• Title/Summary/Keyword: life-sustaining treatment

Search Result 139, Processing Time 0.026 seconds

Combined effects of copper and temperature on Hematological constituents in the Rock fish, Sebastes schlegeli (조피볼락, Sebastes schlegeli의 혈액학적 성분변화에 미치는 구리 및 온도의 복합적 영향)

  • Baeck, SuKyong;Min, EunYoung;Kang, Ju-Chan
    • Journal of fish pathology
    • /
    • v.27 no.1
    • /
    • pp.57-65
    • /
    • 2014
  • Copper ($CuSO_4$) has been widely used to control algae and pathogens in fish culture ponds. However, its toxic effects on fish depend not only on its concentration in water but also on water quality. The susceptibility of the rockfish, Sebastes schlegeli to copper was evaluated at three water-temperatures (WT; 18, 23 and $28^{\circ}C$) for 4 days. After the exposure of two copper concentrations (100 and $200{\mu}g/L$), a hematological effect was exerted on rockfish, by causing changes in red blood cell count and hematocrit value at $28^{\circ}C$. Total protein levels of the fish showed a tendency of co-increase with glucose depend on the WT, after copper exposure. However, the plasma calcium and magnesium levels were significantly increased at $200{\mu}g/L$ copper, regardless of the WT. Enzymes activities including ALT and LDH in serum were also significantly increased depend upon the copper treatment only. This indicates that inorganic components and enzymes activities were sensitive indexes to stress by toxicant such as copper. The cortisol levels were significantly elevated by both WT rising and copper treatment in serum of rock fish. In conclusion, these changes can be seen as an initial response to temperature stress and as a sustaining response to copper exposure. The present findings suggest that a simultaneous stress by temperature change and copper exposure could accelerate an alteration of hematological and plasma biological parameters in the rockfish.

Application of two different synthetic sequential media for the human IVF-ET program: a prospective, randomized, and comparative study

  • Yoon, Jeong;Yoon, Hye-Jin;Juhn, Kyoung-Mi;Ko, Jin-Kyung;Yoon, San-Hyun;Ko, Yong;Lim, Jin-Ho
    • Clinical and Experimental Reproductive Medicine
    • /
    • v.38 no.4
    • /
    • pp.186-192
    • /
    • 2011
  • Objective: Since IVF program was first established, various types of media and culture systems have been developed either in-house or commercially. The aim of this study was to compare the efficacy of in-house Maria Research Center (MRC) media to that of commercially available Sydney IVF media in human day 3 embryo transfer cycles. Methods: Three hundred sixty nine couples were included in this prospective, randomized, and comparative study. All couples undergoing IVF treatment at the Maria Fertility Hospital were randomly assigned to either Sydney IVF (n=178) or MRC (n=191) media. Results: No difference was observed between the MRC media and Sydney IVF media groups with respect to fertilization rate (74.4% vs. 75.5%). The clinical pregnancy and implantation rates of MRC media (47.1% and 20.0%, respectively) were also similar to those of Sydney IVF media (44.4% and 19.4%, respectively). However, the proportion of embryos with good quality on day 3 was significantly higher in the MRC media group than the Sydney IVF media group (50.2% vs. 43.2%) ($p$ <0.05). Conclusion: MRC media were as effective as Sydney IVF media for sustaining embryo development and pregnancy rates. The present study implies that MRC media can be a suitable alternative to commercially available media for human IVF-ET program.

Qualitative Exploration of Dietary Characteristics and Changes in Taste and Smell in Post-Surgical Gastric Cancer Patients (위암환자의 치료 후 식사 경험 및 후미각 변화의 정성적 탐색)

  • Nara Yun;Junghyun Bae;Gibum Song;Sunhyang Kwon;Miyoung Kim;Jae-Hee Hong
    • Journal of the Korean Society of Food Culture
    • /
    • v.38 no.4
    • /
    • pp.224-238
    • /
    • 2023
  • To develop customized food products for gastric cancer patients, it is crucial to understand their dietary characteristics and changes in their perception of smell and taste due to their condition. This study conducted in-depth interviews and administered olfactory and gustatory tests on 20 patients with gastric cancer. A control group of 20 healthy, gender and age matched individuals, was included for comparison. Patients reported difficulties in sustaining their appetite, particularly during chemotherapy. This could be attributed to gastrointestinal discomfort and an altered perception of smell and taste. The olfactory test revealed that cancer patients were significantly less sensitive than the control group. Also, a smaller number of participants in the cancer group were reported to have a normal taste function, which enabled them to perceive umami, one of the five basic taste compared to those in the control group. These findings demonstrated that gastric cancer patients experience post-surgical digestive issues, chemotherapy-induced changes in smell and taste, and appetite loss. To improve the quality of life of these patients and the efficacy of the treatment, it is necessary to consider not only their nutritional requirements but also other factors such as appetite loss and discomfort when developing meals specifically for them.

Health Economic Approach to End-of-Life Care in the US: Based on Medicare (말기의료의 경제적 요소에 관한 논의: 미국 메디케어 상황을 중심으로)

  • Suk, Ryan
    • The Korean Society of Law and Medicine
    • /
    • v.15 no.1
    • /
    • pp.335-373
    • /
    • 2014
  • According to one Medicare report, in the US, total federal spending on health care expends almost 18 percent of the nation's GDP, about double what most industrialized nations spend on health care. And in 2011, Medicare spending reached close to $554 billion, which amounted to 21 percent of the total spent on U.S. health care in that year. Of that $554 billion, Medicare spent 28 percent, or about $170 billion, on patients' last six months of life. So what are the reasons of this high cost in EOL care and its possible solutions? Much spendings of Medicare on End-of-Life care for the terminally ill/chronically ill in the US has led health economics experts to assess the characteristics of the care. Decades of study shows that EOL care is usually supply-sensitive and poor in cost-effectiveness. The volume of care is sensitively depending on the supply of resources, rather than the severity of illness or preferences of patients. This means at the End-of-Life care, the medical resources are being overused. On the other hand, opposed to the common assumption, "The more care the better utility", the study shows that the outcome is very poor. Actually the patient preference and concerns are quite the opposite from what intense EOL care would bring about. This study analyzes the reasons for the supply-sensitiveness of EOL care. It can be resulted from the common misconception about the intense care and the outcome, physicians' mission for patients, lack of End-of-Life Care Decision which helps the patients choose their own preferred treatment intensity. It also could be resulted from physicians' fear of legal liabilities, and the management strategy since the hospitals are also seeking for financial benefits. This study suggests the possible solutions for over-treatment at the End-of-Life resulting from supply-sensitiveness. Solutions can be sought in two aspects, legal implementation and management strategy. In order to implement advance directive properly, active ethics education for physicians to change their attitude toward EOL care and more conversations about end-of-life care between physicians and patients is crucial, and incentive system for the physicians who actively have the conversations with patients will also help. Also, the general education towards the public is also important in the long run, and easy and official advance directive registry system-such as online registry-has to be built and utilized more widely. Alternative strategies in management are also needed. For example, the new strategic cost management and management education, such as cutting unnecessary costs and resetting values as medical providers have to be considered. In order to effectively resolve the problem in EOL care for the terminally ill/chronically ill and provide better experience to the patients, first of all, the misconception and the wrong conventional wisdom among doctors, patients, and the government have to be overcome. And then there should be improvements in systems and cultures of the EOL care.

  • PDF

A Study of Social Workers' Understanding of Elderly Patients' and Family Caregivers' Rights to End-of-Life Care Decisions and of Their Own Roles in the Process (노인환자와 가족의 임종의료결정 권리 및 사회복지사 역할 이해도 - 장기요양 입소 시설 사회복지사를 대상으로 -)

  • Han, Sooyoun
    • Journal of Hospice and Palliative Care
    • /
    • v.18 no.1
    • /
    • pp.42-50
    • /
    • 2015
  • Purpose: This study was aimed to analyze how social workers understand the rights for elderly patient and family caregiver to make end-of-life (EOL) care decisions and their roles the decision making process. Methods: The study employed a quantitative research method of collecting data from a structured questionnaire that was filled out by 334 social workers at long-term care facilities. Data were analyzed by descriptive statistics, mean differences, correlation between variables, using SPSS 20.0 program. Results: The mean score for the understanding the rights to an EOL care decision was $3.46{\pm}0.69$ and of their own roles $3.48{\pm}0.84$. The level of understanding significantly differed by social workers' experience of assisting a process to make an EOL care decision such as advance directives and life sustaining treatment, work experience, and the number of beds. Positive correlation was observed between the level of understanding of the rights for EOL care decisions and of social workers' roles (Pearson r=0.329, P<0.001). Conclusion: This study proposes development of an education program for social workers and devising standards for the EOL care decision making process to protect elderly patients, family caregivers as well as social workers in a long term care facility.

Current Situation on Signing Advance Medical Directives and Actual Life-sustaining Treatment Given at a University Hospital (일개 대학병원의 연명치료 선택 및 사전의료의향서 작성 현황)

  • Yoon, Ho-Min;Choi, Youn-Seon;Hyun, Jong-Jin
    • Journal of Hospice and Palliative Care
    • /
    • v.14 no.2
    • /
    • pp.91-100
    • /
    • 2011
  • Purpose: This study was performed to investigate patients' preferences on receiving life-sustaining treatments (LST) and to analyze the relationship between patients' characteristics and LST selection. We also examined any discrepancy between LST patients' choices regarding medical intervention and actual medical intervention given/not given within 48 hours before death. Methods: This cross-sectional study was performed from March 1, 2008 to August 31, 2008 in the Palliative Care Unit of Korea University Hospital. Electric medical records (EMR) of 102 hospice cancer patients were reviewed, and 74 patients with Glasgow coma scale (GCS) ${\geq}$10 at the time of signing the advance medical directives (AMD) were selected for the first analysis. Then, patients alive at the end of this study, transferred to other hospitals or dead within 48 hours were excluded, and the remaining 42 patients were selected for the second analysis. Results: Preferred LST included antibiotics, total parenteral nutrition, tube feeding, transfusion, and laboratory and imaging studies. The relationship between patients' characteristics and LST could not be analyzed due to skewed preferences. LST chosen at the time of signing the AMD and actual medical intervention given/not given in the last 48 hours showed discrepancy in most cases. Conclusion: When making AMD in hospice cancer patients, it is important to consider the time and possibility of changing the choices. Above all, patients must fully understand the AMD. Thus, LST should always be provided with careful consideration of all possibilities, because legal and social aspects of AMD have not been established yet.

A Study on the Interest in Hospice According to the Perception of Happiness (행복 인식에 따른 호스피스 준비의 관심에 관한 연구)

  • Chang, Kyung-Hee;Lee, Seo-Hui;Kim, Kwang-Hwan
    • Journal of the Korea Academia-Industrial cooperation Society
    • /
    • v.19 no.5
    • /
    • pp.489-498
    • /
    • 2018
  • The purpose of this study is to examine whether there is a difference in the awareness of death based on happiness (since attitude or way of life differs among the general public, depending on the perception of death), and to investigate whether there is a difference in the interest in hospices between a group with a high happiness index and a group with a low happiness index. A survey was conducted on 200 men and women aged over 20 who participated in a walking event held in a metropolitan city on April 22, 2017. The survey consisted of eight demographic items: gender, age, education, occupation, marital status, family cohabitation, religion, and health status. It included 29 questions regarding happiness and nine questions regarding the perception of death. For the statistical tests, a chi-square test, an independent sample t-test, correlation analysis, and canonical correlation analysis were performed on the items of the survey based on a happiness index. The results of the study showed that, for a suitable place for death, medical institutions was the highest score (46.3%) for the group with a low happiness index, and own house was highest (59.4%) for the group with a high happiness index. This was a significant difference. It is thought that management systems should be supplemented by professional manpower, educating people so as to increase the utilization rates of home-based hospice as a way for patients to die in a comfortable and familiar place because, for Korea, death is much more common in hospitals. It is also necessary to increase the awareness of death and to make effective use of hospices through individual and various other approaches, considering the demographics of the subjects.

The Effects of Elevated Atmoshpheric CO2 on Chemical Weathering of Forest Soils (대기 중 이산화탄소의 증가가 산림 토양의 화학적 풍화작용에 미치는 영향)

  • Oh, Neung-Hwan
    • Korean Journal of Agricultural and Forest Meteorology
    • /
    • v.16 no.3
    • /
    • pp.169-180
    • /
    • 2014
  • Chemical weathering of forest soils can reduce atmospheric $CO_2$ concentration over geologic time scales, providing many essential elements for life. Although many studies have been conducted on the effects of elevated atmospheric $CO_2$ on forest carbon storage using open top chambers and FACE (Free air $CO_2$ enrichment) facilities since the 1990s, studies on chemical weathering of forest soils under elevated $CO_2$ are relatively rare. Here I review on how elevated atmospheric $CO_2$ can affect the chemical weathering of forest soils and suggest directions on future research. Despite the recent advances in chemical weathering of forest soils under elevated atmospheric $CO_2$, it is still not clear how the large volume of forest soils would react under the condition. Future studies on weathering of forest soils covering large areas from the tropics to the polar regions with carefully monitored pre-treatment data would provide key information on how soils, the Earth's life sustaining engine, change under climate change.

A Study on the Health Information Management Practice Program Model for EMR Certification System Education -Focus on Patient Information Management- (EMR 인증제 교육을 위한 보건의료정보관리 실습 프로그램 모델 연구 -환자정보관리 중심-)

  • Choi, Joon-Young
    • Journal of the Health Care and Life Science
    • /
    • v.9 no.1
    • /
    • pp.1-9
    • /
    • 2021
  • In this study, a model in which certification standards were added to the health information management practice program was studied and presented in order to understand the EMR certification standards implemented by the Korea Health and Medical Information Service. In the practice program, the certification standard function for patient information management was added to the health information management education system to practice and understand patient information management that corresponds to the functional standard of the EMR certification system. The EMR certification standard practice program for patient information management is composed of the following certification standards. registration number and personal information management, treatment reservation schedule management, personal information revision history management, identification of people with the same name, integrated management of multiple registration numbers, patient search by identification information, patient search by health care type, surgical procedure consent record and inquiry, record/inquiry of consent form for personal information use, display of life-sustaining medical decision information, registration/inquiry of external medical institution documents, registration and inquiry of external examination results. In this way, by operating and practicing the functions of the health information system according to the certification standards, it is possible to understand and practice the certification standards and details of patient information management in the functional area of the certification standards. In addition, since the function of the EMR certification standard can be checked, it will be possible to improve the management ability of the electronic medical record system of the health information manager in the medical institution.

Hospice & Palliative Care Policy in Korea (한국의 호스피스완화의료정책)

  • Kim, Chang Gon
    • Journal of Hospice and Palliative Care
    • /
    • v.20 no.1
    • /
    • pp.8-17
    • /
    • 2017
  • Globally, efforts are being made to develop and strengthen a palliative care policy to support a comprehensive healthcare system. Korea has implemented a hospice and palliative care (HPC) policy as part of a cancer policy under the 10 year plan to conquer cancer and a comprehensive measure for national cancer management. A legal ground for the HPC policy was laid by the Cancer Control Act passed in 2003. Currently in the process is legislation of a law on the decision for life-sustaining treatment for HPC and terminally-ill patients. The relevant law has expanded the policy-affected disease group from terminal cancer to cancer, human immunodeficiency virus/acquired immune deficiency syndrome, chronic obstructive pulmonary disease and chronic liver disease/liver cirrhosis. Since 2015, the National Health Insurance (NHI) scheme reimburses for HPC with a combination of the daily fixed sum and the fee for service systems. By the provision type, the HPC is classified into hospitalization, consultation, and home-based treatment. Also in place is the system that designates, evaluates and supports facilities specializing in HPC, and such facilities are funded by the NHI fund and government subsidy. Also needed along with the legal system are consensus reached by people affected by the policy and more realistic fee levels for HPC. The public and private domains should also cooperate to set HPC standards, train professional caregivers, control quality and establish an evaluation system. A stable funding system should be prepared by utilizing the long-term care insurance fund and hospice care fund.