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Review of 2019 Major Medical Decisions (2019년 주요 의료판결 분석)

  • Yoo, Hyun Jung;Park, Noh Min;Jeong, Hye Seung;Lee, Dong Pil;Lee, Jung Sun;Park, Tae Shin
    • The Korean Society of Law and Medicine
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    • v.21 no.1
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    • pp.107-152
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    • 2020
  • During the main ruling in 2019, a number of rulings that were of interest or meaningful were handed down, such as just because the complication of medical practice has occurred, there is no presumption of negligence, a case involving a fall accident in which a lot of culpability has recently been made. the death of a well-known singer that caused a sensation, a case about damages caused by MERS in 2015, which is more meaningful in connection with damages caused by COVID-19, an infectious disease that has recently hit the world, including Korea. In preaching the principles of the law, just because there has been a complication caused by medical practice, there is no presumption of negligence, 'The scope of the complication without presumption of negligence' was determined differently by the court, the court was not able to specify the criteria. Specific circumstances were presented to limit the responsibility of the medical institution while acknowledging the malpractice of the medical institution in relation to the fall accident. In relation to the scope of damages, judgment was made on issues related to the calculation of lost profits of medical malpractice; criteria for determining celebrities' daily income, criteria for determining daily income in case of receiving survivor's pension due to medical accident, an incident in which the daily income is denied if the labor capacity is already lost at the time of a medical accident. But, it seems that judgments should be made based on clearer and more reasonable standards. Related to Medical Advertise, specific logic of judgment was presented as to whether it was interpreted as being in accordance with the specific prohibition listed in Article 27 paragraph 3 of the Medical Law, which is the criterion for violation of the Medical Law, or if it constitutes a significant harm to the order of the medical market. In response to the prohibition of operating the multiple medical institutions, the Constitutional Court decided that it was constitutional because it did not violate the regulations on excessive funding, and rationally limited the scope of the prohibited 'redundant operation'. The Supreme Court ruled for the first time that even a medical institution established and operated in violation of the Medical Service Act did not make it impossible to receive all medical care benefits implemented by a medical institution under the National Health Insurance Act. Significant rulings were finalized that recognized the existence of specific protection obligations for the people of the country in the management of infectious diseases.

An Elimination of False-Positive I-131 Sites in Esophagus for Thyroid Carcinoma; Using Water with Vitamin C Dissolved (갑상선암의 방사성옥소 치료 후 전신 스캔에서 비타민C 용액을 이용한 식도의 위양성 병소 제거에 대한 고찰)

  • Lee, Seung-Jae;Park, Hoon-Hee;Ahn, Sa-Ron;Cho, Seok-Won;Choi, Young-Sook;Cho, Arther;Kim, Jae-Sam;Lee, Chang-Ho
    • The Korean Journal of Nuclear Medicine Technology
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    • v.12 no.1
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    • pp.49-56
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    • 2008
  • Purpose: Whole body imaging with radioiodine can detect functioning metastases. Non-physiologic I-131 uptake detected on images usually is interpreted as suggesting functioning thyroid metastases. However, extra-thyroidal I-131 accumulation does not always imply thyroid cancer metastases and has been reported in many circumstances. In order to avoid unnecessary therapeutic interventions it is important to distinguish false-positive sites of I-131 localization. We study here to remove false-positive sites around esophagus region on I-131 whole body imaging in patients who were administrated thyroidectomy. Materials and Methods: From April to August in 2007, we had the patients who had visited our department after they received thyroidectomy due to thyroid cancer. They were given I-131, and performed radioiodine body scan after 41 to 50 hours. Patients were whole-body-scanned for the speed of 8 cm per minute. After that, we took anterior and posterior static images around the patients' neck measured by 300 thousand counts per image. We selected 44 patients who had hot spots around neck region, we divided the patients into two groups. One group was given 0.5 L of water and the other group was given 0.5 L of water with 1 g of Vitamin C dissolved. The patients were asked to drink the fluid for one minute in sitting position and after that, we measured 300 kilo counts per image again. We compared prior anterior, posterior static images with anterior, posterior images after the patients had water or water that Vitamin C resolved. Results: In using water, both observer 1 and 2 interpreted 6 patients were washed out. In the water with Vitamin C resolved, observer 1 and 2 interpreted 9 and 8 patients were washed out. Observer 1 and 2 interpreted 6 and 5 patients had 'indeterminate' when they used water. Both observer 1 and 2 interpreted 6 patients had 'indeterminate' when they used water with Vitamin C resolved. When they used water, observer 1 interpreted 10 patients had 'unchanged' and observer 2 interpreted 11 patients had 'unchanged'. Differently, when they used water with vitamin C resolved, observer1 had 8 patients having 'unchanged'and observer 2 had 9. Conclusion: As a result, by making patients drink 0.5 liter of water which has vitamin C resolved helped getting rid of false-positive sites in esophagus. Therefore, based on this study, we believe that drinking water with vitamin C dissolved is very in terms of reducing false-positive hot spot around the esophagus for the iodine-131 whole body scan.

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Study on Amenity and Economical Efficiency of Multi-functionality on the Grassland (초지형 축산의 어메니티 및 경제성 평가에 관한 연구)

  • Cheon, D.W.;Lee, S.Y.;Park, M.S.;Park, H.S.;Hwang, K.J.;Yun, S.H.;Ko, M.S.
    • Journal of The Korean Society of Grassland and Forage Science
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    • v.27 no.4
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    • pp.297-312
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    • 2007
  • This study is conducted to evaluate economical value of Jeju grassland and validity of its preservation, and draw up several measures to support. To measure its economical value, this study examined its environmental value and social and cultural value. For environmental value, this study used replacement method while it applied CVM method, a widely used method, to assess social and cultural value and two-level two-best choice selection method, which ask questions by assuming virtual circumstances to avoid reflecting some biased opinions. Jeju grassland has multiple functions-environmental functions such as preventing soil corrosion and flood, handling animal excrement, and purifying air, and social and cultural functions such as promoting physical and mental health and providing recreation places. From the results of the feasibility study, Jeju grassland's annual multiple functions are assessed to have a total $397,115{\sim}418,995$ million won worth. In addition, it is found that Jeju visitors recognize Jeju grassland for its functions to contribute to public interests. That is, they think it can provide attractive views and educational and recreational places and promote emotional development. Especially, many people presented their ideas that it be continuously preserved since it is worthwhile for us and our next generations. To preserve grassland's cultural resource, which create a huge economic value like this, the Government has to support a certain amount of financial aid for turning to a better grassland environment and its maintenance to realize environment-friendly livestock farming on Jeju Island and promote its tourism industry and consequently, add more value to Jeju.

A Study on the Model Regulation's Improvement for Control of Aeronautical Obstacles in Korea (항공장애물관리규정 개선을 위한 연구)

  • Lee, Kang-Seok
    • Journal of Korean Society of Transportation
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    • v.23 no.3 s.81
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    • pp.21-34
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    • 2005
  • To control the obstacles surrounding aerodrome is significant for preventing air accident and ensuring the long sustaining of aerodromes. On the other hand, within a scope of ensuring safe flight operations, the application of Shielding is one of the issues to be importantly considered to manage efficiently the obstacles limitation around aerodromes, to dissolute the private asset privilege limitation from regulation on aerodrome circumference, and to decrease the pains to manage the obstacles, in terms of not only operating safely but also utilizing efficiently the airspace around aerodromes. The ICAO and other aviation-advanced states mitigate the construction limitation or exempt the obligation of obstacle sign by applying the shielding theory that the obstacles are not regarded as obstacles where are below the shadow surface. The Republic of Korea inserted the new regulation including the applying shielding similar to ICAO on Aviation Act and regulations. It is, however, hard to manage the aviation obstacles around aerodrome efficiently with these new regulation. Particularly, there exists much rooms to dispute because it cannot suggest the specific standard which is necessary to apply shielding theory at airspace of aerodromes. Therefore, in this study, the international standards on aviation obstacles were reviewed, analyzed and compared with those of domestic status. The direction of which guideline for control of aeronautical obstacles applicable within domestic circumstances as well as correspondent with international standard was suggested. Particularly, as far as the disputable application of shielding theory is concerned, the alternatives for aviation safety and efficient airspace operation by suggesting the clear standards alternatives were suggested.

Water Quality in a Drainage System Discharging Groundwater from Sangdae-ri Water Curtain Cultivation Area near Musimcheon Stream, Cheongju, Korea (무심천 인근 상대리 수막재배지에서 지하수 사용 후 배출되는 최종 배수로 물의 수질 특성)

  • Moon, Sang-Ho;Kim, Yongcheol;Hwang, Jeong
    • Economic and Environmental Geology
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    • v.48 no.5
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    • pp.409-420
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    • 2015
  • The Sangdae-ri riverside around Musimcheon stream, flowing through Gadeok-myon of Cheongju City, is one of the representative strawberry fields employing water curtain cultivation (WCC) in Korea. In this area, annual groundwater use for WCC has been calculated by a few methods. On the assumption that all the water flowing through the final ditch may be mostly composed of groundwater, the discharge rate in it can be used as a good proxy for assessing the groundwater use. However, in the study area, the final ditch was set up in an unpaved state near and parallel to Musimcheon stream. Under such circumstances, the drainwater is likely to be influenced by infiltration and/or inflow of nearby stream. Hence, we examined whether or not stream water has influenced water flowing out through the final ditch in respect of ion concentrations or field parameters such as T, pH and electrical conductivity (EC) values. The period of measuring field parameters and sample collection was from February 2012 through February 2015. The drainwater in the final ditch did not show the average quality of groundwater, but similar quality of stream water in respect of pH, EC, ion contents and water type. From this, it is suggested that measuring the flow rate of the final ditch should not be directly used for assessing groundwater use in the study area. In addition, because of its sensitivity to ambient temperature, water temperature proved not to be appropriate for estimating the interaction between ditch and stream. For accuracy, additional methods will be needed to calculate mixing ratios between stream and ground water within drainage system.

A Survey on Preliminary Dental Hygienists' Senses of Employment (예비치과위생사의 취업에 관한 의식 조사)

  • Han, Su-Jin;Lee, Sun-Mi;Lim, Mi-Hee
    • Journal of Korean society of Dental Hygiene
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    • v.7 no.4
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    • pp.583-594
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    • 2007
  • The purpose of this study was to conduct a survey on the senses that preliminary dental hygienists have on employment, who applied for the National Dental Hygienist Examination, so that it could provide a basic reference required for fostering good human resources specializing in oral health with a sense of mission and responsibility as professional. To meet these goals, a self-administered questionnaire survey was conducted for participants in a refresher education meeting for preliminary dental hygienists across three major regions(Seoul, Daejeon and Busan), which was held by the Korean Dental Hygienists Association(KDHA) on Jan. 15, 2006. Total 289 sheets of questionnaire were collected, and 262 sheets except invalid or incomplete ones were used for examination and analysis. As a result, this study came to the following conclusions: First, it was found that 40.4% respondents wanted to be employed in dental clinic or hospital. Most respondents(90.1%) answered that faithfulness is most valued as prerequisite qualification for employment in hospital, and highest percentage of respondents(39.3%) wanted to earn 16 to 17 million Korean won annually. For internship opportunities, 61.9% respondents replied that they could willingly accept the internship, provided that basic pay and switchover to regular employee are all assured. Second, as the results of survey on employment circumstances around respondents, it was found that most respondents(58.3%) were employed in dental clinic or hospital, and highest percentage of respondents(35.0%) earned 15 to 16 million Korean won. Third, it was found that interpersonal relationships among employees had most significant effects(4.81) on selection of employment, which was followed by in-house welfare benefits 1(monthly/annual vacation, resting room, etc; 4.56). For possible influential factors on the selection of employment depending on whether employed or not, it was found that there were Significant differences in pay, welfare benefit 2(seminar, orientation, refresher training opportunities, etc), post-wedding continued employment and merit system between employees and non-employees(pE0.05). Fourth, the survey on respondents' occupational senses of dental hygienist showed that major tasks of dental hygienists were represented by oral disease prevention(92.6%), case management(71.5%), oral health education(66.3%), hospital/clinic management and dental management support(10.4%) and public oral health activities(6.7%) respectively. For job satisfaction, it was found that almost half respondents(48.9%) showed satisfaction at their job and 32.6% felt satisfied at and proud of their job. That is, majority of respondents(81.5%) felt satisfied at their job as dental hygienist. For follow-up requirements to qualify for dental hygienists, it was found that 73.3% felt it necessary to give more investments to self-development, 62.2% respondents considered protection of membership's rights as one of future assignments that KDHA should be more committed to. For future social awareness about dental hygienists as occupation, 69.2% respondents expected that they would be better developed and treated as professional. And desired training courses as a part of qualification for professional dental hygienists were represented by case management(services, manners, etc; 33.3%), implant(28.9%), esthetics(correction, prosthesis, whitening; 18.9%) and so on. For an item on working years, it was noted that 75.9% respondents would keep working as dental hygienists as long as they could.

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Physico-chemical Characteristics and In situ Fish Enclosure Bioassays on Wastewater Outflow in Abandoned Mine Watershed (폐광산 지역의 유출수에 대한 이.화학적 수질특성 및 Enclosure 어류 노출시험 평가)

  • An, Kwang-Guk;Bae, Dae-Yeul;Han, Jeong-Ho
    • Korean Journal of Ecology and Environment
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    • v.45 no.2
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    • pp.218-231
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    • 2012
  • The objectives of this study were to evaluate the physico-chemical water quality, trophic and tolerance guilds in the control ($C_o$) and impacted streams of the abandoned mine, along with the ecological health, using a multimetric health model and physical habitat conditions of Qualitative Habitat Evaluation Index (QHEI), during the period of three years, 2005~2007. Also, eco-toxicity ($EE_t$) enclosure tests were conducted to examine the toxic effects on the outflows from the mine wastewater, using the sentinel species of Rhynchocypris oxycephalus, and we compared the biological responses of the control ($C_o$) and treatment (T) to the effluents through a Necropybased Health Assessment Index ($N_b$-HAI). Tissue impact analysis of the spleen, kidney, gill, liver, eyes, and fins were conducted in the controlled enclosure experiments (10 individuals). According to the comparisons of the control ($C_o$) vs. the treatment (T) in physicochemical water quality, outflows from the abandoned mine resulted in low pH of 3.2, strong acid wastewater, high ionic concentrations, based on an electrical conductivity, and high total dissolved solid (TDS). Physical habitat assessments, based on Qualitative Habitat Evaluation Index (QHEI) did not show any statistical differences (p>0.05) in the sampling sites, whereas, the $M_m$-EH model values in a multimetric ecological health ($M_m$-EH) model of the Index of Biological Integrity (IBI), using fish assemblages, were 16~20 (fair condition) in the control and all zero (0, poor condition) in the impacted sites of mine wastewater. In addition, in enclosure eco-toxicity ($EE_t$) tests, the model values of $N_b$-HAI ranged between 0 and 3 in the controls during the three years, indicating an excellent~good condition (Ex~G), and were >100 (range: 100~137) in the impacted sites, which indicates a poor condition (P). Under the circumstances, organ tissues, such as the liver, kidney, and gills were largely impaired, so that efficient water quality managements are required in the outflow area of the abandoned mine watershed.

Current Status and Activation Plan of Hospice Palliative Care in Korea - Based on Hospice Palliative Care Facilities Survey (국내 호스피스.완화의료 현황 및 활성화 방안 - 호스피스.완화의료 기관 조사를 바탕으로)

  • Kyung, Min-Ho;Jang, Yu-Mi;Han, Kyung-Hee;Yun, Young-Ho
    • Journal of Hospice and Palliative Care
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    • v.13 no.3
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    • pp.143-152
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    • 2010
  • Purpose: This study aimed to evaluate the current status of hospice palliative care facilities in Korea. Based on the result, we attempted to suggest activation plans of hospice palliative in Korea. Methods: To conduct a survey, we obtained a list of hospice palliative care facilities from related agencies and academic societies. A survey was conducted from February, 2009 to March, 2009. The survey was consisted of general characteristics of organizations, manpower, facilities & equipments, and so on. In addition, we used data from Statistics Korea to estimate the number of beds required and the bed occupancy rate. Results: Total number of facilities responded to the questionnaire were 53. Forty-two facilities were general hospitals and 6 facilities were clinics among the total 53 facilities, and 18.8% of facilities were located in Seoul, Incheon and Gyeonggido. Overall bed occupancy rate was rather low as 21.9%, and there were 4 provinces where bed occupancy rates were 0%. Deaths in hospice palliative care facilities during 2008 were 6.3% of total deaths from cancers. As for the questions about the financial status of facilities, 86% of facilities were answered financial insufficiency. Also more than half of the facilities gave financial insufficiency as the reason for shortage of human resource supplies and inability to achieve the standard for authorization by the government. Facilities answered in order to activate the hospice palliative care, governmental support is needed, mostly in financial support (71.2%), donation tax deduction (43.1%), and setting up a public utility foundation (23.5%). Conclusion: This study showed low rates of hospice palliative care use and bed occupancy in Korea. Regional variance in bed occupancy rate was significantly high. As a roadblock for these problems, most of the facilities cited financial insufficiency. Therefore, there must be some action plans to boost financial support to activate hospice palliative care in Korea. Finally, efforts to improve these circumstances including lack of understanding about hospice and palliative care, are needed as well.

A study on improvement of misdiagnosis rate in aortic regurgitation disease by physically correcting EF in 2D echo cardiography (대동맥판 역류질환 진단시 이면성심초음파 박출계수의 보정을 통한 오진율 개선에 관한 연구)

  • Choi, Kwan-Woo;Son, Soon-Yong
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.13 no.5
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    • pp.2142-2147
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    • 2012
  • This study is aimed at decreasing wrong diagnosis with corrected EF(Ejection Fraction) of 2D echo cardiography by analysing the physical time-resolution difference between Cine MRI and 2D echo cardiography and applying the corrected EF in 2D echocardiography. From February 2010 to December 2011, among the 110 patients who had undergone both 2D echo cardiography and cine MRI only 37 patient were selected suffering aortic valve regurgitation. ED, ES and SV were measured and EF was calculated in each system while normal ranges of Cine MRI and 2D echocardiography were compared to evauate misdiagnosis rate. The correlation of physical time resolution between 2D echocardiography and MRI was evaluated and the differences were corrected with linear regression coefficient which is derived from linear regression analysis. Blandt-Altman plot was used to evaluate the reliability of corrected 2D echo cardiography EF and compare the error among measured values. The values were compared with MRI normal range and misdiagnosis rate was measured again. As a result, misdiagnosis rates of physical time resolution were measured to be 32.4%(12people) before the correction of EF and 18.9%(7people) after the correction. Also, EF confirmed in Blandt-Altman plot were almost the same with MRI EF. In conclusion, when diagnosing aortic regurgitation disease, simply using 2D echocardiography can easily raise the misdiagnosis rates, therefore considering the MRI machine's physical merits, correcting the time resolution difference is important by calculating time resolution wrong diagnosis would decrease and it is considered to be useful in clinical circumstances.

Blood Gas Management of a Membrane Oxygenator During Cardiac Surgery with Deep Hypothermic Circulatory Arrest (막형산화기에 의한 저체온 순환정지 심장수술시 혈액가스 조절)

  • Kim, W. G.;Lim, C.;Baek, Y. H.
    • Journal of Biomedical Engineering Research
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    • v.19 no.3
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    • pp.279-284
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    • 1998
  • Deep hypothermic circulatory arrest(DHCA), in which systemic temperatures of 2$0^{\circ}C$ or less are used to allow temporary cessation of the circulation, is an useful adjunct in cardiac surgery. Because man in natural circumstances is never exposed to the extreme hypothermic condition, however, one of the controversial aspects is appropriate blood gas management($\alpha$STAT versus PH-STAT) during DHCA. This study aims to compare $\alpha$STAT with PH-STAT management for control of blood gases in experimental cardiopulmonary bypass(CPB) circuits with a membrane oxygenator. Fourteen young pigs were assigned to one of two strategies of gas manipulation. After a median sternotomy, CPB was established. Core cooling was initiated and continued until nasopharyngeal temperature fell below 2$0^{\circ}C$. The flow rate was set at 2,500 ml/min. Once their temperatures were below 2$0^{\circ}C$, the animals were subjected to circulatory arrest for 40mins. During cooling, blood gas was maintained according to either $\alpha$$\alpha$STAT or pH-STAT strategies. After DHCA, the body was rewarmed to normal body temperature. Arterial blood gases were measured before the onset of CPB, before cooling, before DHCA, at the point of 27$^{\circ}C$ during re-warming, on completion of re-warming. Cooling time was significantly shorter in $\alpha$-STAT than PH-STAT strategy, while there was no significant differences in rewarming time between two groups. Carbon dioxide was added between 5.5 and 3.0% in PH-STAT, while no carbon dioxide was added in $\alpha$STAT management. Amounts of oxygen administration were gradually lowered as temperature decreased. In this way, criteria of PH, PaCO, and PaO adjustments were satisfied in both $\alpha$STAT and PH-STAT management groups.

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