• Journal of Periodontal and Implant Science
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• v.46 no.3
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• pp.166-175
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• 2016

Purpose: Decision-making by dental and medical experts can be influenced by their biases, interests, and experiences, and academic arguments about controversial issues may additionally be considered indirect experiences capable of affecting decision-making. This study reports on the use of interactive communication devices to evaluate preferences and flexibility in decision-making among dental care providers who attended two distinct academic conferences. Methods: Two debates were presented by a team of two lecturers at two academic conferences (focusing on periodontology and implant dentistry, respectively) and the audience members of each session were surveyed. Before each lecture, two case modules about the diagnosis and treatment of multirooted molar lesions were provided, and interactive communication devices were used to collect responses about decision-making preferences in treatment planning immediately before and after a debate about treatment strategies. Results: In total, 81 and 84 completed answers from both conferences were obtained for the first and second case modules, respectively. The preferred treatment plan differed significantly according to the focus of the conference, and a tendency emerged for the clinicians participating in each conference to express uniform preferences. However, attending the debates resulted in significant changes in decision-making preferences regardless of the conference focus or the characteristics of the participants. Conclusions: Our findings suggest that providing continuing education via debates on controversial issues may be effective in widening conceptual knowledge and reducing biases among experts in the dental and medical fields.

• Journal of Korean Society of Water and Wastewater
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• v.29 no.1
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• pp.1-9
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• 2015

A combined treatment system using multiple source water is becoming important as an alternative to conventional water supply for small-scale water systems. In this research, combined water treatment systems were investigated for simultaneous use of multi-source water including rainwater, ground water, river water, and reclaimed wastewater. A laboratory-scale system was developed to systematically compare various combinations of water treatment processes, including sand filtration, microfiltration (MF), granular activated carbon (GAC), and nanofiltration (NF). Results showed that the efficiency of combined water treatment systems was affected by the quality of feed waters. In addition, a simply approach based on the concept of linear combination was suggested to support a decision-making for the optimum water treatment systems with the consideration of final water quality.

• The Korean Society of Law and Medicine
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• v.24 no.4
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• pp.103-128
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• 2023

According to the current act of Decision-Marking in Life-Sustaining Medicine, the decision to withhold or discontinue life-sustaining treatment is primarily based on the wishes of a patient in the dying process. Decision-making regarding life-sustaining treatment for these patients is made by the patient, if he or she is conscious, directly expressing his/her intention for life-sustaining treatment in writing or verbally or by writing an advance medical directive and physician orders for life-sustaining treatment. It can be exercised. On the other hand, if the patient has not written an advance medical directive or physician orders for life-sustaining treatment, the patient's intention can be confirmed with a statement from the patient's family, or a decision to discontinue life-sustaining treatment can be made with the consent of all members of the patient's family. However, in the case of an unrelated patient who has no family or whose family is unknown, if an advance medical directive or physician orders for life-sustaining treatment are not written before hospitalization and a medical condition prevents the patient from expressing his or her opinion, the patient's will cannot be known and the patient cannot be informed. A situation arises where a decision must be made as to whether to continue or discontinue life-sustaining treatment. This study reviewed discussions and measures for unbefriended patients under the current law in order to suggest policy measures for deciding on life-sustaining treatment in the case of unbefriended patients. First, we looked at the application of the adult guardian system, but although an adult guardian can replace consent for medical treatment that infringes on the body, permission from the family court is required in cases where death may occur as a direct result of medical treatment. It cannot be said to be an appropriate solution for patients in the process of dying. Second, in accordance with Article 14 of the Life-Sustaining Treatment Decision Act, we looked at the deliberation of medical institution ethics committees on decisions to discontinue life-sustaining treatment for patients without family ties.Under the current law, the medical institution ethics committee cannot make decisions on discontinuation of life-sustaining treatment for unbefriended patients, so through revision, matters regarding decisions on discontinuation of life-sustaining treatment for unbefriended patients are reflected in Article 14 of the same Act or separate provisions for unbefriended patients are made. It is necessary to establish and amend new provisions. In addition, the medical institution ethics committee must make a decision on unbefriended patients, but if the medical institution cannot make such a decision, there is a need to revise the law so that the public ethics committee can make decisions, such as discontinuing life-sustaining treatment for unbefriended patients.

• Clinics in Shoulder and Elbow
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• v.25 no.1
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• pp.49-56
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• 2022

Background: The treatment approach for proximal humeral fractures is determined by various factors, including patient age, sex, dominant arm, fracture pattern, presence of osteoporosis, preexisting arthritis, rotator cuff status, and medical comorbidities. However, there is a lack of consensus in the literature regarding the optimal treatment for displaced proximal humeral fractures. This study aimed to assess and quantify the decision-making process for either conservative or surgical treatment and the choice of surgical method among shoulder surgeons when treating proximal humeral fractures. Methods: Forty sets of true anteroposterior view, scapular Y projection view, and three-dimensional computed tomography of proximal humeral fractures were provided to 12 shoulder surgeons along with clinical information. Surveys regarding Neer classification, decisions between conservative and surgical treatments, and chosen methods were conducted twice with an interval of 2 months. The factors affecting the treatment plans were also assessed. Results: The inter-rater agreement was fair for Neer classification (kappa=0.395), moderate for the decision between conservative and surgical treatments (kappa=0.528), and substantial for the chosen method of surgical treatment (kappa=0.740). The percentage of agreement was 71.1% for Neer classification, 84.6% for the decision between conservative and surgical treatment, and 96.4% for the chosen method of surgical treatment. The fracture pattern was the most crucial factor in deciding between conservative and surgical treatments, followed by age and physical activity. Conclusions: The decision between conservative and surgical treatment for proximal humeral fractures showed good agreement, while the chosen method between osteosynthesis and arthroplasty showed substantial agreement among shoulder surgeons.

• 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.

• Journal of the Korean Institute of Illuminating and Electrical Installation Engineers
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• v.15 no.6
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• pp.89-96
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• 2001

This paper presents a decision making technique of reasonable $O_2$quantity needed to resolve organic matter via microbe in wastewater treatment. Decision making system of inferring reasonable $O_2$quantity consists of three parts. The first part is to compute reasonable $O_2$quantity with given process data. The second part is to find output features of processed wastewater using process model when $O_2$quantity is changed to a value inferred from decision making system. The third part is to show the results of decision making system. In order to verify performance of proposed decision making system computer simulation was done with process data gathered during 40 days. Simulation result shows that $O_2$quantity can be reduced over 10% under the condition of satisfying the specifications for processed wastewater.

• Journal of Korean Academy of Nursing
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• v.49 no.3
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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.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.19 no.12
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• pp.636-644
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• 2018

This study was conducted to examine the effects of an emergency treatment education program on nursing students' self-leadership, career decision-making self-efficacy, and nursing performance ability. The study was designed using a nonequivalent control group pretest-posttest design, and data were collected from June 1 to August 31, 2017. The participants consisted of 52 nursing students in D College of D City who were assigned to an experimental group (n=27) or control group (n=25). The pretest poll was performed on June 1, 2017 and posttest poll was performed 2 weeks later without any treatment in the control group. In the experimental group, the pretest poll was performed on July 25 before the emergency treatment education program and the posttest poll was performed on August 31 after the education program. The emergency treatment education program for the experimental group consisted of 2 hours of emergency treatment instruction, autonomously watching videos, and 4 hours of teaching elementary students about CPR for adults and first aid for airway obstruction, burns, bleeding, and fractures as a lecturer. The data were analyzed using descriptive analysis, independent t-test, $x^2$ test, and paired t-test with SPSS/WIN 20.0. After receiving the emergency treatment education program, a difference was observed in self-leadership (t=2.08, p<.05), career decision-making self-efficacy (t=4.22, p<.05) and nursing performance ability (t=5.02, p<.05) in the experimental group. The results of this study indicate that the emergency treatment education program was effective at increasing self-leadership, career decision-making self-efficacy, and nursing performance ability in nursing students.

• Health Policy and Management
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• v.16 no.3
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• pp.70-85
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• 2006

The purposes of this study were (1) to describe patients' behaviors to protect themselves from medical errors and their involvement in decision making on the diagnostic and treatment procedures (2) to examine whether patients' characteristics, such as age, sex, education, experience of hospitalization and/or surgery influence their self protect behaviors and involvement in decision making on the diagnostic and treatment procedures. A survey was conducted with 99 patients visited one university hospital in Seoul, Korea. A 20-item questionnaire, a 4-point Likert scale, was used to measure the degree of patients' active involvement in decision making; patients' self protect behaviors regarding medication, hospitalization, and surgery; and communication (Cronbach's alpha=0.801). SPSS 12.0 was used for the descriptive and correlation analysis. Only 6.1% of the participants were involved in the decision making process for the diagnostic tests and treatment. More patients did self-protect behaviors associated with the medication than other areas but widely varied from 18.2 to 94.3 % among various items. More people with age of 60 or older compared to people in younger age groups reported more protect behaviors particularly associated with medication. Patient education is needed to improve their active role in preventing medical errors and to promote patients' safety.

• Journal of Digital Convergence
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• v.16 no.10
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• pp.485-496
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• 2018

This study set out to organize and apply a group program designed to resolve the psychological career barriers of university freshmen and test its effects on their psychological career barriers, self-efficacy in career decision-making, and self-determination. For this purpose, the investigator divided the subjects into a treatment group of eight and a comparison group of nine, implemented a group program designed to resolve psychological career barriers over seven sessions, and applied no treatment to the comparison group. In an effort to examine the program's effects, the investigator conducted tests on psychological career barriers, self-efficacy in career decision-making, and self-determination in the pre- and post-test both in the treatment and comparison groups and examined the differences between them. The findings were as follows: first, the treatment group made a significant decrease to its psychological career barriers scores compared to the comparison group; second, the treatment group made a significant increase to its self-efficacy in career decision-making scores compared to the comparison group; and finally, the treatment group also made a significant increase to its self-determination scores compared to the comparison group with a significant enhancement. That is, the program was effective for lowering the psychological career barriers of university freshmen and improving their self-efficacy in career decision-making and self-determination. The study also discusses the utilization of its findings and future study.