Impact of COVID-19 on the End-of-Life Care of Cancer Patients Who Died in a Korean Tertiary Hospital: A Retrospective Study

Jeongmi Shin,Yejin Kim,Shin Hye Yoo,Jin-Ah Sim,Bhumsuk Keam 한국호스피스완화의료학회 2022 한국호스피스.완화의료학회지 Vol.25 No.4

Purpose: Social distancing and strict visitor restrictions at hospitals have been national policies since the onset of the coronavirus disease 2019 (COVID-19) pandemic. This has challenged the concept of a good death in comfort with the opportunity to say goodbye. Little is known about how these measures have influenced end-of-life (EOL) care among cancer patients who die in acute care hospitals. This study examined changes in the EOL care of cancer patients during the COVID-19 pandemic. Methods: We retrospectively analyzed 1,456 adult cancer patients who died in 2019 (n=752) and 2020 (n=704) at a tertiary hospital. Data on EOL care—symptom control and comfort care in an imminently dying state, preparation for death, place of death, and aggressive care in the last month— were reviewed. Results: The 1,456 patients had a median age of 67 years, and 62.5% were men. Patients who died in 2020 were more likely to experience agitation or delirium before death (17.2% vs. 10.9%), to use inotropes/vasopressors near death (59.2% vs. 52.3%), and to receive cardiopulmonary resuscitation in their last months (16.3% vs. 12.5%) than those who died in 2019. Additionally, the number of deaths in the emergency room doubled in 2020 compared to 2019 (from 7.1% to 14.1%). Conclusion: This study suggests that EOL care for cancer patients who died in a tertiary hospital deteriorated during the COVID-19 pandemic. The implementation of medical care at the EOL and the preferred place of death should be discussed carefully in advance for high-quality EOL care.

Sensitive Data Hiding Scheme for Internet of Things using Function Call Obfuscation Techniques

Jeongmi Shin,Yeonseung Ryu 보안공학연구지원센터 2016 International Journal of Security and Its Applicat Vol.10 No.10

A new era of Internet of Things (IoT) will emerge in near future due to the rapid innovations and advancements in computing and communication technologies. In order to make IoT era become possible, sensitive data in IoT devices such as cryptographic keys should be protected from malicious attackers. In particular, cryptographic keys are vital for securing systems and communication. In this paper, we study a sensitive data hiding scheme for IoT devices using software obfuscation techniques. Proposed scheme exploits function call obfuscation and creates a hidden area between functions to secretly store sensitive data. The proposed scheme outperforms the legacy hardware-based schemes which impose additional hardware cost to IoT devices.

A Feasibility Study of Adenosine Triphosphate-based Chemotherapy Response Assay (ATP-CRA) as a Chemosensitivity Test for Lung Cancer

Shin Myung Kang,Moo Suk Park,Joon Chang,Haeryoung Kim,Dong-Hwan Shin,Se Kyu Kim,Kyung Young Chung,Dae Joon Kim,Joo Hyuk Sohn,최성호,Jeongmi Kim,Eun Jin Yoon,Joo-Hang Kim 대한암학회 2005 Cancer Research and Treatment Vol.37 No.4

Purpose: A chemosensitivity test can reflect the differences in responses of individual cancer patients to chemotherapeutic agents. The adenosine triphosphatebasedchemotherapy response assay (ATP-CRA)is an accurate method, which does not require a large amount of tissue specimen. So far, no studies have evaluated the utility of the ATP-CRA in Korea. Therefore, we investigated the clinical usefulness of the ATP-CRA in 53 patients with lung cancer.Materials and Methods: Tumor tissues were obtained from bronchoscopic biopsies or surgical resections. The validity of ATP-CRA was assessed focusing on the success rate, experimental error level (intraassay mean coefficient of variation [CV]) and reproducibility.Results: The overall success rate of ATP-CRA was 90.6% (48/53). Normal cells were effectively eliminated from the tumor tissues with the use of ficoll gradient centrifugation and immunomagnetic separation, which was confirmed using loss of heterozygosity analysis of the 3p deletion. The mean CV of ATP assays was 10.5± 4.6%. The reproducibility of ATP assays was 94±3.8%. The results of the ATP assays were reported to physicians within 7 days of specimen collection. More than 6 anticancer drugs were tested on the tumor specimens obtained from bronchoscopic biopsies.Conclusion: The ATP-CRA is a stable, accurate and potentially practical chemosensitivity test in patients with lung cancer.

Ethical Issues Referred to Clinical Ethics Support at a University Hospital in Korea: Three-Year Experience After Enforcement of Life-Sustaining Treatment Decisions Act

Yoo Shin Hye,Kim Yejin,Choi Wonho,Shin Jeongmi,Kim Min Sun,Park Hye Yoon,Keam Bhumsuk,Yim Jae-Joon 대한의학회 2023 Journal of Korean medical science Vol.38 No.24

Background: Clinical ethics support is a form of preventive ethics aimed at mediating ethicsrelated conflicts and managing ethical issues arising in the healthcare setting. However, limited evidence exists regarding the specific ethical issues in clinical practice. This study aimed to explore the diverse ethical issues of cases referred to clinical ethics support after the new legislation on hospice palliative care and end-of-life decision-making was implemented in Korea in 2018. Methods: A retrospective study of cases referred to clinical ethics support at a university hospital in Korea from February 2018 to February 2021 was conducted. The ethical issues at the time of referral were analyzed via qualitative content analysis of the ethics consultationrelated documents. Results: A total of 60 cases of 57 patients were included in the study, of whom 52.6% were men and 56.1% were older than 60 years of age. The majority of cases (80%) comprised patients from the intensive care unit. One-third of the patients were judged as being at the end-of-life stage. The most frequent ethical categories were identified as goals of care/ treatment (78.3%), decision-making (75%), relationship (41.7%), and end-of-life issues (31.7%). More specifically, best interests (71.7%), benefits and burdens/harms (61.7%), refusal (53.3%), and surrogate decision-making (33.3%), followed by withholding or withdrawal (28.3%) were the most frequent ethical issues reported, which became diversified by year. In addition, the ethical issues appeared to differ by age group and judgment of the end-of-life stage. Conclusion: The findings of this study expand the current understanding of the diverse ethical issues including decision-making and goals of care/treatment that have been referred to clinical ethics support since the enforcement of the new legislation in Korea. This study suggests a need for further research on the longitudinal exploration of ethical issues and implementation of clinical ethics support in multiple healthcare centers.

OECD DAC 주요 공여국의 기초교육 공적개발원조 비교 연구

신정미(Shin, Jeongmi) 글로벌교육연구학회 2017 글로벌교육연구 Vol.9 No.3

본 연구의 목적은 초등교육 ODA 분야에서 두각을 나타내고 있는 선진공여국의 현황 및 특징의 분석을 통해 한국의 초등교육 ODA가 나아갈 바람직한 방향을 제시할 수 있는 쟁점을 도출하는 것이다. 이를 위하여 문헌연구의 방법을 통해 OECD DAC 공여국 중 초등교육 ODA의 규모가 큰 상위 5개국을 대상으로 이들의 초등교육 ODA 규모, 수원국의 분포, 전달 체제 및 사업 유형, 그리고 구체적인 ODA 사례를 비교분석하였다. 연구 결과, OECD DAC 주요 공여국의 초등교육 ODA 규모는 대체적으로 증가세를 나타내고 있었으며, 교육 ODA에서 기초교육이 차지하는 비중이 클수록 초등교육 ODA의 규모가 크다는 것을 확인할 수 있었다. 또한, 이들은 초등교육 ODA가 시급한 최빈개도국과 사하라 이남 아프리카 지역을 가장 많이 지원하고 있는 것으로 나타났다. 전달 주체 면에서는 NGO 및 시민사회의 참여가 두드러졌으며, 다자기구를 통한 초등교육 ODA 역시 활발하게 이루어지고 있는 것을 확인할 수 있었다. 또한, 사업 유형 면에서 이들은 프로그램 원조와 다자 협력을 통한 초등교육 ODA를 지향하고 있는 것으로 나타났다. 이상의 결과를 바탕으로 본 연구에서는 한국의 초등교육 ODA의 개선을 위한 시사점을 도출하였다. 먼저, 기초교육 ODA 전반에 관한 심도 있는 논의가 이루어져야 한다. 이를 통해 기초교육 ODA에 대한 사회 전반적인 합의가 이루어질 때 초등교육 ODA의 규모를 안정적으로 확보할 수 있을 것이다. 둘째, 초등교육의 지역 간, 국가 간 및 성별 간 격차를 극복하기 위한 포괄적인 초등교육 ODA 전략을 세워야 한다. 셋째, 교육원조의 후발주자로서 선진공여국과의 협력은 물론, 다자기구를 비롯해 NGO 및 시민사회단체를 통한 초등교육 ODA 사업을 확대할 필요가 있다. 넷째, 단기적이고 가시적인 성과중심의 사업을 지양하고 교육의 특수성에 입각한초등교육 ODA를 추진해야 한다. 이를 위해서는 기초교육 ODA의 정책 철학 및 목표 등 국가차원의 핵심가치 수립이 선행되어야 할 것이다. The purpose of this research is to foster advancement of ODA policy in the primary education sector. The study seeks to determine the current status and characteristics of the OECD DAC major donors by analyzing their recent primary education cases from 2010 to 2014 through a detailed literature review that particularly focuses on the scale of ODA, characteristics of recipient countries, main channels of aid, and types of aid. The results of the analysis are as follows: Initially, OECD DAC major donors’ scale of ODA in primary education was generally showing an increasing trend. Additionally, it showed that the larger the scale of ODA in basic education, the greater the yield in educational outcome in primary education. Secondly, the major donors gave the most amount of ODA support in primary education to the least developed countries and to Sub-Saharan Africa, where primary education is urgent. Thirdly, in the aspect of channel of aid, it was clear that NGOs and Civil Society both actively participated in primary education ODA. In the type of aid, meanwhile, there was a tendency to aim a programme-based approach and closer cooperation with multilateral institutions in OECD DAC major donors. This research establishes agendas for Korea’s primary education ODA based on the analysis above. First, Korea needs a discussion over basic education ODA in general. Second, it needs to establish an inclusive strategy to reduce disparity between regions, between countries and between genders. Also, Korea needs to cooperate with leading donor countries and multilateral institutions. In addition, Korea should advance primary education ODA on particularity in education instead of short-term and performance-oriented business. Most of all, the establishment of core values and policy objectives concerning basic education ODA at national level must take precedence in order to improve Korea’s primary education ODA.

The impact of COVID-19 on cancer care in a tertiary hospital in Korea: possible collateral damage to emergency care

Yoo Shin Hye,Sim Jin-Ah,Shin Jeongmi,김범석,Park Jun-Bean,Shin Aesun 한국역학회 2022 Epidemiology and Health Vol.44 No.-

OBJECTIVES: We investigated the impact of the COVID-19 pandemic on cancer care in a tertiary hospital in Korea without specific lockdown measures.METHODS: A retrospective cohort of cancer patients from one of the largest tertiary hospitals in Korea was used to compare healthcare utilization in different settings (outpatient cancer clinic, the emergency department [ED], and admissions to the hematology/oncology ward) between January 1 and December 31, 2020 and the same time period in 2019. The percent changes in healthcare utilization between the 2 periods were calculated.RESULTS: A total of 448,833 cases from the outpatient cohort, 26,781 cases from the ED cohort, and 14,513 cases from the admission cohort were reviewed for 2019 and 2020. The total number of ED visit cases significantly decreased from 2019 to 2020 by 18.04%, whereas the proportion of cancer patients remained stable. The reduction in ED visits was more prominent in patients with symptoms suspicious for COVID-19, high-acuity cases, and those who lived in non-capital city areas. There were no significant changes in the number of total visits, new cases in the outpatient clinic, or the total number of hospitalizations between the 2 periods.CONCLUSIONS: During the pandemic, the number of ED visits significantly decreased, while the use of the outpatient clinic and hospitalizations were not affected. Cancer patients’ ED visits decreased after the COVID-19 outbreak, suggesting the potential for collateral damage outside the hospital if patients cannot reach the ED in a timely manner.

Diagnostic Performance of Diffusion-Weighted Steady-State Free Precession in Differential Diagnosis of Neoplastic and Benign Osteoporotic Vertebral Compression Fractures: Comparison to Diffusion-Weighted Echo-Planar Imaging

Shin, Jae Ho,Jeong, Soh Yong,Lim, Jung Hyun,Park, Jeongmi Korean Society of Magnetic Resonance in Medicine 2017 Investigative Magnetic Resonance Imaging Vol.21 No.3

Purpose: To evaluate the diagnostic performance of diffusion-weighted steady-state free precession (DW-SSFP) in comparison to diffusion-weighted echo-planar imaging (DW-EPI) for differentiating the neoplastic and benign osteoporotic vertebral compression fractures. Materials and Methods: The subjects were 40 patients with recent vertebral compression fractures but no history of vertebroplasty, spine operation, or chemotherapy. They had received 3-Tesla (T) spine magnetic resonance imaging (MRI), including both DW-SSFP and DW-EPI sequences. The 40 patients included 20 with neoplastic vertebral fracture and 20 with benign osteoporotic vertebral fracture. In each fracture lesion, we obtained the signal intensity normalized by the signal intensity of normal bone marrow (SI norm) on DW-SSFP and the apparent diffusion coefficient (ADC) on DW-EPI. The correlation between the SI norm and the ADC in each lesion was analyzed using linear regression. The optimal cut-off values for the diagnosis of neoplastic fracture were determined in each sequence using Youden's J statistics and receiver operating characteristic curve analyses. Results: In the neoplastic fracture, the median SI norm on DW-SSFP was higher and the median ADC on DW-EPI was lower than the benign osteoporotic fracture (5.24 vs. 1.30, P = 0.032, and 0.86 vs. 1.48, P = 0.041, respectively). Inverse linear correlations were evident between SI norm and ADC in both neoplastic and benign osteoporotic fractures (r = -0.45 and -0.61, respectively). The optimal cut-off values for diagnosis of neoplastic fracture were SI norm of 3.0 in DW-SSFP with the sensitivity and specificity of 90.4% (95% confidence interval [CI]: 81.0-99.0) and 95.3% (95% CI: 90.0-100.0), respectively, and ADC of 1.3 in DW-EPI with the sensitivity and specificity of 90.5% (95% CI: 80.0-100.0) and 70.4% (95% CI: 60.0-80.0), respectively. Conclusion: In 3-T MRI, DW-SSFP has comparable sensitivity and specificity to DW-EPI in differentiating the neoplastic vertebral fracture from the benign osteoporotic vertebral fracture.

열플라즈마를 이용한 전이금속 다중도핑 TiO₂ 광촉매 합성 및 밴드갭 특성

MyoungSun Shin,SoonJik Lee,JeongMi Yeon,SunYong Choi 한국진공학회 2018 한국진공학회 학술발표회초록집 Vol.2018 No.8

미래여성인재 육성정책 개선방안

신선미(Seon-Mee Shin):마경희(Kyoung-hee Ma),유정미(Jeongmi Yoo) 한국여성정책연구원 2016 한국여성정책연구원 연구보고서 Vol.2016 No.-

1. 연구개요 가. 연구목적 미래여성인재 육성정책은 관리직과 전문직에 여성진출을 확대함으로써 사회 전반에 걸쳐 여성의 경제활동 참여와 성평등 사회 실현을 선도하려는 목적을 가지고 있다. 이 정책은 어려운 여건 속에서 나름대로 성과를 거두고 있으나 관련 사업들 간에 연관성 부족을 비롯하여 여러가지 문제점이 발견되고 있다. 이에 관련 사업들이 하나의 시스템을 구성하여 상호 연관성을 높여나갈 수 있도록 개선방안을 제안하고자 한다. 나. 연구내용 □ 미래여성인재 육성정책의 범위와 배경에 관한 정책자료 및 선행연구 결과, 그리고 정책개발에 필요한 학문적 기초 점검(2장) □ 미래여성인재 육성정책을 구성하는 세 가지 하위 정책 1)여성인재의 발굴 및 DB 구축, 2)여성인재아카데미사업, 3)여성인재 DB 활용정책의 내용과 추진실적 검토(3장) □ 미래여성인재 육성정책의 개선방안 도출 : 1)정책 목적, 범위, 환류시스템 보완, 3)여성인재 발굴 및 활용정책 개선방안, 4)여성인재아카데미사업 개선방안(4장) 다. 연구방법 □ 문헌분석 : 미래여성인재 육성정책에 관한 정부부처의 문서자료, 보도자료, 신문기사, 관련 법령 등 □ 개인 및 초점집단 면접조사 : 개인별 면접조사 6명, 초점집단(3개 집단) 면접조사 16명 라. 연구기간 : 2016. 9. 1. - 2016. 11. 30. 2. 미래여성인재 육성정책의 추진현황 가. 여성인재의 발굴 및 DB 구축 □ 정책목표 : 2017년까지 10만 명의 여성인재 발굴?DB화 □ 여성인재 DB 등록자의 특징 : 1)31개 전문분야 중에서 문화/예술/체육/관광 분야(9,348명, 10.9%)가 가장 많고 소방/방재/기상분야(154명, 0.2%)가 가장 적음. 2)직종별로는 교수, 연구원 등 교육인(34,614명, 40.2%), 경제/기업인(19,945명, 23.2%), 공무원(13,057명, 15.2%)이 가장 많음(표 Ⅲ-4)). □ 문제점 : 인력과 물리적 시스템의 한계로 등록된 정보의 사실 여부를 검증하고 정보를 지속적으로 업데이트하는 체계적인 절차 부재 나. 여성인재아카데미사업 □ 정책목표 : 2013년 하반기부터 2017년까지 총 3만명 교육수료 □ 주요대상 : 여성 중간관리자, 여성 고위관리자, 전문직 여성, 기타 여성리더(지역여성리더, NGO 여성 리더 등) □ 성과 : 1)교육인프라 구축 및 다수의 교육 인원, 2)교육참여자의 높은 교육 만족도, 3)역량진단 도구 및 강의안의 자체개발, 4)대상별 특성화된 교육 프로그램 체계화 시도 □ 문제점 : 1) 전략적 교육운영의 부족, 2) 여성인재 발굴 및 활용 정책과의 연계 부족, 3) 공공기관/민간기업 대상 교육의 타당성, 지속성 문제, 4)기관별 경영진 및 인사담당자 대상의 여성인재육성 관련 교육 부재 다. 여성인재 DB 활용 정책 □ 정책목표 : 2017년까지 4급 이상 여성공무원 비율 15%, 정부위원회 위촉직 여성비율 40%, 여성 교장?교감 비율 37.3%, 공공기관의 여성 관리자 비율 18.8%(표 Ⅱ-1). □ 추진실적 -정부위원회 위촉직 여성비율 : 중앙행정기관 34.5%, 지방자치단체 30.1%(표 Ⅲ-22, 표 Ⅲ-23) -2013년부터 2016년 10월말까지 총 333개 정부위원회에 3,689명의 여성인재추천(본문 p.32) □ 문제점 : 여성인재 DB 구축 목적은 “여성인재의 육성 및 사회참여 확대 지원”에 있으나 실제 활용처는 공직후보자 추천(정부위원회 위원, 개방형 및 공모직위, 책임운영기관장, 공공기관 임원 등) 등 인사 상 목적으로만 활용되고 있음. This paper is designed to check the status of future female talent cultivation policies and to present ways to improve such policies. Future female talent cultivation policies aim to increase the number of female managers and professionals especially in the public sector. Key research contents include 1) the scope and background of future female talent cultivation policies; 2) the status of three exemplary policies; and 3) ways to enhance policies. Literature reviews and focus group (22 persons) interviews were used for this research study. The policies have been carried out mainly in the public sector but need to expand to include the private sector in the future. More than 86,000 talented women (middle managers and higher-ranking administrators/professionals) are registered in the Female Talent DB. Data on 100,000 female talents are expected to be gathered by 2017. In order to raise the percentage of female managers in the public sector, the following three policy goals should be achieved by 2017: 1) increasing the proportion of female managers in public institutions to 18.8%; 2) improving the percentage of female principals and vice principals to 37.3%; and 3) raising the share of women appointed in government committees to 40.0%. Against this backdrop, policy improvement plans include 1) expanding the scope of female talent data used; 2) strategically gathering information via the analysis of the Female Talent DB; 3) enhancing the Female Talent DB operation system; 4) recommending sectors where curricula for the Women Leader Academy should preferentially expand; and 5) a module for curricula for the Academy for Women in construction.

Water-retentive and anti-inflammatory properties of organic and inorganic substances from Korean sea mud.

Kim, Jung-Hyun,Lee, Jeongmi,Lee, Hyang-Bok,Shin, Jeong Hyun,Kim, Eun-Ki Natural Product Communications 2010 Natural product communications Vol.5 No.3

<P>Sea mud has been popularly used as an effective base in cosmetic preparations although its biologically-active materials and mechanisms on skin have not yet been fully determined. We isolated humic substances as the major organic substance of the sea mud from a tidal flat in Korea, and investigated their water-retentive properties. Among the three isolated humic substances, humic acid (HA) showed the highest water retentive property (approximately 50 % mass increase from water uptake). Based on the observations that mud pack therapy has been traditionally used to soothe UV-irradiated skin, we examined the antiinflammatory property of the sea mud on UVB-irradiated human keratinocytes (HaCaT cells) by measuring PGE2 levels produced by keratinocytes in the presence of either the total water or methanol extracts of the mud. The water extract showed higher inhibition of PGE2 production from HaCaT cells (30% inhibition) than the methanol extract at 200 ppm (microg/g). We further fractionated the water extract to determine the major components responsible for its anti-inflammatory effect. It was found that the minerals in the mud inhibited PGE2 production by 83 % at 200 ppm, which is comparable with the inhibitory effect of 1 microM indomethacin. No mud extract showed cytotoxicity at the tested concentrations. The mineral compositions of the mineral extract were determined by ICP-MS, revealing that the sea mud consisted of more than 19 different mineral components, rich in Na+, Mg2+, and Zn2+. These results imply that the anti-inflammatory effect of the sea mud is largely due to the minerals in the mud. Our research suggests the potential use of the organic and inorganic substances from the sea mud in various skin products as safe biological substances for skin protective purposes.</P>