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A Study on the Decision Point and a Standard of Judgment under the Duty of Inter-hospital Transfer for Patients of Doctor - Focused on the Trend of Supreme Court's Decisions - (의사의 전원의무(轉院義務) 위반 여부의 판단기준과 전원시점 판단 - 판례의 동향을 중심으로 -)

  • Choi, Hyun-tae
    • The Korean Society of Law and Medicine
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    • v.20 no.1
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    • pp.163-201
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    • 2019
  • Doctor has the duty of an inter-hospital transfer, known as inter-facility or secondary transfer, when the diagnostic and therapeutic facilities required for a patient are not available at the given hospital. Also, the decision to transfer the patient to an another facility is rely on whether ill patient is the benefits of care, including clinical and non-clinical reasons, available at the another facility against the potential risks. Crucial point to note is that issues about 'inter-hospital transfer' is limited to questions occurred in the course of transfer between emergency medicals (facilities). 'emergency medical (facility)' is specified by Medical Law, article 3 and the duty of an inter-hospital transfer includes any possible adverse events, medical or technical, during the transfer. Because each medical facility has an different ability to care for a patient in an emergency condition, coordination between the referring and receiving hospitals' emergency medicals would be important to ensure prompt transfer to the definitive destination avoiding delay at an emergency. Simultaneously, transfer of documents about the transfer process, medical record and investigation reports are important materials for maintaining continuity of medical care. Although the duty of an inter-hospital transfer is recognized as one of duty of doctor and more often than not it occurs, there is constant legal conflict between a doctor and a patient related to the duty of the inter-hospital transfer. Therefore, we need clear and specific legal standard about the inter-hospital transfer. This paper attempts to review the Supreme Court's cases associated to the inter-hospital transfer and to compare opinion of the cases with guideline for an inter-hospital transfer already given. Furthermore, this article is intended to broaden our horizons of understanding the duty of an inter-hospital transfer and I wish this article helps to resolve the settlement and case dealt with the duty of inter-hospital transfer.

Research on the Actual Condition of the radiation Safety Management(RSM) for the Educated Training of the Dental Diagnostics X-ray Generators (교육용 치과 엑스선 발생장치에 대한 방사선 안전 관리 실태 조사)

  • Lee, Mihyeon;Yu, Yunsik;Lee, Jaeseung;Im, Inchul
    • Journal of the Korean Society of Radiology
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    • v.8 no.7
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    • pp.467-477
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    • 2014
  • The purpose of this study is to offer data base for establishment of dental training x-ray generator based safety usage through surveying real radiation safety management state of radiation worker's in plan of operations that have dental training x-ray generators and use it. For it, comprehensive references were surveyed referring reports of current state of regulation technique development and domestic radiation safety evaluation and nuclear related legislation regarding radiation safety management of dental training x-ray generators. On the basis of it, questionnaires were filled in about respondent's general characteristic radiation safety manager's status current state of radiation safety management and the level of knowledge & consciousness. For the study, the survey was conducted to 224 people of radiation safety managers and university graduates training assistants and full-time professors who can treat dental training x-ray generators in education center. through this survey 95 questionnaires were used as analysis materials except the insufficient and omitted responses. As a method of analysis, the frequency and percentage were figured out with the general characteristics and safety manager's status. Chi-square test for frequency and correlation per question analysis and Pearson correlation analysis for crosslevel correlation were done with current state of radiation safety management and knowledge & consciousness level. As a result, running dental training x-ray generators was dealt with by 20's to 40's who have high education level over post undergraduate degree and major in dental hygienic. In addition, female have higher consciousness level for radiation safety management than male. It shows significal linear relation statistically(${\chi}^2$ >5, 0.1${\chi}^2$ >5, 0.3${\chi}^2$ >5, 0.3

The infestation states and changing patterns of human infecting metacercariae in freshwater fish in Kyongang-do and Kyonggi-do, Korea (식이성 윤충류질환의 관리전략수립을 위한 감염원의 역학 및 병원체의 생물학적 특성에 관한 조사연구 - 경상도내 3개 강 및 경기도내 4개 하천에서 채집한 민물어류의 인체기생 흡충류 피낭유충 감염상 및 변동)

  • 임한종;김기홍
    • Parasites, Hosts and Diseases
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    • v.34 no.2
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    • pp.95-106
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    • 1996
  • The infestation rates and abundances of human infecting metacercariae (Clonorchis sinensis, Metcgonimus spry. , Centrocestus crmatus, Echinostoma hortense, Echinochusnus japonicw, Clinostomum complanctum) in freshwater fish were investigated at the three river areas - Taewhagang (river), Hyongsangang (river), Nakdonggang (river) - in Kyongsang-do and at four streams - Yonpungchon, Munsanchon, Kyonganchon, and Konjiamchon- in Kyonggi-do, Korea in 1994-1995. The fish caught at Taewhagang were heavily infested with metacercariae of Clonorchis sinensis and Centrocestw armctus. At Hyongsangang, Zncco platypus and Z. temmincki were moderately infested with metacercariae of C. crmctus. Chomanpo, at the basin of Nakdonggang, was still endemic for C. sinensis. In the fish caught at four streams of Kyonggi-do, metacercariae of C. sinensis exhibited the highest infestation rate and intensity out of 6 species of metacercariae. The infestation intensity of C. sinensis metacercariae in fish flesh was markedly different according to each division of flesh. The cause of this difference was conjectured as a result of larval behavior. The metacercariae of C. omnt5 were found in almost all parts, except scales and fins, of fish. The infestation rates and intensities of C. sinensis and C. armntus metacercariae in Taewhagang greatly increased as compared with those of previous reports . RhinoBobius bmnneus and Aconthorhone5 macropterus are newly recorded intermediate hosts of Echinostonn hortense. The reason of large differences from previous data was discussed and the standard method of metacercaria examination was proposed.

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5 Years Follow up Study of Anti HBs Titer After Basic Immunization by Recombinant HBV Vaccine (유전자재조합 B형간염 백신의 기본접종 5년후 추적항체역가에 관한 연구)

  • Kim, Hyun Jung;Lee, Chang Yeun;Hwang, Kwang Soo
    • Pediatric Infection and Vaccine
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    • v.7 no.1
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    • pp.136-142
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    • 2000
  • Purpose : Although there are a lot of the reports about the persistence of anti HBs titer of plasma derives HBV vaccine, it is difficult to find the follow up studies of the recombinant HBV vaccine. We performed this study to compare the persistence of anti HBs titer by vaccination schedule and the seronegative rate of 5 years later according to Anti HBs titer after basic immunization in neonatal period by recombinant HBV vaccination. Methods : This study was performed on 420 neonates at Pusan Moon Hwa Hospital from April to December 1993, followed up for 5 years after basic immunization by recombinant HBV vaccine. The anti HBs titer test was done by radioimmunoassay(RIAAUSAB, Abbott laboratories). The positive anti HBs level that would protect against HBV infection was defined as a level equal to or greater than 10mIU/mL. Results : In this study the seronegative rate after 5 years was 5% in 2 month schedule group, 25.5% in 6 month schedule group(P>0.05). In 2 month schedule group the seronegative rate was 20% when anti HBs titer is lower than 200mIU/mL, 0% when more than 200mIU/mL(P>0.05). In 6 month schedule group the seronegative rate was 66.7% when anti HBs titer was lower than 200mIU/mL, 40% when 200~499.9mIU/mL, 23.9% when 500~999.9mIU/mL, 22.5% when more than 1000mIU/mL. Conclusion : In this study the seronegative rate after 5 years of recombinant HBV vaccination was 5~25.5%. The persistence of anti HBs titer was statistically irrelevant to schedule. The seronegative rate after 5 years was statistically irrelevant to anti HBs titer after basic immunization.

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Clinical Features and the Associated Factors of Staphylococcal Scalded Skin Syndrome during the Recent 10 Years (최근 10년간 포도알균 열상 피부 증후군의 발생 양상과 관련인자 분석)

  • Park, Chan Hee;Na, Se Rin;Cho, Hyung Min;Yoo, Eun Jung;Jung, Kwon;Kim, Eun Young;Kim, Yong Wook;Kim, Kyoung Sim
    • Pediatric Infection and Vaccine
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    • v.15 no.2
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    • pp.152-161
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    • 2008
  • Purpose : Staphylococcal scalded skin syndrome (4S) is uncommon, but reports of 4S are on the increase during the recent years. The purpose of this study is to determine the clinical features and associated factors of 4S during the recent 10 years. Methods : We retrospectively reviewed the medical records and microbiologic results of 63 patients (27 neonates and 36 children) from January 1998 to December 2007. Results : Since 2003, the incidence of 4S has increased. The mean age of the patients was 16.3 months and the gender ratio was 1:1. The clinical types of 4S were 38 cases of the abortive type (60%), 19 cases of the intermediate type (30%) and 6 cases of the generalized type (10%). The culture results were 36 cases of Methicillin resistant S. aureus (MRSA), 4 cases of Methicillin sensitive S. aureus and 17 cases of no growth. The patients were treated with semi-synthetic penicillin. For the 9 patients who had MRSA isolated and who didn't improve with penicillin, they were treated with vancomycin instead of penicillin. All the patients had no complications. 4S abruptly increased in 2005, and especially in neonates, due to an MRSA outbreak at a local nursery room. The associated factors of 4S in neonates were hospitalization (27 cases), including nursery infection in 2005 (18 cases) and dermatitis (1 case). There was an unknown origin for some children, and the suggested factors for their infection were community acquired infection (24 cases), atopic dermatitis (9 cases) and hospitalization (3 cases). Conclusion : 4S has recently been increasing. The major associated factors of 4S are a history of hospitalization, an outbreak in a nursery room, atopic dermatitis and community acquired infection.

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Breeding of New Synthetic Egg Production Line in Domestic Chicken by Introducing Sex Linked Gene II. Selection of Superior Lines from Cross Breeding (성 감별 유전자를 도입한 다산계계통 신품종 육종에 관한 연구 II. 우량 교배조합 선발 시험)

  • 오봉국;손시환;조윤연
    • Korean Journal of Poultry Science
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    • v.20 no.1
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    • pp.1-9
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    • 1993
  • This study carried out to build up new synthetic egg production lines which had sex-linked gene for feather color sexing and also superior combining ability for producing the best commercial chicks. The closed flock breeding method was utilized to improve the general performances in the first experiment and combining ability for heterosis was tested for new synthetic line in the second experimental year. In order to test for the egg production ability in cross breeds synthetic lines, the crossing of B$\times$4 B$\times$C, two imported strains and two domestic strains as controls were compared for the general performances. There was on difference in mortality, body weight to 56 weeks of age. Sexual maturity was delayed about 10 days by comparing with other reports, except 153 days of the Manina White, but no difference among mating systems in this experiment. The hen housed egg production in B$\times$A, B$\times$C was 186.3, 191.3 respectively and it was better than the other controls, except ISA imported lines. The hen-day egg production of B$\times$A, B$\times$C was better than other controls, with 75.7%, 76.8% respectively. In the average egg weight, the B$\times$C cross breed was highest with 64.5g. As the sex of hatching chicks was identified by difference of feather color, the genetic composition of synthetic lines must be homogenized. The feather color of female chicks was brown and that of male was silver (99%), In conclusion, the egg production ability of B$\times$A, B$\times$C cross breeds was superior to the imported and domestic lines. Therefore, it suggest that the synthetic lines with sex-linked gene might be utilized for improving egg production performances.

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Diagnostic Accuracy of PET and MR for Detecting Liver Metastasis from Colorectal Cancer (대장-직장암의 간전이에서 FDG PET과 MR의 진단 성능)

  • Park, Eun-Kyung;Kang, Won-Jun;Eo, Jae-Seon;Lee, Dong-Soo;Chung, June-Key;Lee, Myung-Chul
    • Nuclear Medicine and Molecular Imaging
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    • v.40 no.5
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    • pp.249-256
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    • 2006
  • Purpose: Although computed tomography (CT) is widely used for diagnosing liver metastasis from colorectal cancer, diagnostic accuracy of CT is not satisfactory. Magnetic resonance (MR) imaging and F-18 FDG PET has been reported to be superior to CT. However, studies on direct comparison of PET and MR are scarce. We compared the diagnostic accuracy of FDG PET and MR in detecting liver metastasis from colorectal cancer. Materials and Methods: Among 363 colorectal cancer patients who underwent F-18 FDG PET (ECAT, Siemens-CTI, Knoxville; Gemini, Philips, Milpitas, U.S.), 26 patients (M:F=17:9, age=$62{\pm}11$) underwent MR to evaluate suspicious metastatic liver lesions. Finally, 35 liver lesions detected by CT from 26 patients were enrolled for analysis. PET and MR results were compared with pathologic reports, clinical findings or follow-up results. Results: Of the 35 lesions, 18 lesions (51.4%) were diagnosed as liver metastases, while remaining 17 (48.6%) as benign. The sensitivity and the specificity of PET were 94.4% and 94.1%, respectively, compared to 100% and 82.4% for MR. MR and PET was concordant in 30 lesions (85.7%: 17 metastatic (94.4%) and 13 benign (76.5%) lesions. ROC curve analysis revealed maximal SUV of 3.1 as the optimum standard in differentiating metastatic from benign liver lesions (AUC=0.897, p<0.001, sensitivity 83.3%, specificity 94.1%). For small lesions less than 1 cm ln diameter (n=20), diagnostic accuracy of PET was comparable to that of MR. Conclusion: F-18 FDG PET showed good diagnostic performance in detecting liver metastasis from colorectal cancer, which was comparable to MR.

Alterations of Regional Cerebral Blood Flow in Major Depressive Disorder (주 우울증 환자의 국소 뇌혈류 변화 연구)

  • Lee, Won-Hyoung;Chung, Yong-An;Seo, Ye-Young;Yoo, Ik-Dong;Na, Sae-Jung;Jung, Hyun-Suk;Kim, Ki-Jun
    • Nuclear Medicine and Molecular Imaging
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    • v.43 no.2
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    • pp.107-111
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    • 2009
  • Purpose: The authors analyzed how the regional cerebral blood flow(rCBF) findings of patients with major depression differ from the normal control, and our results were compared to previous reports. Materials and Methods: Twelve patients fulfilling DSM-IV criteria for major depression who were off all psychotropic medications for > 4weeks(male: 7, female: 5, age range: $19{\sim}52$ years, average age: $29.3{\pm}9.9$ years) and 14 normal volunteers(male: 8, female: 6, age range: $19{\sim}53$ years, average age: $31.4{\pm}9.2$ years) were recruited. Images of brain perfusion SPECT were obtained using Tc-99m ECD and patterns of the rCBF were compared between patients with major depression and the healthy control subjects. Results: The patients with major depression showed increase of the r-CBF in right lingual gyrus, right fusiform gyrus, left lingual gyrus, left precuneus, and left superior temporal gyrus, and showed decrease of r-CBF in right pons, left medial frontal gyrus, cingulate gyrus of left limbic lobe, cingulate gyrus of right frontal lobe, and cingulate gyrus of right limbic lobe compared to the normal control. Conclusion: The Tc-99m ECD brain perfusion SPECT findings in our study did not differ from the previously reported regional cerebral blood flow pattern of patients with major depression. Especially, decreased rCBF pattern typical to major depression patients in the right pons, left medial frontal gyrus, and cingulate regions was clearly demonstrated.

Physiological Ecology of parasitic Dinoflagellate Amoebophrya and Harmful Algal Blooms (기생성 와편모류 Amoebophrya의 생리 생태적 특성과 적조)

  • 박명길
    • The Sea:JOURNAL OF THE KOREAN SOCIETY OF OCEANOGRAPHY
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    • v.7 no.3
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    • pp.181-194
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    • 2002
  • Parasitism is a one-sided relationship between two organisms in which one benefits at the expense of the other. Parasitic dinoflagellates, particularly species of Amoebophrya, have long been thought to be a potential biological agent for controlling harmful algal bloom(HAB). Amoebophrya infections have been reported for over 40 species representing more than 24 dinoflagellate genera including a few toxic species. Parasitic dinoflagellates Amoebophrya spp. have a relatively simple life cycle consisting of an infective dispersal stage (dinospore), an intracellular growth stage(trophont), and an extracellular reproductive stage(vermiform). Biology of dinospores such as infectivity, survival, and ability to successfully infect host cells differs among dinoflagellate host-parasite systems. There are growing reports that Amoebophrya spp.(previously, collectively known as Amoebophrya ceratii) exhibit the strong host specificity and would be a species complex composed of several host-specific taxa, based on the marked differences in host-parasite biology, cross infection, and molecular genetic data. Dinoflagellates become reproductively incompetent and are eventually killed by the parasite once infected. During the infection cycle of the parasite, the infected host exhibits ecophysiologically different patterns from those of uninfected host in various ways. Photosynthetic performance in autotrophic dinoflagellates can be significantly altered following infection by parasitic dinoflagellate Amoebophrya, with the magnitude of the effects over the infection cycle of the parasite depending on the site of infection. Parasitism by the parasitic dinoflagellate Amoebophrya could have significant impacts on host behavior such as diel vertical migration. Parasitic dinoflagellates may not only stimulate rapid cycling of dissolved organic materials and/or trace metals but also would repackage the relatively large sized host biomass into a number of smaller dinospores, thereby leading to better retention of host's material and energy within the microbial loop. To better understand the roles of parasites in plankton ecology and harmful algal dynamics, further research on a variety of dinoflagellate host-parasite systems is needed.

Bee Venom Inhibits Angiogenesis by Decreasing HIF-1α Expression in HCT116 Cells (봉독의 HIF-1α 발현감소를 통한 혈관신생 억제효과)

  • Shin, Jae-Moon;Jeong, Yun-Jeong;Park, Kwan-Kyu;Choe, Jung-Yoon;Han, Sang-Mi;Lee, Kwang-Gill;Yeo, Joo-Hong;Chung, Il-Kyung;Chang, Young-Chae
    • Journal of Life Science
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    • v.22 no.1
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    • pp.41-48
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    • 2012
  • Bee venom (BV) has been used in medicine to treat a variety of diseases including arthritis, rheumatism, and various cancers. Recent reports indicate that BV has anti-angiogenic effects, but the precise molecular mechanism underlying the effects of BV against colorectal cancer remains to be elucidated. We examined the effects of BV and its major components (melittin and apamin) on tumor angiogenesis and found that BV significantly decreased protein levels of hypoxia-inducible factor-$1{\alpha}$ (HIF-$1{\alpha}$), an important factor involved in angiogenesis and tumor progression, in human colorectal carcinoma HCT116 cells. BV also suppressed the transcription of HIF-$1{\alpha}$ under hypoxia, leading to a decrease in the expression of vascular endothelial growth factor (VEGF), a major target gene of HIF-$1{\alpha}$. We also found that these effects were mainly elicited by apamin, but not melittin. BV specifically inhibited the phosphorylation of ERK1/2 without changing the total levels of this protein, but had no effect on kinases of p38/JNK and AKT. Our results suggest that BV may inhibit human colorectal cancer progression and angiogenesis by inhibiting HIF-$1{\alpha}$ and VEGF expression, thereby providing a novel potential mechanism for the anticancer action of BV.