• Title/Summary/Keyword: End-Of-Life Care

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Demographic and Survivorship Disparities in Non-muscle-invasive Bladder Cancer in the United States

  • Seo, Munseok;Langabeer, James R. II
    • Journal of Preventive Medicine and Public Health
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    • v.51 no.5
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    • pp.242-247
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    • 2018
  • Objectives: To examine survivorship disparities in demographic factors and risk status for non-muscle-invasive bladder cancer (NMIBC), which accounts for more than 75% of all urinary bladder cancers, but is highly curable with early identification and treatment. Methods: We used the US National Cancer Institute's Surveillance, Epidemiology, and End Results registries over a 19-year period (1988-2006) to examine survivorship disparities in age, sex, race/ethnicity, and marital status of patients and risk status classified by histologic grade, stage, size of tumor, and number of multiple primary tumors among NMIBC patients (n=29 326). We applied Kaplan-Meier (K-M) and Cox proportional hazard methods for survival analysis. Results: Among all urinary bladder cancer patients, the majority of NMIBCs were in male (74.1%), non-Latino white (86.7%), married (67.8%), and low-risk (37.6%) to intermediate-risk (44.8%) patients. The mean age was 68 years. Survivorship (in median life years) was highest for non-Latino white (5.4 years), married (5.4 years), and low-risk (5.7 years) patients (K-M analysis, p<0.001). We found significantly lower survivorship for elderly, male (female hazard ratio [HR], 0.96), Latino (HR, 1.20), and unmarried (married HR, 0.93) patients. Conclusions: Survivorship disparities were ubiquitous across age, sex, race/ethnicity, and marital status groups. Non-white, unmarried, and elderly patients had significantly shorter survivorship. The implications of these findings include the need for a heightened focus on health policy and more organized efforts to improve access to care in order to increase the chances of survival for all patients.

The Experience of Teachers' Self-supervision at After-school Nurseries (방과후 어린이집교사의 자기장학 체험 이야기)

  • Kim, Jin Seon
    • Korean Journal of Childcare and Education
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    • v.9 no.4
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    • pp.235-257
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    • 2013
  • This study intended to deeply understand teachers' experiences about their self-supervision at after-school nurseries through many different stories. This study composed field texts based on the data collected through face-to-face talks with participants, their journals, and e-mails and phone conversations given and taken with participants for a total of 4 months from September to the end of December, 2012. The teachers all had ten years teaching experience, and worked as after-school nursery teachers in S-gu, S-si. The study found many things such as experiencing the joy of learning things that were unknown through self-supervision, hardship involved in self-supervision, co-workers dedicated to joint learning, and time and spaced used to better understand children. The study figured out that the meaning of self-supervision lay in the pursuit of learning and bright eyes(seeing what was not seen before), despite the difficult condition to self-supervise, the after-school nursery teachers unceasing passion for self-supervision brings happiness within oneself. As a result, this study discussed the implications which the experience of after-school nursery teachers who found a happy meaning of life through self-supervision in spite of the actual difficult conditions offered to after-school nursery teachers.

Evaluation of ATM usability test for improving financial life of Impaired elderly (인지저하 노인들의 금융생활 라이프 향상을 위한 ATM 사용성 평가)

  • Choi, Yoo-jung;Choi, Hun
    • Journal of the Korea Institute of Information and Communication Engineering
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    • v.24 no.1
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    • pp.77-82
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    • 2020
  • As Korea enters an aging age, social efforts to improve the IADL of the elderly are increasing. In this study, to improve the performance of financial management activities that the elderly is particularly burdened, we aim to learn the elderly through ATM simulation education contents so that they can use ATM smoothly. To this end, interviews were conducted with seniors to derive four major financial activities (deposits, withdrawals, deposit inquiries and bank account arrangements), and developed tablet PC-based ATM education contents identical to the existing bank ATM interfaces. The experiment was conducted on 20 elderly people in the Elderly Day Care Center, and their satisfaction, fatigue and performance were measured before and after education. The results of this study can provide ATM design guidelines for the elderly who have difficulty using ATM.

A Comparative Study of the Theories of Life Posited by Confucianism and Daesoon Thought (유학과 대순사상의 생명론 비교 고찰)

  • An Yoo-kyoung
    • Journal of the Daesoon Academy of Sciences
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    • v.42
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    • pp.75-108
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    • 2022
  • This paper aims to newly investigate the meaning of life in this era when various discussions on life and ethical living are commonly raised by comparing and examining the theories of life proposed by Confucianism and Daesoon Thought. Both Confucianism and Daesoon Thought explain the creation of all things as having been based on the principles of life in heaven and earth. Specifically, there is the will to live (生意 saengeui) and also divine beings (神明 sinmyeong). For this reason, everything in heaven and earth is created by obtaining the same principle of life such that it is an equal being with the same intrinsic value. Here the consciousness of being one body amid all things as one living thing is established. The consciousness of being one body forms an organic worldview in which all things are one. As a result, all things in heaven and earth exist within a mutual organic relationship, and that makes oneself and others precious life partners that coexist rather than separate beings. Nevertheless, both Confucianism and Daesoon Thought define humans as outstanding beings, set aside for a higher purpose than other beings. The excellence of humans is that by constantly engaging in self reflection and completing tasks through independent efforts, they thereby achieve the great moral doctrine of coexistence and symbiosis. In this process, cultivation of character (修養 suyang) and cultivation of the Dao (修道 sudo) are presented as means to realize one's nature and establish the right human image. By realizing nature or humanity through the cultivation of character and cultivation of the Dao, humans fulfill their responsibilities and missions by independently participating in being nourished by Heaven and Earth (天地化育 cheonjihwayuk) or the Reordering Works of Heaven and Earth (天地公事 cheonjigongsa), both being based in the concept of the three generative forces of Heaven, Earth, and Humanity (天·地·人 cheon·ji·in). In the end, the theories of life posited by Confucianism and Daesoon Thought are based on a consciousness of being one body. Both emphasize the characteristics and roles of humans who are distinguished from other beings and phenomena. At this time, human characteristics and roles are revealed as the reasons for which humans have a responsibility and mission take care of all things. From this point of view, it can be seen that the theoretical structure of Neo-Confucianism and Daesoon Thought, in regards to their theories of life, is rather similar.

Nurses' Understanding and Attitude on DNR (DNR에 대한 간호사의 인식 및 태도조사)

  • Han, Sung-Suk;Chung, Soon-Ah;Moon, Mi-Seon;Han, Mi-Hyun;Ko, Gyu-Hee
    • Journal of Korean Academy of Nursing Administration
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    • v.7 no.3
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    • pp.403-414
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    • 2001
  • The study was intended to identify the nurses' experiences, understanding, and attitudes on DNR. Also, the study was to provide the data base for a standard of DNR decision-making and practice. The sample consisted of 347 nurses in eight general hospitals. The data were collected between August 1 and August 31, 2000. The data were analyzed using descriptive statistics and $x^2-test$. The results of the study were as follows : 1. Regarding DNR-related experience, 74.6 percent of the participants experienced DNR situations. Eleven percent of the participants received DNR education. DNR was most frequently (81.5%) requested by family members and relatives of patients. The decision-making on DNR was most frequently (76.8%) made by agreement between family members and medical staff. The DNR order was recorded at 81.9 percent on charts. Problems after DNR order were negligence in treatment and nursing care (30.6%) and guilty feelings due to doing the best (22.1%). CPR (cardiopulmonary resuscitation) was performed about 49.8 percent of DNR cases. 2. Regarding understanding and attitude on DNR, most of the participants (93.1%) thought DNR was necessary. The major reasons for the necessity of DNR were impossible recovery (44.4%) and death with dignity (41.1%). The decision-making on DNR was most frequently made by patient and family members (47.8%) and followed by agreement between family members and medical staff (25.6%), and patients themselves (16.4%). Most of the participants thought that medical staff must explain DNR to critical and end-of-life patients and their family members. Forty four percent of the participants thought that the most appropriate time for DNR explanation was when patients with critical disease were admitted to hospitals. Most of the participants (90.2%) thought a guide book for DNR is necessary to be made in hospitals. 3. There were significant differences in the participants' understanding and attitudes on DNR according to religion career education and experience of DNR. Of the participants those who have religions and education experience on DNR thought that there would be more DNR requests after DNR is explained to patients and family members (p<.05). In addition, there was higher understanding on the necessity of DNR in those who have more career and DNR experience(p<.01). The findings of the study suggest that a guide book for DNR need to be made with inclusion of legal, ethical, and cultural aspects. Also, there needs to be more education on DNR in medical ethics to health care professional and to provide more information on DNR to the general public.

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Evaluation of a Community-Based Cancer Patient Management Program: Collaboration between a Hospice Center and Public Health Centers (병원 호스피스센터-보건소 연계를 통한 지역사회 재가암환자 관리 프로그램 평가)

  • Lee, Hae-Sook;Park, Sun-Hee;Chung, Young-Soon;Lee, Boo-Kyung;Kwon, So-Hi
    • Journal of Hospice and Palliative Care
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    • v.13 no.4
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    • pp.216-224
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    • 2010
  • Purpose: The purpose of this study was to evaluate a community-based cancer patient management program (CBPCMP) which was collaborated between a hospice center and public health centers. Methods: The CBPCMP proceeded on four steps; 1) Signing agreements with three public health centers, 2) Enrolling the domiciliary terminal cancer patients, 3) Providing home hospice service, and 4) Inquiring patient's level of satisfaction. From February 1 to December 31 in 2009, 43 terminal cancer patients were referred and provided with home hospice service. The hospice team made a total of 605 visits. Medical records for each visit and data from satisfaction surveys were analyzed. Results: 76.7% of patients were older than 60 years, and 90.7% of the patients were alert. The level of functional status for 76.7% of patients rated as lower than ECOG grade 1. 62.8% of the patients or their caregivers signed hospice service agreements. On the initial evaluation, the most frequent reasons for referral were general weakness (86.0%), followed by anorexia (72.1%). Nurses visited the patients' most frequently (371 visits), followed by volunteers (216 visits). Nurses provided emotional support and health promotion counseling on 95.1% and 22.9% of visits, respectively. The mean satisfaction score rated by patients and their family was 4.45 out of 5. Conclusion: This study tested CBPCMP in collaboration with hospice centers and public health centers. CBPCMP showed a possibility to improve the quality of end of life care. To insure the quality care, however, the guidelines for home hospice service should be developed.

A preliminary study for the evaluation of the effects of sex education program on college students (대학생의 성교육 효과측정을 위한 기초 연구)

  • Chang, Soon-Bok;Choi, Yun-Soon;Kang, Hee-Sun;Park, So-Mi
    • The Korean Nurse
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    • v.36 no.2
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    • pp.49-63
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    • 1997
  • This study was performed to provide preliminary data for the development of a useful instrument to measure the effect of sex education. The study was conducted with the voluntary participation of 155 college students enrolled in the course "Sexuality and Relationship" at Y university in Seoul. At the end of that course, they were asked to write freely about the change they had experienced on sexuality. All meaningful statements were elicited and classified into 7 categories; "Change of Knowledge", "Enlightenment", "Change of Attitude on Sexuality", "Buildup of Ability", "Buildup of. Identity", "Change of Emotion", "Change of Behavior:' There were significant changes in the areas of knowledge(28. 6%), enlightenment(27.4%), and attitudes(20.3%) about sexuality among these 7 categories. The Change of Knowledge category consists of 3 areas: "concretion of knowledge", "increase of information", and "correction of misunderstanding." In the category of Enlightenment, total 12 areas are included: "sex role", "erception of lack of knowledge", "importance of family", "life plan", "parent role", "value of life", "equality", "sexual autonomy", "importance of sexuality", "freedom of sexuality", "perception of sexual problem", and "meaning of love." The Attitude Change category consists of 8 areas. These are "being natural", "being progressive", "being sensitive", "being truthful", "being expressive", "being cautious", "being responsible", and "being confident". The category of Buildup of Ability includes 4 areas: "problem solving", "sex education", "relationship", and "communication". The category of Buildup of Identity includes "sexual identity", and "value of sexuality". The Emotional Change category includes 3 areas: "positive feeling", "negative feeling", and "breaking from negative feeling on sexuality". The Behavior Change category includes "sex-related behavioral change". In conclusion, up to now most researches on sex education effect measures only changes of knowledge, attitude, and behavior. But we believe the changes in "Enlightenment", "Buildup of Ability", "Buildup of Identity", "Change of Emotion", should be included in addition to knowledge, attitude, and behavior in the development of an instrument to measure the sex education effects. And the effect of sex education should measure the degree of learning of autonomy, enlightenment, and ability of behavior and so on rather than studying the simple changes in sexuality.enment", "Buildup of Ability", "Buildup of Identity", "Change of Emotion", should be included in addition to knowledge, attitude, and behavior in the development of an instrument to measure the sex education effects. And the effect of sex education should measure the degree of learning of autonomy, enlightenment, and ability of behavior and so on rather than studying the simple changes in sexuality.ng the simple changes in sexuality.

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A Convergence Study on the Differences in Medical Practices and Medical cost according to Auto Insurance Companies (자동차보험사별 진료특성과 진료비 차이에 관한 융합 연구)

  • Lee, Soo-ja;Lee, Chong Hyung;Park, Arma;Kim, Kwang-Hwan
    • Journal of the Korea Convergence Society
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    • v.8 no.5
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    • pp.61-68
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    • 2017
  • This study investigates the differences in medical practices and medical cost according to auto insurance companies based on 8,589,602 cases that were treated by auto insurance corporation for the year of 2015, from the beginning of January to the end of December. The results of this study can be summarized following. First, in terms of the general characteristic in medical treatment, especially the age, the highest figure in both non-life insurance and mutual aid cooperative was shown in the age of 50 to 59 at 22.8 per cent(p<0.001). Second, in terms of a medical cost per a hospital care, classified by clinic, the costs in the department of internal medicine were much higher than those in the surgical department, and the thoracic surgery among parts of the surgical department showed the highest figures in both non-life insurance and mutual aid cooperative. According to the above summarized results of this study, it can be concluded that Health Insurance Review and Assessment Service has to address the problem on the increase of unnecessary costs and the occurrence of social expenses caused by the delay of patients' rehabilitation and return to their daily lives, by carrying out the evaluation for the appropriateness to organizations that ask for payments of auto insurance.

Mouse Single Oral Dose Toxicity Test of Lactobacillus-fermented Araliae Continentalis Radix Aqueous Extracts (fACR) (독활의 복합 유산균 발효 추출액의 마우스에 대한 단회경구투여 독성시험)

  • Jung, Young-Mi;Ku, Sae-Kwang;Lee, Dong Sub;Kwon, Kisang
    • Journal of Life Science
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    • v.26 no.2
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    • pp.204-211
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    • 2016
  • The objective of this study was to obtain acute (single) oral dose toxicity information on Lactobacillus-fermented Araliae Continentalis Radix aqueous extracts (fACR) in female and male ICR mice, as compared with Araliae Continentalis Radix aqueous extracts (ACR). After administering a single oral dose of fACR, no treatment-related mortalities were observed within 14 days after the end of treatment up to 2,000 mg/kg, the maximum dosage for rodents of both sexes; moreover, no fACR treatment-related changes in the body and organ weights, clinical signs, necropsy, and histopathological findings were detected in this experiment. In addition, no ACR 2,000 mg/kg treatment-related mortalities, clinical signs, body and organ weights, or gross and histopathological findings were observed, as compared with equal genders of vehicle control. The results obtained in this study suggest that fACR is non-toxic in mice and is, therefore, likely to be safe for clinical use. The LD50 and approximate LD in female mice and male mice, respectively, were considered after a single oral dose of fACR over 2,000 mg/kg, the maximum dosage for rodents. In addition, no specific targets or clinical signs were detected in the present study. ACR 2,000 mg/kg-treated mice also did not show any treatment-related mortalities, clinical signs, changes to body and organ weights, or gross and histopathological findings, as compared with equal genders of vehicle control.

A Ethnographic Field Study for a Model Development of the Chronic Bed-ridden Patient s Home-ward (만성 재가 기동장애자의 가정병실 모델 개발을 위한 현장 연구)

  • 김태연;정연강
    • Journal of Korean Academy of Nursing
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    • v.24 no.4
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    • pp.597-615
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    • 1994
  • This study is designed to facilitate the creation of home environment conducive to the family taking care of chronic bed-ridden patients with more effective method. The need for this study has emerged against the background of marked changes in the structure of ailments and causes of death, resulting in the number and plights of chronic bed-ridden patients as well as of a rapid increase in demand for medical care and resulting premature discharge. Keeping these in mind, this study focused on home-wards where the majority of chronic bed-ridden patients are being cared for. Despite. their overriding importance, home-words are less than efficient in caring (or chronic bed-ridden patients. These circumstances require the designing of home-wards that can offer greater comfort to patients and at the same time make things easier for caregivers, on the basis of an overall analysis of patients' life and home - ward situation. According1y this study adopted a Participant Observation Method derived cultural anthropology, Toward this end, 3 patients were chosen as subjects of this study for intensive interviewing and participant observation. In the process of this field re-search efforts were made to collect emprical data, that is, to faithfully record the words of the subjects and their caregivers for analysis and interpretation. The findings of these analyses are as follows. Firstly, the chronic bed-ridden patients are mostly being taken care by close family members. Secondly, a room for the exclusive use of the patient, floor, kitchen, bathroom and multipurpose space were found to be necessary for proper caring of the patient. These spaces were respectively used with a view to 1) accomodating the patient as well as caregivers' activities, 2) keeping general and medical supplies and other appliances for patient's care and drying the patient's washing, 3) preparing and keeping the patient's foods and beverages, 4) keeping the supplies necessary for cleaning the patient's body and treating the patient's eliminations, 5) washing the patient's clothes, underwears and bedclothes. The patient's room in turn is subdivided into six portions in terms of uses : specifically the places for accomodating 1) the patient, 2) medical supplies, 3) medicines, 4) linens St clothes, 5) bedclothes and, 6) diapers. Thirdly, the activities of the caregiver are subdivided into seven key areas : hygiene, exercise, diet, elimination, therapeutic nursing, prevention of sore, and other activities. Each area is further classified into several different activities of caring. These activities we mainly carried out in the patient's room. Fourthly, the supplies for caring the chronic bed-ridden patient is divided into two large domains : medical and general supplies. Finally, three main problems areas were found in this study on the part of caregivers, that is, sore prevention, hygiene problem related frequent urination / defecation, the caregiver's physical, psych ological and emotional burden. In consideration of the aforesaid problem areas, a model home-ward was developed in this study. The newly-developed model has been found to have the following six advantages. Firstly, the time and effort required for maintaining the patient's hygiene are reduced, thus relievins the caregiver's physical and psychological bur-den. Secondly, the patient's hygiene can be maintained in satisfactory conditions, because the patient's eliminations are more easily removed. Thirdly, skin irritations caused by the patient's eliminations were remarkably reduced and so were the patient's sores due to moisture and bacteria. Fourthly, the home-ward have a tilt-table ef-fect thanks to the inclining room floor. This improves the patient's cardiovascular function as well as constantly changes pressed skin areas and thus prevents sores. Fifthly, improved shelf arrangements help make the best use of patient's supplies. Sixthly, the trouble of continuously changing clothes, underwears, diapers & bedclothes is remarkably reduced simply by covering the patient with cotton sheets when laid in bed. This is espected to cut down expenses by reducing the comsumptions of diapers and other disposable supplies.

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