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Hospice Medicine and Nursing Ethics (호스피스의료와 간호윤리)

  • Moon, Seong-Jea
    • The Korean Society of Law and Medicine
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    • v.9 no.1
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    • pp.385-411
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    • 2008
  • The goal of medicine is to contribute to promoting national health by preventing diseases and providing treatment. The scope of modern medicine isn't merely confined to disease testing, treatment and prevention in accordance to that, and making experiments by using the human body is widespread. The advance in modern medicine has made a great contribution to valuing human dignity and actualizing a manly life, but there is a problem that has still nagged modern medicine: treatment and healing for terminal patients including cancer patients. In advanced countries, pain care and hospice medicine are already universal. Offering a helping hand for terminal patients to lead a less painful and more manly life from diverse angles instead of merely focusing on treatment is called the very hospice medicine. That is a comprehensive package of medical services to take care of death-facing terminal patients and their families with affection. That is providing physical, mental and social support for the patients to pass away in peace after living a dignified and decent life, and that is comforting their bereaved families. The National Hospice Organization of the United States provides terminal patients and their families with sustained hospital care and home care in a move to lend assistance to them. In our country, however, tertiary medical institutions simply provide medical care for terminal patients to extend their lives, and there are few institutional efforts to help them. Hospice medicine is offered mostly in our country by non- professionals including doctors, nurses, social workers, pastors or physical therapists. Terminal patients' needs cannot be satisfied in the same manner as those of other patients, and it's needed to take a different approach to their treatment as well. Nevertheless, the focus of medical care is still placed on treatment only, which should be taken seriously. Ministry for Health, Welfare & Family Affairs and Health Insurance Review & Assessment Service held a public hearing on May 21, 2008, on the cost of hospice care, quality control and demonstration project to gather extensive opinions from the academic community, experts and consumer groups to draw up plans about manpower supply, facilities and demonstration project, but the institutions are not going to work on hospice education, securement of facilities and relevant legislation. In 2002, Ministry for Health, Welfare & Family Affairs made an official announcement to introduce a hospice nurse system to nurture nurse specialists in this area. That ministry legislated for the qualifications of advanced nurse practitioner and a hospice nurse system(Article 24 and 2 in Enforcement Regulations for the Medical Law), but few specific plans are under way to carry out the regulations. It's well known that the medical law defines a nurse as a professional health care worker, and there is a move to draw a line between the responsibilities of doctors and those of nurses in association with medical errors. Specifically, the roles of professional hospice are increasingly expected to be accentuated in conjunction with treatment for terminal patients, and it seems that delving into possible problems with the job performance of nurses and coming up with workable countermeasures are what scholars of conscience should do in an effort to contribute to the development of medicine and the realization of a dignified and manly life.

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Comparison of Dose Depending on the Position when Shooting Panorama and CBCT (CBCT와 panorama 촬영시 위치에 따른 선량 비교)

  • Jeong, Cheonsoo;Kim, Chongyeal
    • Journal of the Korean Society of Radiology
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    • v.7 no.3
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    • pp.175-179
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    • 2013
  • To find out the appropriate defensive measures for protectors and radiation workers in rotating radiation generating devices such as CBCT and panorama, irradiation dose depending on the position was compared and analyzed. The devices such as panorama DP-90-P PAX-500 (Vatech, Korea) and CBCT DCT-90-P IMPLAGRAPHY Dental CT system (Vatech, Korea) were used. As irradiation dose measuring instruments, Ion chamber model 2026 and Reader 20X5-60E were used. The exposure conditions were set as the factor used in the clinical trial. The result of the experiment showed that panorama was the highest, 81${\mu}R$, at point A where the test starts first and the lowest, 53${\mu}R$, at point D where the test ends. In case of CBCT, it was the highest, 1,021${\mu}R$, at point D where the test ends and was measured as the highest, 809.67${\mu}R$, at point A where the test starts. If protectors and radiation workers are forced to examine a patient holding him, they should be positioned in the middle of the point where X ray tube starts to rotate and the point where it ends to avoid the position where radiation dose is the most. And due to the nature of equipment, it will be the safest for them to stand at the opposite side of the machine and to uphold it from the rear rather than upholding it from the side of a patient and they should wear appropriate the protection gear.

A Study of Clinical Feature of Premature of Cerebral Palsied Children at Kyoung-Nam${\cdot}$Pusan (부산${\cdot}$경남 일부 뇌성마비아들의 임상특성 연구)

  • Cho, Hee-Sun;Kim, Chung-Sun
    • The Journal of Korean Physical Therapy
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    • v.14 no.1
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    • pp.99-108
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    • 2002
  • The purpose of this study was to research the clinical of cerebral palsy taking physical therapy at the department of physical therapy of various clinics at Kyungnam${\cdot}$Pusan. Among the subjects that was born from January, 1985 to June, 2000, 226 parents was answered to questionary of this study. The results of the study were as follows: 1) During the embryonic period, the cerebral palsied children above 37weeks were 114 subjects(50.9%) and there was 51 subjects(22.8%) between 28weeks to 31weeks and 32weeks to 36weeks. The children below 28weeks were 8 subjects(3.6%) and showed the lowest rate. As compared to the delievery methods, the normal delievery, cesserian section delievery, and forceps delievery was 124 subjects(55.1%), 81(36.0%), 16(7.1%), nad 4(1.8%). Among them the mormal delievery indicated the highest percentage. 2) Compared to the weight during birth time, the above 2500g of 121 subjects(55.3%) showed the highest rate and the 28 subjects(12.8%) had the birth weight of 1000to 1499g. There was 4 subjects(1.8%) below the 1000g. 3) Compared to the birth weight of the pregnancy period, the weight of the cerebral palsied children below 28weeks were 1000g to 1499g and showed the highest rate of 4 subjects(50%). The children between 28weeks to 31weeks and 32weeks to 36weeks were 1500 to 2499g, each 23(47.9%), and 28(54.9%) subject. The weight of the children of the above 37weeks were above 2500g and 94 subjects(87.4%). Therefore, if the period of pregnancy is short, the weight birth would indicate the lower weight than the weight of the other times(p<0.05). 4) The spastic type of the pregnant period had the highest rate and the period was the below 28weeks to 31weeks. The cerebral palsied children of athetoid and mixed type were 6 subjects(13.3%) and 5 subjects(31.9%) between 28 and 31weeks. The mixed type of them was each 15 (31.9%) and 33 (30.6%) subjects between 32 to 36 weeks and the above 37weeks. The mixed type showed a slightly high rate (p<0.05). 5) The spastic type indicated the highest rate in the weight of birth time and especially showed the high rate in the case of 1000 to 1499g. The mixed type indicated a slightly high rate of 17 subjects (25.8%) and 32 subjects (29.1%) in case of 1500 to 2499g and the above 2500g (p<0.05).

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A mark-release-recapture experiment with Anopheles sinensis in the northern part of Gyeonggi-do, Korea

  • Cho, Shin-Hyeong;Lee, Hyeong-Woo;Shin, E-Hyun;Lee, Hee-Il;Lee, Wook-Gyo;Kim, Chong-Han;Kim, Jong-Taek;Lee, Jong-soo;Lee, Won-Ja;Jong, Gi-Gon;Kim, Tong-Soo
    • Parasites, Hosts and Diseases
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    • v.40 no.3
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    • pp.139-148
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    • 2002
  • In order to study the range of flight and feeding activity of Anopheles sinensis, the dispersal experiment was conducted in Paju city, located in the northern part of Gyeonggi-do, Republic of Korea, during the period of 7th to 28th September 1998. Unfed females An. sinensis were collected in cowshed and released after being marked with fluorescent dye at 23:00 hours on the same day. Released female mosquitoes were recaptured everyday during 21 days using light traps, which were set at 10 sites in the cowsheds located 1, 3, 6, 9 and 12 km north-northwest and north-northeast and at 3 sites located 1, 6 and 9 km toward south-west from the release point. In addition, to study the longest flight distance in one night, we set the light traps at 16 and 20 km toward north-northeast from the release site. All the collected mosquitoes were placed on filter papers and observed on UV transilluminator after treatment with one drop of 100% ethanol. Out of 12,773 females of An. sinensis released, 194 marked females mosquitoes were recaptured, giving 1.52% recapture rate. Of 194, 72 mosquitoes (37 1%) were recaptured in light traps from three places set at 1 km from the release point, 57 mosquitoes (29.4%) from two places at 1-3 km, 41 mosquitoes (21.1%) from three places at 3-6 km, 20 mosquitoes (10.3%) from three places at 6-9 km, and 4 mosquitoes (2.1%) from two places at 9-12 km. Since 170 female mosquitoes (87.6%) out of 194 marked mosquitoes were captured within 6 km from the release point, this flight radius represents the main activity area. An. sinensis was found to be able to fly at least 12 km during one night.

Comparison of 2D and 3D Brachytherapy Planning for Cervical Cancer (자궁경부암 근접방사선치료 시 2차원, 3차원 치료계획 비교평가)

  • Kim, Jung Hoon
    • Journal of radiological science and technology
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    • v.40 no.2
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    • pp.303-309
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    • 2017
  • To evaluate the usefulness of 3-dimensional brachytherapy(BT) planning technique based on CT in cervical cancer. Patients with cervical cancer underwent 2-D BT treatment planning and then CT scan with HDR intracavitary applicators in place with same positions. Dose was prescribed to Point A with 5Gy per fraction on 2-D BT planning. For 3-D BT planning, and dose was prescribed to the High risk CTV for BT (HR CTV) with 5Gy. The 3-D BT planning goal was to cover at least 90% of the HR CTV with target 5Gy isodose surface while limiting the dose to $2cm^3$ of bladder to less than 7.5 Gy, and $2cm^3$ of rectum to less than 5Gy. In one patient of 10 patients, $D_{2cm3}$ of rectal dose was over 5Gy and 6patients at $D_{2cm3}$ of bladder dose on 2-D BT planning. There was a tendency to underestimate ICRU bladder dose than ICRU rectal dose. CT based 3-D BT planning for cervical cancer will enable evaluation of dose distributions for tumor and critical organs at risk. So, rectal and bladder morbidity as well as geographic miss will be reduced in case of the bulky disease or uterine malposition.

Characteristics of verotoxin non-producing Escherichia coli O157 and verotoxin-producing E coli isolated from healthy cattle (정상 소 분변에서 분리한 verotoxin을 산생하지 않는 Escherichia coli O157과 verotoxin을 산생하는 E coli의 특성 조사)

  • Jung, Byeong-yeal;Jung, Suk-chan;Park, Hong-je;Cho, Gil-jae;Kim, Bong-hwan
    • Korean Journal of Veterinary Research
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    • v.40 no.3
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    • pp.525-531
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    • 2000
  • Verotoxin non-producing E coli O157 strains have been isolated from cattle feces and compared in particular regard to biochemical properties and genotypes with verotoxin-producing E coli (VTEC). E coli O157 : nonH7 strains had different phenotypes in sorbitol fermentation and ${\beta}-glucuronidase$ activity from E coli O157 : H7. Regardless of verotoxin production ability of E coli O157 : H7, uidA gene was uniquely detected from sorbitol and ${\beta}-glucuronidase$ negative E coli O157 : H7. Forty five fecal samples from 6 dairy farms were obtained and VTEC was detected as 15.6% (7 strains) of the samples. Most VTEC isolates were positive for sorbitol fermentation and ${\beta}-glucuronidase$ activity but negative for eaeA gene. This study suggested that cattle could be a reservior for VTEC. However, absence of eaeA gene in VTEC isolates from most of healthy cattle suggested that they might be less virulent than eaeA-positive E coli against human health.

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Surgical Treatment of Obstructive Lobar Emphysema. A Report of Four Cases. (폐쇄성 엽성 폐기종의 외과적치료 - 4례 보고 -)

  • 김근호
    • Journal of Chest Surgery
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    • v.8 no.2
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    • pp.109-118
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    • 1975
  • This is a report on four cases of the lobar emphysema due to proximal bronchial obstruction in the Department of Thoracic Surgery, Hanyang University Hospital, during the period of three and half years from 1972 to 1975. First case, a two years old male child was referred to our Department with the lobar emphysema of the lower lobe of the right lung with pneumonia. This emphysema was developed after aspiration of a piece of peanut. Bronchoscopy revealed that the bronchus of the right lower lobe was obstructed with the foreign body, however removal of the peanut through bronchoscope was not attempted because of corruption and softening of the peanut. The removal of the peanut by bronchotomy was performed after subsiding of acute phase of pulmonary infection. Postoperative course was uneventful and the emphysema was disappeared. Second case, a twenty months old female baby was referred to our Department with lobar emphysema of the lower lobe of the left lung. The emphysema was suddenly developed with coughing and dyspneic symptoms and the diagnosis was made roentgenologically. She gave a history of reccurrent infections of the respiratory tract after birth. Bronchoscopy showed an obstruction of the left main bronchus with the growing of fibrinous tissue on the bronchial mucosa. The protruded tissue in the left main bronchus taken out about O.8ml with biopsy forceps for histological examination. After this procedure, the emphysema of the left lung was disappeared. Histological finding was reported to be a chronic inflammatory granulation tissue. Third case, a two and half years old male child was referred to our Department with roentgenological lobar emphysema. Two weeks prior to admission he had an episode of sudden onset of coughing attack with dyspnea. Bronchoscopy revealed that the bronchus of the left lower lobe was obstructed with a mass which was strongly suspected of a neoplastic tissue. At operation, there was found a perforation of enlarged tuberculous lymph node in the bronchus of the left lower lobe and protrusion of granulation tissue into the bronchus. Ruptured orifice on themembranous wall of the left lower lobe bronchus was closed with interrupted suture after the" removal of a perforated tuberculous lymph node. Postoperative course was uneventful and antituberculous chemotherapy was given. Fourth case, a 47 years old man was admitted to our Department with the complaint of severe dyspnea of few months duration. Twenty years ago, he had a history of lung tuberculosis and was treated for many years. X-ray examination including tomography and bronchography revealed that the upper lobe of the right lung was destroyed with cavities, the lower lobe was completely shrunk, and the right middle lobe was strongly overdistended with narrowing bronchial trees. Differential bronchospirometry and lung scanning confirmed that the respiratory function of the affected lung was impaired almost totally. The value of the right lung was calculated on 6% of oxygen uptake, 1% of Minute volume, and 32% of vital capacity. The right pneumonectomy was performed under the careful consideration of anesthetic and surgical procedures. Postoperative course was uneventful and the respiratory function was improved nearly to the normal level.evel.

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Long Term Survival after the Resection of Esophageal Cancer (식도암 절제수술 후 장기 성적)

  • 김영태;성숙환;김주현
    • Journal of Chest Surgery
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    • v.32 no.7
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    • pp.653-659
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    • 1999
  • Background: Despite the recent promising efforts to improve survival in patients with esophageal carcinoma, the long term survival results of patients with esophageal cancer have seldom been reported in Korea. To establish standard control for future studies, we re trospectively analyzed the surgical treatment results of the esophageal cancer patients managed in our department at Seoul National University Hospital. Material and Method: From January 1984 to December 1996, 734 patients were diagnosed with esophageal cancer. Among them, 253 patients underwent surgery in our department. We retrospectively analyzed the operative results and long term survival rates of these patients. Result: The majority of patients(237) had squamous cell histology and only 6 patients had adenocarcinoma. The final TNM stage grouping for these patients was based on the 1988 revised American Joint Commitee on Cancer classification. Twenty one patients were surgically classified as stage I, 109 as stage II, and 107 as stage III. C respiratory failure in 8, sepsis in 1, hepatic failure in 1, bleeding in 1 and unknown etiology in the remaining 3. The actuarial survival of 222 patients in whom the curative resection was accomplished at 1-, 2-, 3- and 5 years was 74.7${\pm}$3.1%, 46.5${\pm}$3.7%, 32.3${\pm}$3.7%, and 19.9${\pm}$3.3%, respectively. CONCLUSION: The poor long term survival rates suggest that an alternative treatment method such as intensive combined modality therapy should be developed for the management of esophageal cancer.

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Change of Morphologic Pelvis and Deviation According to Gender, Age -Radiological Pelvimetry- (성별과 나이에 따른 골반 형태 변화와 골반 변위 -방사선영상을 이용한 골반 계측-)

  • Kang, Yeong-Han;Kim, Seon-Chil
    • Journal of radiological science and technology
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    • v.34 no.2
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    • pp.91-96
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    • 2011
  • The purpose of this study was to analyze the change of morphologic pelvis according to age and gender. Pelvis AP(anterior-posterior) projection were taken from 382 individuals (men: 194, women: 188) at the age of twenty and older. We measured four values of pelvis using CR (computed radiological system) including maximum pelvic breadth (MPB), sacral breadth (SB), transverse diameter of pelvic inlet (TD), and distance between femoral heads (DFH). Average (t-test, ANOVA) and Pearson correlation were calculated for comparison. While there was no significant difference of gender in case of MPB, significant differences were observed in SB (men 97.76 mm, women 102.00 mm), TD (men 138.0 mm, women 149.79 mm), and DFH (men 141.94 mm, women 150.39 mm). The DFH values were negatively correlated with the age (men r=-0.280, women r=-0.207). The morphological changes of pelvis were measured high in the men of 50's and in the women of 60's and 70's. The SB, TD and DFH were greater in the women than in the man. As the ages get higher, the deviation of pelvis were gradually increased, which indicates that the morphological changes of pelvis with respect to the age reflects an aging process.

A Critical Analysis of Literature for Consumer Health Information Services in Public Libraries (문헌분석을 통해서 도출한 공공도서관 소비자건강정보(CHI) 서비스 연구)

  • Noh, Young-Hee;Oh, Sang-Hee
    • Journal of the Korean BIBLIA Society for library and Information Science
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    • v.22 no.1
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    • pp.47-77
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    • 2011
  • Due to the growth of people's use of the Internet as well as interests in health, people's needs of health information have rapidly increased in public libraries. Nevertheless, there are few studies in Korea about users' needs for health information and services that public libraries can offer to support these user groups. In the current study, a comprehensive literature review was conducted in order to understand the role of public libraries and librarians in serving users with health information and to identify the types of consumer health information(CHI) services available to users in public libraries. As for the CHI services that public libraries can offer for users, the current study emphasizes and discusses the directions and guidelines for improving the following six approaches: 1) CHI collection and information resource building, 2) CHI reference services, 3) CHI user education and training program development, 4) CHI services for minority/disability/cultural diversity groups of users, 5) CHI outreach program development, and 6) CHI network development with medical libraries, academic libraries, hospital, and medical institutions and associations. Although most of the discussion in the current study centers on cases and services provided in the United States or other countries, findings would be used to inform the importance of CHI services in public libraries, and to design and develop CHI services in Korea.