• Title/Summary/Keyword: Against medical advice

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Factors Affecting Vaccination Status of Female Adolescents Subject to the Korean National HPV Immunization Program: Focusing on Mothers' HPV Knowledge and Heath Beliefs of HPV Vaccines

  • Park, Seungmi;Jang, Insun;Lee, Jung Lim;Kim, Youngji
    • Journal of the Korean Society of School Health
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    • v.33 no.1
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    • pp.58-66
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    • 2020
  • Purpose: HPV vaccination is important for the prevention of cervical cancer and genital warts and it is recommended that females be vaccinated against HPV before having sexual contact. Although the national HPV immunization has recently started in Korea, the vaccination rate is still not high. This is a relevant study attempting to investigate the factors affecting the vaccination status of female adolescents in the target age groups focusing on mothers' knowledge and health beliefs of HPV vaccines. Methods: Participants were 206 mothers who had daughters at the target age for the national HPV vaccination program living in a metropolitan city. Data were collected using a self-reported questionnaire about HPV knowledge and health beliefs of HPV vaccines, consisting of perceived susceptibility seriousness, benefits, barriers, and cues to action. Results: The participants' knowledge of HPV was significantly correlated with the overall health beliefs. The factors influencing mothers regarding the HPV vaccination status of their adolescent daughters were found to be perceived barriers, advice on vaccination from medical staff, and perceived benefits. Conclusion: There is a need to organize subject-specific education programs focusing on correcting misinformation about the side effects and benefits of HPV vaccines. When operating education programs, it is recommended that participants include both students and their parents, that various approaches be implemented such as formal health classes, home correspondence and online education, and that medical personnel be also involved as education providers.

Predictive Factors for Mortality among Adult Trauma Victims Transfused in an Emergency Department (응급의료센터에서 수혈을 시행한 성인 외상환자에서 사망 예측 인자)

  • Lee, Kyung Won
    • Journal of Trauma and Injury
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    • v.25 no.3
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    • pp.79-86
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    • 2012
  • Purpose: The most common cuase of transfusion for trauma victims in an emergency department is hypovolemic shock due to injury. After an injury to an internal organ of the chest or the abdomen, transfusion is needed to supply blood products and to compensate tissue oxygen transport and bleeding. From the 1990's, there have been some reports that transfusion is one of the major factors causing multiple-organ failure. Thus, as much as possible, tranfusion has been minimized in the clinical setting. This study aims to analyze the prognostic factors for mortality among trauma victims transfused with blood products in an emergency department. Methods: We conducted this study for the year of 2010 retrospectively. The study group included adult trauma victims tranfused with blood products in our ED. The exclusion criteria were discharge against medical advice, and missing follow-up due to transfer to another facility. During the study period, 34 adult trauma victims were enrolled. We compared the clinical variables between survivors and non-survivors. Results: the mean age of the 34 victims was 58.06 years, and males account for 58.5% of the study group. The most-frequently used form transportation was ambulance(119, 55.9%), and the most common injury mechanism was mobile vehicle accidents(67.6%). The mean revised trauma score (RTS) was 5.9, and the mean injury severity score (ISS) was 47.76. The mortality rate in the ED was 58.5%, Comparison of survivors with non-survivors showed statistical differences in injury mechanism, initial SBP, DBP, RTS, ISS, and some laboratory data such as AST, ALT, pH, PO2, HCO3, glucose (p<0.05). Regression analyses showed that mortality among adult trauma victims transfused in the ED correlated with RTS. Conclusion: When an adult trauma victim is transported to the ED and needs a tranfusion, the emergency physician carefully assess the victim by using physiologic data.

A study on the professional ethical relationship between librarian and library work (도서관 업무와 전문사서간의 윤리적 관계에 관한 이론적 고찰)

  • 손연옥
    • Journal of Korean Library and Information Science Society
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    • v.24
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    • pp.485-517
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    • 1996
  • The purpose of this study is to investigate typical ethical problems found in the technical and public services areas. The followings are the summary of the study. There are three distinct elements that govern ethical problems. One element is legal laws. The copyright law and the privacy act are exact examples. The copyright law has strong influence on the inter library loan service where the majority requests from the users are reproduction of copies. The privacy act also creates difficulties for librarians. Most requests for circulation records infringe on the privacy of library user. And advance online access systems also violates the privacy of library users. The second element is the code or rules that private organization has created. American Library Association created many statements that regulate the conduct of librarians. The bill of right, the professional code of ethics and policy on the confidentiality of library records have strong implications in the obligation of librarian. In the case of censorship at the selection of library materials, the code is a defensive tool against intellectual freedom. Yet self-censoring are prevailing practice among librarians. The thirds element is the competence of librarians. The analyzed table 3 showed that beside two elements, the rest of matters are competence required by librarians. The one aspect of it is humaneness and the other one is technical aspects. Technical aspect of competence are:(l) managerial and operational ability (2) communication skill (3) leadership (4) structure of knowledge and (5) self developing professionalism. Humanity aspect of competence are:(l) trust(fiduciary relationship) gained by diligence, objective judgement, ability, belief, rationality, integrity, kindness) (2) objectiveness (free from bias) (3) user-oriented consideration (need, interest, equal treatment, information gap) (4) caution in providing information (5) pride and (6) ability to distinguish advice and guidance specially in medical and law library.

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Secondary Analysis on Pressure Injury in Intensive Care Units

  • Hyun, Sookyung
    • International journal of advanced smart convergence
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    • v.10 no.2
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    • pp.145-150
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    • 2021
  • Patients with Pressure injuries (PIs) may have pain and discomfort, which results in poorer patient outcomes and additional cost for treatment. This study was a part of larger research project that aimed at prediction modeling using a big data. The purpose of this study were to describe the characteristics of patients with PI in critical care; and to explore comorbidity and diagnostic and interventive procedures that have been done for patients in critical care. This is a secondary data analysis. Data were retrieved from a large clinical database, MIMIC-III Clinical database. The number of unique patients with PI was 2,286 in total. Approximately 60% were male and 68.4% were White. Among the patients, 9.9% were dead. In term of discharge disposition, 56.2% (33.9% Home, 22.3% Home Health Care) where as 32.3% were transferred to another institutions. The rest of them were hospice (0.8%), left against medical advice (0.7%), and others (0.2%). The top three most frequently co-existing kinds of diseases were Hypertension, not otherwise specified (NOS), congestive heart failure NOS, and Acute kidney failure NOS. The number of patients with PI who have one or more procedures was 2,169 (94.9%). The number of unique procedures was 981. The top three most frequent procedures were 'Venous catheterization, not elsewhere classified,' and 'Enteral infusion of concentrated nutritional substances.' Patient with a greater number of comorbid conditions were likely to have longer length of ICU stay (r=.452, p<.001). In addition, patient with a greater number of procedures that were performed during the admission were strongly tend to stay longer in hospital (r=.729, p<.001). Therefore, prospective studies focusing on comorbidity; and diagnostic and preventive procedures are needed in the prediction modeling of pressure injury development in ICU patients.

Questionnaire-based analysis of growth-promoting attempts among children visiting a university growth clinic (대학병원 성장클리닉을 내원한 아동에서 설문 조사를 통한 키성장 관리 실태분석)

  • Huh, Kyoung;Park, Mi Jung
    • Clinical and Experimental Pediatrics
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    • v.52 no.5
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    • pp.576-580
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    • 2009
  • Purpose : Growth-promoting attempts are widespread in Korea, but little is known about their prevalence or associated factors. This study was designed to assess the prevalence of growth-promoting attempts among children visiting a university growth clinic. Methods : A questionnaire-based survey was carried out with 823 children (416 boys, 407 girls) who visited the growth clinic at Paik Hospital. Results : The mean age of the subjects was $10.4{\pm}2.6$ yr, and the height z-score was $-1.58{\pm}0.91$. Approximately 33.4% of the children had tried growth promotion. Among the height-gain methods, herbal medicine was the most frequently used (37.8%), followed by health-promoting supplements (37.1%), exercise or machine (3.0%), and growth hormone treatment (2.9 %). The mean age at which the parents began to worry about their children's height was 7.7 yr. The mean age at which they started height-gain methods was 8.9 yr for herbal medicine, 9.1 yr for health-promoting supplements, 9.4 yr for exercise or machine, and 9.9 yr for growth hormone treatment. Motivating factors included advice from relatives or friends (36.0%), advertisements in the Internet or newspaper (28.4%), advice from pharmacist (16.8%), and advice from their medical doctor (5.5%). The degree of satisfaction from the height-gain methods was 29.1% with growth hormone treatment, 6.6% with exercise or machine, 6.4% with herbal medicine, and 2.8% with growth-promoting supplements. Conclusion : Approximately one third of the children reported use of growth-promoting methods, but the satisfaction rate was not high. The benefits of growth-promoting methods should be carefully weighed against their costs and side effects.

Severity of Comorbidities among Suicidal Attempters Classified by the Forms of Psychiatric Follow-up (자살시도자의 정신건강의학과 치료 연계 형태에 따른 동반질병 심각도의 차이)

  • Lee, Hyeok;Oh, Seung-Taek;Kim, Min-Kyeong;Lee, Seon-Koo;Seok, Jeong-Ho;Choi, Won-Jung;Lee, Byung Ook
    • Korean Journal of Psychosomatic Medicine
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    • v.24 no.1
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    • pp.74-82
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    • 2016
  • Objectives : Suicide attempters have impaired decision making and are at high risk of reattempt. Therefore it is important to refer them to psychiatric treatment. Especially, People with medical comorbidity are at higher risk of suicidal attempt and mortality. The aim of this study was to investigate the characteristics of suicidal attempters and to analyze the influence of the medical comorbidity on decision to receive psychiatric treatment after visit to an emergency department. Methods : One hundred and thirty two patients, who visited the emergency room of a general hospital in Gyeonggi-do between January, 2012 and December, 2012 were enrolled as the subjects of this study. After reviewing each subject's medical records retrospectively, demographic and clinical factors were analyzed. Results : Regardless of the engagement type, either via admission or outpatient clinic, the determinant factors of psychiatric treatment engagement were psychiatric diagnosis, employment status, previous psychiatric treatment history, and previous attempt history. Comparison of severity of medical comorbidity(Charlson Comorbidity Index) showed that suicide attempters who received psychiatric treatment via admission or refused the treatment tended to have higher level of medical comorbidity than who received psychiatric treatment via outpatient department. Conclusions : Our findings showed that medical comorbidity of suicide attempters affected the decision to accept psychiatric treatment. All psychiatrists should evaluate the presence and the severity of medical comorbidity of the suicide attempters and consider implementing more intervention for the medically ill attempters who are willing to discharge against advice.

Epidemiologic Characteristics of Carbon Monoxide Poisoning: Emergency Department Based Injury In-depth Surveillance of Twenty Hospitals (일산화탄소 중독의 역학적 특징: 전국 20개 병원 응급실 손상환자 표본 심층조사)

  • Bae, Sohyun;Lee, Jisook;Kim, Kyunghwan;Park, Junseok;Shin, Dongwun;Kim, Hyunjong;Park, Joonmin;Kim, Hoon;Jeon, Woochan
    • Journal of The Korean Society of Clinical Toxicology
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    • v.14 no.2
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    • pp.122-128
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    • 2016
  • Purpose: This study was conducted to describe the characteristics of patients with carbon monoxide (CO) poisoning. Methods: We retrospectively surveyed data from the Emergency Department based Injury In-depth Surveillance of 20 hospitals (2011-2014). We included patients whose mechanism of injury was acute CO poisoning caused by inhalation of gases from charcoal or briquettes. We surveyed the annual frequency, gender, age, result of emergency treatment, rate of intensive care unit (ICU) admission, result of admission, association with alcohol, and place of accident. We also surveyed the cause and experience of past suicide attempts by intentional poisoning. Results: A total of 3,405 patients were included (2,015 (59.2%) and 1,390 (40.8%) males and females, respectively) with a mean age of $39.83{\pm}18.51$ year old. The results revealed that the annual frequency of CO poisoning had increased and the frequency of unintentional CO poisoning was higher than that of intentional CO poisoning in January, February and December. The mean age of intentional CO poisoning was younger than that of unintentional CO poisoning ($38.41{\pm}13.03$ vs $40.95{\pm}21.83$) (p<0.001). The rates of discharge against medical advice (DAMA), ICU care and alcohol association for intentional CO poisoning were higher than for unintentional CO poisoning (36.4% vs 14.0%, 17.8% vs 4.7%, 45.2% vs 5.6%) (p<0.001). The most common place of CO poisoning was in one's residence. Conclusion: The annual frequency of total CO poisoning has increased, and unintentional CO poisoning showed seasonal variation. DAMA, ICU care, and alcohol association of intentional CO poisoning were higher than those of unintentional CO poisoning.

Clinical Study of Group B β-Hemolytic Streptococcal Meningitis (B군 연쇄상구균 뇌막염에 대한 임상적 고찰)

  • Lee, Seo-Young;You, Sou-Jeong;Kim, Deok-Soo;Ko, Tae-Sung
    • Clinical and Experimental Pediatrics
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    • v.46 no.12
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    • pp.1224-1229
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    • 2003
  • Purpose : Bacterial meningitis is a serious disease, especially in the neonatal period, and it carries a significant degree of mortality and morbidity. Group B streptococcus(GBS) is a common cause of neonatal bacterial meningitis. The purpose of this study was to evaluate the clinical manifestations, treatment results and complications of GBS meningitis. Methods : We analyzed 29 cases retrospectively who had been admitted to the pediatric ward or NICU in Asan Medical Center from May 1990 to January 2002. They had proven GBS in culture or latex agglutination test in CSF. Results : The male to female ratio was 1 : 1.9. There were two cases of early onset type and 27 cases of late onset type. All cases had normal birth weight with full term at delivery. The perinatal predisposing factors were premature rupture of membrane(two cases), and maternal colonization(two cases). The most common presenting symptoms were fever and irritability. Associated diseases were GBS sepsis(21 cases). There was relatively high sensitivity to penicillin derivatives. There were abnormal brain CT or MRI findings in 16 cases(64%), such as infarction, encephalomalatic change, effusion, hydrocephalus, hemorrhage and abscess. The intensive care unit admission rate and the incidence of DIC were higher in the group with complications. Two cases were discharged against advice. Conclusion : We recommend early detection and active treatment in Group B streptococcal meningitis to improve the prognosis.

A Study on the Actual Conditions of Smoking in Middle and High School Students in One Region (일 지역 중·고등학생의 흡연실태)

  • Kim, Hyeon-Ok
    • Journal of the Korean Society of School Health
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    • v.12 no.1
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    • pp.149-167
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    • 1999
  • To investigate the actual conditions of smoking in middle and high school students in Chinan County, I used a sturctured questionnaire for 1,579 students attending twelve middle-high schools from December 1, 1998 to December 20, 1998. I collected and data correlated the using an $SPSS-PC^+$ 1. The smoking rate of middle-high schoo1 students in Chinan County was 17.9%, relatively high. This smoking rate was different according to the gender, grade, religion, and economic situation. In mals, high school students, non-religious, students low income family students, the smoking rate was higher. The smoking rate of high school students was almost the same as the smoking rate of adults, generally higher than that of foreign teenagers. Because the smoking rat of studinets in the third grade of middle school and in the first grade of high School was six times higher, increased education should be conducted during this time in an attempt to curb the sudden increase of the smoking rate. The smoking rate of girl students was 5.0%; this has increased mor than three times from ten years ago. Consequently, counter measures should be taken against the smoking of female students as well as juvenile smoking in general. In addition, the smoking rate of middle-high school students showed interesting differences when correnated with enviornmental factors. Students with low grades, who are not satisfied with school life, who don't have both parents, who have uncaring parents who nare too strict or too arbitary, who have smoking parents, or who have experienced smoking commonly smoked. Therefore, to lower the smoking rate we should improve the school environment, improve a student's interest in school life. And parents or siblings should lead by example and quit smoking at home. Schools should educate students more effectively concerning the harmful effects of smoking and create an accurate understanding of its dancers. From the beginning, we should teach students never ever to touch cigaretts. 2. The surve discovered that most students started out of curiosity, or solicitantion from friends or elders at middle school, and had been smoking one to five cigarettes for more than a year. They obtained cigarettes at stores and most of them have friends who smoke. As a result anti-smoking education should be conducted at elementary schools prior to middle school. More than 95% of the teenagers who smoke had friends who smote and smoked out of curiosity or the recommendation of elders. Thus, we must focus on teenagers who smoke in group, rather than individually. Fuyrthermore, the strict application of the regulation of tobacco sales as well as tobacco cooperation from retailers are needed. While students did not show any mood or academic achievement difference after beginning smoking, 58.1% of the students a health situdation that was worse. Juvenile smoking is more harmful to the juvenile than adult smoking is to the adult. This should be focused on in an anti-smoking campaign. 3. Students who smoke hada more positive attitude toward smoking than students who don't smoke. Students who smoke had a tendency to have a nuetral position and are not concerned about smoking compared to non-smoking students. The survey showed that the great number of students had a nuetral position. Because this nuetrality may increase Juvenile smoking, education that provides an exact understanding of smoking should be performed to build the correct attidude toward smoking. 4. Middle school students smoke when angry, gloomy, anxious, a lone and when they have some problems to solve, on when they feel inconveniened in other wores, they smoke to reliver stress. They also smok due to addiction. Because smoking is not a praetical method to relieve stress, a program which helps to acquire positive relief stress should be provided to help reduce smoking. 5. About 65% of students who smoke want to quit smoking because of health problem, 78% of them have tried mor than once to quit but failed due to weak will power and peer pressure from friends who smoke. Juvenile smoking is group, oriented. Thus, the program that advances less smoking will be the one that focuseds on groups. 6. As for advice to students who want to quit smoking, "persuasion" was used most commonly, followed by a "presentation on how to quit smoking". Another method were severe punishment. About 70% of the students wanted the anti-smoking guide at school. 7. Most students (73.5%) had a position that more anti-smoking education at school is needed. Obriously, then, anti-smoking education at middle-high schools should be reinfoced. Although the education which explains the harmful influence of tobacco is known as an efficient way prevent smoking; it does not influence students who already smoke. Therefore, for students who smoke, multi-dimensional approaches must be attempted that include physical training, phychokogical approache, consultation and discussion, medical chek-ups, audio-visual education technigues, and professonal instructors, in addition, because smoking students have more negative on lukewarm attitude to anti-smoking education anti-smoking education should be conducted through a communicative style by dedicated teachers who care about students. In order to increase the effectiveness of this program.

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Adenovirus Pneumonia with Respiratory Failure in Pediatric Patients (소아에서 발생한 호흡부전이 동반된 아데노 바이러스 폐렴)

  • Do, Sung Suk;Ma, Sang Hyeok;Park, Jae Sun;Lee, Young Ho;Lee, Hwan Jong;Lee, Gyu Man
    • Pediatric Infection and Vaccine
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    • v.5 no.2
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    • pp.258-266
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    • 1998
  • Purpose : Cases of adenoviral penumonia with rapidly progressive clinical course were experienced. We reviewed these patients in viewpoint of clinical manifestation and adenoviral serotypes. Methods : Culture and indirect immunofluorescence for respiratory viruses including respiratory syncytial virus, influenza virus, parainfluenza virus, adenovirus was done with nasopharyngeal aspirates from patients who admitted due to respiratory infections in Fatima Hospital, Masan from Nov. 1996 to Jul. 1997. Cultured adenovirus was serotyped by both neutralization and hemagglutination inhibition test. Medical records were reviewed for 5 patients with respiratory failure from adenovirus was isolated and serotyped. Results : The total number of examined patients was 460 patients. We isolated respiratory viruses in 143(30.9%) patients. Adenovirus was isolated from 66 out of 143(46.2%) patients. During Jan 1997 to May 1997, five patients with ages of 18 days to 11 months who were infected by adenovirus and had high fever with dyspnea and required assisted mechanical ventilation. One patients discharged against doctor's advice then died. Two of four patients had complications of disseminated intravascular coagulation; two had bronchiolitis obliterans. Two isolates were serotype 7, and one was serotype 5, and two were untyped. Conclusion : Severe pneumonia caused by serotype 7 continued to occur in 1997 following the epidemic in 1996, and severe pneumonia may also be caused by serotype 5 and other serotypes.

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