• 한국호스피스완화의료학회:학술대회논문집
• /
• 2004.07a
• /
• pp.100-102
• /
• 2004

Under the current medical system, a terminal patient and his/her family who are neglected inevitably face various aspects of crises including not only physical, but also psychological, social, economic, spiritual and legal problems. Nurses often look after many terminal patents with these types of complicated problems. Therefore, educating the nurses who will take care of such patents would greatly reduce stress so the patents end could their lives in peace and without losing their dignity. This research is a quasi experimental study of nonequivalent control group. A pretest-posttest design where a basic education program is developed for nurses, who frequently treat terminal patents, to understand the importance of the role of hospice and to apply their understandings to treat terminal lancer patents. A sample of the nurses were taken from those who were working in general wards at two general hospitals in Seoul during October, 2003${\sim}$December 2003. The study was composed of 46 experimental group and 43 control group. A basic hospice education program was developed by taking emphasized and overlapping parts from advanced practice hospice nurses education course, short-term education course, an extensive literature survey and by consulting three professionals as well. With the group of 5 professors with vast experiences in oncolgy, 5 nursing administrator, 3 nursing practitioner, the tentative first version of the program was developed and reviewed. Afterwards, by utilizing person to person interviews with 2 head nurses experienced with terminal patients, 1 nurse in charge of hospice, 1 nurse on the contents of the program, and a person to person rating on the educating medium by a nurse were performed. The final version of a basic education program was developed after the second revision. The hospice basic education program consists of introduction to hospice, hospice and commucation, management of pain for terminal cancer patients, physical management for terminal cancer patients, socio-psycological caring of terminal cancer patients and management of death and separation. Total education time was four hours organized into 50 minutes of instruction and 10 minutes of break. $Powerpoint^{(R)}$ software was used as the education medium. As research tools, "Knowledge on Hospice" was developed by the author after receiving a review from one expert. "Attitude of Hospice Nursing" was revised Kim(2001)'s attitude measuring tool which was based on Wang(1998), Kwon(1989), Park and Sung(1991)'s tool. "Liability on nursing terminal patients" was used as developed by Zarits(1980) and Mongomory(1985) translated by Lee(1985). For collecting data, preliminary investigation prior to 1 week of the hospice basic education program and post-investigations after 1 week and 4 weeks of the education were carried out for the nurses at a general ward who understood and agreed on the purpose of the program. Collected data were analyzed throughout t-test, $x^2-test$, Manova test and Bonferroni correction in $SAS^{(R)}$ program. The summary of the investigation is as follows: Hypothesis 1: "Educated experimental group would possess more knowledge on hospice compared to the un-educated control group" was supported after 1 (F=12.14, p=.00) and 4 (F=5.3, p=.02) weeks of education. Hypothesis 2: "Educated experimental group would take a positive attitude toward hospice nursing compared to the un-educated control group" was supported after 1(F=3.92, p=.05) and 4(F=5.05, p=.02) weeks of education. Hypothesis 3: "Educated experimental poop would feel less liability compared to the un-educated control group in nursing terminal cancer patients' was rejected. In this study, it was found that knowledge on hospice was significantly important. By applying hospice basic education programs to nurses, the education program helped nurses to take a positive attitude toward terminal patients. It was, however, seen that the education program had no effect on alleviating liability in nursing terminal patients. Therefore, it is expected that this educational program would help hospices and nurses at general wards to understand the concept and the role of hospice so that terminal patents, now neglected under current medical system, would be able to end their lives in peace.

• Journal of agricultural medicine and community health
• /
• v.19 no.2
• /
• pp.141-158
• /
• 1994

To provide better health care services to the rural population, the government has made the Community Health Practitioner(CHP) a regular government official from April 1, 1992. This study was carried out to study the impact of officialization of CHP on the activities and management system of Primary Health Post(PHP). Fifty PHPs were selected by two stage sampling, cluster and simple random, from 595 PHPs in Kyungnam and Kyungpook provinces. Data were collected by a personal interview with CHPs and review of records and reports kept in the PHPs. The study was done for the periods of January 1-March 31, 1992 (before officialization) and January 1-March 31, 1993 (after officialization). Ninety-six percent of the CHPs wanted to become a regular government official in the hope of better job security and higher salary. The proportion of CHPs who were proud of their iob was increased from 24% to 46% after officialization. Those CHPs who felt insecure for their job decreased from 30% to 10%. Monthly salary was increased by 34% from 802,600 Won to 1,076,000 Won and 90% of the CHPs were satisfied with their salary, also more CHPs responded that they have autonomy in their work planning, implementation of plan, management of the post, and evaluation of their activity. There were no appreciable changes in such CHPs' activities as assessment of local health resources, drawing map for the catchment area, utilization of community organization, grasping the current population structure in the catchment area, keeping the family health records, individual and group health education, and school health service. However, the number of home visits was increased from 13.6 times on the average per month per CHP to 27.5 times. More mothers and children were referred to other medical facilities for the immunization and family planning services. Average number of patients of hypertension, cancer, and diabetes in three months period was decreased from 12.7 to 11.6, from 1.5 to 1.2, and 4.3 to 3.4, respectively. Records for the patient care, drug management, and equipment were well kept but not for other records. The level of record keeping was not changed after officialization. The proportion of PHPs which had support from the health center was increased for drug supply from 14.0% to 30.0%, for consumable commodities from 22.0% to 52.0%, for maintenance of PHP from 54.0% to 68.0%, for supply of health education materials from 34.0% to 44.0%, and supply of equipment from 54.0% to 58.0%. Total monthly revenue of a PHP was increased by about 50,000 Won; increased by 22,000 Won in patient care and 34,700 Won in the government subsidy but decreased in the membership due and donation. However, there was no remarkable changes in the expenditure. The proportion of PHPs which had received official notes from the health center for the purpose of guidance and supervision of the CHPs was increased from 20% to 38% during three months period and the average number of telephone call for supervision from the health center per PHP was increased from 1.8 to 2.1 times(p<0.01). However, the proportion of PHPs that had supervisory visit and conference was reduced from 79% to 62%, and from 88% to 74%, respectively. The proportion of CHPs who maintained a cooperative relationship with Myun Health Workers was reduced from 42% to 36%, that with the director of health center from 46% to 24%, that with the chief of public health administration section from 56% to 36%, and that with the chairman of PHP management council from 62% to 38%. Most of the CHPs (92% before and 82% after officialization) stated that the PHP management council is not helpful for the PHP. CHPs who considered the PHP management council unnecessary increased from 4% to 16%(p<0.05). Suggestions made by the CHPs for the improvement of CHP program included emphasis on health education, assurance of autonomy for PHP management, increase of the kind of drugs that can be dispensed by CHPs, and appointment of an experienced CHP in the health center as the supervisor of CHPs. The results of this study revealed that the role and function of CHPs as reflected in their activities have not been changed after officialization. However, satisfaction in job security and salary was improved as well as the autonomy. Support of health center to the PHP was improved but more official notes were sent to the PHPs which required the CHPs more paper works. Number of telephone calls for supervision was increased but there was little administrative and technical guidance for the CHP activities.

• Tuberculosis and Respiratory Diseases
• /
• v.48 no.6
• /
• pp.837-852
• /
• 2000

Backgrounds : Today, tuberculosis cannot only be cured medically, but also controlled by public health. Despite the overall worldwide decline in tuberculosis, the disease continues to be a significant problem among developing countries and in the slums of large cities in some industrialized countries. Particularly, this communicable disease has come into the public health spotlight because of its resurgence in the 1990's. our country has been operating the Korean National Tuberculosis Control Program since 1962, focusing around public health centers. Therefore, this study aims to compare the effectiveness of tuberculosis control activities, one of the major public health activities in Korea, by producing indexes, such as the yearly registration rate per 100,000 population and treatment compliance of tuberculosis on in small areas (communities). Methods : This work was accomplished by constructing a time-series analytic model using data from "1980~2000: the Yearly Statistical Report" with patient registry data of 234 City. County. District public health centers and by identifying the factors influencing the tuberculosis indexes. Results : The trends of pulmonary tuberculosis positive point prevalence and pulmonary tuberculosis negative point prevalence on X-ray screening have declined steadily, beginning in 1981 and continuing to 1998 by region (city, county, district). Although the tuberculosis mortality rate steadily shows a declining trend by year and region, but Korea still ranks first among 29 OECD countries in 1998, with a tuberculosis mortality rate of 7.1 per 100,000 persons, according to the time-series analysis for fatal diseases. Conclusion : The results of the study will form the fundamental basis of future regional health care planning and the Korean Tuberculosis Surveillance System on 2000. Since the implementation of local autonomy through the Local Health Act of 1995, it has now become vita1 for each city, county, district public health centers to determine its own priorities for relevant health care management, including budget allocation and program goals.

• Journal of radiological science and technology
• /
• v.36 no.1
• /
• pp.1-10
• /
• 2013

IEC publications have applied in many countries all over the world such as Europe or Japan and these also have been published as in dustrial standards (KS) and notifications of Korea Food and Drug Administration (KFDA) in Korea. As the general standard of IEC 60601 series for medical electric (ME) equipment was revised as $3^{rd}$ edition in 2005, additional and particular standards have been revised or established newly. Under these circumstances, it is importance for manufacturing and assembling companies or authorized testing companies to understand the trend for revisions of IEC publications. Therefore in this study, the latest version of 3 IEC standards related to medical X-ray equipment : IEC 60601-2-44 for X-ray equipment for computed tomography (CT), IEC 60601-2-45 for mammographic X-ray equipment and IEC 60601-2-54 for X-ray equipment for radiography or radioscopy were covered and analyzed for trends and features accompanied by revision based on IEC 60601-1 $3^{rd}$ Ed. As KFDA notifications in force have referred to the particular standards based on 2nd edition of IEC 60601-1, those revised version of 3 particular standards were compared to KFDA notifications in force. The features of the latest standards applying IEC 60601-1 $3^{rd}$ Ed were shown as following: 1) Requirements for mechanical hazards, especially (motorized) moving parts were emphasized. 2) Indication and recording of patient dose were required. 3) Risk management process was introduced and enabled to monitor potential risks systematically. 4) DR system (digital radiography system) as well as analogue system (film-screen system) was included in the scope. Presently, KFDA will revise the notifications applying the particular standards based on IEC 60601-1 $3^{rd}$ Ed in a few years. Therefore the features of particular standards applying IEC 60601-1 $3^{rd}$ Ed was expected to help manufacturers, assemblers or testing companies of medical electric equipment understand IEC publications or KFDA notifications slated to be published.

• The Korean Journal of Nuclear Medicine Technology
• /
• v.14 no.2
• /
• pp.77-82
• /
• 2010

Purpose: As PET/CT come into wide use, it caused increasing of expose in clinical use. Therefore, Korea Food and Drug Administration issued Patient DRL (Diagnostic Reference Level) in CT scan. In this study, to build the basis of patient dose reduction, we analyzed effective dose in transmission scan with CT scan. Materials and Methods: From February, 2010 to March 180 patients (age: $55{\pm}16$, weight: $61.0{\pm}10.4$ kg) who examined $^{18}F$-FDG PET/CT in Asan Medical Center. Biograph Truepoint 40 (SIEMENS, GERMANY), Biograph Sensation 16 (SIEMENS, GERMANY) and Discovery STe8 (GE healthcare, USA) were used in this study. Per each male and female average of 30 patients doses were analyzed by one. Automatic exposure control system for controlling the dose can affect the largest by a patient's body weight less than 50 kg, 50-60 kg less, 60 kg more than the average of the three groups were divided doses. We compared that measured value of CT-expo v1.7 and ImPACT v1.0. The relationship between body weight and the effective dose were analyzed. Results: When using CT-Expo V1.7, effective dose with BIO40, BIO16 and DSTe8 respectably were $6.46{\pm}1.18$ mSv, $9.36{\pm}1.96 $mSv and $9.36{\pm}1.96$ mSv for 30 male patients respectably $6.29{\pm}0.97$ mSv, $10.02{\pm}2.42$ mSv and $9.05{\pm}2.27$ mSv for 30 female patients respectably. When using ImPACT v1.0, effective dose with BIO40, BIO16 and DSTe8 respectably were $6.54{\pm}1.21$ mSv, $8.36{\pm}1.69$ mSv and $9.74{\pm}2.55$Sv for 30 male patients respectably $5.87{\pm}1.09$ mSv, $8.43{\pm}1.89$ mSv and $9.19{\pm}2.29$ mSv for female patients respectably. When divided three groups which were under 50 kg, 50~60 kg and over 60 kg respectably were 6.27 mSv, 7.67 mSv and 9.33 mSv respectably using CT-Expo V1.7, 5.62 mSv, 7.22 mSv and 8.91 mSv respectably using ImPACT v1.0. Weight and the effective dose coefficient analysis showed a very strong positive correlation(r=743, r=0.693). Conclusion: Using such a dose evaluation programs, easier to predict and evaluate the effective dose possible without performing phantom study and such dose evaluation programs could be used to collect basic data for CT dose management.

• The Journal of Korean Society for Radiation Therapy
• /
• v.26 no.2
• /
• pp.297-303
• /
• 2014

Purpose : The purpose of this study is reproducibility evaluation of deep inspiration breath-hold(DIBH) technique by respiration data and heart position analysis in radiation therapy for Left Breast cancer patients. Materials and Methods : Free breathing(FB) Computed Tomography(CT) images and DIBH CT images of three left breast cancer patients were used to evaluate the heart volume and dose during treatment planing system( Eclipse version 10.0, Varian, USA ). The signal of RPM (Real-time Position Management) Respiratory Gating System (version 1.7.5, Varian, USA) was used to evaluate respiration stability of DIBH during breast radiation therapy. The images for measurement of heart position were acquired by the Electronic portal imaging device(EPID) cine acquisition mode. The distance of heart at the three measuring points(A, B, C) on each image was measured by Offline Review (ARIA 10, Varian, USA). Results : Significant differences were found between the FB and DIBH plans for mean heart dose (6.82 vs. 1.91 Gy), heart $V_{30}$ (68.57 vs. $8.26cm^3$), $V_{20}$ (76.43 vs. $11.34cm^3$). The standard deviation of DIBH signal of each patient was ${\pm}0.07cm$, ${\pm}0.04cm$, ${\pm}0.13cm$, respectively. The Maximum and Minimum heart distance on EPID images were measured as 0.32 cm and 0.00 cm. Conclusion : Consequently, using the DIBH technique with radiation therapy for left breast cancer patients is very useful to establish the treatment plan and to reduce the heart dose. In addition, it is beneficial to using the Cine acquisition mode of EPID for the reproducibility evaluation of DIBH.

• The Korean Journal of Emergency Medical Services
• /
• v.13 no.1
• /
• pp.87-96
• /
• 2009

Purpose : To grasp the mental burden for legal responsibility that rescue members have in the performance of job. Method : Questionnaire was presented to rescue members serving in 2 direct control safety centers of fire station located in Seoul, Daejon, Incheon, Kwangju, Busan, Daegu and Ulsan. Results : 1. Questioned whether they have mental burden for legal responsibility while performing job on the site, the rescue members responded : very burdensome in 38.0%, burdensome in 56.0%, moderate in 4.5%, not burdensome in 1.0%, no burden at all in 0.5%. 2. Questioned on the first aid treat for which they have the most mental burden, the rescue members responded : intubation into trachea laryngeal mask airway(LMA) in 40.4%, automatic external defibrillator in 16.3%, securing vein providing sap(medicine) in 10.8%, basic cardiopulmonary resuscitation in 7.2%, eliminating foreign matters inserted into body in 5.4%, stanching external bleeding and treating injury in 5.4%, fixing extremities and spine by using splint in 1.8%, measuring the symptom of vitality in 1.2%, providing oxygen in 0.0%. 3. Questioned whether experiencing legal problem or firm petition(complaint) raised by patient while serving as rescue members, they responded : experiencing a complaint in 41.6%, experiencing no complaint in 58.4%. Asked to indicate the stress level in the scale of which they suffered when lawsuit or firm petition was raised, 0(weak)-10(strong), they answered 8.8 in average. 4. Questioned whether 119 rescue members put the legal responsibility in case that they cause damage to patients intentionally in performing, they responded to the inquiry 3.66 in average(of 5.00). It represented meaningful differences (F=2.874, p=.024) whether they had license or not. 5. In future, legal action will raise against the rescue member by 99% because of people's rights improvement(63.1%), high expectations for the rescue system(29.5%), non-licensed rescue members(5.1%). Conclusion : It was found that the rescue members had severe mental burden for advanced life support which was investigated to have low enforcement rate in the preceding research, for instance, intubation into trachea securing vein management by using automatic external defibrillator. To improve the qualitative level of rescue service in the fire fighting, it may be required to construct the environment that eliminates the mental burden of rescue members for legal responsibility.

• Therapeutic Science for Rehabilitation
• /
• v.2 no.2
• /
• pp.21-36
• /
• 2013

Objective : The purpose of this study was to look at a systematic review on the effects of robot-assisted therapy on stroke rehabilitation in upper limbs. Through this comprehensive study, we have to compare the studies. Methods : We systematically examined papers published in journal from June 2012 to September 2012, using EMBASE, MEDLINE, etc. 12 studies(randomized controlled trials) were included in the analyses. Results : Selected 12 studies were Pedro score 2 or more. The primary outcome measure tools including tools for upper extremity function and activities daily of living were used. Through various intervention, Robot-assisted therapy maximizes the effectiveness of intervention. The effects of upper extremity function and functional ability(ADL) by robot-assisted therapy showed significant effect, but no difference exists between the robot-assisted therapy and conventional therapy groups in terms of upper extremity function and functional ability. Conclusions : Robot-assisted therapy has been widely used clinically for stroke patients to maximize the effect had been applied to various interventions. Robot-assisted therapy depending on the methods of intervention showed that the effect of difference. In the future study, the use of robot-assisted therapy applied to a variety of interventions is needed on occupational therapy.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.30 no.3
• /
• pp.341-347
• /
• 2003

Smith-Magenis syndrome (SMS) is a clinically recognizable multiple congenital anomaly and mental retardation syndrome caused by an interstitial deletion of chromosome 17 p11.2. Physical features include short stature, characteristic facial appearance: flattened mid-face, down-turned mouth, prominent and often rosy cheeks; prominent jaw in older children and adults, chronic ear infections, hearing impairment, eye problems, including: strabismus (an eye which turns in or out) and myopia (nearsightedness), hoarse voice, short fingers and toes, heart defects or murmurs, problems related to the urinary system, scoliosis (curvature of the spine), an unusual gait (walking pattern), and decreased sensitivity to pain. Behavioral and developmental characteristics include speech delay and articulation problems, developmental delay, learning disability, mental retardation, hyperactivity, self-injury, including: head banging; hand biting; picking at skin, sores and nails; pulling off finger- and toenails; inserting foreign objects into ears, nose, or other body orifices, explosive outbursts, prolonged tantrums, destructive and aggressive behavior, excitability, arm hugging or hand squeezing when excited. This report is the case of a Korean 3-year-3-month old male with Smith-Magenis syndrome referred from local clinic for the treatment of dental caries. The patient was treated by physical restraint after prophylatic administration of antibiotic(Amoxacillin 50mg/kg).

• Journal of radiological science and technology
• /
• v.31 no.1
• /
• pp.1-10
• /
• 2008

Ubiquitous health care system, which is one of the developing solution technologies of IT, BT and NT, could give us new medical environments in future. Implementing health information systems can be complex, expensive and frustrating. Healthcare professionals seeking to acquire or upgrade systems do not have a convenient, reliable way of specifying a level of adherence to communication standards sufficient to achieve truly efficient interoperability. Great progress has been made in establishing such standards-DICOM, IHE and HL7, notably, are now highly advanced. IHE has defined a common framework to deliver the basic interoperability needed for local and regional health information networks. It has developed a foundational set of standards-based integration profiles for information exchange with three interrelated efforts. HL7 is one of several ANSI-accredited Standards Developing Organizations operating in the healthcare arena. Most SDOs produce standards (protocols) for a particular healthcare domain such as pharmacy, medical devices, imaging or insurance transactions. HL7's domain is clinical and administrative data. HL7 is an international community of healthcare subject matter experts and information scientists collaborating to create standards for the exchange, management and integration of electronic healthcare information. The ASTM specification for Continuity of Care Record was developed by subcommittee E31.28 on electronic health records, which includes clinicians, provider institutions, administrators, patient advocates, vendors, and health industry. In this paper, there are suggestions that provide a test bed, demonstration and specification of how standards such a IHE, HL7, ASTM can be used to provide an integrated environment.