• 호스피스학술지
• /
• 제2권1호
• /
• pp.87-111
• /
• 2002

The hospice activities in Korea have still stood in the premature stage, although the contemporary hospice program, which professionally accommodates terminally ill patients, appeared in the history 35 years ago. Especially, the availability of the facility hospice is not only poor in number, but also lack of a guideline for the conduct of the facility. Saemmul Hospice has keenly felt the necessity of more facility hospices and has interchanged experiences and informations with people interested in hospice. However, the number of facilities has fallen short of one's expectations, and many problems have been revealed in order to maintain the operation. This paper was written in order to improve these atmospheres and to help more terminally ill cancer patients properly. This paper clarifies in detail the principle of management, the method of practice in each departments of Saemmul Hospice, expected effects and supplemental items. We try to provide concrete and practical informations and to help extensively for all peoples who are to begin or currently working. 1.Facility: It secures, maintain, and manage the hospice environment for all around care of patients effectively. 2.Education and Volunteer: It trains and manages hospice volunteers devoted to hospice. 3.Financial: It manages donation by healthy soul with an effective method. 4.Administration and Organization: It executes the administration efficiently and constitutes the organization to operate. 5.Medical and Nursing: It offers the maximum professional supports to a hospital. 6.Medicine and alternative medicine: It improves the quality of life of patients by medical and pharmaceutical approach and by other possible methods available. 7.Nutrition: It helps patients to have diets in accord with the order of the creation. 8.Belief: It offers spiritual care which allows the profound relationship with God. 9. Funeral ceremonies: Funeral ceremonies may heal grieves of families faced with their deaths. 10. Bereaved families: It supports the families after the deaths of patients. 11.Reception and consultation: It seeks to help the patients who meet the purposes for which Saemmul Hospice is established. 12.Publication: It allows publicity activities for Saemmul Hospice. Facility hospice programs are able to overcome the disadvantages that the other type of the hospice possess, like as the economic burdens of the families, and the patients' losses of comforts of home after being transferred to a hospital. Facility hospice can provide home atmosphere with professional manpower and facilities like hospital to the patients. Therefore, it can also improve patients' qualities of life and make them comfortable death. We anticipate that the hospice program in Korea would be more active to let more people be indebted to maintain the nobel human dignity and to cross beautifully in the most painful process of dying in the journey of their lives.

• 의료법학
• /
• 제14권1호
• /
• pp.85-116
• /
• 2013

Korea Medical Dispute Mediation and Arbitration Agency, "K-MEDI" in abbr. herein-after, is established on Apr. 9, 2012 according to the law cited in the title above for the purpose of settling medical disputes in a prompt, fair and efficient manner. Two special professional organizations are established in K-MEDI, one of them is Medical Dispute Mediation and Arbitration Committee(hereinafter referred to as the "Mediation Committee") and the other Medical Malpractice Appraisal Board(hereinaf-ter referred to as the "Appraisal Board"), the mission of the latter is to investigate the facts concerning the disputed medical conduct and to research as to and apprai-se whether the medical conduct was negligent and whether a causal relationship exists. Each panel organized in the Mediation Committee or the Appraisal Board shall be comprised of five mediators or appraisers, including necessarily a judge or a prose-cutor respectively and any disputed case regardless of the scale, the importance or the complicacy shall be handled by a panel. As the system is not thought efficient or economic, the number of the members comprising a panel or total members com-prising the Mediation Committee or the Appraisal Board shoud be adjusted, and the process shoud be versified, including the "Rapid Process," for instance. A petition for the mediation of a medical dispute shall be rejected if the respondent fails to notify K-MEDI of his/her intention to accede to the mediation within 14days from the day on which the petition for the mediation was served(Art. 27 Cl. 7). As the option of an arbitrary decision whether the mediation proceedings shall be commenced or not given to the respondent by the clause is thought unfair, making the process unstable, and moreover, diminishing the purpose of the system established by the law cited above for solving the medical disputes, the clause shoud be amended not to allow the respondent the option of such an arbitrary deci-sion. K-MEDI shall conduct the "Program for Compensation of Medical Accidents"(Art 46) according to which unavoidable injuries caused by the medical accidents in the cour-se of childbirth and the "Advances for Damages"(Art. 47) that are the compensating moneys paid to victims in medical malpractice cases who fail to receive money at all or partly from the operator or the professional of a public health or medical institution although he/she has a final and conclusive right to be paid by them. Some operators or professionals of such institutions claim that both the programs violate their fundamental rights assured by the constitution, and that it be a justifica-tion of refusal to accede to the mediation. As any of the programs needs not to be conducted by K-MEDI, it may be a proper solution to change the conductor of the programs to avoid the unproductive controversy.

• 한국식품조리과학회지
• /
• 제21권1호
• /
• pp.117-123
• /
• 2005

씻어 놓은 쌀에 민들레 추출액을 각각 20, 30, 40 $^{\circ}$Brix의 농도로 하여 쌀에 $5\%$를 첨가하며 10분 동안 5 mL/min의 속도로 분무하여 회전하며 코팅 쌀을 가공하였다. 대조군의 수분함량은 민들레 추출액 코팅 쌀보다 높게 나타났으며, D-40의 수분함량이 가장 낮았다. 색차계 측정값인 L값, a값은 코팅 수준이 증가할수록 낮아졌고 b값은 증가했으며, 밥을 지은 당일과 저장 2일 모두 같은 경향을 보였다 민들레 코팅 수준이 높은 쌀가루에서 DSC 호화 개시 온도는 높게 나타났으나 호화 정점 온도는 낮게 나타났다. 텍스쳐 측정결과 코팅 수준이 높아질수록 경도, 부착성, 탄성, 응집성, 씸힘성, 검성이 증가했고, D-20이 가장 바람직하게 평가되었으며 저장 2일 후도 같은 경향을 보였다.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권20호
• /
• pp.8993-9004
• /
• 2014

Background: The incidence rate and the treatment costs of hepatocellular carcinoma (HCC) are high, especially in Thailand. Previous studies indicated that early detection by a surveillance program could help by down-staging. This study aimed to compare the costs and health outcomes associated with the introduction of a HCC surveillance program with no program and to estimate the budget impact if the HCC surveillance program were implemented. Materials and Methods: A cost utility analysis using a decision tree and Markov models was used to compare costs and outcomes during the lifetime period based on a societal perspective between alternative HCC surveillance strategies with no program. Costs included direct medical, direct non-medical, and indirect costs. Health outcomes were measured as life years (LYs), and quality adjusted life years (QALYs). The results were presented in terms of the incremental cost-effectiveness ratio (ICER) in Thai THB per QALY gained. One-way and probabilistic sensitivity analyses were applied to investigate parameter uncertainties. Budget impact analysis (BIA) was performed based on the governmental perspective. Results: Semi-annual ultrasonography (US) and semi-annual ultrasonography plus alpha-fetoprotein (US plus AFP) as the first screening for HCC surveillance would be cost-effective options at the willingness to pay (WTP) threshold of 160,000 THB per QALY gained compared with no surveillance program (ICER=118,796 and ICER=123,451 THB/QALY), respectively. The semi-annual US plus AFP yielded more net monetary benefit, but caused a substantially higher budget (237 to 502 million THB) than semi-annual US (81 to 201 million THB) during the next ten fiscal years. Conclusions: Our results suggested that a semi-annual US program should be used as the first screening for HCC surveillance and included in the benefit package of Thai health insurance schemes for both chronic hepatitis B males and females aged between 40-50 years. In addition, policy makers considered the program could be feasible, but additional evidence is needed to support the whole prevention system before the implementation of a strategic plan.

• Asian-Australasian Journal of Animal Sciences
• /
• 제29권1호
• /
• pp.73-79
• /
• 2016

The objective was to evaluate the effect of fodder tree species (FTS) with condensed tannin contents: Cordia elaeagnoides, Platymiscium lasiocarpum, Vitex mollis, and Haematoxylon brasiletto, on in vitro methane ($CH_4$) production at 24 h post incubation. The analysis was performed using the in vitro gas production technique, with three levels of inclusion/species: 600, 800, and 1,000 mg and with 4 replicates/species/level of inclusion. The substrate was incubated at $39^{\circ}C$, and the gas and $CH_4$ production were recorded at 4, 8, 12, and 24 h post incubation. The data collected was analyzed through Pearson correlation, polinomial regression and fixed effects models. There were negative correlations between FTS-total gas volume (r = -0.40; p<0.001); FTS-volume of $CH_4$ produced (r = -0.40; p<0.001) and between the inclusion level-volume of $CH_4$ produced (r = -0.20; p<0.001). As well as a positive correlation between hours post incubation-total gas volume (r = 0.42; p<0.001) and between hours post incubation-volume of $CH_4$ produced (r = 0.48; p<0.001). The FTS: C. elaeagnoides, V. mollis, and H. brasiletto have potential, in the three inclusion levels analyzed, to reduce $CH_4$ emission on in vitro trials (>32.7%), taking into account the total $CH_4$ production at 24 h of the forage used as reference (Avena sativa). It's suggested that C. elaeagnoides-according to its crude protein, neutral detergent fiber, and condensed tannins content- is the best alternative within the FTS analyzed, for feeding ruminants and for the control of $CH_4$ emissions during the dry season.

• Asian Pacific Journal of Cancer Prevention
• /
• 제14권5호
• /
• pp.3067-3074
• /
• 2013

Background: Faced with highly prevalent and recalcitrant cancer-related fatigue (CRF), together with the absence of any official guidelines on management, numerous groups have been striving to seek and test alternative therapies including acupuncture and moxibustion. However, different patients have various feedbacks, and the many clinical trials have given rise to varied conclusions. In terms of the therapeutic effect of acupuncture and moxibustion, there exist vast inconsistencies. Objective: The aim of the study was to evaluate the auxiliary effectiveness of acupuncture and moxibustion in the treatment of CRF, and to provide more reliable evidence to guide clinical practice. Methods: Randomized controlled trials (RCTs) published before December 2012 were all aggregated, focusing on evaluation of acupuncture or moxibustion for CRF. The quality of the included studies was assessed basing on Cochrane handbook 5.1.0, and the available data were analyzed with RevMan software (version 5.2.0). Descriptive techniques were performed when no available data could be used. Results: A total of 7 studies involving 804 participants were eligible. With real acupuncture versus sham acupuncture, subjects receiving true acupuncture benefited more in the reduction of fatigue. With real acupuncture versus acupressure or sham acupressure, fatigue level appeared 36% improved in the acupuncture group, but 19% in the acupressure group and only 0.6% with sham acupressure. When real acupuncture plus enhanced routine care was compared with enhanced routine care, the combination group improved mean scores for general fatigue, together with physical and mental fatigue. With real acupuncture versus sham acupuncture or wait list controls, the real acupuncture group displayed significant advantages over the wait list controls at 2 weeks for fatigue improvement and better well-being effects at 6 weeks. When moxibustion plus routine care was compared with routine care alone, the meta-analyses demonstrated the combination had a relatively significant benefit in improving severe fatigue and QLQ-C30. Conclusion: Up to the search date, there exist few high quality RCTs to evaluate the effect of acupuncture and moxibustion, especially moxibustion in English. Yet acupuncture and moxibustion still appeared to be efficacious auxiliary therapeutic methods for CRF, in spite of several inherent defects of the included studies. Much more high-quality studies are urgently needed.

• Clinical and Experimental Pediatrics
• /
• 제53권4호
• /
• pp.579-584
• /
• 2010

목 적: 해외귀국학생들의 수가 매년 증가하고 있다. 이들은 우리말의 체계가 완전히 확립되기 전 다른 언어의 영향을 받고 성장하여 우리말의 이해가 어렵고, 발음이 어눌하여 학업이나 교우관계에 문제가 발생하게 된다. 본 연구는 해외귀국학생의 한국어발음 특징을 음향, 음성학적 방법으로 분석하였다. 방 법: 우리말의 파열음(ㅂ, ㅃ, ㅍ, ㄷ, ㄸ, ㅌ, ㄱ, ㄲ, ㅋ) 9개를 VCV 형식으로 녹음하여 폐쇄구간과 기식구간 길이와 비율을 측정하였다. 해외귀국학생 군과 국내거주학생 간 파열음의 조음오류의 비율과 유형을 비교하고 조음위치와 발성유형에 따른 음향음성학적 특성을 분석, 비교하였다. 결 과: 해외귀국학생 군과 국내거주학생 군 간 조음오류 비율은 해외귀국학생 군 19.4%, 국내거주학생 군 2%로 나타났다. 해외귀국학생군의 발음 오류 중 가장 많이 나타난 유형으로 발성 유형의 오류는 경음화, 조음 위치의 오류는 비음화 이었다. 해외귀국초등학생 군이 국내거주 초등학생군 보다 모든 조음위치와 발성유형에서 파열음의 폐쇄구간, 기식구간 길이가 유의하게 길게 나타났다. 그러나 대상군간 폐쇄구간 대 기식구간의 길이의 비율을 비교한 결과 유의하지 않았다. 결 론: 해외귀국학생은 국내거주학생보다 파열음 산출에 조음 오류가 더 자주 일어나며 국내거주학생보다 각 조음위치에 따른 발성유형을 분류하여 정확한 발음을 찾아 산출하는 우리말 발화속도가 느리다는 것을 알 수 있었다. 해외귀국초등학생 발음의 음향음성학적 문제점을 이해하고 추후 해외귀국초등학생의 조음을 평가하는 객관적인 자료에 도움이 될 것이다.

• 대한의용생체공학회:의공학회지
• /
• 제39권1호
• /
• pp.48-54
• /
• 2018

In this study, We developed a Ancillary device for child radiography for X-ray of children under 5 years old and verified its effectiveness. Chest X-rays of children younger than 5 years of age were performed by Supine method at the position of Table detector, Short - Source to Image Receptor Distance(SID). Existing Supine and Short -SID imaging methods cause many problems, such as errors in image reading and excessive radiation exposure dose to patients, but the use of an Ancillary device for child radiography(ADCR) solves these problems. A total of 160 children were divided into the Upright group using ADCR and Supine group without ADCR. The chest X-ray image was visually evaluated by two radiologists with reference to the European Commission's List of Quality Criteria for Diagnostic Radiographic Images in Pediatrics. The total score of the qualitative evaluation was 5.15% higher in the chest upright method using ADCR than in the chest supine method without ADCR, and the chest upright method score was higher than that of the chest supine method in items 1 to 7. whether infants have deep inspiration or not, 4.87% higher for item 1, whether infants rotate or not and the degree of tilting, 0% higher for the item 2, the reproduction of image from just above apices of lungs to T12/L1, 0% for the item 3, reproduction of the vascular pattern in central 2/3 of the lungs, 6.92% higher for the item 4, reproduction of the trachea and the proximal bronchi, 12.9% higher for the item 5, visually sharp reproduction of the diaphragm and costo-phrenic angles, 10% higher for the item 6, reproduction of the spine and paraspinal structures and visualisation of the retrocardiac lung and the mediastinum, and 3.65% higher for the item 7. Items 2 and 3 showed no statistically significant differences(P > 0.05), and items 1, 4, 5, 6, and 7 showed statistically significant differences(P < 0.05). In conclusion, Upright method using ADCR in pediatric chest X-ray is considered as a good alternative to existing Supine method.

• 대한정형외과스포츠의학회지
• /
• 제2권2호
• /
• pp.149-152
• /
• 2003

목적: 관절경 술식으로 치료한 퇴행성 슬관절염 환자에서 기계적 증상의 유무에 따른 임상 결과를 알아 보고자 하였다. 대상 및 방법: 2000년 10월부터 2002년 1월까지 슬관절의 퇴행성 관절염 으로 관절경 수술을 받은 60명 60례를 대상으로 하였다 추시 기간은 평균 15개월(12$\~$30개월)이었다. 수술전 단순 방사선 소견과 문진 그리고 이학적 검사로 기계적 증상의 유무를 판단 하였다. 치료 결과는 Baumgaertner의 평가 방법을 이용하였다. 결과: 술전 Baumgaertner score는 기계적 증상이 있는 군에서 평균 3.1점에서 술후 8.1점이었으며 기계적 증상이 없었던 군에서는 술전 3.5점에서 술후 5.4점으로 기계적 증상이 있었던 환자군에서 더 높은 만족도를 나타냈다. 결론: 퇴행성 관절염에서 기계적 증상이 있는 경우 관절경적 치료는 의미 있는 치료방법이라고 사료되나 보다 많은 증례에 대한 연구가 필요할 것으로 사료된다

• Clinics in Shoulder and Elbow
• /
• 제14권1호
• /
• pp.1-5
• /
• 2011

목적: 불안정성 쇄골 원위부 골절에서 Endobutton을 이용한 오구 쇄골 인대 보강술을 시행하고 그 방사선학적 및 임상적 결과를 알아보고자 하였다. 대상 및 방법: 2007년 10월부터 2009년 9월까지 오구 쇄골 인대 손상이 동반된 Neer 제 2형 불안정성 쇄골 원위부 골절로 TightRope$^{(R)}$ 고정술을 시행하고 1년 이상 추시 관찰이 가능하였던 연속적 9예를 대상으로 하였다. 방사선적 평가는 단순 방사선 사진을 이용하여 오구 쇄골 간격 측정 및 골유합을 판단하였고, 임상적 평가는 ASES 평가 점수를 이용하였다. 결과: 8예 (88.9%)에서 골유합을 얻을 수 있었으며, 평균 골유합 기간은 12.9 (9~16)주였다. 술 후 및 최종 추시 평균 오구 쇄골 간격은 5.6 mm, 6.2 mm로 통계학적으로 의미있는 정복의 소실은 없었다 (p>0.05). ASES 점수는 평균 90.3 (78~96)점으로 우수 6예, 양호 2예, 보통 1예였으며, 8예 (88.9%)에서 만족할 만한 결과를 나타내었다. 합병증으로 1예에서 초기 정복 소실로 인하여 불유합이 발생하였으며, 보통의 임상적 결과를 보였다. 그 외 고정물의 파손 및 감염 등의 합병증은 없었다. 결론: 불안정성 쇄골 원위부 골절에서 TightRope$^{(R)}$ 고정술은 고정물의 제거가 필요하지 않다는 장점이 있으며, 원위 골편의 고정이 어려운 골절에서 안정된 고정을 얻을 수 있는 하나의 대안이 될 수 있을 것으로 생각된다.