Analysis of Experiments on the Information Systems for the Improving Self-Management after Intracranial Hemorrhage Surgery

Seong-Ran Lee 보안공학연구지원센터 2015 International Journal of Bio-Science and Bio-Techn Vol.7 No.6

The present study is to investigate the analysis of experiments on the information systems for the improving self-management after intracranial hemorrhage surgery. The subjects of this paper were 136 patients who had visited a general hospital located in Metropolitan area. The pairwise t-test was done to compare the before and after application effect of self-management after intracranial hemorrhage surgery. The results of this study are as follows. Firstly, in terms of respondents which have suffered from headache, subjects’ score(54.92±4.18) after application by information systems significantly decreased than subjects(73.92±3.26) before application(t=2.49, p=.000) Secondly, for self-management, the change of follow-up survey showed higher level in the experimental group than the control group, regardless of the time elapsed of 8 weeks after application by information systems as compared with previous status. Therefore, this paper showed that health improving behaviors using the information systems as measurement tools was a good way to enhance the practice rate of self-management in patients after intracranial hemorrhage surgery.

수술 중 정보제공을 통한 환자 부모 및 가족의 만족도 증진

홍희정,이명애 한국의료QA학회 2000 한국의료질향상학회지 Vol.7 No.1

Background : This study was designed to assess the effects of information on the satisfaction of parents and families whose children underwent elective surgery in the Pediatric Operating Room. Methods : We measured parent and family satisfaction with information given before and after offering informational interventions. The data were collected from 510 patients parents and families whose children had undergone elective surgery in the Pediatric Operating Room of Seoul National University Hospital in Seoul. South Korea. The data collection ran from May 3, 1999 to May 30. 1999 and from September 6, 1999 to September 30. 1999. The research instrument consisted of four categories (pre-operative period, intra-operative period. post-operative period, others) and 24 questionnaires. SPSS was used to analyze the data. Results : The major findings of this study are summarized as follows: 1. Before surgery, the satisfaction with the following was increased: the explanations of the necessary preparation for the surgery (6.0%), the time the patient would enter the operating room (20.6%), the operative procedure (2.0%), and the use of the waiting room (10.0%). 2. During the operation, the satisfaction with the situation board (15.1%), public announcements in the waiting room (8.4%). and the answering of the families questions (12.2%) was increased, however, the satisfaction with the surgeons explanations of the surgical outcomes decreased by 8.3%, even though the frequency of these explanations increased by 5%. 3. After surgery, the satisfaction with the following was increased: the explanations of patient's status of recovery-do.3%) the time the patient would be moved from the recovery room (17.6%). how the patient would be transferred to the ward (19.2%), and post-operative care (6.3%). Conclusion : Based upon the above findings, we concluded that pre-, intra-, and post-operative informational interventions were effective in increasing the satisfaction of the parents and families of children undergoing elective surgery.

유령수술에 대한 미국 판례의 동향

성수연 한국의료윤리학회 2015 한국의료윤리학회지 Vol.18 No.3

Substituting other unauthorized doctor for a surgeon given prior permission by the patient, or allowing an unauthorized doctor to perform surgery without proper supervision corresponds to ghost surgery. Ghost surgery constitutes an infringement on a patient's inherent personal right to control his/her own body and a right to well-informed decision on his/her intention. Such illegal medical practices destroy trust relationships between a doctor and a patient, and may be punished for violating criminal laws, the Medical Service Act, and the Act on Special Measures for the Control of Public Health Crimes. Assistance provided by a resident or a fellow surgeon under proper supervision after disclosing all substantial information related to surgery to a patient and obtaining informed consent does not fall under ghost surgery. The ghost surgery may happen in any hospital. To avoid this, the role, position and identification of the surgeon, including the surgeon's participation, should be disclosed on the written consent form, as well as in the obligatory explanation of the surgeon. The smooth communication and interaction between physicians and patients are essential for the success of treatment. It is important for a patient to ask questions about surgery in order to avoid ghost surgery and to get clear and comprehensible answers to the questions. The doctor should take responsibility for the patients well-being in the whole process of surgery as well as the doctor should not substitute a surgeon, practicing a deception on the patient, nor leave the operating room or the patient. 유령수술이란 용어는 주로 병원의 암묵적 동의하에 수술 적임이 아닌 의사가 적임인 외과 의사를 수술실로 불러 수술을 시행하도록 하는 것을 말한다. 그런 다음 수술하지 않은 의사가 의료기록지에 서명하고 환자에게 비용을 청구한다. 이런 관행에 대해 미국은 오래 전 판례와 미국 의학협회 등을 통해 비윤리적이라고 비난하였다. 유령수술은 환자가 마취상태에서 유령처럼 생긴 인물이 수술실로 몰래 들어오는 장면을 떠오르게 한다. 유감스럽게도 이 용어가 다른 맥락 다시 말해 동료의사나 레지던트가 수술하는 관행에 적용되었을 때 원래 그 용어의 용법에 있는 부정적인 의미들이 새로운 용법과 연관성을 띠게 되었다. 의사의 온정주의에서 환자의 자율 보장으로 관점이 바뀌면서 환자는 자신의 의료에 관한 결정에 합리적인 정보에 입각한 참여를 할 권한을 지니게 되었다. 환자의 자율권은 온전한 상태에서 수술에 대해 이해하고, 자발적으로 동의하지 않으면 어떤 시술도 받지 않으며, 환자는 시술이나 치료를 승인하고 시행하는 데 누가 책임을 지고 있는지 알 권한을 보장한다. 미국 의학협회(American Medical Association)와 미국 외과학회(American College of Surgeons)에서는, 만일 환자가 선택한 외과의사가 아닌 레지던트나 동료의사가 실제로 수술을 시행한다면, 환자는 그 사실을 알아야 하고 의사는 보조의사에 대해 동의를 받아야 한다고 말한다. 이에 대해 유령수술의 개념과 사전 동의, 유령수술이 분업적 의료에서 시행되고 있는 점을 보고 이에 대한 대책을 알아보도록 한다.

유령수술의 형법적 쟁점에 대한 이론적 접근

한성훈(Han, Sung-Hoon) 원광대학교 법학연구소 2021 의생명과학과 법 Vol.25 No.-

유령수술이란 환자의 동의를 벗어나 환자가 모르는 사람으로부터 수행된 수술을 의미한다. 유령수술은 기본적으로 환자의 동의를 전제로 하며, 동의된 수술의사를 대체한 자는 수술에 적법한 의사일 수도 있으며 때로는 해당 의료행위의 자격이 없는 의료인 및 의료면허가 없는 무자격자가 될 수도 있다. 후자의 경우는 대리수술이라는 용어로 대체되기도 한다. 어떠한 대체자를 상정하더라도 유령수술의 본질은 환자의 동의를 벗어난 점에 있다. 환자의 동의, 즉 수술 시점 이전에 이루어진 피해자 승낙이 가지고 있는 정당화적 효력은 상실하며 해당 침습적 치료행위는 신체침해에 대한 불법의 완성을 이루고 있는 것처럼 보인다. 하지만 유령수술이 문제가 된 사례를 보면 의료사고가 발생하지 않는 한 형법상 문제가 된 쟁점은 사기죄뿐이다. 유령수술의 본질이 환자의 동의를 벗어나는데 있음에도 불구하고 피해자 승낙이 이루어진 신체 침해의 영역에 대한 판단이 이루어지고 있지 않음은 매우 의문스럽다. 이러한 의문은 새로운 것이 아니다. 거슬러 올라가 보면 이러한 의문은 의료영역의 ‘해묵은’ 주제와 만나게 되는데, 바로 의사의 침습적 치료행위에 대한 형사판단의 문제이다. 유령수술은 대부분 외과적 수술로서 환자가 무의식 상태에 들어간 이후에 수행되기 때문에 수술 시점 이전에 표시된 환자의 동의는 법적으로 더욱 강하게 존중되고 보호받아야 할 필요가 있다. 아울러 유령수술에 대한 처벌을 강화하기 위해 최근 발의된 무면허 의료행위를 지시한 자에 대한 처벌의 강화를 내용으로 하는 의료법 개정법률안에 대해 살펴보았다. Ghost surgery refers to surgery performed by a person who does not know the patient s consent. Ghost surgery is basically subject to the consent of the patient, and the person who replaces the agreed surgeon may be a legitimate surgeon, sometimes a medical person who is not qualified for the medical practice and a medical license-free person. In the latter case, the term “proxy surgery” may be substituted. Whatever alternative is postulated, the nature of ghost surgery lies outside the patient s consent. The patient s consent, that is, the victim s consent made before the time of surgery, loses its justification effect, and the invasive treatment seems to be completing the illegal violation of the body. However, in cases where ghost surgery has become a problem, fraud is the only issue that has become a problem under criminal law unless a medical accident occurs. Although the nature of ghost surgery is beyond the consent of the patient, it is highly questionable that no judgment has been made on the area of physical infringement in which the victim s consent has been made. These questions are not new. Back in the day, this question meets the “old” theme of the medical domain: the issue of criminal judgment on the invasive treatment of doctors. Since ghost surgery is mostly performed after the patient enters unconscious state as a surgical operation, the consent of the patient shown before the time of surgery needs to be more strongly respected and protected legally. In order to strengthen punishment for ghost surgery, the government also examined a revised bill on the Medical Law, which calls for tougher punishment for those who ordered unlicensed medical practices recently proposed.

Cognitive Investigation Study of Patients Admitted for Cosmetic Surgery: Information, Expectations, and Consent for Treatment

Barone, Mauro,Cogliandro, Annalisa,La Monaca, Giuseppe,Tambone, Vittoradolfo,Persichetti, Paolo Korean Society of Plastic and Reconstructive Surge 2015 Archives of Plastic Surgery Vol.42 No.1

Background In all branches of medicine, it is the surgeon's responsibility to provide the patient with accurate information before surgery. This is especially important in cosmetic surgery because the surgeon must focus on the aesthetic results desired by the patient. Methods An experimental protocol was developed based on an original questionnaire given to 72 patients. The nature of the responses, the patients' motivation and expectations, the degree of patient awareness regarding the planned operation, and the patients' perceptions of the purpose of the required consent for cosmetic surgery were all analyzed using Fisher's exact test. Results Candidates for abdominal wall surgery had significantly more preoperative psychological problems than their counterparts did (P=0.035). A significantly different percentage of patients under 40 years of age compared to those over 40 years of age searched for additional sources of information prior to the operation (P=0.046). Only 30% of patients with a lower educational background stated that the preoperative information had been adequate, whereas 92% of subjects with secondary schooling or a postsecondary degree felt that the information was sufficient (P=0.001). A statistically significant difference was also present between patients according to their educational background regarding expected improvements in their quality of life postoperatively (P=0.008). Conclusions This study suggests that patients require more attention in presurgical consultations and that clear communication should be prioritized to ensure that the surgeon understands the patient's expectations.

Cognitive Investigation Study of Patients Admitted for Cosmetic Surgery: Information, Expectations, and Consent for Treatment

Mauro Barone,Annalisa Cogliandro,Giuseppe La Monaca,Vittoradolfo Tambone,Paolo Persichetti 대한성형외과학회 2015 Archives of Plastic Surgery Vol.42 No.1

Background In all branches of medicine, it is the surgeon’s responsibility to provide the patient with accurate information before surgery. This is especially important in cosmetic surgery because the surgeon must focus on the aesthetic results desired by the patient. Methods An experimental protocol was developed based on an original questionnaire given to 72 patients. The nature of the responses, the patients’ motivation and expectations, the degree of patient awareness regarding the planned operation, and the patients’ perceptions of the purpose of the required consent for cosmetic surgery were all analyzed using Fisher’s exact test. Results Candidates for abdominal wall surgery had significantly more preoperative psychological problems than their counterparts did (P=0.035). A significantly different percentage of patients under 40 years of age compared to those over 40 years of age searched for additional sources of information prior to the operation (P=0.046). Only 30% of patients with a lower educational background stated that the preoperative information had been adequate, whereas 92% of subjects with secondary schooling or a postsecondary degree felt that the information was sufficient (P=0.001). A statistically significant difference was also present between patients according to their educational background regarding expected improvements in their quality of life postoperatively (P=0.008). Conclusions This study suggests that patients require more attention in presurgical consultations and that clear communication should be prioritized to ensure that the surgeon understands the patient’s expectations.

시청각매체를 이용한 정보제공 프로그램이백내장 수술 환자의 불안과 교육만족도에 미치는 효과

오윤희,최은정 병원간호사회 2016 임상간호연구 Vol.22 No.3

Purpose: The purpose of this research was to identify the effects of providing an information service program by media on preoperative anxiety and postoperative educational satisfaction in patients with cataract surgery. Methods: For this study 52 patients who visited the ophthalmology clinic at P Hospital in B metropolitan city and who were scheduled to undergo one-day cataract surgery under local anesthesia were recruited. The 52 patients were assigned to the experimental group (25) or the control group (27). This study was conducted from August 27, 2015 to May 29, 2016. Results: Following the provision of cataract surgery related information service by media, the experimental group had a lower mean score for anxiety and higher mean score for educational satisfaction compared to the control group of patients. Conclusion: Results indicate that information service program by media 『Goodbye Cataract』is useful educational materials for cataract patients in outpatient department and outpatient operating rooms.

파열된 뇌동맥류 수술 후 건강실천에 영향을 미치는 요인

이성란 사단법인 인문사회과학기술융합학회 2015 예술인문사회융합멀티미디어논문지 Vol.5 No.5

This study was performed to identify the factors influencing on the practice of health behaviors after ruptured cerebral aneurysm surgery. Data were surveyed using interview and questionnaires by 168 patients who visited a general hospital which was located in Metropolitan area from October 20 to November 21, 2014. The results of this study are as follows. First, for information after cerebral aneurysm surgery, it showed 4.21 points in men were significantly higher than 2.75 points in women. Secondly, a result of multiple regression analysis, the health practice after cerebral aneurysm surgery was significantly influenced by age-related differences(R²=.057, p=.000) and showed the explanatory power of health practice by 5.7%. And then health practice was significantly influenced by the uncertainty of treatment(R²=.084, p=.002). In conclusion, strategies for enhancing medical information and reducing uncertainty are needed to promote the practice of health behaviors in ruptured intracranial aneurysm patients. 본 연구는 파열된 뇌동맥류 수술 후 건강실천에 영향을 미치는 요인을 파악하기 위해 수행하였다. 자료는 2014년 10월 20일부터 11월 21일까지 수도권에 소재한 종합병원에 내원한 뇌동맥류 수술환자 168명을 대상으로 설문 및 면접조사를 하였다. 연구결과 첫째, 뇌동맥류 수술 후 정보성에서 의료정보의 평균은 남성에서 4.21점, 여성은 2.75점으로 남성이 유의하게 높게 나타났다(t=1.37, p<0.01). 둘째, 다중회귀분석결과 뇌동맥류 후 환자의 건강실천의 영향요인은 연령(R²=0.057, p=0.000)으로 유의한 요인으로 설명력은 5.7%이었다. 그 다음은 치료의 불확실성(R²=0.084, p=0.002)으로 나타났다. 따라서 파열된 뇌동맥류 환자들의 건강행태 실행을 높이기 위해서는 의료정보를 높이고 불확실성을 낮춰 줄 수 있는 전략들이 필요하다.

미용성형공화국의 고지되지 않는 위험

임인숙 ( In-sook Lim ) 한국사회사학회 2010 사회와 역사 Vol.0 No.88

이 연구는 미용성형에 따른 부작용과 사망 사건을 다룬 한국의 신문보도를 중심으로 성형공화국의 위험 실상을 드러내는 한편, 이런 위험성을 정확하고 구체적으로 전달하지 않고 있는 의료정보 제공 방식의 문제점을 분석했다. 미용성형이 생명까지 앗아가는 위험요인이 될 수 있다는 점을 드러내기 위해서, 1990년대부터 2010년 9월까지 언론에 보도된 미용성형 관련 사망 기사 27건 (36 명의 피해자)의 특성을 분석했다. 또한 1970년대 이후 4개 국내일간지 의료정보 코너 5개에 실린 기사 223개를 토대로 미용성형의 부작용과 위험이 배제되거나 이야기되는 맥락을 분석했다. 1990년대를 기점으로 미용성형 정보를 제공하는 기사는 증가했지만 미용성형의 위험을 적시하는 정보는 감소해왔다. 1970-80년대는 미용성형수술에 따를 수 있는 부작용이나 미용효과의 한계를 부각시켰던 반면, 1990년대는 규격화된 미인의 조 건들과 새로운 성형 유행에 대한 정보들이 두드러진다. 1990년대부터 미용성형의 들이 추진하는 ``아름다움의 의료화`` 프로젝트가 본격 가동되기 시작했다고 해석할 수 있다. 새로 나온 수술기법의 상대적 우위를 선전하기 위해서 비로소 이전 기법 의 결함들이 노출되고, 특정 수술로 인한 인사 사고가 터진 후에야 일시적으로 위 험 정보들이 언급되는 정도이다. 성형산업과 언론이 미용성형의 미용효과만을 과장되게 선전하는 한국사회에서 미용성형의 위험성은 충분히 고지되지 않고 있다. 이런 측면에서, 안전성과 위험성을 가장 중요한 프레임으로 삼아 언론의 의료정보가 제공될 필요성을 논의한다. This study aims to examine critically how the Korean newspapers have provided cosmetic surgery informations since 1970s, focusing on whether the dangers of specific cosmetic surgeries have been intentionally reduced and hided. For this, 223 articles of 5 regular medical columns are analyzed. Since 1970s plastic surgeons started exerting their authority as medical specialists in the public press, providing more informations about reconstructive plastic surgeries than cosmetic ones, and emphasizing cosmetic surgeries`` side effects rather than their beauty effects. Since 1990s, however, the situations were reversed, then the project of medicalising the beauty has got momentum, consequently informations about detailed conditions of the perfect beauty and new cosmetic surgeries trends have overflowed in Korea. Under the situation, actual incidents and possible dangers relating the surgeries have become silenced or vague. There are only two contexts in which the problems of specific cosmetic surgeries are leaked: firstly, in order to promote relative supremacy of the new surgery technique, side effects of the previous one are revealed as fatal faults; secondly, personnel accidents temporarily make risk informations mentioned. These findings imply that Korean women are not sufficiently informed of health risks of cosmetic surgeries in the society which beauty benefits are constantly overemphasized by the cosmetic industry and press.

정보제공이 외래 의식 하 수술, 시술 환자의 불안에 미치는 영향: 체계적 문헌고찰

정애리 ( Ae Ri Jung ),이인숙 ( In Sook Lee ) 서울대학교 간호과학연구소 2016 간호학의 지평 Vol.13 No.1

Purpose: The purpose of this study was to investigate the research methods, contents, and effects of providing information to alleviate patients` anxiety during outpatient surgery. Methods: The PICOTS-SD (Participants, Interventions, Comparisons, Outcomes, Time, Setting, Study design) was used and 11 randomized controlled trials studies that met the inclusion and exclusion criteria were selected. For assessing the quality of the studies, the Cochrane Risk of Bias tool was used. Results: In the 11 selected studies, intervention methods included verbal, written paper, video, and websites, and the outcome variable was anxiety. Regarding the effectiveness of providing information on anxiety, the result of the present study was ambivalent. Conclusion: This study showed the current trends in providing information as an intervention. However, randomized controlled trials are further needed in Korea, to verify the effects of such an intervention on patients` anxiety.