Prevention of medical malpractice and disputes through analysis of lawsuits related to coronary angiography and intervention

Cheol Won Hyeon,Won Lee,So Yoon Kim,Ji Yong Park,Su Hwan Shin 대한내과학회 2020 The Korean Journal of Internal Medicine Vol.35 No.3

Background/Aims: Possible fatal complications arising from coronary angiography (CAG), percutaneous coronary intervention (PCI), and coronary artery disease itself, are likely to cause medical disputes. Presenting the current status and reasons for judgments given in lawsuits related to CAG/PCI, this study aimed to identify ways to prevent unnecessary disputes and medical malpractice suits related to CAG/PCI through lawsuit analysis. Methods: A total of 13 cases (20 judgments) found in the Supreme Court of Korea’s Written Judgment Management System from 1998 to 2017 were analyzed. Results: Coronary artery injury was the most common causative complication that led to lawsuits (n = 6, 46%). Six cases (46%) were ruled in favor of the plaintiff for violation of duty of care (n = 4) and duty of explanation (n = 2), respectively. Cases that violated duty of care included two errors in intra-procedure device manipulation, one in pre-procedure diagnosis, and one in management of post-procedure complication. Lack of explanation regarding the risk of complications was pointed out in both cases that violated duty of explanation. The average awarded amount for the damages was 114,436,064 Korean won. Conclusions: Physicians need not fear unfair judgments so long as they follow standard of care because the Court consistently looked at the probability, the foreseeability, and the evidence. Therefore, maintaining standard of care is important. Besides, specific, detailed, and comprehensible explanations, including the risk of complications in addition to the necessity of procedures, are important to ensure the patient clearly understands the possible risk of adverse outcomes.

원문 : 크레아틴-중탄산나트륨의 복합투여가 암-에르고미터 운동수행력에 미치는 영향

이철원 ( Cheol Won Lee ) 한국운동생리학회(구 한국운동과학회) 2014 운동과학 Vol.23 No.3

이철원. 크레아틴-중탄산나트륨의 복합투여가 암-에르고미터 운동수행력에 미치는 영향. 운동과학, 제23권 제3호. 257-266 2014. 본 연구는 크레아틴, 중탄산나트륨, 그리고 크레아틴과 중탄산나트륨의 복합투여가 암-에르고미터(arm-ergometer)를 이용한 상지 근기능에 미치는 효과를 알아보기 위해 경기도 소재 Y대학교 체육계열 남·여학생 17명을 대상으로 실시하였다. 무선추출법을 통해 크레아틴 투여집단(n=7), 중탄산나트륨 투여집단(n=5), 크레아틴과 중탄산나트륨의 복합투여집단(n=5), 총 3 집단으로 나누어 암-에르고미터를 이용한 상지 근기능 사전검사(pre-test) 후 집단별 로딩(loading)이 완료된 5일 후 사후검사(post-test)를 동일하게 실시하였다. 자료처리는 통계패키지 SPSS Ver. 12.0을 이용하여 모든 변인의 측정결과를 평균과 표준편차로 산출하고, 집단 및 시기 차이에 대한 주효과검정과 집단과 상호작용효과를 알아보기 위해 반복측정에 의한 이원변량분석 (Two-way repeated measured ANOVA)을 실시하였으며, 모든 통계적 유의수준은 p<.05로 설정하였다. 본 연구의 결과 암-에르고미터를 통한 검사 항목에서 최고 파워, 피로지수, 체중당 피크파워, 안정시 젖산농도 등에서 시기에 따른 유의한 차를 나타내었으나, 집단 간 유의한 차이는 나타나지 않았다. 결론적으로, 크레아틴과 중탄산나트륨 그리고 크레아틴과 중탄산나트륨의 복합투여는 암-에르고미터를 이용한 상지 운동수행력에 긍정적인 영향을 미치는 것으로 나타났으나, 복합투여의 우수성은 나타나지 않았다. Lee, Cheol-Won. The Effect of Combined Creatine and Sodium Bicarbonate Supplementation on Arm Ergometer Performance. Exercise Science. 23(3): 257-266, 2014. The purpose of this study was to assess the effects of creatine, sodium bicarbonate and combined creatine and sodium bicarbonate supplementation on upper limbs with arm-ergometer. Seventeen students majoring in physical education were randomly assigned to 3 groups [creatine (n=7), sodium bicarbonate (n=5), creatine & sodium bicarbonate (n=5)]. Pre-test consisted of muscular function of upper limbs with arm-ergometer and after 5 days later for creatine and sodium bicarbonate loading, post-test was processed with the same way as pre-test. Statistical analysis was performed by two-way repeated measured ANOVA for intervention. Significance was accepted at p<.05. The following results were obtained from this study. Peak power, fatigue index, peak power/kg and peak attainment time of arm-ergometer test were significantly (p<.05) increased by time but no difference among the groups. In conclusion, creatine, sodium bicarbonate and combined creatine & sodium bicarbonate supplementation favorably affected muscular function of upper limbs with arm-ergometer but there were no significant difference among the groups.

알레르기 ; 알레르기 환자에서 한방 이외의 대체 요법의 사용 현황에 대한 다기관 조사

이현정 ( Hyun Jung Lee ),이재현 ( Jae Hyun Lee ),이용원 ( Yong Won Lee ),김철우 ( Cheol Woo Kim ),동헌종 ( Hun Jong Dhong ),박해심 ( Hae Sim Park ),조영주 ( Young Joo Cho ),조진희 ( Jin Hee Cho ),조상헌 ( Sang Heon Cho ),편복양 ( 대한내과학회 2011 대한내과학회지 Vol.80 No.1

목적: 한국에서 알레르기 질환 치료를 위한 한방 치료뿐만 아니라 대체 요법이 많이 이용되고 있으며, 그 현황에 대하여 다기관 조사를 시행하였다. 방법: 10개의 대학병원 외래로 내원한 647명의 알레르기 환자를 대상으로 설문조사를 시행하였으며, 이 중 510명이 한방 이외의 대체 요법에 응답하였다. 이환되어 있는 알레르기 질환은 천식(50.0%), 알레르기 비염(36.0%), 아토피 피부염(36.0%), 그리고 두드러기(9.3%)였다. 각각 환자들에게 12 문항의 설문조사를 시행하였으며, 한방 이외의 대체 요법의 사용 빈도 및 종류, 대체 요법에 의지하게 된 이유, 비용, 그리고 치료효과에 대한 의견을 물어 보았다. 결과: 16.7%의 알레르기 환자에서 한방 이외의 다른 대체 요법을 받았으며, 평균 1.6종의 한방 이외의 대체 요법을 받았다. 가장 많이 의지하는 대체 요법은 민간 식이요법 (48.6%)이었고, 그 다음이 아로마 요법(23.8%), 지압(14.3%), 건강 호흡법(7.6%), 마인드 컨트롤(5.7%), 목욕요법(5.7%) 순이었다. 대체 요법을 받은 환자 중 마인드 컨트롤(50%), 식이요법(50%), 그리고 건강 호흡법(75%)의 경우 치료 효과가 만족스럽다는 응답이 높았으며, 목욕요법, 아로마 요법, 그리고 지압은 만족도가 각각 33.3%, 28.0%, 26.7%로 저조하였다. 대체 요법 사용자의 63.6%가 5회 미만의 대체 요법을 받았고, 91.8%가 1년 이내로 치료받았으며, 1인당 평균 연 37 만원을 지출하였다. 대체 요법을 선택한 가장 큰 이유는 체질이 개선될 수 있을까 해서(44.2%)였으며, 대체 요법이 몸에 부담이 없어서(31.4%), 면역기능이 강화되어서(22.9%) 순으로 나타났고, 15.7%는 양약치료가 도움이 되지 않아서 대체 요법을 선택하였다고 응답하였다. 결론: 한국에서 알레르기 환자의 상당수가 한방뿐만 아니라 여러 가지의 대체 요법을 사용하고 있음을 알 수 있었다. 대체 요법의 사용 빈도가 증가하고 그 종류가 다양함을 고려할 때, 의료진은 대체 요법의 현황에 대하여 정확히 인지하고 이에 대해 관심을 가지고 환자를 대하여야 하며 올바른 알레르기 질환 치료법에 대해 환자뿐만 아니라 의료인에게 교육하는 것이 필요하다. Background/Aims: The use of unproven complementary/alternative medicine (CAM) to treat allergies is popular in Korea. We conducted a multicenter survey of the current use of CAM other than herbal medication in Korean allergy patients. Methods: This study enrolled 510 adults with allergic diseases, including asthma, allergic rhinitis, atopic dermatitis, and chronic urticaria, from ten hospitals. They underwent a structured questionnaire interview and clinical assessment of the prevalence, motivation, costs, and subjective assessment of CAM. Results: Of the patients, 16.7% used at least one type of CAM to treat their allergic diseases. Common types of CAM were diet (48.6%), aroma therapy (23.8%), massage (14.3%), breathing exercises (7.6%), baths (5.7%), and mind control (5.7%). The therapeutic effects of CAM included improved in patients using mind control (50%), diet (50%), breathing exercises (75%), and baths (33.3%), but worse in patients using aroma therapy (28%), and massage (26.7%). About 36.4% of the patients used CAM more than four times per year, and the average cost per CAM user was 370,000 won/year. The main reason for trying CAM was `hope to improve my constitution`. Conclusions: CAM is used widely for treating allergic diseases in Korea. Detailed knowledge of CAM and patient education are important. Further studies of the clinical efficacy of CAM are needed. (Korean J Med 2011;80:68-77)

소음인(少陰人) 태음병(太陰病) 심하비증(心下?證)의 병증약리(病證藥理) 고찰

서영광,이지원,이준희,최원철,이의주,고병희,Seo, Young-Kwang,Lee, Ji-Won,Lee, Jun-Hee,Choi, Won-Cheol,Lee, Eui-Ju,Kho, Byung-Hee 사상체질의학회 2010 사상체질의학회지 Vol.22 No.3

1. Objective: Gastric Stuffiness (心下?證) in the Soeumin Taeeum symptomatology (少陰人 太陰病) in Sasang Constitutional Medicine shows an interesting evolutionary process. Originally found in the texts of Sanghanlun (傷寒論), the perspectives regarding the symptoms of Gastric Stuffiness were expanded by many medical scholars and Lee Jema. To comprehend the Jema's concept of Taeeum symptomatology and utilize his prescription clinically, it deserves to study on the Gastric Stuffiness in Donguisuseowon (東醫壽世保元). 2. Methods: Many texts including Sanghanlun (傷寒論) and Dongeuibogam (東醫寶鑑) were reviewed in order to track the evolutionary process concerning the symptoms of Gastric Stuffiness. Also, Lee Jema's works including the different versions of Donguisuseowon (東醫壽世保元) were reviewed to examine the development of Lee's concepts regarding the Gastric Stuffiness in the Soeumin Taeeum symptomatology. 3. Results and Conclusions: 1) Most of the previous concepts on Gastric Stuffiness were generally similar to those found in Sanghanlun, especially in that they addressed Yang deficiency of the middle triple energizeer as the central pathogenic process. 2) Lee Jema's views on the epigastric discomfort in the Soeumin Taeeum symptomatology evoloved over time and culminated in the finalized pathology and therapeutics appearing in his last work, the Shinchuk version of Donguisuseowon (東醫壽世保元). 3) 4 kinds of prescription which invented by Lee Jema to treat the Gastric Stuffiness in the Soeumin Taeeum symptomatology can be matched to the prescription of Sanghanlun respectively. However through evolutionary process of Jema's prescriptions, the indication of them expanded: not only to treat Gastric Stuffiness but to diverse symptoms of Soeumin.

Risk factors for MDRD-GFR of less than 60 mL/min per 1.73 m² in former kidney donors

LEE, JANG HAN,KIM, SONG CHEOL,HAN, DUCK JONG,CHANG, JAI WON,YANG, WON SEOK,PARK, SU KIL,LEE, SANG KOO,PARK, JUNG SIK,KIM, SOON BAE Blackwell Publishing Asia 2007 Nephrology Vol.12 No.6

<P>SUMMARY:</P><P>Background: </P><P>Although several previous studies have reported that kidney donors are not at increased risk for adverse effects, some donors have been found to progress to chronic kidney disease (CKD). We retrospectively evaluated the risk factors for estimated glomerular filtration rate (GFR) from abbreviated Modification of Diet in Renal Disease (MDRD) equation (MDRD-GFR) of less than 60 mL/min per 1.73 m<SUP>2</SUP> in kidney donors.</P><P>Methods: </P><P>Of the 756 individuals who underwent open donor nephrectomy between 27 June 1990 and 30 April 2001, 104 had follow-up records for 50 months or more. MDRD-GFR of 60 mL/min per 1.73 m<SUP>2</SUP> at final follow up divided these individuals into a normal group (<I>n</I> = 78) and a CKD-GFR group (<I>n</I> = 26). We compared several clinical parameters between the two groups at baseline and follow up to evaluate the risk factors for MDRD-GFR of less than 60 mL/min per 1.73 m<SUP>2</SUP> in kidney donors.</P><P>Results: </P><P>The CKD-GFR group was significantly older than the normal group at baseline (47 ± 12 <I>vs</I> 41 ± 11 years old, <I>P</I> = 0.02). Hypertension was more prevalent in the CKD-GFR group at baseline (15% <I>vs</I> 2%, <I>P</I> = 0.005). Binary logistic regression analysis showed that age (Odds ratio (OR) 1.06, 95% confidence interval (CI) 1.01–1.10) and hypertension (OR 7.91, 95% CI 1.13–55.2) at baseline were independent risk factors for MDRD-GFR of less than 60 mL/min per 1.73 m<SUP>2</SUP>. At final follow up, the prevalence rates of hypertension (31% <I>vs</I> 8%, <I>P</I> = 0.006) and proteinuria (15% <I>vs</I> 0%, <I>P</I> = 0.003) were significantly higher in the CKD-GFR group.</P><P>Conclusion: </P><P>Older kidney donors and those with hypertension were significantly more likely to have a MDRD-GFR of less than 60 mL/min per 1.73 m<SUP>2</SUP>.</P>

Comparative study between atmospheric microwave and low-frequency plasmas: Production efficiency of reactive species and their effectiveness

Won, Im Hee,Kim, Myoung Soo,Kim, Ho Young,Shin, Hyun Kook,Kwon, Hyoung Cheol,Sim, Jae Yoon,Lee, Jae Koo Publication Board, Japanese Journal of Applied Phy 2014 Japanese journal of applied physics Vol.53 No.5

The characteristics of low-frequency (LF) and microwave-powered plasmas were investigated. The optical emission of these two plasmas indicated that more chemicals were generated by microwave plasma than by LF plasma with the intensities being higher by factors of about 9, 3, 5, and 1.6 for OH (309 nm), O (777 nm), NO (247 nm), and Ca2+ (290 nm), respectively. Application experiments were also conducted. A steel plate became hydrophilic after 45 s of microwave plasma treatment. This is more than ten times faster than in the case of LF plasma treatment, an action related to the generation of reactive species (e.g., OH, O, and NO) as measured by optical emission spectroscopy (OES). Ca2+ generation was verified by blood coagulation experiment. Microwave-plasma-induced coagulation was twice faster than LF-plasma-induced coagulation. Simulation results that explain the chemical generation in microwave plasma were also included. High-energy electrons were considered a major factor for microwave plasma characteristics. (C) 2014 The Japan Society of Applied Physics

Identification of Three Positive Regulators in the Geldanamycin PKS Gene Cluster of Streptomyces hygroscopicus JCM4427

( Won Cheol Kim ),( Jung Joon Lee ),( Sang Gi Paik ),( Young Soo Hong ) 한국미생물 · 생명공학회 2010 Journal of microbiology and biotechnology Vol.20 No.11

In the Streptomyces hygroscopicus JCM4427 geldanamycin biosynthetic gene cluster, five putative regulatory genes were identified by protein homology searching. Among those genes, gel14, gel17, and gel19 are located downstream of polyketide synthase genes. Gel14 and Gel17 are members of the LAL family of transcriptional regulators, including an ATP/GTP-binding domain at the N-terminus and a DNA-binding helix-turn-helix domain at the Cterminus. Gel19 is a member of the TetR family of transcriptional regulators, which generally act to repress transcription. To verify the biological significance of the putative regulators in geldanamycin production, they were individually characterized by gene disruption, genetic complementation, and transcriptional analyses. All three genes were confirmed as positive regulators of geldanamycin production. Specifically, Gel17 and Gel19 are required for gel14 as well as gelA gene expression.

Factors Affecting First-Line Triple Therapy of Helicobacter pylori Including CYP2C19 Genotype and Antibiotic Resistance

Lee, Ju Yup,Kim, Nayoung,Kim, Min Soo,Choi, Yoon Jin,Lee, Jung Won,Yoon, Hyuk,Shin, Cheol Min,Park, Young Soo,Lee, Dong Ho,Jung, Hyun Chae Springer-Verlag 2014 Digestive diseases and sciences Vol.59 No.6

Materials and Resources Items in Green Building Certification in Korea: Critiques and Suggestions

Lee, Kang Guk,Hong, Won Hwa,Jang, Cheol Yong,Ahn, Byung Lip,Kim, Tae Woo Trans Tech Publications, Ltd. 2013 Advanced materials research Vol.689 No.-

<P>In this study, critiques and suggestions on the materials and resources items in the current green building certification system in Korea. The green building certification system in Korea for promoting the construction of high-energy-efficiency buildings use. Korean green building certification system are based on the marks obtained from the Energy Efficiency Index Report.</P>

Treatment outcome of nasal natural killer/T-cell lymphoma

Lee, Hyun-Jin,Lee, Sang-Wook,Suh, Cheol-Won,Huh, Joo-Ryung,Yoon, Sang-Min,Kim, Young-Seok,Kim, Su-San,Kim, Jong-Hoon,Choi, Eun-Kyung,Ahn, Seung-Do The Korean Society for Radiation Oncology 2011 Radiation Oncology Journal Vol.29 No.3

Purpose: To evaluate the radiotherapy treatment outcome of patients in stage IE and IIE nasal natural killer/T-cell lymphoma. Materials and Methods: From August 1999 to August 2009, 46 patients with stage IE and IIE nasal natural killer/T-cell lymphoma were treated by definitive radiotherapy and chemotherapy. 33 patients were treated with chemotherapy followed by radiotherapy (CT + RT) and they received 50.4 Gy in 28 fractions. 13 patients were treated with concurrent chemoradiotherapy (CCRT) and they received 40 Gy in 20 fractions. Results: The median follow-up period was 4.6-137.6 months (median, 50.2 months) for all patients. The 4-year overall survival was 68.6% and 4-year disease free survival (DFS) was 61.9%. The 4-year locoregional recurrence free survival was 65.0%, and 4-year distant metastasis free survival (DMFS) was 66.2%. For patients treated with CT + RT, 15 patients (45.5%) achieved complete response after chemotherapy, and 13 patients (39.4%) achieved partial response. 13 patients (81.8%) achieved complete response after radiotherapy, and 6 patients (18.2%) achieved partial response. For patients treated with CCRT, 11 patients (84.6%) achieved complete response, and one patient (7.7%) achieved partial response. In univariate analysis, presence of cervical lymph node metastasis was only significant prognostic factor for DFS and DMFS. Conclusion: This study did not show satisfactory overall survival rate and disease free survival rate of definitive radiotherapy and chemotherapy for stage IE and IIE nasal natural killer/T-cell lymphoma. For patients with cervical lymph node metastasis, further investigation of new chemotherapy regimens is necessary to reduce the distant metastasis.