BACKGROUND: The purpose of this study was to investigate the characteristics of and to analyze the factors re-lated to the cost of the resolution of a medical dispute. METHODS: We have reviewed 2,346 cases reported to the Korean Medical Association(KMA)mutual-aid association from Nov. 1. 1981 to Oct. 31. 1994. RESULTS: The percentage rate of reported cases of were related field as follows .' obstetric gynecology(OBGYN) 31.9%, general practitice 28.1%, general surgery 13.3%, orthopedics 6.9% and internal medicine 6.4% 1,829 cases (80.0%) were settled out of court and without public intervention. 310 cases(13.2%) were settled by the police, the public procurators office or the court. The mean settlement amount per case was 9,340,000 won with annual growth rate 10.8%, and median settlement amount was 5,890,000 won. The mean settlement amount for OBGYN was 930,000 won, surgical group 8,900,000 won, medical group 7,710,000 won, and general practitice 7,490,000 won. The cases of medical dispute according to the types of medical care were : operation 21.1%, injection 18.0%, treat-ment and care 18.0%, delivery 13.0%, artificial abortion 10.3%, Cesarian section 7.2% and anesthesia 2.5%. The mean settlement amount according to the types of medical care were: delivery and Cesarian section 15,190,000 won, operation and anesthesia 9,500,000 won, others 6,610,000 won, and injection and medication 6,230,000 won. The mean settlement amount that was settled out of court without public intervention was 7,940,000 won. The mean settlement with public intervention in the court was 17,290,000 won. The cases of medical dispute according to the patients status were .' death 37.5%, complications 20.8%, disability 12.2% and others 28.9%. The mean settlement amout for death was 16,150,000 won, disability 9,430,000 won, others 4,850,000 won and complications 3,550,000 won. The mean settlement amount where doctors have asserted that the outcome was inevitable or have not agreed that it was their fault was higher than the cost of cases where they had admitted responsibility. The settlement amout where there was a misdiagnosis present had not shown to be higher than when the misdiagnosis was absent. The mean settlement amount for cases where multiple doctors were involved was higher than for cases of a single doctor. The mean settlement amount for disturbing the medical practice and suspension of are high. The mean settlement amount for complications was lower than others, and the mean settlement amount for disability and death presented were high. Concerning the types of care, the mean settlement amount for operation/anesthesia, delivery/ Cesarian sections were higher than for injection/medication. Concerning the type of settlement, the mean settlement amount in the police and public procurators office was higher than in out of court without public intervention. CONCLUSIONS: The mean settlement amount depended on the patient's status, the type of settlement, and the disturbance of medical practice regardless of the doctors misdiagnosis, fault, and standard care. Therefore, a reason-able method of resolution for medical dispute is needed.
Anesthesia ; Diagnostic Errors ; Dissent and Disputes ; Humans ; Internal Medicine ; Malpractice* ; Orthopedics ; Police

BACKGROUND: Medical dispute is increasing and its effect on society is serious, but reasonable settlement system is absent. Nevertheless patients and families choose medical dispute. But there is little research on patients and their families who choose to settle by medical dispute. Therefore this study examines the impact of medical malpractice to patients and their families and their reasons for choosing medical dispute after mishap. METHODS: Data were collected from 234 subjects who inquired of Medical Malpractice Family Association about malpractice suit. Questionnaire was composed of demographic characteristics, characteristics of hospital, characteristics of medical malpractice, degree of satisfaction with explanation and attitude of the treating doctor, effect of medical malpractice on patients' life and reasons patients and their families choose to settle by medical dispute. Factor analysis with varimax rotation was carried out to reduce the reasons to a smaller number of clearly interpretable factors. Multiple regression analysis was carried out to identify the variables relevant to these main themes. RESULTS: Degree of satisfaction with doctor's explanation and attitude was less than 10%. Over 60% of respondents stated that medical malpractice seriously affected their lives. Four main themes emerged from the factor analysis of reasons for dispute which includes dissatisfaction with doctor's attitude, wanting to prevent similar incident in the future, call t? account, and compensation. The relative importance in the order of frequency was wanting to prevent similar incident in the future, dissatisfaction with doctor's attitude, call to account, followed by compensation. Multiple regression analysis was used to identify the variables relevant to these four main themes. Clinical speciality group and degree of satisfaction on attitude were signi(icantly associated with the dissatisfaction with doctor's attitude. Clinical speciality group, patient's condition, effect of medical malpractiee on life and degree of satisfaction on attitude were significantly associated with the call to account. Academic carrier, clinical speciality group, patient's condition, effect of medical malpractice on life and degree of satisfaction on attitude were significantly associated with the compensation. CONCLUSIONS: From the above results, the reasons patients and their families cheese to settle by medical dispute were diverse and associated with demographic characteristics, doctor's attitude, effect of mishap on life, et. at.
Cheese ; Compensation and Redress ; Surveys and Questionnaires ; Dissent and Disputes* ; Humans ; Malpractice ; Social Responsibility

The Finnish type of Congenital Nephrotic Syndrome is characterized by large placenta, early manifestation, growth and developmental delay and resistance to treatment. Authors experienced a case of characteristic Finnish type of Congenital Nephrotic Syndrome in a girl, who was admitted to the Pediatric Department of KHUH at 2 1/1 months of age because of generalized edema and abdominal distension and died of pneumonia at 5 1/2 months of age. The diagnosis was made by birth history, clinical manifestation, laboratory findings and finally by the autopsy findings, Literatures are reviewed briefly.
Autopsy ; Diagnosis ; Edema ; Female ; Growth and Development ; Humans ; Nephrotic Syndrome* ; Placenta ; Pneumonia ; Reproductive History

To investigate how the beverage consumption of middle school students are different in some respects; favorite kinds, drinking time and so on. 579 middle school students in Jeonju were participated in this study. This study shows the frequency of drinking beverage and the correlation between the frequency and the various factors to have effects on the frequency. The students usually drink water 8.55 times, milk or yogurt 3.01 times, sport beverage 2.13 times, soft drink 1.93 times, and fruit and vegetable juice 1.85 times for one week. The boy students prefer more soft or sport drink to the girl students. However the drinking of other beverages such as water, milk, juice, traditional ones don't have any meaningful differences between the boys and the girls. The students drink water mostly when they have meals. And the second consuming beverage is milk at table. It explains the students who drink more milk than water with bread. There is a big difference according to their excercise frequency. The students who excercise regularly or excercise over 3 hours drink more soft or sport drink and milk or yogurt than the students who exercise less than 1 hour. The beverages are firstly needed during the exercise because they sweat. And the second beverage time is when they have snacks and when they take a break. It should be suggested that nutrition education targeted to middle school students and their parents should encourage limited consumption of soft drinks. Therefore, policies that limit students' access to soft drinks at schools should be promoted.
Beverages* ; Bread ; Carbonated Beverages ; Drinking ; Education ; Female ; Fruit ; Humans ; Jeollabuk-do* ; Male ; Meals ; Milk ; Parents ; Snacks ; Sports ; Sweat ; Vegetables ; Water ; Yogurt

Dially disulfide (DADS), a component of garlic (Allium sativum), has been known to exert potent chemopreventive activity against various cancers. In this study, the synergistic effect of DADS and daunorubicin on the cytotoxicity of HL-60 cells, a human leukemia cell line, was investigated. DADS at 25 M greatly potentiated daunorubicin-induced cell death, decreasing cell viabilityto50%ofthe control. Daunorubicin-induced apoptosis was accompanied by the activation of caspase-3, the degradation of poly-(ADP-ribose) polymerase (PARP) and D4-GDI, and DNA fragmentation, which were blocked by pre-treatment with acetyl-Asp-Glu-Val-Asp- dialdehyde (Ac-DEVD-CHO). Treatment that combined 25 M DADS and 100 nM daunorubicin caused a similar degree of caspase-3 activation, PARP and D4-GDI degradation, and DNA fragmentation to that caused by treatment with 250 nM daunorubicin alone. These results indicate that combined therapy using daunorubicin with DADS, a component of food, and garlic can effectively decrease the therapeutic dose of daunorubicin, preventing the severe side effects of daunorubicin.
Apoptosis* ; Caspase 3 ; Cell Death ; Cell Line ; Daunorubicin ; DNA Fragmentation ; Garlic ; HL-60 Cells* ; Humans ; Leukemia

Purpose: To investigate chorioretinal vascular changes in the non-surgical eyes of patients who underwent vitreoretinal surgery under general anesthesia using optical coherence tomography angiography (OCTA). Methods: Data from 40 patients who underwent retinal surgery were retrospectively analyzed. Ophthalmologic examinations (including OCTA) were performed in the morning before and after surgery. The presence of intraoperative hypotension (IOH; mean arterial pressure <70 mmHg) was determined based on medical records. The vessel density of superficial and deep retinal capillary plexus layers, choriocapillaris void features, and thickness of the choroid and retina were quantified after image processing. Associations between retinal OCTA parameters and anesthesia profiles were also assessed. Results: DCP vessel density was increased after general anesthesia (p < 0.05). Among the patients who experienced IOH, there was no statistical difference in chorioretinal vessel parameters before and after general anesthesia. Also, we did not observe a difference in chorioretinal vessel parameters after general anesthesia between healthy patients and patients with chronic disease, including hypertension and diabetes (p > 0.05). The duration of anesthesia and average size of the choriocapillaris void (p < 0.05, r = -0.32), and the intraoperative mean arterial pressure (MAP) fluctuation and DCP, showed statistically significant negative linear correlations (p < 0.05, r = -0.38). The choriocapillaris void size and intraoperative MAP fluctuation also displayed a significant negative correlation (p < 0.05, r = -0.37), while the average size signal void showed a weak positive linear correlation (p < 0.01, r = 0.41; and p < 0.01, r = 0.44, respectively). Conclusions This is the first study to assess the effects of general anesthesia on chorioretinal vessels using OCTA. The Vessel density of the DCP was significantly increased in the non-surgical eye after total vitrectomy under general anesthesia. Furthermore, we found a correlation between MAP fluctuation and choriocapillaris void features. More studies are needed to confirm and expand on these observations.

PURPOSE: To analyze the learning objectives and test items for Fundamentals in Nursing which were established between 1999 and 2000 and to develop these items toward a nationwide faculty workshop for national board examination for Korean nurses. RESULTS: 1. According to Bloom's taxonomy, learning objectives established in 1999 mainly consisted of two domains, comprehension (56.1%), and knowledge (27.7%). The learning objectives established in 2000, mainly consisted of comprehension (45.2%) and application (25.4%). 2. According to McGuire's taxonomy, domain of test items established in 1999 consisted of recall (66.7%), interpretation (28.0%) and problem solving (4.9%). Domain of test items established in 2000, consisted of recall (65.1%), interpretation (22.0%) and problem solving (12.9%). 1) Department of Nursing, Chung-Ang University 2) College of Nursing, Yonsei University 3) College of Nursing, Seoul National University 4) Department of Nursing, Kyung-Hee University 5) College of Nursing, Ewha University 6) College of Nursing, The Catholic University of Korea(corresponding author, Email: sky@catholic.ac.kr) 7) National Medical Center Nursing College 8) Red Cross Nursing College 9) Department of Nursing, Gachun Gil College 3. The proportion of learning objectives in the knowledge and comprehension domains established in 200, decreased from 27.7% to 13.5%, and from 56.1% to 45.2% respectively over that of 1999. But the domain of application increased from 5.3% to 25.4% over that of 1999. 4. With regard to McGuire's taxonomy, the proportion for the recall and interpretation domains established in 2000 decreased from 66.7% to 65.1%, and from 28.0% to 22.0% respectively. But the proportion for the problem solving domain increased from 4.9% to 12.9% over that of 1999. For type of test items, the proportion of A type established in 2000 decreased from 47.2% to 37.6%, and K type increased from 52.1% to 60.8% over that of 1999. CONCLUSION: The learning objectives and test items established in 2000 showed remarkable improvement compared to those established in 1999. For better learning objectives and test items in Fundamentals of Nursing, further research is recommended on essential content and standardization of job analysis for national board examination for nurses in Korea.
Classification ; Comprehension ; Education ; Electronic Mail ; Korea* ; Learning* ; Nursing* ; Problem Solving ; Red Cross ; Seoul

OBJECTIVES: Present study was conducted to evaluate work-related symptom prevalence among hairdressers. METHODS: Exposed group comprised 184 employee employed 73 hair salons in 6 districts of Pusan city, and non-exposed grouts comprised 119 people living recent apartments. A trained interviewer interviewed them with organized questionnaire which included dermatologic, respiratory and musculo-skeletal symptoms. RESULTS: Prevalence of hand eczema wart 28.3 % in exposed group, and 5.9 % in non-exposed group. Adjusted odds ratio for age and atopy history was 4.30(2.34-7.93). Prevalence of respiratory symptom(coughing) in exported group was 22.1%, and 9.4% for non-exposed group. Adjusted odds ratio for coughing which was adjusted for age, smoking and atopy history was 2.76(1.32-5.78). Prevalences of musculo-skeletal symptoms among exposed group were neck(59.9%) shoulder(76.6%), upper back(41.2%), lower back (72.2%), arm and elbow(31.3%), wrist(44.2%), finger(35.0%), leg(71.1%). Adjusted Odds Ratios for musculo-skeletal symptoms which wag adjusted for age were neck 2.13(1.29-3.51), shoulder 2.52 (1.50-4.24), upper back 1.71(1.01~2.88), lower back 1.78(1.06~2.99), arm and elbow 3.10(1.62~5.94), wrists 2.09(1.23~3.57), finger 4.83(2.41~ 9.68), leg 3.46(2.07~5.79). CONCLUSIONS: These results chow that employees in hair salon are likely to have high risk for work-related dermatologic, respiratory and musculo-skeletal symptoms and diseases. Hence, prevention methods from those work-related diseases are required to be developed. Also, the scope of occupational and environmental medicine should be expanded to service area including hairdressers.
Arm ; Busan ; Cough ; Eczema ; Elbow ; Environmental Medicine ; Fingers ; Hair ; Hand ; Leg ; Neck ; Odds Ratio ; Prevalence* ; Questionnaires ; Shoulder ; Smoke ; Smoking ; Warts ; Wrist

PURPOSE: We proposed a new classification of pediatric intussusception based on clinical and radiologic findings. METHODS: Data from 88 consecutive patients with intussusception were reviewed. We retrospectively analyzed six factors; patient age, sites of intussusception, symptoms, therapeutic methods, existence of enlarged mesenteric lymph nodes, and ultrasonographic (US) findings from clinical records. RESULTS: 1) There was one neonatal case (1.1%), the others (98.9%) were infants and children. 2) These 87 infant and child cases consisted of 14 cases (16.1%) of small bowel intussusception (SBI) and 73 cases (83.9%) of ileo-colic intussusception (ICI). Of the 14 SBI cases, 12 cases were symptomatic and 2 cases were asymptomatic. The symptomatic group comprised 8 transient cases (66.7%), 3 operative cases (25.0%), and 1 enema-reduction case (8.3%). Two asymptomatic cases were incidentally captured by computed tomography. Of the 73 ICI cases, 19 cases (26.0%) required operation, and 54 (74.0%) enema-reduction. 3) When transient SBI cases were compared with operated SBI cases, enema-reduced and operated ICI cases, the age (38.0+/-22.9 months) of transient SBI cases were significantly higher than those of the others (p=0.003). Mean mass size (20.8+/-2.7 mm) in transient SBI was significantly smaller than in the others (p=0.0001). 4) No correlation was found between the existence of enlarged mesenteric lymph nodes and therapeutic method or concomitant illness. 5) Most of the target types observed by US were in transient SBI cases, the remainder were in the enema-reduced ICI cases. In terms of the doughnuts type, all 8 cases (34.8%) with an external hypoechoic rim thickness of >8.9 mm were treated surgically. CONCLUSION: Pediatric intussusception may be classified based on clinical and radiologic findings, which are likely to indicate appropriate therapies.
Child ; Classification* ; Humans ; Infant ; Intussusception* ; Lymph Nodes ; Retrospective Studies

BACKGROUND: This study was performed to evaluate the effects of pre-emptive subdiaphragmatic instillation of lidocaine before pneumoperitoneum on postoperative pain following a laparoscopic cholecystectomy (LC) and also to evaluate it's effect on the changes of blood pressure during an operation. METHODS: Thirty-three relatively healthy patients for an LC were allocated into the two groups. after the induction of general anesthesia with sodium thiopental, vecuronium, nitrous oxide and enflurane (1-2 vol%), 0.2% lidocaine 200 ml was subdiaphragmatically instilled 10 min before pneumoperitoneum in the lidocaine group (n = 15), and normal saline in the control group (n = 18). The changes of the systolic and mean arterial pressure (SAP and MAP), postoperative pain score, and the number of analgesics used during the postoperative 24 h were compared between two groups. RESULTS: The pain scores at postoperative 1, 3, 6, 12, 18 and 24 h and the number of analgesics used were significantly low in the lidocaine group compared to the control group (P<0.01). The elevations of SAP and MAP during pneumoperitoneum were significantly attenuated in the lidocaine group (P<0.01). CONCLUSIONS: This data suggests that subdiaphragmatic instillation of lidocaine before pneumoperitoneum is effective in the control of postoperative pain following an LC and also effective to attenuate the elevation of blood pressure during pneumoperitoneum. However, further study is needed to evaluate the safety of these methods before recommendation of routine use.
Analgesics ; Anesthesia, General ; Arterial Pressure ; Blood Pressure* ; Cholecystectomy, Laparoscopic* ; Enflurane ; Humans ; Lidocaine* ; Nitrous Oxide ; Pain, Postoperative* ; Pneumoperitoneum* ; Sodium ; Thiopental ; Vecuronium Bromide