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Issues and Considerations surrounding Revocation Physician's Medical License Arising from Criminal Offenses (의사의 형사범죄에 따른 면허취소처분의 쟁점과 고려사항)

  • Kim, Sung-eun
    • The Korean Society of Law and Medicine
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    • v.19 no.1
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    • pp.113-142
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    • 2018
  • In recent years, there have been opinions in which physicians are liable to the revocation of their medical license if they are sentenced to above a certain level for criminal charges regardless of the types of offenses. Accordingly, a revised bill of law was submitted in the National Assembly, and related discussions are thus expected to commence. Considering the morality and ethics or the level of the rule of law that the general public expects of physicians, as well as the license revocation system in other professional sectors, it is assessed that medical license revocation due to criminal convictions of physicians is appropriate to some degree. However, if a poorly devised system is established based on unrefined inferences or emotional judgements, unexpected side-effects are likely to arise. With regard to serious criminal acts that society generally perceives as unacceptable, it can be assessed that the revocation of physicians' licenses would appropriately protect the general public from threats. However, given the life-saving characteristics of high-risk medical practices, higher malpractice exposures, and social values, it is difficult to assess charges of professional negligence resulting in death(or in injury) and minor offences in the same manner as anti-social criminal offences are handled. Physicians need to be treated the same as any other professions. At the same time, they are engaged in administering medical treatment to patients in the face of great risks as professionals. Under the circumstances, a discussion on the introduction of a more specific and empirical system is needed by considering the intrinsic characteristics of medical treatment and the need for an equitable health and medical policy. Accordingly, based on the above judgment and perception, this study explores the code of ethics for physicians and medical license revocation related to criminal offences at home and abroad, and examines various legislative alternatives appropriate for the Republic of Korea. In doing so, the purpose of the study is to contribute to the development of a reasonable system for handling criminal offences by physicians.

Factors Influencing the Adoption of Location-Based Smartphone Applications: An Application of the Privacy Calculus Model (스마트폰 위치기반 어플리케이션의 이용의도에 영향을 미치는 요인: 프라이버시 계산 모형의 적용)

  • Cha, Hoon S.
    • Asia pacific journal of information systems
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    • v.22 no.4
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    • pp.7-29
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    • 2012
  • Smartphone and its applications (i.e. apps) are increasingly penetrating consumer markets. According to a recent report from Korea Communications Commission, nearly 50% of mobile subscribers in South Korea are smartphone users that accounts for over 25 million people. In particular, the importance of smartphone has risen as a geospatially-aware device that provides various location-based services (LBS) equipped with GPS capability. The popular LBS include map and navigation, traffic and transportation updates, shopping and coupon services, and location-sensitive social network services. Overall, the emerging location-based smartphone apps (LBA) offer significant value by providing greater connectivity, personalization, and information and entertainment in a location-specific context. Conversely, the rapid growth of LBA and their benefits have been accompanied by concerns over the collection and dissemination of individual users' personal information through ongoing tracking of their location, identity, preferences, and social behaviors. The majority of LBA users tend to agree and consent to the LBA provider's terms and privacy policy on use of location data to get the immediate services. This tendency further increases the potential risks of unprotected exposure of personal information and serious invasion and breaches of individual privacy. To address the complex issues surrounding LBA particularly from the user's behavioral perspective, this study applied the privacy calculus model (PCM) to explore the factors that influence the adoption of LBA. According to PCM, consumers are engaged in a dynamic adjustment process in which privacy risks are weighted against benefits of information disclosure. Consistent with the principal notion of PCM, we investigated how individual users make a risk-benefit assessment under which personalized service and locatability act as benefit-side factors and information privacy risks act as a risk-side factor accompanying LBA adoption. In addition, we consider the moderating role of trust on the service providers in the prohibiting effects of privacy risks on user intention to adopt LBA. Further we include perceived ease of use and usefulness as additional constructs to examine whether the technology acceptance model (TAM) can be applied in the context of LBA adoption. The research model with ten (10) hypotheses was tested using data gathered from 98 respondents through a quasi-experimental survey method. During the survey, each participant was asked to navigate the website where the experimental simulation of a LBA allows the participant to purchase time-and-location sensitive discounted tickets for nearby stores. Structural equations modeling using partial least square validated the instrument and the proposed model. The results showed that six (6) out of ten (10) hypotheses were supported. On the subject of the core PCM, H2 (locatability ${\rightarrow}$ intention to use LBA) and H3 (privacy risks ${\rightarrow}$ intention to use LBA) were supported, while H1 (personalization ${\rightarrow}$ intention to use LBA) was not supported. Further, we could not any interaction effects (personalization X privacy risks, H4 & locatability X privacy risks, H5) on the intention to use LBA. In terms of privacy risks and trust, as mentioned above we found the significant negative influence from privacy risks on intention to use (H3), but positive influence from trust, which supported H6 (trust ${\rightarrow}$ intention to use LBA). The moderating effect of trust on the negative relationship between privacy risks and intention to use LBA was tested and confirmed by supporting H7 (privacy risks X trust ${\rightarrow}$ intention to use LBA). The two hypotheses regarding to the TAM, including H8 (perceived ease of use ${\rightarrow}$ perceived usefulness) and H9 (perceived ease of use ${\rightarrow}$ intention to use LBA) were supported; however, H10 (perceived effectiveness ${\rightarrow}$ intention to use LBA) was not supported. Results of this study offer the following key findings and implications. First the application of PCM was found to be a good analysis framework in the context of LBA adoption. Many of the hypotheses in the model were confirmed and the high value of $R^2$ (i.,e., 51%) indicated a good fit of the model. In particular, locatability and privacy risks are found to be the appropriate PCM-based antecedent variables. Second, the existence of moderating effect of trust on service provider suggests that the same marginal change in the level of privacy risks may differentially influence the intention to use LBA. That is, while the privacy risks increasingly become important social issues and will negatively influence the intention to use LBA, it is critical for LBA providers to build consumer trust and confidence to successfully mitigate this negative impact. Lastly, we could not find sufficient evidence that the intention to use LBA is influenced by perceived usefulness, which has been very well supported in most previous TAM research. This may suggest that more future research should examine the validity of applying TAM and further extend or modify it in the context of LBA or other similar smartphone apps.

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Estimation of Amount and Frequency of Consumption of 50 Domestic Livestock and Processed Livestock Products (국내 50가지 축산물 및 축산가공 식품의 섭취량 및 섭취빈도 조사)

  • Park, Jin Hwa;Cho, Joon Il;Joo, In Sun;Heo, Jin Jae;Yoon, Ki Sun
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.45 no.8
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    • pp.1177-1191
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    • 2016
  • Estimation of food consumption details, such as portion size and frequency of consumption, is needed for exposure assessment step in microbiological risk assessment. This study investigated the amounts and frequencies of 50 kinds of consumed livestock products. A quantitative survey was performed by trained interviewers in face-to-face interviews with 1,500 adults aged over 19, who were randomly selected from seven major provinces in Korea. Respondents received a picture of one serving size for each of the 50 livestock products, including meats, processed meat products, milk and dairy products, and eggs and processed egg products. A t-test and general linear model were carried out using SPSS statistics. The most important factor affecting consumption of livestock products was residence area. The most frequently consumed food was milk (2.6 times/week), followed by pork (1.4 times/week), liquid yogurt (1.3 times/week), rolled omelet (1.2 times/week), semisolid yogurt (1.0 times/week), steamed egg (1.0 times/week), ice cream (0.9 times/week), chicken (0.8 times/week), low fat milk (0.7 times/week), and beef (0.6 times/week). In the case of consumption amount, people living in a city consumed meat (beef, pork, chicken, and duck) 1.5 times more than those living in a village, whereas milk and dairy products and eggs and processed egg products were consumed more frequently by people living in a town. When people eat meat, they consume twice the amount of one serving size. Students consumed livestock and processed livestock products more frequently with greater portions all at once. People living in Seoul, Incheon/Gyeonggi, and Busan/Ulsan/Gyeongnam consumed livestock products more frequently in large amounts. Data from this study can be used for risk assessment of livestock and processed livestock products as well as education for safe consumption of livestock products.

Analysis of Epidemiological Characteristics, PFGE Typing and Antibiotic Resistance of Pathogenic Escherichia coli Strains Isolated from Gyeonggi-do (경기도에서 분리한 병원성대장균의 역학적 특성 및 PFGE, 항생제 내성 연구)

  • Kim, Kyung-A;Yong, Kum-Chan;Jeong, Jin-A;Huh, Jeong-Weon;Hur, Eun-Seon;Park, Sung-Hee;Choi, Yun-Sook;Yoon, Mi-Hye;Lee, Jong-Bok
    • Korean Journal of Microbiology
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    • v.50 no.4
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    • pp.285-295
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    • 2014
  • This study was conducted to survey the epidemiological characteristics and the isolated strains for pathogenic E. coli which was the major causative organisms for food poisoning occurred at school food services in the Gyeonggi-do area during the past three years. We investigated 19 accidents of food-borne disease outbreaks by pathogenic E. coli at school food services from 2010 to 2012. Food-borne disease outbreaks by pathogenic E. coli were usually occurred at direct management type (18 accidents, 95%) and high schools. For the seasonal factors, 13 accidents (65%) were occurred in June to September, especially the end of August and September after the summer holidays. The first patients were occurred on Wednesday (7 accidents, 37%) and Thursday (7 accidents, 37%), and they were mainly reported on Thursday (7 accidents, 37%) and Friday (5 accidents, 26%). The exposure of risk was estimated in Monday (4 accidents, 21%), Tuesday (7 accidents, 37%) and Wednesday (4 accidents, 21%), and kimchi (5 accidents, 50%) was estimated as the food of the high risk responsible for the outbreaks. 98 isolates of pathogenic E. coli consisted of PEC (50%), ETEC (34%), EAEC (15%), and EHEC (1%). The antibiotic resistance of pathogenic E. coli showed in the descending order of ampicilline (40%), nalidixic acid (37%), trimethoprim/sulfamethoxazole (24%), and tetracycline (19%). The antibiotics of second and third generation cephalosporins, cabarpenem, aminoglycosides, and second generation quinolones had antimicrobial susceptibilities and cefalotin, ampicillin/sulbactam and chloramphenicol showed medium resistance at 29%, 25%, and 6% respectively, and 70% of isolates were resistant to more than one antibiotic. By the PFGE analysis, they were classified into nine major groups and 31 profiles with 57% pattern similarity. It was very difficult to find the correlation of antimicrobial susceptibilities and genotype in the small scale-food poisoning, but the similarity of antimicrobial resistance and PFGE patterns in the large scale-food poisoning enabled the outbreaks to estimate the same pathotype of E. coli derived from identical origins.

The Clinical Significance and Detection of Intraperitoneal Micrometastases by $ThinPrep^{(R)}$ Cytology with Peritoneal Lavage Fluid in Patients with Advanced Gastric Cancer (진행성 위암 환자에서 복강 내 미세전이 진단을 위한 복강 세척액 $ThinPrep^{(R)}$ 세포진 굄사의 임상적 의의)

  • Ryu, Chun-Kun;Park, Jong-Ik;Min, Jae-Seok;Jin, Sung-Ho;Park, Sun-Hoo;Bang, Ho-Yoon;Chae, Gi-Bong;Lee, Jong-Inn
    • Journal of Gastric Cancer
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    • v.8 no.4
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    • pp.189-197
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    • 2008
  • Purpose: Peritoneal lavage cytology is regarded as a useful diagnostic test for detecting intraperitoneal micrometastsis. However, there are currently no reports about cytological examination with $ThinPrep^{(R)}$ (CY), a newly introduced fluid-based diagnostic system, in patients with advanced gastric cancer (AGC). This study was performed to analyze the clinical significance of intraoperative peritoneal lavage for CY in AGC patients. Materials and Methods: 424 AGC patients were suspected to have serosal exposure macroscopically during surgery and they underwent intraoperative peritoneal lavage for CY between 2001 and 2006 at Korea Cancer Center Hospital. The clinical data, pathological data and CY results were collected and analyzed retrospectively. Results: The percentage of cytology positive results was 31.1%, and this was well correlated with the T-stage, N-stage and P-stage. The 3-year survival rates of CY0 and CY1 were 68.1% and 25.9%, respectively. According to the P-stage and CY, the 3-year survival rates were 71.1% in P0CY0, 38.9% in P0CY1, 38.5% in P1/2/3CY0 and 11.0% in P1/2/3CY1. Interestingly, both the P0CY1 and P1/2/3CY0 survival curves were similar figures, but they were significantly different from those of the other groups. Multivariate analysis indicated that CY was an independent, strong prognostic factor for survival, as well as sex, the T-stage, N-stage, P-stage, other metastasis and the serum CEA. CY1 was revealed as a risk factor for peritoneal recurrence in the curative resection group. Conclusion: The results certify indirectly that cytological examination using $ThinPrep^{(R)}$ is a very reliable diagnostic method for detecting intraperitoneal micrometastasis from the fact that it is not only a strong prognostic factor, but it is also a risk factor for peritoneal recurrence in AGC patients. Therefore intraoperative peritoneal lavage should be included in the routine intraoperative staging workup for AGC, and its result will provide a good target for the treatment of peritoneal micrometastasis.

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Serum HBsAg and Anti-HBs Positive Rate among a City Health Center Visitors (일개 도시 보건소 이용자들의 혈청 HBsAg 및 Anti-HBs 양성률)

  • Shin, Mal-Sook;Hwang, Tae-Yoon;Kim, Chang-Yoon
    • Journal of Preventive Medicine and Public Health
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    • v.30 no.3 s.58
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    • pp.508-517
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    • 1997
  • Hepatitis B virus(HBV) infection is one of the major health problems in Korea and HBsAg positive rate was known to be about $5\sim15%$ in general population. This study was conducted to identify the positive rates of serum HBsAg and anti-HBs among community population regarded as having hish HBV vaccination rate than in previous decade, using EIA(Enzyme immunoassay) method, in Seo-Gu, Taegu, Korea. The study subjects were 1,160 who visited Seo-Gu Health Center for check-up serologic markers of hepatitis 3. The data were obtained from the serologic test for hepatitis markers and questionnaire survey was conducted to obtain the general characteristics, vaccination history, past history of hepatitis and other liver disease, and exposure history to risk factors of hepatitis of the study subjects. The positive rates of HBsAg and anti-HBs were 5.2% and 62.4% respectively. The positive rates of HBsAg for male and female were 6.6% and 4.3% respectively. The age was divided into two groups as group I (less than 15 years old), group II (more than 16 years old) according to the hypothesis that these two groups might be different in HBV vaccination rate. HBV vaccination rates for group I and II were 83.1% and 52.3%. The positive rates of HBsAg for group I and II were 2.6% and 6.5%. The positive rates of HBsAg for the vaccinated people of the group I and II were 2.2% and 3.5%, the positive rates of anti-HBs for the vaccinated people of the group I and II were 70.1% and 71.1% respectively. The most significant factor in positive rate of HBsAg was 'hepatitis carrier in family'. Multiple logistic regression analysis revealed that 'hepatitis history' and 'hepatitis carrier in family' were significant variables for positivity of HBsAg, and 'hepatitis B vaccination' was only a significant variable for positivity of anti-HBs.

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Monitoring and Safety Assessment of Pesticide Residues and Sulfur Dioxide on Functional Rice Products (기능성 쌀의 잔류농약 및 이산화황 안전성 실태조사)

  • Lee, You-Jin;Park, Myung-Ki;Kim, Ki-Yu;Park, Eun-Mi;Kang, Heung-Gyu;Lim, Ji-Hyun;Cho, Wook-Hyun;Kim, Youn-Ho;Lee, Sun-Young;Yong, Kum-Chan;Yoon, Mi-Hye
    • Journal of Food Hygiene and Safety
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    • v.32 no.6
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    • pp.493-499
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    • 2017
  • This study was conducted to monitor the current status of pesticide residues and sulfur dioxide in a total of 91 functional rice products from February to October 2016. Multi class pesticide multiresidue methods of 220 pesticides was performed by the GC/ECD, GC/NPD, GC/TOF/MS, LC/PDA, and LC/FLD. As a result of analysis, the pesticides were detected in 3 samples, representing a detection rate of 3.3%. The kind of pesticides was propiconazole and isoprothiolane used for germicide in agriculture or plant growth regulator purposes. The detected levels were 0.0340~0.0566 mg/kg, which were under the MRL (Maximum Residues Limits). The contents of sulfur dioxide in 91 samples by the Monier-Williams method were not detected. Risk assessment of pesticides evaluated using human health exposure with the ratio of EDI (Estimated daily intake) to ADI (Acceptable daily intake). %ADI (the ratios of EDI to ADI) were 0.24~1.25% with safety level.

Evaluation of the Usefulness for VMAT of multiple brain metastasis using jaw tracking (Jaw tracking을 이용한 다발성 뇌 전이의 용적세기조절회전치료에 대한 유용성 평가)

  • Kim, Tae Won;Yoo, Soon Mi;Jeon, Soo Dong;Yoon, In Ha;Back, Geum Mun
    • The Journal of Korean Society for Radiation Therapy
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    • v.30 no.1_2
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    • pp.73-81
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    • 2018
  • Purpose : The aims of this study were to compare and assess the effectiveness of Volumetric Modulated Arc Therapy(VMAT) using jaw tracking(JT) and fixed jaw(FJ) in radiation therapy of multiple brain metastasis. Methode and material : Among the patients with Multiple Brain Metastasis treated with jaw tracking, 10 patients with more than 6 tumors and with the size of radiation field $14{\times}14cm^2$ or more were included. Each Treatment plans with jaw tracking(JT) and fixed jaw(FJ) was established with Eclipse (Ver. 13.6 Varian, USA). Gamma Index (3 mm, 3 % confidence interval - 95 %) and maximum dose difference were measured with an electronic portal imaging device(EPID). The $D_{max}$ and $D_{mean}$ of Organ At Risk(OAR) were assessed and compared, and the Conformity Index(CI) and Homogeneity Index(HI) were evaluated. Result : Evaluating jaw tracking(JT) and fixed jaw(FJ) outcomes, in all cases, Gamma Index met the permissible standard of 3 mm, 3 % confidence intervals of 95 %. The maximum dose difference value from the areas with leaf end transmission was measured at a maximum of 98.4 % and an average of 43.6 % in clockwise(CW), and 67.9 % and 41.0 % for each in Counter-Clockwise(CCW). With jaw tracking, the maximum value of $D_{max}$ for each normal organ in OAR decreased in 15.36 %~74.59 % with the average value decreasing in 2.84 %~39.80 %. The maximum value of $D_{mean}$ in OAR decreased in 27.90 %~65.23 %, with the average value decreasing in 7.70 %~41.71 %. No change has been found in Conformity Index and Homogeneity Index values. Conclusion : When Jaw tracking is used in treating patients with multiple brain metastasis with VMAT, the unnecessary exposure due to leakage and transmission of radiation in unspecified areas was reduced, without affecting the dose distribution of the planning target volume(PTV), and the availability of radiation therapy with lower doses in normal organs is expected.

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Clinical Experience of Three Dimensional Conformal Radiation Therapy for Non-Small Cell Lung Cancer (비소세포성 폐암에서 3차원 입체조형 방사선 치료 성적)

  • Choi Eun Kyung;Lee Byong Yong;Kang One Chul;Nho Young Ju;Chung Weon Kuu;Ahn Seung Do;Kim Jong Hoon;Chang Hyesook
    • Radiation Oncology Journal
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    • v.16 no.3
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    • pp.265-274
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    • 1998
  • Purpose : This prospective study has been conducted to assess the value of three dimensional conformal radiation therapy (3DCRT) for lung cancer and to determine its potential advantage over current treatment approaches. Specific aims of this study were to 1) find the most ideal 3DCRT technique 2) establish the maximum tolerance dose that can be delivered with 3DCRT and 3) identify patients at risk for development of radiation pneumonitis. Materials and Methods : Beginning in Nov. 1994, 95 patients with inoperable non-small cell lung cancer (stage I; 4, stage II; 1, stage IIIa; 14, stage IIIb; 76) were entered onto this 3D conformal trial Areas of known disease and elective nodal areas were initially treated to 45 Gy and then using 3DCRT technique 65 to 70 Gy of total dose were delivered to the gross disease. Sixty nine patients received 65 Gy of total dose and 26 received 70 Gy Seventy eight patients (82.1$\%$) also received concurrent MVP chemotherapy. 3DCRT plans were compared with 2D plans to assess the adequacy of dose delivery to target volume, dose volume histograms for normal tissue, and normal tissue complication Probabilities (NTCP). Results : Most of plans (78/95) were composed of non-coplanar multiple (4-8) fields. Coplanar segmented conformal therapy was used in 17 pateints, choosing the proper gantry angle which minimize normal lung exposure in each segment. 3DCRT gave the full dose to nearly 100$\%$ of the gross disease target volume in all patients. The mean NTCP for ipsilateral lung with 3DCRT (range; 0.17-0.43) was 68$\%$ of the mean NTCP with 2D treatment planning (range; 0.27-0.66). DVH analysis for heart showed that irradiated volume of heart could be significantly reduced by non-coplanar 3D approach especially in the case of left lower lobe lesion. Of 95 patients evaluable for response, 75 (79$\%$), showed major response including 25 (26$\%$) with complete responses and 50 (53$\%$) with partial responses. One and two rear overall survivals of stage III patients were 62.6$\%$ and 35.2$\%$ respectively. Twenty percent (19/95) of patients had pneumonitis; Eight patients had grade 1 pneumonitis and 11 other patients had grade 2. Comparison of the average of NTCP for lung showed a significant difference between patients with and without radiation pneumonitis. Average NTCP for Patients without complication was 62$\%$ of those with complications. Conclusions : This study showed that non-coplanar multiple fields (4-8) may be one of the ideal plans for 3DCRT for lung cancer. It also suggested that 3DCRT may provide superior delivery of high dose radiation with reduced risk to normal tissue and that NTCP can be used as a guideline for the dose escalation.

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The Content and Risk Assessment of Heavy Metals in Herbal Pills (유통 환제의 유해 중금속 함량 및 위해도 평가)

  • Lee, Sung-Deuk;Lee, Young-Ki;Kim, Moo-Sang;Park, Seok-Ki;Kim, Yeon-Sun;Chae, Young-Zoo
    • Journal of Food Hygiene and Safety
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    • v.27 no.4
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    • pp.375-387
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    • 2012
  • The objective of this study is investigation of contamination levels and assessment of health risk effects of heavy metals in herbal pills. 31 Items and 93 samples were obtained for this investigation from major herbal medicine producing areas, herbal markets and on-line supermarkets from Jan to Jun in 2010. Inductively coupled plasma mass spectrometer method was conducted for the quantitative analysis of Pb, Cd and As. In addition, the mercury analyzer system was conducted for that of Hg without sample digestion. The average contents of heavy metals in samples were as follows : 0.87 mg/kg for Pb, 0.08 mg/kg for Cd, 2.87 mg/kg for As and 0.16 mg/kg for Hg, respectively. In addition, the average contents of heavy metals in different parts of plants, including cortex, fructus, herba, radix, seed, algae and others were 0.63 mg/kg, 3.94 mg/kg, 1.42 mg/kg, 1.05 mg/kg, 0.16 mg/kg, 22.31 mg/kg and 10.17 mg/kg, respectively. After the estimations of dietary exposure, the acceptable daily intake (ADI), the average daily dose (ADD), the provisional tolerable weekly intake (PTWI) and the relative hazard of heavy metals were evaluated. As the results, the relative hazards compared to PTWI in samples were below the recommended standard of JECFA as Pb 3.1%, Cd 0.9%, Hg 0.5%. Cancer risks through slope factor (SF) by Ministry of Environment Republic Korea and Environmental Protection Agency was $4.24{\times}10^{-7}$ for Pb and $3.38{\times}10^{-4}$ for As (assuming that the total arsenic content was equal to the inorganic arsenic). Based on our results, possible Pb-induced cancer risks in herbal pills according to parts used including cortex, fructus, herba, radix, seed, algae and others were $1.95{\times}10^{-7}$, $1.45{\times}10^{-6}$, $2.14{\times}10^{-7}$, $6.27{\times}10^{-7}$, $1.99{\times}10^{-8}$, $3.61{\times}10^{-7}$ and $9.64{\times}10^{-8}$, respectively. Possible As-induced cancer risks in herbal pills by parts used including cortex, fructus, herba, radix, seed, algae and others were $1.54{\times}10^{-5}$, $7.24{\times}10^{-5}$, $1.23{\times}10^{-4}$, $2.02{\times}10^{-5}$, $3.25{\times}10^{-6}$, $2.18{\times}10^{-3}$ and $5.67{\times}10^{-6}$ respectively. Taken together, these results indicate that the majority of samples except for some samples with relative high contents of heavy metals were safe.