• 대한간호학회지
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• 제30권4호
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• pp.1066-1077
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• 2000

The purpose of this study is to develop self-efficacy promotion program and to test its effects on self-efficacy, self-care, physiologic index of hemodialysis patients after applying this program to them. Preliminary study was carried out to identify the levels and types of self-care, self-efficacy of hemodialysis patients. To develop self-efficacy promoting program, several discussions with nursing professors and nurse specialists on hemodialysis patients were made after in-depth literature review on the area. Through these processes, the self-efficacy promoting program including 20 minutes long videotape and other counciling documents were completed. This videotape consisted of specific self-care techniques for hemodialysis patients including management of fistula, measurement of blood presure and body weight, special diets, medications, exercise and rest, management of physical problems and social adjustment. Two group equivalent pre and post test quasai-experimental research design was used in this study. The total subjects were 34 hemodialysis patients who received hemodialysis three time per week at 1 university hospital. Seventeen experimental group subjects were matched with control group subjects in sex and age. Data were analysed with the SPSS window program. Homogeniety between experimental and control group pretest data was tested by x$^2$ and t-test. There were no significanct differences in general characteristics, illness history, specific self-efficacy and self-care between the two groups. The differences of general self-efficacy of two groups were tested with the Repeated Measure ANCOVA because of significant differences of pretest data of general self efficacy between two groups. The differences of self-efficacy and self-care of two groups were tested with Repeated Measure ANOVA and the differences of physiologic indecies including blood potassium level and blood phosphorus level and interdialytic weight gain were tested by t-test. The results were as follows: 1. There was no significant difference in general self-efficacy between the two groups over four different time, and no interaction by groups and by time. 2. There was significant difference in specific self-efficacy between the two groups over four different time, and interaction by groups and by time. 3. There was significant difference in self-care between the two groups over four different time, and interaction by groups and by time. 4. There were no significant differences of blood potassium level and blood phosphorus level, but there was significant difference of interdialytic weight gain between the two groups. From the results above, it can be concluded that the self-efficacy promotion program for hemodialysis patients was effective to improve degree of specific self-efficacy and self-care and to decrease interdialytic weight gain. Considering results, the followings are recommended: 1) Repeated studies are needed for another hemodialysis patients. 2) This program can be used for improving degree of self-efficacy and self-care of hemodialysis patients by nurse practitioner and nurse educator.

• 대한약침학회지
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• 제4권3호
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• pp.109-117
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• 2001

Objective : There has been no known report on the pain shock after administering Korean bee-venom therapy. Three accounts of pain shock were observed at the Sangji university affiliated Oriental medicine clinic from July 2001 through September 2001. This thesis will inform clinical progression and cautions on administering Korean bee-venom therapy. Methods: We were able to witness different patterns of pain shock during the treatment of degenerative knee joint, progressive oral paralysis, and A.L.S. In order to reduce heat toxicity of the bee venom, needling points were first massaged with the ice for 10 minutes before injecting $0.1{\sim}0.2cc$ of the bee venom. Points of injection were ST36, LI11, LI4 and others. Pain shock occurred after injecting on inner xi-an, outer xi-an and LI4. The phenomena associated with pain shock was recorded in chronological order and local changes were examined. Results: Through examining 3 patients with the pain shock, we managed to observe clinical progression, duration, and time linked changes on specific regions. We also managed to determine sensitive needling points for the pain shock. Conclution: Following results were obtained from 3 patients with the pain shock caused by Korean bee-venom therapy from July 2001 to September 2001. 1. Either positive or negative responses were shown after the pain shock. For case 1, extreme pain was accompanied with muscular convulsion and tremble, ocular hyperemia, delirium, stiffening of extremities, and hyper ventilation which all suggest positive responses. For case 2 and 3, extreme pain was accompanied with facial sweating, asthenia of extremities, pallor face, dizziness, weak voice, and sleepiness which are the signs of negative responses. 2. The time required to recover to stable state took nearly an hour (including sleeping time) and there was no side effect. 3. Precautions required to prevent the pain shock includes full concentration from the practitioner, accurate point location, precise amount of injection, physiological condition and psychological stability of the patient 4. Coping with the pain shock should be similar with a needle shock, and since extreme pain is accompanied, sufficient psychological rest must be provided. 5. Pain shock occurs because the patient cannot tolerate stimulation on the needling point. Thus, symptoms were similar to the needle shock in addition to excruciating pain. Further investigation and research must be done to have better understanding of an immune response and the pain shock associated with Korean bee-venom therapy.

• 항공우주정책ㆍ법학회지
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• 제32권1호
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• pp.139-175
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• 2017

국회는 2017년 3월 30일 제조물책임법 일부개정법률안을 국회본회의에서 통과시켰다. 본 개정안에는 무엇보다 피해자인 소비자의 입증책임을 완화시키며 제조물책임의 배상책임을 3배까지 증액하는 신설조항이 있어서, 제조물책임관련 소송이 증대될 것이며, 제조물책임보험 가입이 증가할 것이다. 군용항공기 제작사는 군용항공기의 제작목적이 기동성 위주이며, 군의 작전성을 위주로 운용되기 때문에 현실적으로 군용항공기 제조사들이 군용항공기 제조물책임보험을 들 수 없는 현실 상황하에 군용항공기제작사는 제조물책임법과 하자담보책임, 채무불이행책임의 손해배상 위험에 직면하여 있다. 제조물책임법의 시원지인 미국은 1970년대 제조물책임법이 시행되게 되자, 군용항공기제작사의 책임한도에 대하여 학계, 법조계, 보험업계에서 큰 논란이 있었으며, 군용항공기 제작사의 책임문제를 해결하기 위하여, Government Contractor Defense (GCD, 정부계약자항변) 라는 법리를 판례로 만들어 냈다. 한국과 미국정부가 맺고 실제 적용하고 있는 Foreign Military Sales(FMS) 계약서에는 군용항공기제작사에 대한 면책조항이 있다. 군용항공기 제작사가 높은 제조물책임보험을 들 수 없고, 방산원가에도 제조물책임보험료를 반영시키지 않는 현실에서 외국의 수출을 확대하고 있는 군용항공기제작사는 위기 그 자체에 직면하고 있음을 정확히 알고, 시급히 이러한 위기를 해결할 수 있는 입법개정, 정책수립을 하여야만 한다.

• 의료법학
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• 제9권1호
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• pp.385-411
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• 2008

The goal of medicine is to contribute to promoting national health by preventing diseases and providing treatment. The scope of modern medicine isn't merely confined to disease testing, treatment and prevention in accordance to that, and making experiments by using the human body is widespread. The advance in modern medicine has made a great contribution to valuing human dignity and actualizing a manly life, but there is a problem that has still nagged modern medicine: treatment and healing for terminal patients including cancer patients. In advanced countries, pain care and hospice medicine are already universal. Offering a helping hand for terminal patients to lead a less painful and more manly life from diverse angles instead of merely focusing on treatment is called the very hospice medicine. That is a comprehensive package of medical services to take care of death-facing terminal patients and their families with affection. That is providing physical, mental and social support for the patients to pass away in peace after living a dignified and decent life, and that is comforting their bereaved families. The National Hospice Organization of the United States provides terminal patients and their families with sustained hospital care and home care in a move to lend assistance to them. In our country, however, tertiary medical institutions simply provide medical care for terminal patients to extend their lives, and there are few institutional efforts to help them. Hospice medicine is offered mostly in our country by non- professionals including doctors, nurses, social workers, pastors or physical therapists. Terminal patients' needs cannot be satisfied in the same manner as those of other patients, and it's needed to take a different approach to their treatment as well. Nevertheless, the focus of medical care is still placed on treatment only, which should be taken seriously. Ministry for Health, Welfare & Family Affairs and Health Insurance Review & Assessment Service held a public hearing on May 21, 2008, on the cost of hospice care, quality control and demonstration project to gather extensive opinions from the academic community, experts and consumer groups to draw up plans about manpower supply, facilities and demonstration project, but the institutions are not going to work on hospice education, securement of facilities and relevant legislation. In 2002, Ministry for Health, Welfare & Family Affairs made an official announcement to introduce a hospice nurse system to nurture nurse specialists in this area. That ministry legislated for the qualifications of advanced nurse practitioner and a hospice nurse system(Article 24 and 2 in Enforcement Regulations for the Medical Law), but few specific plans are under way to carry out the regulations. It's well known that the medical law defines a nurse as a professional health care worker, and there is a move to draw a line between the responsibilities of doctors and those of nurses in association with medical errors. Specifically, the roles of professional hospice are increasingly expected to be accentuated in conjunction with treatment for terminal patients, and it seems that delving into possible problems with the job performance of nurses and coming up with workable countermeasures are what scholars of conscience should do in an effort to contribute to the development of medicine and the realization of a dignified and manly life.

• Journal of Preventive Medicine and Public Health
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• 제15권1호
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• pp.17-31
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• 1982

A physician assumes toward his patient the obligation to use such reasonable care and skill as is commonly possessed and exercised by physicians in the same general line of practice in the same or similar localities and to use his best judgment at the times. Medical disputes between physicians and patients are, ever more increased in these days as human body, happens to cause a variety of changes in body unlike the function of machine. Such increased trends of medical disputes became a problem in common across the word under the influence of affluent living standard, high consciousness of life value and right by today's people. The aim of this dissertation is oriented to forming a physician's responsibilities in medicalcare accidents arising between physicians and patients. A general physician, for example, has not been negligent merely because, a specialist might have treated the patient with greater skill and knowledge. However, the fact that a physician may have acted to the best of his ability will not avoid legal problems for damages resulting from substandard treatment, that is the degree of care and skill which is to be expected of the ordinary practitioner in his field of practice. The duty of a physician who is, or holds himself out to be, a specialist is greater in the field of his specialty than one who is a general physician. A patient's consent to routine medical procedures is implied from the fact that patient comes to the physician with a medical problem and voluntarily submits to the procedures. For the more serious medical procedures and for major operations, however, it is preferable for the physician to have the patient's consent in writing, to facilitate proof of the consent in the event of a dispute or litigation. Suppose that mistakes on the part of physicians are likely to be blamed in all cases of malpractice. Then it will create a sort of shrinkage in activities of medical treatment. There should be some limitation on excessive application of 'The thing speaks for itself' on mistakes by physicians and availablity of cause and effect. It is a matter of complicity as well as a matter of importance to draw a definite boundary on responsibilities of physician. A series of further research on this particular aspect is strongly urged.

• Journal of Preventive Medicine and Public Health
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• 제26권4호
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• pp.614-627
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• 1993

It is well known that a physician's personal characteristic affects his practice pattern. Furthermore, a physician's specialty has powerful influences on his practice pattern. However, despite the fact that specialization has received the most attention for its influence on physician's service behavior, few studies have been conducted on the variations of contents and volume of physician's services. This study has intended to identify factors influencing the practice variations according to various physician characteristics. There are some other evidences that medical care providers are different in using of health services and resources in Korea. Four physician characteristics were selected for the analysis, two demographical factors, age and sex, and two practice factors, place of practice and medical specialty. Also, three indicators of service amount (total amount of insurance claim bill, number of visits per case, number of prescriptions per case) were selected. From the pool of insurance claims for ambulatory care received by the Korean National Federation of Medical Insurance(NFMI), 84,898 cases were randomly sampled. In the meantime using physician database of NFMI, 613 general practitioners (GP), 107 regular family physicians (FP), 483 'grandfather' family physicians(GFP), and 1,157 specialist practitioners(SP) were randomly sampled. Their different practice contents were compared concerning the specialty, age groups, sex, and practice sites (urban-rural) Specialist physicians tend to provide more costly care than do generalists. General practitioners and family physicians usually make fewer following visits and prescriptions. Age is also the important factor in determining the amount of services, which is highest at the physician's age group of 40's. Female doctors and urban practitioners use much more resources than their counterparts respectively. Research findings suggest that physician's characteristics particularly the specialty can affect practice patterns and resource utilizations. Other characteristics such as age and sex are not controllable but physician's specialty is relatively easily controllable during the entire phases of policy implementation. This is all the more true in the individual's initial decision of his specialty. Specialization therefore should receive policymaker's attention for its potential influence on medical care utilization and health care expenditure.

• 지역사회간호학회지
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• 제5권2호
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• pp.130-146
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• 1994

Our medical care system is trying to diversify in order to meet the client's needs, and to adjust to a medical environment which is changing very rapidly. Because current nursing theory and practice focus on holistic care, health care management, education, and research, contrary to the traditional emphasis on only assisting a physician, more autonomy and specialization for the implementation of nursing are required. Considering these trends and actual needs, the category of clinical nurse specialist should be established as soon as possible. In order to develop strategies for implementing this new professional specialty, the authors conducted a field survey and literature review of the current system in Korea. As a result, various obstacles and constraints were discovered as follows : 1) There are few accredited educational programs for the training of CNS's. 2) Several hospitals already have staff designated as clinical nurse specialist (CNS) even though the term CNS is not yet standardized or adopted in nationwide. 3) The role of the CNS is not clearly understood by the medical societies, or even nursing societies. A nurse who works in specific nursing areas such as central supply, kidney dialysis, intensive care, coronary care, etc. for a long time, considers herself /himself a CNS. Based upon the above findings, the following alternatives are recommended. 1) The role of the CNS should be defined according to specified functions and authority : professional autonomy ; counselling and educating patients and their familes, nurses, and even other medical personnel ; research on improvement of nursing ; and management of the nursing environment including medical resources, information, and cases. 2) the qualification of CNS should be attained only by a nurse who has an RN license and clinical experience of more than 3 years in a specific nursing field: passes a qualifying examination; and contributes to the professional development of peers, colleagues, and others. A master's degree should only be optional, because of the insufficient of graduate programs which are well designed for the CNS. 3) The CNS should initially be a head nurse rather than line staff in order to deal with as wide an experience base as possible. 4) The nursing specialty could be divided into two areas such as a clinical field and a community field. The clinical field could then be categorized by the Styles' classification such as diseases and pathogenics, systems, ages, acuity, skills/techniques, and function/role ; the community field could be classified according to work site.

• 지역사회간호학회지
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• 제13권4호
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• pp.757-766
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• 2002

Purpose: Recently there have been many changes in health care environments in Korea. To perform public health programs effectively and efficiently, it is necessary to analyze and identify the demand and supply for the public health nurses. Method: The study analyzed experts' opinions regarding the supply of public health nurses, as well as national and foreign statistical data on workforce supply of public health nurses. Two methods for estimating the amount of demand for public health nurses were used: one was applying the indicators of developed countries for public health nurses based on population: the other was to refer to regulations and/or recommended guidelines in Korea. Result: 1) The number of public health centers, public health sub-centers, and primary health care posts have decreased between 1990 and 2001, from 260 to 242, 1318 to 1270, 2038 to 1907, respectively. 2) Between 1997 and 2002, the number of public health nurses has also decreased from 5572 to 5112. 3) In the case of applying regulations, the number (5112) of existing public health nurses falls shortly by 942. 4) In 2001, the Korean population per one public health nurse was 9262. 5) In the case of applying regulations, the number of public health nurses required to meet the demand for health services in 2001 and 2020 is estimated at 5932 and 6347, respectively. 6) In the case of applying the indicators of developed countries, the number of public health nurses required to meet the demand for health service in 2001 and 2020 is estimated at 9.469 and 10.310, respectively. Conclusion and suggestions: Because of the importance of public health industry, public health nurses have been approved as a field specialist and specialized nurse practitioner by the newly revised legal regulation, there have been absence of approval of their role differentiation and capability. In addition, organizational activity and insufficient number of the public health nurses have contributed to the inactive utilization of them. As community public health is focused on caring individuals as well as organizations, it requires more autonomy and special skills than other fields. Therefore, public health nurses need to enhance the capability as health educator, consultant, and information management persons through advanced education course for public health nurses. Public health nurses need to be prepared as advanced nurse practitioners by receiving advanced education courses and field experiences.

• 의료법학
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• 제11권2호
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• pp.113-145
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• 2010

Nowadays, it is surely the quack which stands as one of the most controversial, problematic. the quack has been a consistent target of contested public protection strategies in the past few centuries in many countries. Recently, complementary and alternative medicine (CAM) is increasingly utilized and accepted by patients and providers throughout the health care system in the world, most accounts attribute this growing acceptability to the shortcomings of conventional medicine, the appeal of CAM's core beliefs, and the growing body of research indicating that CAM actually works. However, the governments of western countries have called for measures to ensure that the public are protected from incompetent and dangerous practitioners. Common to these controversies has been a suggestion to ban, exclude or limit the medical practice of those deemed to be damaging rather than improving the health of individuals as a measure of public protection. This article describes the experiences of western counties' health care system which is moving in a more pluralistic direction. By examining the ways in which regulatory efforts in the countries have come to address what is invariably described as a growing interest in CAM, this study show how the problem of CAM/quackery today is increasingly located in an ethical field of practitioner competency, qualifications, conduct, responsibility and personal professional development, regardless of the form of therapy in question. Many countries developed a series of measures and strategies to contain the acceptance of CAM groups, such as insisting on scientific evidence of safety and efficacy, resisting integration of CAM with conventional medicine and opposing government support for research and education. In a sense, those countries' movements serve to protect not only patients, but the dominant position of medicine and its allied professions, and to maintain existing jurisdictional boundaries within the healthcare system. The popular support for CAM will require that health professional stakeholders continue to address the challenges this poses, and at the same time protect their position at healthcare system. To cope with the quack, professional body, public sector and health authorities should consider the safety of consumers of healthcare and responding to the demands of the community for CAM therapies as well as the claims of the established healthcare professions. Finally, some implications for future health care were suggested.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제30권6호
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• pp.497-503
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• 2004

One of the most difficult problems to damage in dentistry is an odontogenic infection. These infections may range from low-grade, well-localized infections that require only minimal treatment to a severe, life-threatenig fascial space infection. Although the overwhelming majority of odontogenic infections are easily managed by minor surgical procedures and supportive medical therapy that includes antibiotic administration, the practitioner must constantly bear in mind that these infections may become severe in a very short time. We made an investigation was targeting on 78 male and 47 female patients (125 patients in total) who had been hospitalized because of the fascial space abscess on the oral and maxillofacial area and gained a complete recovery in Daegu Catholic University Hospital, Oral & Maxillofacial Surgery from January 1999 to December 2003. By tracing their charts, we could grasp the characteristics such as age, gender, the time of breakout and specific areas of the attacks, making a conclusive study of the statistical analysis and finally, we could reach conclusions. Now, we report the conclusion from the investigation with the literature. The proportion of males and females was approximately 3 to 2, and in age group, patients under 10 years old marked the highest, 22.4%. The patients between the age of 10 and 40 were only 14.4%, yet those who were between 40 and 80 marked 53.6% in contrast. In the monthly distribution, the order was Dec.(13.6%)-Sep.(12%)-Jan.(10.4%) and in seasonal distribution, it was winter(30.4%)-fall(28%)- summer(24.4%)- spring(19.2%). Considering the medical history, D.M. was the highest which was 30.3%, hypertension marked 24.4%, and the patients with both D.M. and hypertension were 9.0%. The major cause of infection of oral and maxillofacial areas was odontogenic infection, which marked about 96%, and especially the cases related to dental caries occurred most frequently, which was 51.2%. In the number of relaxed fascial space, single fascial space was 81.6%, and in the degree of relaxation of fascial space, the buccal space abscess marked 40.8%, following submandibular space abscess, which was 30.4%.