• Journal of Korean Academy of Nursing
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• v.26 no.3
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• pp.576-590
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• 1996

Advanced countries such as the USA and Japan are eagerly seeking ways to improve health and welfare of the elderly. One of the services is home health care service using the telephone. Various types of services using the telephone have been developed, improved and are being utilized ranging from the basic consulting to emergency response systems in the area of health care for the elderly. A demonstration project was launched to study the feasibility of a consulting system and telemedicine for the elderly using the public phone system in Korea. For this project, a gathering site for the elderly was selected and those who visited this place were interviewed to find out what kinds of services they wanted and what kind of system they needed to provide the required services. Based on the users' requests and the surrounding environment, a telephone consulting facility was established at the Research Institute of Nursing Science at Seoul National University and consulting personnel was recruited, trained and posted at the center. An Application program for home health care nurses to use when they visited the patients at their homes was developed. This system operates on a notebook Computer and allows nurses to communicate with a doctor at a local hospital through a modem and telecommunication line. These systems were implemented for three months and problems which developed during operation of the systems were identified and progressively modified. Through system evaluation, it was found that a consulting system using phone service will be an invaluable system for the welfare of the elderly in the future. But in order to meet the elderly's need, more services than mere consultation are needed. That is, communication with physicians and hospitals are needed. Thus, when there is any need for physicians' attention, physicians or hospitals should be contacted directly. Similarly for telemedicine, when the home health care nurse visits elderly patients she can assess the patient's problem and provide nursing care, access a physician or hospital to refer her patient to or consult directly using the telecommunication the system. The above mentioned system is a basic form of futuristic telemedicine for the elderly and those who have chronic disease problems. This kind of system will be of great value when it is used on the national information super-highways in the future. In order to get to that stage, of course, this project needs great improvement in the technical, academic, and legal aspects.

• Journal of agricultural medicine and community health
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• v.17 no.1
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• pp.5-16
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• 1992

The maternal and child health is a basis of national health, and indicates the level of social welfare and health of the country, because it is related with community welfare status, general cultural conditions, and medical and health sciences. This is a study carried out to identify the present practices of maternal and child health care programs implemented by the private clinics located in Guns(counties ; rural area) in Kyungsangnam Province and to propose alternatives to improve their current programs through a self-administrative questionnaire. The subjects were 90 private physicians who operated their own clinics since 1990 and were general practitioners, Obstertrician/Gynecologists or pediatricians: This survey was conducted by mail from 15 January to 25 February 1992. The response rate was 94.4 percent. 1) The major manpower for MCH programs of the studied clinics was physicians and nurseaids. 70.3% of physicians were general practitioners, 81.1% of nursing manpower were nurseaids. 31.1% of the studied clinics employed lab-technicians. 89.2% of them had MCH room whatever the size and the setting, and 84.4% of Ob/Gyn clinics installed laboratory equipments. 2) 55.4% and 63.5% of the studied clinics provided 151 or above consulting services and curative services of MCH per physician a month respectively and 33.8% and 25.7% of them provided 10 or less consulting services and curative services per physician a month. 91.9% of lab-technicians had 10 or less laboratory tests per technician a month. 3) There was a difference between Ob/Gyn and pediatric clinics in terms of services delivered : for example, 80% of Ob/Gyn clinics provided pre- and post- natal care services, while 84.6% of pediatric clinics provided vaccinations for children. It was also found that only a few of general practitioners involved pre-and post- natal care services. 4) There were no clinics which had opened regular health education session but 24.3% of them had opened the sessions irregularly. Ob/Gyn clinics put emphasis on maternity and pediatric clinics did on child health, but general practitioners touched with both maternal and child health. 21.6% of the studied clinics had some kind of educational materials for MCH programs. Most of the materials were pamphlets or small booklets. 5) Proteinuria/glucosuria, blood pressure and blood type were tested in 48.6~69% of the studied clinics ; tests for blood sugar and hepatitis B were provided in 39.2~41.9% of them, most of them were done in Ob/Gyn clinics. 6) 41.9% of physicians, 29.7% of nurses and 45.9% of nurses-aids wanted to receive on-job-training for MCH programs.

• Journal of Society of Preventive Korean Medicine
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• v.14 no.1
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• pp.13-24
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• 2010

Objectives : This study aimed to investigate the current job-related characteristics coordinators in East-West Collaborative Medical Practices(EWCMP) and to develop activation plans for them. Method : The participants were 51 personnel who were supporting EWCMP in the 28 institutions. Data were collected with self-administered questionnaires and analyzed with descriptive statistics. Results : The major role of the participants was educating and consulting patients(74.5%) and followed by supporting collaborating physician(70.6%). They assumed to be helpful to make the patients easy to use EWCMP(98%) and to give patients full information what they asked(96%). However, participants responded lack of adequate educational programs and role ambiguity as chief complaints(91.7%). They showed relatively high level of job importance(78.7points on 100points) and job satisfaction(72.8points on 100points). Coordinators were expected to have bachelor and more than 8 years clinical career, and communication skill. Conclusions : Coordinators have played key roles in giving information for the patients and coordinating EWCMP. However their roles and job description was not clear, and educational programs was insufficient as required. Therefore, it is needed to clarify their roles and job description and establish professional educational programs for supporting coordinators.

• The Korean Society of Law and Medicine
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• v.10 no.2
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• pp.309-341
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• 2009

According to a case of Supreme Court's Sentence No. 2009DA17417 (May 21, 2009), the Supreme Court judges that 'the right to life is the ultimate one of basic human rights stipulated in the Constitution, so it is required to very limitedly and conservatively determine whether to discontinue any medical practice on which patient's life depends directly.' In addition, the Supreme Court admits that 'only if a patient who comes to a fatal phase before death due to attack of any irreversible disease may execute his or her right of self-determination based on human respect and values and human right to pursue happiness, it is permissible to discontinue life-sustaining treatment for him or her, unless there is any special circumstance.' Furthermore, the Supreme Court finds that 'if a patient who is attacked by any irreversible disease informs medical personnel of his or her intention to agree on the refusal or discontinuance of life-sustaining treatment in advance of his or her potential irreversible loss of consciousness, it is justifiable that he or she already executes the right of self-determination according to prior medical instructions, unless there is any special circumstance where it is reasonably concluded that his or her physician is changed after prior medical instructions for him or her.' The Supreme Court also finds that 'if a patient remains at irreversible loss of consciousness without any prior medical instruction, he or she cannot express his or her intentions at all, so it is rational and complying with social norms to admit possibility of estimating his or her own intentions on withdrawal of life-sustaining treatment, provided that such a withdrawal of life-sustaining treatment meets his or her interests in view of his or her usual sense of values or beliefs and it is reasonably concluded that he or she could likely choose to discontinue life-sustaining treatment, even if he or she were given any chance to execute his or her right of self-determination.' This judgment is very significant in a sense that it suggests the reasonable orientation of solutions for issues posed concerning withdrawal of meaningless life-sustaining medical efforts. The issues concerning removal of medical instruments for meaningless life-sustaining treatment and discontinuance of such treatment in regard to medical treatment for terminal cases don't seem to be so much big deal when a patient has clear consciousness enough to express his or her intentions, but it counts that there is any issue regarding a patient who comes to irreversible loss of consciousness and cannot express his or her intentions. Therefore, it is required to develop an institutional instrument that allows relevant authority to estimate the scope of physician's medical duties for terminal patients as well as a patient's intentions to withdraw any meaningless treatment during his or her terminal phase involving loss of consciousness. However, Korean judicial authority has yet to clarify detailed cases where it is permissible to discontinue any life-sustaining treatment for a patient in accordance with his or her right of self-determination. In this context, it is inevitable and challenging to make better legislation to improve relevant systems concerning withdrawal of life-sustaining treatment. The State must assure the human basic rights for its citizens and needs to prepare a system to assure such basic rights through legislative efforts. In this sense, simply entrusting physician, patient or his or her family with any critical issue like the withdrawal of meaningless life-sustaining treatment, even without any reasonable standard established for such entrustment, means the neglect of official duties by the State. Nevertheless, this issue is not a matter that can be resolved simply by legislative efforts. In order for our society to accept judicial system for withdrawal of life-sustaining treatment, it is important to form a social consensus about this issue and also make proactive discussions on it from a variety of standpoints.

• Quality Improvement in Health Care
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• v.9 no.1
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• pp.52-64
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• 2002

Background : Coding of principal diagnosis is essential component for producing reliable health statistics. We performed this study to evaluate the current practice of principal diagnoses determination and coding, and to give some basic data to improve coding of principal diagnosis. Method : Nineteen medical record administrators (MRAs) of 3 university hospitals participated in coding principal Dx. from August 1, 2001 to August 31, 2001. From each hospital, 10 medical records of patients with high frequency disease were selected randomly. Each 10 medical records were grouped into three (A. B, C). Then, these 30 medical records were given to each MRAs for coding. At the same time questionnaire was given to each of them. Questions were to prove how they decide and code the principal diagnosis among many current diagnoses; how they decide and code the principal diagnosis when they see irrelevant diagnosis recorded as the principal diagnosis in medical record, when only tentative diagnoses were recorded without final diagnosis, and when different diagnoses were recorded in different sheets of same record. Agreement of coding among 3 hospitals were compared and survey results were analysed with SAS 6.12. Results : Agreement of coding was found in medical records 5-6 of each 10 medical records. Causes of disagreement were as follows. Difference of clinician's opinion from each hospital; mixed use of guideline from KCD-3 and guideline from DRG; difference in 4th digit classification according to the absence of pathology report in the medical record; difference of abbreviations among hospitals. 57.9% of MRAs selected the principal diagnosis recorded by physician, 42.1% of MRAs decided principal diagnosis after consulting to KCD-3 guideline. When there were difficulties in determining the principal diagnosis, 42.1% of MRAs decided principal diagnosis after discussion with the physician, 26.3% after discussion with fellow MRAs. Conclusion : There were differences in codings among hospitals. To minimize the difference, we suggest the development of disease-specific guidelines for coding in addition to the current general guideline such as KCD-3. To do this, Coding Clinic which can produce guidelines is needed.

• Journal of Preventive Medicine and Public Health
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• v.32 no.4
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• pp.546-555
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• 1999

Objectives : To determine the prevalence, pattern. and out-of-pocket expenditure of complementary and alternative medicine (CAM) utilization in Korean adult population. Methods : We conducted a representative telephone survey of 2,042 persons aged 18 or older. Data about any health problem, details of their use of medical doctors(MDs) offices/hospitals/pharmacies services and CAM during the preceding 12 months were collected with structured questionnaire. Results : The utilization rate of CAM among Korean adults was 29% in one year. A total of 231 kinds of CAM was identified from this survey. Annual out-of-pocket expenditure associated with CAM use in 1998 amounted to ${\xi}{\S}1.88$ billion and was comparable to 40.8% of out-of-pocket expenditure paid for MDs offices/hospitals/pharmacies services. Among those(N=424) who paid for both MDs offices/hospitals/pharmacies services an d CAM, 35.8% paid more for CAM. CAM gave more satisfaction than western medicine to those who had experience of both types of therapy. About half of CAM users were willing to recommend CAM to others. Disclosure rate to physician among CAM users was not high(40.6%). Conclusion : CAM became a popular source of health care in Korea, Korean spent a substantial amount of out-of-pocket money on CAM without any public control. Because CAM use is likely to be increased rapidly through lay referral system, health policy makers and health professionals should pay more attention to CAM for making appropriate utilization of CAM.

• Tuberculosis and Respiratory Diseases
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• v.76 no.6
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• pp.276-283
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• 2014

Background: We aimed to investigate the role of the physician in practice and the factors that influence the success rate of smoking cessation. Methods: This study retrospectively analyzed 126 adult smokers who had visited the outpatient department of pulmonology, and received motivational interviewing with or without supplement drugs. The findings include continuous smoking abstinence rate, which was evaluated at 6, 12 and 24 weeks, and the factors associated with continuous abstinence for 6 months or longer. Results: The patients with only motivational interviewing accounted for 57.9%, while the nicotine patch therapy was applied to 30.2%; and varenicline was prescribed to 11.9%. The smoking cessation success rates of at 6, 12, and 24 weeks were 55.6%, 47.6%, and 33.3%, respectively. However, even in the failure group at six months, tobacco consumption was decreased under 10 cigarettes per day in 42.1% (53/126). In multivariate logistic regression analysis, degree of Fagerst$\ddot{o}$m Test for Nicotine Dependence (p=0.034; odds ratio, 3.607; 95% confidence interval [CI], 1.102-1.807), the absence of smoking-related lung disease (p=0.008; odds ratio, 4.693; 95% CI, 1.497-14.707), and education level (p=0.001; odds ratio, 181.420; 95% CI, 8.414-3,911.502) were the predictors of successful smoking cessation. Conclusion: An improved continuous smoking abstinence rate can be obtained by motivational interviewing, regardless of the association with pharmacotherapy.

• Korean Journal of Health Education and Promotion
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• v.13 no.1
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• pp.1-27
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• 1996

Recently diseases related to personal health habit and lifestyle have become common in modern industrial society. These kinds of diseases can be prevented simply by changing one's lifestyle to be more healthy. As a result of realization our interest in general health has become stronger. The most basic environment for human-being in society is the home. Humans secure their livelihood, physically. mentally, and socially at home. Therefore health care at home is very important. In modern society the responsibility for this task is traditionally given to housewives. The purpose of this study was to measure the degree of the health knowledge, health concern, health behavior and family health care of the married women and to analyze its related factors. The subjects for this study. 1,100 married women who studied at social education institutes and who had children attending an elementary school or a kindergarten, were surveyed with questionnaires. The preliminary survey was carried out from Aug. 7, to Aug. 19, 1995. With complement of questions, the main survey was carried out from Sep. 11, to Sep. 30, 1995. The data was analysed by using the SAS program. The results were as follows. 1. General Characteristics (1) In the individual characteristics of the respondents, the married women aged 30-39 were 54.8%, the average age was 39.8 years old. 33.8% of respondents had 6-10 years of marriage period, and the average marriage period was 14.9 years. Most of them(96.5%) lived with their husband. Those who graduated from college and graduate school were 53.4%. And 68.3% of respondents had no job. (2) In the family characteristics, 69.3% of the married women had 3 or 4 family members and the average family size was 4.1 person. 60.0% of the respondents had 2 children. Most of the respondents(90.9%) had no married children. 84.8% of the respondents lived with their parents. Those who reported that the total family income was more than 2,500,000 won a month were 32.3%. When making the decisions, 68.5% of the married women discussed the family matter with their husband. (3) In the individual characteristics of the respondents, 51.5% answered they were in good health. 61.7% of the married women answered they obtained the health knowledge through mass media. 24.3% of the women answered they had patients in their family in these days. 67.5% of the respondents answered they could generally control their health by themselves. 2. The Health Knowledge, Concern and Behavior. (1) For the health knowledge, the average score was 11.8. The lowest percent of correct answer(27.8%) was in the item about the skin tests for tuberculosis. And the highest percent(97.%) was in the item about taking a rest. (2) For the health concern, the married women had the highest concern about washing hands. But they were indifferent to smoking. (3) For the health behavior, the highest score was in "changing socks and underwear everyday", and the lowest one was in "taking a regular dental examination". 3. The Family Health Care (1) For the family health care, the item of "using a drug with the order of doctor or pharmacist" had the highest grade(4.78), and "consulting with the family physician about the health problem" had the lowest grade(2.03). (2) Older women and the women with a longer period of marriage had the highest level of the family health care(p<0.001). The married women who had 3 children had the highest level of the family health care(p<0.001). Those who had 5 or 6 family member and higher income had the highest level had the high level of the family health care(p<0.01). Women in good health and those who had the health knowledge from health experts had a high level of the family health care. (3) For the correlation of the family health care and other variables, the health behavior showed the highest correlation with family heath care practice(r=0.74) and the second was health concern(r=0.43). The variables which could explain the family health care were health behavior, the health concern and married women's health status(r²=55.87). The most closely associated with family health care was health behavior(r²=54.93)