Rapid progress in modern medical technology has made it possible to sustain life and/or delay death using 'heroic' treatments. The availability of life-sustaining treatment brings several issues in end-of-life care such as 'dying with dignity' and an radical increase in health care costs. The use of Advance Directives(AD) have been widely heralded by health care providers, gerontologists, and advocacy groups as means of protecting patients' right to accept or refuse life-sustaining treatment in end-of-life care. The use of AD can not only improve patients' autonomy and quality of life but also bring efficiency in distributing health care resources. The proportion of older persons in Korean population has been increasing. Those 65 years of age or over were about 7 percent of the population. Death and dying is not limited to older persons, but it is more prevalent among them. In conjunction with an aging population and the increasing prevalence of death, the issues of death and dying will become crucial in near future in terms of 'dying with dignity', 'autonomy', and 'self-control'. This paper attempts to explode and establish the concept of advance directives (AD) based on literature review. Data sources are computer searches with the MEDLINE database. Due to the lack of prior study on AD for a Korean cases, studies abroad are reviewed. This paper suggests the need for future study on the possibility of the use of AD in Korea.
Advance Directives* ; Aging ; Surveys and Questionnaires ; Delivery of Health Care ; Health Care Costs ; Health Personnel ; Humans ; Korea ; Patient Rights ; Prevalence ; Quality of Life

Congenital hepatic fibrosis is an inherited, congenital disorder of the liver, and is occasionally associated with cystic disease of the liver and kidney. We present a case of congenital hepatic fibrosis with Caroli's disease. A 21-year-old woman had suffered from an episodic fever with headaches for 3 years. In laboratory examination, the liver function test was within the normal limits. Esophageal varix was noted by an endoscopic examination. Hepatosplenomegaly and multiple dilated bile ducts were seen by abdominal CT scanning. An orthotopic whole liver transplantation was done. The liver was fibrotic and enlarged. Multiple cystically dilated intrahepatic ducts were noted. Microscopically, diffuse portal fibrosis and widening with proliferation of bile ductules were seen. Intrahepatic bile ducts were markedly dilated and tortuous. The liver cell cords were well preserved.
Bile ; Bile Ducts ; Bile Ducts, Intrahepatic ; Caroli Disease* ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Esophageal and Gastric Varices ; Female ; Fever ; Fibrosis* ; Headache ; Humans ; Kidney ; Liver ; Liver Function Tests ; Liver Transplantation ; Tomography, X-Ray Computed ; Young Adult

BACKGROUND: To know the effect of droperidol and ondansetron on nausea and sedation in postoperative patients, we studied 120 gynecological patients receiving patient-controlled analgesia (PCA) with morphine and droperidol or ondansetron. METHODS: Subjects were randomly allocated to one of four groups according to PCA regimen, morphine 0.5 mg/cc alone (group M); morphine plus droperidol 0.034 mg/morphine 1 mg (group D); morphine plus ondansetron 0.132 mg/morphine 1 mg (group O1); morphine plus ondansetron 0.066 mg/morphine 1 mg (group O2). The PCA device, WalkMed was set at basal rate 2 ml/hr (1 mg/hr), bolus dose 1 ml (0.5 mg), lockout time 10min, 1 hour maximum dose 4 mg. The severity of nausea, sedation and pain were assessed at 1h, 4h, 8h, 12h, 24h, and 48h postoperatively. RESULTS: The occurrence of nausea was not different among groups. But there were statistical differences in the nausea severity (p<0.05). The group D and group O1 had lower nausea scores, and between them there was no difference. The scores for sedation were significantly lower in the group O1 compared with group M and group D (p<0.05). Overall pain scores were not different among groups. CONCLUSIONS: Ondansetron and droperidol are effective in reducing nausea. Ondansetron is superior to droperidol in avoiding excessive sedation.
Analgesia, Patient-Controlled* ; Droperidol* ; Humans ; Morphine ; Nausea ; Ondansetron* ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting*

PURPOSE: The purpose of this study was to examine lifestyle, BMI, BP, and lipids profiles in male subjects and to explore the relationships among variables. METHODS: A total of 148 male subjects were recruited from one life insurance company from December 1, 2005 to February 28, 2006. Data collection methods were structured questionnaire, anthropometry and serum analysis. The relationships among lifestyle, BMI, BP, and serum lipid profiles were assessed by descriptive analysis, t-test, ANOVA, and partial Pearson's correlation coefficient of variables after controlling for age, educational level, and economic status. RESULTS: The mean BMI of the participants was relatively high as 25.38(range: 18.38 - 32.83). The differences of serum lipid profiles according to age, educational level, and economic status were significant. 'Use of caffeine and drugs'(r = -.187, p < .05) and 'consciousness of safety'( r= -.200, p < .05) was negatively related to BMI. Higher score of 'type of personality' domain was correlated with lower systolic BP(r = -.221, p < .01) and lower diastolic BP(r = -.195, p < .05) and was positively correlated with HDL(r = .191, p < .05). CONCLUSION: 'Use of caffeine and drugs', 'consciousness of safety' and 'type of personality' of lifestyle as well as 'dietary habit' and 'exercise' played a key role in circulatory disease.
Anthropometry ; Blood Pressure ; Caffeine ; Data Collection ; Humans ; Insurance, Life ; Life Style ; Male ; Surveys and Questionnaires

OBJECTIVES: The purpose of this study was to identify predictors of coronary heart disease risk factors in healthy men and women. METHOD: The subjects of this study were 346 people (173 men and women aged 20 years and over) who received health screenings. Data was collected from December 1, 2005 to February 28, 2006. The FANTASTIC Lifestyle Assessment Inventory except smoking and the Framingham risk score of subjects were investigated. Data was analyzed by descriptive analysis, t-test, ANOVA, pearson correlation coefficients and stepwise multiple regression using the SPSS 10.0 program. RESULTS: The mean score of the lifestyle of the women (64.24) was higher than that of the men (59.12). The mean score of the risk of coronary heart disease of the men (5.28%) was higher than that of the women (0.28%). The framingham risk for men was significantly related to lifestyle such as dietary habit, use of caffeine and drugs, anxiety and depression, job satisfaction, and closeness with family. The main predictors of framingham risk for men and women were 'use of caffeine and drugs', and 'menopause' which explained 16.5%, and 30.7% respectively. CONCLUSION: Since lifestyles can be changed with effort, coronary heart disease can be prevented while people are healthy.
Adult ; Age Factors ; Aged ; Cohort Studies ; Coronary Disease/diagnosis/*epidemiology ; Female ; Food Habits ; Health Behavior ; Humans ; Life Style ; Male ; Middle Aged ; Multivariate Analysis ; Predictive Value of Tests ; Risk Factors

BACKGROUND: The purpose of this study is to evaluate the evidence for the effectiveness of different isolation policies in reducing the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infection in hospital in-patients. METHODS: We prospectively evaluated the effectiveness of an isolation policy on transmission of MRSA in the 745-beds hospital. First period, all patients with MRSA (March - July 2000) were not isolated Second period, strict isolation policies were performed (August 2000 - January 2002). All patients with MRSA were isolated in separated room, hand hygiene using alcohol handrub, gowning and g1oving, apply of MRSA notice sticker, criteria in isolation remove, separated disinfection and wastement. Third period, semi strict isolation policies were performed (February 2002 - August 2005). Some patients with MRSA were isolated in separated room and others were admitted in general ward for bed shortage. Only some practices were performed in hand washing and separated disinfection in general ward. RESULTS: The rates of MRSA nosocomial infection per patients during 1st, 2nd, and 3rd surveillance were reported 0.56, 0.23, and 0.42 (P<0.05). Patient-days rate of MRSA nosocomial infection during 1st, 2nd, and 3rd surveillance were reported 0.62, 0.27, and 0.38 (P<0.05). CONCLUSION: With many different isolation policies, it was possible to reduce nosocomial infection of MRSA. In this study, strict isolation policies (2nd period) were the most effective practices in reducing MRSA infection.
Cross Infection ; Disinfection ; Hand Disinfection ; Hand Hygiene ; Humans ; Incidence ; Infection Control ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Patients' Rooms ; Prospective Studies

No abstract available.
Polycystic Kidney Diseases*

PURPOSE: To confirm the effect of tailored life style improvement program, provided by occupational health nurse for hypertensive workers on their blood pressure, self-efficacy, and life style changes in workplace. METHOD: The experimental and control group of thirty subjects each were randomly assigned for those who agreed to participate in the study among the pre-hypertensive workers. The tailored life style improvement program was provided to the experimental group and conducted once a week for 8 weeks. This program was composed of exercise and low salt diet to control high blood pressure and weight, and the measurement of carbon monoxide for non-smoking inducement. RESULT: In the experimental group, the systolic and diastolic blood pressure significantly decreased while self-efficacy increased after the program compared to the control group. Smoking and drinking habits of the experimental group were significantly decreased whereas exercise and nutritional habits were significantly improved compared to the control group. CONCLUSION: The tailored life style improvement program provided by occupational health nurses for the hypertensive workers was positively affected on their blood pressure, self-efficacy and life style changes in workplace.
Blood Pressure ; Carbon Monoxide ; Diet ; Drinking ; Hypertension ; Life Style ; Occupational Health ; Smoke ; Smoking

PURPOSE: The purpose of this study is to examine how well patients who had hip arthroplasty comply with medical regimens given to them after the operation. METHOD: The subjects of the study were patients who had arthroplasty at P Hospital between April 1. 2001 and August 30, 2002. 20 patients of the subjects experienced complications after the operation and the other 20 did not. Data from a survey using the qustionnaire were statistically analyzed in terms of real number, percentage point, mean and standard deviation by using chi2test. t-test and ANOVA. RESULT: 1) the surveyed patients were significantly different in the compliance of medical regimen among them according to their education background as one of the subjects general characteristics. 2) It was found that the group of complication was higher in the compliance of medical regimen than that of non-complication. The two groups showed statistically significant difference with each other in the degree of compliance with therapeutic instructions than the experimental group in terms of the maintenance of abduction after the operation, training instructions on step-by-step basis, urination cotrol on bed, accurate use of crutch, compliance with medication, balance among medical treatment, training, leisure, rest and nutrition. instructions by physicians, nurses and physical therapists, use of low armchairs and toilet bowels and no bending of the body forward, and use of a non-operated leg in case of go upstairs or downstairs. CONCLUSION: It seems necessary to develop systematic and sessional education programs for improving the compliance of medical regimen. ultimately reducing complications following hip arthroplasty.
Arthroplasty* ; Compliance ; Education ; Hip* ; Humans ; Leg ; Leisure Activities ; Patient Compliance* ; Physical Therapists ; Urination

No abstract available.
Aneurysm, Dissecting* ; Paraplegia*