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The Historical Study of Headache in Chinese Ming Dynasty (명대의가(明代醫家)들의 두통(頭痛)에 대한 인식변화에 관한 연구)

  • Chun, Duk-Bong;Maeng, Woong-Jae;Kim, Nam-Il
    • The Journal of Korean Medical History
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    • v.24 no.1
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    • pp.43-56
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    • 2011
  • Everyone once in a life experience headaches as symptoms are very common. According to a study in a country of more than a week and as many as those who have experienced a headache amounts to 69.4%. In addition, the high reported prevalence of migraine in 30s for 80% of all migraine sufferers daily life interfere with work or was affected. In Western medicine, the cause of headaches is traction or deformation of pain induced tissue like scalp, subcutaneous tissue, muscle, fascia, extracranial arteriovenous, nerves, periosteum. But it turns out there are not cause why pain induced tissue is being tracted or deformated. Therefore, most of the western-therapy is mainly conducted with regimen for a temporary symptom reduction. Therefore, I examined how it has been developed in Chinese Ming Dynasty, the perception of headache, change in disease stage and an etiological cause. Oriental medicine in the treatment of headache is a more fundamental way to have an excellent treatment. The recognition of head in "素問($s{\grave{u}}$ $w{\grave{e}}n$)" and "靈樞($l{\acute{i}}ng$ $sh{\bar{u}}$)" began to appear in 'Soul-神($sh{\acute{e}}n$) dwelling place' and 'where to gather all the Yang-'諸陽之會($zh{\bar{u}}$ $y{\acute{a}}ng$ $zh{\bar{i}}$ $hu{\grave{i}}$)'. Also, head was recognized as '六腑($li{\grave{u}}f{\check{u}}$) 淸陽之氣($q{\bar{i}}ng$ $y{\acute{a}}ng$ $zh{\bar{i}}$ $q{\grave{i}}$) and 五臟($w{\check{u}}$ $z{\grave{a}}ng$) 精血($j{\bar{i}}ng$ $xu{\grave{e}}$) gathering place'. More specific structures such as the brain is considered a sea of marrow(髓海-$su{\check{i}}$ $h{\check{a}}i$) in "內經($n{\grave{e}}i$ $j{\bar{i}}ng$)" and came to recognized place where a stroke occurs. Accompanying development of the recognition about head, there had been changed about the perception of headache and the recognition of the cause and mechanism of headache. And the recognition of headache began to be completed in Ming Dynasty through Jin, Yuan Dynasty. Chinese Ming Dynasty, specially 樓英($l{\acute{o}}u$ $y{\bar{i}}ng$), in "醫學綱目($y{\bar{i}}xu{\acute{e}}$ $g{\bar{a}}ngm{\grave{u}}$)", first enumerated prescription in detail by separating postpartum headache. and proposed treatment of headache especially due to postpartum sepsis(敗血-$b{\grave{a}}i$ $xu{\grave{e}}$). 許浚($x{\check{u}}$ $j{\grave{u}}n$) accepted a variety of views without impartial opinion in explaining one kind of headache in "東醫寶鑑($d{\bar{o}}ng-y{\bar{i}}$ $b{\check{a}}oji{\grave{a}}n)$" 張景岳($zh{\bar{a}}ng$ $j{\check{i}}ng$ $yu{\grave{e}}$), in "景岳全書($j{\check{i}}ng$ $yu{\grave{e}}$ $qu{\acute{a}}nsh{\bar{u}}$)", established his own unique classification system-新舊表裏($x{\bar{i}}nji{\grave{u}}$ $bi{\check{a}}ol{\check{i}}$)-, and offered a clear way even in treatment. Acupuncture treatment of headache in the choice of meridian has been developed as a single acupuncture point. Using the classification of headache to come for future generation as a way of locating acupoints were developed. Chinese Ming Dynasty, there are special treatments like 導引按蹻法($d{\check{a}}o$ y ${\check{i}}n$ ${\grave{a}}n$ $ji{\check{a}}o$ $f{\check{a}}$), 搐鼻法($ch{\grave{u}}$ $b{\acute{i}}$ $f{\check{a}})$, 吐法($t{\check{u}}$ $f{\check{a}}$), 外貼法($w{\grave{a}}i$ $ti{\bar{e}}$ $f{\check{a}}$), 熨法($y{\grave{u}}n$ $f{\check{a}}$), 點眼法($di{\check{a}}n$ $y{\check{a}}n$ $f{\check{a}}$), 熏蒸法($x{\bar{u}}nzh{\bar{e}}ng$ $f{\check{a}}$), 香氣療法($xi{\bar{a}}ngq{\grave{i}}$ $li{\acute{a}}of{\check{a}}$). Most of this therapy in the treatment of headache, it is not used here, but if you use a good fit for today's environment can make a difference.

A Preliminary Study for the Application of Michigan Alcoholism Screening Test-Geriatric Version in Korea (한국에서 노인용 미시간주정의존선별검사의 적용을 위한 예비연구)

  • Cheon, Jin-Sook;Oh, Byoung-Hoon;Choi, Young-Tai
    • Korean Journal of Biological Psychiatry
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    • v.6 no.1
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    • pp.102-110
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    • 1999
  • Objectives : The alcohol dependence in elderly people has been prevalent because of increase in geriatric population. However, it is difficult to find out alcohol dependence in the aged, because they have less specific clinical features as compared with adult alcoholics. The aims of this study were to screen alcohol dependence among elderly Koreans and to know the clinical characteristics of Korean delerly alcoholics. Methods : The questionnaires translated into Korean such as Michigan Alcoholism Screening Test(MAST-K), the Brief MAST and the MAST-Geriatirc Version (MAST-KG) were used to screen alcohol dependence in the elderly alcoholic inpatients aged over 60(N=43), adult alcoholic inpatients within 20-59 Yrs of age(N=60), which were compared with age matched normal healthy aged(N=18) or adult controls(N=45). The demographic data such as sex, age, education, occupation, socioeconomic status, marital status, numbers of children, dwelling and religion as well as alcohol history such as duration of alcohol drinking, onset age, family history, impulsivity, somatic illness and motivation were also obtained to identify characteristic features of Korean aged alcoholics by structured interviews. Results : 1) The aged alcoholics had the charateristic features of more in males, lower age, low education levels, more in blue-collar workers, lower socioeconomic class, more in single, few babies, more living alone, having no religion without statistical significance. 2) The onset age of alcohol dependence was significantly higher in the aged alcoholics($45.3{\pm}13.6Yrs$) than in the adult alcoholics($27.7{\pm}8.7Yrs$)(p<0.0001). The duration of problematic alcohol drinking was significantly longer in the aged alcoholics($22.0{\pm}15.1Yrs$) than in adult alcoholics($14.2{\pm}8.4Yrs$)(p<0.01). Otherwise, there were no significant difference between aged and adult alcoholics in the family history, imulsivity, somatic illness and motivation. 3) The mean score of the MAST-K was significantly higher in the aged alcoholics($20.6{\pm}5.4$) than in the normal aged($6.7{\pm}4.4$)(p<0.0001), which was significantly lower than in the adult alcoholics($26.2{\pm}8.0$) and in normal adult controls($9.5{\pm}3.2$)(p<0.05). The mean score of the Brief MAST was significantly lower in the aged alcoholics($9.3{\pm}3.5$) than in the adult alcoholics($14.5{\pm}6.6$)(p<0.0001). The mean score of the MAST-KG was significantly higher in the aged alcoholics($10.6{\pm}3.5$) than in the normal aged($4.8{\pm}4.3$)(p<0.0001). The former was significantly lower than in the adult alcoholics($12.9{\pm}4.3$)(p<0.005), and the mean score was $4.5{\pm}2.8$ in normal adult controls. 4) The items which showed statistically significant differences between aged alcoholics and normal aged controls could be found in 10 items of the MAST-K(items 2, 3, 4, 5, 11, 14, 17, 21, 22 and 23), 2 items of the Brief MAST(items 2 and 9), and 7 items of the MAST-KG(items 6, 13, 18, 19, 22, 23 and 24)(p<0.01). Conclusions : The scores of the MAST-K, the Brief MAST and the MAST-KG were significantly lower in the aged alcoholics than those in the adult alcoholics (p<0.05). The statistically significant differences between aged alcoholics and normal aged controls could be found in 10 items of the MAST-K, 2 items of the Brief MAST and 7 items of the MAST-KG. Therefore, a briefer rating scales around 10 items are needed to screen alcohol dependence among Korean elderly people.

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Development of Source Template ICRT Dose Planning Software for Uterine Cervix Using the HDR: $^{192}Ir$ (강내조사를 위한 고선량률 근접조사 선원맞춤형 선량계획)

  • Choi, Tae-Jin;Oh, Young-Kee;Kim, Jin-Hee;Kim, Ok-Bae
    • Progress in Medical Physics
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    • v.20 no.2
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    • pp.112-118
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    • 2009
  • The source position and source dwelling time in a given source arrangement in the applicators is very high effect to determine the expose time which in general is derived from the brachytherapy planning system. In high dose rate (HDR) intracavitary radiation therapy (ICRT), the treatment is often performed in based out-patient during the whole fractionation irradiations. However, the patient should be waited on coutch for ICR treatment in first start fraction as unconvinent and immobilized state until perform the dose plannings. In our experiments, the HDR source contributed dose for$55.89{\pm}4.20%$ for straight tandem source, $38.14{\pm}4.46%$ for the right ovoid soucre on the fornix and$5.97{\pm}0.50%$ for left ovoid source. It also showed the $60.33{\pm}6.53%$ for the tandem, $33.10{\pm}6.74%$ for right ovoid and $6.58{\pm}0.30%$ for the left ovoid source in 10 degrees of applicator. The authors designed the source template dose planning software for ICRT of uterine cervix results average $-0.55{\pm}2.15%$ discrepancy of the full charged brachytherapy dose planning. Developed Source temperate ICRT plaanning software guide a minimized the complains and operating times within a ${\pm}3%$ of dose discrepancies.

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Size Distribution and Physicochemical Characteristics of MSW for Design of Its Mechanical Biological Treatment Process (폐기물전처리(MBT)시설 설계를 위한 생활폐기물의 입도분포 및 물리화학적 특성에 관한 연구)

  • Park, Jin-Kyu;Song, Sang-Hoon;Jeong, Sae-Rom;Jung, Min-Soo;Lee, Nam-Hoon;Lee, Byoung-Chul
    • Journal of the Korea Organic Resources Recycling Association
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    • v.16 no.1
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    • pp.62-69
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    • 2008
  • There has been a recent trend in Korea that treatments for combustible wastes among municipal solid waste (MSW) by those methods, such as incineration and landfill are restricted as much as possible and Mechanical Biological Treatment (MBT) are encouraged actively in order to promote resource recovery. To build and operate properly these facilities, the physicochemical characteristics of MSW should be analyzed precisely beforehand. In particular, designing a crusher or separator properly which is the main process in MBT facilities of MSW. require the information on the size distribution characteristics of MSW, but they are nor sufficient in the qualities and quantities yet as of now. Accordingly, this study aims to evaluate size distribution characteristics of MSW and its physicochemical characteristics by size. The samples of MSW were collected from detached dwelling area, apartment area, business area, and commercial area of A city in Korea. According to the result of analysis, paper records 29.78~60.02% by wet weight basis, so it was the most regardless of the regions where the wastes were generated. And in terms of element analysis, Carbon(C) was 34.77~44.39%, the largest friction, and Oxygen(O) was the next occupying 19.46~33.71%. As indices of RDFs, Chlorine(Cl) was 0.39~0.83%, so it was less than the standard, 2.0%(by dry weight basis); moreover, Sulfur(S) did not exceed the standard, 0.6%, either. In the size distribution of MSW, waste fraction ranging 50~80mm in diameter was the most in combustible waste while 30~50mm was in incombustible waste.

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Physicochemical Characteristics of Seawater in Gamak Bay for a Period of Hypoxic Water Mass Disappearance (가막만 빈산소 수괴 소멸기의 물리화학적 특성)

  • Kim, Jeong-Bae;Park, Jung-Im;Jung, Choon-Goo;Choi, Woo-Jeung;Lee, Won-Chan;Lee, Yong-Hwa
    • Journal of the Korean Society of Marine Environment & Safety
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    • v.16 no.3
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    • pp.241-248
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    • 2010
  • Hypoxic(oxygen-deficient) water masses are a key threat to the ecosystem of shallow marine coastal areas worldwide. The phenomena of hypoxia occurred at Gamak Bay, on the southeast coast of Korea, in late June 2007. In this paper, the physicochemical characteristics of seawater were surveyed for a period of hypoxic water mass disappearance. The hypoxic water mass was located between Sunso and the northwestern area of the inner bay. The dissolved oxygen(DO) concentrations of surface and bottom water were $1.3mgL^{-1}$ and less than $2mgL^{-1}$, respectively, in the hypoxic water masses, and $4.5{\sim}6.8mgL^{-1}$ and $3.8{\sim}6.0mgL^{-1}$ at the other oxygen-rich sample sites, respectively. Chlorophyll a concentrations were $4.9{\sim}25.3{\mu}gL^{-1}$ at the surface, $2.3{\sim}23.1{\mu}gL^{-1}$ in the middle, and $1.9{\sim}9.0{\mu}gL^{-1}$ at the bottom of the hypoxic water masses. When the hypoxic water mass appeared in Gamak Bay, it formed three different vertical types. The first type occurred throughout the water depth around Sunso. The second type developed from the bottom. The third type of hypoxic water mass was formed in the middle water layer when the inversion of water temperature occurred. The third type of phenomena appeared at only St. 9, St. 14 and St. 21 sites near the Hodo coast. Aquatic surface respiration of bottom-dwelling fishes such as the oriental goby(Acanthogobius flavimanus) was observed and many crustaceans were seen along the adjacent shore of the hypoxic water mass area. About 3,000 oriental gobies as well as many crustaceans died due to this event in Gamak Bay. The results of this study could provide fundamental data for the mechanism of hypoxic water masses in Gamak Bay.

Development of 'the safety' theme-based integrated teaching·learning process plans for the middle school Home Economics Instruction (중학교 가정과 수업을 위한 '안전' 주제 중심 통합 교수·학습 과정안 개발)

  • Kim, Nam Eun;Chae, Jung Hyun;Cho, Jae Soon
    • Journal of Korean Home Economics Education Association
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    • v.28 no.1
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    • pp.19-39
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    • 2016
  • The purpose of this study was to develop the safety theme-based integrated teaching learning process plans for the middle school Home Economics(HE) Instruction and ultimately to contribute for the middle school students to live their safe lives. To achieve the goals of this study, HE curriculum documents from the 1st to the 2015 revision were analyzed and a survey was conducted to identify the middle school students' current status of safety accidents and needs on the HE safety education. The respondents of the survey were the 512 students of one ${\bigcirc}{\bigcirc}$ Girls' Middle School in Busan. And then, the seven integrated themes were selected, each seven integrated theme-networks were formed, and safety theme-based Home Economics curriculum and learning materials were developed. The results of this study were as the follows. The safety education content has continually been included from the first HE curriculum of 1954 to the 2015 revised HE curriculum. The middle school student respondents highly needed the content of 'the methods to deal with sexual violence and prostitution prevention', 'suicide prevention', and 'bullying net' for the HE safety education. All the 42 items were needed for the HE safety education by the respondents. The safety theme-based HE teaching learning process plans developed finally included the seven integrated themes, which were (1) dietary life safety, (2) adolescents' sex and safety, (3) adolescents' relationships with friends and safety, (4) family life and safety, (5) dwelling life and safety, (6) adolescents' egos and safety, and (7) social environment and safety. Each integrated theme consisted of three to six small themes, which amounted to total 28(for 35 lessons). Each small theme was presented with learning objectives and particular goals. The total 157 learning materials including the Home Economics curriculum were developed, which offered learning objectives and content for each safety theme, total 28 teaching and learning plans(for 35 lessons) were developed, which offered specific instructions for the easy implementation of the curriculum in the classroom, 28 PPTs, 25 film materials, four reading materials, 61 workbooks, 14 activity sheets, 16 evaluation sheets, 3 test sheets, 2 reference materials, and 4 learning material models(the refrigerator model, traffic lights for discussions, food tray model and stickers, and food mileage card). In this study, the safety education themes of 'clothing life and safety', 'conflict and safety', 'professional life and safety', and 'consumer and safety' were not addressed because these theme were not needed highly by the respondents. Therefore, for the further development of the teaching learning process plans for the HE safety education, it is necessary to develop and evaluate the teaching learning process plans to address the themes of 'clothing life and safety', 'conflict and safety', 'professional life and safety', and 'consumer and safety'.

Association between Bone Mineral Density and Bone Nutrition Indicators in Elderly Residing in Low Income Area of the City (도시거주 저소득층 노인들의 골지표 및 영양소섭취와 골밀도와의 상관관계에 관한 연구)

  • 손숙미;전예나
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.33 no.1
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    • pp.107-113
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    • 2004
  • This study explored the association between the bone nutrition indicators and the bone mineral density (BMD) in 138 apparently healthy elderly (male: 38, female: 100) dwelling in a low income area of the city. Dietary intakes were estimated from two meals (breakfast & dinner) and snack using 24 hr-recall method and lunch with weighing over 3 consecutive days. Female elderly showed significant lower intakes (p<0.001∼p<0-05) for most of the nutrients except calcium and vitamin C than the elderly male. Calcium and vitamin D intakes for both male and female were 331.0 mg, 1.89 $\mu\textrm{g}$ and 308.6 mg, 1.21 $\mu\textrm{g}$, respectively and they were below the 50% of the RDA. Both the BMDs at lumbar spine (LS) and femoral neck (FN) were positively correlated with the energy intake, calcium intake and vitamin D intake (p<0.05, respectively) for male. In female BMDs of the both sites were positively correlated with the intakes of carbohydrates, protein, lipid, calcium and vitamin D (p<0.01∼p<0.05). Female showed higher serum osteocalcin (p<0.01) and urinary deoxypyridinoline/creatinine (DPYR/CR) (p<0.001), meaning that female had elevated rate in bone turn over and bone resorption. The proportion of subjects with vitamin D deficiency assessed with serum 25(OH)VitD$_3$<10 mg/mL was 35.0% for female and 23.7% for male, respectively Both the BMDs at lumbar spine and trochanter were positively correlated with serum 25(OH)VitD$_3$ but BMDs in most of the sites were negatively associated with urinary DPYR/CR, phosphate/CR. Stepwise multiple regression showed physical activity, serum alkaline phosphatase, weight, vitamin D explained 47.6% of the variation of the LS BMD. The indicator variable for serum alkaline phosphatase was negatively associated with LS BMD. However, the indicator variable for weight and vitamin D intake were positive and significant (p=0.0087, p=0.0007, respectively). For FN BMD, the indicator variable for age and serum alkaline phosphatase were negative and significant (p<0.0075, p<0.0015, respectively) and the weight was positively associated with the FN BMD.

PROPERTIES OF FLUORIDE-RELEASING RESIN COMPOSITE RESTORATIVE MATERIALS (불소방출성 콤포짓트 레진계 수복재의 특성)

  • Kim, Sang-Hoon;Baik, Byeong-Ju;Kim, Jae-Gon;Yang, Yeon-Mi;Park, Jeong-Yeol
    • Journal of the korean academy of Pediatric Dentistry
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    • v.35 no.3
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    • pp.418-426
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    • 2008
  • The objectives of this study were to examine the properties of fluoride-releasing resin composite restorative materials. Four commercially available compomer materials (Compoglass F: CF, $Dyract^{(R)}$ AP: DA, $Dyract^{(R)}$ flow: DF, F2000: FT) and one fluoride-releasing composite resin ($Tetric^{(R)}$ Ceram: TC) were selected as experimental materials. Rectangular-shaped tensile test specimens were fabricated in a teflon mold giving 5mm in gauge length and 2mm in thickness. Disk-shaped specimens were fabricated in the split teflon mold with diameter of 15mm and thickness of 1mm. After curing for an hour, specimens were immersed in deionized water at $37^{\circ}C{\pm}1^{\circ}C$ for 30 days. All specimens were thermocycled for 10,000 cycles with 15 seconds of dwelling time in each $5^{\circ}C$ and $55^{\circ}C$ water baths. Toothbrush abrasion test was conducted under a load of 1.5 N and the abraded surfaces were examined with surface roughness tester (SV-3000, Mitutoyo Co, Japan) and SEM (JSM-5800, JEOL, Japan). Fluoride recharging was done by toothbrushing for 3 min. using a fluoride toothpaste (Perio Alpine Herb, LG Household & Health Care, Korea). The results obtained were summarized as follows; 1. The highest tensile strength value of 32.3 MPa was observed in TC group and the lowest value of 16.8 MPa was observed in CF group. The tensile strength of TC group was significantly higher than those of CF and DF groups (P<0.05). 2. The lowest Ra value of 0.287 was observed in TC group and the highest value of 1.516 was observed in FT group. The Ra value of FT group was significantly higher than other groups (P<0.05). 3. The abraded surfaces revealed the increase of surface roughness due to the protrusion and missing of filler particles. 4. The release of fluoride of compomers after tooth brushing by Perio Alpine Herb was initially large and then followed by small and continuously. But it remains small and constant in fluoride-releasing composite resin of TC. 5. The highest value of fluoride release after toothbrushing by Perio Alpine Herb was $2.064{\mu}g/cm^2$ in CF group and the lowest value was $0.1119{\mu}g/cm^2$ in TC group. The amount of fluoride release of CF group was significantly higher than other groups (P<0.05).

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A Study of the Standard of Costume life in the Chosen Dynasty Period -Focus on Literature- (조선시대의 의생활규범에 관한 연구 -문헌을 중심으로-)

  • Hyun Jin Sook;Min Gil Ja
    • Journal of the Korean Society of Clothing and Textiles
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    • v.9 no.2
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    • pp.67-74
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    • 1985
  • According to the records that all the people in our country were taught the way of braiding the hair and hatting in the first year of 'Tangun' (the founding father of the Korean nation) and that the discipline between sovereign and subject, man and woman, and the standard of food, drink and dwelling were originated from that year, it seems that all the people in our country had lived with keeping a certain standard of food, clothing and shelter, and with maintaining the order in life from ancient times. So, our country have been called 'the Eastern Land of Courtesy' and also regarded as 'the country of the true gentle-man' which was characterized as the custom of a humane, and as the country that had the immortality since a benevolent person lived to a great age. Thus, all the people in our country have lived with keeping and maintaining a certain standard of all aspects in life, and the philosophy in life that we have today was established by the influences of our characteristic thought, Confucianism, Buddhism, Taoism and Christianity, especially the life style in the Chosun Dynasty Period have strong influence on our today life. Thus, the contents concerned with the standard of custume life among those of all life in the Chosun Dynasty Period was studied, and clothes itself is unable to give expression to its ends but when the relationship that is, the inter-harmony among clothes, the body which will be dressed in, and the inherent psyche in that body is formed, then the ends, the complete beauty will be expressed. Though there were many studies dealt with clothes itself, no one was concerned with the all kinds of standard in activities that the dresser should keep, so the purpose of this article is that as above. The literature search is used as the research method. The eight books, 'Noneo' (the Analects of Confucius), 'Yeogi' (the Book of Courtesy), 'Sohak' (the book of Precepts for child-ren), 'Yeosaseo'(the Women's Four Books), 'Sasojeol'(Korean Scholars' Minor Principles) 'Eonhaenaehoon' (Private Moral Instructions for Women), 'Woo-am seonsaeng kyenyeoseo' (Master Woo-am's Cautions for Girls) and 'Kyoobangkasa' (the Lyric Lines of the Boudoir) that had influenced the whole field of life in the Chosun Dynasty Period are analyzed, selected and finally arranged for studyilng the foundation of culture of the clothing and for helping to that culture in modern and future life. The results are as follows: 1. The standard of the clothing life in the Chosun Dynasty Period had deeply rooted in the teaching of confucianism, but also had been influenced by the custom which rooted in our people. 2. There is the emphasis upon the trinity among mind, clothes and activities in the clothing life. 3. The clothing and hat have to be dressed symmetrically in full of all required elements, 4. There is the harmony between the clothing with hat and environments or surroundings. 5. The true elegance in the clothing life will be realized not by the exterior outfit but by the interior outfit with the attitude of chastiny. In conclusion, as the material of clothing life in the Chosun Dynasty Period has the characteristics of the simplicity, the cleanliness, the elegance and the refinement, our clothing life is to be mastered with the simplicity, the cleanliness and the elegance in that life and with the harmony between the inside and the outside.

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Problems of the Current Referral System of the Terminal Cancer Patients in Korea (말기 암 환자의 완화 의료 연계 시스템의 문제점과 개선 방안)

  • Yun, Cho-Hee;Lee, Ju-Young;Kim, Mi-Ra;Heo, Dae-Seok
    • Journal of Hospice and Palliative Care
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    • v.5 no.2
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    • pp.94-100
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    • 2002
  • Purpose : The system to refer terminally ill patients to palliative or hospice care which ultimately give them emotional, psychological, and social support hasn't been fully developed and organized yet in Korea. The controversies concerning the current referral system are being analyzed to present the improvements. Methods : The questionnaires were asked to be filled out by family members of the 76 patients by phone interview, who were referred from the Seoul National University Hospital between April, 2001 to March, 2002. They were referred to the 35 palliative and hospice care-giving institutes and hospitals which were given questionnaires by mail. Results : Of the 76 patient's family members, 47 family members accepted to answer the questionnaire. The first thing that influence to family to determine the referral of patient was solicitation of doctors or nurses (44%). And they were influenced by allowance for the other things such as convenience of patients (32%), convenience of caring family members (24%). In the course of determining of referred institutes, responders had considered at first their dwelling area, and then fame of institutes, the place which patent had wanted to spend last hours or which is suitable for patient's funeral service, and their financial condition. Thirty-eight the 47 responders answered that they had experienced difficulties in referral procedure. The worst among difficulties was unwanted discharge, and followings were lack of information about the referred institutes, concern about patient's suffering, resistance of patient and opposition of other family members, etc. Although they expressed dissatisfaction in referral procedure, most of them answered they had been satisfied with hospice care at referred institute after referral. Merits of referral which responders counted were patient's peace, caring family's comfort and reduced cost in order. Of the 35 referred institutes, 24 institutes' staffs responded mail questionnaires and sent to us in return. Except one responder, the rest approved the referral system and thought that referred patients had been satisfied with their hospice care. And they claimed that systemic support of the government is definitely necessary. The most difficult thing which responders experienced in care of referred patients was lack of information about patients. Besides, there were patient's financial problems, lack of understanding about their institutes of patients or family, and inconvenience of terminal cancer patient's pain control. Conclusion : The development and support of the organized referral system is needed to alleviate the troubles which patients, family members, and palliative or hospice institutes and hospitals have to face through the procedure of the referral.

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