• The Korean Society of Law and Medicine
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• v.23 no.1
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• pp.37-80
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• 2022

By analyzing informed consent and the refusal of emergency medical treatment (called patient dumping) under the current Emergency Medical Service Act, this study suggests that an emergency medical professional is only liable for patient dumping if their duty to protect the patient's life takes precedence over the patient's right to self-determination. In emergency medical situations, as in general medical situations, medical treatment should be performed after the emergency medical professional informs the patient about the medical treatment, including its necessity and methods, and obtains consent from the patient. Refusing or evading the performance of emergency medical services on the excuse of the informed consent not considering a waiver or alteration of informed consent requirements without reasonable reasons violates the Emergency Medical Service Act and thus makes an emergency medical professional liable to administrative disposition or criminal penalty. In other words, depending on the existence of a waiver of alteration of the informed consent, patient dumping may be established. If the patient is a minor or has no decision-making ability, and their legal representative makes a decision against the patient's medical interests, the opinion of the legal representative is not unconditionally respected. A minor also has the right to decide over their body, and the decisions of their legal representatives should be in the patient's best interests. If the patient refuses treatment, in principle, the obligation of life protection of emergency medical professionals is the top priority. However, making these decisions in the aforementioned situations in the emergency medical field is difficult because of the absence of explicit regulations regarding these exceptional problems. This study aims to organize the following precedents of the Supreme Court of Korea. The court states that, when balancing the conflicting interests between the duty to provide emergency medical service and the duty to inform is unavoidable for emergency medical professionals, they should put the duty to protect the patient's life ahead of the duty to inform if the patient's life matters. Exceptionally, when a patient has seriously considered whether they should receive treatment before the emergency medical situation, their right to self-determination can be considered equal to the obligation of emergency medical professionals to provide emergency medical treatment. This research also suggests that an amendment of the Emergency Medical Service Act should include the following. First, the criteria for determining the decision-making ability of emergency patients should consist of medical content. Second, additional consent from a medical professional is unnecessary for first-aid treatment. Finally, new provisions for emergency medical obligations for minors, new provisions for the decision standard when there are conflicting opinions about the treatment of a patient, and new penalty provisions for professionals who suspend emergency medical examinations and treatments need to be established.

• The Journal of Korean Medical History
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• v.33 no.2
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• pp.45-65
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• 2020

This study interprets the records of Bianque (醫案) as a medicine practice rather than a simple legend or story, and analyzes its effect on the development of oriental medicine. It also compares aspects of the Bianque related to patient treatment as described in 『韓非子』, 『韓詩外傳』, 『史記』, and reinterpreted using other contemporary literature. The clairvoyant power of 『史記』 「扁鵲傳」 was created by Sama-Cheon(司馬遷) exaggerating the pulse diagnosis with clairvoyance. The contents of the treatment of Sogan-Ja(趙簡子)'s confusion affairs in the first agenda, show that Bianque master the pulse diagnosis. The contents of the treatment of Kwek-Seja(虢世子)'s disease in the second agenda is a record of knowledge of acupuncture using acupuncture points. The content of refusal of treatment in the third agenda, 腠理, 肌膚, 腸胃, 骨髓 and the progression of the disease and the corresponding treatment of 湯熨, 鍼石, 火齊 are specified in detail. From the content of Bianque, he was not a martial art, but a doctor who practiced medicine, and contributed to the development of the pulse diagnosis.

• Journal of East-West Nursing Research
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• v.20 no.2
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• pp.93-102
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• 2014

Purpose: This study aimed to investigate the characteristics of patients attempting suicide and to analyze treatment determination factors for patients with mental illness who go to an emergency center for treatment. Methods: Data collected from 117 suicide attempters who visited Busan Regional Emergency Medical Center were analyzed using frequency, percentage, ${\chi}^2$-test with SPSS/WIN 15.0. Results: Only 31 cases consulted with the psychiatric department; the other attempters' refused to consult (26.5%). Among the 31 attempters who consulted, 23 cases (74.2%) were suffering from depression. The most common reason (38.6%) suicidal attempters gave to refuse psychiatric treatment was "I'm not mad. I don't need the psychiatric treatment". Treatment determination factors for mental illness were religion (p<.001), past history (p=.017), financial satisfaction (p=.048), previous history of suicidal attempts (p=.006), sleep disturbance (p<.001), expression of suicide (p=.010), and type of leaving the emergency room (p=.020, p<.001). Conclusion: Results suggest that people frequently misunderstand psychiatric treatment which leads to their refusal to accept psychiatric treatment. Therefore hospitals need to develop standard guidelines and procedures for suicidal attempters with the collaboration of emergency and psychiatry departments. In addition, medical teams need to provide attempters appropriate information and encourage them to actively seek psychiatric treatment.

• Journal of Korean Academy of Nursing Administration
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• v.13 no.4
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• pp.462-472
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• 2007

Purpose: Purpose of the this study is to define the hemodialysis noncompliance Indicators and discriminant standards levels for low Flux Hemodialysis patients and development of Hemodialysis noncompliance measurement - brief form. Method: Data was collected from 269 hemodialysis patients. To establish the hemodialysis noncompliance Indicators and to discriminate standards, 13 hemodialysis nurses and 2 nephrology doctors are participated in professional group. To verify the indicators and discriminant standards, data was ananlyzed by the canonical discriminant analysis method using by SAS 8.3 program. Result: 4 Indicators- interdialysis weight gain(IWG); average of recent 4weeks, serum phophate level, skipping of hemodialysis and hemodialysis time shortening without permission- of hemodialysis noncompliance are established and discriminant standards are developed. Discriminant ability of these 4 noncompliance indicators is 99.7%(p=.000). Hemodialysis noncompliance measurement - brief form has 96.3% discriminant accuracy. Conclusion: Hemodialysis noncompliant patients have high risks. It means that special intervention to noncompliance is needed. Also continuous and objective assessment and standards of noncompliance are needed.

• Clinical and Experimental Pediatrics
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• v.60 no.12
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• pp.379-384
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• 2017

Feeding is an interaction between a child and caregiver, and feeding difficulty is an umbrella term encompassing all feeding problems, regardless of etiology, severity, or consequences, while feeding disorder refers to an inability or refusal to eat sufficient quantities or variety of food to maintain adequate nutritional status, leading to substantial consequences, including malnutrition, impaired growth, and possible neurocognitive dysfunction. There are 6 representative feeding disorder subtypes in young children: infantile anorexia, sensory food aversion, reciprocity, posttraumatic type, state regulation, and feeding disorders associated with concurrent medical conditions. Most feeding difficulties are nonorganic and without any underlying medical condition, but organic causes should also be excluded from the beginning, through thorough history taking and physical examination, based on red-flag symptoms and signs. Age-appropriate feeding principles may support effective treatment of feeding difficulties in practice, and systematic approaches for feeding difficulties in young children, based on each subtype, may be beneficial.

• Clinical and Experimental Pediatrics
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• v.48 no.2
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• pp.204-207
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• 2005

Ketogenic diet is a high-fat, low-carbohydrate, low-protein diet used in the treatment of epilepsy since 1920's. Recently, it's use for intractable epilepsy in childhood has increased. Complications of ketogenic diet are known to include dehydration, vomiting, diarrhea, renal stones, metabolic derangement, hypercholesterolemia and refusal to eat. We experienced two cases of renal stones in children with intractable epilepsy during ketogenic diet.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.22 no.3
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• pp.298-302
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• 2019

A previously healthy 2.5-year-old male child presented with vomiting, diarrhea, and fever. During hospitalization he developed odynophagia and refusal to eat. His symptoms did not respond to acid suppressant therapy. He underwent upper endoscopy which showed severe inflammation, ulcerations and abundant necrosis. Histopathological features and serological testing were consistent with herpetic esophagitis. He had no history of recurrent infections or history of sick contacts. His immunological work up showed normal level of immunoglobulins and his White Blood Cells subpopulations were normal. His HSV serology was positive. The patient was started on acyclovir 5 mg/kg q 8 hours. He resolved his symptoms within 24 hours of treatment.

• Archives of Plastic Surgery
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• v.32 no.3
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• pp.314-318
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• 2005

For treatment of full thickness skin defects caused by trauma or infections, skin grafts or flaps have been the treatment of choice to date. However, in patients who are not candidates for surgery, either due to his general conditions or refusal to receive treatment, supportive methods have been the only means of care, which inherently caused psychological trauma to the patient due to uncertainties of ultimate outcome and the length of treatment. This study aimed to heal full thickness skin defects through application of topical epidermal growth factor in patients who have received 2 to 3 weeks of conservative management using medifoam $B^{(R)}$ without improvement. Six patients from March 2002 to July 2004 were enrolled. The mean size of defects was $5.4{\times}4.6cm$ in 4 patients with carcinoma and $6.4{\times}4.1cm$ in 2 patients with osmidrosis. Commercially available 0.005% EGFR solution was used, and dressing was performed once daily. All patients benefitted from the use of EGF, with closure of skin defects taking an average of 28 days in cancer patients and 22.5 days in osmidrosis cases. EGF can be used as a supportive mean of treatment in the inoperable patients with skin defects, with resultant hastening of healing shortening duration of treatment.

• Journal of Korean Neurosurgical Society
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• v.29 no.8
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• pp.1050-1054
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• 2000

Objective : The incidence of head injury has been increasing in the rural area. The author investigated the clinical features and difficulties in care of the acute head-injured patients in this area. Method and Material : The authors performed a retrospective review of radiological data and clinical records in patients with mild to moderate head injury. Cause, type of craniocerebral injury, delayed intracranial lesions, complications, its relation to alcohol abuse, and outcome were analyzed. Results : In total of 68 cases, 20(29.4%) victims were associated with acute alcohol intoxication. Motor vehicle accident was the leading cause of head injury and the most common craniocerebral lesion was basilar skull fracture. Eight(11.8%) patients showed delayed radiological and clinical deterioration and 40(58.8%) were followed-up regularly after discharge. The subdural hygroma was commonly noted in the elderly and alcoholics. Causes of thirty events that resulted in an atypical and difficult neurosurgical practice were as follows : delayed admission, premature discharge against doctor's request, refusal of radiological studies and admission, misunderstanding of disease entity, and unreasonable desire of transfer to tertiary hospitals. Inaccurate initial diagnoses were made by emergency doctors in twenty patients. During the course of treatment, there were a few complications such as alcohol withdrawal, acute otitis media, cerebrospinal fistula, facial weakness, and posttraumatic seizure. Outcome was good in 60(88.2%) patients. Conclusion : Most of minor head trauma patients in this series have shown good results, but we have to consider some possible complications and delayed intracranial lesions in these patients that should be managed with special cautions with various kinds of treatment difficulties.

• Journal of Oriental Neuropsychiatry
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• v.28 no.4
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• pp.341-347
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• 2017

This case report presents a 31-year-old male intellectual disability patient with problem behavior such as food refusal and temper tantrums. He was treated with the Korean traditional herbal medicine (Yokukan-san-gami) continuously for 56 days. The effects of the treatment were measured by the frequency of his problem behavior and the score of the Korean version of Aberrant Behavior Checklist (ABC). After treatment, his challenging behavior became reduced, and his ABC score had been decreased by 24.6%. The findings from this case suggest that the Korean traditional herbal medicine (Yokukan-san) could be effective for challenging behavior in patients with intellectual disabilities.