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A Study on the Perception Changes of Physicians toward Duty to Inform - Focusing on the Influence of the Revised Medical Law - (설명의무에 대한 의사의 인식 변화 조사 연구 -의료법 개정의 영향을 중심으로-)

  • Kim, Rosa
    • The Korean Society of Law and Medicine
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    • v.19 no.2
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    • pp.235-261
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    • 2018
  • The Medical law stipulates regulations about the physician's duty to inform to contribute to patient's self-determination. This law was most recently revised on December 20, 2016, and came into effect on June 21, 2017. There has been much controversy about this, and it has been questioned whether or not it will be effective for physicians to comply with the duty to inform. Therefore, this study investigated perceptions of physicians of whether they observed the duty to inform and their legal judgment about that duty, and analyzed how the revision of the medical law may have affected the legal cognition of physician's duty to inform. This study was conducted through an online questionnaire survey involving 109 physicians over 2 weeks from March 29 to April 12, 2018, and 108 of the collected data were used for analysis. The questionnaire was developed by revising and supplementing the previous research (Lee, 2004). It consisted of 41 items, including 26 items related to the experience of and legal judgment about the duty to inform, 6 items related to awareness of revised medical law, and 9 items on general characteristics. The data were analyzed using SAS 9.4 program and descriptive statistics, Chi-square test, Fisher's exact test and Binary logistic regression were performed. The results are as follows. • Out of eight situations, the median number of situations that did not fulfill the duty to inform was 5 (IQR, 4-6). In addition, 12 respondents (11%) answered that they did not fulfill the duty to inform in all eight cases, while only one (1%) responded that he/she performed explanation obligations in all cases. • The median number of the legal judgment score on the duty to inform was 8 out of 13 (IQR, 7-9), and the scores ranged from a minimum of 4 (4 respondents) to a maximum of 11 (3 respondents). • More than half of the respondents (n=26, 52%) were unaware of the revision of the medical law, 27 (25%) were aware of the fact that the medical law had been revised, 20(18%) had a rough knowledge of the contents of the law, and only 5(5%) said they knew the contents of the law in detail. The level of awareness of the revised medical law was statistically significant difference according to respondents' sex (p<.49), age (p<.0001), career (p<.0001), working type (p<.024), and department (p<.049). • There was no statistically significant relationship between the level of awareness of the revised medical law and the level of legal judgment on the duty to inform. These results suggest that efforts to improve the implementation and cognition of physician's duty to inform are needed, and it is difficult to expect a direct positive effect from the legal regulations per se. Considering the distinct characteristics of medical institutions and hierarchical organizational culture of physicians, it is necessary to develop a credible guideline on the duty to inform within the medical system, and to strengthen the education of physicians about their duty to inform and its purpose.

Comparative Study on Factors that Affect Outsourcing Performances in Medical Institutions and Hotel Industries (아웃소싱 성과에 영향을 미치는 선행요인에 대한 의료기관과 호텔산업 간의 비교연구)

  • Ryou, Se-Seon;Lee, Jun-Bom;Jung, Mun-Suk
    • CRM연구
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    • v.3 no.2
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    • pp.21-41
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    • 2010
  • The current research was conducted to examine the factors that affect outsourcing performances, and further investigate whether a discrepancy in performance exists between the medical institutions and hotel service institutions. The study surveyed both medical and hotel administrators for approximately two months, who managed outsourcing tasks. Total of 325 responses out of 350 distributed were collected. However, due to inadequate responses, six responses were excluded, amounting to total of 319 (155 medical institutions, 164 hotels) valid responses included in the final analysis. First, the informal outsourcing relationships between representatives of outsourcing service seekers and providers did not appear to have significant effects in terms of the levels of trust in neither medical institutions nor hotel industries. However, the relationships affected outsourcing degrees exclusively in medical institutions, showing the disparity between the two service institutions. This was explained due to the continuing long term efforts required to establish an informal relationship in medical institutions. Second, communication was shown to have positive effects on levels of trust in both medical institutions and hotel industries. This indicates a prominent outsourcing trait that emphasizes the significance of mutual cordial communication that contributes to establishing positive relationships. Third, opportunistic behavior of the outsourcing service providers appeared to negatively affect the levels of trust as well as outsourcing degrees for both medical and hotel industries. Therefore, opportunistic behaviors were found to have more tendencies to causing tension and discomfort rather than creating a relationship based on mutual credibility or conviviality. Fourth, the effect of service infrastructures on the level of trust did not appear to be significant on medical institutions, while showing positive influence on hotel industries. Additionally, service infrastructures were found to positively influence the outsourcing performance levels for both sectors. Fifth, trust between outsourcing service seekers and providers did not appear to have noticeable impact on the outsourcing degrees for either institution. On the contrary, trust appeared to have positive impacts on performance for both institutions. This further indicates that, when engaging in outsourcing, strengthening relationships through mutual partnership with outsourcing entities rather than establishing contractual relationships leads to improving the reciprocal trust, which in turn improves work results. Lastly the outsourcing degree of service seekers appeared to have positive impact on the outsourcing performance for both medical institutions and hotel industries, indicating the causal relationship between the affectability of outsourcing degrees and the following performance results.

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Comparative analysis of volatile and non-volatile flavor compounds in rice paste made by α-amylase according to cultivars (α-amylase를 이용하여 제조한 쌀 페이스트의 품종에 따른 휘발성비휘발성 향미성분 비교분석)

  • Son, Eun Young;Kim, Hye Won;Kim, Sun Ah;Lee, Sang Mi;Paek, Se Hee;Kim, Sun Hee;Seo, Yong Ki;Park, Hye-Young;Oh, Sea-Kwan;Kim, Young-Suk
    • Journal of Applied Biological Chemistry
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    • v.60 no.3
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    • pp.283-291
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    • 2017
  • Rice that the half of population in the world eats as a staple food is mostly produced and consumed in Asia. However, its consumption is nowadays decreasing mainly due to diet diversity. Accordingly, some attempts are in demand to enhance the utilization of rice. In this study, profiling of volatile and non-volatile flavor components in rice pastes obtained by ${\alpha}$-amylase was performed and compared according to nine different rice cultivars domestically cultivated in Korea using gas chromatography-mass spectrometry combined by solid phase microextraction and gas chromatography-time of flight-mass spectrometry after a derivatization, respectively. In total, 46 volatile compounds identified included 6 alcohols, 6 aldehydes, 4 esters, 4 furan derivatives, 4 ketones, 1 acid, 1 sulfur-containing compound, 7 hydrocarbons, 5 aromatics and 8 terpenes. The non-volatile flavor components found were composed of 12 amino acids, 6 sugars and 4 sugar alcohols. In principal component analysis, rice paste samples could be discriminated according to cultivars on the score plots of volatile and non-volatile flavor compounds. In particular, some volatile compounds such as pentanal and 4,7-dimethylundecane could contribute to distinguish Senong 17 white and Senong 17 brown, whereas ethanol, 6-methylhep-5-en-2-one, and tridecane could be highly related to the discrimination of Iipum from other cultivars. Among non-volatile compounds, some amino acids such as glycine, serine and ${\gamma}$-aminobutyric acid and some sugars such as sucrose and fructose were mainly responsible for the discrimination of Danmi from the other cultivars. On the other hand, galactose, arabitol and mannose were more closely related to Senong 17 white than Senong 17 brown.

Molecular Phylogenetic Study of Nesiohelix samarangae Based on Metallothionein Gene (동양달팽이(Nesiohelix samarangae)의 metallothionein 유전자를 기초로 한 분자계통 분류학적 연구)

  • Lee, Jun-Seo;Min, Byung-Jun;Kang, Se-Won;Lee, Jae-Bong;Baek, Moon-Ki;Hwang, Seung-Young;Kim, So-Hee;Kho, Weong-Gyu;Choi, Sang-Haeng;Chae, Sung-Hwa;Park, Hong-Seog;Han, Yeon-Soo;Lee, Jun-Sang;Jeong, Kye-Heon;Lee, Yong-Seok
    • The Korean Journal of Malacology
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    • v.24 no.1
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    • pp.73-80
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    • 2008
  • Numerous morphological studies on N. samarangae have been well conducted over the last ten years. In this context, we have attemtped to do molecular phylogenetic analysis by using metallothionein (MT) gene from N. samarangae. To this end, we cloned the full length cDNA of MT from cDNA library of N. samarangae. The complete cDNA sequences were obtained from the expressed sequence tag (EST) sequencing project of N. samarangae, The coding region of 195 bp gives an amino acid sequence of 65 residues including methionine. There are 5' (61 bp) and 3' (48 bp) untranslated region at both ends of the Ns-MT cDNA sequence. The combined results from BLAST analyses, multiple sequence alignment and molecular phylogenetic study of Ns-MT cDNA indicate that N. samarangae has similarity to land snails such as Helix pomatia, Helix aspersa and Arianta arbustorum.

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Pseudotachylyte Developed in Granitic Gneiss around the Bulil Waterfall in the Jirisan, SE Korea: Its Occurrence and Characteristics (지리산 불일폭포 일원의 화강암질편마암에 발달한 슈도타킬라이트: 산상과 특성)

  • Kang, Hee-Cheol;Kim, Chang-Min;Han, Raehee;Ryoo, Chung-Ryul;Son, Moon;Lee, Sang-Won
    • The Journal of the Petrological Society of Korea
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    • v.28 no.3
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    • pp.157-169
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    • 2019
  • Pseudotachylytes, produced by frictional heating during seismic slip, provide information that is critical to understanding the physics of earthquakes. We report the results of occurrence, structural characteristics, scanning electron microscopic observation and geochemical analysis of pseudotachylytes, which is presumed to have formed after the Late Cretaceous in outcrops of the Paleoproterozoic granitic gneiss on the Bulil waterfall of the Jirisan area, Yeongnam massif, Korea. Fault rocks, which are the products of brittle deformation under the same shear stress regime in the study area, are classified as pseudotachylyte and foliated cataclasite. The occurrences of pseudotachylyte identified on the basis of thickness and morphology are fault vein-type and injection vein-type pseudotachylyte. A number of fault vein-type pseudotachylytes occur as thin (as thick as 2 cm) layers generated on the fault plane, and are cutting general foliation and sheared foliation developed in granitic gneiss. Smaller injection vein-type pseudotachylytes are found along the fault vein-type pseudotachylytes, and appear in a variety of shapes based on field occurrence and vein geometry. At a first glance fault vein-type seudotachylyte looks like a mafic vein, but it has a chemical composition almost identical to the wall rock of granitic gneiss. Also, it has many subrounded clasts which consist predominantly of quartz, feldspar, biotite and secondary minerals including clay minerals, calcite and glassy materials. Embayed clasts, phenocryst with reaction rim, oxide droplets, amygdules, and flow structures are also observed. All of these evidences indicate the pseudotachylyte formed due to frictional melting of the wall rock minerals during fault slip related to strong seismic faulting events in the shallow depth of low temperature-low pressure. Further studies will be conducted to determine the age and mechanical aspect of the pseudotachylyte formation.

The Difference of Lung Cancer Prevalence According to Smoking Habits (흡연 습관에 따른 폐암 발생의 차이)

  • Park, Moo Suk;Chung, Jae Ho;Jung, Jae Hee;Kim, Young Sam;Kim, Se Kyu;Jee, Sun Ha;Chang, Joon;Kim, Sung Kyu
    • Tuberculosis and Respiratory Diseases
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    • v.55 no.3
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    • pp.267-279
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    • 2003
  • Background : The purpose of this study was to analyze the smoking habits in patients with lung cancer and identify any difference of prevalence according to histologic types of lung cancer. Methods : The data were calculated by total amounts of tar and nicotine inhaled during the whole lifetime according to variation of smoking habit. This study was to investigated any difference of prevalence in lung cancer according to smoking habits. The subjects comprised 150 lung cancer cases and 300 hospital control cases that were matched by age and sex. Smoking habits during the whole lifetime were surveyed by standardized questionnaire. Odds ratios were estimated by unconditional logistic regression analysis. Results : There were 104 male and 34 female lung cancer cases. By histologic type, there were 53 cases of squamous cell carcinoma, 67 of adenocarcinoma and 30 of small cell lung carcinoma. The differences between lung cancer cases and controls according to smoking habits were total duration of smoking, total pack years of smoking and number of cigarettes smoked per day during the previous two years. The odds ratio were higher in Kreyberg I, but not in Kreyberg II, for the longer duration of smoking, the greater total pack years of cigarettes consumed, the more cigarettes smoked per day during the previous two years, the longer duration on non-filter smoking, the earlier life cases who began to smoke, and the higher amounts of calculated total tar and nicotine inhaled over the whole lifetime. When we added grade of inhalation to calculation of amounts of tar and nicotine inhaled over the lifetime, the odds ratios of total inhalation amounts of tar and nicotine were as high as those the without them. Conclusions : This study reconfirmed that smoking habits were strongly associated with lung cancer and that there were different associations between smoking habits and histologic types of lung cancer. In particular, calculations of total tar and nicotine amounts inhaled over the whole lifetime were calculated for the first time in trials from lung cancer epidemiologic studies.

Characters of motile aeromonads isolated from imported ornamental fish (수입 관상어에서 분리한 motile aeromonads의 특성)

  • Jin, Se-yun;Ko, Chang-yong;Lee, Ye-ji;Jung, Yun-hee;Ju, Seong-cheol;Kim, Eunheui
    • Journal of fish pathology
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    • v.30 no.2
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    • pp.89-96
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    • 2017
  • The majority of freshwater ornamental fish are imported and distributed domestically, causing high risk of exposure to exotic pathogens and drug resistant bacteria in Korea. Aeromonas hydrophila is known as a common species of fresh water bacteria and opportunistic fish pathogen, as well as a species causing zoonotic infection. In this study, we isolated motile aeromonads from various imported freshwater ornamental fish and studied the characters of the isolates. Imported freshwater ornamental fish were purchased on day 1 after the fish were deposited in the aquarium. Bacteria were isolated from the liver, kidney and spleen of fish using 0.5% NaCl containing tryptic soy agar medium. Bacteria were grouped on the basis of their morphological characteristics. The colonies with clear zone on starch-ampicillin agar (SA agar) were tentatively identified as Aeromonas spp. Two hundred and twenty-six strains, about 70% of total isolates were assumed to be Aeromonas spp. Nine isolates were further identified based on the result of the API 20E test and PCR using primers specific for A. hydrophila 16S rRNA gene. The isolates were identified as A. hydrophila and the API 20E test showed differences in trisodium citrate, D-sucrose, D-melibiose, amygdalin and L-arabinose availability between the nine isolates and standard A. hydrophila. The susceptibilities of the isolated bacteria to 10 antibacterial agents were confirmed by the disk diffusion method. Isolated strains were found to be resistant to amoxicillin and ampicillin and sensitive to florfenicol. However, 7 isolates showed multiple drug resistances to erythromycin, oxytetracycline, nalidixic acid etc. Pathogenicity of the isolates was determined by the artificial challenge test on goldfish (Carassius auratus). Three isolates caused 60 ~ 80% mortality in goldfish within 5 days after the initiation of challenge. These results indicate that multiple drug resistant, highly pathogenic and exotic A. hydrophila can spread to domestic aquarium and the preventive treatment of fish before sale is necessary.

Effect of the Seedlings Difference in Cylindrical Paper Pot Trays on Initial Root Growth and Yield of Pepper (원통형 종이포트 고추 묘의 생육 차이가 초기 뿌리 생육과 수량에 미치는 영향)

  • Seo, Tae Cheol;An, Se Woong;Kim, Sun Min;Nam, Chun Woo;Chun, Hee;Kim, Young Chul;Kang, Tae Kyoung;Kim, Sung Woo;Jeon, Su Gyeong;Jang, Kil-Su
    • Journal of Bio-Environment Control
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    • v.26 no.4
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    • pp.368-377
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    • 2017
  • This study investigated the possibility of application of the recently introduced cylindrical paper pot seedlings in hot pepper (Capsicum annuum L.) cultivation. The seedling growth, initial rooting after planting and accumulated fruit yield were investigated with the treatments of tray type (paper pot and plug) as a main factor, tray cell number (40 cell and 50 cell) as a sub-factor, and fertigation method (continuous fertigation and fertigation after 35 days sowing) as a sub-sub factor, respectively. The growth of pepper seedlings was significantly affected by tray type and fertigation method showing the highest value at 50 cell plug tray with continuous fertigation, and the effect of fertigation was greater than that of trays. 'Cheongyang', 'Daekwonseoneon' and 'Longgreenmat' cultivar showed all the same pattern in seedling growth. These three-cultivar seedlings were planted in plastic house and in open field in Jeonju area, respectively, and another 'Daekwonseoneon' seedlings raised Yeongyang local area was also planted at the same area. There was no difference in the rooting of 'Cheongyang' pepper at 2 weeks after planting in plastic house. The accumulated fruit weight was not significantly different between paper pot seedlings and plug seedlings in three cultivar grown in plastic house. However, that of 'Cheongyang' pepper showed higher at paper pot seedlings than plug seedlings and the other two cultivar were higher at plug seedlings in open field. 'Daekwonseoneon' pepper yield grown in open field in 'Yeongyang' area was not significant between paper pot seedlings and plug seedlings. In conclusion, the pattern of seedlings growth grown in the cylindrical paper pot was the same as those of the conventional plug seedlings and also fruit yield was similar between paper pot seedlings and plug seedlings even though minute difference among cultivars. These results suggest that pepper seedlings grown in paper pot should be highly applicable to pepper cultivation.

Evaluation of Metal Volume and Proton Dose Distribution Using MVCT for Head and Neck Proton Treatment Plan (두경부 양성자 치료계획 시 MVCT를 이용한 Metal Volume 평가 및 양성자 선량분포 평가)

  • Seo, Sung Gook;Kwon, Dong Yeol;Park, Se Joon;Park, Yong Chul;Choi, Byung Ki
    • The Journal of Korean Society for Radiation Therapy
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    • v.31 no.1
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    • pp.25-32
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    • 2019
  • Purpose: The size, shape, and volume of prosthetic appliance depend on the metal artifacts resulting from dental implant during head and neck treatment with radiation. This reduced the accuracy of contouring targets and surrounding normal tissues in radiation treatment plan. Therefore, the purpose of this study is to obtain the images of metal representing the size of tooth through MVCT, SMART-MAR CT and KVCT, evaluate the volumes, apply them into the proton therapy plan, and analyze the difference of dose distribution. Materials and Methods : Metal A ($0.5{\times}0.5{\times}0.5cm$), Metal B ($1{\times}1{\times}1cm$), and Metal C ($1{\times}2{\times}1cm$) similar in size to inlay, crown, and bridge taking the treatments used at the dentist's into account were made with Cerrobend ($9.64g/cm^3$). Metal was placed into the In House Head & Neck Phantom and by using CT Simulator (Discovery CT 590RT, GE, USA) the images of KVCT and SMART-MAR were obtained with slice thickness 1.25 mm. The images of MVCT were obtained in the same way with $RADIXACT^{(R)}$ Series (Accuracy $Precision^{(R)}$, USA). The images of metal obtained through MVCT, SMART-MAR CT, and KVCT were compared in both size of axis X, Y, and Z and volume based on the Autocontour Thresholds Raw Values from the computerized treatment planning equipment Pinnacle (Ver 9.10, Philips, Palo Alto, USA). The proton treatment plan (Ray station 5.1, RaySearch, USA) was set by fusing the contour of metal B ($1{\times}1{\times}1cm$) obtained from the above experiment by each CT into KVCT in order to compare the difference of dose distribution. Result: Referencing the actual sizes, it was appeared: Metal A (MVCT: 1.0 times, SMART-MAR CT: 1.84 times, and KVCT: 1.92 times), Metal B (MVCT: 1.02 times, SMART-MAR CT: 1.47 times, and KVCT: 1.82 times), and Metal C (MVCT: 1.0 times, SMART-MAR CT: 1.46 times, and KVCT: 1.66 times). MVCT was measured most similarly to the actual metal volume. As a result of measurement by applying the volume of metal B into proton treatment plan, the dose of $D_{99%}$ volume was measured as: MVCT: 3094 CcGE, SMART-MAR CT: 2902 CcGE, and KVCT: 2880 CcGE, against the reference 3082 CcGE Conclusion: Overall volume and axes X and Z were most identical to the actual sizes in MVCT and axis Y, which is in the superior-Inferior direction, was regular in length without differences in CT. The best dose distribution was shown in MVCT having similar size, shape, and volume of metal when treating head and neck protons. Thus it is thought that it would be very useful if the contour of prosthetic appliance using MVCT is applied into KVCT for proton treatment plan.

Two Cases of Chemical Pneumonitis Caused by Hydrogen Sulfide (황화수소로 인한 화학성 폐렴 2예)

  • Kim, Jung Ha;Lee, Kyung Joo;Jung, Jin Yong;Lee, Eun Joo;Jung, Ki Hwan;Kang, Eun Hae;Lee, Sung Yong;Lee, Sang Yeub;Kim, Je Hyeong;Shin, Chol;Shim, Jae Jeong;In, Kwang Ho;Kang, Kyung Ho;Yoo, Se Hwa
    • Tuberculosis and Respiratory Diseases
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    • v.64 no.3
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    • pp.210-214
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    • 2008
  • Chemical pneumonitis is an occupational lung disease that's caused by the inhalation of chemical substances. Its severity depends on the characteristics of the substances, the exposure time and the susceptibility of the patients. Hydrogen sulfide is not only emitted naturally, but it also frequently found in industrial settings where it is either used as a reactant or it is a by-product of manufacturing or industrial processes. Inhalation of hydrogen sulfide causes various respiratory reactions from cough to acute respiratory failure, depending on the severity. Two pharmaceutical factory workers were admitted after being rescued from a waste water disposal site that contained hydrogen sulfide. In spite that they recovered their consciousness, they had excessive cough and mild dyspnea. The simple chest radiographs and high resolution computed tomography showed diffuse interstitial infiltrates, and hypoxemia was present. They were diagnosed as suffering from chemical pneumonitis caused by hydrogen sulfide. After conservative management that included oxygen therapy, their symptoms, hypoxemia and radiographic abnormalities were improved.