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A Re-discussion on the Characteristics of Medicine (의료행위의 특질 재론)

  • HeeTae Suk
    • The Korean Society of Law and Medicine
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    • v.25 no.1
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    • pp.3-58
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    • 2024
  • It has become a general idea today that the characteristics of medicine should be considered as a basis when discussing a medical personnel's duty of care and whether or not it has been violated, and when discussing its duty of explanation and whether or not it has been fulfilled in medical practice. However, in the discussion of its characteristics, some shortcomings still exist, so the need for a re-discussion has been raised. Firstly, existing discussions on characteristics have failed to comprehensively grasp and explain the characteristics of medical practice. Secondly, in some researchers' arguments, there are discrepancies between the terms used to express characteristics and their conceptual definitions or content. Thirdly, the lack of exemplified cases that reflect the characteristics of medicine - especially Supreme Court precedents - has led some to think negatively about the recognition and reflection of certain characteristics. In my early writings, I have described five characteristics of medical practice: 'conflict in medical goals', 'initiating appropriate medical actions (progression of illness)', 'dynamics of medical intervention (diversity of symptoms)', 'diversity of medical effects', 'inherent risk of medical treatment (invasiveness)'. In this paper, keeping in mind the reasons for the need for reconsideration, I aim to analyze the characteristics of medicine in detail and cite key parts of representative Korean Supreme Court precedents that reflect each characteristic. The characteristics of medicine extracted from this paper are; There are ten factors, including the legitimacy of the essence of medical practice, timeliness of medical execution, dynamics of medical progress, diversity of medical effects, risk of medical invasion, non-uniformity of medical methods, limitations of medical capabilities, intervention of the medical subject, high degree of medical standards, and maldistribution of medical data.

The Criteria of Medical Malpractice of Medical Doctors and Oriental Medical Doctors in Korea (이원적 의료체계에서 의사와 한의사의 과실판단)

  • Lee, Baek-Hyu
    • The Korean Society of Law and Medicine
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    • v.12 no.2
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    • pp.123-158
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    • 2011
  • The Korea health care system has been divided into Western and Oriental (Korea traditional) medicine since 1951. In accordance with dualistic medical system, there are many conflict cases between medical doctors and oriental medical doctors. Meanwhile, there were much discussions about the meaning and criteria of medical malpractice(negligence). Especially, many cases have been built up about the criteria of medical malpractice through lawsuits. But, comparatively, there's few the medical malpractice case of the oriental medical doctors. According to a recent ruling of the Supreme Court, the legal principles of medical doctor's malpractice case are equally applied to the criteria of the oriental medical doctor's malpractice case. But there are much considerations in addition to these principles for the dualistic medical system and academic distinctiveness. This study is intended to review the dualistic medical system, the criterion of medical malpractice, and analysis this issues. To make long story short, under our dualistic medical system, judging the medical and oriental malpractice should be considered relatively. However, it makes sense that we want medical doctor or oriental medical doctor to demand the reinforced negligence to restrict the unnecessary discretion. If there is lack of evidence-based medicine or the rationality suspected, the health care providers must give enough proof.

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Fundamental Study on Curriculum of Domestic and Foreign Medical Schools (국내외 의과대학의 교육과정 기초조사 및 분석)

  • Ryue, Soo-hee;Kim, Bo-Hyun
    • Korean Medical Education Review
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    • v.10 no.1
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    • pp.9-17
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    • 2008
  • Objectives: Medical schools are trying to improve the quality of medical education by offering students better medical curriculum. In this study, we intend to provide basic information for improvement and development of medical curriculum by analyzing the medical curriculum of domestic and foreign medical schools. Methods: Based on various materials, we selected out 5 domestic medical schools and 11 foreign medical schools and collected materials relevant to medical curriculum of each medical school. Then, we divided collected materials into four domains(educational objectives, educational contents, educational assessment, and curriculum implementation), and analyzed them synthetically. Results and Conclusion: First, concerning the educational objectives, it is necessary that more various educational objectives are included to medical curriculum. Especially, there is a growing need for medical curriculum reflecting social responsibility and requests of local community. Second, educational contents should be constantly improved and constructed considering students' academic achievement levels and traits. Third, not only students but also educational program, educational contents, and professors should be included to the objects of educational assessment. Also, various assessment methods should be developed. Finally, especially for domestic medical schools, it is necessary to make use of more educational specialists in medical education.

Endothelial Aquaporin-1 (AQP1) Expression Is Regulated by Transcription Factor Mef2c

  • Jiang, Yong;Liu, He;Liu, Wen-jing;Tong, Hai-bin;Chen, Chang-jun;Lin, Fu-gui;Zhuo, Yan-hang;Qian, Xiao-zhen;Wang, Zeng-bin;Wang, Yu;Zhang, Peng;Jia, Hong-liang
    • Molecules and Cells
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    • v.39 no.4
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    • pp.292-298
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    • 2016
  • Aquaporin 1 (AQP1) is expressed in most microvasculature endothelial cells and forms water channels that play major roles in a variety of physiologic processes. This study aimed to delineate the transcriptional regulation of AQP1 by Mef2c in endothelial cells. Mef2c cooperated with Sp1 to activate human AQP1 transcription by binding to its proximal promoter in human umbilical cord vein endothelial cells (HUVEC). Over-expression of Mef2c, Sp1, or Mef2c/Sp1 increased HUVEC migration and tube-forming ability, which can be abolished AQP1 knockdown. These data indicate that AQP1 is a direct target of Mef2c in regulating angiogenesis and vasculogenesis of endothelial cells.

The role of protein arginine-methyltransferase 1 in gliomagenesis

  • Wang, Shan;Tan, Xiaochao;Yang, Bin;Yin, Bin;Yuan, Jiangang;Qiang, Boqin;Peng, Xiaozhong
    • BMB Reports
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    • v.45 no.8
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    • pp.470-475
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    • 2012
  • Protein arginine methyltransferase 1 (PRMT1), a type-I arginine methyltransferase, has been implicated in diverse cellular events. We have focused on the role of PRMT1 in gliomagenesis. In this study, we showed that PRMT1 expression was up-regulated in glioma tissues and cell lines compared with normal brain tissues. The knock-down of PRMT1 resulted in an arrest in the G1-S phase of the cell cycle, proliferation inhibition and apoptosis induction in four glioma cell lines (T98G, U87MG, U251, and A172). Moreover, an in vivo study confirmed that the tumor growth in nude mouse xenografts was significantly decreased in the RNAi-PRMT1 group. Additionally, we found that the level of the asymmetric dimethylated modification of H4R3, a substrate of PRMT1, was higher in glioma cells than in normal brain tissues and decreased after PRMT1 knock-down. Our data suggest a potential role for PRMT1 as a novel biomarker of and therapeutic target in gliomas.

Evolution of Radiological Treatment Response Assessments for Cancer Immunotherapy: From iRECIST to Radiomics and Artificial Intelligence

  • Nari Kim;Eun Sung Lee;Sang Eun Won;Mihyun Yang;Amy Junghyun Lee;Youngbin Shin;Yousun Ko;Junhee Pyo;Hyo Jung Park;Kyung Won, Kim
    • Korean Journal of Radiology
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    • v.23 no.11
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    • pp.1089-1101
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    • 2022
  • Immunotherapy has revolutionized and opened a new paradigm for cancer treatment. In the era of immunotherapy and molecular targeted therapy, precision medicine has gained emphasis, and an early response assessment is a key element of this approach. Treatment response assessment for immunotherapy is challenging for radiologists because of the rapid development of immunotherapeutic agents, from immune checkpoint inhibitors to chimeric antigen receptor-T cells, with which many radiologists may not be familiar, and the atypical responses to therapy, such as pseudoprogression and hyperprogression. Therefore, new response assessment methods such as immune response assessment, functional/molecular imaging biomarkers, and artificial intelligence (including radiomics and machine learning approaches) have been developed and investigated. Radiologists should be aware of recent trends in immunotherapy development and new response assessment methods.

Recognition and Request for Medical Direction by 119 Emergency Medical Technicians (119 구급대원들이 지각하는 의료지도의 필요성 인식과 요구도)

  • Park, Joo-Ho
    • The Korean Journal of Emergency Medical Services
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    • v.15 no.3
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    • pp.31-44
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    • 2011
  • Purpose : The purpose of emergency medical services(EMS) is to save human lives and assure the completeness of the body in emergency situations. Those who have been qualified on medical practice to perform such treatment as there is the risk of human life and possibility of major physical and mental injuries that could result from the urgency of time and invasiveness inflicted upon the body. In the emergency medical activities, 119 emergency medical technicians mainly perform the task but they are not able to perform such task independently and they are mandatory to receive medical direction. The purpose of this study is to examine the recognition and request for medical direction by 119 emergency medical technicians in order to provide basic information on the development of medical direction program suitable to the characteristics of EMS as well as for the studies on EMS for the sake of efficient operation of pre-hospital EMS. Method : Questionnaire via e-mail was conducted during July 1-31, 2010 for 675 participants who are emergency medical technicians, nurses and other emergency crews in Gyeongbuk. The effective 171 responses were used for the final analysis. In regards to the emergency medical technicians' scope of responsibilities defined in Attached Form 14, Enforcement regulations of EMS, t-test analysis was conducted by using the means and standard deviation of the level of request for medical direction on the scope of responsibilities of Level 1 & Level 2 emergency medical technicians as the scale of medical direction request. The general characteristics, experience result, the reason for necessity, emergency medical technicians & medical director request level, medical direction method, the place of work of the medical director, feedback content and improvement plan request level were analyzed through frequency and percentage. The level of experience in medical direction and necessity were analyzed through ${\chi}^2$ test. Results : In regards to the medical direction experience per qualification, the experience was the highest with 53.3% for Level 1 emergency medical technicians and 80.3% responded that experience was helpful. As for the recognition on the necessity of medical direction, 71.3% responded as "necessary" and it turned out to be the highest of 76.9% in nurses. As for the reason for responding "necessary", the reason for reducing the risk and side-effects from EMS for patients was the largest(75.4%), and the reason of EMS delay due to the request of medical direction was the highest(71.4%) for the reason for responding "not necessary". In regards to the request level of the task scope of emergency medical technicians, injection of certain amount of solution during a state of shock was the highest($3.10{\pm}.96$) for Level 1 emergency rescuers, and the endotracheal intubation was the highest($3.12{\pm}1.03$) for nurses, and the sublingual administration of nitroglycerine(NTG) during chest pain was the highest($2.62{\pm}1.02$) for Level 2 emergency medical technicians, and regulation of heartbeat using AED was the highest($2.76{\pm}.99$) for other emergency crews. For the revitalization of medical direction, the improvement in the capability of EMS(78.9%) was requested from emergency crew, and the ability to evaluate the medical state of patient was the highest(80.1%) in the level of request for medical director. The prehospital and direct medical direction was the highest(60.8%) for medical direction method, and the emergency medical facility was the highest(52.0%) for the placement of medical director, and the evaluation of appropriateness of EMS was the highest(66.1%) for the feedback content, and the reinforcement of emergency crew(emergency medical technicians) personnel was the highest(69.0%) for the improvement plan. Conclusion : The medical direction is an important policy in the prehospital EMS activity because 119 emergency medical technicians agreed the necessity of medical direction and over 80% of those who experienced medical direction said it was helpful. In addition, the simulation training program using algorithm and case study through feedback are necessary in order to enhance the technical capability of ambulance teams on the item of professional EMS with high level of request in the task scope of emergency medical technicians, and recognition of medical direction is the essence of the EMS field. In regards to revitalizing medical direction, the improvement of the task performance capability of 119 emergency medical technicians and medical directors, reinforcement of emergency medical activity personnel, assurance of trust between emergency medical technicians and the emergency physician, and search for professional operation plan of medical direction center are needed to expand the direct medical direction method for possible treatment beforehand through the participation by medical director even at the step in which emergency situation report is received.