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A Review on the Change of Health Policy Based on Ethical Issues (윤리적 쟁점을 중심으로 한 보건의료정책 변화의 고찰)

  • Lee, Dong Hyun;Kim, So Yoon;Sohn, Myongsei
    • Health Policy and Management
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    • v.28 no.3
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    • pp.222-225
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    • 2018
  • Health policy is a historical product in the process of development, including the political and economic factors of the state as well as the social and cultural elements of the country. Bioethics began to debate the ethical questions that arise in the overall process of life's birth and death, and gradually evolved by presenting ethical directions for various social phenomena. Especially, according to the moral awakening of 'scientific medicine' which caused in some human problems in the rapidized scientific society from the late 19th century to the early 20th century, as a result of distress including the concept of various social relations, it is possible to say that it has reached the bioethics. Although health policy and bioethics are different in terms of starting and concept, they can be found in common with social, cultural, and political diversity in the times. In 2004, 'Bioethics Law' was enacted through the issue of research ethics in the life sciences. Therefore, in order to examine ethical aspects of current health policy direction and major issues, it can be divided into before and after enactment of 'Bioethics Law' in 2004. The authors would like to examine how the evolution of the ethical viewpoint on the health policy has changed in line with the enactment of the 'Bioethics Law' and how it is trying to solve it from an ethical point of view. Through the various events that took place in the 1990s and the 2000s, various discussions on bioethics were conducted in Korea. Prior to the enactment of the 'Bioethics Law,' ethical judgments of professions, distribution of healthcare resources, if the discussion focused on the ethical judgment of abortion, and the various events that appeared in the early 2000s became the beginning to inform that the ethical debate about the life, death, and dignity of human beings began in earnest in Korea with the enactment of the 'Bioethics Law.' Since then, 'Hospice and Palliative care Law' which was enacted in 2017, is based on the fact that the health policy of our country focuses on the treatment of the past diseases, health promotion, and delivery of health care services. It was an opportunity to let them know that even the quality problems were included. Therefore, considering the various circumstances, the ethical issue facing Korea's health care system in the future is the change of the demographic structure due to aging and what is to be considered as the beginning and the process of life in the overall process of life. It is the worry about how to die and when it sees as death. This has far exceeded the paradigm of traditional health care policies such as disease prevention and management and health promotion, and calls for innovative policy response at the national level that reflects the new paradigm, which in many cases creates a predictable ethical environment. And health policy should be shifted in the direction of future ethical review considering sustainability in the development process of future health care rather than coercive management.

Factors Related to Fatigue in Cancer Patients Receiving Chemotherapy (항암 화학요법 환자의 피로 관련 요인)

  • Jung, Eun-Ja;Jung, Young;Park, Mi-Young
    • Journal of Hospice and Palliative Care
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    • v.7 no.2
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    • pp.179-188
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    • 2004
  • Purpose: The purpose of this study was to investigate the degree of fatigue and its related factors in cancer patients during chemotherapy. Methods: The subjects of this study consisted of 90 patients over 20 years old who were receiving chemotherapy at the injection room of the o.p.d. and ward admission care unit in a University hospital located in Gwang-ju city and data were collected from August 8th to October 2nd, 2002. Collected data were analysed using SPSS v 10.0. to obtain summary statistics for the descriptive analysis, t-test, ANOVA, pearson correlation, and multiple regression. Results: 1. Fatigue of the subjects was significantly correlated with physical distress score. and 6 items of subscale those were nausea, vomiting, anorexia, pain, and immobility, showed statistically significant correlation. 2. Fatigue of the subjects showed statistically significant differences according to a nap satisfaction. Fatigue of the subjects was significantly correlated with mood state, Also, all 5 items of subscale, which are those were anxiety, confusion, depression, energy, and anger showed statistically significant correlations. 3. Fatigue of the subjects showed statistically significant differences according to metastasis, chemotherapy cycle, post operation existence, post radiation therapy existence. There were significant negative correlation between fatigue and hematocrit and fatigue and weight change. There was no significant correlation between fatigue and spiritual well-being state. With the result to multiple regression, Immobility, Anorexia, Anger explained fatigue by, pain, and immobility showed statistically significant correlation.

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A Lab-Made Wound Maker for Analysis of Cell Migration in a 96-Well Plate (세포 이동능력 분석을 위한 96-Well Plate 전용 Lab-Made Wound Maker)

  • Lee, Tae Bok;Kim, Hwa Ryoung;Park, Seo Young
    • Korean Journal of Clinical Laboratory Science
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    • v.52 no.1
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    • pp.53-61
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    • 2020
  • Cell migration is a central process for recovering from wounds triggered by physical distress besides embryogenesis and cancer metastasis. Wound healing assay is widely used as a fundamental research technique for investigation of two-dimensional cell migration in vitro. The most common approach for imitating physical wound in vitro is mechanical scratching on the surface of the confluent monolayer by using sharp materials. The iron metal pin with a suspension spring for fine adjustment of the orthogonal contact surface between the scratching point and the individual bottom of multi-well plate with planar curvatures were adopted for the creative invention of a 96-well plate wound maker. While classic tips drew diverse and zigzag scratching patterns on the confluent monolayer, our wound maker displayed synchronized linear wounds in the middle of each well of a 96-well plate that was seeded with several cell lines. Given that several types of multi-well plates commercially available are compatible with our lab-made wound maker for creating uniform scratches on the confluent monolayer for the collective cell migration in wound healing assay, it is certain that the application of this wound maker to the real-time wound healing assay in high content screening (HCS) is superior than utilization of typical polypropylene pipette tips.

What Can We Apply to Manage Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Acute Respiratory Failure?

  • Kim, Deog Kyeom;Lee, Jungsil;Park, Ju-Hee;Yoo, Kwang Ha
    • Tuberculosis and Respiratory Diseases
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    • v.81 no.2
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    • pp.99-105
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    • 2018
  • Acute exacerbation(s) of chronic obstructive pulmonary disease (AECOPD) tend to be critical and debilitating events leading to poorer outcomes in relation to chronic obstructive pulmonary disease (COPD) treatment modalities, and contribute to a higher and earlier mortality rate in COPD patients. Besides pro-active preventative measures intended to obviate acquisition of AECOPD, early recovery from severe AECOPD is an important issue in determining the long-term prognosis of patients diagnosed with COPD. Updated GOLD guidelines and recently published American Thoracic Society/European Respiratory Society clinical recommendations emphasize the importance of use of pharmacologic treatment including bronchodilators, systemic steroids and/or antibiotics. As a non-pharmacologic strategy to combat the effects of AECOPD, noninvasive ventilation (NIV) is recommended as the treatment of choice as this therapy is thought to be most effective in reducing intubation risk in patients diagnosed with AECOPD with acute respiratory failure. Recently, a few adjunctive modalities, including NIV with helmet and helium-oxygen mixture, have been tried in cases of AECOPD with respiratory failure. As yet, insufficient documentation exists to permit recommendation of this therapy without qualification. Although there are too few findings, as yet, to allow for regular andr routine application of those modalities in AECOPD, there is anecdotal evidence to indicate both mechanical and physiological benefits connected with this therapy. High-flow nasal cannula oxygen therapy is another supportive strategy which serves to improve the symptoms of hypoxic respiratory failure. The therapy also produced improvement in ventilatory variables, and it may be successfully applied in cases of hypercapnic respiratory failure. Extracorporeal carbon dioxide removal has been successfully attempted in cases of adult respiratory distress syndrome, with protective hypercapnic ventilatory strategy. Nowadays, it is reported that it was also effective in reducing intubation in AECOPD with hypercapnic respiratory failure. Despite the apparent need for more supporting evidence, efforts to improve efficacy of NIV have continued unabated. It is anticipated that these efforts will, over time, serve toprogressively decrease the risk of intubation and invasive mechanical ventilation in cases of AECOPD with acute respiratory failure.

Biological Mechanism of Somatization : Mainly Focused on the Neuropsychological Model of Somatization (신체화의 생물학적 기전 : 신체화의 신경심리학적 모델을 중심으로)

  • Lee, Young-Ho
    • Korean Journal of Psychosomatic Medicine
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    • v.8 no.1
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    • pp.122-140
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    • 2000
  • Somatization disorder is a chronic condition characterized by multiple somatic complaints that are not due to any apparent organic illness. Somatization disorder is related historically to hysteria and hysteria has been defined by the existence of somatic complaints for which no organic reason can be found. Therefore most theories of somatization have focused on the psychodynamic and sociological perspectives. However, the concept that the somatic presentation of emotional distress or psychiatric illness might have a neurobiological basis has also aroused considerable interest. Relative to this perspective, the case of Anna O. which has been considered the prototype of hysteria, was reformulated from a neuropsychological perspective. Several neurophysiological and neuropsychological studies, studies concerning hemispheric differences in symptom presentation of the patients with hysteria have been shown the evidences for the biological basis of somatization. Moreover, recent neuroimaging studies in somatization disorder also show that brain dysfunction in somatization. The author reviewed several candidate theories which could help to explain the process of somatization in the perspective of biological basis and proposed the new neuropsychological model of somatization. The author also examined the possible application of this model to the treatment of somatization disorder and discussed it's limitation and the future directions in this field.

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Palliative Surgery in Two Dogs with Non-Curative Palatal Tumors (두 마리 개에서 완치가 어려운 구개 종양의 완화 수술 적용 증례)

  • Yoon, Hun-Young;Lee, Jung-Ha;Shin, Dong-Wook;Park, Hee-Myung;Jeong, Soon-Wuk
    • Journal of Veterinary Clinics
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    • v.31 no.5
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    • pp.425-429
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    • 2014
  • Two dogs were presented with a history of anorexia, respiratory distress, or epistaxis. On physical examination, the dogs showed difficulty breathing and open-mouth breathing and large masses were found on the hard palate and soft palate. Cardiac arrest happened in case 2 and the dog was stabilized with cardiopulmonary resuscitation and oxygen therapy. Computed tomography demonstrated that the mass occupied the oropharynx, intrapharyngeal ostium, and laryngopharynx including the hard palate and soft palate in case 1. Palliative surgery was decided to improve swallowing and breathing with owner's consent in two dogs. Buccal mucosal flaps were performed for reconstruction of defects using rotational and single-pedicle advancement flaps and bilateral 90 degree transposition flaps in cases 1 and 2, respectively. Histopathology results described the oral masses as amelanotic melanoma in two dogs. The owners reported that there was normal swallowing and breathing at 7 days postoperatively in two dogs. In case 1, recurrent tumor was identified caudal to the hard palate 4 weeks after surgery. The owner did not allow further treatment and the dog became lost to follow-up at 2 months postoperatively. In case 2, there was no clinical or radiographic evidence of a local recurrence or distant metastasis at 3 weeks after surgery. The owner informed that the dog died suddenly with no signs of anything particularly wrong at 7 weeks after surgery.

A CLINLCAL STUDY OF the TYPE OF DISEASE AND SYMTOM ACCORDING TO SASANG CONSTITUTION CLASSWICATION (in the field of questionnaire analysis) (체질진단분류(體質診斷分類)에 따른 질병(疾病) 및 증상유형(症狀類型)에 관한 임상적 연구 - 문진표를 중심으로 -)

  • Kim, Jong-Wean
    • Journal of Sasang Constitutional Medicine
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    • v.8 no.1
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    • pp.337-347
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    • 1996
  • The 73 outpatients who had been treated in the Oriental Medical Hospital at Dong Eui Medical Center have participated in this study. The following conclusions were made in comparison with the type of disease and symptom and sasang constitution classification. (in the field of questionnaire analysis) 1. The symptom of "weight loss" is significant differences in sasang constitution classification. The frequency of Taeeum goup is more than Soyang group and Soeum group. 2. The symptom of "vomitig" is significant differences in sasang constitution classification. The frequency of Taeeum goup is more than Soyang group and Soeum group. 3. The symptom of "hoarseness" is significant differences in sasang constitution classification. The frequency of Soeum goup is more than Soyang group and Taeeum group. 4. The symptom of "respiratory distress" is significant differences in sasang constitution classification. The frequency of Taeeum goup is more than Soyang group and Soeum group. 5. The symptom of "arthralgia" is significant differences in sasang constitution classification. The frequency of Soyang goup is more than Taeeum group and Soeum group. 6. The symptom of "menstrual pain" is significant differences in sasang constitution classification. The frequency of Soeum goup is more than Soyang group and Taeeum group. 7. The analysis of past history and sasang constitution classification didn't show any significant differences. Only the analysis of past history and age show significant differences. I think that it is necessary to go deep into the clinical study of the type of disease and symptom according to sasang constitution classification.

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Adjuvant Glucocorticoids Therapy in Canine Mast Cell Tumor (Canine Mast Cell Tumor에서 Adjuvant Glucocorticoids 치료)

  • Kim Myung-jin;Lee Jae-il;Kim Young-suk;Son Hwa-young;Jun Moo-hyung;Park Chang-sik;Kim Myung-cheol
    • Journal of Veterinary Clinics
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    • v.22 no.3
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    • pp.264-267
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    • 2005
  • A 12-year-old, 8.0 kg, spayed female, mixed-breed dog was presented to the Veterinary Medical Teaching Hospital of Chungnam National University (VMTH, CNU). That case has been growing up mass in her left upper hindlimb about for 2 years and has showed vomiting and anorexia for 3 days. The patient was diagnosed with mast cell tumor on the basis of fine-needle aspiration (FNA) cytology techniques. According to World Health Organization clinical staging system for diagnosing mast cell tumors, it was classified into stage IIIa. The patient was treated by adjuvant corticosteroid therapy, but complete surgical excision was not achieved by owner's request. In the early stage of therapy, the size of the mass was gradually reduced with only adjuvant glucocorticoid therapy, so the patient's general condition was maintained well. But after 53 days later, the treatmant was not effective anymore and mass size was increased. Two months later, she was euthanized because of intermittent vomiting and severe respiratory distress. Splenic mass, duodenal ulceration, liver mass and infiltrated mast cell tumor in upper hindlimb muscle region were found in necropsy examination.

Cognitive Impairment in the Patients with Mildly Active Systemic Lupus Erythematosus (경증 전신성 홍반성 루프스 환자의 인지기능장애)

  • Kim, Jin-Hee;Lee, Chul;Lee, Chang-Uk;Paik, In-Ho
    • Korean Journal of Psychosomatic Medicine
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    • v.5 no.1
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    • pp.89-96
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    • 1997
  • This study was designed to determine whether cognitive impairment was evident in patients with SLE. Also, it aimed to examine the association of cognitive impairment with other clinical variables. The subjects consisted of 20 patients with mildly active SLE and 20 healthy controls. Methods : A total of 20 SLE patients and 20 normal controls completed a computerized neuropsychological test battery using Vienna Test System. These included Cognitrone test, Continuous attention test, Corsi block tapping test, Standard progressive matrices. Also, neuro-behavioral cognitive status examination was done. The symptom severity of depression was measured with Beck Depression Inventory, Hamilton Depression Rating Scale, and current medications were documented. Disease activity was rated using the SLE diasease activity index (SLEDAI). Results : SLE patients had poorer performance than normal controls on the tests of Cognitrone, attention, nonverbal IQ and memory, independent of age, education, disease activity, steroid use and depression status. Conclusion : Cognitive dysfunction was not uncommon in ambulatory SLE patients as measured by standardized neuropsychological tests. It seemed to occur independently of various clinical variables. These findings would suggest that cognitive dysfunction in SLE may be explained by reflecting subclinical central nervous system(CNS) involvement, rather than coexisting psychological distress due to chronic illness or side effect of medication.

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A Survey on Back Pain of Nurses (간호활동의 유형과 요통 발생에 관한 일 조사연구)

  • 한윤복
    • Journal of Korean Academy of Nursing
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    • v.7 no.1
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    • pp.39-46
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    • 1977
  • Despite the fact that it is not a fatal symptom. the lower back pain of human species is considered a health problem of modern society: 80% of world population experience it and the distress and dysfunction caused by interferes daily life as well as the general productivity. This study was performed to investigate the general tendency of lower back Pain on nurses: influence of nursing activities, working condition and the physical characteristics of nurses on the pain in order to provide data for prevention and treatment. 386 nurses working at 16 general hospitals throughout the country were sampled. Questionaries developed by the researcher was used for data gathering. Results are as follows : 1. Lower back pain was experienced by most(72.3%) of the nurses: the highest rate of -Pain experience was revealed to be the a9e group of 35-39 (80.8%) followed by 25-29 group (74.2%). 2. In almost all instances (91.4%), the first pain attack occurred before the age of 29, and in 73.1%. the attack occurred between the age of 15-24. 3. In 10.1%, the pain was almost persistent or occurred every other day frequency. In 9%, the pain was relieved by the administration of analgesics or "unable to move". 4. More than 6 days′sick leave due to the pain revealed to be in 2.2%. No significant difference was revealed between specialities of service. 5. Pain experience and the over or under weight revealed not to have significant relations. (X$^2$=0.55224, p〉0.7587) 6. The length of working hour of I. C. U. and O. R, revealed to be longer than that of nurses general ward, however. no significant difference on the rate of pain occurrence apparent. (X$^2$=0.4952, p〉0.8239) No significant difference on the rate of pain occurrence between nurses working over 46 hours/week and under 45 hours/week. (X$^2$=3.86241, p〉0.078318) 7. The most frequent Pain related movement revealed to be "lifting patient or heavy object" (24. 7%, N=68) followed by "the sameness of position, either standing or sitting"(16.8%) 8. Regular physical exercise revealed to have no significant influence on the rate of Pain occurrence. 9. Higher raft of pain experience was revealed in the group of nurses wearing eye glasses. Uncomfortable shoes revealed to have influenced the pain. 10. The most frequent pain relieving treatment revealed to be "rest" (54.2%, N= 151) followed by "analgesics" (12.6%, N=35) and "hot compress/fomentation"(10.5%, N=29). In 13.7% (N=38) no special care was given.

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