    • Child Health Nursing Research
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    • v.23 no.3
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    • pp.364-374
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    • 2017
  • Purpose: The purpose of this study was to describe feelings and actions of nurses following withdrawal of life-sustaining treatment from children being cared for by the nurses. Methods: Data were collected by in-depth interviews with 7 nurses from different hospitals where children receiving nursing care had life-sustaining treatment withdrawn. The interviews were conducted from August 2016 to February 2017 when all data were saturated. Interviews lasted 30~90 minutes and were conducted 2~3 times per participant. Data were analyzed using Giorgi's phenomenological research methodology. Results: The following factors constituted experiences of nurses working in pediatric wards when life-sustaining treatment was withdrawn from children: "agony and conflict in the aspects of care", "heavy mind and regret for exhausting care", "intentionally avoiding parents' sadness", "comforting sadness in the heart" and "orientation in the role of caring for children undergoing withdrawal of life-sustaining treatment." Conclusion: Findings indicate that support systems and intervention programs need to be developed so that nurses can understand and wisely deal with experiences of withdrawal of life-sustaining treatment from children who receive care from nurses.

Exploring the Factors Influencing Attitudes Toward Withdrawal of Life-sustaining Treatment in Adolescents (청소년의 연명치료중단에 대한 태도에 영향을 미치는 요인)

  • Lee, Insook;Kim, Kyeong Ja
    • Journal of Korean Academic Society of Home Health Care Nursing
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    • v.27 no.1
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    • pp.82-91
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    • 2020
  • Purpose: This study aimed to explore the factors influencing attitudes toward withdrawal of life-sustaining treatment (WLST) in adolescents. Methods: This study used a descriptive research design. A structured questionnaire was administered to 185 adolescents. Data were analyzed based on t-tests, analysis of variance, Pearson's correlation coefficient, and multiple regression using the IBM SPSS 20.0. Statistical package. Results: There was a negative correlation between attitudes toward WLST and respect for life (r=-.188, p=.010). Knowing about life-sustaining treatment (β=-0.30, p<.001), experience of WLST education (β=0.21, p=.003), experience of respect for life education (β=-0.16, p=.021), and experience of death (family or acquaintance) (β=-0.13, p=.039) explained 16.7% (F=8.39, p<.001) of the variance in attitudes toward WLST. The respect for life did not affect attitudes toward WLST (β=-0.07, p=.347). Conclusion: The study findings suggest that WLST in adolescents is different from that of adults. Further research is needed to develop strategies for sound and positive attitudes toward WLST in adolescents.

Alleviating Effect of Salicylic Acid Pre-treatment on Soil Moisture Stress of Waxy Corn

  • Seo, Youngho;Ryu, Sihwan;Park, Jongyeol;Choi, Jaekeun;Park, Kijin;Kim, Kyunghi
    • Korean Journal of Soil Science and Fertilizer
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    • v.48 no.3
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    • pp.213-217
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    • 2015
  • Soil moisture shortage can reduce yield of waxy corn because maize is one of the sensitive crops to the drought stress. Farmers cannot irrigate due to limited water resource and irrigating facilities although applying water is the most effective practice to solve the drought problem. The study was conducted to investigate the pre-treatment effect of salicylic acid on reducing drought damage of waxy corn (Zea mays L.). Salicylic acid at concentration of 0.2 mM was applied at seven-leaf stage or ten-leaf stage three times. Drought stress was imposed by withholding irrigation from 11 days before anthesis to 10 days after anthesis. Application of salicylic acid significantly increased ear length by 11.0~12.3% and yield by 8.8~11.3% compared with non-treated control, indicating that the drought injuries of waxy corn can be alleviated through pre-treatment of salicylic acid at the vegetative stage.

Chiari Malformation (키아리기형)

  • Han, Jeong-Hoon
    • The Journal of the Korean life insurance medical association
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    • v.27 no.1
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    • pp.37-38
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    • 2008
  • The concept of Chiari malformations emerged toward the end of $19^{th}$ century from Chiari's initial descriptions of "alterations in the cerebellum resulting from cerebral hydrocephalus." In 1891, Hans Chiari(1851-1916) suggested cerebellar ectopia in which he classified Type I as "elongation of the tonsils and medial parts of the inferior lobes of the cerebellum into cone-shaped projections, which accompany the medulla oblongata into the spinal canal. The incidence of Chiari malformation has been found to be between 0.56% and 0.77% on MR imaging studies, as well as 0.62% in brain dissection studies. the definition of the adult Chiari malformation has varied with the evolution of neurodiagnositic capabilities and knowledge of physiopathology. This disorder can be associated with significant symptomatology, risk of secondary injury due to trauma, and the risk of progression and damage of the spinal cord due to associated Syringomyelia. Syringomyelia is found in 50 to 70% of Chiari I malformation. It is the clinical judgment of the physicians evaluating this disorder that is of the importance to avoid the therapeutic extremes of pursuing unnecessary surgery or withholding necessary treatment from patients.

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Nutritional Support for Acute Diarrhea in Children: Focused on Age-appropriate Diet Therapy after Rehydration (영유아 급성 설사의 영양 공급: 탈수 치료 후 연령별 식이요법을 중심으로)

  • Chu, Mi Ae;Choe, Byung-Ho
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.12 no.sup1
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    • pp.53-61
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    • 2009
  • The mainstay in the management of mild to moderately dehydrated children is fast rehydration by using hypotonic ORS (oral rehydration solution) and complete resumption of normal diet, including lactose-containing formula after 4 hours rehydration. Since the majority of young children with uncomplicated acute diarrhea will tolerate large amounts of undiluted non-human milk, withholding food and milk from children during diarrhea is not recommended anymore, regarding time to resolution and diarrhea control. In addition, routine dilution of milk and routine use of lactose-free formula are not necessary after fast ORS therapy. Breastfed infants and children fed with solid foods may safely continue receiving their usual diets during diarrhea instead of gradual reintroduction of feeding. However, young infants or children with severe diarrhea or malnutrition should be carefully treated under supervision if fed with lactose containing, non-human milk exclusively.

Influence of Drought Stress on Chemical Composition of Sesame Seed

  • Kim, Kwan-Su;Ryu, Su-Noh;Chung, Hae-Gon
    • KOREAN JOURNAL OF CROP SCIENCE
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    • v.51 no.1
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    • pp.73-80
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    • 2006
  • Sesame (Sesamum indicum L.) seeds contain abundant oil and antioxidative lignans related to the seed quality. To evaluate the potential effects of drought stress on the chemical composition of sesame seeds, eighteen cultivars were imposed water-deficit condition by withholding irrigation during 15 days at podding and maturing stage, compared with well-watered plants as control in seed yield and chemical composition. Drought treatments showed great decrease of seed yield with not affecting seed weight. The contents of sesamin and sesamolin decreased while lignan glycosides inversely increased in response to drought stress. Oil content was not significantly changed by drought treatment in spite of its slight decrease. In case of fatty acid composition, there were significant differences in increase of oleic acid while inverse decrease of linoleic acid under drought stress condition. These results demonstrate that the chemical composition of sesame seed may be modified with drought stress. In particular, the increase of sesaminol glucosides with strong antioxidative activity was observed.

Association of Physician Orders for Life Sustaining Treatment Completion and Healthcare Utilization before Death (연명의료계획서 작성과 사망 전 의료이용의 관계)

  • Eunji Kim;Hongsoo Kim
    • Health Policy and Management
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    • v.33 no.1
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    • pp.19-28
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    • 2023
  • Background: With the enactment of the Hospice, Palliative, Care, and Life-sustaining Treatment Decision-Making Act in February 2018, legal guidelines for physician orders for life-sustaining treatment (POLST) were presented. This study was conducted to analyze the association of writing POLST on the use of health care before death. Methods: The study analyzed the electronic medical records and POLSTs of 1,003 adult patients who died at a tertiary hospital located in Seoul from February 4, 2018 to February 4, 2019. Results: Of the deaths, 80% (n=804) completed POLST. Among patients who completed POLST before death, 51% (n=412) were written 1-7 days before death, and only 31% (n=246) were completed by patients themselves. 99% (n=799) decided to withdraw or withhold cardiopulmonary resuscitation. As a result of analyzing the effect of POLST on medical use before death, it was found that POLST and inpatient cost had a significant negative correlation, and POLST completion significantly reduced death in the intensive care unit (ICU). However, both inpatient costs and death at ICU increased when the POLST was completed by surrogate decision-makers rather than patients themselves. Conclusion: The enactment of the Hospice, Palliative, Care, and Life-sustaining Treatment Decision-Making Act provided a legal basis for withdrawing and withholding meaningless life-sustaining treatment. By specifying the treatment to be received at the end of one's life through the POLST, inpatient treatment costs and death at the ICU were decreased. However, the frequent decision-making by the surrogates and completion of POLST close to death may hinder the original purpose of the law.

A Simple Method of Seedling Screening for Drought Tolerance in Soybean

  • Kim, Young-Jin;S. Shanmungasundaram;Yun, Song-Joong;Park, Ho-Ki;Park, Moon-Soo
    • KOREAN JOURNAL OF CROP SCIENCE
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    • v.46 no.4
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    • pp.284-288
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    • 2001
  • Water deficit is a serious constraint to soybean [Glycine max L. (Merr.)] production in rainfed regions of Asia, Africa, and America. This study was conducted to develop a simple and effective screening method for drought tolerance in soybean. Fifteen soybean cultivars, eight identified to be drought-tolerant and seven drought-sensitive in previous studies, were used for the evaluation of drought tolerance under the new screening conditions. The seedling screening method was consisted of a treatment in a PEG solution and drought treatment in parafilm-layered pots. 5-day-old seedlings were treated in a 18% PEG solution for 4 days and their wilting and hypocotyl browning were recorded. Three seedlings grown in a parafilm-layered pot containing peat moss were drought-stressed by withholding water from the third day after seedling emergence, and root and seedling growth were examined. Degree of drought tolerance were rated based on seedling vigor in the PEG solution and drought-stressed parafilm-layered pots, and also on the penetration ability of roots through parafilm layer. Most of seedlings of the drought-tolerant cultivars showed higher vigour and root penetration than those of the drought-sensitive cultivars under the new screening conditions. Our results indicate that the new method can be used as a simple and effective screening procedure for drought tolerance in soybean breeding programs.

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A Legal Study on 「the Act on Decision on Life-sustaining Treatment for Patient's in Hospice and Palliative Care or at the End of Life」 (연명의료결정법의 법적 고찰)

  • Park, Kwang-Hyun
    • Proceedings of the Korean Society of Computer Information Conference
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    • 2019.07a
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    • pp.195-198
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    • 2019
  • 연명의료결정법의 정식 명칭은 '호스피스 완화의료 및 임종 과정에 있는 환자의 연명의료 결정에 관한 법'이다. 이 법은 호스피스 완화의료에 대한 것과 환자의 연명의료 결정에 대한 것을 규정하고 있다. 특히, 후자의 연명의료결정에 관한 부분은 법제정 과정에서 법 종교 의료 윤리 등 다양한 분야에서 논박이 있었지만 2018년 2월 4일부터 시행되고 있다. 법학에서는 이 법이 생명이라는 법익과 관련되어 있어 형사법적, 민사법적으로 중요한 의미를 갖는다. 이 법이 탄생되기 위해 두 번의 변곡점이 있었다. 첫째, 1997년 '보라매병원 사건'에서 의사를 작위에 의한 살인방조죄로 판결한 사건 둘째, 2009년 '김 할머니' 사건에서 회생할 수 없을 경우 가족 등이 진술한 환자 의사에 따라 연명 의료를 중단할 수 있다는 대법원 판결이다. 연명의료결정법은 헌법상 생명권과 자기운명결정권이라는 기본권 충돌이 발생한다. 두 기본권이 서로 상충 할 때에는 어떠한 기본권을 우선해야 하는지가 실질적으로 문제되는데, 이익형량을 통한 규범의 조화로운 해석을 통해 해결해야 한다. 또한 이 법의 흠결과 문제점을 고찰하여 개정작업이 진행되어야 한다.

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Individualized ibuprofen treatment using serial B-type natriuretic peptide measurement for symptomatic patent ductus arteriosus in very preterm infants

  • Shin, Jeonghee;Lee, Eun Hee;Lee, Jee Hyun;Choi, Byung Min;Hong, Young Sook
    • Clinical and Experimental Pediatrics
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    • v.60 no.6
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    • pp.175-180
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    • 2017
  • Purpose: Plasma level of B-type natriuretic peptide (BNP), an emerging, sensitive, and specific biomarker of hemodynamically significant patent ductus arteriosus (PDA), rapidly decreases in infants receiving cyclooxygenase inhibitors for ductal closure. We investigated the usefulness of serial BNP measurement as a guide for individual identification of early constrictive responses to ibuprofen in preterm infants with symptomatic PDA (sPDA). Methods: Before March 2010, the standard course of pharmacological treatment was initiated with indomethacin (or ibuprofen) and routinely followed by 2 additional doses at intervals of 24 hours. After April 2010, individualized pharmacological treatment was used, starting with the first dose of ibuprofen and withholding additional ibuprofen doses if the BNP concentration was <600 pg/mL and clinical symptoms of PDA improved. Results: The BNP-guided group received significantly fewer doses of ibuprofen than the standard group did during the first course of treatment and the entire study period. The need for further doses of cyclooxygenase inhibitors and for surgical ligation was not significantly different between the 2 groups. No significant differences were seen in clinical outcomes and/or complications related to sPDA and/or pharmacological treatment. Conclusion: Individualized BNP-guided pharmacological treatment may be used clinically to avoid unnecessary doses of cyclooxygenase inhibitors without increasing the ductal closure failure and the short-term morbidity related to sPDA.