• Korean Journal of Psychosomatic Medicine
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• v.25 no.1
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• pp.46-55
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• 2017

Objectives : Outpatient treatment orders refer to a mandatory social program in which mentally ill persons are ordered by the court to participate in specified outpatient treatment programs. This study aimed to investigate the factors that affect outpatient treatment orders and adherence to outpatient treatment in mental health patients. Methods : A survey on outpatient treatment orders and adherence to outpatient treatment was conducted on 60 psychiatrists between October and November 2016. The questionnaire items were drafted based on a literature review, and they were then evaluated by 3 psychiatrists and 1 law school professor before being finalized. Answers from the respondents were analyzed using descriptive statistics, and the median, maximum, and minimum values of the effectiveness scores of outpatient treatment orders were calculated. Results : Among the 60 psychiatrists, 45(75.0%) were aware of outpatient treatment orders; however, only 2 out of the 45(4.0%) had actually used the program in the last 12 months. The subjective effectiveness was very low, with only 40 points out of 100. Furthermore, of the readmitted patients, 37.7% had received continued outpatient treatment, whereas 53.1% chose to quit the outpatient treatment programs, meaning that the number of dropouts was higher. Among the discharged patients, approximately two-thirds were receiving continued treatment. With regard to follow-up for dropouts, majority of the responses were either "Not taking any action"(n=27) or "Not following up"(n=15). Only two respondents answered "Contact the community mental health promotion center," meaning that this response was very rare. Meanwhile, when asked about efficient measures to be implemented for dropouts, a vast majority of the respondents(n=30) selected the answer "Work with the community mental health promotion center." Conclusions : The outpatient treatment orders currently being administered were found to be ineffective, and the associated adherence to outpatient treatment was also found to be extremely poor. Hence, the effectiveness of the therapeutic interventions could benefit from institutional as well as administrative improvements. Community mental health promotion centers are expected to have an important role in the future.

• Journal of Hospice and Palliative Care
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• v.20 no.1
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• pp.8-17
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• 2017

Globally, efforts are being made to develop and strengthen a palliative care policy to support a comprehensive healthcare system. Korea has implemented a hospice and palliative care (HPC) policy as part of a cancer policy under the 10 year plan to conquer cancer and a comprehensive measure for national cancer management. A legal ground for the HPC policy was laid by the Cancer Control Act passed in 2003. Currently in the process is legislation of a law on the decision for life-sustaining treatment for HPC and terminally-ill patients. The relevant law has expanded the policy-affected disease group from terminal cancer to cancer, human immunodeficiency virus/acquired immune deficiency syndrome, chronic obstructive pulmonary disease and chronic liver disease/liver cirrhosis. Since 2015, the National Health Insurance (NHI) scheme reimburses for HPC with a combination of the daily fixed sum and the fee for service systems. By the provision type, the HPC is classified into hospitalization, consultation, and home-based treatment. Also in place is the system that designates, evaluates and supports facilities specializing in HPC, and such facilities are funded by the NHI fund and government subsidy. Also needed along with the legal system are consensus reached by people affected by the policy and more realistic fee levels for HPC. The public and private domains should also cooperate to set HPC standards, train professional caregivers, control quality and establish an evaluation system. A stable funding system should be prepared by utilizing the long-term care insurance fund and hospice care fund.

• Journal of Hospice and Palliative Care
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• v.2 no.2
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• pp.125-137
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• 1999

Purpose : Surveying the rates, severity, and variables influencing depression and their correlation between pain and depression in Korean cancer patients, we attempted to provide a basic database for the effective depression management program. Methods : The results of survey were colleted from 10 patients who were hospitalized at Seoul National University Hospital for cancer treatment from February to June of 1999. Factors of depression and the level of pain were examined by self-reported survey employing Korean version of Beck Depression Inventory(BDI) and an abridged version of Brief pain Inventory respectively. The purpose of this study and guidelines for the questionnaires were clearly explained to participating patients by Resgitered Nurses before answering the survey. Demographic and clinical characteristics of patients were compiled by reviewing their medical records in corporation with a family physician. The difference in the level of depression among patient groups was analyzed with the t-test and ANOVA, and the correlation between variables with Pearson correlation coefficient. Results : 1) 142 subjects comprised 79 male and 63 female, and their mean age was 51.86. 2) The mean scores of the worst pain for last 24-hours was 6.08(SD 2.23), the average pain for last 24-hours 4.44(SD 1.85), and the mean scores of pain at the time of survey 3.48(SD 2.25), while the mean scores of the least pain for last 24-hours 2.25(SD 1.83). 3) The mean BDI scores were 23.73(SD 0.99), and 55.6% of patients were evaluated to be in depression(cutting point 21). Scores of depression for cancer patients were higher than normal population. 4) The correlation between worst pain for last 24-hours and depression(r=0.252, P=0.002), average pain for last 24-hours and depression(r=0.225, P=0.007), present pain and depression(r=0.291, P=0.000) were significant. 5) Significant differences were found among groups of cancer patients with pain with respect to gender(t=3.59, p=0.000), level of education(F=4.063, P=0.009), ECOG(F=3.352, P=0.021). There was significant positive correlation between depression and pain(r=0.171, P=0.042). Conclusions : More than 50% of cancer patients with pain are suffering from depression. We have shown that the variables like the degree of pain, gender, level of education, ECOG, and age are significantly related to the depression in cancer patients. The findings of this study may be used for assessing high-risk patients in need of intervention and for planning effective therapeutic strategies for them after the routine assessment. Further study is necessary to investigate the cultural differences and the variables influencing on depression in Korean cancer patients.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.13 no.2
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• pp.747-754
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• 2012

The purpose of this study was to compare inter-regional accident modes using the National Hospital Discharge Patient Injury Survey. In order to determine economic status of each region, 234 cities and counties were categorized as 5 groups according to their financial self-reliance ratio. The main results are as follows. First, transport accidents had increased by the age group of 25 to 44 but decreased thereafter. Second, the frequency of car accidents was the highest among several types of transport accidents. Most common site of transport accidents was roads and highways. Third, there was significant difference in the modes of transport accident among regions. Fourth, emergency admission rate was quite different according to regional groups but it was no significant difference by economic status. Lastly, there was significant difference in injury patterns by region groups. In regions which were high economic status, there were relatively less serious injury patterns such as sprain, strain, dislocation while regions which were in low economic status had experienced serious injury including fracture, stab wound, and open fracture. We could find the difference in accident modes by regional economic status. Therefore, health authority should consider different accident prevention strategies by regional groups.

• Journal of Yeungnam Medical Science
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• v.24 no.2
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• pp.137-147
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• 2007

Background : Interpretative reporting is an important aspect of laboratory medicine. The large menu of laboratory tests available today makes it increasingly difficult for the non-specialist to order and interpret all laboratory tests. The aim of this study was to determine the usefulness of an expert system to interpret laboratory tests and help physicians order the appropriate tests. Materials and Methods : In order to interpret laboratory tests, a rules-based expert system was developed. In this module, if-then rules were used to interpret the given test result patterns (e.g. urinalysis, anemia, hepatitis B virus, hypercholesterolemia, glucose, syphilis, and tumor markers) and select matching text elements. The system was used to evaluate 535 subjects who visited a health-check program. Results : The overall abnormal rate was 50.5% in the expert system; 34% for cholesterol, 9.9% for urinalysis, 8.0% for anemia, 7.7% for thyroid function tests, 4.5% for tumor marker study, 4.7% for hepatitis virus antigen, 4.3% for serum glucose, and 1.1% for syphilis. Conclusion : These results indicate that the application of the expert system for the interpretation of laboratory tests may provide a useful method for the interpretation of reports. However more rules are needed for the application to in-patients.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.18 no.4
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• pp.570-577
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• 2017

The purpose of this study was to provide a basis for the development of a health insurance payment system by exploring inpatient hospice & palliative care activities in a long-term care hospital by occupational personnel. The contents and frequency of inpatient hospice-palliative care activities were obtained retrospectively from the chart review of 12 terminally ill patients who died during the 6 months before their deaths. According to their occupational personnel, doctors were doing blood transfusion, family counseling, and medication guidance. Nurses' main activities were airway suction, oxygen supply, EKG monitoring, observing patient's status, helping medication and tube feeding. Other workers' activities are as follows: social workers were applying individualized programs, physical therapists were doing electrostimulation, nutritionists were giving nutrition evaluation and meal rounding, and careworkers were assisting with meals and nutrition. Although certain nursing activities, like emotional support, were performed by nurses, the hospice-palliative activities from doctors, social workers and physical therapists were largely unavailable for terminally ill patients in a long-term care hospital. And some terminally ill patients were receiving too intensive and invasive medical cares for end end-of-life care. The results highlight the importance of valid measures of hospice-palliative care quality and the need for establishing an adequate reimbursement system for ensuring and improving end-of-life care.

• Childhood Kidney Diseases
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• v.4 no.1
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• pp.33-39
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• 2000

Purpose: Our study was designed to investigate the association of MHC Class II (DR, DQ) allele with IgA nephropathy and its significance as a prognostic factor for progression to ESRD Material and Methods: 69 children with IgA nephropathy with normal renal function(serum creatinine $\leq$ 1.5mg/dL) was classified as group A and 70 patients who received renal transplantation due to IgA nephropathy were selected as group B. The HLA-DQB1 and HLA-DRB1 alleles were studied by polymerase chain reaction using sequence specific primers. We have compared the difference in alleles between these two groups and with normal control and also examined any possible effect of the MHC class II genes on the histopathological severity and prognosis of IgAN. Results: Mean age was $8.8{\pm}2.9$ years in group A and $35.0{\pm}15.5$ years in group B. Male to female ratio was 2.8:1 in group A and 2.5:1 in group B. There was a significantly higher frequency of HLA-$DQB1^*03\;and\;DQB1^*05$ in Group B. The frequency of HLA-$DQB1^*0302\;and\;^*05031$ allele had increasing tendency in Group B(P<0.05). HLA-$DRB1^*03\;and\;^*05$ were more common in Group B(P<0.05). HLA-$DRB1^*04$ allele was the most common DR alleles in both group, but there was no statistical significance. There were no significant correlation with MHC class 13 genes on the hjstopathological severity in Group A. Conclusion: In conclusion, $HLA-DQB1^*0302\;and\;HLA-DQB1^*05031 $ allele seemed to be more common in transplanted patients compared to group with normal renal function suggesting that this allele is associated with poor prognosis in IgAN. However larger studies and follow up are required to confirm this due to uncharacterized heterogeneity in etiopathogenesis of IgA nephropathy and possibly one or more than one gene may exert influence in determining susceptibility to the diseases.

• Pediatric Infection and Vaccine
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• v.18 no.1
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• pp.23-30
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• 2011

Purpose : Acinetobacter baumannii is an aerobic, gram negative coccobacillus. Due to its pathogenicity and ability to accumulate diverse mechanisms of resistance, the importance of this organism is increasing. Many reports have targeted adults, and studies of pediatric patients are limited. This study aims to investigate the current status of A. baumannii infection in children. Methods : From January 2001 to December 2008, 505 patients hospitalized with A. baumannii infection were enrolled. Admission records for underlying disease, duration of hospitalization, previous antibiotic use, location of admission, presence of ventilator care, and resistance to antibiotics were retrospectively reviewed and analyzed. Results : Hemato-oncological disease and neurological disease were 30.6% and 24.3% of all cases; therefore, these were the most common underlying diseases of patients with A. baumannii infection. Prevalence of A. baumannii infection was 78.1% in patients with previous antibiotic use, which was higher than that of the group not using previous antibiotic. And prevalence of multi-drug resistant and pan-drug resistant A. baumannii infection was 76.4% and 38.3% in patients with ICU care, 76.8% and 38.9% with ventilator care, and these were higher than the others. Rate of resistance to all groups of antibiotics showed a gradual increase to over 50% in 2008. Multi-drug resistant A. baumannii was 63.5% and pan-drug resistant A. baumannii was 48.2% of all cases. Conclusion : Prevalence of A. baumannii infection and resistance to antibacterial agents of A. baumannii is increasing. Adequate use of antibiotics and infection control should be emphasized in pediatric patients.

• Clinical and Experimental Pediatrics
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• v.49 no.4
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• pp.394-400
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• 2006

Purpose : This study was design and performed for evaluations of resent clinical pattern of bronchiolitis caused by RSV infection with children under 2 year of age for 5 years, who were admitted to pediatric ward. Methods : The inclusion criteria of the patients were children under 24 month-of-age, clinical manifestations of lower respiratory tract infection, and RSV antigen that was detected by a direct immunofluorescence test from the nasal secretions. The additional laboratory and simple chest X-ray findings were reviewed from the medical records of children who were admitted Wonkwang university hospital from Jan. 1999 to Dec. 2003. Results : In the 5 year study duration, 127 patients were enrolled and outbreak of RSV bronchiolitis took place in 2001. The 80 cases(63 percent) of RSV infection were concentrated in later autumn and winter. Number of the cases show coughing were 120(94.5 percent), but rale was audible in 78 cases(61.4 percent). Dyspnea, wheezing, and intercostal retraction were noticed in 27(21.3 percent), 21(16.5 percent), and 4(3 percent) cases respectively. The most common chest X-ray finding was hyperinflation of the lung that was noticed in 110 cases(86.6 percent). Care with mechanical ventilator for more than 2 days required in 5 cases. Conclusion : Lower respiratory tract infection by RSV was common in late autumn and winter season but year-round infection was noticed. The severity of RSV respiratory tract infectiontakes in some degree a grave course. So we suggest that population-based surveillance of acute respiratory infection due to RSV is necessary for assessment of prevalence and epidemiology of this disease.

• Pediatric Infection and Vaccine
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• v.15 no.2
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• pp.174-179
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• 2008

Purpose : The purpose of this study was to investigate the clinical features of adolescent TB. Methods : We retrospectively reviewed the medical records of the adolescents aged 12 to 18 years and who are hospitalized with the diagnosis of TB at Dong Kang General Hospital between January 2003 and December 2007. Results : Of the 29 patients who were identified, 65.5% were male. The median age at diagnosis was 16.9 years (range: 12.1-18.9 years). A tuberculin skin test (TST) was performed for 6 patients (20.7%). Among them, 5 (5 of 8[62.5%]) in the 12-15 years age group (Group A) and 1 (1 of 21[4.8%]) in the 16-18 years of age group (Group B) were TST positive, which showed that the TST performing rate decreased with age (P<0.01). Twenty-five patients (86.2%) were detected by evaluating the clinical symptoms that suggested TB and 4 patients (13.8%) were detected by screening, but no cases were detected by contact tracing. Twenty patients (69.0%) had isolated pulmonary disease. Seven patients (24.1%) had pulmonary and extrapulmonary disease and 2 patients (6.9%) had exclusively extrapulmonary disease. Most patients presented with multiple symptoms, and the most common were cough (79.3%), fever (75.9%), sputum (65.8%) and chest pain (34.5%). M. tuberculosis was isolated from the sputum of 20 patients (69.0%). The culture-positive rate increased with age (range: 62.5% in Group A to 71.4% in Group B), but the difference between the groups was not significant. Cavitary lesions were found 13 patients (44.8%). The cavitary lesion rate increased with age (range: 25.0% in Group A to 52.4% in Group B), but the difference between the groups was not significant. Four patients (13.8%) were lost during follow-up. One patient (6.9%) relapsed. Conclusion : Clinicians need to be aware of the unique features of adolescent TB, and they also need awareness of the importance of TST and contact investigation for an adult suspected of having TB for making the diagnosis of TB.