• Journal of Korean Neurosurgical Society
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• 제55권4호
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• pp.195-199
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• 2014

Objective : Age is a strong predictor of mortality in traumatic brain injuries. A surgical decision making is difficult especially for the elderly patients with severe head injuries. We studied so-called 'withholding a life-saving surgery' over a two year period at a university hospital. Methods : We collected data from 227 elderly patients. In 35 patients with Glasgow Coma Score 3--8, 28 patients had lesions that required operation. A life-saving surgery was withheld in 15 patients either by doctors and/or the families (Group A). Surgery was performed in 13 patients (Group B). We retrospectively examined the medical records and radiological findings of these 28 patients. We calculated the predicted probability of 6 month mortality (IPM) and 6 month unfavorable outcome (IPU) to compare the result of decision by the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) calculator. Results : Types of the mass lesion did not affect on the surgical decision making. None of the motor score 1 underwent surgery, while all patients with reactive pupils underwent surgery. Causes of injury or episodes of hypoxia/hypotension might have affected on the decision making, however, their role was not distinct. All patients in the group A died. In the group B, the outcome was unfavorable in 11 of 13 patients. Patients with high IPM or IPU were more common in group A than group B. Wrong decisions brought futile cares. Conclusion : Ethical training and developing decision-making skills are necessary including shared decision making.

• 한국식품영양학회지
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• 제34권2호
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• pp.196-206
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• 2021

The main purpose of this study was to examine the correlation between the consumption of red ginseng-based 'SSR' for 30 days and the reduction in human fatigue, blood component changes, and immune cell activity in 35 human subjects. 'SSR' is composed of zinc oxide, folic acid, and D-α-tocopherol with red ginseng as the main component. According to the protocol criteria of the study, 35 subjects who understood the purpose of the study and signed an informed consent form were selected. The fatigue survey was conducted through a questionnaire, and after taking 'SSR', a decreased tendency of physical, mental, and neurosensory fatigue was observed. In hematological analysis, no significant changes were observed in the levels of WBC, RBC, and hemoglobin; however, AST (SGOT) and ALT (SGPT) levels were statistically significantly decreased. In immunological analysis, it was observed that the proliferative effect of T cells (CD3+CD4+) was greater than that of NK cells (CD16+CD56+). The collected data were subjected to t-test analysis using the SPSS 25.0 statistical program. The result from this study proposes that 'SSR' can be used as a functional food material as it reduces human fatigue and enhances immune function.

• Clinical and Experimental Pediatrics
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• 제51권3호
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• pp.225-232
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• 2008

The mission of National Health Screening Program for Infant and Children is to promote and improve the health, education, and well-being of infants, children, families, and communities. Although the term 'diagnosis' usually relates to pathology, a similar diagnostic approach applies to the child seen primarily for health supervision. In the case of health, diagnosis determines the selection of appropriate health promoting and preventive interventions, whether medical, dental, nutritional, educational, or psychosocial. Components of the diagnostic process in health supervision include the health 'interview'; assessment of physiological, emotional, cognitive, and social development (including critical developmental milestones); physical examination; screening procedures; and evaluation of strengths and issues. Open and informed communication between the health professional and the family remains the most significant component of both health diagnosis and health promotion. Families complete medical history forms at their health supervision visit. Family-friendly questionnaires, checklists, and surveys that are appropriate for the child's age are additional tools to improve and update data gathering. This type of information helps initiate and inform discussions between the family and the health professional. This article provides a comprehensive review of current National Health Screening Program for Infant and Children in Korea.

• 인삼문화
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• 제1권
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• pp.28-42
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• 2019

위대한 철학자이자 미적분을 발견한 수학자로 잘 알려진 라이프니츠(Gottfried Wilhelm Leibniz, 1646~1716)가 인삼에 대해 물었다는 사실은 거의 알려져 있지 않다. 유럽의 계몽주의를 열었던 라이프니츠는 왜 인삼에 관심을 가지게 되었을까? 이 글은 라이프니츠가 남긴 방대한 기록 속에서 인삼을 찾아내고, 개인적 생애와 당대의 지적 흐름을 엮어 그가 인삼에 관심을 갖게 된 경로를 추적한 작업이다. 16세기부터 유럽에서는 약물지와 같은 고대 그리스 텍스트의 재발견과 해외에서 들여온 새로운 식물들로 인해 본초학이 크게 발달하게 되었다. 같은 맥락에서 '구대륙' 중국에서 만병통치약으로 이름을 떨치던 인삼 또한 여행기 등을 통해 유럽에 소개되기 시작했다. 중상주의 기치 하에 유용한 약용식물에 대한 관심이 커 가던 유럽에서는 과학단체들을 중심으로 본격적으로 인삼에 대한 연구가 시작되었다. 라이프니츠는 그런 연구의 중심지였던 왕립학회와 프랑스 왕립과학원을 방문하고 학자들과 교류를 나누었으며 독일에 그와 같은 연구기관을 설립하는 것을 평생의 목표로 삼았다. 라이프니츠는 로마를 방문했을 때 예수회 선교사들과 긴밀하게 교류하는 기회를 갖게 되었다. 그 과정에서 중국에 대한 지적 호기심이 한층 더 깊어갔고, 그 맥락에서 인삼에 대한 관심도 커갔다. 라이프니츠는 그리말디, 부베 등 중국선교에서 핵심적인 활동을 했던 학자들과 인삼의 효능에 대한 정보를 주고받게 된다. 이 논문은 유럽의 계몽주의에서 전혀 주목받지 못했던 인삼이 17세기 말 유럽의 학문적 지형과 지식인들 사이의 교류, 중상주의적 해외팽창을 얽어내는 단초가 될 수 있음을 제시한 것이다.

• Journal of Chest Surgery
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• 제40권11호
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• pp.759-764
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• 2007

배경: 중증근무력증 환자의 약 10% 정도에서 흉선종이 동반된다. 흉선과 흉선종은 중증근무력증의 병태생리에 의미 있는 역할을 한다. 그러나 흉선 절제술 후 환자의 증상과 예후에 흉선종이 미치는 영향에 대해 아직 정립되어 있지 않은 실정이다. 흉선종이 중증근무력증 환자의 증상 관해에 미치는 영향에 대해 후향적으로 연구하였다. 대상 및 방법: 1992년 7월부터 2002년 12월까지 중증근무력증으로 확대 흉선절제술을 시행받은 100명의 환자를 대상으로 하였다. 흉선종군은 30명, 비흉선종군은 70명이었고, 두 군간의 수술 전후 Ossermann병기 변화를 비교하였다. 결과: 비흉선종군은 평균 나이가 34.7 ($12.7{\sim}47.7$)세였다. 그리고, 수술 전 Ossermann 병기는 평균 3.06이었고, 수술 우 평균 1.41로 감소하였다 흉선종군은 평균 나이가 50.9 ($37.3{\sim}64.5$)세였다. 그리고, 수술 전 Ossermann 병기는 평균 3.00이었고, 수술 후 평균 1.47로 감소하였다. 남자의 비율은 흉선종군보다 비흉선종군에서 더 높았다(35% vs 30%). 흉선종의 Masaoka 병기는 1기가 27명, 2기가 3명이었다. 흉선종군과 비 흉선종군 간의 Ossermann 병기 변화는 통계적으로 차이가 없었다(p=0.09). 결론: 흉선종의 유무는 흉선제거술을 시행받은 중증근무력증 증상의 관해나 호전에 영향이 없었다.

• 한국아프리카학회지
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• 제29권
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• pp.27-53
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• 2009

At the start of the new century, South Africa probably had the largest number of HIV-infected people of any country in the world. The only nation that comes close is India with a population of one billion people compared to South Africa's figure of 57 million. The tragedy is that this did not have to happen. South Africa was aware of the dangers posed by AIDS as early as 1985. In 1991, the national survey of women attending antenatal clinics found that only 0.8percent were infected. In 1994, when the new government took power, the figure was still comparatively low at 7.6 %. The 2004 figure which has been published is 26.5%. This article tracks the epidemic globally, in the region and in South Africa. I explain some of the basic concepts around the disease and look at what may happen with respect to numbers. The situation is bad, and the number of people falling ill, dying and leaving families will rise over next few years. This will impact on South Africa in a number of important ways. This article assesses the demographic, economic and social consequences of the epidemic. It disposes of a number of myths and present the real facts. The AIDS in South Africa is not related to individuals only. It warns that AIDS in Africa is becoming a community and systemic problem. The acuteness of the problem does not stem merely from the fact that communities are affected, or could even be wipe out by the end of this decade, but from the fact that AIDS will place incredible burdens and obligations upon medical services, health care and religious communities such as churches. The facts confront churches' mission with the important question: who is going to take care of all the patients and where? The reality is that people dying of AIDS will have to be cared for at home by relatives and friends. A further question that arises is whether our people are prepared for this. AIDS was considered to be a homo-plague and the hunt was on for a scapegoat in the light of the fatal implication of the disease. At present we are in the strategic phase where we all realize that it will be of no avail to scare people with the ominous threat of AIDS AIDS destroys the optimism of our achievement ethics. This exposure of the culture of optimism is also an exposure of the so-called 'human basic fear which accuses Christianity that their concept of sin is a damper on man's search for liberation and basic need to be freed from all Imitation. AIDS is also a test for our ecclesiastical genuineness and the sincerity of our mission sensibility. It poses the question: How unconditional is Christian love? Is there room for the AIDS sufferer in the community of believers, despite the fact he is an acknowledged homosexual? The question to put to the church is whether the community of believers is an exclusive to put to the koinonia which excludes homosexuals. They may be welcome on principle, but in actual fact are not acceptable to the church community. As South Africa enters the new century, it is clear that the epidemic is not having a measurable impact. However, the impact of AIDS is gradual, subtle and incremental. The author's proposal of what is currently most needed in South Africa is that the little things will make a difference. It's about doing lots of little things better at grassroots level, with the emphasis on doing. There are so many community, churches and NGOs initiatives worth building on and intensifying. One must not underestimate the therapeutic value of working together in small groups to overcome a problem

• 의료법학
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• 제15권1호
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• pp.335-373
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• 2014

한 자료에 의하면 2011년 미국의 의료비 지출 총액은 국내총생산의 약 18 퍼센트에 달하였으며, 그 비율은 다른 대다수 선진국의 두 배에 해당하는 것이었다. 그중 메디케어 비용은 전체 의료비의 21 퍼센트인 5540억 달러 였는데, 환자의 최후 6 개월에 들어간 의료비는 그 5540억 달러의 28 퍼센트 (전체 의료비의 5.9 퍼센트)인 1700억 달러에 달하였다. 이러한 말기의료의 고비용성은 어떤 사유에 기인하며, 그 해소 방안은 무엇인가. 지난 수십 년 간의 의료경제학적 연구는 말기의료가 일반적으로 공급민감성을 지니며 비용대비 효율성이 매우 낮다는 결론에 도달하였다. 의료서비스 공급의 양은 질병의 정도나 환자의 선호도와는 무관하고, 그보다는 의료서비스 공급자원에 민감하게 반응한다는 것이다. 이는 말기의료에서는 의료자원이 과용된다는 것을 의미한다. 한편 "더 많은 의료처치에 더 나은 효용"이라는 일반적인 추론과는 반대로, 많은 의료처치의 결과는 오히려 매우 부정적인 것이었다. 실제 환자들의 선호와 관심사는 격렬한 말기의료가 기도하는 것과는 아주 달랐던 것이다. 이 논문은 먼저 말기의료에서의 공급민감성의 원인을 분석한다. 그 원인으로는 격렬한 치료와 그 효용성에 대한 일반적인 오해, 의사들의 환자에 대한 직업적인 사명의식, 환자 자신의 말기의료 의향결정의 부재, 의사들의 법적 책임에 대한 우려, 의료기관의 경영차원에서의 관리전략 등을 들 수 있다. 다음으로, 논문에서는 말기의료의 공급민감성에서 연유하는 과잉진료에 대한 현실적 해결책을 제시한다. 그 해결책은 두 가지 측면으로 나누어서 들 수 있는데, 하나는 사전의료의향서 제도의 활성화 방안이고, 다른 하나는 의료기관 경영관리전략적 관점에서의 방안이다. 우선 사전의료의향서의 활용도를 제고하기 위해서 다음과 같은 구체적 노력이 필요하다. 즉 의사들의 말기의료에 대한 태도를 바꾸도록 하는 새로운 의료윤리 교육 실시, 의사와 환자 간 말기의료에 대한 소통 기회의 강화, 환자와 말기의료에 대한 대화를 적극적으로 실천하는 의사에 대한 보상제도 도입, 일반 공공에 대한 관련 교육 확대, 온라인 등록시스템과 같은 용이하고도 공식적인 사전의료의향서 등록체제의 구축 확대 등이 필요하다. 경영관리적 측면에서는 대체 전략이 필요하다. 예컨대 불필요한 비용을 절감하고 의료공급자로서의 가치를 재정립하는 등의 새로운 재무전략과 경영교육계획 등이 고려되어야 할 것이다. 효과적으로 말기의료의 경제적 문제점을 해소하고 환자에게 더 나은 의료경험을 제공하기 위해서는 의료 환자 국가 등 모든 부문에서 관행과 오해에서 비롯된 신조가 시급히 수정되어야 하고, 그 기초 위에서 제도와 문화가 개선되어야 하는 것이다.

• 지역사회간호학회지
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• 제10권2호
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• pp.455-466
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• 1999

Western missionary nurses practiced in Korea from 1891. and the first trial to begin missionary public health nursing service in 1909 could not put into practice for short of nursing staff and budget. The main focus of missionary medical practice was not in public health program but in the management of missionary hospitals. A few of missionary western R.N. tried district nursing in 1910s. but their activities were personal and focused on the rescue of poor and sick patients. In 1917 the North American Methodist Church dispatched R.N. Elizabeth S. Roberts to begin district nursing in Korea. Roberts began maternal and child district nursing service. Her service was focused on teaching the method of bringing up children. bathing service, and home visiting for delivery. She could not but stop district-nursing service in 1918 to serve for a hospital in Siberia. The North American Methodist Church dispatched a few of R.N. to Korea in early 1920s and the missionary public health nursing of Korea could be activated. R.N. E. T. Rosenberger began public health nursing program in Seoul with Korean graduate nurse, Shin-gwang Han, and missionary M.D. Hall. Their public health nursing program was focused on maternal and childcare. They did home visiting in the morning, and served at a well baby clinic in the afternoon. The first baby competition began in 1925. and contributed to the teaching the method of bringing up children. They expanded public health nursing activity to school health nursing and milk station. Their public health nursing program was such a success that In 1929 Severance hospital. Eastgate Hospital. Taehwa Social Evangelistic center organized Seoul Child Health Union. Maren P. Bording, another missionary R.N. and midwife dispatched by the North American Methodist Church began public health nursing program at Kongjoo in 1924. Her program was focused on the maternal and childcare and close to that of Seoul. She started the first milk station in Korea in 1926. As she was a midwife and could get M. D. license in Korea, her program was more focused on maternal care than that of Seoul. The first day nursery school in Korea and the first graduate course for public health nursing in Korea began at Kongjoo in 1930. As the city of Choongcheongnam Province moved from Kongjoo to Daejeon in 1932, missionary public health nursing service in Kongjoo extended to Daejeon. There were lots of public health nursing program in Korea in 1920s and 1930s by missionary western nurses and Korean nurses. There were 13 missionary public health-nursing center in Korea in 1932. But in the late 1930s. Japan extended colonial war and drove out western missionaries. The missionary service in Korea was daunted. and the missionary public health nursing service could not but shrink.

• 정보관리학회지
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• 제30권4호
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• pp.265-281
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• 2013

우리나라 초기 개신교 선교사에 대한 역사는 19세기 말 쇄국정치가 막을 내리고 서구문명에 대한 문이 열리면서 외국인 선교사들이 의사 혹은 교사 등의 전문가 신분으로 들어와 활동하면서 시작되었다. 이러한 선교사들의 기록물은 단순한 종교적인 가치를 넘어 우리나라 근대 역사, 정치, 경제, 사회를 새로운 시각으로 조명할 수 있는 중요한 사료로 평가되고 있다. 하지만 초기 선교사 자료의 역사적인 가치는 인정하면서도 이러한 자료를 수집하고 보존하며 접근을 용이하게 할 수 있는 정책이나 방안에 대한 체계적인 시도는 현재까지 매우 미비한 것으로 나타나고 있다. 보고서, 서적, 정기간행물, 일기, 편지, 사진 등의 다양한 형태를 띠고 있는 초기선교사 자료는 현재 이들을 파송한 선교회, 신학대학, 정부기관, 도서관, 박물관, 연구소, 선교사 가족 등에 산재되어 있는 실정이다. 이에 본 연구는 이러한 초기 외국인 선교사 자료에 대한 현황조사 및 전문가 심층면담을 통해 이들 자료의 아카이브 현황과 향후 체계화된 디지털 아카이브 시스템 구축에 필요한 기초 자료를 제공하는데 목적이 있다. 본 연구의 범위는 우리나라에 개신교 선교사가 처음 들어오기 시작한 1800년대부터 일본강점기 이전 1910년으로 제한하였다.

• 대한간호학회지
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• 제24권4호
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• pp.696-705
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• 1994

This study was done to provide a basis for home health care management for women following Cesarean delivery. Furthermore it was initiated as an possible application of home health care in the future. In this study, client selection criteria was developed by the researcher and assessment tools for home health care, recording system and problem oriented recording system were revised from Jun's(1993) methods. The selection criteria tool for home health care for women who had a Cesarean delivery was structured and consisted of five areas : physical status, functional status, psychological-emetional status, educational needs status and environmental status. The structured assessment tool consisted of general items, obstetric history, past medical history, methods of feeding, medications taken before ad-mission, laboratory results, discharge instructions, discharge medications, family tree, economic status, environmental status, a map, health assessment of women and their newborns. The visit note consisted of the date : nursing problems : nursing process including initial assessment : nursing goals : visit plan : health status of the postpartum women and their newborn : nursing diagnoses : nursing implementation evaluation : summary : next visit plan and revision. The problem oriented recording system consisted of the date, problem numbers, nursing diagnoses, problem appearance date, problem resolution date. The results of the research are as follows : The seven cases having had a Cesarean delivery were discharged on an average on the 5th day after the Cesarean birth. The total number of home visits was 13. According to Cordon's functional health patterns the total possible nursing diagnoses was 34 diagnoses for the methers and their newborns. Among the 34 diagnoses, there were 13 diagnoses in the health perception /management pattern, 7 in the psychosocial health perception / management pattern, 8 in the psychosocial self-perception, 2 in the nutrition / metabolism pattern of physical function, 2 in the knowledge deficit of newborn management, anxiety related to newborn management, knowledge deficit related to disease process of new-born, anxiety related to disease process of newborn anxiety related to prognosis of baby's condition, knowledge deficit related to newborn jaundice each appeared once. The changes in the number of nursing diagnoses was related to not the number of visits but to the number of nursing diagnoses decreasing. The con-tent of the home health care was categorized ac-cording to assessment, direct care, counseling, education, family care. The recommendation based on the results of this research are Home health care nurses for Cesarean postpartum women and their neonates requires comprehensive knowledge of pregnancy, delivery, and the postpartum period and of the neonate so that they can provide appropriate care and holistic views. Most of cases terminated after the second visit, this outcome may be related to the subjects being discharged on the 5th day after delivery. Therefore, study done with earlier discharge after delivery may have different outcome. It is very hard to assess psychological aspects that need follow-up and to develop communication channels.