• The Korean Society of Law and Medicine
• /
• v.23 no.2
• /
• pp.39-65
• /
• 2022

There are two aspects of clinical practice guidelines that act as non-legal control before medical practice and as legal control standards after medical practice. The essential purpose of clinical practice guidelines is the former, but the latter action cannot be excluded. The clinical practice guidelines are a means of linking law and medical care. The negative perception of clinical practice guidelines that medical professionals' autonomy can be violated by the enactment of clinical practice guidelines is an excessive negative evaluation of clinical practice guidelines. Rather, judicial judgment based on clinical practice guidelines plays a role in respecting the autonomy of medical professionals. In other words, the clinical practice guidelines suppress legal regulations on medical care as much as possible and are based on doctors' professional ethics and self-discipline, and patient awareness and cooperation. In order to establish an ideal relationship of cooperation between doctors and patients, 'medical ethics' must be incorporated as a legal means. Clinical practice guidelines are the most appropriate means for incorporating such medical ethics into legal procedures. The lawyer solves the case with a legal syllogism that establishes a norm and applies facts to it to conclude. For the resolution of medical disputes, Clinical practice guidelines are used to establish norms that doctors should perform for specific diseases, and conclusions are drawn by applying the established norms to specific medical practices. When it is not easy to apply the established norms to specific medical practices, medical judgments by experts, such as emotions, expert testimony, and explanations by expert members, are used. As such, the Law respects the autonomy of medical care even in the establishment of norms and the application of norms. In particular, Clinical practice guidelines prepared independently by the medical community are referred to in establishing norms, which are the prerequisites for legal syllogism. This shows that doctors participate in the formation of precedents and contribute to the formation of norms. The use of clinical practice guidelines in trials is respect and consideration for the autonomy of medical care. Although there may be an aspect in which the autonomy of individual doctors is limited by clinical practice guidelines, it should be considered that the autonomy of doctors as a group is respected. In this way, the clinical practice guidelines play a role in protecting the autonomy of the "medical" group from the logic of the "law."

• Clinical and Experimental Pediatrics
• /
• v.59 no.12
• /
• pp.466-470
• /
• 2016

Early, aggressive nutrition is an important contributing factor of long-term neurodevelopmental outcomes. To ensure optimal growth in premature infants, adequate protein intake and optimal protein/energy ratio should be emphasized rather than the overall energy intake. Minimal enteral nutrition should be initiated as soon as possible in the first days of life, and feeding advancement should be individualized according to the clinical course of the infant. During hospitalization, enteral nutrition with preterm formula and fortified human milk represent the best feeding practices for facilitating growth. After discharge, the enteral nutrition strategy should be individualized according to the infant's weight at discharge. Infants with suboptimal weight for their postconceptional age at discharge should receive supplementation with human milk fortifiers or nutrient-enriched feeding, and the enteral nutrition strategy should be reviewed and modified continuously to achieve the target growth parameters.

• Radiation Oncology Journal
• /
• v.37 no.2
• /
• pp.67-72
• /
• 2019

Concurrent chemoradiation therapy (CCRT) has played the most important and central role in the definitive therapy for the patients with locoregionally advanced stage nasopharynx cancer. The addition of induction chemotherapy (IC) or adjuvant chemotherapy (AC) to CCRT have been widely accepted with the rationale of improving distant control in the clinical practices. This review article investigated the role of IC and AC based on 11 recent meta-analysis publications, and found that the clinical benefits obtained by the additional IC or AC to CCRT, at the cost of the increased risks of more frequent and more severe side effects, seemed not big enough. More intervention is not always better, however, less seems frequently good enough. The author would speculate that 'less is more' and would advocate CCRT alone as the current standard.

• The Journal of the Acoustical Society of Korea
• /
• v.29 no.3E
• /
• pp.119-130
• /
• 2010

Extracorporeal shock wave therapy (ESWT) is simply evolved from extracorporeal shock wave lithotripsy known as a revolutionary non-invasive technique for treating kidney stone diseases. Since ESWT was approved for treating plantar fasciitis by FDA in 2000, it has been rapidly accepted into various clinical practices. Its indication includes chronic tendinitis and pseudoarthrosis, and has been widened to various applications other than orthopeadics. Little has been reported on their acoustic properties, yet, even if a number of clinical ESWT systems are readily available. This article reviews the acoustical aspects of ESWT and discusses critical issues towards acoustic exposure optimization and shock wave dosimetry.

• Parasites, Hosts and Diseases
• /
• v.44 no.1 s.137
• /
• pp.95-98
• /
• 2006

Scabies and pediculosis are ubiquitous, contagious, and debilitating parasitic dermatoses. The tendency of high prevalence of pediculosis and scabies among school and preschool age children has prompted us to conduct a head louse and scabies prevalence survey among preschool nursery children in our district. A school-based, crosssectional study was performed, with 1,134 children chosen for evaluation. All cases were evaluated by physical examination and a detailed, structured questionnaire. The infestation was found in 14 $(1.2\%)$ of 1,134 children; 9 $(0.8\%)$ with pediculosis capitis and 5 $(0.4\%)$ with scabies. We found that infestations were more frequent in children with mothers whose education levels were low. This indicates the necessity of an improvement in the economic and sociocultural status of the community and the promotion of hygiene concepts and practices in order to improve health of preschool age children.

• Korean Medical Education Review
• /
• v.20 no.1
• /
• pp.6-14
• /
• 2018

In recent years, Korean medical schools have shown a growing interest in the longitudinal integrated clerkship (LIC) as a means of improving clinical education. Some overseas medical schools have tried the LIC since the 1970s. In the 1990s, several universities in the United States, Canada, and Australia introduced LICs. A variety of studies have confirmed positive results of the LIC. Traditional block-rotation is a discipline-based, inpatient-centered practice. Instead, under the LIC system, a medical student responsible for a panel of longitudinal patients observes developments of their diseases, serving several departments simultaneously. Overseas medical schools have different LIC models depending on their affiliate hospitals' sizes and characteristics. The purpose of this study is to introduce LIC practices in Harvard Medical School and University of California San Francisco, which could be applied by Korean medical schools. This paper also aims to find out the strategies that have been able to help the two US medical schools implement the LIC successfully.

• The Journal of Korean Medical History
• /
• v.28 no.2
• /
• pp.105-120
• /
• 2015

Confucian doctors (儒醫) emerged who either voluntarily or involuntarily studied medical science and participated in clinical practices. This was made possible by a newly established position known as Euiseoseupdokgwan (醫書習讀官), made up of officials who had knowledgeable about medical books, during the reign of King Sejong. By the 16th century, Confucian doctors who acquired knowledge from medical books began to practice more broadly. Most of the Confucian doctors had either direct or indirect connections with the Sarim faction 士林派, and had interest in practicing medicine in provincial regions. In 1610, Donguibogam (東醫寶鑑) was published, providing the Confucian doctors with solid academic and clinical foundations. From the late 17th century onwards, the medical environment quickly became commercialized and the status of Confucian doctors gradually weakened.

• Clinical Endoscopy
• /
• v.56 no.6
• /
• pp.706-715
• /
• 2023

Postoperative gastrointestinal bleeding is a rare but serious complication that can lead to prolonged hospitalization and significant morbidity and mortality. It can be managed by reoperation, endoscopy, or radiological intervention. Although reoperation carries risks, particularly in critically ill postoperative patients, minimally invasive interventions, such as endoscopy or radiological intervention, confer advantages. Endoscopy allows localization of the bleeding focus and hemostatic management at the same time. Although there have been concerns regarding the potential risk of creating an anastomotic disruption or perforation during early postoperative endoscopy, endoscopic management has become more popular over time. However, there is currently no consensus on the best endoscopic management for postoperative gastrointestinal bleeding because most practices are based on retrospective case series. Furthermore, there is a wide range of individual complexities in anatomical and clinical settings after surgery. This review focused on the safety and effectiveness of endoscopic management in various surgical settings.

• Journal of Digestive Cancer Research
• /
• v.11 no.3
• /
• pp.130-140
• /
• 2023

Gastric cancer (GC) is one of the most common malignant tumors worldwide, with a 5-year survival rate of < 40%. The diagnosis and treatment decisions of GC rely on human experts' judgments on medical images; therefore, the accuracy can be hindered by image condition, objective criterion, limited experience, and interobserver discrepancy. In recent years, several applications of artificial intelligence (AI) have emerged in the GC field based on improvement of computational power and deep learning algorithms. AI can support various clinical practices in endoscopic examination, pathologic confirmation, radiologic staging, and prognosis prediction. This review has systematically summarized the current status of AI applications after a comprehensive literature search. Although the current approaches are challenged by data scarcity and poor interpretability, future directions of this field are likely to overcome the risk and enhance their accuracy and applicability in clinical practice.

• Journal of Korean Academy of Nursing Administration
• /
• v.8 no.1
• /
• pp.55-72
• /
• 2002

Purpose : This study aimed at understanding the lived experience of new graduate nurse in hospital setting.Method : This study was based on a phenomenological approach. For this study, 8 new graduate nurses participated. The unstructured in-depth interviews were carried out from June to October, 1998. The data was analyzed Van Kaam's method.Results : Clinical new graduate nurses experienced clinical adaptation and endeavor, professional conflict of nursing, disability of nursing performance, work stress and management, maladaptation of human relationships, diverse emotions of interpersonal relationships, change of personal identity, difference between theory and reality of nursing.Clinical adaptation and endeavor included to get familiar with hospital life, satisfaction and worth for nursing, to get familiar with scoldings, calm down by oneself, efforts for self-development. Professional conflicts of nursing included future uncertainties in the hospital, dissatisfactions in work, doubts and regrets in nursing.Disability of nursing performance included lack of knowledges and skills, desolate working, stresses from mistake in working. Work stress and management included psychological signs and symptoms, physical signs and symptoms, management of stress. Maladaptation of human relationships included unsuitabilities in nursing unit climate, difficulties in human relationship. Diverse emotions of interpersonal relationships included regrets and absurdities to clients, thanks and regrets to colleagues, difficulties with doctors, sense of rivalry with colleague nurses. Change of personal identity included to become narrowing life circle, change of personality. The differences between theoretical knowledge and practice included needs of systematic pre-education for clinical nursing practice, differences between nursing educations and clinical practices.Conclusion : Therefore, the human resource management reflecting new graduate nurses' experiences should be developed.