• Journal of agricultural medicine and community health
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• v.44 no.4
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• pp.195-208
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• 2019

Objectives: The purpose of this study was to analyze whether there are differences in medical expenses according to medical security type in the use of medical services with high disease burden such as coronary intervention. Methods: Chi-square test and covariance analysis(ANCOVA) were conducted to identify the differences in the characteristics and costs according to medical security type of 1,904 patients who underwent coronary intervention in a university hospital from 2011 to 2012. Hierarchical regression analysis was conducted to determine whether the cost affects medical expenses. Results: In the medical aid group, the proportion of women, those without a job, those without a spouse, and those who received hemodialysis was high, length of stay was high, patients using the emergency room and those who died was high. The medical aid patients were significantly higher in the non-benefit medical expenses, optional medical expenses, physician and admission, meals, medications and injections. National health insurance patients were significantly higher in procedure. The medical security type was found to be significant as a variable affecting the medical expenses. Conclusions: Provision of medical expenses should be managed in advance by providing prevention and education services for the vulnerable, and care services in the region should be provided to suppress the occurrence of medical expenses due to the increase in the number of days spent. In addition, it is necessary to support medical expenses to prevent unsatisfactory medical services from occurring for non-benefit and optional care.

• Journal of Yeungnam Medical Science
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• v.20 no.2
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• pp.197-205
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• 2003

서론: 급성 관동맥 증후군과 심근경색증의 진단과 예후 예측에 도움을 주는 새로운 심효소인자가 여러 가지 발견이 되어 현재 응급의료센터에서도 기본적으로 허혈성 흉통이 있는 환자에게 많이 사용하고 있다. 특히 최근에는 troponin과 CK-MB의 유용성에 대해서 많이 언급을 하고 있다. CRP도 역시 급성 관상동맥증후군에서 중요성이 인식되고 있다. 저자들은 세 가지 인자를 동시에 평가하여 상승되는 인자 수에 따라 그 중요성이 다를 수 있다는 가정 하에 총체적인 환자에 대한 정보를 제공할 수 있고, 응급실 근무 의사에게 급성 심근 경색증 환자를 좀 더 효율적으로 평가 할 수 있도록 하기 위하여 다표지 인자에 관한 연구를 시작하였다. 방법: 저자들은 응급의료센터에 내원한 급성 허혈성 흉통이 있는 환자 중 심효소 검사와 심전도에서 급성 심근 경색증에 합당한 소견을 보이고 이후 검사한 심혈관 조영술에서 심근경색증으로 확진된 환자를 대상으로 하였다. 내원 초기에 troponin T와 CK-MB, CRP를 동시에 측정하였고 또한 후향적으로 환자에 대한 기본적인 특징과 정보, 심전도 소견, 합병증 발생, 심혈관 조영술 소견과 경색관련 혈관 수, 치료 및 치료결과 등에 대한 자료를 정리하여 분석하여 보았다. 이때 환자는 두 군으로 나누어 분석하였는데, 1군은 증가된 효소수가 1개 이하인 경우이고, 2군은 2개 또는 3개 및 좌주관상동맥을 포함한 경우로 하였다. 결과: 전체 130명의 환자가 대상이 되었고, 1군 40례, 2군 90례로 2군이 훨씬 많았다. 과거력에서 이전에 관동맥 성형술을 시술받은 경우가 2군에서 유의 있게 많았다(p<0.05). 이전의 약물 복용은 전체적으로 1군에서 많았으나 질산제 복용(p<0.05)을 제외하고는 의의가 없었다. 치료는 혈전용해제 사용이 오히려 1군에서 의의있게 많았으나(p<0.05), 합병증으로 쇽이나 폐부종을 동반한 경우가 2군에서 많았다. 하지만 본 연구에서는 6개월 추적 기간중의 사건 발생이나 합병증, 예후 결과에 대한 양군간의 차이를 발견하지 못했다. 결론: 급성 심근경색증 환자에게 다표지 인자를 이용한 접근법을 적용한 결과, 기본적으로 환자에 대한 몇 가지 정보, 즉 과거에 약물 투여 여부와 혈전용해제 사용, 혈관성형술을 시술 받은 경력과 같은 기초자료에 대한 제한적인 차이를 발견할 수 있었으나, 본 연구에서는 다표지 인자를 이용하여 추적기간중 환자의 상태와 예후를 평가하고 합병증을 조기에 예측한다든지 하는 중요한 역할을 발견하지 못하였다. 그래서 향후 이에 대한 제한점을 해결한 더 보완된 연구가 필요할 것으로 사료된다.

• Tuberculosis and Respiratory Diseases
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• v.48 no.4
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• pp.464-470
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• 2000

Background : The recognition of bronchial asthma as an inflammatory disease led to the search for soluble markers that would be useful in assessing airway inflammation. Interleukin-6 (IL-6) is a representative proinflammatory cytokine that has been shown to be connected with various inflammatory diseases. IL-6 acts via specific receptors that consist of the IL-6 binding glycoprotein gp80 and the signal transducer gp130. In the search for markers of airway inflammation, delete the role of soluble interleukin-6 receptor (sIL-6R) and IL-6 in acute asthma were investigated. Methods : Serum levels of sIL-6R and IL-6 were measured in 78 acute asthmatics, in 15 patients with asymptomatic asthma and in 10 healthy control subjects by a specific ELISA using a murine antihuman IL-6R, IL-6 mAb ($Quantikine^{(R)}sIL$-6R, IL-6). Results : Serum levels of IL-6 in acute asthmatics significantly exceeded those of control subjects. The levels of sIL-6R in acute asthmatics were also significantly increased compared to those of control subjects. The serum concentrations of IL-6 obtained in acute asthmatics were elevated compared with those in asymptomatic asthmatics. However, association between eosinophilic count/IgE and IL-6/sIL-6R in acute asthma could not be found. Conclusion : Our results suggest that IL-6 may be involved in the pathogenesis of acute asthma, and serum levels of IL-6 and sIL-6R may reflect the severity of airway inflammation.

• Journal of agricultural medicine and community health
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• v.45 no.3
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• pp.154-161
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• 2020

Purpose: The purpose of this study is to compare the clinical features and complications of snake bite patients in urban and rural areas. Methods: A retrospective study was conducted on patients over 18 years of age who were hospitalized for snake bites from January 2013 to December 2019. Patients were categorized into urban and rural groups according to their respective locations at the time of the snake bite and the clinical characteristics and complications of the two patient groups were researched and compared. Results: Of the 77 snake bite patients, 44 patients were categorized into the rural group (57.1%). The rura1 group showed significant differences in old age (p=0.011), delayed hospital visits (p=0.010), far hospital distance (p<0.001), high local effect score (p<0.001), high traditional snake-bite severity grading scale (p=0.008) and use of large amounts of antivenins (p=0.026). There was a significantly higher incidence of acute kidney injury (p=0.030), rhabdomyolysis (p=0.026), and coagulopathy (p=0.033) in the rural group as well as a longer hospitalization period (p<0.011). Conclusion: Snake bites that occurred in rural areas resulted in patients with more complications compared to urban areas due to farther distances from hospitals, causing a delay in antivenom treatment.

• Journal of The Korean Society of Clinical Toxicology
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• v.19 no.2
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• pp.110-126
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• 2021

Purpose: The purpose of this study is to find out the current status of toxicology laboratory operated by six locations nationwide and to investigate the satisfaction of emergency medical professionals who working at local and regional emergency medical centers. Methods: This survey was conducted prospective. It was conducted on 665 emergency medical professionals working at regional and regional emergency medical centers across the South Korea. Among them, the analysis was conducted with data that 510 emergency medical professionals who respond to this survey. The questionnaire was conducted on an online basis for a month. To ensure statistical significance, consider a dropout rate of 10% based on a minimum response recovery rate of 70%. 506 people were selected for the survey. Results: According to a survey on the status of addiction analysis room usage, the average monthly usage of addiction test rooms among respondents were 406 cases.71.0 cases (17.4%) of toxicology laboratory in Seoul and 71 cases (17.4%) in Gwangju. 32 cases (7.8%), 118 cases (29.0%) requested by toxicology laboratory in Busan, and the toxicology laboratory in Daegu. Eighty two cases (20.1%), Daejeon area 25 cases (6.1%), Wonju area toxicology laboratory was 78 (19.6%). According to a survey on the satisfaction of the addiction analysis room,Seoul (4.9±2.71) and Gwangju (4.8±2.52) showed high satisfaction. Conclusion: Due to the limited operation time of the four addiction analysis rooms currently in operation, the satisfaction level of addiction analysis by emergency medical professionals in the area is low due to the delay until the result is notified.

• Journal of Dental Rehabilitation and Applied Science
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• v.37 no.3
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• pp.171-176
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• 2021

Pneumomediastinum is a very rare and potentially catastrophic complication of dental procedures. Its common causes are tooth extraction, endodontic treatment, and subgingival curettage using handpieces and high-pressure air/water syringes. We present a case of massive pneumomediastinum with subcutaneous emphysema in a 61-year-old female who underwent bone grafting into the maxilla for pretreatment of dental implantation using a syringe. The patient suffered from abrupt severe odynophagia and loss of consciousness. The patient transferred to emergency department and images work-up revealed a pneumomediastinum and subcutaneous emphysema on the entire face and neck. We performed conservative treatments including prophylactic antibiotics, oxygen inhalation, and fasting meals, and then discharge after 7 days uneventfully. The patient's syncope might be resulting from hypotension and pain shock induced by pneumomediastinum with a sudden chest compression. The pneumomediastinum could be resulting from concurrent perforation and massive air infiltration into the maxillary sinus during bone grafting. We suggest that pneumomediastinum needs prompt diagnosis and management because of the risk of airway obstruction when a patient present syncope in the dental room.

• The Korean Journal of Blood Transfusion
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• v.29 no.3
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• pp.320-327
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• 2018

A 72-year-old man with general weakness visited the outpatient clinic of the hematology department. The patient had been treated under the diagnosis of autoimmune hemolytic anemia for 2 years. His hemoglobin level at the time of the visit was 6.3 g/dL, and a blood transfusion was requested to treat his anemia. The patient's blood type was A, RhD positive. Antibody screening and identification test showed agglutination in all reagent cells with a positive reaction to autologous red blood cells (RBCs). He had a prior transfusion history with three least incompatible RBCs. The patient returned home after receiving one unit of leukoreduced filtered RBC, which was the least incompatible blood in the crossmatching test. After approximately five hours, however, fever, chills, dyspnea, abdominal pain, and hematuria appeared and the patient returned to the emergency room next day after the transfusion. The $anti-Fy^a$ antibody, which was masked by the autoantibody, was identified after autoadsorption using polyethylene glycol. He was diagnosed with an acute hemolytic transfusion reaction due to $anti-Fy^a$ that had not been detected before the transfusion. In this setting, it is necessary to consider the identification of coexisting alloantibodies in patients with autoantibodies and to become more familiar with the method of autoantibody adsorption.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.20 no.4
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• pp.435-447
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• 2019

In order to prevent unnecessary re-admission, it is necessary to intensively manage the groups with high probability of re-admission. For this, it is necessary to develop a re-admission prediction model. Two - year discharge summary data of one university hospital were collected from 2016 to 2017 to develop a predictive model of re-admission. In this case, the re-admitted patients were defined as those who were discharged more than once during the study period. We conducted descriptive statistics and crosstab analysis to identify the characteristics of rehospitalized patients. The re-admission prediction model was developed using logistic regression, neural network, and decision tree. AUC (Area Under Curve) was used for model evaluation. The logistic regression model was selected as the final re-admission predictive model because the AUC was the best at 0.81. The main variables affecting the selected rehospitalization in the logistic regression model were Residental regions, Age, CCS, Charlson Index Score, Discharge Dept., Via ER, LOS, Operation, Sex, Total payment, and Insurance. The model developed in this study was limited to generalization because it was two years data of one hospital. It is necessary to develop a model that can collect and generalize long-term data from various hospitals in the future. Furthermore, it is necessary to develop a model that can predict the re-admission that was not planned.

• Health Policy and Management
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• v.34 no.2
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• pp.196-210
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• 2024

Background: In January 2018, revised elderly fixed outpatient copayment for the elderly were implemented. When people ages 65 years and older receive outpatient treatment at clinic-level medical institutions (clinic, dental clinic, Korean medicine clinic), with medical expenses exceeding 15,000 won but not exceeding 25,000 won, their copayment rates have decreased differentially from 30%. This study aimed to examine the changes of health utilization of elderly after revised elderly fixed outpatient copayment. Methods: We used Korea health panel data from 2016 to 2018. The time period is divided into before and after the revised elderly fixed outpatient copayment. We conducted Poisson segmented regression to estimate the changes in outpatient utilization and inpatient utilization and conducted segmented regression to estimate the changes in medical expenses. Results: Immediately after the revised policy, the number of clinic and Korean medicine outpatient visits of medical expenses under 15,000 won decreased. But the number of clinic outpatient visits in the range of 15,000 to 20,000 won and Korean medicine clinic in the range of 20,000 to 25,000 won increased. Copayment in outpatient temporarily decreased. The inpatient admission rates and total medical expenses temporarily decreased but increased again. Conclusion: We confirmed the temporary increase in outpatient utilization in the medical expense segment with reduced copayment rates. And a temporary decrease in medical expenses followed by an increase again. To reduce the burden of medical expense among elderly in the long run, efforts to establish chronic disease management policies aimed at preventing disease occurrence and deterioration in advance need to continue.

• The Korean Journal of Emergency Medical Services
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• v.11 no.3
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• pp.119-128
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• 2007

It is happening a lot that the pediatric patients who are offering help in emergency room with background 119 rescuer require emergency care compared to adults. Our study was conducted to have a clear grasp of the status quo of pediatric patients who are offering help in emergency room with 119 rescuer. METHOD & OBJECT pediatric patients under 8 age who were offering help was conducted as objects by 119 cases from January, 2006 to January 2007, with 119 rescuer at C university hospital in Gwangju metropolitan city, which were 87 cases for a boy(73.1%), 32 cases for a girl. Based on emergency diary of emergency members and the medical treatment record of emergency room in C university hospital, a disease and a type of an external wound were analyzed according to ages of these patients, a time zone and season. RESULT In terms of an age, 25 cases(21.0%) have less than 1 age extremelymuch, in case of emergency, 61 cases(51.3%), which were more than non-emergency, in terms of happened places of patients, there were households up to 78 cases(65.5%) extremely much. In terms of happened time, 13:00 to 18:00 have highest data up to 48 cases(40.3%). According to season, there were no big differences in 4 seasons(spring : 30.3%, summer : 24.4%, fall : 29.4%, winter : 16.0%). In case of being offered help at emergency room due to diseases, 1-2 ages have highest estimate with 55.7%, in terms of a time zone, 19:00-24:00 have highest with 33.7%, in terms of season, summer(6, 7, 8) have highest with 32.8%. in case of traffic accident, 7-8 age have highest with 47.1%, according to a time zone, 13:00 to 18:00 have highest with 88.2%, according to season, fall have highest with 64.7%. In case of an external wound, 3-4 age have highest with 38.2%, according to a time zone, 13:00-18:00 have highest with 41.2%, according to season, spring have highest with 38.2%. CONCLUSION It shows that in case of pediatric patients who were offering help at emergency room with 119 rescuer, a pediatric under 1 age was due to a disease, in case of an external wound, there were 3-4 age, in case of traffic accident, 7-8 age have highest, a case for emergency have highest.