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Health Law and Adult Guardianship System (성년후견제도와 정신보건법상 환자의 동의권에 관한 연구)

  • Moon, Sang hyuk
    • The Korean Society of Law and Medicine
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    • v.16 no.1
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    • pp.221-254
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    • 2015
  • The amendment of the Korea Civil Code will take place July 1, 2013. One of the most import issues related to adult guardianship system is a part. Though more than 100 new provisions, the revised Civil Code fundamentally reformed the guardianship system to establish a system to meet the diverse and complex needs of those who need a guardian and ensure due process. The new adult guardianship system intended to respect dignity and human right of mentally incapacitated adults, to guaranee their autunomy and to minimize the public interventions for assisting them. The new guardianship system for vulnerable adult has three kinds of legal guardianship system (adult guardianship, limited guardianship and specific guardianship). Mental patients forced the hospitalization of the mental health code and will be treated as an agreement incapable person. In principle an agreement incapable person has capacity of consent. The consent of the mental patients are admitted first. It is advisable to medical care only by the consent of the guardian when the the mental patient do not agree ability. If the mental patient do not agree with the mentally ill, but there should be a supervisory capacity for a guardianship of the couple guardian supervision. In conclusion, it not lost the capacity to consent to inpatient mental illness called. Therefore, we must discuss in detail the scope of the agreement for the mental patients. Mental Health Act amendments are necessary in accordance with the amended Civil Code.

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Study of the Patients with Dizziness who visited the Korean Medicine Hospital (한방병원에 내원한 어지럼증 환자에 대한 고찰)

  • Oh, Jeong Min;Eom, Tae Min;Choi, Koh Eun;Heo, Jong Won;Kim, Hyun Tae;Jo, Hyun Kyung;Yoo, Ho Rhyong;Seol, In Chan;Kim, Yoon Sik
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.29 no.5
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    • pp.378-385
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    • 2015
  • Dizziness is one of the most common symptoms in clinical practice. The purpose of this study was to investigate the characteristics of patients with dizziness who visited Korean medicine hospital. This study analyzed 328 patients with dizziness who visited Dunsan Korean Medicine Hospital of Dae-Jeon University from Nov. 1st, 2012 to Oct. 31st, 2014. We gathered the data of the patients based on the medical charts. The patients were divided into 4 gorups ; central dizziness group, peripheral dizziness group, presyncope dizziness group, functional dizziness group, In the distribution according to sex, the number of female patients was higher than the male patients in all the types of dizziness except the presyncope group. The average age of the central group was higher than any other types. The peripheral and central group were most frequently admitted. The average hospitalization period were categorized as follows : central group 37.31, presyncope group 17, functional group 14.21, peripheral group 13.5 days. The following numbers of patients showed the distribution of each syndrome differentiation ; deficiency of qi and blood(氣血兩虛) 58.8%, plegm-dampness syndrome(濕痰中阻) 18.0%, hyperactivity of liver yang(肝陽上亢) 14.3%, deficiency of kidney essence(腎精不足) 8.8%. The distribution of herbal medicine for dizziness were categorized as follows ; Jaeumkeonbi-tang(Ziyinjianpi-tang, 滋陰健脾湯) 50.4%, Banhabaekchulcheonma-tang(Banxiabaishutianma-tang, 半夏白朮天麻湯) 10.2% and Bojungikgi-tang(Buzhongyiqi-tang, 補中益氣湯) 4.1%. The 86.0% of patients with dizziness has improved. The peripheral showed highest rate of improvement(100%). This report would serve as a reference data for further study about patients with dizziness in the clinical field of Korean medicine.

Monitoring of $Clostridium$ $difficile$ Colonization in Preterm Infants in Neonatal Intensive Care Units

  • Chang, Ju-Young;Shim, Jung-Ok;Ko, Jae-Sung;Seo, Jeong-Kee;Lee, Jin-A;Kim, Han-Suk;Choi, Jung-Hwan;Shin, Sue;Shin, Son-Moon
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.15 no.1
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    • pp.29-37
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    • 2012
  • Purpose: To examine the prevalence of $Clostridium$ $difficile$ ($C.$ $difficile$) colonization (CDC) and potential neonatal determinants of CDC in hospitalized preterm infants. Methods: Fecal samples were serially collected within 72 h after birth and at 1, 2, and 4-6 weeks of age from preterm infants in the neonatal intensive care units (NICUs) of two different university hospitals. Total bacterial DNA was extracted from each fecal sample from 49 infants, and polymerase chain reaction (PCR) was performed with primers for the 16S gene of $C.$ $difficile$ and the toxin A and toxin B genes. The correlation between the results of $C.$ $difficile$ PCR assays and the clinical characteristics of the infants was analyzed. Results: The prevalence rates of CDC were 34.7, 37.2, 41.3, and 53.1% within 72 h after birth and at 1, 2, and 4.6 weeks of age, respectively. The toxin positivity rate was significantly higher in the infants with persistent CDC than in those with transient CDC (8/12 [66.7%] vs. 6/25 [24.5%] ($p$=0.001). Among the various neonatal factors, only the feeding method during the first week after birth was significantly associated with persistent CDC. Exclusive breast-milk feeding (EBMF) significantly decreased the risk of persistent CDC compared to formula or mixed feeding (adjusted odds ratio: 0.133, 95% confidence interval: 0.02-0.898, $p$=0.038). Conclusion: The prevalence of CDC increased with the duration of hospitalization in preterm infants in the NICU. EBMF during the first week after birth in hospitalized preterm infants may protect against persistent CDC.

Epidemiologic and Clinical Comparisons of Three Measles Outbreaks in Korea(1989~2001) (국내에서 1989년부터 2001년 사이에 세 번 돌발 유행한 홍역의 역학 및 임상적 비교)

  • Yoon, Ju-Yun;Lee, Kyung-Yil;Kang, Jin-Han
    • Pediatric Infection and Vaccine
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    • v.10 no.2
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    • pp.223-228
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    • 2003
  • Purpose : We evaluated and compared clinical and laboratory characteristics of patients with measles in three epidemics(1989~90, 1993~94, and 2000~01) in Daejeon, Korea. Methods : Retrospective analyses were performed using medical records of 520 patients with measles at the Catholic University of Korea, Daejeon St. Mary's Hospital during three epidemics. We divided the subjects into three groups, i.e., those who admitted during 1989~1990(group I, 116 patients), those during 1993~1994(group II, 127 patients), and those during 2000~2001(group III, 277 patients). We compared clinical, demographic and laboratory characteristics among these 3 groups. Results : In age distribution, ratios of under 2 years of age in three groups were 61%, 58% and 57%, respectively with no statistical differences. However there are differences in age distribution above 2 years of age, as 21% in 2~5 years of group I, 28% in 6~9 years of group II, and 21% above 10 years of group III. No statistical differences were present between 3 groups in the male to female ratio, MMR vaccination rate in above 2 years of age, duration of fever, incidence of hepatitis. Hospitalization days(P=0.019) and rate of complications(P=0.012) were longer and higher in group I than in group III. Conclusion : In three epidemics, the second peak age group(except 0~1 year) of children above 2 years of age who had mostly received MMR vaccination showed a trend for increased age with increasing time(statistical difference). This result suggest that secondary vaccine failure may have a role in each epidemics. So, if measles outbreaks is happened in the future, we will have consideration in this aspect.

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Nasal Carriage of Staphylococcus aureus from Healthy Children Attending Day Care Center (어린이집 소아에서의 황색포도알균의 비강 보균율에 관한 연구)

  • Kim, Young Min;Oh, Chi Eun;Kim, So Hee;Lee, Jina;Choi, Eun Hwa;Lee, Hoan Jong
    • Pediatric Infection and Vaccine
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    • v.17 no.1
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    • pp.9-15
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    • 2010
  • Purpose : This study was performed to investigate the prevalence of Staphylococcus aureus (S. aureus) nasal carriage in Korean children attending day care centers. Methods : During September and October 2009, a survey for nasal carriage of S. aureus and methicillin-resistant S. aureus (MRSA) was conducted among children attending day care centers located in Seoul with questionnaire survey for evaluation of risk factors of acquisition of MRSA was obtained from their guardians. A culture of the anterior nares swabs using enrichment broth was executed for isolating S. aureus and oxacillin susceptibility was assessed by the disk diffusion method. Results : Out of the 428 children enrolled whose mean age was 55 months old, 163 (38.1%) were colonized with S. aureus. Of the 163 isolates, 40 (24.5%) were MRSA. The nasal carriage rate of S. aureus showed an increasing trend with increase of age. Based on the answer to the questionnaire, 9.2% and 3.6% of children had a recent history of hospitalization and surgery, respectively, and approximately 40% of children had a history of prescription of antibiotics within 1 year prior to enrollment. Of the 428 subjects, 40 (9.3%) were MRSA nasal carriers. Conclusion : S. aureus and MRSA carriage rate of children attending day care center in Korea was 38.1% and 9.3%, respectively. Continued surveillance for nasal carriage rate of S. aureus and MRSA (especially community-associated MRSA) is mandatory.

Differential Diagnosis of Bacterial Cervical Lymphadenitis and Kawasaki Disease in Patients with Fever and Cervical Lymphadenopathy (발열과 림프절 종대를 보인 환자에서 화농성 경부 림프절염과 가와사키병의 감별 진단)

  • Jang, Homin;Ha, Eun Gyo;Kim, Hee Jin;Lee, Taek-jin
    • Pediatric Infection and Vaccine
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    • v.23 no.3
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    • pp.188-193
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    • 2016
  • Purpose: This study identified the characteristics differentiating node-first presentation of Kawasaki disease (NFKD) from bacterial cervical lymphadenitis (BCL) and typical Kawasaki disease (KD). Methods: From July 2007 to June 2015, the medical records of patients with BCL, NFKD, and typical KD were retrospectively reviewed. We analyzed and compared the demographic, clinical, laboratory, and imaging characteristics of the cohorts. Results: Twenty-two patients with BCL, 37 with NFKD, and 132 with typical KD were included in this study. Patients with BCL had longer durations of hospitalization than patients with NFKD. Bilateral and multiple enlarged cervical lymph nodes were associated more with NFKD than BCL. Compared with BCL patients, NFKD patients had lower platelet counts, higher percentages of neutrophils, and higher C-reactive protein (CRP) levels. NFKD patients were older and presented with higher white blood cell counts, percentages of neutrophils, absolute neutrophil counts, and CRP levels as well as lower platelet counts and alanine aminotransferase levels than typical KD patients. Conclusions: In febrile patients with cervical lymphadenopathy, the combination of bilateral and multiple enlarged nodes, low platelet count, high percentage of neutrophils, and high CRP levels should prompt consideration of NFKD for prevention of delayed diagnosis of KD.

Rehabilitative Effect of Intramuscular Electrostimulation after Reconstruction of Medial Patellar Luxation in Small Sized Dog (소형견의 내측 슬개골 탈구 정복술 후 근육 내 전기자극의 재활효과)

  • Lee, Shinho;Lee, Joo-Myoung;Park, Hyunjung;Won, Sangcheol;Cheong, Jongtae
    • Journal of Veterinary Clinics
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    • v.32 no.1
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    • pp.16-21
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    • 2015
  • Medial patellar luxation (MPL) of dog is one of the most common joint diseases. This study performed to know rehabilitative effect after reconstruction as application with intramuscular electrostimulation (IMES) on the cranial part of sartorius muscle. In this study, the 12 dogs with operated medial luxation divided into electrostimulation group (n = 8) and no electrostimulation group (n = 4) measured affected sided range of motion, muscle mass, lameness score and weight bearing for hospitalization 2 weeks. IMES group showed significant results after operation on 5th day (p < 0.01). Except lameness score, IMES group showed significant results on 10th day (p < 0.05). As results, in small sized dog after reconstruction of MPL, IMES on the cranial part of sartorius muscle considered a great help in the initial rehabilitation.

Effective Identification of Ochrobactrum anthropi Isolated from Clinical Specimens (임상검체에서 분리된 Ochrobactrum anthropi의 효과적인 동정)

  • Ko, Hyun-Mi;Jo, Jun-Hyeon;Baek, Hae-Gyeong
    • Korean Journal of Clinical Laboratory Science
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    • v.52 no.3
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    • pp.221-228
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    • 2020
  • Ochrobactrum anthropi is a non-fermentative oxidative gram-negative bacillus that produces oxidase. Distinguishing a mixed culture with non-fermenting bacteria having a similar appearance and oxidase-positive is difficult, and there is a limit to accurate identification with a biochemical identification system. This paper proposes that the Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry Platform (MALDI-TOF) method is useful for classifying bacteria that are difficult to identify using biochemical testing methods. As a result of analyzing five cases of O. anthropi examined using MicroScan, it took 6.5 days to the final report, which was 3.5 days more than the 3.0 days of E. coli. The pus sample in patient 5 was a mixed infection with Achromobacter xylosoxidans, and it took 11.3 days because of multiple subculture and retests. Four patients were over 60 years old with an underlying disease, and the possibility of opportunistic and nosocomial infections could not be excluded. Among them, samples collected after 92 days of hospitalization were resistant to imipenem and meropenem. Therefore, an examination using the MALDI-TOF method will be useful for the rapid and adequate treatment of patients with difficult identification, such as O. anthropi.

Video Assisted Thoracoscopic Surgery, 31 Cases (비디오 흉강경을 이용한 흉부수술 31예)

  • Sung, Sook-Whan;Kim, Kwhan-Mien;Kim, Joo-Hyun
    • Tuberculosis and Respiratory Diseases
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    • v.40 no.5
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    • pp.468-473
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    • 1993
  • Background: Recent advance in video technology, endoscopic equipments, and surgical techniques have expanded the use of thoracoscopy from diagnosis of the pleural diseases to treatment of the various intrathoracic diseases. Video Assisted Thoracoscopic Surgery(VATS) is a pretty new and fascinating thoracic surgical modality, and so we present our early VATS resuls. Methods: Using Video Thoracoscopic techniques in 30 patients for 10 months from July 1992 to April 1993, we had performed a variety of procedures. These incuded (1) bleb resections in 18 patients (19 cases), (2) mediastinal tumor excision in 4, (3) lung biopsies for parenchymal pulmonary disease in 3, (4) pleural biopasies in 3, (5) pleural tumor excision in 1, (6) and pleuropericardial window in 1. Results: There were no mortality associated with the procedures. We had minor 8 complications; prolonged air leak in 3 patients, prolonged serous drainage in 2, recurrence of pneumothorax in 1, Honer's syndrome in 1, and hoarseness in 1 patient. None of the 30 patients had reverted to the conventional full thoracotomies. Mean postoperative hospital stay of non-complicated pneumothoraces was about 5 days, which was a little shorter than conventional thoracotomy group. Conclusion: Though we had somewhat higher postoperative complication rate due to lack of experiences in the begining, we were able to convince that VATS had benifical value for patients; lesser postoperative pain, shorter hospitalization, quicker recovery time, and cosmetically superior scar. The role of VATS can be expanded to the diagnosis and treatment of various thoracic diseases, even to the cardiovascular diseases, with satisfactory outcome and less postoperative morbidity.

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MANAGEMENT OF THE IMPACTED TOOTH ASSOCIATED WITH DENTIGEROUS CYST IN AUTISTIC YOUNG PATIENTS (자폐증 환자에서 함치성 낭종과 연관된 매복치의 처치)

  • Kim, Ki-Rim;Song, Je-Seon;Choi, Byung-Jai;Kim, Seung-Hye;Lee, Jae-Ho
    • The Journal of Korea Assosiation for Disability and Oral Health
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    • v.7 no.1
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    • pp.25-28
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    • 2011
  • Autism is a developmental, neuropsychiatric disorder that begins in early childhood. A patient with autism seen in the dental office frequently may have many complications. Therefore, it may be needed to consider modified or alternative therapy for dental care of autistic patients. This is the case of a 16-year old boy who have autism. He came to the department of the pediatric dentistry, Yonsei University Dental Hospital, for evaluation and treatment of dentigerous cyst associated with impacted teeth(#33,34,35). Under daily hospitalization and general anesthesia, the cyst was enucleated with surgical extraction of #34 and autotransplantation of #33,35. And during the periodic dental followup, apexification of #33,35 was performed for periapical lesion and root maturity. At 2 year 6 months follow- up, now, bony healing was completed and there are some complications like external resorption of #33 and space loss of #34 area. Generally, the marsupialization has been widely recommended for treatment of dentigerous cyst. However, in this case, there is a little possibility of spontaneous eruption after marsupialization considering of patient's age, location and angulation of the impacted tooth, root maturity. And there is necessity to choose the treatment that has low recurrence risk and needs short-term follow-up for autism. Above all, poor oral hygiene and lack of cooperation for decompression treatment is a matter of primary consideration. Consequently, enucleation of the cyst was chosen for the final treatment plan in this case. It is important to consider the conditions that affect the eruption of a dentigerous cyst-associated tooth to predict the successful eruption and special health care needs of the patient when the treatment plan is settled.