A Survey on Petition and Process for the Extension of Hospitalization in Mental Hospital / 신경정신의학

OBJECTIVES: The authors performed this survey to find out current status of petition and process for the extension of hospitalization of patients who were hospitalized more than 6 months. METHODS: Authors designed a questionnaire named 'Questionnaire for Survey of Current Status and Process of Petition for Extension of Hospitalization of Psychiatric Patients' and distributed it to 242 psychiatric facilities with closed wards for psychiatric patients. The psychiatric facilities includes 4 categories;psychiatric department of university hospital, psychiatric department of general hospital, psychiatric hospital and small sized private clinic. The period of survey was from Jan. 1 to Dec. 31 of 2002. RESULTS: Among 84 psychiatric facilities responded, 2,615 petitions for extension of hospitalization were submifted to the Local Mental Health Tribunal, and the dissent rate was 4.1%. The most of petitions were from psychiatric hospitals (2,265). The psychiatric departments of general hospitals favored the discharge-readmission method rather than applying extension by due process of the Mental Health Act when further admission was needed after 6 months hospitalization (280 vs. 106). The main reason for the petitions for extension of hospitalization was "no improvement" (72.7%) than "dangerousness to self or others" (14.7%). Against doctor's recommendation for discharge agter improvement, many patients couldn't be discharged becanse of guardians' refusal or cut off from caregiver or guardian. In cluded were these patients applied petitions for extension of hospitalization. CONCLUSION: This study suggests that hospitalization of some patients are extended improperly in view of the spirif of the Mental Health Act. The authors proposea new system of ambulatory treatment, reinforcement of psychiatric rehabilitation, legal control of the neglected patient by guardians.

A Survey on The Current Status of Mental Health Act Application / 신경정신의학

OBJECTIVES: The purpose of this study is to find out how the Mental Health Act(MHA) which was enacted in 1995 has been practiced in reality since it was enforced. This study focuses on the following provisions of this law; admission procedures in relation to the protection of patients' rights, discharge procedures in view of the human rights, and the conditions of the restriction of the patients' rights in hospital. METHODS: The questionnaire on "the current state of the application of the MHA" was designed by the authors and was distributed by mail to 213 psychiatric hospitals and general hospitals which operate psychiatric closed wards as of 1999. RESULTS: One hundred ten hospitals responded to the survey(51.6%) and 92.5% of the total admission to the closed ward were by 'admission by agreement of guardian'(article 24 of MHA). It was reported that a written agreement paper of guardian was filed in 98% and the official document(for the article 14 of rule for enforcement of MHA) for legal guardianship was filed in 85 % of these ad-missions respectively. However, the rate of filling the official document is actually below 85% accor-ding to the direct telephone confirmation. Other kind of admissions such as 'admission by the order of head of prefecture(article 25 of MHA) and 'emergency admission'(article 26 of MHA) were not performed except in several psychiatric hospitals. There cases no report regarding the patient's or guardian's appeal for the improvement of patient's right and better treatment and/or disagreement to involuntary admission. Sixty three percent of hospitals reported that the patients were free to use telephone, and 18.1% reported that the official forms to appeal human right violation of the institute were accessible to patients. However, the actual rates are suspected to be lower than the reports by the institutes. Petition for extension of hospital stay requested by the doctor in charge(article 24-3 of MHA) was submitted mostly by psychiatric hospitals, and its rejection rate was 3.7%. CONCLUSION: In case of 'admissions by agreement of guardian', the required qualification for guardianship and the accompanying document to prove the legal guardianship should be amended to make it more realistic. For other kinds of admissions, such as 'emergency admission' and 'admission by order of head of prefecture', admission procedure should be modified to make it more efficient and practical. The rules and regulations for the human rights of psychiatric patients are not observed properly, which needs much improvement. As this study was done by a survey, it has limitation in understanding how the MHA is actually applied and therefore msufficient as data for the use of revising the Act. However, it appears that MHA is not properly observed with problems in applying MHA in practice. The information obtained from this study suggests that extensive study on national level should be done to find out how the MHA is practiced in reality with much discussion on improving the MHA on the basis of its finding.

Detection of Collagenase in Inflammatory Gingiva using Root planning and Argon Laser / 대한치주과학회지

The major cause of periodontal disease is microorganism in the dental plaque. Gingival sulcular fluid, which is exudate released from the tissue near crevicular epithelium is related with inflammation. The purpose of this study was to evaluate the argon laser efficiency between the clinical index and onset of collagenase of gingival sulcular fluid. Material divided 16 patients into 4 groups. The first control was without treatmemt. The second was with just treatment of argon laser, The third was treated by scaling and root planning and the fourth was treated with both scailing and root planning and argon laser. The level of periocheck test, the index of bleeding, and the depth of periodontal pocket were evaluated from for 128 teeth of 64 anterior teeth and 64 posterior teeth. The results were as follows; 1. In the score of periocheck test, root planing group(group 3) was significantly reduced more than the group without treatment(group 1) and the argon laser treatment(group 2) for results of 3 days and 7 days. But root planing plus argon laser treatment(group 4) in the 7days after experiment, was significantly reduced than no treatment(group 1) and root planing treatment(group 3)(P < 0.05), in the 3 days after experiment, was significantly reduced than root planing(group3)(P < 0.05). The score of periocheck test to the root planning group(group 3) were significantly reduced between days1, day3 and day7(P < 0.05). Root planning plus argon laser group(group 4) were significantly reduced to 1 or 7days and 3 or 7days(P < 0.05). The argon laser group(group 2) didn't show any changes. 2. In the case of sulcus bleeding index, the root planning group(group 3) and root planning plus argon laser group(group 4) were reduced more than without treatment group(group 1)(P < 0.05) and sulcus bleeding index in the root planning group(group 3) were reduced more than the argon laser group(group 2)(P < 0.05). 3. There wasn't any changes of pocket depth between the control and the experiment group as with experiment periods also.

Case reports of bone grafting in unilateral alveolar-palatal cleft patients / 영남의대학술지

We obtained successful functional and esthetic results by grafting of iliac marrow-cancellous bone in 2 cases of alveolar-palatal cleft patients. Bone graft of alveolar-palatal clefts provide bony support to adjacent teeth of cleft area, prevented from relapse of orthodontic arch expansion, closure of oroantral fistula and improvement of speech problem. 1. In one case, extraction of upper right central incisor that was little bone support, alignment of rotated teeth and expansion of collapsed arch segment were done with pre-orthodontic treatment. The other case. Bone grafting was done after removal of prosthesis with no pre-orthodontic treatment. 2. After mucoperiosteal incision in cleft area, the mucosal flap of labial area, palate and nose were separation and the raised nasal mucosa was sutured for closure of oroantral fistula. Then, the iliac marrow-cancellous bones were grafted to cleft site. 3. After 6 months of operation, we had seen the new bone deposition to cleft site in dental radiograph and prosthetic treatment of missing teeth were done.