Purpose: This study is aimed to investigate perceptions of caregivers and medical staff toward do not resuscitate (DNR) and advance directives (AD). Methods: Participants were 141 caregivers and 272 medical staff members from five general hospitals. A questionnaire used for the study consisted of 20 items: 14 about DNR perceptions, three about AD, one each for age, gender and employment. Results: Both medical staff and caregivers strongly recognized the need for DNR and AD, and the level of recognition was higher with medical staff than caregivers (DNR ${\chi}^2=44.56$, P=0.001; AD ${\chi}^2=16.23$, P=0.001). The main reason for the recognition was to alleviate sufferings of patients in the terminal phase. In most cases, DNR and AD were filled out when patients with terminal conditions were admitted, and patients made the decisions by consulting with their guardians. Medical staff better recognized the need and for growing demand for guidelines for the DNR and AD decision making process than caregivers (${\chi}^2=7.41$, P=0.0025). Conclusion: This study showed that patients highly rely on their caregivers when making decisions for DNR and AD. Thus, it is important that patients and caregivers are provided with objective information about the decisions. Since participants' strong support for DNR and AD was mainly aimed at alleviating patients' suffering, further study is needed in the association with hospice care. Medical staff also needs to understand the different views held by caregivers and fully consider the disparity when informing patients/caregivers to make the DNR and AD decisions.
Park, Tae Shin;Yoo, Hyun Jung;Jeong, Hye Seung;Lee, Dong Pil;Lee, Jung Sun
The Korean Society of Law and Medicine
/
v.18
no.1
/
pp.297-341
/
2017
We searched out court rulings on medical affairs through court library search sites and specialized articles on medically relevant judgments sentenced in 2016. And we selected and analyzed the judgements of the court we considered important as follows. In relation to the medical civil judgements, (1) In the case of applying surgery for female infertility during cesarean section operation but it has not been done, we expressed the regret for the lack of judgment in the process of entering the medical contract, introducing the rights infringed and the scope of compensation, (2) We pointed out that the ruling on the medical malpractice estimation goes out of limit of negligence estimation doctrine, and that the court asked very high degree duty of the traditional Korean medicine doctors to cooperate with Western medicine doctors. (3) In the case of admitting hospital's 100% responsibility, we pointed out the court overlooked the uncertainty and good intention of the medical practice. (4) Additionally, We introduced the cases admitted the hospital's responsibility in the accident related to the psychiatric patients in closed ward. Relating to a medical criminal ruling, we analyzed the supreme court decision about whether the dentist's Botox injection on the patient's face is a medical practice within the scope of the license from the viewpoint whether it is within the possible range of the word. And, concerning decisions on healthcare administration, (1) we analyzed the case about when medical personnel operate multiple medical institutions, whether it is possible to get back medical care costs under the National Health Insurance Law, (2) We commented on the ruling regarding explanation obligation in terms of object, degree, subject of explanation as a prerequisite for permissible arbitrary uninsured benefits. Finally, we reviewed the decision of the Constitutional Court about the Article 24 of the Mental Health Law, which it had allowed for a mental patient to be hospitalized forcibly by the consent of two guardians and a diagnosis of a psychiatrist. Also we indicated the problems of the revised Mental Health Law.
With the development of the 4th industrial, research is being conducted to prevent diseases and reduce damage in various fields of science and technology such as medicine, health, and bio. As a result, artificial intelligence technology has been introduced and researched for image analysis of radiological examinations. In this paper, we will directly apply a deep learning model for classification and detection of pneumonia using chest X-ray images, and evaluate whether the deep learning model of the Inception series is a useful model for detecting pneumonia. As the experimental material, a chest X-ray image data set provided and shared free of charge by Kaggle was used, and out of the total 3,470 chest X-ray image data, it was classified into 1,870 training data sets, 1,100 validation data sets, and 500 test data sets. I did. As a result of the experiment, the result of metric evaluation of the Inception V3 deep learning model was 94.80% for accuracy, 97.24% for precision, 94.00% for recall, and 95.59 for F1 score. In addition, the accuracy of the final epoch for Inception V3 deep learning modeling was 94.91% for learning modeling and 89.68% for verification modeling for pneumonia detection and classification of chest X-ray images. For the evaluation of the loss function value, the learning modeling was 1.127% and the validation modeling was 4.603%. As a result, it was evaluated that the Inception V3 deep learning model is a very excellent deep learning model in extracting and classifying features of chest image data, and its learning state is also very good. As a result of matrix accuracy evaluation for test modeling, the accuracy of 96% for normal chest X-ray image data and 97% for pneumonia chest X-ray image data was proven. The deep learning model of the Inception series is considered to be a useful deep learning model for classification of chest diseases, and it is expected that it can also play an auxiliary role of human resources, so it is considered that it will be a solution to the problem of insufficient medical personnel. In the future, this study is expected to be presented as basic data for similar studies in the case of similar studies on the diagnosis of pneumonia using deep learning.
Purpose : Malaria is known to have been eradicated for a few decades through persistent national health program in South Korea. However, malaria caused by Plasmodium vivax has started to reappear incidiously among military personnel near to DMZ since 1993. After then, the number of malarial cases have been increased abruptly year by year. We analyzed the children of indigenous malaria who were diagnosed by peripheral blood smear and malarial antibody test with regards to epidemiologic and clinical manifestations. Methods : The study 13 cases below 15 years of age, who were confirmed as vivax malaria during from January 2000 to August 2003. We retrospectively analyzed epidemiologic data, clinical manifestations, laboratory findings and therapeutic responses. Results : All of 13 cases were indigenous and tested positive for Plasmodium vivax. Of 13 patients, 9 were male and 4 were female. Mean age of onset was $9.5{\pm}3.6$ years old. Ilsan(n=9) was the most prevalent area, the most patients(n=11) were presented in summer (from June to August). A characteristic feature of periodic 3 day fever in patients with P.vivax infection was reported in only 2 among 13 cases. Thrombocytopenia was most prominent findings, which was accompanied by 12 of 13 patients and pancytopenia was appeared in 3 patients on this study. The therapeutic responses of hydroxycholoquine were very good in all cases, and abnormal laboratory findings were recovered and no relapse during follow-up period. Conclusion : Vivax malaria is indigenous in Korea near to DMZ, but recently endemic area seemed to be extended southward. Plasmodium vivax is the cause of indigenous malaria of children. As for children with high fever accompanying thrombocytopenia in endemic area of Korea, malaria must be included in differential diagnosis whether the type of fewer is periodic 3 day fever or not. Malaria antibody test is helpful as a screening test for malaria.
A highly sophisticated expertise and systematic and integrated management of security operation are essential for a crowded stadium. a special object of security guarding. Nonetheless, the recent incident in a singing concert hall reveals the overall problem like the lacking safety management system. lacking deployment of professional security personnel, absence of safety manuals and safety measures, as well as the lack of professionalism of private sector security companies. In this study, we presented three categories that needed improvement, like the legal and institutional improvement, improvement of policy and improvement of operation which are required to set up the model to operate the optimal private sector security duties. For the revision of law and institution for a better and more desirable method, we discussed the revision of related laws and regulations pursuant to the security operation at places where events are held, including the revision of law on security guarding work, regulation on common housing management, uniformity of security guarding, and law on performance. For the improvement of policies, we discussed the introduction of security consultants, strengthening the security instructor system, expansion of relevant organizations, establishment of mutual cooperation, privatization of profitable events, improvement of awareness about the security activities provided by private sector, policy for the professionalism of private security operation, expansion of security exhibition and seminar. For the improvement of operation. we discussed professional security techniques. such as the technique of security consulting, the application of CPTED technique, the technique for the integration of system, the method of operation, the establishment of a system to support public security operations and volunteers, establishment of a manual for security guarding performance, modernization and high tech-oriented equipment, organization of security guarding entity in which the industry, academic society and government participates together.
The Guard over the royal household in the "Goryeo" era was the same as if was over the President or Ruler of a nation today. In those days, a king represented a nation and any threat to the safety of a king could bring the destruction of a nation and the dispersion of the people. by reviewing the change of the 2-Gun 6-Wi system of the era, it can be, summed up as follow, Ther will be suggestions. The Guard might focus on a king's personal safety in the wake of the system of the Silla and Taebong dynasties until the establishment of the Goryeo Dynasty's unique political system. "Goryeo" rebuilt the royal palace in Gyeonyeong-gun to take the shape of unified country after its accomplishment of unification of the late three countries, Then it was afraid of the rebellion and uprising of local powerful clans, The country put them under control and organized the local army with them in the era of Kings, Seongjong, through the kings, Seongjong and Gwangjong. The army system of "Goryeo" consisted of 2-Gun and 6-Wi, and 2-Gun placed above the 6-Wi played the role of the Royal guards, and among the organizations a certain army under the specific name of "Gyeonyong-gun" guarded the kings in the nearest position. An aristocratic culture enjoyed its golden age in the period of stability of the aristocracy of "Goryeo", but afterward in the confusion of the aristocratic disruption and incompatible confrontation the country lost its control, and faced military rebellions by treating civil officials well and ill-treating military officials The safety of kings become unstable with the grasping political power by the military officials, and "Dobang" was established in the era of Choi's family to grasp political power. In the era of Choi Woo, he gathered his men and organized his familys army with them and managed the personnel administration with the civil officials of "Jeongbang and Seobang under his command. Such a fact shows the similarity to today's task of guarding. Considering the facts that "Sambyeolcho, the military ground of the military-men-rule, was at the center of the struggling against Mongolia and that even after the fall of the military regime, they rebelled and fought against Mongolia to the end, we came to know that the nationalism in the era of the military era was great. In the transition of external situations from "Myeong" to "Won"(Chinese dynasties), the conflict between the old "Won"-friendly power and the new "Myeong"-friendly power caused the weakness of the power to guard the royal household, and "Goryeo" at last gave way to the newly rising "Joseon" led by Lee, Seong Gye who won the people's confidence.
Our country security industry 1960's service expense of the beginning U.S. army unit it accomplishes the growth which is quick with start, currently about 2,500 triumph the security enterprises which it goes over are being active. But the majority in these enterprise about lower cotton can a forever characteristic with pressure and the manpower civil official ability insufficient back of faithlessness management and capital power. To sleep with afterwords it presents the security dogs deployment plan for an efficient security together from the research which it sees hereupon and it does. First, it cultivates the domestic mountain progress dog which is a breed which is suitable with the security dogs and the shovel flesh dog back with the security dogs. Specially the Jindo of the breed which is excellent training which is suitable in task of the security dogs it leads and if it uses appropriately, it industrializes our specific the Jindo and protection there is a possibility of getting the effect which falls to also the gist which it rears rightly. It cultivate the second, security dogs and it magnifies training. The security dogs consequently is it will be able to accomplish the task above 2 branches to training method. Namely, after finishing obedience training, it is to be in security activity it will execute guard or detection back special training which is suitable in task and it will be able to commit. Third, it uses the security dogs which is trained rightly in task. The security dogs the adult escorts, facility expense, the explosive and narcotic drug detection, it will be able to use with the other blind man guidance dogs back. The narcotic drug detection dogs which currently is used specially technique intelligence anger, when considering the tendency of the narcotic drug smuggling offense field which becomes diversification that the role very it is important is a possibility of saying at day. It cultivate a fourth, escort relation specialty manpower and it improves the breed of the security dogs. The hazard which cultivate the security dogs use necessary personnel the breed of security dogs, the security dogs training center it opens the security crane relation subject of the college which stands and (university) it improves it establishes and training which is suitable in task it is to do to execute letting in the training map company. Specially, the hazard which improves the breed of security dogs in the progress mind quality which stands against the portion where the breed improvement is demanded as the portion where the internal organs research and investment are necessary sees. The security dogs compares in labor cost and the expense holds few, if it uses the our specific domestic dogs it will be able to use efficiently in the task which is various it solves the multi branch plans for wisly with the security dogs industrial development security of course contemporary history sliced raw fish sees demands compared to being immediacy and the life which is happy business the place where it does it sees it will be able to contribute a lot as.
This study analyzed safety management system against disasters perceived by local residents of Chungcheongbuk-do and then examined the policy directions to be considered in order for local governments to improve the safety level of residents and build an effective safety management system against disasters. The findings were as follows. First, in their recognition of risks of safety against disasters, recognition on the possibility of the occurrence of natural disasters was higher than that of social disasters or safety accidents. Secondly, also in the aspect of the importance of category of safety management against disasters, they recognized that of natural disasters far higher than others. Third, they showed satisfaction higher than average with basic job performance of local governments related with safety management, whereas they showed relatively less satisfaction with the aspects of check and publicity of risk factors, and short-term restoration system out of phased job performance. Fourth, in the aspect of capability of local governments for safety management against disasters, they rated positively capability of the responsible departments and the professionality, whereas they relatively underestimated the scale or budget of safety-related organizations. Fifth, the policy directions to be taken for safety against disasters by local governments included strengthening of regular education like experience-based training, expansion of education among local residents, more support for relevant facilities and resources, activation of residents-participating campaigns, improvement of apparatus and personnel treatment related with firefighting and security, frequent patrol and oversight, more exercises against disasters. So, to strengthen safety management system against disasters in local governments and build a effective responding system may need to extend programs assisting vulnerable class to safety against disasters, build a community-friendly safety management system, extend the cooperation system by participation of residents, enhance collaboration and support system with safety-related bodies like police, firefighters.
In the Soviet Union School health services are provided as an integral part of the health care delivery system, which is under the Ministry of Health. This paper presents an overview of the Soviet Union's health care delivery system, the model for the delivery of school health service, the role and training of school personnel involved in school health services and implications the Soviet model may have for the countries. 1. School health services are a part overall Soviet health system under the Ministry of Health. 2. Municipal and rural health departments implement programs at the local level. Diagnosis and treatment are conducted through "polyclinics" that are outreach divisions of a district hospital. 3. Education institutions for the development of health manpower, including medical schools and nursing schools, are under the Ministry of Health, as are medical and scientific search institutes.
This study performed microbiological hazards analysis in raw food materials, cooking processes, kitchen staff, utensils, and the environment in order to obtain contamination levels of S. aureus in school foodservice operations. S. aureus was not detected in cooked foods offered by the foodservice operations; however, it was found in raw food materials prior to cooking. In the case of vegetables, S. aureus was detected in washed mung bean sprouts, parboiled mung bean sprouts, and bellflower roots both before and after disinfection, at levels of 2.2, 1.0, 1.0, and 1.0 log CFU/g, respectively. For processed foods, S. aureus was detected in one sample of packaged bean curd as well as in mung bean jelly cake at the level of 1.5 log CFU/g. For meat products, S. aureus was detected in beef brisket and chicken at levels of 2.3 and 1.3 log CFU/g, respectively. To determine microbiological hazard data for the hands and gloves of cooking personnel, the staff members were divided into two groups: a group presenting Enterobacteriaceae or coliforms, and another group presenting neither Enterobacteriaceae nor coliforms. The results showed that S. aureus was detected on the hands of staff in each group at levels of 2.0 and 2.1 log CFU/hand, respectively, and at 1.8 and 0.0 log CFU/hand on the gloves of staff in each group, respectively. Among kitchen utensils, as an environmental factor in school foodservice operations, S. aureus was detected on meat knives, mixing bowls, and dish cloths at levels exceeding 1.0 log CFU/hand.
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