• The Korean Journal of Emergency Medical Services
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• v.15 no.3
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• pp.31-44
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• 2011

Purpose : The purpose of emergency medical services(EMS) is to save human lives and assure the completeness of the body in emergency situations. Those who have been qualified on medical practice to perform such treatment as there is the risk of human life and possibility of major physical and mental injuries that could result from the urgency of time and invasiveness inflicted upon the body. In the emergency medical activities, 119 emergency medical technicians mainly perform the task but they are not able to perform such task independently and they are mandatory to receive medical direction. The purpose of this study is to examine the recognition and request for medical direction by 119 emergency medical technicians in order to provide basic information on the development of medical direction program suitable to the characteristics of EMS as well as for the studies on EMS for the sake of efficient operation of pre-hospital EMS. Method : Questionnaire via e-mail was conducted during July 1-31, 2010 for 675 participants who are emergency medical technicians, nurses and other emergency crews in Gyeongbuk. The effective 171 responses were used for the final analysis. In regards to the emergency medical technicians' scope of responsibilities defined in Attached Form 14, Enforcement regulations of EMS, t-test analysis was conducted by using the means and standard deviation of the level of request for medical direction on the scope of responsibilities of Level 1 & Level 2 emergency medical technicians as the scale of medical direction request. The general characteristics, experience result, the reason for necessity, emergency medical technicians & medical director request level, medical direction method, the place of work of the medical director, feedback content and improvement plan request level were analyzed through frequency and percentage. The level of experience in medical direction and necessity were analyzed through ${\chi}^2$ test. Results : In regards to the medical direction experience per qualification, the experience was the highest with 53.3% for Level 1 emergency medical technicians and 80.3% responded that experience was helpful. As for the recognition on the necessity of medical direction, 71.3% responded as "necessary" and it turned out to be the highest of 76.9% in nurses. As for the reason for responding "necessary", the reason for reducing the risk and side-effects from EMS for patients was the largest(75.4%), and the reason of EMS delay due to the request of medical direction was the highest(71.4%) for the reason for responding "not necessary". In regards to the request level of the task scope of emergency medical technicians, injection of certain amount of solution during a state of shock was the highest($3.10{\pm}.96$) for Level 1 emergency rescuers, and the endotracheal intubation was the highest($3.12{\pm}1.03$) for nurses, and the sublingual administration of nitroglycerine(NTG) during chest pain was the highest($2.62{\pm}1.02$) for Level 2 emergency medical technicians, and regulation of heartbeat using AED was the highest($2.76{\pm}.99$) for other emergency crews. For the revitalization of medical direction, the improvement in the capability of EMS(78.9%) was requested from emergency crew, and the ability to evaluate the medical state of patient was the highest(80.1%) in the level of request for medical director. The prehospital and direct medical direction was the highest(60.8%) for medical direction method, and the emergency medical facility was the highest(52.0%) for the placement of medical director, and the evaluation of appropriateness of EMS was the highest(66.1%) for the feedback content, and the reinforcement of emergency crew(emergency medical technicians) personnel was the highest(69.0%) for the improvement plan. Conclusion : The medical direction is an important policy in the prehospital EMS activity because 119 emergency medical technicians agreed the necessity of medical direction and over 80% of those who experienced medical direction said it was helpful. In addition, the simulation training program using algorithm and case study through feedback are necessary in order to enhance the technical capability of ambulance teams on the item of professional EMS with high level of request in the task scope of emergency medical technicians, and recognition of medical direction is the essence of the EMS field. In regards to revitalizing medical direction, the improvement of the task performance capability of 119 emergency medical technicians and medical directors, reinforcement of emergency medical activity personnel, assurance of trust between emergency medical technicians and the emergency physician, and search for professional operation plan of medical direction center are needed to expand the direct medical direction method for possible treatment beforehand through the participation by medical director even at the step in which emergency situation report is received.

• Journal of Korean Academy of Nursing Administration
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• v.8 no.1
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• pp.169-191
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• 2002

As the tendency of the society is centralized into consumers and services, patients are getting to ask better medical services. The consumers influenced from various social surroundings became to have some expectation of nursing service. Compared with their expectation, the quality of the services which they virtually get may be recognized and evaluated. So it is necessary to know exactly what the consumers want in nursing services. The purpose of this study is to examine the determinants which can evaluate the quality of nursing services by researching into consumers' expectation and perception of the nursing services depending on the consumer-oriented attributions on the basis of the model of SERVQUAL. 1,144 of outpatients were selected as the subjects for this research. They used to continuously visit the same hospital after being hospitalized and nursed in 9 hospitals randomly selected among the second-level medical organizations in Seoul from January to February, 2001. The collected data are analyzed into the Descriptive Statistics, t-test, GLM and Multiple Regression through the SAS program. Delphi was used for the research tool and the results of the research are as follows; the determinants in evaluating the quality of nursing services consist of 5 categories such as Tangibility, Reliability, Responsiveness, Assurance, Empathy. The values of Cronbach' $\alpha$ appeared to be 0.96 in the expectation of nursing services, 0.94 in the perception of nursing services and 0.96 in the importance of nursing services. The determinants in the expectation of nursing services were ranged in the order of Assurance, Empathy, Reliability, Responsiveness and Tangibility. And those in the perception of nursing services were in the order of Assurance, Empathy, Reliability, Tangibility and Responsiveness. Those in the importance of nursing service were in the order of Empathy, Assurance, Reliability, Tangibility and Responsiveness. Finally, those in the quality of nursing service were in the order of Tangibility, Responsiveness, Empathy, Reliability and Assurance. Each expectation of nursing services appeared different depending on the subjects' age, gender, clinical department and reason for hospitalization. The hypothesis examined in this research shows that the group having higher personal needs shows meaningful differences in the expectation of nursing services, and the subjects who have had external communication show higher perception of nursing service than uncommunicative ones. After all, we can see that the statistical differences in the perception of nursing services depend on whether the subjects have external communications or not. The determinants in the expectation of nursing services can explain the quality of nursing service up to 14.96%. The statistically meaningful determinants in the expectation could be arranged in the order of Reliability, Assurance and Tangibility. And the more expectation brings about the lower evaluation of the quality of nursing services. The determinants in the perception of nursing service can explain the quality of nursing services up to 29.85%. The statistically meaningful determinants in the perception could be arranged in the order of Responsiveness, Reliability, Tangibility, Empathy, and Assurance. And the more perception brings about the higher evaluation of the quality of nursing services. According to the result of the above research, I would like to propose as follows. As long as this research is oriented to get knowledge of the consumer-oriented nursing services, it should be continued to draw the other elements determining the quality of the nursing services. Furthermore, this research is based upon the Parasuraman, A., et al.'s SERVQUAL Model(1991), which deals only expectation, perception and quality of consumer-oriented nursing services, so it will be necessary to inspect and verify it through the other models containing the offerers of nursing services in the future. On the other hand, as this research evaluates the actual quality of nursing services based on the expectation and perception of nursing services, it can be utilized as fundamental data to develop the marketing strategies and to estimate the qualities as well. I hope this research will be periodically estimated to be the useful data to develop the marketing strategies in the nursing service area.

• Journal of Digital Convergence
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• v.10 no.6
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• pp.311-319
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• 2012

This study, by grasping the degree of anxiety of Korean mothers and multicultural family mothers because of their hospitalized children, was aimed to arrange the basic data for developing the program to help the mothers of Korea and multicultural family reduce the anxiety happening due to the hospitalization of their children and adapt to their environment. Methods: The subjects of the study were a total of 200 people composed of 100 multicultural family mothers, and 100 Korean mothers respectively whose children were hospitalized in the pediatric department of K university hospital located in Daejeon City. And the period of data collection was from Aug 1, 2010 to Aug 31, 2010.As a study tool, the measuring tool of Kim Jeong Taek(1978), which STAI of Sielberger(1972) was adapted to Koreans, was used.The collected data was analyzed using SPSS WIN 12.0. Results. A result of the state anxiety of the Korean mothers with that of the multicultural family mothers of the inpatient children, Korean mothers 2.11, multicultural family mothers 2.17, result of temperament anxiety showed Korean mothers 2.09, multicultural family mothers 1.94. As a result of comparing the anxiety of the Korean mothers with that of the multicultural family mothers of the inpatient children, there was no difference between groups in both temperament anxiety and state anxiety. In a situation of anxiety, when there was no explanation of the treatment or therapy, both Korean mothers and multicultural family mothers showed the severe anxiety. In the degree of anxiety according to the general characteristics of the mothers of the inpatient children, there was not a statistically significant result in anxiety according to general characteristics of the inpatient children of korean family mothers, there was a significant difference in state anxiety according to the state of average monthly income in Korean mothers(P<.05), however, there was a significant one in temperament anxiety in the course of perceiving a test method in multicultural family mothers(P<.05). In the degree of anxiety according to the general characteristics of the mothers of the inpatient children, there was a significant difference in state anxiety according to the state of average monthly income in Korean mothers(P<.05), however, there was a significant one in temperament anxiety in the course of perceiving a test method in multicultural family mothers(P<.05). Conclusion: Through the results of the study above, no matter what socio-demographic characteristics of the mothers of the inpatient children are, regardless of the general characteristics of the inpatient children, it was found out that most of mothers felt anxiety.

• Journal of the Korean Society of Radiology
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• v.11 no.5
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• pp.303-312
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• 2017

The central goal of Gamma Knife radiosurgery(GKRS) is to maximize the conformity of the prescription isodose surface, and to minimize the radiation effect of the normal tissue surrounding the target volume. There are the various kinds of indices related with the quality of treatment plans such as conformity index, coverage, selectivity, beam-on time, gradient index(GI), and conformity/gradient index(CGI). As the best treatment plan evaluation tool, we must check by all means conformity index, GI, and CGI among them. Specially, GI and CGI related with complication of healthy normal tissue is more indispensible than conformity index. Then author calculated and statistically analysed CGI, the newly defined conformity/gradient index as well as GI being applied widely using the treatment planning system Leksell GammaPlan(LGP) and the verification method Variable Ellipsoid Modeling Technique(VEMT). In the study 10 patients with intracranial lesion treated by GKRS were included. Author computed the indices from LGP and VEMT requiring only four parameters: the prescribed isodose volume, the volume with dose > 30%, the target volume, and the volume of half the prescription isodose. All data were analyzed by paired t-test, which is statistical method used to compare two different measurement techniques. No statistical significance in GI at 10 cases was observed between LGP and VEMT. Differences in GI ranged from -0.14 to 0.01. The newly defined gradient index calculated by two methods LGP and VEMT was not statistically significant either. Author did not find out the statistical difference for the prescribed isodose volume between LGP and VEMT. CGI as the evaluation index for determining the best treatment plan is not significant statistically also. Differences in CGI ranged from -4 to 3. Similarly newly defined Conformity/Gradient index for GKRS was also estimated as the metric for the evaluation of the treatment plans through statistical analysis. Statistical analyses demonstrated that VEMT was in excellent agreement with LGP when considering GI, new gradient index, CGI, and new CGI for evaluating the best plans of GKRS. Due to the application of the fast and easy evaluation tool through LGP and VEMT author hopes CGI and newly defined CGI as well as gradient indices will be widely used.

• Journal of Environmental Health Sciences
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• v.43 no.1
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• pp.1-22
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• 2017

'The worstest environment disaster', 'World's first biocide massacre', 'Home-based Sewol ferry disaster' are all phrases attached to the recent humidifier disinfectant disaster. In the spring of 2011, four of 8 pregnant women including 1 adult man passed away at a university hospital in Seoul due to breathing failure. Epidemiologic investigation conducted by the Korean CDC soon revealed the inhalation of humidifier disinfectant, which had been widely used in Korea during the winter, to be responsible for the disease. As well as lung fibrosis hardening of the lungs, other diseases including asthma, rhinitis, skin disease, liver disease, fetal disease or cancers have been researched for their relation with exposure to the products. By February 9, 2017, 5,342 cases had registered for health problems and 1,131 of them were already dead (20.8% mortality rate). Based on studies by government agencies and a telephone survey of the general population by Seoul National University and civic groups, around 20% of the general public of Korea has used these products. Since the market release of the first product by SK Chemical in 1994, over 7.1 million items from around 20 brands were sold up to 2011. Most of the products were manufactured by well-known large conglomerates such as SK, Lotte, Samsung, Shinsegye, LG, and GS, as well as some European companies including UK-based Reckitt Benckiser and TESCO, the German firm Henkel, the Danish firm KeTox, and an Irish company. Even though this disaster was unveiled in 2011 by the Korean government, the issue of the victims was neglected for over five years. In 2016, an unexpected but intensive investigation by prosecutors found that Reckitt Benckiser manipulated and concealed animal tests for its own brand and brought several university experts and company employees to court. The matter was an intense social issue in Korea from May to June with a surge in media coverage. The prosecutor's investigation and a nationwide boycott campaign organized by victims and environmental groups against Reckitt Benckiser, whose product had been used by more than 70% of victims, led to the producer's official apology and a compensation scheme. A legislative investigation organized after the April 2016 national election revealed the producers' faults and the government's responsibility, but failed to meet expectations. A special law for the victims passed the National Assembly in January 2017 and a punitive system together with a massive environmental epidemiology investigation are expected to be the only solutions for this tragedy. Sciences of medicine, toxicology and environmental health have provided decisive evidence so far, but for the remaining problems the perspectives of social sciences such as sociology and jurisprudence are highly necessary, similar to with the Minamata disease and Wonjin Rayon events. It may not be easy to follow this issue using unfamiliar terminology from medical and chemical science and the long, complicated history of the event. For these reasons the author has attempted to write this article in a question and answer format to render it easier to follow. The 17 questions are: Q1 What is humidifier disinfectant? Q2 What kind of health problems are caused by humidifier disinfectant? Q3 How many victims are there? Q4 What is the analysis of the 1,112 cases of death? Q5 What is the problem with the government's diagnostic criteria and the solution? Q6 Who made what brands? Q7 Has there been a recall? What is still on sale? Q8 Was safety not checked by any producers? Q9 What are the government's responsibilities? Q10 Is it true that these products were sold only in Korea? Q11 Why and how was it unveiled only in 2011 after 17 years of sales? Q12 What delayed the resolution of the victim issue? Q13 What is the background of the prosecutor's investigation in early 2016? Q14 Is it possible to report new victim cases without evidence of product purchase? Q15 What is happening with the victim issue? Q16 How does it compare with the cases of Minamata disease and Wonjin Rayon? Q17 Are there prevention measures and lessons?

• Journal of radiological science and technology
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• v.37 no.4
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• pp.331-339
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• 2014

To test feasibility of proton arc therapy (PAT) in the treatment of para-aortic lymph node tumor and compare its dosimetric properties with advanced radiotherapy techniques such as intensity modulated radiation therapy (IMRT) and conventional 3D conformal proton beam therapy (PBT). The treatment plans for para-aortic lymph node tumor were planned for 9 patients treated at our institution using IMRT, PBT, and PAT. Feasibility test and dosimetric evaluation were based on comparisons of dose volume histograms (DVHs) which reveal mean dose, $D_{30%}$, $D_{60%}$, $D_{90%}$, $V_{30%}$, $V_{60%}$, $V_{90%}$, organ equivalent doses (OEDs), normal tissue complication probability (NTCP), homogeneity index (HI) and conformity index (CI). The average doses delivered by PAT to the liver, kidney, small bowel, duodenum, stomach were 7.6%, 3%, 17.3%, 26.7%, and 14.4%, of the prescription dose (PD), respectively, which is higher than the doses delivered by IMRT (0.4%, 7.2%, 14.2%, 15.9%, and 12.8%, respectively) and PBT (4.9%, 0.5%, 14.12%, 16.1% 9.9%, respectively). The average homogeneity index and conformity index of tumor using PAT were 12.1 and 1.21, respectively which were much better than IMRT (21.5 and 1.47, respectively) and comparable to PBT (13.1 and 1.23, respectively). The result shows that both NTCP and OED of PAT are generally lower than IMRT and PBT. This study demonstrates that PAT is better in target conformity and homogeneity than IMRT and PBT but worse than IMRT and PBT for most of dosimetric factor which indicate that PAT is not recommended for the treatment of para-aortic lymph node tumor.

• Tuberculosis and Respiratory Diseases
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• v.62 no.5
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• pp.374-381
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• 2007

Background: This study evaluated which CT findings could be used to predict the negative results of a sputum smear in patients with active pulmonary tuberculosis and multiple cavities. Methods: Thirty-eight patients with active pulmonary tuberculosis and multiple cavities on CT were classified into 2 groups: smear-positive (n = 30) and -negative (n = 8). The CT findings were reviewed retrospectively. The maximum internal diameter of the largest cavity, the number of the cavities and lobes with cavities, and the characteristics of the associated findings such as consolidation, ground glass opacity, micronodules and nodule were accessed. The number of cavities above 20 mm in the maximum internal diameter and a necrotizing pneumonia-like pattern were also evaluated. Result: The maximum internal diameter and number of cavities was $32.23{\pm}17.66mm$ and $15.50{\pm}11.12mm$ (p = 0.0042), and $5.53{\pm}3.17$ and $2.43{\pm}1.13$ (p = 0.0002) in the smear-positive and -negative group, respectively. Three or more cavities were observed at 76.7% and 12.5% in the smear-positive and -negative group, respectively (p < 0.005). There were $2.00{\pm}1.34$ and $0.25{\pm}0.46$ (p = 0.001), and $1.5{\pm}1.50$ and $0.38{\pm}0.52$ (p =0.0016) lobes with consolidation and ground glass opacity in the smear-positive and -negative group, respectively. A necrotizing pneumonia-like pattern was observed in 43.3% of the smear-positive group only. The other findings were similar in both two groups. The sensitivity, specificity, positive and negative predictive value for the presence of at least a finding of consolidation, more than 3 cavities or the largest cavity > 20 mm in the maximum internal diameter were 100%, 62.5%, 90.9%, and 100%, respectively. Conclusion: Two cavities 20 mm or less in the maximum internal diameter without consolidation on CT might be associated with a negative result of the sputum smear in patients with active pulmonary tuberculosis and multiple cavities.

• Radiation Oncology Journal
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• v.9 no.1
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• pp.47-52
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• 1991

From April,1983 through April,1989, we have treated histologically proven 21 patients with oligodendroglioma using 6 MV linear accelerator at the Division of Radiation Therapy, Kangnam 51. Mary's Hospital Catholic University Medical College. These are 8% of the irradiated 246 primary brain tumors during the same period. To investigate influencing factors on the survival of irradiated U patients with oligodendroglioma, we analyzed the cerebral location of the involvements, initial symptoms, CT findings and survival rates, retrospectively. One case was lost to follow up and excluded from survival data. Of the 28 patients, thirteen were male and 8 female. Ages ranged from 5 to 68 years with a median age of 38 years. Radiation doses varied from 3900 cGy to 0480 cGy and were given for 5 to 8 weeks. All but one were supratentorial. The involvement of the frontal and parietal lobes were 10 (48%) patients in each and temporal lobe in 8 (38.1%). Histological diagnosis was made by stereotactic biopsy in 3 and postoperatively in 18. The type of surgery was divided into partial, subtotal and total resection in 7,9 and 2 cases respectively. In 6 cases, chemotherapy was also tried during or after radiation therapy. Major presenting symptoms were headache, cerebral motor, nausea & vomiting and epilepsy in 18,12, 7 and 5 respectively in decreasing order. In CT analysis, low density (02%), cystic mass (33%), calcifiestion (66%) and positive contrast enhancement (42.8%) were observed as the highest frequency. Mean survival duration after radiation therapy was 38 months (K-M methods). We could not achieve statistically significant factors influencing on the survival rate after radiation therapy for oligodendrogliomas by one or two tail test.

• Radiation Oncology Journal
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• v.10 no.1
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• pp.27-34
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• 1992

Cis-Platinum (DDP) was utilized as a radiosensitizer in a pilot study for stage III and IV squamous cell carcinoma between 1984-1987, and DDP 20 $mg/M^2$/day was administered for 4 days at 3 week interval with concurrent radiotherapy. This study consisted of three phases: cytoreduction phase, eradicative treatment phase and adjuvant phase. Total 59 patients were subjected to evaluate a tumor response and its toxicity. During the eradicative phase,27 patients underwent surgery (group I ), 29 patients were treated with radiotherapy only (group II) and 3 patients did not complete the second phase of therapy. At the cytoreduction phase, $95\%$ response rate with complete response (CR) $47.5\%$ and partial response (PR) $47.5\%$ was observed. Complete tumor clearance (CTC) rate following 2nd phase of therapy was $84\%$ (47/56) with 26/27($96\%$) in group I achieved CTC with surgery and 21/29 ($72\%$) patients In group II achieved CTC following 2nd phase. $67\%$ of primary lesions and $70\%$ of nodal diseases in group I showed no tumor in the surgical specimen. $34\%$ of patiets who achieved CTC at 2nd phase developed recurrence and median time to recur was 8 months. Actuarial disease free survival at 4 years was $59\%$ and $51\%$(24/27) of patients who achieved CTC at 2nd phase were alive without any evidence of disease at median follow-up 31 months (range, 10-48 months). There was no significant difference in overall and disease free survival between group I and II between CR and PR group following 1st Phase. Only significant Prognostic factor in this study was the complete tumor clearance following 2nd phase theapy. In general, toxicity was not excessive. Author concludes that this study confirmed the significant radiosensitizing effect of DDP with the acceptable toxicity and warrant the prospective study to determine optimum scheduling for DDP and radiotherapy which maximizes the therapeutic gain.

• Korean Journal of Biological Psychiatry
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• v.3 no.2
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• pp.222-239
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• 1996

The purpose of this study was to evaluate the effects of alcohol on the psychomotor performance and subjective assessment in healthy Korean adults with acetaldehyde dehydrogenase I(ALDH-I) isozyme variance. A total of 20 male subjects, half with active ALDH-I and the other half with inactive ALDH-I, were selected through both a self-reporting questionnaire examining alcohol sensitivity and the Higuchi's ethanol patch test detecting ALDH-I deficiency. In a doule-blind, placebo-controlled cross-over design, each subject consumed four doses of alcohol(0.25, 0.5, 0.75, 1.0g/kg) and placebo on five separate occasions at weekly intervals, Treatment order was fully balanced using a $5{\times}5$ Latin square, Psychomotor performance tests[coritical flicker fusion threshold(CFF) and choice reaction time(CRT)] and self-estimate questionnaires were conducted at baseline and at time points of 20, 40, 60, 90, 120, 150, 180 minutes after consuming the test drug for 20 minutes, Blood alcohol concentrations(BACs) using breath analyzer were measured at baseline and at time points of 10, 20, 30, 40, 50, 60, 75, 90, 105, 120, 150, 180 minutes after drinking, The BACs and the mean changes in the psychomotor performances and subjective assessments from pre-alcohol baseline, were compared between the two groups. The findings were summarized as follows : 1) BACs were tended to be higher in the inactive group than the active in all of the four alcohol doses. However significant group differences were only after the 0.5g/kg dose of alcohol. 2) The inactive group showed significant impairment in CFFT at most time points alter 0.75 and 1.0g/kg doses of alcohol. 3) In CRT, total reaction time(TRT) significantly prolonged in the inactive group than the active group at 20 minutes after 0.25 and 1.0g/kg doses of alcohol and at 40, 60, 90 minutes alter 0.75g/kg dose of alcohol. In the inactive group, recognition time component significantly increased at 20, 60, 90 minutes after 1.0g/kg dose of alcohol, while movement time component significantly increased at 40, 60 minutes after 0.75g/kg dose of alcohol. 4) Subjective evaluation of the effect of alcohol revealed that physical and mental conditions as well as a self-estimate of the effects of alcohol on performance were significantly worse in the inactive group than the active at some time points alter all of the lour alcohol doses, wihch were more pronounced after 0.75 and 1.0g/kg doses of alcohol. 5) Most of the group differences mentioned above, still remained statistically significant after BAC was entered as a covariate, These findings demonstrated that the alcohol sensitivity is higher in individuals with inactive ALDH-I than those with active ALDH-I both on the subjective assessments and the objective psychomotor performances. Furthermore, these results suggest thai the alcohol sensitivity may be determined by acetaldehyde concentration rather than BAC per se. In future studies, after more accurate genotyping for ALDH-I, the relationships between BAC, acetaldehyde concentration and alcohol sensitivities should be clearly defined.