Objectives: To investigate in depth the use of complementary and alternative medicines (CAMs) by cancer patients at the end-of-life (EOL) and how they communicate with physicians about them. Design and location: In 17 hospitals in Korea between January and December 2004 we identified 4,042 families of cancer patients. Results: The prevalence of CAM use among cancer patients at the EOL was 37.0%, and 93.1% had used pharmacologic types of agents. The most frequent motive for CAM use was the recommendation of friends or a close relative (53.4%) or a physician (1.6%). Only 42.5% discussed CAM use with their physicians. Satisfaction with CAMS was recalled for 37.1%. The most common reason given for that satisfaction was improvement of emotional or physical well-being, while ineffectiveness was the most common reason given for dissatisfaction. The average cost of CAM during the last month of life was $US 900. CAM use was associated with longer disease periods, primary cancers other than liver, biliary, and pancreatic, and need of support from physicians or religion. Conclusions: CAM use among cancer patients at the EOL was common, not discussed with physicians, and associated with expectation of cure. Expectations were generally unmet while the treatments were a financial burden. Further studies evaluating the effects of CAM at the EOL and factors that enhance communication with the physician are needed.
Objective: The objective of this study was to evaluate the prevalence and incidence of accidents with biological material, the level of knowledge, and compliance to standard precautions (SPs) among dentists, physicians, nurses, and dental and medical students. Methods: A closed cohort study with a prospective and retrospective component was conducted between August 2014 and September 2015. The participants were contacted in two moments during the follow-up period, during which a structured questionnaire divided into six sections was used; the interviews were conducted during the follow-up period (Month 6) and at the end of the observation period (Month 12). Results: The global prevalence of accidents in the previous 12 months was 10.2%, with a difference between professionals and students (13.0% vs. 5.1%, respectively; p < 0.003). The incidence rate was 6.49 per 100 person/year, with difference between the groups (6.09 per 100 person/year in professionals and 7.26 per 100 person/year in students), type of specialization (hazard ratio, 3.27), and hours worked per week (hazard ratio, 2.27). The mean of compliance to SP was 31.99 (±3.85) points, with a median of 33 (30, 35) points against the expected 27.75 points. Adherence to SP was associated with the accident report (p < 0.020). Conclusion: We conclude that the proportion/incidence rate of accidents with biological material was high in relation to that in the literature, being higher in professionals and especially among physicians. The levels of knowledge and adherence to SP were good, with the best found in dentists and dental students.
Background: The over-prescription of acid-suppressive therapy for the provision of stress ulcer prophylaxis (SUP) in hospitalized patients has been identified in a proceeding study. Objective: This study was conducted to evaluate clinicians' beliefs, knowledge and other factors that influence the over-prescribing of SUP in low-risk, non-intensive care unit (non-ICU) patients. Method: A cross-sectional survey consisting of multiple-choice queries and close-ended questions was distributed to healthcare personnel at a major teaching hospital in Korea. Results: More than half of total respondents reported that they would continue SUP following patients discharge from the ICU (77.8%, 43.5%, and 39.7% in the physician, pharmacist, and nurse groups, respectively). Over 55% of physicians would also initiate non-ICU patients on SUP upon hospital admission, and 42.6% of physicians would even continue prophylaxis post hospital discharge. The mean knowledge score regarding SUP indications and side effects was higher in pharmacists compared to physicians and nurses (12.44, 7.40, and 7.28, respectively; p<0.001). High-prescribing behavior was associated with a prescriber's belief that SUP is effective for preventing bleeding (odds ratio 7.40; 95% confidence interval 1.57 to 31.94; p=0.012). Low knowledge score and computerized order set also showed statistically significant association with the overutilization of SUP.
Objectives : The study investigated the actual condition of the class for Qi-gong gymnastics among health promotion service programs using oriental medicines, which the public health center has been conducting for local residents. Method : Of a total of 964 oriental medical physician in public health center across the country, it examined 27 places consisting of public health centers and public health sub-centers, and public hospitals, all of which were running the class for Qi-gong gymnastics. Then, it carried out the tele research of those oriental medical physicians in charge of the class there. Result : As a result, area that is enforcing the Class for Qi-gong Gymnastics was expose each attempt that difference is particularly, and appeared by thing which form and practice law that operate the classroom are various. Also, in many cases, the oriental medical physicians instructed the gymnastics directly instead of inviting an external lecturer. Conclusions : In conclusion, based on the contents surveyed, by making the well-organized system of the class for Qi-gong excercise; by developing the common excercise and texts; and by publicizing and educating the oriental medical physicians engaged in public health, that the Class for Qi-gong Gymnastics is real in health promotion of local residents.
Physicians should be able to address health-related issues of patients and populations from a multidimensional perspective. Therefore, medical schools have a social responsibility to develop and implement curricula that enable trainees to acquire the competencies needed to improve all aspects of patient care and healthcare delivery. This study explored the concept of health systems science concept as the third pillar of medical education (the other two are basic science and clinical medicine) in the Korean context, as well as related educational needs. The theoretical foundation of health systems science is the biopsychosocial conceptual model, which emphasizes the biological, psychological, and social factors surrounding patients. We concluded that the three domains (core functional, foundational, linking) and 12 subcategories of health systems science proposed by the Association of American Medical Colleges could be applied to Korean medical education. Health systems science education must be emphasized to solve the various healthcare problems facing Korea today and to train physicians to provide medical services in line with society's needs. Introducing a health systems science curriculum will be challenging in the Korean medical environment, which has traditionally emphasized basic science and clinical medical education. Health systems science education should begin in the basic medical education phase, where physicians' professional identity is formed, and continue through graduate medical education. It is essential to understand related educational needs, develop curricular content, conduct faculty development programs, and provide financial resources for the development of an integrated curriculum.
Background : It is almost important therapy modality to control pain for the terminal cancer patients for the last 24 hours because those terminally illed patient deserved to have pain free and peaceful time before death. Physician who is deal with terminal cancer patients for their last 24 hours does not need to worry about drug addiction or other untoward side reactions of pain medications. The purpose of this study was to evaluate if terminally illed cancer patient was given pain medication properly and sufficiently and if there was any different behavior to control pain of terminal cancer patients between medical physicians and surgeons in terms of type, amount and administration route and frequency. Methods : A retrospective chart audit of analgesic type, amount and administration route was performed on the medical recorders of 160 hospitalized terminal cancer patients who had died in the Korea University Medical Center Anam Hospital during the period of July 1, 1994 to June 30, 1995. Patients were classified into 103 patients were cared for by medical physicians and 57 patients were cared for by surgeons. After then, we analysed the difference of pain control pattern between them. Different types and amount of analgesics were converted to a common standard, an oral morphine equivalents(OME) relative to 1mg of oral morphine. Results : 1) The total number of patients was 160, male 102 cases(63.8%), and the female was 58 cases(36.2%) respectively. 2) The mean age was 56.4(${\pm}14.62$) years old and mean admission period was 27.8 days(${\pm}34.85$). 3) The frequent cancer site was stomach 42 cases(26.315), lung and liver 29 cases(18.1%) each, pancreas 10 cases(6.2%) in order 4) 125 out of 160 subjects (78.13%) complained pain, and 66 out of 103(64.08%) and 31 out of 57(54.39%) were treated with analgesics to relieve pain. 50 out of 97(51.55%) were able to continue on oral medication. 5) 86 cases(53.75%) were well oriented 24 hours prior to death. 6) The frequent analgesics for regular basis were long acting form of oral morphine 34 cases(Medical phsicians 24, Surgeons 10), intravenous morphine 26 cases(Medical physicians 20, Surgeons 6) in order, and the most common p.r.n.(pro re nata) analgesics used was intravenous morphine. 7) The mean amount of analgesics on regular basis was 115.41 OME by medical physicians and 52.7 OME by surseons(P<0.05). The mean amount of p.r.n. analgesics was significantly larger in patients are for by surgeons(66.64 OME) than medical physicians 23.49 OME(P<0.01). 8) The mean frequency of administrated number of p.r.n. analgesics was 0.62 times/day on medical part and 1.88 times/day on surgical part (P<0.001). Conclusion : Of the 97 patients with advanced cancer, 51.55% were able to take oral medications in the last day of life. The parenteral analgesics were more frequently used in the patients cared for by surgeons than medical physicians. Over the half of terminal cancer patients were well oriented in the last day of life. Doctor's knowledge and attitude towards pain is very important to mange the pain, effectively.
It seems that the pharmacy has been too much concerned about either science or professional business, neglecting the pharmaceutical identity. Here, we the pharmacists should consider the root how the pharmacist profession was born. The most important role of pharmacists in their own profession is to review the prescriptions written by physicians. (omitted)
The majority of medical educators agree that scientific education is critical to the development of physician-scientists. However, the proportion of physicians interested or engaged in research has been decreasing. To overcome this deficit of research oriented physicians, many medical schools in the United States have introduced scholarly concentration (SC) programs into their medical curricula since 2000. In contrast, Korea has very few medical schools with such programs. Research programs at American medical schools were surveyed and investigated in order to better design and develop SC programs appropriate for Korean medical schools. Information on SC programs was gathered by reviewing medical school web sites and related articles. The SC programs of Brown Alpert Medical School, University of Pittsburgh School of Medicine, Duke University School of Medicine, and Stanford University School of Medicine are discussed in depth. The characteristics of each program were organized into seven parts: program description, administrative structure, orientation, curricular content, mentors and mentoring, student evaluation, and challenges. For a successful SC program in Korea we must consider providing guaranteed time for SC programs with necessary modifications in the core medical curriculum, educating and training of mentors, providing orientation and motivating students to pursue research, developing curricula for SC programs, and evaluating the progress of SC projects.
Kang, Young-Ah;Lim, Kyung-Choon;Kim, Joo Hyun;Jeoung, Jae Sim;Han, Ji Eun
Journal of muscle and joint health
/
v.26
no.3
/
pp.290-306
/
2019
Purpose: This study aimed to describe the experiences of health-care providers about advanced practice nurses (APNs) focusing on the perspectives of physicians and APNs in Korea. Methods: Qualitative data were collected with snowball sampling. Six physicians and 13 APNs participated in this study through in-depth interviews or a focus-group interview. Qualitative content analysis was employed. Results: Three themes and seven categories were emerged. Three themes were 1) challenging start and attempts to settle down on unfamiliar system, 2) being positioned as an APN at clinical settings, 3) long journey for social recognition and legal institutionalization of APNs' role. Seven categories were 1) challenges to new area, 2) introduction and conflict of APN system, 3) driving force for stepping toward becoming APNs, 4) dedication and commitment to role development, 5) efforts to prove APNs' competency, 6) approaches to guarantee legal APNs' activities, and 7) filling the gap in health-care service. Conclusion: The findings suggest that health-care providers who have collaborated with APNs are aware of the needs to operate APN system more stably through the legislation of APNs' scope of practices. Further research is needed to provide the evidences of APNs' practice outcomes such as health care quality, patient safety, reduction of medical expenses, etc.
Park, Seungmi;Kwak, Eunju;Lee, Ye-Won;Park, Eun-Jun
The Journal of Korean Academic Society of Nursing Education
/
v.29
no.3
/
pp.319-334
/
2023
Purpose: This study investigated the prevalence and perceptions of workplace violence against registered nurses (RNs) in hospitals. Methods: One thousand RNs replied to a nationwide survey from November 14 to December 22, 2022. They reported their general characteristics, prevalence of and their responses to different types of workplace violence from patients, family caregivers, physicians, and nurse peers, as well as their perceptions of workplace violence management systems. Results: A total of 71.1% of the RNs reported that they had experienced workplace violence in the last six months. The violence and sexual harassment experienced from patients and family caregivers were 57.3% and 19.1%, respectively. Furthermore, violence, sexual harassment, and workplace harassment from physicians were experienced by 24.6%, 4.0%, and 7.4%, respectively, of the RNs, and those from nurse peers by 21.4%, 3.1%, and 11.3%, respectively. The RNs stated that they often responded to workplace violence with passive and inactive behaviors, which were more serious toward physicians' workplace violence or sexual harassment from different perpetrators. Only 69.5% were aware of their hospital's workplace violence management systems, while only 14.7%~27.4%, according to the type of hospital (p=.471), perceived the systems as effective. Multiple important strategies were identified to prevent workplace violence. Conclusion: Critical suggestions are discussed for the prevention of workplace violence, including protecting the human rights of healthcare professionals, inter-organizational collaboration, and a culture of person-centered healthcare, and training nurse managers' competency in managing workplace violence.
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